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Ever since the critical role of androgen deprivation therapy for the treatment of metastatic prostate cancer was established, several trials aimed to show an improved outcome with the early introduction of chemotherapy in metastatic disease. Until recently, all these trials-including the GETUG-AFU 15 trial-failed to confirm an improvement in survival. The recently published CHAARTED and STAMPEDE trials showed a striking benefit and changed the standard of care for patients with newly diagnosed metastatic prostate cancer. We summarize the evidence that emerged from these trials that support the use of combined chemohormonal therapy in metastatic hormone-sensitive prostate cancer.

Myeloid-derived suppressor cells (MDSCs) represent a heterogenous collection of immature myeloid cells endowed with suppressive function on the immune response. Their presence has been extensively investigated in preclinical models, especially in the context of cancer. One of the major obstacles in their accurate identification has been the definition of an unambiguous phenotype, shared between mice and humans, and clearly correlating with their suppressive function. In this paper, we review the literature concerning the phenotype in mouse and in humans, showing that at least 2 subsets of MDSCs are present under different situations. We also address the role of MDSCs in tumor progression, evaluate the prognostic significance of MDSC in cancer patients, and their possible role as marker of clinical outcome and response to therapy. Finally, we examine the strategies designed to modulate MDSCs in cancer patients, which might represent an innovative approach to enhance the effectiveness of immune-based therapies.

Studies exploring predictors of mortality in patients with ventilator-associated pneumonia (VAP) produced conflicting results. The present work is a meta-analysis of studies that enrolled only patients with microbiologically confirmed VAP and reported on mortality. Potentially eligible reports were searched in PubMed, EMBASE, CINAHL, and HEALTHSTAR with no language restrictions. Twenty-six reports were included. Factors associated with mortality were malignancy (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.10-4.40) at intensive care unit admission as well as inappropriate initial treatment (i.e., treatment either in vitro inactive against the causative bacteria or administered later than 24 h after diagnosis of VAP) (OR, 2.92; 95% CI, 2.01-4.22), bacteremia (OR, 2.07; 95% CI, 1.16-3.71), acute respiratory distress syndrome/acute lung injury (OR, 2.28; 95% CI, 1.24-4.21), shock (OR, 3.90; 95% CI, 2.31-6.61), sepsis (OR, 4.77; 95% CI, 2.22-10.25), disease severity, and sepsis-related organ failure score at the day of diagnosis of VAP. Isolation of nonfermenting gram-negative bacteria in general (OR, 1.71; 95% CI, 1.09-2.68) and Acinetobacter baumannii in specific (OR, 1.74; 95% CI, 1.02-2.96) was also associated with higher fatality. Intensive care unit admission caused by trauma, as opposed to other reasons, was linked to lower mortality (OR, 0.35; 95% CI, 0.22-0.57). These findings may help investigators to formulate appropriate predicting scores for patients with VAP and may further motivate clinicians to provide appropriate initial treatment and to manage sepsis and shock optimally in such patients.