Bladder Cancer, Loss of Y Chromosome, and New Opportunities for Immunotherapy.

Immune checkpoint inhibitors (ICI) have emerged as an important therapeutic approach for patients with cancers including bladder cancer (BC). This commentary describes a recent study that demonstrated that the loss of Y chromosome (LOY) and/or loss of specific genes on Y chromosome confers an aggressive phenotype to BC because of T cell dysfunction resulting in CD8+T cell exhaustion. Loss of expression of Y chromosome genes KDM5D and UTY was similarly associated with an unfavorable prognosis in patients with BC as these genes were partially responsible for the impaired anti-tumor immunity in LOY tumors. From a clinical perspective, the study showed that tumors with LOY may be susceptible to treatment with ICIs.

Use of hydromorphone (Dilaudid) and morphine for patients with hepatic and renal impairment.

Management of pain in the elderly is very challenging. First, the compromised ability to perceive pain because of loss of sensory neurons and other comorbid conditions such as dementia and degenerative joint diseases make the assessment of severity source and localization of pain very difficult. Second, decrease in the renal and hepatic blood flow and decrease in the hepatic and renal mass, along with decrease in volume of distribution caused by decrease in total body water and hypoproteinemia, makes the elderly very sensitive to adverse effects of different pain medicines. Third, many elderly patients have comorbid conditions causing impaired hepatic and renal impairment. In this article, we review the role of 2 more commonly used opiates, morphine and hydromorphone, in elderly patients with hepatic and renal impairment.