Response to erlotinib and bevacizumab combination therapy after acquired resistance to osimertinib in patients with non-small cell lung cancer.

Osimertinib is the most reliable epidermal growth factor receptor-tyrosine kinase (EGFR-TKI) and is recommended as the first-line EGFR-TKI. Therefore, developing acquired resistance to this TKI might be problematic because no appropriate treatment with TKIs has been established after acquired resistance to osimertinib. For patients with osimertinib resistance, antitumor drugs having different mechanism from that of EGFR-TKI are usually prescribed. However, these treatments do not include the effective utilization of several EGFR-TKIs for these patients. We herein report two cases of response to erlotinib and bevacizumab combination therapy after acquired resistance to osimertinib in patients with non-small cell lung cancer. Although the precise biological mechanism is unknown, this combination therapy may be an option for some patients who suffer from acquired resistance to osimertinib.

A Long-Term Control of Intramedullary Thoracic Spinal Cord Metastasis from Small Cell Lung Cancer.

Radiotherapy with systemic corticosteroid therapy has been used to treat intramedullary spinal cord metastasis (ISCM), but recovery of function and long-term survival of these patients has been rarely observed. We report herein a small cell lung cancer (SCLC) patient with recurrent thoracic ISCM, who was successfully treated with radiotherapy and systemic corticosteroid therapy. A 70-year-old man, who was diagnosed as having SCLC seven months previously, developed thoracic ISCM. Soon after the detection of the lesion, the patient received radiotherapy with systemic corticosteroid therapy. Sensory disturbance in both extremities and neurogenic bladder and bowel dysfunction was recovered. The patient could walk after irradiation again. The patient received additional chemotherapy and survived 20 months after the diagnosis of ISCM recurrence. Prompt diagnosis and appropriate treatment for ISCM and effective chemotherapy for recurrent SCLC might be the favorable factors for such patients. Further studies will be required to define a favorable subset of patients most likely to benefit from a conventional approach.

Skin metastasis from small cell lung cancer.

Patients with skin metastasis always had disseminated metastases in many organs. We herein report an unusual case with skin metastasis from small cell lung cancer (SCLC). The patient was treated with platinum-containing chemotherapy, and the response to the therapy was evaluated as partial response. The patient had slowly progressive disease and died of SCLC 16 months after the diagnosis of the diseases. If skin lesions, whether it may be typical or not, are found in SCLC patients, biopsy from the lesion would be considered to perform. Although trunk may be the most common sites, it is important to suspect such metastasis occurs in patients with SCLC.

Non-interventional management of small pneumothorax in the very elderly.

The non-interventional management (NIM) of elderly patients with small pneumothorax has rarely reported. We show herein three elderly cases of successful treated with NIM for small pneumothorax (< 20% on chest computerized tomography scan). With adequate evaluation of chest radiographs and careful cardiopulmonary monitoring, we evaluated that NIM for small pneumothorax can be a possible therapeutic choice even in the elderly.

[Hemoptysis in a patient with old pulmonary tuberculosis showing atypical findings in chest computed tomography].

We report the case of an 85-year-old woman who had pulmonary tuberculosis when she was in her forties. She was referred to our hospital because of hemoptysis, which lasted for a few days. Her laboratory data was unremarkable. Chest computed tomography (CT) scan showed a thin-walled cavity with extensive calcification in the right S2. There was no infiltrative shadow or bronchiectatic changes observed around the cavity. Active bleeding was observed to be occurring from the right B2. After arterialization, embolization was performed in the right S2. On the basis of the findings from this case, we recommend that clinicians perform bronchoscopy in patients with hemoptysis even if imaging studies show no typical findings suggesting hemorrhage. Further, although rare, old tuberculosis lesions such as a thin-walled cavity with calcification can cause hemoptysis.

[A case of thymoma and Mycobacterium intracellulare infection].

A 69-year-old man, who underwent total thymectomy 5 years previously, was referred to our division because the chest radiograph revealed abnormal shadows in both the lungs. The chest radiograph and CT scan showed pleural thickening in both apexes and tree-in-bud signs in both the lower lobes, which suggested bronchiolitis. We had retrospectively confirmed similar centrilobular small nodules and tree-in-bud signs on the chest CT scan when the thymoma was diagnosed. Mycobacterium intracellulare was detected in the sputum by acid-fast staining and polymerase chain reaction. The coincidence of thymoma and Mycobacterium intracellulare infection appeared to be incidental. Thus, in patients with thymoma, clinicians should carefully evaluate the lung parenchyma as well as the mediastinum on the chest radiograph to identify occult diseases, including Mycobacterium intracellulare infections.

Body Weight Change in Non-small Cell Lung Cancer Patients Treated With EGFR-TKI.

