A Complete Response to Pembrolizumab in Malignant Peritoneal Mesothelioma: A Case Report.

Malignant peritoneal mesothelioma (MPeM) is a rare cancer of the peritoneum with a poor prognosis and nonspecific clinical course. We discuss a case of MPeM in a 59-year-old male who presented with abdominal pain and distension, without any known previous asbestos exposure. The diagnosis was made after a second biopsy finally confirmed epithelioid MPeM in an advanced stage with pleural effusion. The patient underwent six cycles of chemotherapy with cisplatin and pemetrexed, experienced disease progression, and was then started on pembrolizumab as a second-line treatment. The patient achieved a complete response after two years of treatment with pembrolizumab and has been disease-free for almost four years with an Eastern Cooperative Oncology Group (ECOG) performance status of 0. Despite the lack of evidence to support the treatment with immunotherapy for MPeM, our case report encourages its use, highlighting its ability to enable a complete response with pembrolizumab with an excellent quality of life.

360 Health Analysis (H360)-A Comparison of Key Performance Indicators in Breast Cancer Management across Health Institution Settings in Portugal.

BACKGROUND: The increased focus on quality indicators (QIs) and the use of clinical registries in real-world cancer studies have increased compliance with therapeutic standards and patient survival. The European Society of Breast Cancer Specialists (EUSOMA) established QIs to assess compliance with current standards in breast cancer care. METHODS: This retrospective study is part of H360 Health Analysis and aims to describe compliance with EUSOMA QIs in breast cancer management in different hospital settings (public vs. private; general hospitals vs. oncology centers). A set of key performance indicators (KPIs) was selected based on EUSOMA and previously identified QIs. Secondary data were retrieved from patients' clinical records. Compliance with target KPIs in different disease stages was compared with minimum and target EUSOMA standards. RESULTS: A total of 259 patient records were assessed. In stages I, II, and III, 18 KPIs met target EUSOMA standards, 5 met minimum standards, and 8 failed to meet minimum standards. Compliance with KPIs varied according to the type of hospital (particularly regarding diagnosis) and disease stage. Although small differences were found in KPI compliance among institutions, several statistical differences were found among treatment KPIs according to disease stage, particularly in stage III. CONCLUSIONS: This study represents the first assessment of the quality of breast cancer care in different hospital settings in Portugal and shows that, although most QIs meet EUSOMA standards, there is room for improvement. Differences have been found across institutions, particularly between oncology centers and general hospitals, in diagnosis and compliance with KPIs among disease stages. Stage III showed the greatest variability in compliance with treatment KPIs, probably related to the lower specificity of the guidelines in this disease stage.

Haemodialysed patient with lung cancer in the COVID-19 era: a clinical challenge.

A 66-year-old man was referred to the oncological pneumology consultation due to a mass in the right upper lobe observed in a routine X-ray of the chest. The CT scan confirmed a mass in the same location. The biopsy revealed a lung adenocarcinoma. It was decided to start chemotherapy adapted to kidney function. In April 2020, the patient contracted SARS-CoV-2 infection and developed bilateral pneumonia with partial respiratory failure. He was transferred to the intensive care unit, where he had a positive evolution. In the next 5 months, there was a clinical improvement; however, the CT scan of the chest showed disease progression. After a new multidisciplinary approach, it was decided to start a second line with atezolizumab. After four cycles of atezolizumab, there was a clear clinical improvement, and a reduction by more than 50% in the tumour size, without significant adverse effects.

Depression and quality of life in patients with breast cancer undergoing chemotherapy and monoclonal antibodies.

BACKGROUND: Depression is one of the major psychiatric morbidities in cancer patients. The purpose of our study was to evaluate the impact of depressive symptoms in the quality of life (QoL) of patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments. METHODS: Observational, cross-sectional study conducted between April and November 2016. To evaluate the QoL, the EORTC QLQ-C30 and QLQ-BR23 questionnaire were used. The patients were screened for depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) and those with a positive HADS-D positive questionnaire were referenced to the Psychiatry and Mental Health Department for further assessment and follow-up. RESULTS: We included 45 female patients. Sixteen (35.6%) patients had a positive HADS-D questionnaire and depressive symptoms confirmed by a psychiatric physician. Of those patients, 7 (15.6%) had a major depressive episode confirmed by psychiatric interview. There was a significant association of depressive symptoms with the future perspectives scale (p = 0.022), breast symptoms scale (p = 0.011) and arm symptom scale (p = 0.005). Significant differences were found in the fatigue (p = 0.024), pain (p = 0.037) and dyspnea (p = 0.009) subscales being worse in patients with depressive symptoms. The association between having depressive symptoms or not was shown to be significant or marginally significant for the variables stage of the tumour (p = 0.057), presence of distant metastasis (p = 0.072) and previous diagnosis of depression (p = 0.011). The patients treated with regimens containing monoclonal antibodies presented better outcomes in various subscales of the EORTC QLQ-C30 and QLQ-B23 questionnaires than those patients treated with chemotherapy regimens without monoclonal antibodies. CONCLUSIONS: Despite the small sample of our study, this study provided evidence that depressive symptoms in patients with breast cancer undergoing chemotherapy and monoclonal antibodies treatments detrimentally reduced various aspects of QoL.

Triple-negative breast cancer with brain metastasis in a pregnant woman.

A woman aged 35 years was diagnosed with triple-negative breast cancer in October 2012. During the investigation, it was discovered that she was pregnant, the patient decided to have an abortion. She was submitted to a radical modified mastectomy and adjuvant chemotherapy followed by adjuvant breast radiotherapy of the left breast. 2 months after the adjuvant treatment, she began to have headaches and dizziness. The cranial MRI (head MRI) showed brain metastasis. She was then treated with whole brain radiotherapy, stereotactic radiosurgery and concomitant temozolomide which resulted in complete response. 1.5 year later, she was able to get pregnant and gave birth to a baby without complications. The previous imaging reassessment performed in September 2016 shows no evidence of recurrent breast cancer.