Pretherapeutic Assessment Research Articles

Clinical and economic impact of pharmacist interventions to identify drug-related problems in multidisciplinary cancer care: a prospective trial.

The prescription of antitumor drugs has often been associated with drug-related problems. Pretherapeutic multidisciplinary risk assessment programs including pharmaceutical care have been established to secure the initiation of injectable and oral antitumor therapies. This prospective cross-sectional double-center study evaluated the clinical and economic impact of the pharmacist in detecting drug-related problems in patients initiating antitumor therapies. Following pharmaceutical consultations, pharmaceutical interventions were validated by a multidisciplinary team. A committee of independent clinical experts assessed the potential clinical impact of drug-drug interactions. The association of clinical variables with pharmaceutical interventions was tested using a multivariate logistic regression model. Pharmacist cost of the program was assessed by valuing pharmacists' time at their salaries and compared with potentially avoided costs. Four hundred thirty-eight patients with solid tumors were included: 62% males, mean age of 65 ± 13 years, and average of 6 medications. Half of the patients required at least one pharmaceutical intervention and independent factors associated with pharmaceutical interventions were the number of medications (5-9 vs <5: OR = 2.91 [95% CI 1.82-4.65], P < .001) and the type of antitumor treatment (immunotherapy vs intravenous chemotherapy: OR = 0.35 [95% CI 0.18-0.68], P = .002). One hundred seventy-four out of 266 pharmaceutical interventions (130 patients) involved clinically significant drug-drug interactions. Pharmacist costs were estimated to range between €4899 and €6125. Average costs were estimated at €11.4-14.3 per patient. Avoided hospitalization costs were estimated to be €180 633. Clinical pharmacists contribute to the cost-effective reduction of drug-related problems in pre-therapeutic assessment programs for patients with cancer.

RETOUR DEXPERIENCE CLINIQUE SUR TROIS ANS DE PRESCRIPTION DE LA FLUOXETINE EN PEDOPSYCHIATRIE UNIVERSITAIRE

Objectives: Our work has three objectives: To analyze our prescribing practices for fluoxetine in the light of international recommendations, to evaluate the tolerance and effectiveness of this molecule in children and adolescent and to identify the rules for proper use in this age group. Patients and method: We conducted a cross-sectional and descriptive clinical study spanning a period of 3 years, from January 2021 to January 2024, concerning children and adolescents aged between 8 and 17 years old who had been diagnosed with major depressive disorder, persistent depression, and/or anxiety disorders, or bulimia and placed on fluoxetine for a minimum follow-up period of 4 months and a maximum of 18 months. Results: The prescription of fluoxetine concerned 76 patients out of 660 patients with mood and anxiety disorder out of a total of 2215 patients. Major depressive disorder is the most common child psychiatric diagnosis (90%), anxiety disorders are present in 10%. Fluoxetine is prescribed as first-line treatment with psychotherapy in 40% of cases. Indicated as second-line treatment in 60% of patients due to an insufficient response or non-response to psychotherapy. No pre-therapeutic assessment is carried out. Fluoxetine is prescribed as monotherapy at an initial dose of 20 mg/day taken in the morning for an average duration of 9 months for depressive disorders and 12 to 18 months for anxiety disorders. Consented cessation of treatment is gradual. We report good therapeutic compliance and good tolerance with an average effectiveness time of 10 days. Mainly two side effects are described: headache and nervousness. We report one case of manic conversion in a 14years old girl. Discussion: The prescription of psychotropic medications in children and adolescents can only be considered as part of multimodal care, generally as second-line treatment when the adequate therapeutic response is not achieved or sometimes as first-line treatment when the clinical case is immediately severe or with there is an impact on the child and/or those around him. Only fluoxetine has label use in children aged over 8 years for moderate to severe depressive episodes. Fluoxetine is supported by the greatest results of evidence for its effectiveness and superiority compared to other SSRIs in this indication. Fluoxetine is also indicated in juvenile anxiety disorders and obsessive-compulsive disorder. Conclusion: In the case of mood and anxiety disorders in children, notably depression, fluoxetine is the choice molecule with the best tolerance-effectiveness ratio.

