Etoposide plus cisplatin, given alongside accelerated hyperfractionated thoracic radiotherapy (AHTRT), remains the gold standard regimen for patients with limited-stage small-cell lung cancer (SCLC), Japanese researchers say.

The phase III Japan Clinical Oncology Group 0202 trial failed to show a significant benefit for treatment with irinotecan plus cisplatin over etoposide plus cisplatin despite promising results for this regimen in patients with extensive-stage SCLC.

Median overall survival was 3.2 years for the 129 patients randomly assigned to receive four cycles of etoposide plus cisplatin with concurrent AHTRT versus 2.8 years for the 129 patients given three cycles of irinotecan plus cisplatin with AHTRTR, after an induction cycle of etoposide plus cisplatin. This gave a nonsignificant hazard ratio of 1.09.

Three- and 5-year overall survival rates were 52.9% and 35.8%, respectively, for patients given the etoposide regime compared with 46.6% and 33.7% for those assigned to receive the irinotecan regimen.

Progression-free survival was also comparable in the two groups, at 1.1 and 1.0 years, respectively.

Grade 3 and 4 adverse events were comparable in the treatment arms, except for a reduced rate of diarrhea in the etoposide plus cisplatin versus irinotecan plus cisplatin groups (2 vs 10%). In all, 90% of etoposide-treated and 86% of irinotecan-treated patients completed treatment.

“Thus, compliance does not explain the negative results in the present study,” say Kaoru Kubota (Nippon Medical School, Tokyo) and co-authors in The Lancet Oncology.
Noting that full-dose irinotecan cannot be given alongside AHTRT, the researchers say that future research should focus on other radiosensitizers as it is “unlikely that the addition of irinotecan to radiotherapy improves the outcome of patients with limited-stage SCLC who receive combined chemotherapy and radiotherapy treatment.”

They therefore conclude: “At the present time, the results of our study indicate that four cycles of etoposide plus cisplatin plus concurrent AHTRT should continue to be the standard of care in patients with limited-stage SCLC.

“Because SCLC is strongly smoking-related, discouragement and cessation of tobacco use is still the most effective strategy to reduce deaths from SCLC.”

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No abstract is available for this article.

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The Saudi Arabian Ministry of Health implemented a proactive surveillance program for MERS coronavirus (MERS-CoV). We report MERS-CoV data from 5,065 KSA individuals who were screened for MERS-CoV over a 12 month period.

Methods : From October 1st, 2012 to September 30th 2013 demographic and clinical data was prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV RT-PCR test results.

Findings : 5,065 individuals were screened for MER-CoV: Hospitalized patients with suspected MERS-CoV infection (n=2,908, 57.4%), Health care worker (HCW) contacts (n=1695; 33.5%), and family contacts (FC) of laboratory confirmed MERS cases (n=462; 9.1%). 11% of persons tested were children (<17years old). There were 106 cases (99 adults and 7 children) of MERS-CoV infection detected during the 12 month period (106/5065, 2% case detection rate). Of 106 cases, 44 were females (5 children and 39 adults), and 62 were males (2 children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalised patients, 19 were HCW contacts, and 10 family contacts. There was no significant rises in MERS-CoV detection rates over the 12 month period, 2.6% (19/731) in July 2013, 1.7% (19/1100) in August and 1.69% (21/1238) in September 2013. Male patients had a significantly higher MERS-CoV infection rate (62/2318, 2.6%) than females (44/2747, 1.7%) (P=0.013).

Interpretation : MERS-CoV rates remain at low levels with no significant increase over time. Proactive surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.

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Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause mortality.

Methods : In this retrospective cohort study, data were obtained from the Department of Veterans Affairs administrative databases. We included veterans age >=65 years who were immunocompromised and hospitalized due to pneumonia. Multilevel logistic regression analysis was used to determine the relationship between the use of invasive versus non-invasive mechanical ventilation and 30-day and 90-day mortality.

Results : Of 1,946 patients in our cohort, 717 received non-invasive mechanical ventilation and 1,229 received invasive mechanical ventilation. There was no significant association between all-cause 30-day mortality and non-invasive versus invasive mechanical ventilation in our adjusted model (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.66-1.10). However, those patients who received non-invasive mechanical ventilation had decreased 90-day mortality (OR 0.66, 95% CI 0.52-0.84). Additionally, receipt of guideline-concordant antibiotics in our immunocompromised cohort was significantly associated with decreased odds of 30-day mortality (OR 0.31, 95% CI 0.24-0.39) and 90-day mortality (OR 0.41, 95% CI 0.31-0.53).

Conclusions : Our findings suggest that physicians should consider the use of non-invasive mechanical ventilation, when appropriate, for elderly immunocompromised patients hospitalized with pneumonia.

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