Survival Outcomes Associated with First and Second-Line Palliative Systemic Therapies in Patients with Metastatic Bladder Cancer.

BACKGROUND: Real-world data on palliative systemic therapies (PST) in treating metastatic bladder cancer (mBC) is limited. This study investigates current trends in treating mBC with first- (1L) and second-line (2L) chemotherapy (CT) and immunotherapy (IT). METHODS: A chart review was conducted on patients diagnosed with stage II-IV bladder cancer in 2014-2016. Survival outcomes were compared between chemotherapy, immunotherapy, and supportive care. RESULTS: out of 297 patients, 77% were male. 44% had stage IV disease at diagnosis. Median age at metastasis was 73 years. 40% of patients received 1L PST and 34% received 2L PST. Median overall survival (mOS) was longer in those receiving PST versus no treatment (p < 0.001). Patients receiving CT and IT sequentially had the longest mOS (18.99 months). First-line IT and CT mOS from treatment start dates were 5.03 and 9.13 months, respectively (p = 0.81). Gemcitabine with cisplatin (8.88 months) or carboplatin (9.13 months) were the most utilized 1L chemotherapy regimens (p = 0.85). 2L IT and CT mOS from treatment start dates were 6.72 and 3.78 months, respectively (p = 0.15). CONCLUSION: real-world mOS of >1.5 years in mBC is unprecedented and supports using multiple lines of PST. Furthermore, immunotherapy may be a comparable alternative to chemotherapy in both 1L and 2L settings.

Approach to allergic contact dermatitis caused by topical medicaments.

OBJECTIVE: To provide an approach to identifying topical medicament ingredients that cause allergic contact dermatitis (ACD) and to recognizing common clinical scenarios in which these ingredients might present. SOURCES OF INFORMATION: A retrospective chart review was conducted of patients patch tested at the Contact Dermatitis Clinic at St Paul's Hospital in Vancouver, BC, between November 2016 and June 2019. Data from the North American Contact Dermatitis Group from 2015 to 2016 and The Ottawa Hospital patch test clinic from 2000 to 2010 were also reviewed. MAIN MESSAGE: Topical antibiotics are the most common cause of ACD to medicaments and frequently cause cosensitization to multiple allergens. This hypersensitivity reaction is often seen following surgical procedures and should be distinguished from postoperative infection. Corticosteroid allergy is easy to miss and should be suspected in cases of corticosteroid-sensitive dermatoses that worsen despite appropriate treatment. Topical anesthetics and propylene glycol are other causes of ACD found in many prescription and over-the-counter products. CONCLUSION: Allergic contact dermatitis is easy to miss and should always be considered in cases of eczematous eruptions. A thorough drug history including all topical products-both prescription and over-the-counter-is critical. Patch testing can help identify specific allergens for the patient to avoid.

Approche de la dermatite de contact allergique causée par les médicaments topiques.

OBJECTIF: Fournir une approche pour déterminer quels sont les ingrédients contenus dans les médicaments topiques qui causent la dermatite de contact allergique (DCA) et reconnaître les scénarios cliniques courants où ces ingrédients pourraient être présents. SOURCES D'INFORMATION: Revue rétrospective des dossiers de patients ayant subi un test épicutané à la clinique de dermatite de contact de l'Hôpital Saint-Paul à Vancouver, en Colombie-Britannique, entre les mois de novembre 2016 et juin 2019. Ont également été évaluées, les données de 2015 à 2016 du North American Contact Dermatitis Group et celles de 2000 à 2010 de la clinique de test épicutané de l'Hôpital d'Ottawa. MESSAGE PRINCIPAL: Les antibiotiques topiques sont la cause la plus courante de DCA aux médicaments, et ils causent fréquemment la cosensibilisation à plusieurs allergènes. Cette réaction d'hypersensibilité survient souvent après une intervention chirurgicale, et il faut la différencier de l'infection postopératoire. L'allergie aux corticostéroïdes est facile à manquer, et il faut la soupçonner dans les cas de dermatose sensible aux corticostéroïdes qui s'aggravent malgré le traitement approprié. Les anesthésiques et le propylèneglycol topiques, trouvés dans de nombreux produits d'ordonnance ou en vente libre, sont d'autres causes de DCA. CONCLUSION: La dermatite de contact allergique est facile à manquer et doit toujours être envisagée dans les cas d'éruption eczémateuse. Il est essentiel d'établir l'historique des médicaments, dont tous les produits topiques d'ordonnance ou en vente libre. Le test épicutané contribue à déterminer quels allergènes spécifiques le patient doit éviter.