No abstract

A survey was performed on behalf of the European Respiratory Society to assess end-of-life practices in patients admitted to European respiratory intermediate care units and high dependency units over a 6-month period.A 33-item questionnaire was sent by e-mail to physicians throughout Europe and the response rate was 28 (29.5%) out of 95. A total of 6,008 patients were admitted and an end-of-life decision was taken in 1,292 (21.5%). The mortality rate in these patients was 68% (884 out of 1,292).The patients received similar proportions of withholding of treatment (298 (23%) out of 1292), do-not-resuscitate or do-not-intubate orders (442 (34%) out of 1,292) and noninvasive mechanical ventilation as the ceiling of ventilatory care (402 (31%) out of 1,292). Withdrawal of therapy was employed in 149 (11%) out of 1,292 patients and euthanasia in one. Do-not-intubate/do-notresuscitate orders were more frequently used in North compared with South Europe. All of the 473 competent patients directly participated in the decision, whereas, in 722 (56%) out of 1,292 cases, decision-making was reported to be shared with the nurses.In European respiratory intermediate care units and high dependency units, an end-of-life decision is taken for 21.5% of patients admitted. Withholding of treatment, do-not-intubate/do-notresuscitate orders and noninvasive mechanical ventilation as the ventilatory care ceiling are the most common procedures. Competent patients are often involved, together with nurses.

Background: Mucinous ovarian carcinoma have a poorer prognosis compared with other histological subtypes. The aim of this study was to evaluate, retrospectively, the activity of chemotherapy in patients with platinum sensitive recurrent mucinous ovarian cancer.

The role of immunotherapy in hormone receptor (HR)-positive, HER2-negative breast cancer (BC) is underexplored. Experimental designThe neoadjuvant phase II GIADA trial (NCT04659551, EUDRACT 2016-004665-10) enrolled stage II-IIIA premenopausal patients with Luminal B (LumB)-like BC (HR-positive/HER2negative, Ki67>20% and/or histologic Grade 3). Patients received: three 21-days cycles of epirubicin/cyclophosphamide followed by eight 14-days cycles of nivolumab, triptorelin started concomitantly to chemotherapy, and exemestane started concomitantly to nivolumab. Primary endpoint was pathological complete response (pCR; ypT0/is, ypN0). ResultsA pCR was achieved by 7/43 patients (16.3%; 95%CI 7.4-34.9), the rate of Residual Cancer Burden class 0-I was 25.6%. pCR rate was significantly higher for patients with PAM50 Basal BC (4/8, 50%) as compared to other subtypes (LumA 9.1%; LumB 8.3%; p=0.017). Tumor infiltrating lymphocytes (TILs), immune-related gene expression signatures, and specific immune cells subpopulations by multiplex immunofluorescence were significantly associated with pCR. A combined score of Basal subtype and TILs had an AUC of 0.95 (95%CI 0.89-1.00) for pCR prediction. According to multiplex immunofluorescence, a switch to a more immune activated tumor microenvironment occurred following exposure to anthracyclines.Most common Grade >3 treatment-related adverse events (AEs) during nivolumab were: γglutamyltransferase (16.7%), alanine aminotransferase (16.7%), and aspartate aminotransferase (9.5%) increase. Most common immune-related AEs were endocrinopathies (all Grade 1-2; including adrenal insufficiency, n=1). ConclusionsLuminal B-like BCs with a Basal molecular subtype and/or a state of immune activation may respond to sequential anthracyclines and anti-PD-1. Our data generate hypotheses that, if validated, could guide immunotherapy development in this context.Research.