Real-world treatment patterns and clinical outcomes in patients with stage III non-small cell lung cancer: results of KINDLE-Egypt cohort.

Background: Stage III non-small cell lung cancer (NSCLC) being highly heterogeneous requires multimodal therapeutic strategies for optimal management. We present findings on treatment patterns and their associated survival outcomes in patients with stage III NSCLC from the Egypt subset of the KINDLE global real-world study conducted across countries from Asia, Middle East, Africa, and Latin America. Method: Retrospective data from the Egypt subset (21 centers) of adult patients diagnosed with stage III NSCLC between January 2013 and December 2017 were analyzed. Descriptive and inferential statistics summarized treatment modalities, progression-free survival (PFS), and overall survival (OS). Results: Of 421 patients enrolled (median age: 59.0 years), 77.9% were males, 53.5% had stage IIIA disease, 60.8% had adenocarcinoma, 78.4% had an unresectable disease, and 81.5% had Eastern Cooperative Oncology Group performance status ⩽1. Overall, chemotherapy alone (40.4%) was predominantly used in the initial line, whereas definite radiotherapy was used in only 5.0% of patients. In resectable patients, chemotherapy plus surgery (33.8%), surgery alone (20.6%), or other surgery (20.6%) were the top three modalities used in initial line of treatment. Chemotherapy alone was most preferred (48.8%) in unresectable patients, followed by sequential chemoradiotherapy (CRT) (17.6%) and concurrent CRT (9.3%). The overall median PFS was 10.3 months [95% confidence interval (CI), 9.43-12.02], whereas the median OS was 18.5 months (95% CI, 16.46-21.88). Overall, female gender, adenocarcinoma histology, and radical therapy as surgery or CRT predicted significantly longer OS (all p < 0.05). Conclusion: KINDLE-Egypt cohort revealed wide heterogeneities in the treatment patterns of stage III NSCLC. Although deemed resectable, few patients did not undergo surgery, probably due to high smoking rates leading to poor lung function. Lower survival outcomes than other published real-world studies highlight the need for timely approval and availability of novel targeted and immunotherapies to enhance patient outcomes. Trial registration: NCT03725475.

Assessment of fetal growth and anomalies in the era of COVID-19 pandemic: an Egyptian pilot study.

BACKGROUND: Many issues need to be studied regarding pregnant women during the SARS-CoV-2 (COVID-19) infection pandemic. The aim of this study was to assess fetal growth, fetal well-being, and any observed gross anomalies that may follow SARS-CoV-2 infection in Egyptian pregnant women. During fetal anomaly scan at 22 weeks, we compared 30 pregnant women with a history of SARS-CoV-2 infection at 6­12 weeks of gestation (group A) with 60 pregnant women (group B) who had no history of SARS-CoV-2. Then, we followed them on 28 and 34 weeks of gestation with fetal biometry and Doppler study. RESULTS: Our results revealed no significant difference between both groups regarding fetal biometry, estimated fetal weight, amniotic fluid index, Doppler scan, and gross anomaly scan throughout all visits. CONCLUSION: According to the results of our pilot study, SARS-CoV-2 infection in pregnancy was not found to increase the risk of fetal growth restriction or possible fetal gross anomalies. Nevertheless, larger-scale studies are needed to confirm those findings. Perhaps, post-SARS-CoV-2 infection pregnancies may run an uncomplicated course regarding fetal parameters.

FSH versus AMH: age-related relevance to ICSI results.

BACKGROUND: Women's fecundity is known to decrease with the increase in chronologic age. Several biomarkers of the ovarian reserve, including follicle stimulating hormone (FSH), anti Müllerian hormone (AMH), have been proposed as possible predictors for the response to controlled ovarian stimulation (COS). Although there are assumptions indicating that the relationship between age and ovarian reserve is highly variable and the potential different validity of ovarian reserve markers in women in different age groups remains to be demonstrated. The purpose of our study was evaluating FSH and AMH as potential predictors of response to controlled ovarian stimulation and prediction of intracytoplasmic sperm injection (ICSI) outcome according to age. This prospective study has been carried out on 218 women having ICSI cycles. Cases were divided into two groups, group 1 (n 148), their age < 35 years, and group 2 (n 70), their age ≥ 35 years. All women received antagonist protocol during their ICSI cycles. Basal FSH and AMH were measured and correlated to the number of follicles on the day of trigger, the number of oocytes retrieved, chemical, and clinical pregnancies. RESULTS: The fertilization rate in group 1 was 68.15%, while in group 2 was 77.82% (p = 0.003) while the implantation rate (number of gestational sacs observed at 6 weeks of pregnancy divided by the number of transferred embryos) was 18.95 and 11.98% in group 1 and group 2, respectively (p = 0.041). The clinical pregnancy rate among both groups was 38.51% in group 1, while 24.29% in group 2 (p = 0.038). Women who got pregnant among those aged < 35 years had significantly lower basal FSH (p < 0.001), while women who got pregnant among those aged ≥ 35 years had significantly higher AMH levels (p value < 0.001) and higher E2 levels on the day of trigger (p = 0.007). CONCLUSION: We found that below the age of 35 years, the chances of pregnancy are more correlated to FSH levels, while above the age of 35 years, AMH was a more relevant test.

The use of laser assisted hatching of frozen/thawed embryos versus laser assisted hatching of fresh embryos in human intracytoplasmic sperm injection.

Cryopreservation of human embryos has become an essential part of assisted reproduction. It limits the number of embryo transferred while supernumerary embryos can be transferred in subsequent cycles, however, it is associated with zonal hardening, which lowers the success rate in the majority of (ICSI) centres, associated with decreased implantation rate and clinical pregnancy rates. Assisted hatching has been used to induce microdissection of the zona pellucida. Many techniques have been used, such as mechanical, chemical, piezo and laser techniques. AIM: To compare the efficacy of laser assisted hatching of vitrified embryos and fresh embryos with regards to implantation rate and clinical pregnancy rate. STUDY DESIGN: Prospective randomised study. PATIENTS AND METHODS: One hundred twenty women with fresh embryos scheduled for (ICSI) were randomised in two groups; laser assisted hatching (LAH) group (test group), containing 60 women and the other is (non LAH) (control group). Second group with 120 women with frozen embryos were randomised in (LAH group) and (non LAH group). On the day of embryo transfer, 1.48 µm Infrared Diode laser, class 1 M, was used in test group to induce zonal microdissection, the quality and safety of embryos is assessed morphologically after hatching. On the other hand, the zona of the control group were left intact. Both clinical pregnancy and implantation rates were estimated. RESULTS: Laser assisted hatching group had clinical pregnancy and implantation rates of 38% and 50%, respectively. Non laser assisted hatching group had lower clinical pregnancy and implantation rates; 30% (p = .442) and 33% (p = .095), respectively, with no statistically significant difference p < .05. CONCLUSION: LAH does not improve statistically both pregnancy rate and implantation rate in fresh embryos. However, there is improvement in both implantation and pregnancy rate in Vitrified group.