Dermatomyositis is a rare autoimmune disease characterized by muscle weakness and distinctive skin rashes. Patients typically present with symmetric proximal muscle weakness alongside extramuscular manifestations, including interstitial lung disease and skin infections. While the exact cause remains unknown, researchers believe genetics, infections, and underlying autoimmune processes contribute to its development. The disease likely involves inappropriate complement protein activation targeting the perimysium, which triggers blood vessel inflammation and destruction around muscle fascicles. This process leads to ischemia and infarction of muscle tissue, ultimately causing muscle inflammation and atrophy. This paper analyzes existing data to determine whether early diagnosis and treatment of dermatomyositis reduce musculoskeletal complications. Several factors contribute to diagnostic delays: dermatomyositis occurs less frequently than other myopathies, early symptoms remain non-specific, and accurate diagnosis requires combining clinical, serologic, and muscle biopsy findings. Current evidence demonstrates that early detection and treatment of autoimmune diseases like dermatomyositis result in higher remission rates and reduced disease activity.

Standardized salvage treatments for refractory/relapse Langerhans cell histiocytosis (LCH) remain to be established. Trametinib (TRA) has shown marked efficacy in LCH, but cohort studies regarding efficacy and safety of TRA monotherapy in refractory/relapse LCH were scarce. We retrospectively analyzed 22 patients with refractory/relapse LCH treated with TRA monotherapy. Patients were treated for a median of 21.4 months (3.0-51.6 months). Nineteen (86.4%) of 22 of patients remained progression-free during TRA treatment. Sixteen patients stopped TRA (not due to progression or toxicity), of which 10 remained progression free, with median follow-up time of 28.7 months (1.5-44.6 months) after TRA withdrawal, and 6 patients experienced relapse, with median time to relapse from post-TRA withdrawal of 3.7 months (2.7-16.5 months). Two patients continued on TRA at last follow-up and one switched to chemotherapy due to toxicity. Three-year event-free survival was 50.7% (95% CI: 27.7-69.8), with a median follow-up time of 36.4 months (3.0-67.6 months). From TRA initiation to 12 months of treatment, cell-free BRAF/MAP2K1 mutation status in blood presented as negative to negative or positive to negative was correlated with superior event-free survival rate (EFS) rate. Toxicity was tolerable, and adverse events were predominantly skin rash (77.3%), paronychia (22.7%), and diarrhea (13.6%). Overall, TRA was effective and safe in the treatment of patients with refractory/relapse LCH, offering a convenient therapeutic alternative.

During preparedness activities in Senegal to the 2024 Mpox Public Health Emergency of International Concern, a study was conducted to assess the prevalence of Varicella-Zoster virus among patients suspected of having Mpox. Samples, including skin swabs, serum, and nasopharyngeal swabs, were collected from 103 patients who presented with Mpox-like symptoms. Molecular testing via qPCR revealed that 30.1% of patients tested positive for herpesviruses, whereas no Mpox cases were detected. Common symptoms include fever, skin rash, headache, and myalgia, which closely resemble Mpox symptoms, increasing the risk of misdiagnosis. The most affected group was children under 15 years of age (50% of herpesvirus cases), followed by adults over 30 years of age (30.8%). The male/female sex ratio among herpesvirus-positive patients was 2.1, indicating a higher prevalence in males. Phylogenetic analysis of 14 newly characterized Varicella-Zoster virus genomes from metagenomic sequencing revealed that the strains circulating in Senegal were closely related to those from Guinea-Bissau, suggesting possible regional transmission. In addition, viral and bacterial coinfections were identified in Mpox-negative patients, which may have contributed to some skin lesions initially suspected to be Mpox. Our data highlight the importance of differential diagnostic testing to distinguish between Mpox and other infections, such as Chickenpox. The unexpectedly high prevalence of herpesviruses among suspected Mpox cases underscores the need for improved laboratory diagnostics, enhanced epidemiological surveillance, and targeted public health interventions to prevent misdiagnosis and improve patient management.