French guidelines on TIPS: Indications and modalities.

Transjugular intrahepatic portosystemic shunt (TIPS) has become essential in the treatment or prevention of portal hypertension-related complications. In the early 1990s, the primary indication was refractory bleeding. It is now proposed for the treatment of ascites for the prevention of bleeding and in patients with vascular diseases of the liver. Thus, there are a growing number of patients being treated with TIPS all over the world. The broadening of indications, the involvement of multiple stakeholders, the need for an accurate selection, the positioning in relation to transplantation and the lack of standardization in pre-therapeutic assessment, in the procedure itself and in the follow-up have led the board of the French Association for the Study of the Liver to establish recommendations.

Pre-Therapeutic Assessment of Older People in Sub-Saharan Africa: Introduction to the Comprehensive Geriatric Assessment.

Objectives: With the ongoing epidemiological transition in sub-Saharan Africa (SSA), conditions that require invasive treatment (surgery, cancer, and anaesthesia, etc.) will become increasingly common. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcomes. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce, and staff members have little training in geriatrics. The current work is a situational analysis on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods: We searched PubMed-MEDLINE and other sources for studies reporting on CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusions: We found no study that had comprehensively examined CGA and invasive care in SSA. There is, however, evidence that the offer of invasive care to older people has improved in SSA. Further research is needed to explore the applicability of CGA in SSA. Similarly, more investigations are needed on the role of CGA in the care trajectories of older people in SSA, in terms of outcomes and affordability.

The multifaceted musculoskeletal hydatid disease.

Musculoskeletal hydatid disease is rare and can be located anywhere but most commonly the bone and muscles of the spine, pelvis, then the lower limbs. Imaging is essential for its diagnosis, performing the pre-therapeutic assessment, guiding possible percutaneous treatments, and providing post-therapeutic follow-up. Musculoskeletal hydatidosis can take several forms that may suggest other infections and tumors or pseudotumors. MRI and CT are superior for its diagnosis but ultrasound and radiography remain the most accessible examinations in developing countries where this parasitosis is endemic. In this review, we provide an overview of this disease and describe its different imaging patterns in soft tissue and bone involvement that should be sought to support the diagnosis.

Cerebral Metabolism Analysis for Predicting Response to Radiosurgical Thalamotomy in Tremor Management: A Retrospective Pre-Therapeutic PET-FDG Assessment

Cerebral Metabolism Analysis for Predicting Response to Radiosurgical Thalamotomy in Tremor Management: A Retrospective Pre-Therapeutic PET-FDG Assessment

Molecular Imaging Biomarkers in Cardiooncology: A View on Established Technologies and Future Perspectives.

Novel therapeutic options have significantly improved survival and long-term outcomes in many cancer entities. Unfortunately, this improvement in outcome is often accompanied by new and increasingly relevant therapy-related cardiovascular toxicity. In this context, cardiooncology has emerged as a new field of interdisciplinary individual patient care. Important tasks are pretherapeutic risk stratification and early detection and treatment of cardiotoxicity, which comprises cardiac damage in relation to cardiovascular comorbidities, the tumor disease, and cancer treatment. Clinical manifestations can cover a broad spectrum, ranging from subtle and usually asymptomatic abnormalities to serious acute or chronic complications. Typical manifestations include acute and chronic heart failure, myo- and pericarditis, arrythmias, ischemia, and endothelial damage. They can be related to almost all current cancer treatments, including cytotoxic chemotherapy, targeted therapy, immunotherapy, hormonal therapy, and radiotherapy. Molecular imaging biomarkers can aid in pretherapeutic cardiooncologic assessment for primary prevention and personalized surveillance, detection, and differential diagnosis of cardiotoxic complications. Potential advantages over conventional diagnostics are the higher detection sensitivity for subtle changes in cardiac homeostasis, higher reproducibility, and better observer independence. Hybrid imaging with highly sensitive PET/MRI may be particularly suited for early diagnosis. Important technologies that are encouraged in current multidisciplinary guidelines are equilibrium radionuclide angiography for evaluation of ventricular function and chamber morphology, as well as myocardial perfusion imaging for additional detection of ischemia. Novel modalities that may detect even earlier signs of cardiotoxicity comprise 123I-metaiodobenzylguanidine SPECT to visualize sympathetic innervation, 18F-FDG and somatostatin receptor (68Ga-DOTATOC/DOTATATE) PET to indicate a metabolic shift and inflammation, and 68Ga-fibroblast activation protein inhibitor PET to monitor cardiac remodeling. In addition, PET imaging of mitochondrial function has recently been introduced in preclinical models and will potentially broaden the field of application through higher sensitivity and specificity and by enabling higher individualization of diagnostic concepts.

