Challenges and Limitations of Endocrine Toxicity Evaluation in Non-Small Cell Lung Cancer Patients Treated with Immunotherapy-Retrospective Study from a Tertiary-Level Hospital in Romania

(1) Background: The endocrine system has become a prominent target to autoimmune damage during treatment with immune checkpoint inhibitors (ICIs) in cancer patients. Real-world data regarding endocrine immune-related adverse events (irAEs) are needed to explore their impact in cancer patients. An analysis was conducted to evaluate endocrine irAEs caused by ICIs, besides the challenges and limitations of daily medical practice in oncology in Romania. (2) Methods: This was a retrospective cohort study of lung cancer patients treated with ICIs at Coltea Clinical Hospital, Bucharest, Romania, from 1 November 2017 to 30 November 2022. Endocrine irAEs were identified through endocrinological assessment and were distinguished as any occurring endocrinopathy during treatment with ICIs and related to immunotherapy. Descriptive analyses were performed. (3) Results: Of 310 cancer patients treated with ICIs, we identified 151 with lung cancer. From this cohort, 109 NSCLC patients qualified for baseline endocrine estimation and 13 patients (11.9%) developed endocrine irAEs, such as hypophysitis (4.5%), thyroid disorder (5.5%) and primary adrenal insufficiency (1.8%), with one or more endocrine glands being affected. There might be a correlation between endocrine irAEs and duration of ICI treatment. (4) Conclusions: Early diagnosis and adequate management of endocrine irAEs may be challenging in lung cancer patients. A high incidence of endocrine irAEs is expected with the growing use of ICIs, and because not all endocrine events are immune-related, cooperation between oncologists and endocrinologists is crucial in the management of these patients. More data are needed to confirm the correlation between endocrine irAEs and the efficacy of ICIs.

Surgical Features after Neoadjuvant Treatment for Breast Cancer

Introduction: Patients with breast cancer may receive neoadjuvant cancer treatment in order to benefit from radical surgery or to turn an indication for extensive surgery into a conservatory or oncoplastic operation.

AIM

To establish the main implications of therapeutic management of the cases of breast cancer treated initially with chemotherapy followed by surgery.

MATERIAL AND METHOD

35 breast cancer patients operated in 2020 after NACT (neoadjuvant chemotherapy) in Surgery Clinic of Coltea Hospital are analyzed, and the response after treatment is pathologicaly evaluated using the Residual Cancer Burden method Results: The results of the analysis of the group of patients showed that most patients presented downstaging of the disease after neoadjuvant treatment with a proportion of 17,14% with complete pathologic response.

DISCUSSIONS

We performed clinical and imagistic evaluation of patients before and after NACT and pathologic evaluation of the surgical specimen using residual tumor burden method, taking into account the age of the patients, clinical and pathological staging and the status of hormone receptors and Her 2. Conclusions: Neoadjuvant chemotherapy is currently part of the therapeutic arsenal of breast cancer being followed in most cases by downstaging of tumors and increasing the number of cases that can be operated. 17.1% of cases achieved pathologic complete response, 2 of them being Her 2 positive carcinomas. The use of conservative and oncoplastic surgical techniques is possible after downstaging tumors by NACT.

Effectiveness and safety profile of ipilimumab therapy in previously treated patients with unresectable or metastatic melanoma - the Romanian Patient Access Program

PURPOSE

The Romanian Patient Access Program (Ro-PAP, CA 184-427), part of the European Expanded Access Program (EAP), was developed to evaluate the effectiveness and safety profile ipilimumab in previously treated patients with advanced melanoma (unresectable or metastatic melanoma). The objective of our retrospective observational study of patients included in this program was to provide data recorded in real-life settings.

METHODS

We analysed 89 patients enrolled in Ro-PAP, CA 184-427 (54 men and 35 women) aged between 29 and 89 years. The patients received ipilimumab 3mg/kg, administered with short 30-min i.v. infusion every 3 weeks, having a total of 4 doses. Patients were assessed for tumor response, overall survival (OS) and progression-free survival (PFS), and were monitored for adverse events (AE).

