Introdução e objetivos: A imunoterapia tem introduzido avanços no tratamento do carcinoma pulmonar de não- -pequenas células. Contudo, dados da prática clínica atual sobre potenciais grupos respondedores, duração ideal de tratamento e questões de segurança permanecem por esclarecer. Pretende -se produzir uma reflexão sobre a população de doentes com resposta favorável ao Pembrolizumab e como têm evoluído clinicamente longo do tempo. Materiais e métodos: Estudo retrospetivo de doentes que cumpriram pelo menos 2 anos/35 ciclos de Pembrolizumab, com análise descritiva das características clinicopatológicas e dos resultados médicos obtidos ao longo do período de seguimento. Resultados: Identificaram -se 23 doentes, maioritariamente, homens (95.7%), diagnosticados com adenocarcinoma (78.3%) em média aos 62.0anos de idade, apresentando bom estado funcional. Durante o tratamento, 69.6% dos casos alcançaram resposta objetiva. À data do estudo, com um seguimento mediano de 35.2meses, 17 doentes estavam vivos e em remissão (73.9%), 7 dos quais (41.1%) com doença controlada por tempo superior a 32.6 (máximo observado de 48.7)meses; entre os que que progrediram (13.0%), apenas 1 alcançou novamente resposta parcial ao fim de 5.1meses desde a reintrodução da imunoterapia. Ocorreram eventos adversos grau >2 em 9 doentes (39%), condicionando diferentes desfechos clínicos; desses, 44% evidenciaram reincidência mesmo após suspensão da imunoterapia. Discussão e conclusões: Os dados parecem corroborar o potencial benefício duradouro do Pembrolizumab descrito em estudos recentes, com perfil de segurança manejável, embora não desprezível. Na ausência de toxicidade relevante e perante progressão da doença, um segundo curso poderá ser ponderado. Todavia, mais estudos prospetivos e multicêntricos, com maior amostra e longo período de seguimento, são necessários para sustentar estes dados.
for successful management. We describe a chest wall and diaphragm reconstruction for a recurrent chest wall tumor, using a single patch of Polytetrafluoroethylene (PTFE) mesh with diaphragm implanted into the middle of the mesh surface to avoid stretching the diaphragm too much by high or low insertion which will affect the diaphragm function. There were no operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. there is no recurrence 18 months after surgery. We concluded that this is a safe technique resulting in stable reconstruction after full-thickness chest wall resections involving the diaphragm.
Identification of clinical phenotypes and biomarkers, like eosinophilia, allows tailoring treatment of severe asthma.Benralizumab, an IL-5-Receptor a monoclonal antibody, presented good results in clinical trials, but real-life evidence is still small due to its recent approval.
METHODS:Retrospective study of patients with severe eosinophilic asthma with at least 2 exacerbations in the previous year, despite optimized treatment, treated with Benralizumab in a University Hospital (national approval since 2019).RESULTS: 13 patients with severe eosinophilic asthma were identified. Benralizumab was the chosen therapy in 5 patients, including 3 females and 2 males, with mean age 60 years-old. The mean duration of follow-up was 12 months. 1 patient had previously been treated with Omalizumab without improvement.Relevant asthma comorbidities included obesity (60%), rhinosinusitis (40%), gastroesophageal reflux disease (40%), depression/anxiety (40%) and bronchiectasis (20%).Selected patients presented uncontrolled symptoms and a median of 4 AE 1 exacerbations in the previous year, with asthma motivating emergency room visits in 3 patients and hospitalization in 1 case.In the 12 months preceding biologic treatment, 80% of patients received two or more courses of oral corticosteroids (median 4 AE 2) and 60% had two or more antibiotic cycles. All patients reported daily use of reliever medication, despite high dose ICS and at least two other controller medication.Baseline mean blood eosinophil count was 1260/mL and total IgE was 305 IU/mL. 4 patients had an obstructive ventilatory defect, namely one very severe and one moderately severe.During treatment with Benralizumab none of the patients experienced new exacerbations or required oral corticosteroids. Use of reliever medication was reduced in 40% of patients.The eosinophil count was reduced to zero in all patients. Regarding lung function, 2 patients showed an improvement over 200 mL in FEV1.There were no significant adverse effects of anti-IL-5Ra treatment.CONCLUSIONS: Treatment with Benralizumab led to complete reduction in exacerbations and oral corticosteroids courses, with some benefit in reliever use and lung function.CLINICAL IMPLICATIONS: This study describes a local clinic experience with a recently approved drug and, despite the small cohort, illustrates the real-life benefit of anti-IL-5Ra treatment.
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