Positron emission mammography (PEM): a potentially promising one-stop shop for local staging of ILC

BackgroundInvasive lobular cancer (ILC) has a high propensity for multiplicity, along with a high probability of incomplete surgical excision. Due to its insidious proliferative pattern, it tends to be clinically silent and radiologically elusive. We assess the performance characteristics of PEM in the detection and local staging of ILC.MethodsA retrospective study evaluated a total of 193 patients who underwent PEM examination, including 44 patients with ILC. Image analysis of PEM examinations included morphological criteria, uptake pattern, lesion to background ratio (LTB) and maximum PEM uptake value (PUV max) assessment. The findings were correlated with the histopathological results.ResultsPEM showed high performance in surgical planning and detection of additional ILC lesions with sensitivity of 90.6% and specificity 82%. The mean PUV max and LTB of ILC lesions were significantly different from those of benign lesions and IDC lesions. The cutoff average LTB and PUVmax values to differentiate ILC from benign lesions were ≥ 3.3 & ≥ 2.2, respectively.ConclusionsThe inclusion of PEM provides a functional image that can improve the diagnostic accuracy of the conventional studies, decreasing the rates of false results and improving the detection of multicentric ILC lesions identification and their differentiation from other benign breast lesions.Advance in knowledgePEM is a promising new imaging technique that further improves the pretherapeutic assessment of ILC and facilitates the assessment of patients with renal impairment.

Reliability of MRI in Pre-Therapeutic Assessment of Tumor Depth Invasion in Oral Cavity Carcinoma

Background Head and neck carcinomas account for 5% of all cancers, with approximately half of those arising from the oral cavity, thus creating a significant health problem. Accurate loco-regional staging determines the appropriate treatment plan and subsequently favorable outcome and disease prognosis. Patients &amp; Methods 20 patients (12 females and 8 male) were included in this study. Conventional MRI, diffusion MRI and Dynamic contrast MRI were performed for local and nodal disease staging. MRI staging was correlated to operative histopathology as a reference standard. Diagnostic accuracy was estimated for MRI techniques. Results Results revealed high accuracy of MRI in local tumor and nodal staging. Conclusion MRI remains the cornerstone in loco-regional staging of tongue carcinoma. DCE-MRI is the most accurate MRI technique in evaluation of local extension and depth of invasion. Combination of DCE-MRI and DWI-MRI achieves highest accuracy for detection of regional nodal spread.

Analysis of correlation of pre-therapeutic assessment and the final diagnosis in endometrial cancer: role of tumor volume in the magnetic resonance imaging.

To evaluate whether the introduction of tumor volume as new parameter in the MRI assessment could improve both concordance between preoperative and postoperative staging, and the identification of histological findings. A retrospective observational study with 127 patients with endometrial cancer (EC) identified between 2016 and 2021 at the Juan Ramon Jimenez University Hospital, Huelva (Spain) was carried out. Tumor volume was measured in three ways. Analyses of Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) were performed. Although preoperative MRI had an 89.6% and 66.7% sensitivity for the detection of deep mucosal invasion and cervical stroma infiltration, preoperative assessment had an intraclass correlation coefficient of 0.517, underestimating tumor final stage in 12.6% of cases, with a poor agreement between preoperative MRI and postoperative staging (κ=0.082) and low sensitivity (14.3%) for serosa infiltration. The cut-off values for all three volume parameters had good/excellent AUC (0.73-0.85), with high sensitivity (70-83%) and specificity (64-84%) values for all histopathological variables. Excellent/good agreement was found all volume parameters for the identification of deep myometrial invasion (0.71), cervical stroma infiltration (0.80), serosa infiltration (0.81), and lymph node metastases (0.81). Tumor volume measurements have good predictive capacity to detect histopathological findings that affect final tumor staging and might play a crucial role in the preoperative assessment of patients with endometrial cancer in the future.

