Search

Prostate cancer (PCa) seldom metastasizes to the thyroid gland, and only a limited number of cases are documented in the literature. The application of a relatively recent and highly sensitive imaging technique, prostate-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET/CT), has enhanced the identification of metastatic disease. Nevertheless, as PSMA is expressed in various tissue types, the clinical importance of a PSMA-avid thyroid lesion remains largely uncertain. A minor, yet noteworthy, percentage of these lesions are ultimately determined to be malignant. Here we describe the case of a 70-year-old man with a past medical history of Lynch syndrome who presented to an outpatient oncologic clinic for management of very high risk localized PCa. He developed metastatic recurrence and his disease progressed through several lines of therapy, including immunotherapy and targeted treatments. He was found to have a new, intense PSMA uptake in an existing, previously benign thyroid nodule. Sonographic evaluation revealed changing morphology despite grossly stable size. Repeat biopsy confirmed the unusual finding of PCa metastasis to a known thyroid nodule. The shift in PSMA avidity played a pivotal role in discerning this metastatic deposit. There is a potential risk that such lesions may be inadequately acknowledged. The impact of the patient's Lynch syndrome on this presentation remains uncertain., (© 2024. The Author(s).)

Genetic testing is an integral part of the workup of metastatic prostate cancer, in part, because the results can have a profound impact on the subsequent management of this disease. There are now several Food & Drug Administration (FDA) approved therapeutics available for patients with prostate cancer and certain genetic abnormalities - most notably, mutations in DNA damage repair (DDR) pathways such mismatch repair (MMR) and homologous recombination repair (HRR). In this review of the current literature, we discuss the indications for somatic and germline testing, the genetic changes of particular clinical relevance, the associated therapeutic options, and the clinical data supporting their use. We also highlight select trials-in-progress and future directions for the field., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To summarise the current body of published evidence on the use of low-dose and/or adjuvant methadone in the palliative care setting., Methods: The authors searched multiple databases (PubMED, SCORPUS, EMBASE and the Cochrane library) for relevant articles using the terms 'methadone', 'palliative', 'low dose' and 'adjuvant'. The review was restricted to articles published between 2003 and 2018. Paediatric and single-case studies were also excluded. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method., Results: Our search yielded 171 results, of which seven met the inclusion criteria. Four were retrospective chart reviews, one was a retrospective cohort study, one was a case series and one was a double-blind randomised control trial. The overall quality was found to be very low. Of the seven articles, all seven reported some improvement in pain with the addition of low-dose or adjuvant methadone. This improvement was statistically significant in four out of seven articles; statistical significance was not commented on in the remaining three articles., Conclusion: While case series and chart reviews offer promising results about the utility of adjuvant and/or low-dose methadone in the management of complex pain, the very low evidence quality, relative dearth of studies and near absence of randomised controlled trials make it impossible to draw firm conclusions. Thus, while very preliminary evidence suggests methadone is a potentially effective and valuable agent, further research must be performed before such findings can be implemented into clinical practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Anti-PD1 checkpoint inhibitors (ICI) represent an established standard-of-care for patients with recurrent/metastatic head and neck squamous cell carcinoma (RMHNSCC). Landmark studies excluded patients with ECOG performance status (PS) ≥2; the benefit of ICI in this population is therefore unknown., Methods: We retrospectively reviewed RMHNSCC patients who received 1+ dose of ICI at our institution between 2013 and 2019. Demographic and clinical data were obtained; the latter included objective response (ORR), toxicity, and any unplanned hospitalization (UH). Associations were explored using uni- and multivariate analysis. Overall survival (OS) was estimated using a Cox proportional hazards model; ORR, toxicity, and UH were evaluated with logistic regression., Results: Of the 152 patients, 29 (19%) had an ECOG PS ≥2. Sixty-six (44%) experienced toxicity; 54 (36%) had a UH. A multivariate model for OS containing PS, smoking status, and HPV status demonstrated a strong association between ECOG ≥2 and shorter OS (p < 0.001; HR = 3.30, CI = 2.01-5.41). An association between OS and former (vs. never) smoking was also seen (p < 0.001; HR = 2.17, CI = 1.41-3.35); current smoking did not reach statistical significance. On univariate analysis, poor PS was associated with inferior ORR (p = 0.03; OR = 0.25, CI = 0.06-0.77) and increased UH (p = 0.04; OR = 2.43, CI = 1.05-5.71). There was no significant association between toxicity and any patient characteristic., Conclusions: We observed inferior OS, ORR, and rates of UH among ICI-treated RMHNSCC patients with ECOG 2/3. Our findings help frame discussion of therapeutic options in this poor-risk population., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background/Objective: End-of-life health care utilization (EOLHCU) is largely uncharacterized among patients with recurrent/metastatic head and neck squamous cell carcinomas (RMHNSCC), particularly now that immune checkpoint inhibitors (ICI) have been introduced to the treatment landscape. We examined this in a single-institution, retrospective study. Design/Settings: We utilized a database of deceased, ICI-treated RMHNSCC patients to obtain demographic and EOLHCU data, the latter of which included advanced care plan documentation (ACPD) and systemic therapy or emergency room (ER)/hospital/intensive care unit (ICU) admission within 30 days of death (DOD). This was compared with a cohort of deceased thoracic malignancy (TM) patients in an exploratory analysis. Multivariate analysis was performed to examine for association between patient factors (such as age, Eastern Cooperative Oncology Group (ECOG) performance status, or smoking status) and overall survival (OS); associations between the said patient factors and EOLHCU were also evaluated. This study was conducted at an academic, tertiary center in the United States. Results: The RMHNSCC patients ( n  = 74) were more likely to have ACPD ( p  < 0.01), an emergency department visit ( p  < 0.01), and/or hospital admission ( p  < 0.01) within 30 DOD relative to the TM group. There was no difference in ICU admissions, ICU deaths, or systemic therapy at end of life (EOL). The OS declined in association with ECOG performance status (PS) and smoking. No association was observed between patient factors and any EOLHCU metric. Conclusions: At our center, patients with ICI-treated RMHNSCC have higher rates of both ACPD and EOLHCU, suggesting high symptom burden and representing opportunities for further study into supportive care augmentation.

