Purpose: Patients with lung cancer and interstitial lung disease treated with radiotherapy have been reported to be at a risk of developing radiation pneumonitis. However, the association between interstitial lung abnormalities (ILA) and radiation pneumonitis in patients with limited-stage small cell lung cancer (LS-SCLC) remains unclear. Furthermore, the prognosis is unclear for patients with SCLC and ILA treated with chemoradiotherapy. We investigated the impact of ILA on radiation pneumonitis and assessed the prognosis of patients with LS-SCLC and ILA treated chemoradiotherapy. Methods and materials: We retrospectively reviewed the medical records of 149 patients with LS-SCLC who received first-line treatment between January 2009 and December 2016. Results: In a univariate analysis, the patients with ILA showed a higher incidence rate of radiation pneumonitis compared with those without ILA (64% vs. 10%); multivariate analysis confirmed that ILA was significantly associated with the incidence of radiation pneumonitis. In the univariate analysis, patients with ILA showed poorer overall survival than those without ILA (median, 18.9 vs. 67.9 months). Multivariate analysis showed that ILA was a significant independent negative prognostic factor. However, the 2-year and 5-year survival rates for the patients with ILA treated with chemoradiotherapy were 36% and 26%, respectively; for those treated with chemotherapy alone were 8% and 0%, respectively.Conclusions: ILA was a predictive factor for radiation pneumonitis in patients with LS-SCLC treated with chemoradiotherapy. The prognosis of the patients with LS-SCLC and ILA was poor; however, some patients with ILA treated chemoradiotherapy achieved long-term survival.

Background When a patient has multiple tumors in different organs, it is very important to identify whether the tumors are multiple cancers or metastasis from one tumor in order to establish an optimal treatment strategy. However, it is difficult to obtain an accurate diagnosis from conventional diagnostic strategies, including immunohistochemistry. We report two patients with multiple tumors in which a somatic mutation comparison using next-generation sequencing (NGS) was useful for the diagnosis of a metastatic tumor. Case presentations Patient 1: A 64-year-old man was diagnosed with gastric and lung cancer. After radical chemoradiotherapy for lung cancer, gastrectomy was planned for gastric cancer. At gastrectomy, the patient underwent a multiple omics analysis for “Project HOPE”. The gene mutational signature of the gastric tumor showed signature 4 of COSMIC mutational signature version 2, which was associated with smoking and has not been found in gastric cancer. To confirm that the gastric tumor was metastasis from lung cancer, we conducted a somatic mutation comparison of the two tumors with 409-gene panel sequencing, which revealed that 28 of 97 mutations in the lung tumor completely matched those of the gastric tumor. Based on these findings, the gastric tumor was diagnosed as metastasis from lung cancer. Patient 2: A 47-year-old woman underwent distal gastrectomy for gastric cancer. A colon tumor was detected 6 years after gastrectomy. The colon lesion was a submucosal tumor-like elevated tumor, and was suspected to be metastasis from gastric cancer. The patient underwent sigmoidectomy, and participated in “Project HOPE”. The possibility of primary colon cancer could not be ruled out, and we conducted a somatic mutation comparison of the two tumors as we did with Patient 1. Panel sequencing revealed 11 mutations in the gastric tumors, 4 of which completely matched those of the colon tumor. The colon tumor was diagnosed as metastasis from gastric cancer. Conclusion We reported two patients with multiple tumors in which a somatic mutation comparison using NGS was useful for the diagnosis of a metastatic tumor.

Background Immune-related hepatotoxicity is often regarded as immune-related hepatitis (irHepatitis) despite including immune-related sclerosing cholangitis (irSC). This study examined the clinical differences between irSC and irHepatitis.Methods A single-center retrospective study of 530 consecutive patients who received immunotherapy between August 2014 and April 2020 was performed. IrSC and irHepatitis were respectively defined as the radiological presence and absence of bile duct dilation and wall thickness.Results Forty-one patients (7.7%) developed immune-related hepatotoxicity. A CT scan was performed on 12 patients, including 11 of 12 with ≥grade 3 aminotransferase elevations. IrSC and irHepatitis were diagnosed in 4 (0.8%) and 8 (1.5%) patients, respectively. All the irSC patients had been treated with anti-PD-1. IrHepatitis was more common among patients receiving anti-CTLA-4 than among those receiving anti-PD-1/PD-L1 inhibitors (14%, 7/50 vs. 0.2%, 1/480, P <0.001). A ≥grade 2 alkaline phosphatase (ALP) elevation resulting in a cholestatic pattern was seen in all 4 irSC patients. Among the irSC patients, 3 (3/4, 75%) developed ≥grade 3 aminotransferases elevation. The median duration from the start of immunotherapy until ≥grade 2 liver enzymes elevation was 257 and 55.5 days in irSC and irHepatitis patients. The median times for progression from grade 2 to 3 liver enzyme elevation were 17.5 and 0 days, respectively.Conclusions IrSC and irHepatitis have different characteristics in the class of immune checkpoint inhibitor and onset pattern. Radiological examination for the diagnosis of irSC should be considered for patients with ≥grade 2 ALP elevation resulting in a cholestatic pattern. (Registration number J2020-36, Date of registration June 3, 2020)