Nidus Compacity Determined by Semi-Automated Segmentation is aStrong Quantitative Predictor of Brain Arterio-Venous Malformation Cure.

Acompact nidus is awell-known feature of good outcome after treatment in brain arteriovenous malformations (bAVM). This item, included in the "Supplementary AVM grading system" by Lawton, is subjectively evaluated on DSA. The present study aimed to assess whether quantitative nidus compacity along with other angio-architectural bAVM features were predictive of angiographic cure or the occurrence of procedure-related complications. Retrospective analysis of 83patients prospectively collected data base between 2003 to 2018 having underwent digital subtraction 3D rotation angiography (3D-RA) for pre-therapeutic assessment of bAVM. Angio-architectural features were analyzed. Nidus compacity was measured with adedicated segmentation tool. Univariate and multivariate analyses were performed to test the association between these factors and complete obliteration or complication. Compacity was the only significant factor associated with complete obliteration in our predictive model using logistic multivariate regression; the area under the curve for compacity predicting complete obliteration was excellent (0.82; 95% CI 0.71-0.90; p < 0.0001). The threshold value maximizing the Youden index was acompacity > 23% (sensitivity 97%; specificity 52%; 95% CI 85.1-99.9; p = 0.055). No angio-architectural factor was associated with the occurrence of acomplication. Nidus high compacity quantitatively measured on 3D-RA, using adedicated segmentation tool is predictive of bAVM cure. Further investigation and prospective studies are warranted to confirm these preliminary results.

Rhinolithiasis: A Case Report

Rhinolithiasis is a rare condition characterized by a hard mass in the nasal cavity, consisting of mineral deposits around a central endogenous or exogenous focus. This study presents the case of a 32-year-old patient with right nasal obstruction, diagnosed with rhinolithiasis through endonasal examination. The rhinolith was extracted under general anesthesia with endoscopic guidance, and histopathological examination confirmed the diagnosis. This report aims to discuss the management of this uncommon condition, highlighting the importance of early surgical extraction to prevent complications and the usefulness of nasal endoscopy and imaging in diagnosis and pretherapeutic assessment. Recurrences of rhinolithiasis are unusual.

Cutaneous Lupus Erythematosus: An Update on Pathogenesis and Future Therapeutic Directions.

Lupus erythematosus comprises a spectrum of autoimmune diseases that may affect various organs (systemic lupus erythematosus [SLE]) or the skin only (cutaneous lupus erythematosus [CLE]). Typical combinations of clinical, histological and serological findings define clinical subtypes of CLE, yet there is high interindividual variation. Skin lesions arise in the course of triggers such as ultraviolet (UV) light exposure, smoking or drugs; keratinocytes, cytotoxic T cells and plasmacytoid dendritic cells (pDCs) establish a self-perpetuating interplay between the innate and adaptive immune system that is pivotal for the pathogenesis of CLE. Therefore, treatment relies on avoidance of triggers and UV protection, topical therapies (glucocorticosteroids, calcineurin inhibitors) and rather unspecific immunosuppressive or immunomodulatory drugs. Yet, the advent of licensed targeted therapies for SLE might also open new perspectives in the management of CLE. The heterogeneity of CLE might be attributable to individual variables and we speculate that the prevailing inflammatory signature defined by either T cells, B cells, pDCs, a strong lesional type I interferon (IFN) response, or combinations of the above might be suitable to predict therapeutic response to targeted treatment. Therefore, pretherapeutic histological assessment of the inflammatory infiltrate could stratify patients with refractory CLE for T-cell-directed therapies (e.g. dapirolizumab pegol), B-cell-directed therapies (e.g. belimumab), pDC-directed therapies (e.g. litifilimab) or IFN-directed therapies (e.g. anifrolumab). Moreover, Janus kinase (JAK) and spleen tyrosine kinase (SYK) inhibitors might broaden the therapeutic armamentarium in the near future. A close interdisciplinary exchange with rheumatologists and nephrologists is mandatory for optimal treatment of lupus patients to define the best therapeutic strategy.