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) and morbilliform drug eruption (MDE) are 2 distinct drug eruptions that can appear clinically similar at presentation. Given the significant morbidity of DRESS, there is a need for objective markers that can aid in early recognition.Objective: The purpose of this study is to explore the diagnostic potential of routine hematological data on or near the date of rash onset.Methods: We use machine learning as an exploratory method to identify any early hematological patterns capable of differentiating DRESS from MDE.Results: We found that lymphocyte count, pan-immune inflammation value, neutrophil-to-lymphocyte ratio, and platelet levels were strong discriminators of DRESS from MDE at initial presentation.Conclusions: These findings highlight the potential of hematologic profiles to enhance early diagnostic accuracy.

Dermatomyositis (DM) is classically associated with distinctive skin manifestations, such as Gottron's sign or heliotrope rash. Cases of DM without these skin manifestations-termed DM sine dermatitis (DMSD)-have recently been reported, with an increasing association with anti-nuclear matrix protein 2 (NXP-2) antibody. We report a 26-year-old Japanese man who presented with muscle weakness and myalgia but without the characteristic skin manifestations of DM. Laboratory findings showed only mildly elevated levels of myogenic enzymes, and initial screening for myositis-specific antibodies (MSAs) was negative. However, the muscle biopsy demonstrated necrotic and regenerative muscle fibres with perifascicular expression of myxovirus resistance A. The findings were consistent with DM. Further MSA testing revealed positivity for the anti-NXP-2 antibody, confirming the diagnosis of DMSD. This case presented a diagnostic challenge because of the absence of typical skin rashes and only mild elevation of myogenic enzymes. Clinicians should be aware of DMSD as a potential diagnosis, particularly in patients with muscle symptoms but lacking the characteristic DM skin manifestations. In a myositis diagnosis, proactive muscle biopsy and MSA testing, including the anti-NXP-2 antibody, are crucial for ensuring early diagnosis and treatment.

Cutaneous adverse drug reactions (CADRs) are the most common form of adverse drug reactions, ranging from mild rashes to life-threatening diseases, such as Stevens-Johnson syndrome and toxic epidermal necrolysis. However, there is no effective tool to predict antibiotic-associated CADRs. In this study, we propose an antibiotic-associated CADR prediction model using electronic health record (EHR) foundation models (FMs). EHR FMs are based on the pretraining-finetuning paradigms of language models, corresponding medical codes and their sequences to words and sentences. We included 802,131 inpatients across three tertiary hospitals in Korea, combining EHR data with nursing statements and reports to extract skin rash records. Our approach achieved the best predictive performance compared to all the other baseline models across all datasets. To enhance clinical relevance, we classified CADRs into immediate and delayed types and conducted a detailed sub-analysis. Finally, we found that properly configured EHR FMs can effectively predict the risk of developing antibiotics-associated CADRs, particularly for delayed-type reactions where predictive testing options are limited.

Platinum-based chemoradiotherapy (CTRT) is the standard treatment for head and neck squamous cell carcinoma (HNSCC). While cetuximab-based radiotherapy (CxRT) has been proposed as an alternative, its efficacy remains controversial. Multiple meta-analyses have compared CxRT with CTRT for HNSCC though they combined randomized controlled trials (RCTs) with lower-evidence studies, compromising result validity. This study presents the first meta-analysis using exclusively RCT data, providing the highest level of evidence for clinical decision-making. We systematically searched MEDLINE, Embase, Cochrane, and SCOPUS, identifying 10 RCTs (n = 2,557 patients). Primary outcomes included overall survival (OS), disease-free survival (DFS), and all-cause mortality; secondary outcomes were Grade ≥ 3 toxicities. Hazard ratios (HRs) and odds ratios (ORs) were pooled using random effect models. CxRT was associated with a 50% higher recurrence risk (HR 1.50, 95% CI 1.07-2.10) and 27% increased all-cause mortality (OR 1.27, 95% CI 1.05-1.55) compared to CTRT. OS did not differ significantly (HR 1.33, 95% CI 0.79-2.22). Toxicity profiles varied: CxRT had higher mucositis (OR 1.17, 95% CI 1.04-1.32) and skin rash (OR 3.46, 95% CI 1.28-9.36), while CTRT showed more anemia (OR 0.15, 95% CI 0.05-0.52) and nausea/vomiting (OR 0.31, 95% CI 0.19-0.53). CxRT is inferior to CTRT in HNSCC, with poorer disease control and survival outcomes. The lack of biomarker (EGFR/RAS) stratification in trials may have contributed to suboptimal patient selection. While CxRT may be an option for cisplatin-ineligible patients, platinum-based therapy appears to be the standard. Future research should optimize cetuximab's role through biomarker-driven selection.

