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Cancer-related anorexia-cachexia syndrome (CACS) is a debilitating condition afflicting up to 80% of advanced-stage cancer patients. Characterized by progressive weight loss, muscle wasting, and metabolic abnormalities, CACS significantly compromises patients' quality of life and treatment outcomes. This comprehensive review navigates through its intricate physiopathology, elucidating its stages and diagnostic methodologies. CACS manifests in three distinct stages: pre-cachexia, established cachexia, and refractory cachexia. Early detection is pivotal for effective intervention and is facilitated by screening tools, complemented by nutritional assessments and professional evaluations. The diagnostic process unravels the complex interplay of metabolic dysregulation and tumor-induced factors contributing to CACS. Management strategies, tailored to individual patient profiles, encompass a spectrum of nutritional interventions. These include dietary counseling, oral nutritional supplements, and, when necessary, enteral nutrition and a judicious use of parenteral nutrition. Specific recommendations for caloric intake, protein requirements, and essential nutrients address the unique challenges posed by CACS. While pharmacological agents like megestrol acetate may be considered, their use requires careful evaluation of potential risks. At its core, this review underscores the imperative for a holistic and personalized approach to managing CACS, integrating nutritional interventions and pharmacological strategies based on a nuanced understanding of patient's condition.
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AIM: To describe the clinical management and PD-L1 testing of patients with newly diagnosed stage IV non-small cell lung cancer (NSCLC) without driver mutations in Spain. METHODS: Multicenter, retrospective study. RESULTS: Among 297 evaluated patients, 89.2% received systemic treatment for stage IV disease, of whom 53.6% received platinum doublet therapy, 26.8% immunotherapy as monotherapy and 14.7% immunotherapy + chemotherapy, with 9.4% receiving treatment as part of a clinical trial. Treatment was initiated 1 month after histological diagnosis, with PD-L1 test results available in most cases (92.6%). PD-L1 testing was performed in 287 patients, 95.1% by in-house tests, mostly with the 22C3 pharmDx assay. The factor most strongly associated with treatment selection was, as expected, the expression of PD-L1. CONCLUSION: PD-L1 testing is implemented in clinical practice and seems to guide treatment decisions in patients with NSCLC in Spain.
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OBJECTIVE: The aim of this study was to describe treatment results in patients with sinonasal mucosal melanomas (SMMs) and to compare three different classification staging systems. MATERIALS AND METHODS: From 1988 to 2013, we performed a retrospective study of 20 patients with primary sinonasal melanomas. The median age at diagnosis was 71 years. There were 10 males and 10 females. RESULTS: Nine SMMs (45%) were originated in the ethmoidal sinus complex, four (20%) in the inferior turbinate, three (15%) in the nasal septum, two (10%) in the maxillary sinus, and two (10%) in the nasal vestibule. Local recurrence was diagnosed in eight patients (40%), and six out of 20 patients (30%) developed distant metastasis during the course of their disease. The adjusted survival rates at three and five years were 47% and 34%, respectively. The adjusted three-year survival rate according to the sinonasal staging system 7th edition for SMM (TNM-SMM) was 60% in T3 stage, 50% in T4a stage, and 34% in T4b stage (p = 0.05). According to Thompson's staging system, survival was 33% for group one, 58% for group two, and 0% for group three (p = 0.006). With the sinonasal staging system 7th edition for carcinoma (TNM-CAR) survival was 33% in T1, 100% in T2 and T3, 0% in T4a, and 34% in T4b (p = 0.006). CONCLUSIONS: Our experience confirms the distribution of patients according to survival rates was better with the TNM-SMM than with Thompson's or the TNM-CAR systems.