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Swallowing disorders are common manifestations in patients with advanced lung cancer, this paper describes a rare clinical case of a foreign body (chicken bone) accidently found in the lumen of the left upper lobe bronchus during bronchoscopy. A 41 year- old man, with smoking history of 20 PA presented to our department with paraplegia and left arm paresis, he complained over 6 months from dyspnea, increasing posterior chest pain and persistent dry coughing. He had a history of swallowing disorders and difficulties with shocking episode passed unnoticed. The patient was apyretic but presented weight loss and weakness. On physical examination, he had a digital hippocratism, a WHO performance status was at 4 and there were diffuse snoring rales on pulmonary auscultation. The body CT scan showed a voluminous left upper mediastinal tumor involving the left upper lobe and the left apical pyramidal lobe, this tumor was extended to vascular elements and to the dorsal spine. The cerebral CT scan showed discreetly a compressive right parietal process measuring 3cm*3cm. The flexible bronchoscopy has been performed showing an extrinsic compression of the posterior wall of the trachea, a blood clot removed showing a piece of chicken bone presented in the lumen of the anterior segmental bronchus. The patient was referred to the oncology department for palliative treatment, after being diagnosed as lung adenocarcinoma by a CT guided lung biopsy. This is the first paper reported an accidently discovery of bronchial foreign body during bronchoscopy in a patient with stage IVB lung cancer. Dysphagia has been reported as common manifestation in patients with advanced lung cancer due to underlying mediastinal disease and brainstem lesions metastasis, it is considered as a disorder which may increase the risk of morbi-mortality and has a potential of life-threatening.

Simple Summary The following paper was developed as a reference for healthcare workers who are looking for information on advanced non-small cell lung cancers that lack driver mutations and their treatment with immunotherapy. The aim of the present study is to provide a reliable data source based on a review of the most current papers on the PD-1/PD-L1 and CTLA-4 inhibitors, as well as their use in medical practice. Abstract From a complete literature review, we were able to present in this paper what is most current in the treatment with immunotherapy for advanced non-small cell lung cancer (NSCLC). Especially the use of immunotherapy, particularly inhibitors of PD-1 (programmed cell death protein 1), PDL-1 (programmed cell death protein ligand 1), and CTLA-4 (cytotoxic T-lymphocyte antigen 4). Since 2015, these drugs have transformed the treatment of advanced NSCLC lacking driver mutations, evolving from second-line therapy to first-line, with excellent results. The arrival of new checkpoint inhibitors such as cemiplimab and the use of checkpoint inhibitors earlier in the therapy of advanced and metastatic cancers has been making the future prospects for treating NSCLC lacking driver mutations more favorable and optimistic. In addition, for those patients who have low PDL-1 positivity tumors, the combination of cytotoxic chemotherapy, VEGF inhibitor, and immunotherapy have shown an important improvement in global survival and progression free survival regardless the PDL-1 status. We also explored the effectiveness of adding radiotherapy to immunotherapy and the most current results about this combination. One concern that cannot be overlooked is the safety profile of immune checkpoint inhibitors (ICI) and the most common toxicities are described throughout this paper as well as tumor resistance to ICI.

Purpose: This paper studies the Quality of Life (QL) of Spanish advanced non-small-cell lung cancer (NSCLC) patients receiving platinum-doublet chemotherapy, compares our results with those from studies from other cultural areas, and identifies factors associated with global QL and survival prognostic variables. Methods: EORTC QLQ-C30 and QLQ-LC13 questionnaires were completed three times by 39 patients along treatment and follow-up. Univariate and multivariate logistic regression analyses were performed to study global QL determinants (≤50 points considered low global-QL score). Analyses of prognostic variables for death were performed (Cox proportional hazards models). Results: QL mean scores in the whole sample were moderately high, with limitations (>30) in physical, role, social functioning, emotional areas, fatigue, pain, neuropathy and global QL. Differences with studies from other cultural areas were mainly found in the lower score for dyspnoea (≥15 points). There were no significant differences in QL scores between the first and second assessments. In six areas, the third assessment was lower than the first and second: fatigue, hair loss (>20 points); physical, social functioning, neuropathy (10–20 points); emotional functioning (5–10 points). The best model to explain the chances of low QL includes, as explanatory variables, high emotional functioning as protective factor and fatigue as risk factor (R2 = 0.70). Eight QL areas (four pain-related) and performance status showed a statistically significant association with survival. Conclusion: Patients adapted well to their disease and treatments. Platinum-doublet can be administered in advanced NSCLC patients. Our QL data are in line with those from other cultural areas. This study was supported by grants from the Instituto de Salud Carlos III and the Departamento de Salud del Gobierno de Navarra, Spain, to finance a research assistant to interview the patients.