RESUMEN
INTRODUCTION: Immune Checkpoint Inhibitor (ICI) therapy is now a standard of care in numerous cancers with very promising results. Nevertheless, adverse events, and especially immune-related adverse events (irAEs) not reported during clinical trials, are emerging and can be life-threatening. OBSERVATION: We report here a teachable case of a 80 year-old man, of third-degree atrioventricular block consecutive to myocarditis associated with the administration of nivolumab (anti-PD1) monotherapy. CONCLUSION: Myocarditis occurring during ICI treatment is a rare but potentially lethal event. Daily serum troponin level seems to predict ICI-related myocarditis but interpretation could be difficult in the context of associated myositis. Echocardiography and cardiac MRI are also useful but can remain negative. Electrocardiogram is a cornerstone of myocarditis diagnosis. In case of cardiac involvement, continuous heart rhythm monitoring should be performed in addition to the administration of high-dose corticosteroids therapy and the cessation of ICI therapy. Add-on treatments should be discussed with a well-trained multidisciplinary team.
Asunto(s)
Bloqueo Atrioventricular/inducido químicamente , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Miocarditis/inducido químicamente , Nivolumab/efectos adversos , Anciano de 80 o más Años , Antineoplásicos Inmunológicos/efectos adversos , Antineoplásicos Inmunológicos/uso terapéutico , Bloqueo Atrioventricular/complicaciones , Bloqueo Atrioventricular/patología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Inmunoterapia/efectos adversos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Miocarditis/complicaciones , Miocarditis/patología , Nivolumab/uso terapéutico , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Receptor de Muerte Celular Programada 1/inmunologíaRESUMEN
BACKGROUND: The aim of ESCAP-2011-CPHG, promoted by the French College of General Hospital Respiratory Physicians, was to describe therapeutic strategies in lung cancer in the first 2 years after diagnosis, in a real-life setting. This article focuses on patients undergoing surgical management of a non-small cell lung cancer (NSCLC). METHODS: A prospective multicentre study was conducted in 53 French general hospitals. For each patient with lung cancer diagnosed in 2010, a standardised form was completed following each change in treatment strategy up to 2 years after diagnosis. RESULTS: Overall, 3418 of the 3943 included patients had NSCLC. 741 patients (21.7%) underwent curative surgery (stage 0-II, IIIA, IIIB, and IV: 65%, 27%, 3% and 5%, respectively). The therapeutic strategy changed less often in surgical than non-surgical patients and average follow-up time was longer: 23.3 months (SD: 9.3) versus 10.4 months (SD: 9.5) for non-surgical patients. Among patients with a surgical first strategy (92.6% of surgical patients as a whole), 56.9% did not receive any other treatment, 34.7% received chemotherapy, 5.9% radio-chemotherapy, 2.6% radiotherapy. At the end of follow-up, 55.8% were still alive without any other strategy, 13.1% had died, and 31.1% had received at least one more strategy. Among patients with a surgical second strategy, 63% had received chemotherapy alone during the first strategy. CONCLUSIONS: ESCAP -2011- CPHG assessed everyday professional practice in the surgical management of NSCLC in general hospitals. It pointed out the discrepancies between current guidelines and the therapeutic strategies applied in real life conditions.
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Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/terapia , Pautas de la Práctica en Medicina , Neumología/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Francia/epidemiología , Hospitales Generales/organización & administración , Hospitales Generales/estadística & datos numéricos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Neumonectomía/métodos , Neumonectomía/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neumología/organización & administración , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Recursos HumanosRESUMEN
Gastrointestinal metastasis from lung cancer is exceptional and generally asymptomatic. Other secondary localizations are often present. Metastastic dissemination may involve any portion of the gastrointestinal tract. Clinical expression is variable: dysphagia, anemia, bowel obstruction, peritonitis. Surgical treatment may be indicated in selected patients. We describe the cases of two patients who developed obstruction of the small bowel due to metastases from squamous-cell lung cancer. Bowel obstruction was in the inaugural sign in the first patient. Mesenteric metastasis was associated in the second patient.
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Carcinoma de Pulmón de Células no Pequeñas/secundario , Carcinoma de Células Escamosas/secundario , Neoplasias Intestinales/secundario , Obstrucción Intestinal/etiología , Neoplasias Pulmonares/patología , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Carcinoma de Células Escamosas/complicaciones , Humanos , Neoplasias Intestinales/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Vibrio vulnificus proliferates during the summer in salt water where it infects the crustaceans. Expression of its pathogenicity depends on the underlying condition and mode of contamination. OBSERVATION: A 65 year-old man presented with a Vibrio vulnificus septicaemia of cutaneous origin, transmitted when he cut himself with a crawfish. The severity of the infection was enhanced by severe immuno-depression and haemochromatosis. The infection regressed with appropriate antibiotherapy. COMMENTS: Severe V. vulnificus infections are rare. Depending on the underlying condition and mode of contamination, one can distinguish between benign gastro-enteritis, local occasionally devastating infections and usually fatal septicaemia. CONCLUSION: Even the most severe forms of V. vulnificus infections may be cured with early and well adapted anti-infectious treatment.