Patient-reported outcomes in immunotherapy for head and neck cancer

BACKGROUND

Data about patient-reported outcomes (PROs) among patients with head and neck squamous cell carcinoma (HNSCC) treated with immune checkpoint inhibitors are sparse. Our exploratory study evaluated PROs in patients with HNSCC starting treatment with immune checkpoint inhibitor monotherapy or combination therapy with cetuximab.

METHODS

Patients were recruited prior to receipt of their first checkpoint inhibitor therapy infusion. Participants completed measures of checkpoint inhibitor toxicities and quality of life (QOL) at on-treatment clinic visits.

RESULTS

Among patients treated with checkpoint inhibitor monotherapy (n = 48) or combination therapy (n = 38) toxicity increased over time (p < 0.05), while overall QOL improved from baseline to 12 weeks, with stable or declining QOL thereafter (p < 0.05). There were no group differences in change in toxicity index or QOL. Toxicity index scores were significantly higher in the combination group at 18-20 weeks and 6 months post-initiation of immune checkpoint inhibitor (p < 0.05). There were no significant group differences at baseline, the 6-8 week (p = 0.13) or 3-month (p = 0.09) evaluations. The combination group reported better emotional well-being at baseline than the monotherapy group (p = 0.04), There were no other group differences QOL at baseline or later timepoints.

CONCLUSIONS

Despite increasing patient-reported toxicity, checkpoint inhibitor monotherapy and combination therapy were associated with similar transient improvements, then worsening, of QOL in patients with HNSCC.

Monitoring rainwater and seaweed reveals the presence of (131)I in southwest and central British Columbia, Canada following the Fukushima nuclear accident in Japan

Detailed analysis of (131)I levels in rainwater and in three species of seaweed (Fucus distichus Linnaeus, Macrocystis pyrifera, and Pyropia fallax) collected in southwest British Columbia and Bella Bella, B.C., Canada was performed using gamma-ray spectroscopy following the Fukushima nuclear power plant accident on March 11, 2011. Maximum (131)I activity was found to be 5.8(7) Bq/L in rainwater collected at the campus of Simon Fraser University in Burnaby, B.C. nine days after the accident. Concomitantly, maximum observed activity in the brown seaweed F. distichus Linnaeus was observed to be 130(7) Bq/kg dry weight in samples collected in North Vancouver 11 days following the accident and 67(6) Bq/kg dry weight in samples collected from the Bamfield Marine Sciences Centre on Vancouver Island 17 days following the accident. The (131)I activity in seaweed samples collected in southwest B.C. following the Fukushima accident was an order of magnitude less than what was observed following Chernobyl. Iodine-131 activity in F. distichus Linnaeus remained detectable for 60 days following the accident and was detectable in each seaweed species collected. The Germanium Detector for Elemental Analysis and Radioactivity Studies (GEARS) was modeled using the Geant4 software package and developed as an analytical tool by the Nuclear Science group in the Simon Fraser University Department of Chemistry for the purpose of these measurements.

Interstitial fluid pressure. IV. Its effect on fluid movement through the capillary wall

Fluid movement through the capillary membrane has been measured in the lower legs of dogs by using implanted, perforated capsules as internal plethysmographs. Utilizing this procedure it was possible to compare the effects of changes in interstitial fluid pressure with the effects of changes in venous pressure and arterial pressure on movement of fluid through the capillary membrane. A decrease in interstitial fluid pressure of 1 mm Hg increased the filtration of fluid out of the capillaries 1.20 as much as did 1 mm Hg increase in venous pressure. The filtration coefficient for fluid movement through the capillary wall per unit change in interstitial fluid pressure was 0.058 µliter/min per mm Hg per g of tissue. This value is in the same range as filtration coefficients that others have determined following changes in capillary pressure .

Interstitial fluid pressure. 3. Its effect on resistance to tissue fluid mobility

The resistance to fluid mobility in the interstitial fluid spaces has been measured between perforated catheters inserted into the subcutaneous abdominal tissues of the dog and between perforated capsules implanted in the tissues 1 month previously. When the pressures in the catheters or perforated capsules were less than atmospheric pressure, the resistance to fluid movement was almost infinite, but when the pressures were increased almost to or above atmospheric pressure the resistance usually decreased more than 100,000-fold, indicating a suddenly increased size of the tissue spaces.

The shape of the pressure-volume curve relating (a) interstitial fluid pressure to (b) volume of mobile interstitial fluid was calculated from pressure-conductance curves recorded in these experiments. On comparing this pressure-volume curve with a previously measured pressure-volume curve of the entire interstitial fluid compartment, two important points were observed: first, both curves exhibit a sudden increase in volume when the interstitial fluid pressure rises above atmospheric pressure. Second, the mobile interstitial fluid volume approaches zero when the interstitial fluid pressure falls below atmospheric pressure while the measured volume is still very great. It is postulated that this difference is caused by entrapment of large amounts of water in a relatively immobile state in the gelatinous matrix of the ground substance filling the interstitial spaces.