Pembrolizumab-combination therapy for NSCLC- effectiveness and predictive factors in real-world practice.

Introduction: Pembrolizumab combined with chemotherapy has become the standard of care for patients with non-small-cell lung cancer (NSCLC) and the expression of programmed death ligand 1 (PD-L1) in <50% of tumour cells (TC). Methods: We evaluated the efficacy of the treatment in real-world practice, paying attention to the predictive factors, with a special focus on low level of PD-L1 expression. This study is a multicenter retrospective analysis of patients with stage IV NSCLC. Results: A group of 339 consecutive patients was analysed, among them 51% patients with low PD-L1 expression. In the overall population, the ORR was 40.6%, median PFS and OS were 13 months (95% CI 11.4-15) and 16.8 months (95% CI 13.3-20.3), respectively. In multivariate analysis for the entire study population, performance status - ECOG 1 vs. 0 (HR 2.2, 95%CI 1.1-4.6; p=0.02), neutrophil to lymphocyte ratio (NLR)>3 (HR 2.3, 95%CI 1.3-4.2; p=0.04), presence of liver (HR 2.0, 95%CI 1-3.7; p=0. 03) and bone metastases (HR 1.3, 95%CI 1-3; p=0.04), weight loss (HR 1.8, 95%CI 1.1-2.8; p=0.01) and sum of measurable lesions diameters >110 mm (HR 1.7, 95%CI 1-2.9, p=0.049) had a negative impact on OS. Conclusions: In the real world, patients can clinically benefit from immunochemotherapy, regardless of the expression of PD-L1 and the histological type. Other clinicopathological factors such as performance status, extent, and location of secondary lesions have prognostic significance.

[Myocardial infarction and pulmonary embolism in a 45 year-old woman with the prothrombin 20210A mutation--a case report]. / Zawal serca i zator tetnicy plucnej u 45-letniej kobiety, nosicielki mutacji genu protrombiny 20210A.

We present a case of a 45-year-old-female who developed myocardial infarction and 6 weeks following first hospitalisation--pulmonary embolism. The disease was probably triggered by hormone replacement therapy. Coronary angioplasty and anticoagulant therapy with unfractioned heparin and acenokumarol were used with success. The woman and her 17-year-old daughter were shown to be heterozygous for prothrombin mutation G20210A. This case shows that trombophilia should be considered in young women with deep venous thrombosis, pulmonary embolism, venous thromboembolism or with myocardial infarction especially in women with high-risk factors.