Historically, treatment options for patients who develop central nervous system (CNS) metastases have been limited and associated with poor outcomes. The development of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has improved outcomes for patients with EGFR-mutated disease, and emerging data have demonstrated the ability of these drugs to cross the blood-brain barrier and elicit significant intracranial responses. Recent studies have indicated a role for next-generation EGFR-TKIs, such as osimertinib, in the treatment of CNS metastases. In the context of an evolving treatment paradigm, treatment should be individualized to the patient and requires a multidisciplinary approach.

However, it must be noted that the incidence of ITP is about 3.3 per 100 000 adults/year. 8 Therefore, it is also plausible that this patient's diagnosis was purely coincidental, given that the United States has administered over 12 million vaccines to date. 9 Additionally, 43 448 participants were included in the Pfizer-BioNTech trial, and no ITP was reported. 2 Moreover, considering the low complement C4 (10.9 mg/dL), mildly elevated SSA Ab (1.5), and 2 months prior, the platelet count (145 × 10 9 /L) was near the lower limit, it is difficult to exclude alternative causes, such as an underlying autoimmune condition with pre-existing ITP. In this scenario, the ITP became clinically apparent following the vaccine, though this patient never manifested symptoms suggestive of autoimmune disease. This case was reported to the FDA's Vaccine Adverse EventsReporting System (VAERS) and is valuable both for post-approval pharmacovigilance and as a foundation for clinicians to evaluate future patients with suspected ITP. Rare vaccination events are important, but do not diminish the enormous utility of vaccination and the well-documented safety profile 2 of the Pfizer-BioNTech BNT16B2b2 mRNA vaccine.

The identification of driver mutations and drugs that inhibit their activity has been a major therapeutic advance for patients with advanced lung adenocarcinoma. Unfortunately, the success of these drugs is limited by the universal development of resistance. Treatment failure can result from inadequate drug exposure or selection of resistant malignant clones. Clinically distinct mechanisms of disease progression have been identified and can inform treatment decisions. Investigations into the biochemical mechanisms of tyrosine kinase inhibitor resistance may provide additional therapeutic targets by which the efficacy of targeted therapy can be improved.

BackgroundScreening high-risk individuals with low dose CT decreased lung cancer mortality in the National Lung Screening Trial (NLST), but the validity of directly extrapolating these results to an Asian population is unclear. Using statistical models on Surveillance, Epidemiology and End Result (SEER) data, 27 % of lung cancer patients in the United States were estimated to meet the screening criteria. This study aims to evaluate the performance of the NLST criteria in Asian lung cancer patients and to examine the characteristics of those who did not meet the criteria.MethodsWe conducted a retrospective study of Asian lung cancer patients treated at Maimonides Cancer Center between 1/2008 and 6/2013. Data on demographics, smoking history, cancer stage, histology, and EGFR/ALK mutation status were collected and analyzed.ResultsOf 116 eligible patients, 75 patients (65 %) were smokers which included 26 light smokers (22 %). Thirty-two patients (27.8 %) met the NLST criteria. Extending the age limit to 79 would cover 8 % more patients while removing the lower age limit would only cover 2 % more. None of the female patients met the criteria as they were all never or light smokers. Two-thirds of male patients younger than age 55 were never or light smokers. The EGFR mutation rate was 67 % in female and 28 % in male patients.ConclusionThe percentage of Asian patients meeting the NLST criteria is similar to that estimated for the United States population, suggesting that extension of the criteria to an Asian population is valid. One-third of the patients were non-smokers and an additional one-fourth were light smokers, comprised mostly of female and young male patients. Further strategies for screening these individuals based on non-tobacco factors are urgently needed.

Background/Aim: National guidelines offer little guidance on the use of PSA progression (PSA increase as defined below) as a clinical endpoint in metastatic castrationresistant prostate cancer (mCRPC). The aim of the study was to examine treatment patterns/outcomes with abiraterone (abi)/enzalutamide (enza) throughout PSA progression and near the end of life (EOL). Patients and Methods: Cases of mCRPC treated with abi or enza from the New York Veterans Affairs (VA) from 6/2011-8/2017 were reviewed. Regression analyses were conducted to identify factors associated with continuation of abi/enza treatment up to the EOL, and survival. Results: Of 184 patients, 72 received abi alone, 28 received enza alone, and 84 received both. Treatment was changed for PSA progression alone in 39.1% (abi) and 25.7% (enza) of patients. A total of 37 patients (20%) received abi/enza within 1 month before death, 30% of whom were receiving hospice services. Older patients and black patients were less likely to receive abi/enza up to the EOL. Conclusion: Abi/enza are frequently discontinued for PSA progression alone and continued at EOL. The clinical benefit of these practices warrants additional study. Materials and Methods Study design. A multi-center, retrospective cohort study of patients with advanced prostate cancer at 2 participating VA medical centers (Manhattan, Brooklyn) was conducted to characterize abiraterone and enzalutamide treatment and patient outcomes. The study was approved by the institutional review board. Population and variables. A total of 184 patients with metastatic prostate cancer who received prescriptions for abiraterone acetate or 2467 This article is freely accessible online.