Childhood-onset Sjögren's disease is a rare and under-investigated rheumatic condition. The natural course of childhood-onset Sjögren's disease in adulthood in not known. This study aimed to evaluate long-term disease trajectories and complications of childhood-onset Sjögren's disease and explore management strategies. This combined retrospective and prospective analysis of a childhood-onset Sjögren's disease cohort with long-term follow-up into adulthood was done in individuals aged 13-36 years with childhood-onset Sjögren's disease recruited from a single tertiary adolescent and young adult rheumatology service at University College London Hospital, UK. Participants were either approached consecutively during routine clinical appointments, or their data were collected retrospectively from the time of diagnosis to the time of transition to the service, and prospectively thereafter. We mapped the cohort onto clinical phenotypes defined by the Florida Scoring System at disease onset and stratified them based on the Newcastle Sjögren's Stratification Tool at last assessment. Disease activity, symptom severity, and damage trajectories were assessed using European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), and Sjögren's Syndrome Disease Damage Index (SSDDI), respectively. People with related lived experience were involved in the study design and implementation. Between March 1, 2020, and June 30, 2024, we identified 30 children and young people diagnosed with childhood-onset Sjögren's disease based on expert opinion. Mean age at onset was 12·7 years (SD 3·3). 28 (93%) of 30 individuals were female and two (7%) were male. The most common disease manifestations at onset were fatigue (22 [73%] of 30 individuals), arthralgia (21 [70%]), dryness (17 [57%]), glandular swelling (15 [50%]), and skin rashes (ten [30%]). Diagnostic delay of more than 3 years from symptoms onset increased the prevalence of reported dryness (nine [100%] of nine vs eight [38%] of 21; p=0·0014). Children and young people with childhood-onset Sjögren's disease had two distinct disease activity and symptom trajectories (high ESSDAI: mean 3·9 [SD 2·2] vs low ESSDAI: mean 0·8 [1·1]; p<0·0001 and high ESSPRI: mean 5·6 [2·7] vs low ESSPRI: mean 3·1 [1·0]; p=0·036), which could not be predicted by sex or age at onset, symptom duration, or duration of follow-up. Damage accrual did not differ based on activity and symptom trajectory (p=0·080 and p=1·0, respectively). At last review, the median ESSDAI score was 2·0 (IQR 2·0-8·0) and the ESSPRI score was 5·3 (3·0-7·0). Four (13%) of 30 patients developed lymphoma and 17 (57%) accumulated damage (SSDDI score ≥1). This preliminary evaluation of long-term outcomes of childhood-onset Sjögren's disease in adulthood showed distinct patterns of disease and symptom trajectories and that a high proportion of children and young people develop damage in early adulthood. These findings highlight the need for improved research quality and evidence-based management strategies for better outcomes in this population. None.

Small Vessel Vasculitis from Mycoplasma Infection and Concurrent Topical Nonsteroidal Anti-Inflammatory Drug (NSAID) Medication.

