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Zhou K, Liu Y, Zhu H. Dramatic response and acquired resistance to savolitinib in advanced intrahepatic cholangiocarcinoma with MET amplification: a case report and literature review. Front Oncol 2023; 13:1254026. [PMID: 38023194 PMCID: PMC10652553 DOI: 10.3389/fonc.2023.1254026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cholangiocarcinoma (CCA) is an aggressive disease with limited treatment options. Despite substantial efforts to explore better regimens, gemcitabine-based chemotherapy has been the standard first-line treatment for decades. With the growing field of precision medicine, biomarker-guided treatments are gaining popularity. MET alteration is a frequent occurrence in various cancer types, making it a promising target. Case presentation A 53-year-old man visited our hospital with a complaint of upper abdominal pain. Advanced CCA was diagnosed based on the biopsy of the metastatic lymph nodes and immunohistochemistry. Next-generation sequencing revealed MET amplification. As the patient was intolerant to traditional chemotherapy, savolitinib (a c-MET inhibitor) was administered. Partial response was achieved, and the treatment was well tolerated. After 1 year, the patient developed progressive disease, to which the emergence of epidermal growth factor receptor amplification may have contributed. Conclusion Our study verified the therapeutic value of a c-MET inhibitor in advanced CCA-harboring MET amplification and provides an alternative strategy for patients who are intolerant to chemotherapy.
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Affiliation(s)
- Kexun Zhou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yingping Liu
- The Second Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Hong Zhu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Kotoulas SC, Tsiouprou I, Domvri K, Ntontsi P, Pataka A, Porpodis K. Open and Closed Triple Inhaler Therapy in Patients with Uncontrolled Asthma. Adv Respir Med 2023; 91:288-300. [PMID: 37489386 PMCID: PMC10366885 DOI: 10.3390/arm91040023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
Long-acting muscarinic antagonists (LAMAs) are a class of inhalers that has recently been included as add-on therapy in the GINA guidelines, either in a single inhaler device with inhaled corticosteroids plus long-acting β2-agonists (ICS + LABA) (closed triple inhaler therapy) or in a separate one (open triple inhaler therapy). This review summarizes the existing evidence on the addition of LAMAs in patients with persistently uncontrolled asthma despite ICS + LABA treatment based on clinical efficacy in the reduction of asthma symptoms and exacerbations, the improvement in lung function, and its safety profile.
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Affiliation(s)
| | - Ioanna Tsiouprou
- Pulmonary Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
| | - Kalliopi Domvri
- Laboratory of Histology-Embryology, Medical School, Aristotle University of Thessaloniki, Leoforos Agiou Dimitriou, 54124 Thessaloniki, Greece
| | - Polyxeni Ntontsi
- 2nd University Department of Respiratory Medicine, Attikon Hospital, 1st Rimini Street, Haidari,12462 Athens, Greece
| | - Athanasia Pataka
- Respiratory Failure Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
| | - Konstantinos Porpodis
- Pulmonary Clinic of Aristotle University of Thessaloniki, General Hospital of Thessaloniki "Georgios Papanikolaou", Leoforos Papanikolaou, Exohi, 57010 Thessaloniki, Greece
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Ulm L, Hoffmann S, Nabavi D, Hermans M, Mackert BM, Hamilton F, Schmehl I, Jungehuelsing GJ, Montaner J, Bustamante A, Katan M, Hartmann A, Ebmeyer S, Dinter C, Wiemer JC, Hertel S, Meisel C, Anker SD, Meisel A. The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke. Front Neurol 2017; 8:153. [PMID: 28484421 PMCID: PMC5402305 DOI: 10.3389/fneur.2017.00153] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Pneumonia is among the most common acute complications after stroke and is associated with poor long-term outcome. Biomarkers may help identifying stroke patients at high risk for developing stroke-associated pneumonia (SAP) and to guide early treatment. Aims This trial investigated whether procalcitonin (PCT) ultrasensitive (PCTus)-guided antibiotic treatment of SAP can improve functional outcome after stroke. Methods In this international, multicenter, randomized, controlled clinical trial with blinded assessment of outcomes, patients with severe ischemic stroke in the middle cerebral artery territory were randomly assigned within 40 h after symptom onset to PCTus-based antibiotic therapy guidance in addition to stroke unit care or standard stroke unit care alone. The primary endpoint was functional outcome at 3 months, defined according to the modified Rankin Scale (mRS) and dichotomized as acceptable (≤4) or unacceptable (≥5). Secondary endpoints included usage of antibiotics, infection rates, days of fever, and mortality. The trial was registered with http://ClinicalTrials.gov (Identifier NCT01264549). Results In the intention-to-treat-analysis based on 227 patients (112 in PCT and 115 in control group), 197 patients completed the 3-month follow-up. Adherence to PCT guidance was 65%. PCT-guided therapy did not improve functional outcome as measured by mRS (odds ratio 0.79; 95% confidence interval 0.45–1.35, p = 0.47). Pneumonia rate and mortality were similar in both groups. Days with fever tended to be lower (p = 0.055), whereas total number of days treated with antibiotics were higher (p = 0.004) in PCT compared to control group. A post hoc analysis including all PCT values in the intention-to-treat population demonstrated a significant increase on the first day of infection in patients with pneumonia and sepsis compared to patients with urinary tract infections or without infections (p < 0.0001). Conclusion PCTus-guided antibiotic therapy did not improve functional outcome at 3 months after severe ischemic stroke. PCT is a promising biomarker for early detection of pneumonia and sepsis in acute stroke patients.
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Affiliation(s)
- Lena Ulm
- NeuroCure Clinical Research Center, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Sarah Hoffmann
- NeuroCure Clinical Research Center, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukoelln, Berlin, Germany
| | - Marcella Hermans
- Department of Neurology, Vivantes Klinikum Neukoelln, Berlin, Germany
| | | | - Frank Hamilton
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Ingo Schmehl
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Gerhard-Jan Jungehuelsing
- Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Department of Neurology, Juedisches Krankenhaus Berlin, Berlin, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mira Katan
- Department of Neurology, Universitaetsspital Zuerich, Zurich, Switzerland
| | - Andreas Hartmann
- Department of Neurology, Klinikum Frankfurt Oder, Frankfurt Oder, Germany
| | - Stefan Ebmeyer
- Thermo Fisher Scientific BRAHMS GmbH, Hennigsdorf, Germany
| | | | - Jan C Wiemer
- Thermo Fisher Scientific BRAHMS GmbH, Hennigsdorf, Germany
| | - Sabine Hertel
- Thermo Fisher Scientific BRAHMS GmbH, Hennigsdorf, Germany
| | - Christian Meisel
- Department of Immunology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Goettingen, Goettingen, Germany.,Centre for Clinical and Basic Research, IRCCS, Rome, Italy
| | - Andreas Meisel
- NeuroCure Clinical Research Center, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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