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Outside clinical trials, few data are available on the effect of long-term first-line pembrolizumab in patients with advanced non–small-cell lung cancers with ≥50% of tumor cells expressing programmed cell death ligand 1 (PD-L1). This French, multicenter study included consecutive advanced patients with non–small-cell lung cancer given first-line pembrolizumab alone between May 2017 (authorization date for this indication) and November 2019 (authorization date for pembrolizumab–chemotherapy combination). Information was collected from patients’ medical files, with a local evaluation of the response and progression-free survival (PFS). Overall survival (OS) was calculated from pembrolizumab onset using the Kaplan-Meier method. The analysis concerned 845 patients, managed in 33 centers: median age: 65 (range: 59–72) years, 67.8% men, 78.1% Eastern Cooperative Oncology Group performance status 0/1, 38.9%/51.5%/6.6% active, ex or never-smokers, respectively, 10.9%/16.8% taking or recently took corticosteroids/antibiotics, 69.6% nonsquamous histology, 48.9% ≥75% PD-L1–positive, and 20.8% had brain metastases at diagnosis. After a median (95% CI) follow-up of 45 (44.1–45.9) months, respective median (95% CI) PFS and OS lasted 8.2 (6.9–9.2) and 22 (8.5–25.9) months; 3-year PFS and OS rates were 25.4% and 39.4%, respectively. Multivariate analysis retained never-smoker status, adenocarcinoma histology, Eastern Cooperative Oncology Group performance status ≥2, and neutrophil/lymphocyte ratio >4 as being significantly associated with shorter survival, but not brain metastases at diagnosis or <75% PD-L1 tumor-cell expression. These long-term results of pembrolizumab efficacy based on a nationwide “real-world” cohort reproduced those obtained in clinical trials.

Little is known about the prevalence, prognosis, and response to treatment of advanced NSCLC harboring multiple genomic alterations.

L’utilisation des traitements par facteur de croissance est courante en oncologie et en hématologie. Dans la littérature, des cas d’atteinte lésionnelle pulmonaire sous G-CSF (granulocyte colony-stimulating factor) sont décrits. L’imputabilité des lésions à ce traitement reste toujours controversée, principalement en raison du contexte de survenue: les atteintes décrites surviennent principalement en association à d’autres produits toxiques pour le poumon. Le mécanisme d’action des G-CSF permet d’expliquer en partie les atteintes pulmonaires retrouvées et principalement les syndromes de détresse respiratoire aiguë (SDRA). Il existe une toxicité propre de ces traitements mais qui reste rare et sous-estimée. La plupart des lésions imputables aux G-CSF surviennent dans des situations à risque de toxicité pulmonaire, notamment en cas de pneumonie pendant la neutropénie. Ce contexte est pourtant une indication à l’instauration d’un traitement curatif par facteur de croissance en cas de neutropénie fébrile.

Les chambres implantables percutanées (CIP) sont des dispositifs à la fois très utilisés dans le cadre des traitements des pathologies cancéreuses mais également, responsables de complications non négligeables notamment dans ce type de population fragile. Ces complications peuvent être immédiates ou tardives. Les infections sur CIP sont les plus fréquentes suivies par les thromboses sur CIP. Le traitement de ces complications dépend des critères de gravité et du contexte clinique, l’ablation de la chambre implantable reste la meilleure attitude thérapeutique curative mais il est toujours important de prendre en compte dans cette population d’oncologie, le contexte de fin de vie et l’intérêt de conserver une voie d’abord.

Background. Henoch–Schönlein purpura (HSP) is an uncommon syndrome that mostly occurs in children, in whom it is frequently triggered by infections. In contrast, HSP in adults is more frequently of neoplastic origin. Case Presentation. We report HSP associated with a locally advanced lung squamous cell carcinoma that was considered a paraneoplastic syndrome. Systemic corticosteroids were given because a kidney biopsy revealed active glomerulonephritis. Concomitant chemoradiotherapy achieved a partial response of the lung tumor. Consolidation immunotherapy (programmed death protein-1-ligand-1 (PD-L1) inhibitor) was cancelled because HSP is known to be an autoimmune vasculitis, and long-term corticosteroid therapy was pursued. Conclusion. Further prospective studies are needed to evaluate the effect of anti-PD-(L) 1 immunotherapies on autoimmune manifestations.

A 49-year-old man was referred to our department for an assessment of a cerebral metastasis of unknown primary with 18F-FDG PET/CT. This imaging led to detection of a suspected pulmonary primary carcinoma, as well as an incidental left focal thyroid uptake. An ultrasonography, performed a month later, revealed a thyroiditis aspect. An anti-PD1 immunotherapy was also proposed 2 months later after confirmation of a lung adenocarcinoma. A second baseline FDG PET/CT surprisingly showed a diffuse thyroid uptake. A fine-needle aspiration biopsy of thyroid parenchyma finally revealed a diffuse involvement from lung adenocarcinoma (ie, primary lung metastasis to the thyroid gland).