Recent global outbreaks of Mpox have posed significant diagnostic challenges, particularly in resource-limited settings. Conventional diagnostic methods are often inaccessible due to cost, logistical constraints, or lack of trained personnel. These limitations highlight the urgent need for alternative, scalable diagnostic strategies. This study explored the application of machine learning (ML) classifiers trained on clinical symptom data as a rapid, cost-effective tool for Mpox detection. An open-access dataset of clinical symptoms from suspected Mpox cases was used to train and evaluate five supervised ML algorithms: Extra Trees, Quadratic Discriminant Analysis (QDA), Decision Trees, Perceptron, and Support Vector Classifier (SVC). Prior to training, data preprocessing steps, including normalization and handling of missing values, were performed after which model training was carried out using a stratified 80:20 train-test split. Performance was assessed using accuracy, recall, area under the receiver operating characteristic curve (ROC-AUC), and F1-score metrics. Subsequently, feature importance was analyzed using permutation-based techniques to determine the contribution of each clinical symptom to model predictions. Among the five evaluated models, SVC, QDA, and Perceptron achieved superior and identical performance metrics, with accuracy, ROC-AUC, and F1-score values of 97.7%, and a recall of 95.5%. Each of these models correctly identified 44 true positive cases with zero false positives. In addition, QDA and SVC produced the lowest number of false negatives (2) and the highest number of true negatives (42), indicating robust discriminatory power. Feature importance analysis identified skin rash as the most predictive clinical feature, with a permutation importance score of 0.12. These findings demonstrate the strong potential of machine learning classifiers for detecting Mpox based on clinical features. Incorporating these models into healthcare systems could significantly enhance early case detection, improve clinical decision-making, and bolster disease surveillance. Future research should focus on prospective validation of these ML classifiers in real-world clinical environments.

Reactive arthritis is a form of sterile inflammatory oligoarthritis that occurs days to weeks following a genitourinary or gastrointestinal infection presenting with joint pain and swelling. Extra-articular manifestations include uveitis, oral ulcers, urethritis, and skin rashes. It is commonly due to gram negative bacteria such as Chlamdyia, Campylobacter, Salmonella, Shigella, and Yersinia. Recently, rare pathogens such as Streptococci, Clostridium difficile, Escherichia coli, Mycoplasma pneumoniae have also been implicated. However, Abiotrophia defectiva, a gram-positive bacterium, is not listed among them. We present to the best of our knowledge the only case of Abiotrophia defectiva as a causative agent of reactive arthritis.

Abstract Introduction: Capivasertib in combination with Fulvestrant is approved for a second or later line treatment option for metastatic ER/PR positive HER2 negative breast cancer, for patients harboring one or more PIK3CA, AKT1, and PTEN alterations, especially after use of CDK4/6 inhibitors. These mutations are seen in ∼55% patients with HR+ mBC. There is limited real-world data on the use of the combination. The purpose of this analysis is to assess the real-world efficacy and safety of this regimen in patients with HR positive metastatic breast cancer. Methods: We conducted a single-center, IRB-approved retrospective chart review of patients diagnosed with metastatic breast cancer (mBC) who received capivasertib in combination with Fulvestrant, with the last follow-up date as of June 30, 2025. Patient-specific demographic, clinical, pathological, and treatment data were collected. Data was summarized using descriptive statistics. Time to treatment failure (discontinuation either because of progression or adverse effects) and PFS were calculated by the Kaplan-Meier method. Results: We identified 28 patients who received Capivasertib; median age - 57 years (IQR 49-66.5). 21 (75%) had PICK3CA, 5 (17.9%) PTEN, and 4 (14.3%) AKT1 mutation with 2 patients had both PICK3CA and PTEN mutation. All the patients had received prior CDK4/6 inhibitors and 11 had exposure to prior chemotherapy. The median follow-up was 7.6 months (IQR, 4.1-12.3) compared to 13 months (IQR 9·1-16·7) in CAPItello-291, with a median time to treatment failure of 5 +/- 0.5 months (5.8 months in CAPItello-291). Median PFS was 6 +/- 0.5 months (7.2 months in CAPItello-291). Treatment was discontinued in 19 (67.9%) patients due to disease progression and in 3 (10.7%) patients because of adverse effects. The reason for discontinuation was hyperglycemia, liver injury, and skin rashes. Medications were either discontinued or reduced for 10/28 (34%). Skin rash was the most common reason for dose reduction. 7/28 (25%) patients died by the last follow-up date, with 4/7 (57.1%) having prior exposure to chemotherapy. 4/7 (57.1%) Patients had either visceral or treated brain metastases before starting capivasertib. 1/4 (25%) of patients with treated brain metastasis and 3/15 (20%) with one or more visceral metastases died during the study period. Conclusion: In this single-center experience, the findings of CAPItello-291 was validated, that a combination of capivasertib and fulvestrant is an effective treatment in second or later-line therapy for metastatic HR+ HER2- breast cancer patients harboring AKT pathway alterations, with a similar discontinuation rate. Citation Format: V. Singh, A. Al-Alwan, S. Kabraji, E. Levine, V. Gupta. Real world outcomes of use of Capivasertib in patients with HR positive HER2 negative metastatic breast cancer: A single center study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-04-03.