Predictive factors associated with pemetrexed acute toxicity

Pemetrexed has shown efficacy as monotherapy or in combination with platinum salts in the treatment of non-small cell lung cancer and mesothelioma. However, severe hematological toxicities induced by pemetrexed-based chemotherapy have been observed. Some studies have suggested that drug interactions may be associated with pemetrexed toxicity. The objective of this study was to determine predictive factors, including drug interactions, associated with pemetrexed toxicity. This retrospective open monocentric study included patients consecutively treated with pemetrexed after a multidisciplinary risk assessment. Patients who experienced toxicity of grade 3 or 4 according to the Common Terminology Criteria for Adverse Events v5.0, or a grade 2 leading to a change in management, during the first four courses of pemetrexed, were assigned to the early limiting toxicities (ELT) group. Univariate and multivariable logistic regression models were used to test the association variables with the occurrence of ELT. Seventy-four patients were included in this study (median age: 67years, with non-small cell lung cancer adenocarcinoma (88%), mesothelioma (7%), or others (5%). Thirty-six patients (49%) were assigned to the ELT group (27 grades 3 and 4; 9 grade 2 with management modification). Three baseline factors were associated with pemetrexed ELT in univariate and multivariate analysis: cystatin clearance (p = 0.0135), albumin level (p = 0.0333), and proton pump inhibitors use (p = 0.035). To conclude, ELT induced by pemetrexed-based treatments occur frequently in cancer patients in a real-world setting. A pretherapeutic assessment before pemetrexed initiation should include three major checkpoints: use of proton pump inhibitors, sarcopenia, and denutrition evaluation.

Diagnostic Value of Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) for the Pre-Therapeutic Loco-Regional Staging of Cervical Cancer: A Feasibility and Interobserver Reliability Study.

(1) Background: cervical cancer is one of the leading causes of cancer-related deaths and the fourth most common cancer among women worldwide. Magnetic resonance imaging (MRI) is the modality of choice for loco-regional staging of cervical cancer in the primary diagnostic workup beginning with at least stage IB. (2) Methods: we retrospectively analyzed 16 patients with histopathological proven cervical cancer (FIGO IB1−IVA) for the diagnostic accuracy of standard MRI and standard MRI with diffusion-weighted imaging with background body signal suppression (DWIBS) for the correct pre-therapeutic assessment of the definite FIGO category. (3) Results: In 7 out of 32 readings (22%), DWIBS improved diagnostic accuracy. With DWIBS, four (13%) additional readings were assigned the correct major (I−IV) FIGO stages pre-therapeutically. Interobserver reliability of DWIBS was weakest for parametrial infiltration (k = 0.43; CI-95% 0.00−1.00) and perfect for tumor size <2 cm, infiltration of the vaginal lower third, infiltration of adjacent organs and loco-regional nodal metastases (k = 1.000; CI-95% 1.00−1.00). (4) Conclusions: the pre-therapeutic staging of cervical cancer has a high diagnostic accuracy and interobserver reliability when using standard MRI but can be further optimized with the addition of DWIBS sequences when reporting is performed by an experienced radiologist.

Impact of Guidelines Regarding Dihydropyrimidine Dehydrogenase (DPD) Deficiency Screening Using Uracil-Based Phenotyping on the Reduction of Severe Side Effect of 5-Fluorouracil-Based Chemotherapy: A Propension Score Analysis.

