The etiology of spontaneous coronary artery dissection has not been well clarified. Different studies associate it to pregnancy, physical stress, collagen diseases and vasculitis. In general, patients do not have the classic risk factors for coronary artery disease, which makes mandatory the suspicion of this condition, especially in young adults with acute coronary syndromes. We report the case of a 38-year-old female with non-ST segment elevation acute coronary syndrome and intracoronary hematoma with no apparent dissection, diagnosed by intravascular ultrasound, in the right coronary artery. There is no consensus so far on the best way to treat these cases.
Background: CNS mets occur in 20%e40% of pts with adv NSCLC and are associated with poor overall survival (OS; median z7 mo). We evaluated nivo in this subgroup by: 1) pooling nivo-treated pts with adv NSCLC and pretreated (pretx) stable CNS mets at baseline (BL) across CheckMate 063 (phase [ph] II), 017 (ph III), and 057 (ph III); and 2) comparing OS with nivo vs docetaxel (doc) in pts with stable BL CNS mets in CheckMate 017 and 057.Method: 1) Nivo-treated pts with adv NSCLC and pretx BL CNS mets from CheckMate 063 (n¼3), 017 (n¼9), and 057 (n¼34) were pooled to assess BL characteristics, safety, and CNS progression. 2) OS was analyzed in pts with pretx BL CNS mets and squamous (SQ; Check-Mate 017) or non-SQ (NSQ; CheckMate 057) NSCLC treated with nivo 3 mg/kg Q2W vs doc 75 mg/m 2 Q3W. Results: Of 46 nivo-assigned pts with pretx CNS mets, 74% had prior CNS-site radiotherapy and 85% had 2 extra-CNS sites of mets. Median follow-up was 8.4 mo (range: 0.3, 23.4); median treatment duration (n¼45; 1 pt not treated) was 2.3 mo (range: 0.03, 23.3). Any grade (gr) treatment-related (TR) adverse events (AEs) occurred in 67% of pts; gr 3e4 TRAEs occurred in 7%, with no TR deaths. CNS TRAEs occurred in 5 pts (11%) and were all gr 1e2 (paresthesia, n¼2; dizziness, somnolence, and tremor, n¼1 each). At time of overall disease progression (PD) or last tumor assessment, 33% of pts had no evidence of CNS progression (stable/ decreased CNS lesions) and 52% had unequivocal progression in the CNS (15% had no post-BL CNS assessment). In pts with pretx CNS mets from CheckMate 017, median OS (events, n; HR) with nivo (n¼9) vs doc (n¼8) was 4.99 mo vs 3.86 mo (6 vs 8; not determined); in CheckMate 057, median OS with nivo (n¼34) vs doc (n¼34) was 7.61 mo vs 7.33 mo (30 vs 27; 1.04, 95% CI: 0.62, 1.76). Conclusion: Nivo was well-tolerated in pts with adv NSCLC and pretx CNS mets, with generally low-grade toxicities. One-third of pts had no evidence of CNS progression at time of PD/last assessment. In pts with SQ and NSQ NSCLC with pretx CNS mets, median OS was similar with nivo vs doc. Additional results (including OS and CNS progression rates in pts with/without pretx CNS mets and safety/efficacy of nivo in pts with untreated BL CNS mets from CheckMate 012) will be presented.Background: Immunotherapy is an effective strategy in the treatment of advanced non-small cell lung cancer. Its associated toxicities are diverse and different from those of chemotherapy, so patients and clinicians should be alert for early signs and symptoms.
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