IntroductionAdult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disorder characterized by dysregulation of the innate immune system and excessive cytokine production. Its presentation is often non-specific and heterogeneous, making diagnosis challenging and one of exclusion.Case descriptionWe report the case of an 18-year-old woman admitted with quotidian fever, frequent episodes of tonsillitis, intermittent skin rash and progressive distal lower limb weakness. Neurological assessment demonstrated progressive motor neuropathy. Laboratory findings revealed neutrophilic leucocytosis, significantly elevated inflammatory markers and hyperferritinaemia. Extensive investigation excluded infectious, malignant and autoimmune causes, and the patient met the Yamaguchi classification criteria for AOSD. Treatment with systemic corticosteroids, colchicine and the interleukin-1 receptor antagonist resulted in rapid and sustained clinical improvement.ConclusionThis case highlights the diagnostic complexity of AOSD and emphasizes the importance of considering this diagnosis in patients with persistent fever, hyperferritinaemia and rare neurological manifestations.LEARNING POINTSAdult-onset Still’s disease should be considered in patients with fever of unknow origin and hyperferritinaemia.Neurological involvement, including polyneuropathy, may occur as an atypical manifestation.Early cytokine-targeted therapy is associated with rapid clinical improvement and better outcomes.

We herein report a case of disseminated strongyloidiasis in a 64-year-old man with human T-lymphotropic virus type 1 infection who developed the condition after undergoing chemoradiotherapy for lung cancer. Treatment included daily ivermectin, which eradicated Strongyloides stercoralis after 7 days but was interrupted after 14 days due to the development of skin rashes. After excluding ivermectin as the cause of the drug eruption, intermittent ivermectin was continued monthly for six months, with no recurrence of strongyloidiasis or bacteremia. This case highlights the importance of obtaining a comprehensive patient history and making an early diagnosis to improve the outcomes of disseminated strongyloidiasis.

We evaluated long-term outcomes of 288 children with refractory-Langerhans cell histiocytosis (R-LCH) from 26 countries prescribed off-label mitogen-activated protein kinase inhibitors (MAPKis) according to clinical indications. MAPKi indications were: 148 R-risk-organ-positive (R-RO+), 67 R-RO-negative (R-RO-), 13 lung destruction (lung), 9 sclerosing cholangitis (SC), 49 neurodegeneration (ND) and 2 diabetes insipidus (DI). Median ages at diagnosis and MAPKi onset were 1.3 and 2.3 years, respectively, with median follow-up of 3.7 years (1166 person-years). Agents were mostly prescribed as monotherapies: 184 vemurafenib, 115 dabrafenib, 3 encorafenib, 42 cobimetinib, 45 trametinib and/or 1 binimetinib; followed 51 times by various chemotherapies or hematopoietic stem-cell transplantation, or combined anti-BRAF-anti-MEK 28 times. Short-term responses (<8 weeks) ranged from 98% (R-RO+ and R-RO-), to 30% (lung) to none (ND, DI and SC), although long-term lung and ND responses could be observed. Skin rash was the most frequent adverse event (~55%); 7 others were 1 cardiomyopathy and 6 retinitis. Five developed MAPKi-unrelated tumors. Nine patients died. Five-year survival was 98%. After 113 patients with R-LCH discontinued MAPKi, 69 experienced disease reactivation. None of the various empirical maintenance therapies were able to prevent secondary reactivation. Among the 143 assessable patients without ND-LCH at MAPKi onset, 60 developed ND: 45% 5-year risk. MAPKis appeared to be safe and effective in children with R-RO+/RO-LCH, while other indications' responses were less frequent or occurred later. Further studies are needed to find effective maintenance-therapy approaches, particularly to prevent frequently observed secondary ND.

