Opioid-induced Neurotoxicity in Patients with Cancer Pain

Comparison of Diagnostic Parameters of Acute Coronary Syndromes in Patients with and without Cancer: A Multifactorial Analysis

BACKGROUND

The simultaneous occurrence of cancer and acute coronary syndromes (ACSs) presents a complex clinical challenge. This study clarifies variances in diagnostic parameters among ACS patients with and without concurrent cancer.

METHODS

This retrospective study included 320 individuals diagnosed with ACS, stratified equally into two cohorts-one with cancer and the other cancer-free. We evaluated risk factors, symptom profiles, coronary angiography results, echocardiographic evaluations, and laboratory diagnostics. Statistical analysis was performed using Student's t-test, the Mann-Whitney U test, and the chi-square test.

RESULTS

Cancer patients were older (mean age 71.03 vs. 65.13 years, p < 0.001) and had a higher prevalence of chronic kidney disease (33.1% vs. 15.0%, p < 0.001) but a lower prevalence of hyperlipidemia (59.7% vs. 82.5%, p < 0.001). Chest pain was less frequent in cancer patients (72.5% vs. 90%, p < 0.001), while hypotension was more common (41.9% vs. 28.8%, p = 0.022). NSTEMI was more common in cancer patients (41.9% vs. 30.6%, p = 0.048), while STEMI was less common (20.6% vs. 45.3%, p < 0.001). RCA and LAD involvement were less frequent in cancer patients (RCA: 18.1% vs. 30.0%, p = 0.018; LAD: 18.8% vs. 30.0%, p = 0.026).

CONCLUSIONS

This study demonstrates differences in the clinical presentation of ACS between patients with and without cancer. Cancer patients were less likely to present with chest pain and more likely to experience hypotension. Additionally, they had a higher prevalence of chronic kidney disease and they were less likely to have hyperlipidemia. These findings highlight the need for a careful approach to diagnosing ACS in oncology patients, considering their distinct symptomatology.

First-line immunotherapy in non-small cell lung cancer: how to select and where to go

INTRODUCTION

Immunotherapy (IO) has established a new milestone in lung cancer treatment. Several registrational studies have approved immune checkpoint inhibitors (ICIs) in different settings, including the metastatic nonsmall cell lung cancer (NSCLC). As well known, responders are just a certain proportion of patients; therefore, their selection by using predictive factors has stood out as a crucial issue to address in tailoring a patient-centered care.

AREAS COVERED

In our review we propose a detailed yet handy cross section on ICIs as first-line treatment in metastatic NSCLC, regarding indications, histological, clinical, and blood-based biomarkers, other than their mechanisms of resistance and new immunological actionable targets. We performed a literature search through PubMed entering keywords complying with crucial features of immunotherapy.

EXPERT OPINION

IO represents the backbone of lung cancer treatment. Trials are currently testing novel immune blockade agents assessing combinatorial approaches with standard ICIs, or antibody drug conjugates (ADC), harboring immunological targets. Perfecting patients' selection is an ongoing challenge and a more and more urgent need in order to best predict responders who will consistently benefit from it.

Epigenetic regulation in opioid induced hyperalgesia

About 25 million American adults experience pain daily and one of the most commonly prescribed drugs to treat pain are opioids. Prolonged opioid usage and dose escalations can cause a paradoxical response where patients experience enhanced pain sensitivity. This opioid induced hyperalgesia (OIH) is a major hurdle when treating pain in the clinic because its underlying mechanisms are still not fully understood. OIH is also commonly overlooked and lacks guidelines to prevent its onset. Research on pain disorders and opioid usage have recognized potential epigenetic drivers of disease including DNA methylation, histone modifications, miRNA regulation, but their involvement in OIH has not been well studied. This article discusses epigenetic changes that may contribute to pathogenesis, with an emphasis on miRNA alterations in OIH. There is a crucial gap in knowledge including how multiple epigenetic modulators contribute to OIH. Elucidating the epigenetic changes underlying OIH and the crosstalk among these mechanisms could lead to the development of novel targets for the prevention and treatment of this painful phenomena.