Long-term results in patients with lung resections for colorectal cancer metastases. Experience of a single center in Argentina / [Resultados a largo plazo en pacientes con resecciones pulmonares por metástasis de cáncer colorrectal. Experiencia de un solo centro de Argentina.]

Introduction: Between 5-10% of patients who undergo curative surgery for colorectal cancer (CRC) will present recurrence of their disease on the lungs. Surgical treatment of pulmonary metastases (PM) has gained popularity over the years, different publications report an overall survival rate at 5 years of between 30% and 60%. We present a review of patients with PM resections of CRC treated in a single center in Argentina. Materials and methods: A descriptive, observational, retrospective study was conducted between 2008 and 2018. All patients with pulmonary metastasectomy of colorectal cancer were included. The primary endpoint was to evaluate overall survival and disease-free survival. Possible prognostic factors were evaluated as a secondary endpoint. Results: A total of 99 surgeries were performed in the 68 patients, the resection was multiple in 48.5%, with more than 3 nodules in 13%. Overall and progression-free survival at 5 years was 55% and 27%, respectively. In the statistical analysis we found that the lesions in more than one lobe (p = 0.015) and the resection of more than 3 nodules (p = 0.011) presented a lower overall survival. Conclusions: In this retrospective analysis we evidenced comparable values to the world literature regarding morbidity, mortality, overall survival and progression-free. In our series, patients with disease in more than one lobe or more than three resected lesions had significantly lower overall survival.

Introducción: Entre el 5-10% de los pacientes que se someten a cirugía curativa por cáncer colorrectal (CCR) presentarán en algún momento recurrencia de su enfermedad a nivel pulmonar. El tratamiento quirúrgico de las metástasis pulmonares (MP) fue ganando popularidad a través de los años, diferentes publicaciones informan una tasa de supervivencia global a los 5 años de entre 30% a 60%. Presentamos una revisión de pacientes con resecciones por MP de CCR tratados en un único centro en Argentina. Materiales y métodos: Se realizó un estudio descriptivo, observacional, retrospectivo entre 2008 y 2018. Se incluyeron todos los pacientes con resecciones de MP de CCR.  El objetivo primario fue evaluar la supervivencia global y  supervivencia libre de enfermedad. Como objetivo secundario se evaluaron posibles factores pronósticos. Resultados: Se realizaron un total de 99 cirugías en los 68 pacientes, la resección fue múltiple en un 48,5%, siendo más de 3 nódulos en un 13%. La supervivencia global y libre de progresión a los 5 años fue del 55% y del 27% respectivamente. En el análisis estadístico encontramos que las lesiones en más de un lóbulo (p=0.015) y la resección de más de 3 nódulos (p=0.011) presentaron una menor supervivencia global. Conclusiones: En este análisis retrospectivo evidenciamos valores comparables a la literatura mundial con respecto a morbilidad, mortalidad, supervivencia global y libre de progresión. En nuestra serie los pacientes con enfermedad en más de un lóbulo o más de tres lesiones resecadas presentan significativamente menor supervivencia global.

Outcomes of patients with non-small cell lung cancer and poor performance status treated with immune checkpoint inhibitors in the real-world setting.

BACKGROUND: Immune-checkpoint inhibitors (ICIs) are standard treatments for metastatic non-small cell lung cancer (NSCLC). Patients with poor performance status (PS) are underrepresented in clinical trials. We evaluate the efficacy and safety of ICIs in a real-world setting. METHODS: We conducted a multi-institutional retrospective study to assess clinical outcomes of NSCLC treated with ICIs. We categorized pts within two groups (PS 0-1 vs 2) and assessed clinical outcomes and safety. RESULTS: Two hundred and sixty nine patients were included, 44 patients (16.4%) had baseline PS 2 and 223 patients (82.9%) PS 0-1. The overall response rate (ORR) was 30.4%, median PFS was 7.26 months (95% CI 5.1-9.4), and median OS was 15.18 months (95% CI 9.5-20.9). Patients with a PS 2 were most likely to received ICIs in the second or later line (84.1% vs 64.6%; p = 0.01), had baseline steroids (21.4% vs 8.2%; p 0.010), lower response rate (16.7% vs 34.5%; p 0.02) and clinical benefit (35.7% vs 71%; p 0.000) compared to PS 0-1 pts. Moreover, PS ≥ 2 patients had shorter PFS, median 2.2 months (95% CI 1.3-3.1) compared to 9.9 months (95% CI 6.7-13.1] and shorter OS, 3.3 months (95% CI 2.6-4.2) versus 24.1 months (95% CI 16.1-32.1), respectively. PS was significantly associated with PFS and OS in multivariate analysis. As it was expected, immunotherapy was well tolerated with a safety profile comparable to the previous published data. CONCLUSION: Based on these retrospective results, patients with poor baseline performance status seem to have poor clinical outcomes with ICIs in the real-world setting.

Immunotherapy in Lung Cancer: Are the Promises of Long-Term Benefit Finally Met?

Over the last few years, agents targeting immune checkpoints have shown potential to improve therapeutic outcomes in patients with lung cancer in multiple clinical settings. Inhibitors of PD-1/PD-L1 have been approved for the treatment of different types of lung cancer by the FDA either alone or in combination with chemotherapy or other immune checkpoint inhibitors, such as anti-CTLA-4 agents. The introduction of these agents in clinical practice has revolutionized the therapeutic approach to lung cancer, keeping the promises of long-term benefit in selected patient populations. The therapeutic indications of immunotherapy in lung cancer are rapidly growing, and multiple combinations entered clinical practice or are under active development. Furthermore, the quest for a reliable predictive biomarker is still ongoing to overcome the limits of currently approved tests for patients' selection. In this review, we summarized the current status and progress of anti-PD-1/PD-L1 agents in lung cancer treatment.

Tumor desmoide abdominal / Abdominal desmoid tumor

Los tumores desmoides son infrecuentes, presentan crecimiento localmente agresivo, no suelen dar metástasis pero con frecuencia desarrollan un crecimiento infiltrante que amenaza la vida y puede conducir a una gran morbi-mortalidad. Representan el 0.03% de todos los tumores. En base a la experiencia, los expertos recomiendan la administración de dosis altas de tamoxifeno y sulindac como tratamiento primario para los pacientes con tumores desmoides asociados a poliposis adenomatosa familiar (PAF). Sin embargo, el mejor enfoque después de la intervención quirúrgica para pacientes con tumores desmoides esporádicos, aún no se ha determinado (AU)

Desmoid tumors are infrequent, locally aggressive growth, do not usually metastasize but often develop an infiltrating growth that threatens life and can lead to great morbidity and mortality. They represent 0.03% of all tumors. Based on experience, experts recommend the administration of high doses of tamoxifen and sulindac as a primary treatment for patients with desmoid tumors associated with familial adenomatous polyposis (FAP). However, the best approach after surgical intervention for patients with sporadic desmoid tumors has yet to be determined (AU)