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Background: Local ablative therapy (LAT) may be beneficial for patients with epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) with oligo-residual disease after treatment with EGFR tyrosine kinase inhibitor (EGFR-TKI). However, this has not been fully established. This study aimed to evaluate the predominant progressive disease (PD) pattern limited to residual sites of disease after treatment with EGFR-TKI.Methods: Patients with advanced EGFR-mutated NSCLC treated with EGFR-TKIs as first-line therapy were retrospectively analysed during a 7-year period. Oligo-residual disease was defined as the presence of 1 – 4 lesions (including the primary site) at 3 months from the start of EGFR-TKI treatment. The predictive factors of PD patterns after EGFR-TKI treatment were evaluated.Results: A total of 207 patients were included. Three months after the start of EGFR-TKI treatment, 66 patients (32%) had oligo-residual disease. A total of 191 patients had PD, 60 with oligo-residual disease and 131 with non-oligo-residual disease. Regarding the pattern, 44 patients (73%) with oligo-residual disease and 37 patients (28%) with non-oligo-residual disease had PD limited to the residual sites. Multivariate logistic regression analysis at 3 months from the start of EGFR-TKI treatment revealed that oligo-residual disease (P < 0.001), the lack of residual central nervous system metastases (P = 0.032), and initial treatment with osimertinib (P = 0.028) were independent predictors of PD limited to residual disease sites.Conclusions: This study provided a rationale for LAT to all sites of residual disease in patients with oligo-residual disease during EGFR-TKI treatment.

Purpose Staphylococcus aureus bacteremia (SAB) is a common infection in patients with solid tumors undergoing chemotherapy. In medical oncology, this dilemma often arises between infection control and cancer treatment. We aimed to explore whether early resumption of chemotherapy yielded unfavorable outcomes in oncologic patients with SAB. Methods We retrospectively reviewed patients who received antineoplastic chemotherapy within 90 days of SAB onset. We divided patients who resumed chemotherapy into early and late resumption groups and investigated whether chemotherapy after SAB was associated with treatment failure. Treatment failure included recurrence or relapse, 90-day all-cause mortality after initiation of antibiotics toward susceptible microorganisms, and 30-day all-cause mortality after resumption of chemotherapy. Results Among the 78 eligible patients, catheter-related bloodstream infection was the most common (51 patients, 65.4%). Thirty-six patients (46.2%) resumed chemotherapy under the supervision of infectious disease specialists. The median interval from the date of negative blood culture to the date of chemotherapy resumption was 17.5 days (0–69). Two patients in the early resumption group (\(<\)17.5 days, 11.1%) and one in the late resumption group (\(\ge\) 17.5 days, 5.6%) died within 90 days after the initiation of antibiotics toward susceptible microorganisms. One patient (5.6%) in the early resumption group experienced SAB recurrence. None of the patients experienced SAB relapse or died within 30 days of resuming chemotherapy. Conclusion Early resumption of chemotherapy may not be directly associated with unfavorable outcomes in SAB in patients with solid tumors under appropriate infection management.

Background: Immune checkpoint inhibitors (ICIs) combined with chemotherapy have been approved as first-line treatment for patients with untreated extensive disease-small cell lung cancer (ED-SCLC). However, there are few reports about the long-term survival in patients with ED-SCLC treated without ICIs. Thus, we analyzed the long-term survival in patients with ED-SCLC.Methods: We retrospectively examined the medical records of patients with SCLC who were treated at our hospital between September 2002 and September 2019. The main inclusion criteria were as follows: (1) histological or cytological confirmation of SCLC, (2) diagnosed with ED-SCLC, and (3) received chemotherapy, not including ICIs, as the first-line treatment. To assess the trends of treatment outcomes, we compared the survival outcomes between 2002–2010 (early) and 2011–2019 (late) groups.Results: A total of 314 patients were included in this study. Patient characteristics at the time of first-line treatment were as follows: median age was 69 years; 82% of the patients were male; and 70% had a performance status of 0 or 1. The median follow-up time of overall survival (OS) was 7.4 years, and 89% of the patients died. The median progression-free survival and survival time were 4.9 months and 12.1 months, respectively. Five-year survival rate was 2%. There was no significant difference in survival between the early and late groups.Conclusion: We found that the long-term survival in ED-SCLC patients treated without ICIs was poor. Prior to the approval of ICI treatment for ED-SCLC, there was no improvement in the OS for approximately 20 years.