This study dealt with the microbial assessment of the water system of Davao Oriental State College of Science and Technology (DOSCST). It determined the Most Probable Number (MPN) of coliforms, identifying the genera of coliforms, water consumption, and health-related information among the students, faculty, staff, and management intervention to water supply. The study was conducted in the DOSCST's main campus. Collection of water samples was done on December 2006 and January 2007 Results disclosed that the Most Probable Number (MPN) of coliforms in the water sample ranged from 9, 11, 13, and 16. Thermotolerant bacteria, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumonia were the four (4) genera of coliforms found in the water samples. Thus, water proved to be not suitable for drinking. Evidently, the students (50.70%), faculty (49.98%), and staff (43.33%) consumed the water supply of the college for drinking, washing, cooking, bathing, and watering of plants. The frequency of usage was seldom for students, frequent for the faculty, and most frequent for the staff. Of all the respondents, students (0.3%) and faculty (0.7%) had experienced water-related health problems such as stomach aches and skin rashes. Students had experienced water-related health problems most frequently, while the faculty had experienced them always. On the other hand, the staff had never experienced any water-related health problems.

Adult-onset Still's disease (AOSD) is a systemic inflammatory disease characterized by spiking fever, salmon-pink skin rash, and polyarthritis. Overproduction of interleukin (IL)-1 and IL-6 is one of the causes of AOSD, the pharmacological inhibition of which was proven to be effective. Meanwhile, uncontrolled AOSD causes several complications, such as reactive hemophagocytic lymphohistiocytosis; however, kidney involvement has been barely studied because of its rarity. We encountered a 54-year-old female with uncontrolled chronic AOSD who showed nephrotic range proteinuria, microhematuria, and rapid progressive glomerulonephritis. A kidney biopsy revealed amyloid A deposition, mes-angiolysis, crescent formation, and massive accumulation of macrophages. Steroid pulse therapy, followed by tocilizumab, a IL-6 receptor inhibitor, in combination with oral glucocorticoids dramatically improved kidney and cardiac manifestations with reduction in systemic inflammation. This case highlights the importance of regular monitoring of urinalysis in patients with AOSD, and the early recognition followed by anti-inflammatory treatment can stabilize kidney involvement.

Helicobacter pylori infection, linked to peptic ulcer disease and gastric cancer, faces declining eradication rates due to antibiotic resistance. High-dose esomeprazole-amoxicillin dual therapy (HDDT) is a promising rescue regimen, but its efficacy and safety compared to standard therapies remain unclear. This systematic review and meta-analysis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, included four randomized controlled trials (n = 1,230) that compared HDDT with standard regimens. PubMed, Embase, and Cochrane CENTRAL were searched through April 2025. Outcomes included eradication rates, compliance, and adverse events. A meta-analysis was conducted using the inverse variance method, with heterogeneity assessed via I² statistics. HDDT showed no significant difference in eradication rates (RR = 0.98, 95% CI: 0.89-1.08, P = 0.6438) or compliance (RR = 1.04, 95% CI: 0.97 to 1.12, P = 0.2522) compared to standard therapies. However, HDDT significantly reduced overall adverse events (RR = 0.28, 95% CI: 0.18-0.44, P < 0.0001), including nausea, headache, fatigue, dysgeusia, bloating, and abdominal pain. No significant differences were observed for serious adverse events, diarrhea, dizziness, decreased appetite, constipation, or skin rash. Heterogeneity varied across the outcomes. HDDT is as effective as standard regimens for H. pylori rescue treatment, with a superior safety profile, supporting its use in patients with prior treatment failures.

