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Purpose: In lung cancer patients, radiation therapy modifies lung architecture, resulting in functional deterioration, which worsens symptoms and reduces quality of life., Methods and Materials: A multicenter, prospective, longitudinal study was conducted in a cohort of patients with locally advanced and oligometastatic non-small cell lung cancer treated with concurrent chemoradiation therapy (CCRT). A wide array of pulmonary function tests (forced spirometry, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity, fraction of exhaled nitric oxide, arterial blood gases, and 6-minute walk test) were used to evaluate lung function at baseline; after radiation therapy; and at 6, 12, 24, and 48 weeks after CCRT. Relative changes in test results (percentages) were estimated at the aforementioned intervals and compared with baseline results., Results: Thirty-seven patients completed the follow-up and were included in the analysis. After CCRT, patients showed a maximum decline in lung volumes as follows: (1) 31% in forced expiratory volume in the first second after 24 weeks (P = .008), (2) 9.6% in forced vital capacity after 48 weeks (P = .04), and (3) 15.1% in total lung capacity after 48 weeks (P = .0015). Similarly, at 12 weeks after CCRT, patients showed a 21.8% decrease in carbon monoxide diffusing capacity (P = .002). Increases were found in total airway resistance (respiratory system resistance at 5 Hz), frequency dependence of resistance (change in respiratory system resistance at 5 Hz-respiratory system resistance at 20 Hz, P = .012), and reactance (P = .0003 for respiratory system reactance at 5 Hz and P = .001 for reactance area), which together indicate small-airway dysfunction., Conclusions: The longitudinal evaluation of lung function through pulmonary function tests detects CCRT-induced damage before the appearance of clinical symptoms associated with CCRT lung toxicity., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Afatinib has shown long progression free survival and improvement in quality of life in advanced Non-Small Cell Lung Cancer (NSCLC) patients. Although afatinib causes acneiform rash, it can be manageable. Tetracyclines are usually used to treat it; nonetheless, there is no trial that evaluates their prophylactic efficacy on afatinib induced-skin toxicities (AIST)., Patients and Methods: This open-label, randomized, controlled trial assessed the preventive effect of tetracycline for reducing afatinib-skin toxicities in NSCLC patients receiving afatinib 40 mg/day. Patients were randomly assigned to receive pre-emptive treatment with tetracycline 250 mg every 12h for 4 weeks or not. Reactive treatment in both groups included general dermatological recommendations such as use of skin moisturizers, sunscreen and topical steroids, according to toxicity severity. All patients were blindly monitored for skin toxicities by an expert dermatologist at the start of treatment with afatinib (day 0), weeks 2 and 4 of treatment. The protocol is registered on clinicaltrials.gov (NCT01880515)., Results: We included 90 patients, no differences were found in clinical and dermatological baseline characteristics. Rash incidence of any grade, and grade ≥2 was less frequent in the pre-emptive arm vs. the control arm (44.5 vs. 75.6%, RR 0.4 [95% CI 0.17-0.99], p=0.046 and 15.6 vs. 35.6%, RR 0.35 [95% CI, 0.12-0.91], p=0.030, respectively). No difference was found in paronychia, xerosis, mucositis, folliculitis, and skin fissure. No adverse event was associated with tetracycline. Neither rash nor pre-emptive tetracycline impacted on response rate, progression-free or overall survivals., Conclusion: Pre-emptive tetracycline was well tolerated and reduced the rash incidence and severity associated with afatinib in more than 60%., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Low-dose, prolonged infusion of gemcitabine has effects similar to standard doses in several cancers. We evaluated the toxicity and efficacy of low-dose gemcitabine in prolonged infusion plus cisplatin in patients with advanced pleural mesothelioma., Methods: Patients with mesothelioma received gemcitabine (250 mg/m(2)) in a 6-h infusion plus cisplatin (35 mg/m(2)) on days 1 and 8 every three weeks. We used the modified response evaluation criteria in solid tumours. This study is registered in clinical trials (NCT01869023)., Results: We included 39 patients; 82.1 % were low risk according to the European Organisation for Research and Treatment of Cancer prognostic group. Partial response was observed in 53.8 % (21/39), stable disease in 33.3 % (13/39) and progression in 12.8 % (5/39). The median progression-free survival was 6.9 months (95 % CI 3.2-10.6 months), and the associated factors were the EORTC risk and histology. The median overall survival was 20.7 months (95 % CI 10.7-30.8 months). The functional, physical and emotional roles and dyspnoea, insomnia and pain symptom scales improved. The most commonly graded 3/4 side effects were neutropenia (24.4 %), lymphopenia (14.6 %), thrombocytopenia (14.7 %) and anaemia (12.2 %)., Conclusions: Low-dose, prolonged gemcitabine infusion plus cisplatin has acceptable toxicity and high efficacy with improved quality of life, representing an affordable regimen for the low-income population.