Dihydropyrimidine dehydrogenase (DPD) deficiency is associated with severe fluoropyrimidines-induced toxicity. As of September 2018, French recommendations call for screening for DPD deficiency by plasma uracil quantification prior to all fluoropyrimidine-based chemotherapy. A dose reduction of fluoropyrimidine is recommended when uracil concentration is equal to or greater than 16 ng/mL. This matched retrospective study assessed the impact of DPD screening on the reduction of severe side effects and on the management of DPD-deficient patients. Using a propensity score, we balanced the factors influencing 5-Fluorouracil (5-FU) toxicity. Then, the severity scores (G3 and G4 severity as well as their frequency) of patients who did not benefit from DPD screening were compared with those of patients who benefited from DPD screening for each treatment cycle (from 1 to 4). Among 349 screened patients, 198 treated patients were included. Among them, 31 (15.7%) had DPD deficiency (median uracilemia 19.8 ng/mL (range: 16.1–172.3)). The median toxicity severity score was higher in the unscreened group for each treatment cycle (0 vs. 1, p < 0.001 at each cycle from 1 to 4) as well as the cumulative score during all courses of treatment (p = 0.028). DPD-deficient patients received a significantly lower dose of 5-FU (p < 0.001). This study suggests that pretherapeutic plasmatic uracil assessment, along with 5-FU dosage adjustment, may be beneficial in reducing 5-FU toxicity in real-life patients.

Prévention des infections et vaccination dans les rhumatismes inflammatoires chroniques

Patients with chronic inflammatory rheumatisms (CIR) have a higher risk of infections compared to healthy subjects. Viral and bacterial pneumonia are the most frequent infections observed in CIR under targeted DMARDs. Moreover, drugs used to treat CIR and especially biologic and synthetic targeted disease modifying anti-rheumatic drugs (DMARDs) increase this risk of infection and expose CIR patients to opportunistic infections such as tuberculosis reactivation. In order, to limit the risk of infection, the benefit and risk ratio has to be evaluated for each patient according to characteristics and comorbidities. To prevent infections, an initial pretreatment work up has to be performed especially before initiation of conventional synthetic DMARDs or biological and synthetic targeted DMARDs. This pre-therapeutic assessment is based on questioning, biological and morphological explorations as well. Vaccination's update has to be checked and recommended vaccines for patients with auto-immune diseases and treated with conventional synthetic DMARDs, bDMARDs, tsDMARDs and/or steroids should be done. Information and education of patients are very important. During specific workshop, they learn how to manage drugs in situations at risk and they learn symptoms that require drug discontinuation.

PB2120: HIV AND MALIGNANT HEMOPATHIES

Background: Hematological malignancies remain a major cause of morbidity and mortality in patients living with the HIV virus (PLHIV). Their training would be linked to several factors. Aims: The objective of our study is to describe the main types of blood diseases malignancies and their epidemiological characteristics in PLHIV followed up internal medicine department – ​​clinical hematology of the CHU Ibn Sina in Rabat. Methods: This is a retrospective and descriptive observational study of PLHIV having an associated hematological malignancy. Results: Among the 1035 PLHIV followed, we collected 11 patients with blood disease malignant (1.06%). The average age was 40.6 years (29 – 73 years). The F/M sex ratio was 0.1. 90% of patients were in stage C. Heterosexual transmission was the main mode of contamination (100%). They had as antecedent: chronic smoking 60%; pulmonary tuberculosis 30%; drug addiction 10%. The regimens of ARVs received corresponded to international recommendations: 90% received triple therapy of the TNF+FTC+EFZ type and 10% received DTG+TNF+3TC. HIV infection was discovered incidentally in 73% of PLHIV during the pre-therapeutic assessment of the management of hemopathy. their viral status revealed an average viral load of 6.2 log (4.3 – 6.5 log). the mean CD4 count was estimated at 148 (78 – 243 cells/mm3). 27% of patients had an average follow-up time of 4 months. they had an undetectable viral load and persistently low CD4 count (< 200 /mm3). We identified 9 cases (82%) of NHL: 2 DLBCL (22%), 2 plasmablastic lymphomas (22%), 3 Burkitt’s lymphomas (34%), 1 T-cell lymphoma angioimmunoblastic (11%), 1 T/NK lymphoma (11%), 1 case of classic HL at mixed cellularity (9%), and 1 case of multiple myeloma (9%). The other syndromes lymphoproliferative or myeloproliferative were not found in our series. The advanced Ann Arbor stage (III – IV) was found in 90% of PLHIV. All patients received first-line poly-chemotherapy: 40% of patients received an R-DAEPOCH, 20% CHOEP, 20% R-CHOP, 10% BEACOPP, 10% CTD. 10% of patients required a second line of therapy (R-DHAOX) then a third line (Ciclosporine). The evolution was favorable with remission complete in 30% of patients. A negative viral load was obtained in 80% of PLHIV. We mourn 6 deaths: 5 deaths were related to hematological malignancy, and 1 was related to opportunistic infections complicating HIV after poor adherence to ARVs. Summary/Conclusion: Our series is mainly distinguished by a low frequency of the HIV association – hematological malignancy, but also by the diversity of these hemopathies. The persistence of a low CD4 count in PLHIV on ARVs should encourage look for possible hematological malignancies. Early introduction of ARVs is mandatory before starting any chemotherapy. The prognosis mainly depends type and stage of hemopathies.

