Predicting response to immunotherapy in non-small cell lung cancer- from bench to bedside.

Background: Immune checkpoint inhibitor (ICI) therapy is first-line treatment for many advanced non-small cell lung cancer (aNSCLC) patients. Predicting response could help guide selection of intensified or alternative anti-cancer regimens. We hypothesized that radiomics and laboratory variables predictive of ICI response in a murine model would also predict response in aNSCLC patients. Methods: Fifteen mice with lung carcinoma tumors implanted in bilateral flanks received ICI. Pre-ICI laboratory and computed tomography (CT) data were evaluated for association with systemic ICI response. Baseline clinical and CT data for 117 aNSCLC patients treated with nivolumab were correlated with overall survival (OS). Models for predicting treatment response were created and subjected to internal cross-validation, with the human model further tested on 42 aNSCLC patients who received pembrolizumab. Results: Models incorporating baseline NLR and identical radiomics (surface-to-mass ratio, average Gray, and 2D kurtosis) predicted ICI response in mice and OS in humans with AUCs of 0.91 and 0.75, respectively. The human model successfully sorted pembrolizumab patients by longer vs. shorter predicted OS (median 35 months vs. 6 months, p=0.026 by log-rank). Discussion: This study advances precision oncology by non-invasively classifying aNSCLC patients according to ICI response using pre-treatment data only. Interestingly, identical radiomics features and NLR correlated with outcomes in the preclinical study and with ICI response in 2 independent patient cohorts, suggesting translatability of the findings. Future directions include using a radiogenomic approach to optimize modeling of ICI response.

Trauma scissors vs. the rescue hook, exposing a simulated patient: a pilot study.

The objective of this study was to compare the exposure times using trauma scissors vs. the rescue hook on a simulated patient. This was a prospectively randomized, parallel group comparison study with two arms. The control group used trauma scissors (15 cycles), and the intervention group used rescue hooks (15 cycles). The uniform and footwear were standardized for each cycle. Ten participants were trained on each instrument. For each cycle, four participants were randomly chosen, and the use of either instrument was randomized. Each participant was then queried about their preferences for either instrument and why. The rescue hook's mean time of exposure was 24 s with a SD of 7 s and a 95% confidence interval (CI) of 20-28 s. The trauma scissors' mean exposure time was 42 s with a SD of 5 s and a 95% CI of 39-45 s. The mean difference was 18 s, with a 95% CI of 13-23 s. On average, the rescue hook was 43% faster. Nine of 10 participants preferred the rescue hook, stating that it was faster, easier, smaller, and more durable. The rescue hook was found to be faster than trauma scissors when exposing a simulated patient, and it was the instrument preferred by the majority of participants.