IntroductionSystemic inflammation is associated with prognosis in solid tumors. The neutrophil-to-lymphocyte ratio (NLR) is a marker for the general immune response to various stress stimuli. Studies have shown correlation of NLR to outcomes in immune checkpoint blockade, peripheral neutrophil count to intratumor neutrophil population, and NLR to intratumoral levels of myeloid-derived suppressor cells. Studies have shown elevated peripheral blood regulator T cells accompanied by elevated NLR are associated with poor outcomes further highlighting the importance of inflammation in the prognosis of cancer patients.MethodsWe performed a meta-analysis of published articles on the utility of baseline NLR in predicting outcomes in patients treated with immune checkpoint inhibitors (ICIs) using Review Manager, version 5.3. Seven studies on the prognostic utility of NLR in ICI treatment were included in this analysis. For outcomes of interest, the hazard ratios (HRs) were computed. Subgroup analyses were planned based on type of malignancy and type of immune checkpoint inhibitor.Results/discussionA high NLR resulted in worse overall survival (OS) (HR, 1.92; 95% CI, 1.29–2.87; p=0.001) and progression-free survival (PFS; HR, 1.66; 95% CI, 1.38–2.01; p<0.00001) across types of malignancies studied (melanoma, non-small-cell lung cancer, and genitourinary cancer). Subgroup analysis across different types of malignancies treated with ICI showed similar results for OS and PFS. The single study on genitourinary cancers also showed worse OS and PFS (OS: HR, 1.82; 95% CI, 1.29–2.87; p=0.001 and PFS: HR, 1.83; 95% CI, 0.97–3.44; p=0.06). A high NLR also showed worse OS and PFS across all ICIs (ipilimumab, nivolumab, and unspecified or pooled pembrolizumab and nivolumab; OS: HR, 1.92; 95% CI, 1.29–2.87; p=0.001 and PFS: HR, 1.66; 95% CI, 1.38–2.01; p<0.00001). Subgroup analysis by type of ICI showed similar results.ConclusionA high NLR is associated with poorer outcomes across studies. This shows that NLR has the potential as a readily available prognostic indicator for patients receiving ICI based on available studies. Studies utilizing more stringent design may serve to better determine the utility of this tool.

The COVID-19 pandemic has caused disruptions in cancer care around the world due to logistical and psychosocial reasons. This paper was written with the primary objective of providing a guide for medical oncologists in addressing concerns in the management of adult patients with solid tumours in the Philippines and for those working under similar circumstances. These recommendations are divided into prioritisation of cancer care, ensuring a safe work environment, organising the transition of cancer care, and maintaining cohesion in a time of isolation.

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Evasion of immune destruction is considered one of the hallmarks of cancer. Chronic inflammation can enable immune escape by suppressing immune surveillance and permitting the development of tumors and creating a tumor microenvironment that sustains cancer. This includes generating mechanisms that prevent the effectiveness of anti-tumor treatment including immune checkpoint inhibitor therapy. In this review, we explore the interplay of inflammation and immunosuppression, their effects on the tumor microenvironment, and their implications for immune checkpoint inhibitor therapy particularly in the context of predictive biomarkers for their use.

PURPOSE Cancer treatment causes significant financial burden, especially in developing countries such as the Philippines. This led the Philippine Department of Health to create the Z-Package colorectal cancer benefit program, an insurance system specifically designed to treat Filipinos with colorectal cancers with early to locally advanced-stage disease. The main goal of this program is to optimize treatment outcomes for this curable disease without causing financial toxicity. MATERIALS AND METHODS Three-year data on patients enrolled in the Z-Package colorectal cancer benefit program from 2016 to 2018 were reviewed by the University of the Philippines, Philippine General Hospital Colorectal Polyp and Cancer Study Group. RESULTS A total of 251 patients were enrolled in the Z-package colorectal cancer benefit program from 2016 to 2018. Mean age was 57 years old and a majority of patients (66%) were male. A majority of patients had rectal cancer (78%) and were diagnosed with stage III disease (82%). A majority (75%) were compliant to their treatment plans and clinic follow-up. Specifically, compliance to the prescribed surgery, chemotherapy, and/or radiation treatment were 90%, 77%, and 96%, respectively. Recurrence, morbidity, and mortality rates of enrolled patients in the Z-Package program from 2016 to 2018 were 17%, 22%, and 19%, respectively. Morbidities were mostly chemotherapy related (8%). Finally, patients in this program had a 2- and 3-year survival probability of 74% and 70%, respectively, which are comparable with data from more developed nations. CONCLUSION Results of this study include real-world data that show that when the highest standards of patient care are provided through a multidisciplinary team, patients’ overall survival is also maximized.

