[Efficacy and future of the aerosoltherapy in the treatment of cystic fibrosis patients infected by Pseudomonas aeruginosa]. / Efficacité et avenir de l'aérosolthérapie dans le traitement des infections à Pseudomonas aeruginosa chez les patients atteints de mucoviscidose.

Pseudomonas aeruginosa is considered as the most redoubtable pathogenic agent at cystic fibrosis patients. Its eradication is a priority to avoid the passage to chronic infection, the real turning point of the disease. For this, a wide therapeutic panel of intravenous antibiotics exists, and for some years, the research teams concentrate more and more on the inhaled way. The synthesis of the literature data presented herein focuses on both already experienced molecules (colistin and tobramycin), and on new therapeutics. This review aims at loosening advantages and inconveniences of each of these therapeutic options, while bringing to light the necessity of follow-up studies in order to prove the therapeutic interests of molecules in development.

Adverse Events Induced by PD-1/PD-L1 Inhibitors: A Real-World Single-Centre Experience with a Management-Based Approach.

AIM: To assess the efficacy and tolerance of programmed death-1 (PD-1) and PD-ligand 1 (PD-L1) inhibitors and the impact of a standardised management-based protocol in a real-world setting. PATIENTS AND METHODS: Data from patients who had received anti-PD-(L)1 were collected from our pharmacy database. Clinical response and toxicity were assessed using RECIST criteria and CTCAE version 5.0, respectively. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method. Potential prognostic factors were identified using Cox's model. RESULTS: A total of 196 patients and 201 lines of treatment were included (median age: 66 (range: 38-89) years). Types of cancer included non-small cell lung cancer (73%), transitional cell carcinoma (10%), renal cell carcinoma (6%), small cell lung cancer (5%), head and neck squamous cell carcinoma (4%) and classical Hodgkin's lymphoma (1%). Twenty-five (12%) patients had pre-existing autoimmune conditions. Our standardised management-based protocol included 129 (64%) patients. Objective response rate was 29%, median OS was 10 months (IQR: 7-15) and median PFS was 5 months (IQR: 1-22). Patients with an abnormal baseline complete blood count had a worse OS (HR=2.48 [95% CI: 1.24-4.96]; p=0.0103). Thirty-three (16%) patients experienced severe (grade 3 or 4) immune-related adverse event (irAE). There were three (1%) irAE-related deaths. AEs resolved faster when patients were assessed by an internist before anti-PD-(L)1 initiation (p=0.0205). CONCLUSION: PD-1 and PD-L1 inhibitors are effective and safe in a real-world setting. Implementation of a standardised management-based protocol with internal medicine specialists is an effective way to optimise irAE management.