Impact of Early Supportive Care Assessment on treatment decision in head and neck cancer before concomitant chemoradiotherapy.

To assess the impact of a global pretherapeutic comprehensive supportive care assessment performed in an outpatient supportive care clinic (OSCC) and early supportive care interventions on oncological treatment choice in patients with chemoradiation (CRT) indication for head and neck cancer (HNC). In this monocentric prospective observational study, we included all patients considered for CRT (exclusive or post-operative) for HNC from February 2019 to March 2020. The following frailty indicators were assessed: comorbidities (Charlson index), nutritional status, altered functional ability (ADL and IADL), social precarity (EPICES score), cognitive impairment (MoCA score), addictive habits and pain. OSCC led to a change in treatment for 13.7% of patients, mainly de-escalations. Ninety-three percent of patients had at least one altered domain, including 50% with three or more altered domains. Cognitive function was the most frequently altered domain (66.7%). Altered functional ability was significantly associated with treatment de-escalation after OSCC. Treatment interruptions were significantly associated with treatment de-escalation and social precarity. De-escalation was also associated with a significantly poorer PFS (median of 23.2 mos. vs 8.8 mos., HR = 2.18 95%IC[1.02-4.63] p = 0.037)) and a non-significant trend towards worse OS (median 23.3mos. vs not reached (HR = 2.16 95%CI[0.88-5.31] p = 0.0836). We strongly encourage the creation of OSCC for patients treated with chemoradiation for HNC. This practice, through an exhaustive assessment, favours therapeutic adaptation, personalized follow-up and optimization of supportive care.

Shining Damaged Hearts: Immunotherapy-Related Cardiotoxicity in the Spotlight of Nuclear Cardiology.

The emerging use of immunotherapies in cancer treatment increases the risk of immunotherapy-related cardiotoxicity. In contrast to conventional chemotherapy, these novel therapies have expanded the forms and presentations of cardiovascular damage to a broad spectrum from asymptomatic changes to fulminant short- and long-term complications in terms of cardiomyopathy, arrythmia, and vascular disease. In cancer patients and, particularly, cancer patients undergoing (immune-)therapy, cardio-oncological monitoring is a complex interplay between pretherapeutic risk assessment, identification of impending cardiotoxicity, and post-therapeutic surveillance. For these purposes, the cardio-oncologist can revert to a broad spectrum of nuclear cardiological diagnostic workup. The most promising commonly used nuclear medicine imaging techniques in relation to immunotherapy will be discussed in this review article with a special focus on the continuous development of highly specific molecular markers and steadily improving methods of image generation. The review closes with an outlook on possible new developments of molecular imaging and advanced image evaluation techniques in this exciting and increasingly growing field of immunotherapy-related cardiotoxicity.