[What is the place of the combinations for immunotherapy with chemotherapy or with other immune checkpoint inhibitors?]

Do All Patients Benefit From the Soothing Properties of a Conversational Nursing Intervention to Reduce Symptom Burden During Outpatient Chemotherapy?: A Multimethod Secondary Analysis

BACKGROUND

Soothing conversation (SC) is particularly promising for symptom management during outpatient chemotherapy. However, we know little about the profile of patients who are most likely to benefit from this intervention.

OBJECTIVE

To gain a better understanding of the profile of patients most likely to benefit from SC to reduce symptom burden during outpatient chemotherapy.

METHODS

We performed a multimethod secondary analysis of 2 data sets: the first gathered during a quantitative pilot trial investigating the impact of SC on patients' symptom fluctuations during chemotherapy perfusion (n = 24); the second derived from qualitative interviews about nurses' experiences with SC in this context (n = 6).

RESULTS

Secondary quantitative analysis suggests that symptom control with SC is more effective in older patients, reporting lower education, widowed status, work incapacity, advanced cancer, and undergoing chemotherapy perfusion for less than 1 hour. According to nurses' interviews, SC could best benefit patients (1) prone to anxiety and fear, (2) with unalleviated pain, (3) who are unaccompanied during treatment, and contrary to what was shown with quantitative data, (4) undergoing longer perfusion duration.

CONCLUSION

Although this study provides valuable insights, much work remains to be done to fully understand the factors that predispose patients to respond positively to SC during outpatient chemotherapy.

IMPLICATIONS FOR PRACTICE

This study extends previous research on the effectiveness of SC for symptom management during outpatient chemotherapy by comparing nurses' experience with the intervention to patients' results. Results could be used to inform the assignment and delivery of supportive communication-based interventions during chemotherapy protocols.

The influence of transarterial chemoembolization on serum levels of soluble programed cell death ligand-1 in advanced hepatocellular carcinoma patients

AIMS

To investigate the implications of soluble programmed cell death-ligand 1 (sPD-L1) in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) and to evaluate the potential value of sPD-L1 to guide selection of the optimal time to begin combination therapy with TACE and immune checkpoint inhibitors (ICIs).

MATERIALS AND METHODS

Thirty-one HCC patients suitable for TACE and 55 healthy volunteers were enrolled in this study. Three milliliters of peripheral venous blood of patients were collected on 1 day before TACE and 3, 7, and 30 days after TACE respectively for assay of sPD-L1 using enzyme-linked immunosorbent assay. The associations of the sPD-L1 level with the clinical features, outcomes, and the fluctuation of sPD-L1 during the treatment were analyzed.

RESULTS

The initial sPD-L1 level of patients was significantly higher than that of the control group. And it was significantly associated with BCLC stage, portal venous invasion, tumor size, and number of foci. The sPD-L1 levels of 3 and 7 days after TACE were both significantly higher than the initial level. And that of 30 days after TACE was lower than the initial level, but the difference was not statistically significant. There was no significant difference of sPD-L1 level after embolization with embolic beads of different size. The level of sPD-L1 of CR patients was lower than that of PR, SD patients, but the differences were not significant.

CONCLUSION

The level of sPD-L1 was associated with tumor aggressiveness and outcomes, suggesting its role as a possible predictive biomarker. The increases in sPD-L1 after TACE suggests that combined treatment with TACE and ICIs may be a promising therapeutic strategy in HCC. One week after TACE might be a suitable time to begin the administration of immunotherapy.

Immunothérapie dans les carcinomes urothéliaux

IMMUNOTHERAPIES FOR UROTHELIAL CARCINOMA

Therapeutic advances in the last 3 decades in bladder cancer were very limited. The 21^th century will be more promising with the advent of immunotherapies, with at the top of the list the immune-checkpoint inhibitors. The promising results of the early trials let us hope that these new therapies will soon enroll in the therapeutic landscape of urothelial carcinoma. This article reviews the clinical data of ongoing immunotherapeutic trials (checkpoint inhibitors, vaccine, cytokine) and also the association of the therapies with chemotherapy, antiangiogenics and radiotherapy.

[Hot topics about early clinical trials at ASCO congress 2018: News pathways, new targets, new associations]

Looking at the results of the early trials presented at the 2018 American Society of Clinical Oncology (ASCO) conference can help identify the molecules and strategies that will potentially enter the practices of tomorrow. It is in this spirit that this subject has justified the attention of residents in oncology and the writing of this synthesis. Molecules that can represent breakthrough innovations are presented as well as new therapeutics under development acting on targets already validated in clinical practice and early data of checkpoint inhibitors in combination with different immunomodulators, as well as new strategies for immunotherapies (vaccines and cell therapy).