Stuart H. Packer

Nivolumab-related cutaneous sarcoidosis in a patient with lung adenocarcinoma

CTLA-4: cytotoxic T-lymphocyte-associated protein 4 irAE: immune-related adverse event PD-1: programmed cell death-1 PD-L: programmed cell death ligand INTRODUCTION Immune checkpoint inhibitors are able to harness and stimulate the immune system’s innate antitumor capabilities. One of these targeted checkpoints is the programmed cell death-1 (PD-1) pathway. When PD-1 is bound to its ligands, it transduces a coinhibitory signal to activated T cells allowing for immune system dampening and peripheral tolerance. Cancer cells exploit this pathway by expressing their own PD-1 ligands enabling them to evade immune system recognition and elimination. Nivolumab is a PD-1 antibody that disrupts this T-cell inhibitory pathway. It is approved by the US Food and Drug Administration for the treatment of metastatic melanoma, nonesmall cell lung cancer, renal cell carcinoma, and classical Hodgkin lymphoma. Immune-related adverse events (irAEs), such as colitis, endocrinopathies, and dermatitis, have been well documented in patients treated with checkpoint inhibitors. We report a case of immunerelated cutaneous sarcoidosis in a patient with lung adenocarcinoma on nivolumab monotherapy.

Screening Patterns and Mortality Differences in Patients With Lung Cancer at an Urban Underserved Community

Micro‐Abstract: Mortality reduction via lung cancer screening is mixed in prospective trials. In a community study of 175 lung cancer screening‐eligible patients with lung cancer, only 19% had a screening‐driven diagnosis. Screening completion was associated with improved mortality, mediated by early cancer detection facilitating curative treatment in multivariate regression. Provider knowledge, patient race, and socioeconomic factors may have contributed to low screening rates. Background: The landmark National Lung Screening Trial demonstrated significant reduction in lung cancer‐related mortality. However, European lung cancer screening (LCS) trials have not confirmed such benefit. We examined LCS patterns and determined the impact of LCS‐led diagnosis on the mortality of newly diagnosed patients with lung cancer in an underserved community. Patients and Methods: Medical records of patients diagnosed with primary lung cancer in 2013 through 2016 (n = 855) were reviewed for primary care provider (PCP) status and LCS eligibility and completion, determined using United States Preventative Services Task Force guidelines. Univariate analyses of patient characteristics were conducted between LCS‐eligible patients based on screening completion. Survival analyses were conducted using Kaplan‐Meier and multivariate Cox regression. Results: In 2013 through 2016, 175 patients with primary lung cancer had an established PCP and were eligible for LCS. Among them, 19% (33/175) completed screening prior to diagnosis. LCS completion was associated with younger age (P = .02), active smoking status (P < .01), earlier stage at time of diagnosis (P < .01), follow‐up in‐network cancer treatment (P = .03), and surgical management (P < .01). LCS‐eligible patients who underwent screening had improved all‐cause mortality compared with those not screened (P < .01). Multivariate regression showed surgery (hazard ratio, 0.31; P = .04) significantly affected mortality. Conclusion: To our knowledge, this is the first study to assess LCS patterns and mortality differences on patients with screen‐detected lung cancer in an urban underserved setting since the inception of United States Preventative Services Task Force guidelines. Patients with a LCS‐led diagnosis had improved mortality, likely owing to cancer detection at earlier stages with curative treatment, which echoes the finding of prospective trials.