This study aimed to evaluate the effectiveness of tocilizumab (TCZ) combined with short-term high-dose glucocorticoids in rapidly controlling disease activity and reducing glucocorticoid use in patients with adult-onset Still's disease (AOSD). In this single-center retrospective study, all patients meeting the inclusion criteria were enrolled. Patients receiving short-term high-dose glucocorticoids (5 mg/kg/day for 3 days) with TCZ (400 mg every 4 weeks) were assigned to the TCZ group, while those receiving standard-dose glucocorticoids (1 mg/kg/day) without TCZ formed the non-TCZ group. Efficacy was evaluated based on laboratory data, clinical and Pouchot scores. Glucocorticoids -retention rate was estimated by the Kaplan-Meier method. Fifty patients (11 men, 39 women) were included (19 in the TCZ group and 31 in the non-TCZ group). The TCZ group had a higher incidence of skin rash (100% vs 58.1%, P = 0.003) and sore throat (84.2% vs 29.0%, P < 0.001). Over the follow-up period, inflammatory markers (CRP, ESR, SF), liver enzymes (AST, ALT), and WBC counts significantly declined in the TCZ group (P < 0.05). Remission rates were higher in the TCZ group at months 1 (63.2% vs 9.7%), 3 (88.9% vs 20.0%), and 6 (83.3% vs 25.9%) (P < 0.001). Despite a higher initial glucocorticoid dose, no significant differences in subsequent doses were observed between groups. By 36 months, the TCZ group showed a significantly higher glucocorticoid discontinuation rate (77.0% vs 30.9%, P = 0.0046). TCZ treatment was also associated with improved liver function indicators and reduced liver injury (10.5% vs 32.3%). Tocilizumab combined with short-term high-dose glucocorticoids may provide rapid disease control and facilitate glucocorticoid tapering in AOSD. More prospective studies are needed to confirm these findings.

BackgroundNo standard second-line treatment has been established for patients with recurrent or metastatic (R/M) squamous-cell carcinoma of the head and neck (SCCHN) progressing after first-line pembrolizumab-based therapy, representing a critical evidence gap in current clinical practice.Patients and methodsPatients with R/M SCCHN of the oropharynx, hypopharynx, larynx, or oral cavity, progressing after first-line pembrolizumab-based regimens, received paclitaxel (PTX) 175 mg/m2 every 21 days plus weekly cetuximab (C) 250 mg/m2 for up to six cycles, followed by C maintenance. The primary endpoint was overall response rate (ORR) at 12 weeks. Secondary endpoints included best overall response (BoR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), duration of response (DoR), quality of life, and safety.ResultsFifty-seven patients were enrolled (median age 64 years). Twenty-five patients (43.9%) had a primary tumor in the oropharynx, 17 (29.8%) in the oral cavity, 9 (15.8%) in the hypopharynx, and 6 (10.5%) in the larynx. The ORR was 43.9% [95% confidence interval (CI) 30.7% to 57.6%], the BoR was 47.4% (95% CI 34.0% to 61.0%) with nine (15.8%) complete responses, and the DCR was 71.9% (95% CI 58.5% to 83.0%). DoR was 5.7 months (95% CI 5.1 months-not reached). Median PFS and OS were 5.9 months (95% CI 5.5-8.4 months) and 12.2 months (95% CI 10.5-17.6 months), respectively. Six-month PFS and OS rates were 49.0% and 73.0%, respectively. The most frequent non-hematological treatment-related adverse events were C-associated skin rash (78.9%) and PTX-related polyneuropathy (35.1%).ConclusionsThis is the first prospective trial specifically evaluating PTX plus C after failure of first-line pembrolizumab-based therapy in patients with R/M SCCHN. The observed clinical activity and tolerability support this widely available regimen as a potential standard-of-care option in the absence of randomized evidence in this setting.