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Abstract Introduction Dyspnea is often encountered in terminally ill cancer patients and is attributed to multiple factors. The use of fan-on-face therapy is a nonpharmacologic adjunct treatment for adult cancer patients suffering from dyspnea at the end-of-life. This study was done to determine if the use of fan-on-face therapy in addition to the standard of care treatment indeed confers clinical benefit to terminally ill adult cancer patients with dyspnea. Materials and Methods A meta-analysis of randomized controlled trials on the use of fan-on-face therapy in relieving dyspnea among terminally ill adult cancer patients was performed. A computerized search was done in MEDLINE, NICE, CENTRAL, Science Direct, and Google Scholar for relevant articles. Other publications were searched, and authors were contacted for additional information. The primary outcome measure was the mean change in dyspnea score, determined by the Modified Borg Scale, Numeric Rating Scale, or Visual Analog Scale. The secondary outcome was the post-intervention mean change in respiratory rate (RR). Results Four eligible randomized controlled trials of low to moderate risk of bias employed a total of 139 cancer patients. Fan-on-face therapy was effective in decreasing mean dyspnea scores (standard mean difference = −1.81, 95% confidence interval [CI]: −3.12, −0.50, p < 0.00001, I 2 93%) and improving mean change in RR (mean difference = −0.91, 95% CI: −1.68, −0.15; p = 0.001, I 2 = 81%) versus control. Conclusion Fan-on-face therapy, as an adjunct to standard of care, is effective in alleviating dyspnea among adult cancer patients during the end of life.

PURPOSE Several factors affect how medical oncologists in the Philippines use biomarkers in real-world practice. This study describes patterns of biomarker testing for the management of breast, colorectal, and lung cancers among medical oncologists in the Philippines. METHODS A cross-sectional survey was performed among practicing medical oncologists in the Philippines from November to December 2019. The questionnaire determined the ideal and practical use of biomarkers as perceived by the respondents. Responses were summarized. Associations between biomarker use across select conditions were determined. RESULTS A total of 127 respondents (38% of medical oncologists in the Philippines) participated in this study. In actual practice, 97% of the respondents requested estrogen receptor/progesterone receptor testing, and 93% requested human epidermal growth factor receptor 2 testing. For colorectal cancer, the respondents would use KRAS and mismatch repair/microsatellite instability, but 59.84% had never used BRAF. For lung cancer, 97.64% of respondents would test for epidermal growth factor receptor ( EGFR), 88.19% would test for PD-L1, 80.31% for anaplastic lymphoma kinase, 58.27% for ROS1, and 33.07% for BRAF. In actual practice, EGFR was the most frequently ordered test (67.72%), while 44.80% of medical oncologists had never used ROS1. The most common reason for testing was adherence to international guidelines (96%). The most commonly cited barrier to biomarker use was patients’ financial constraints (94.49%). Overall, the respondents’ use of biomarkers was not significantly associated with institutional affiliation, the number of patients they saw monthly, and the availability of biomarker tests in their areas of practice. CONCLUSION Medical oncologists in the Philippines would use biomarkers in treating breast, colorectal, and lung cancers if these were clinically indicated and if cost were not a factor. Financial difficulty experienced by patients was the most commonly cited barrier to biomarker use.