BACKGROUND/AIM: Body weight (BW) changes in epidermal growth factor inhibitor-tyrosine kinase (EGFR-TKI) treated non-small cell lung cancer patients has yet to be fully investigated. For the purpose of clarifying changes in body weight in patients who received EGFR-TKI treatment in clinical practice, we performed a retrospective study. In this study, comparison between pretreatment BW and those at 12, 24 weeks, and 12 months in these patients was performed. PATIENTS AND METHODS: We included all the patients diagnosed with EGFR mutated NSCLC in two tertiary hospitals between April 2009 and March 2021. BW records in the medical chart of each patient who was treated with EGFR-TKI for more than 12 weeks were surveyed. In each patient, BW at 12, 24 weeks, and 12 months from the initiation of EGFR-TKI treatment were compared with pretreatment BW. RESULTS: Sixty-three patients obtained TKI treatment for more than 12 weeks and had comparable body weight records. Compared with the pretreatment BW, decreased BW was observed at 12, 24 weeks, and 12 months from the initiation of TKI treatment. CONCLUSION: Even in patients treated with EGFR-TKI, which is evaluated as less toxic and a more effective therapy, there might be patients who lose weight during the treatment period. Chest physicians will be required to provide medical care even for EGFR mutated patients, taking into consideration changes in BW.

Maintaining Weight and Nutritional Status with Ninjin'yoeito in Elderly Patients with Chronic Wasting Diseases.

Objectives: This retrospective study aimed to obtain information on the nutritional maintenance effects of Ninjin'yoeito (NYT) in elderly patients with chronic wasting diseases. Methods: Changes in body weight and serum levels of total protein and albumin were investigated in patients who received NYT for chronic wasting diseases for more than six months in Mito Medical Centre, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan, from April 2009 to October 2019. Results: During the study period, 11 patients (median age: 75 years) received NYT for six months or more. The median administration period of NYT was 14 months. The body weight and serum levels of total protein and albumin at the time of the last observation were not significantly different from those at the beginning of NYT administration (P = 0.176, P = 0.766 and P = 0.550, respectively). Conclusion: This study suggested the possibility of maintaining nutritional condition by administering NYT in elderly patients with chronic wasting disease of various aetiologies. More evidence will be required to confirm these results.

Common exacerbation-prone phenotypes across asthma and chronic obstructive pulmonary disease (COPD).

BACKGROUND AND OBJECTIVES: Chronic inflammatory airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are complex syndromes with diverse clinical symptoms due to multiple pathophysiological conditions. In this study, using common and shared risk factors for the exacerbation of asthma and COPD, we sought to clarify the exacerbation-prone phenotypes beyond disease labels, and to specifically investigate the role of the IL4RA gene polymorphism, which is related to type 2 inflammation, in these exacerbation-prone phenotypes. METHODS: The study population comprised patients with asthma (n = 117), asthma-COPD overlap (ACO; n = 37) or COPD (n = 48) and a history of exacerbation within the previous year. Cluster analyses were performed using factors associated with both asthma and COPD exacerbation. The association of the IL4RA gene polymorphism rs8832 with each exacerbation-prone phenotype was evaluated by multinomial logistic analyses using non-asthma non-COPD healthy adults as controls (n = 1,529). In addition, the genetic influence of rs8832 was also examined in asthma patients with allergic rhinitis and no history of exacerbation (n = 130). RESULTS: Two-step cluster analyses identified five clusters that did not necessarily correspond to the diagnostic disease labels. Cluster 1 was characterized by high eosinophil counts, cluster 2 was characterized by smokers with impaired lung function, cluster 3 was characterized by the presence of gastroesophageal reflux, cluster 4 was characterized by non-allergic females, and cluster 5 was characterized by allergic rhinitis and elevated total immunoglobulin E levels. A significant association with rs8832 was observed for cluster 5 (odds ratio, 3.88 (1.34-11.26), p = 0.013) and also for the type 2 exacerbation-prone phenotypes (clusters 1 and 5: odds ratio, 2.73 (1.45-5.15), p = 1.9 × 10-3). DISCUSSION: Our results indicated that the clinical heterogeneity of disease exacerbation may reflect the presence of common exacerbation-prone endotypes across asthma and COPD, and may support the use of the treatable traits approach for the prevention of exacerbations in patients with chronic inflammatory airway diseases.

Chronic eosinophilic pneumonia with subpleural curvilinear shadow.

We report a rare case of chronic eosinophilic pneumonia with subpleural curvilinear shadow. CT scan showed a patchy consolidation in the bilateral upper lungs. In addition, subpleural curvilinear shadow was found in the bilateral upper lungs. A bronchoalveolar lavage obtained from the right middle lobe showed 25 % eosinophils. Although very rare, we should therefore keep in mind that patients, who have patchy consolidation with areas of subpleural curvilinear shadow in the bilateral upper lungs, may have chronic eosinophilic pneumonia.