RESULTS

At 12 weeks after the completion of therapy, the complete and partial response rates were 6.74% each, stable disease 15.73%, with the best overall response rate 13.48% and disease control rate 29.21%. Median OS was 189.00 days (95% CI 69.50-308.49) and median PFS 124.00 days (95% CI 85.05-162.94). The level of patient functionality at the beginning of ipilimumab treatment showed to be an important predictor of outcome, as patients with ECOG performance status (PS) (0) before therapy with ipilimumab had a higher OS compared with those with impaired functionality.

CONCLUSIONS

The use of ipilimumab in daily clinical practice demonstrated to be effective and safe, consistent with data coming from randomized clinical trials or other observational studies.

[The therapeutical strategy for locally advanced breast cancer]

As for the other cancers, the strategy of therapy of breast cancers is going to a unitary standardization. In our department between 1984-1999 we are operated 1040 patients with breast cancers, which means 25.3% of all cancers treated. 688 (64.3%) were CMLA, 646 (96.7%) of them were in patients women and 22 (3.3%) men. The mean age was 52.4 years (3-84 years). All patients were divided into two trials and analyzed: retrospectively (A) 312 (46.7%) and prospectively (B) 356 (53.3%) patients, 51.2% of patients was in III and IV TNM stage. The patients from trial B were treated concerning with specific therapeutically protocol, adapted by age, anatomopathological form, volume of tumor, skin or thoracic wall invasion, inflammatory lesions, lymph node invasion and physiological period. The results were: the increase of number of radical surgical interventions, the decrease of the morbidity, the increase of survival and a better quality of life.

[A case of intraductal multicentric breast carcinoma with bilateral axillary metastases]

It is recognized that the breast cancer is frequently accompanied by local and regional nodal metastases, but contralateral axillary dissemination is considered a rarity. It is presented a case of a 42 old female patient with intraductal multicentric right mamar carcinoma (T2) with bilateral axillary nodal metastases who had underwent to the complex treatment: surgical, chemotherapy and radiotherapy and hormonal therapy. The prognosis is reserved. It is required a careful supervision from point of view clinical biological, mamography, echography, tomography, RMN for diagnosis of recurrences, metastases and becoming a bilateral cancer at the remaining breast.

Efficiency of utilisations of food energy by female growing minks

The efficiency of utilisation of food energy by female growing minks, from weaning to adult age, was studied. The food given, pelleted according to an original technology, has the following chemical composition on a DM basis: 87.0% organic matter, 37.1% crude protein, 11.7% crude fat, 2.6% crude fiber, 35.6% nitrogen-free extractives and 13.0 per cent ash. Young minks had a feed intake, in relation to body weight, warying from 11.6 g to 58.6 g DM/d. Maximum feed intake related to kg0.75 was recorded at 700 g body weight (approximately 98 g DM/kg0.65). Digestibility of the given food expressed in DE, averaged 87.7 +/- 1.2%, while metabolizability, 82.3 +/- 1.1%. Total heat production related to the intaked gross energy, was 48.0 +/- 3.0%, and the retained energy, 34.3 +/- 4.0 per cent. The net efficiency of the metabolizable energy used for maintenance and production could not be accurately determined. However, taking to account the calculated values required for maintenance, of 649 kJ/kg0.75 in 300 to 600 g young minks, and of 607 kJ/kg0.75 in 600 to 1100 g young minks and also the maintenance efficiency, Km = 0.75, the coefficient for ME utilisation in protein and fat synthesis, of 0.50 and 0.75, respectively, it was able to determine the average ME efficiency used as net energy for maintenance and production: 70%. The highest values of nictemeral metabolism were recorded in the evening, and the lowest ones, at noon; the difference between the maximal and the minimal value did not exceed 6 per cent.