Introduction: In Kenya, abortion is illegal under most circumstances, yet about 48 abortions per 1,000 women occurred in 2012. Given the stigma around abortion, little is known about the availability of safe abortion. Thus, we explored the feasibility and acceptability of using SMS mobile surveys to collect information about women's pregnancy and abortion histories in Kenya., Methods: We sent a one-time mobile survey to 500 18-24year old women who had opted-in to a 16,000-person mobile survey panel. Women elected to answer questions about pregnancy only (number of pregnancies, number of births, age at first pregnancy) or pregnancy and abortion (ever tried to obtain an abortion and whether medical treatment was sought for any complications). The final question for all survey versions was an open-ended question asking respondents how they felt answering these questions., Results: 356 (71%) responded to the initial survey question and 333 (94%) consented to answer questions about pregnancy. Of these, 233 (70%) agreed to answer questions about just pregnancy and 76 (23%) agreed to answer questions about pregnancy and abortion. Three-quarters of respondents indicated that they had positive or neutral feelings about answering these questions over SMS. Lastly, all data was retrieved within 24h of survey distribution allowing for immediate analysis and dissemination., Conclusion: Women's willingness to share their pregnancy history suggests mobile surveys are a cost-effective and accessible method for gathering information on abortion in Kenya., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Polymeric binders are essential to battery electrodes, mechanically stabilizing the active materials. Most often, these binders are insulating, and conductive carbons must be added to the electrode structure. Conductive polymer binders, those that transport both ions and electrons, are of primary interest because they potentially eliminate the need for carbon additives. However, it is challenging to incorporate both ion- and electron-conductive polymeric binders into electrode systems because of differences in physical affinities among the two polymer types and the electroactive material. Here, we investigate amphiphilic polymeric binders comprised of electron- and ion-conducting poly(3-hexylthiophene)-block-poly(ethylene oxide) (P3HT-b-PEO) as compared to P3HT, PEO, and a blend of P3HT/PEO homopolymers in carbon-free V 2 O 5 cathodes. The electrode with P3HT-b-PEO binder has the highest capacity of 190 mAh/g, whereas V 2 O 5 is only 77 mAh/g at a C rate of 0.1 after over 200 cycles: a 2.5-fold improvement. Similarly P3HT, PEO, and the blend have capacities of 139, 130, and 70 mAh/g, which are not nearly as impressive as the block copolymer binder. The unique architecture of P3HT-b-PEO, wherein P3HT and PEO blocks are covalently bonded, promotes the uniform distribution of conductive binders within the V 2 O 5 structure, whereas the analogous P3HT/PEO blend suffers from phase separation. This work demonstrates that conductive block copolymer binders enable carbon-free electrodes for lithium-ion battery systems.