Impact of the use of antibiotics on the clinical response to immune checkpoint inhibitors in patients with non-small cell lung cancer.

OBJECTIVE: Recent research suggests that the use of antibiotics could reduce the efficacy of checkpoint inhibitors, in addition to other well-known factors. It could be due to gut microbiota modification, which impact over the immune system response. However, the information available so far is contradictory. The objective of this research was to clarify whether antibiotic use influences efficacy of checkpoint inhibitors treatments in non-small cell lung cancer patients in clinical practice. METHODS: Therefore, a retrospective observational study was designed. Use of antibiotics among patients treated with atezolizumab, pembrolizumab or nivolumab was assessed within 2 months of checkpoint inhibitors treatments initiation. RESULTS: A total of 140 patients were included, mostly men, with good performance status (ECOG 0-1), all of them previously treated with chemotherapy. An antibiotic prescription was identified in 31% of these patients, mainly fluoroquinolones or beta-lactams. The most frequent indication was respiratory infection. Both progression-free survival and overall survival were lower for patients treated with anti-infective drugs, although this difference was not statistically significant. CONCLUSIONS: More studies are needed to draw conclusions about the impact of antibiotics on the efficacy of immunotherapy.

La nutrición parenteral domiciliaria, un interrogante en pediatría / Home parenteral nutrition, question mark in pediatrics

La nutrición parenteral domiciliaria es una terapia necesaria pero infrautilizada en España, respecto de los países de nuestro entorno. El primer foro de discusión de la SENPE ha estudiado este problema y aconseja entre otras iniciativas el diseño de estudios que analicen los diferentes problemas detectados. Nuestro equipo decidió analizar el nivel de conocimientos y la opinión que tienen los profesionales de la salud que trabajan en Pediatría, porque un número importante de pacientes que son candidatos a beneficiarse de esta forma de tratamiento son niños. Un equipo multidisciplinar diseñó un cuestionario que se distribuyó entre 136 profesionales (70 médicos y 66 enfermeras) que pertenecen a 4 hospitales públicos (H) y 8 centros de Atención primaria (AP) de Asturias y Salamanca. El análisis de las respuestas muestra que un escaso número de estos profesionales afirma tener conocimientos teóricos y prácticos, haber recibido información en el último año o en su formación académica. La capacidad para responder a posibles dudas de los pacientes y cuidadores en la actividad diaria (manejo, almacenamiento, compatibilidad y estabilidad de la nutrición, problemas de los equipos de infusión, etc) está solamente en el 10 % de AP y en el 50 % de H. Estas cuestiones pueden verse en los manuales NADYA y en su página web, pero solo 6 personas (4.4 %), todos pertenecientes al H, conocen este grupo de expertos. Hay unanimidad en las ventajas de la NPD en términos de calidad de vida, eficacia económica y en la importancia de la cooperación entre el H y la AP. Concluimos que un importante número de profesionales que trabajan en la Pediatría no conocen la NPD, sobre todo en la AP. Los conocimientos en NPD deben de ser fomentados en los servicios clínicos relacionados con pacientes susceptibles de beneficiarse de este tipo de terapia. Deben usarse los recursos existentes como los manuales NADYA e incluir programas específicos con lecciones teóricas y entrenamientos prácticos en los futuros profesionales: médicos, farmacéuticos y enfermeras. Pensamos que es necesario que equipos multidisciplinares desarrollen protocolos específicos de cerrada colaboración entre H y AP para ayudar a los pacientes, porque es el objetivo de nuestra actividad asistencial (AU)

Home parenteral nutrition (HPN) is a necessary but under-used therapy in Spain as compared to other European countries. This problem has been studied at the 1st Discussion Forum of the Spanish Society for Parenteral and Enteral Nutrition. One of its recommendations has been "to design studies in order to analyze the problems detected in HPN practice". Our study attempts to assess pediatric professionals knowledge and opinion about this concern, because children are important recipients of this therapy. A multi-disciplinary team prepared a questionnaire to be distributed among 136 health professionals (70 physicians and 66 nurses) working in 4 public hospitals (H) and 8 Primary Health Care Centers (PHC) from Asturias and Salamanca (Spain). Answers show that few professionals have appropriated theoretical and practical knowledge about HPN. Most of them have received neither academic training education nor information over the last year on this matter. The ability to solve patient and caregiver doubts in daily management (handling, storage, compatibility and nutrition stability, parenteral infusion equipment problems, etc) is only 10% in PHC and 50% in H. Only 6 physicians (4,4%) from H group know about the existence of NADYA expert group despite its website and handbooks providing a wide information about HPN. The advantage of HPN to improve life quality, its economic efficacy and the need of cooperation to this respect between H and PHC are matters with a high level of agreement. Conclusion: an important number of pediatric professionals does not have enough knowledge about HPN in PHC. The awareness of HPN must be promoted among clinical services dealing with patients able to benefit from this therapy. All available resources must be used to improved this issue. Specific protocols developed by multidisciplinary teams would promote H and PHC collaboration to help patients, who are the aim of our activity (AU)

[Home parenteral nutrition, question mark in pediatrics]. / La nutrición parenteral domiciliaria, un interrogante en pediatría.

Home parenteral nutrition (HPN) is a necessary but under-used therapy in Spain as compared to other European countries. This problem has been studied at the 1st Discussion Forum of the Spanish Society for Parenteral and Enteral Nutrition. One of its recommendations has been "to design studies in order to analyze the problems detected in HPN practice". Our study attempts to assess pediatric professionals knowledge and opinion about this concern, because children are important recipients of this therapy. A multidisciplinary team prepared a questionnaire to be distributed among 136 health professionals (70 physicians and 66 nurses) working in 4 public hospitals (H) and 8 Primary Health Care Centers (PHC) from Asturias and Salamanca (Spain). Answers show that few professionals have appropriated theoretical and practical knowledge about HPN. Most of them have received neither academic training education nor information over the last year on this matter. The ability to solve patient and caregiver doubts in daily management (handling, storage, compatibility and nutrition stability, parenteral infusion equipment problems, etc) is only 10% in PHC and 50% in H. Only 6 physicians (4.4%) from H group know about the existence of NADYA expert group despite its website and handbooks providing a wide information about HPN. The advantage of HPN to improve life quality, its economic efficacy and the need of cooperation to this respect between H and PHC are matters with a high level of agreement. An important number of pediatric professionals does not have enough knowledge about HPN in PHC. The awareness of HPN must be promoted among clinical services dealing with patients able to benefit from this therapy. All available resources must be used to improved this issue. Specific protocols developed by multidisciplinary teams would promote H and PHC collaboration to help patients, who are the aim of our activity.