BACKGROUND:The impact of the starting dose of tyrosine kinase inhibitors (TKIs) following combination therapy of immune checkpoint inhibitors with TKIs (i.e. IO-TKI) for advanced renal cell carcinoma (RCC) remains unclear. METHODS:We retrospectively evaluated clinical data from 155 patients treated with first-line IO-TKI for RCC. Patients were categorized into full-dose and reduced-dose groups based on their starting dose of TKIs. Effectiveness and safety profiles were compared between groups. RESULTS:A reduced starting dose was administered to 52 patients (34%). These patients were older (P = 0.0137) and received pembrolizumab plus axitinib more frequently, while lenvatinib plus pembrolizumab was less used (P = 0.0258) compared to the full-dose group. Progression-free survival and overall survival did not significantly differ between the full-dose and reduced-dose groups (P = 0.202 and P = 0.309, respectively). Although the objective response rate appeared higher in the full-dose group, the difference was not statistically significant after adjusting for other covariates (P = 0.0588). Safety profiles were comparable, with no significant differences in TKI dose reduction, drug interruption or discontinuation, or glucocorticoids use (P > 0.05). However, adverse events of grade ≥3 were more frequent in the full-dose group, although not statistically significant (P = 0.121). CONCLUSION:The starting dose of TKIs did not significantly impact clinical outcomes following IO-TKI for RCC. These findings suggest a potential for the optimization of the starting dose of TKIs; however, prospective studies are warranted to confirm these findings.
BACKGROUND:Early oral intake (EOI) is a core component of Enhanced Recovery After Surgery (ERAS) protocols. Although EOI after gastrectomy has been shown to improve recovery and reduce postoperative complications, its real-world implementation across Japan remains unclear. This study aimed to evaluate the current status and institutional factors influencing EOI after gastric cancer surgery using a nationwide database. METHODS:This retrospective observational study used Japan's nationwide Diagnosis Procedure Combination (DPC) database to analyze 26,097 patients who underwent gastric cancer surgery at 472 institutions from 2017 to 2022. Patients were divided into EOI and non-EOI groups based on oral intake initiation within two days postoperatively. Surgical methods, hospital characteristics, and length of stay were compared. RESULTS:Only 20.8 % of patients initiated EOI. Laparoscopic distal gastrectomy had significantly higher EOI rates compared to open procedures. However, no significant difference was observed for proximal or total gastrectomy. Larger hospitals and designated cancer centers showed higher EOI rates. The EOI group had a significantly shorter postoperative stay (median 9 vs. 12 days, p < 0.001). CONCLUSIONS:EOI following gastrectomy is associated with shorter hospitalization, yet its adoption remains low in Japan. Institutional factors and multidisciplinary collaboration may play crucial roles in promoting EOI. Findings may inform perioperative optimization and ERAS standardization in oncologic gastric surgery.
A 74-year-old man presented with leg edema and was found to have nephrotic-range proteinuria. Renal biopsy revealed AL amyloidosis. Subsequent bone marrow examination demonstrated an increase in monoclonal plasma cells accounting for 13% of nucleated cells. Right-sided pleural effusion developed and was confirmed to be chylothorax. Although treatment with daratumumab, lenalidomide, and dexamethasone (DLd regimen) was initiated, the pleural effusion continued to increase. Lymphangiography using ethiodized oil identified a leakage point in the anterior mediastinum. A chest drain was inserted on the following day, and approximately 4 l of chylous fluid was drained. The tube was removed one week later, and pleural effusion did not recur thereafter. Although a hematologic response was achieved, the nephrotic syndrome persisted, and the patient ultimately died. Chylothorax associated with AL amyloidosis is rare and difficult to treat. This case suggests that lymphangiography using ethiodized oil may be both diagnostic and therapeutic.
