Tarlatamab, a bispecific delta-like ligand 3-directed T-cell engager, shows promise for extensive-stage small-cell lung cancer (ES-SCLC), but real-world data in patients with unstable brain metastases are limited.A 50-year-old Japanese man with ES-SCLC progressed after three lines of therapy. Despite prior whole-brain radiation, MRI showed multiple brain metastases with edema and new extracranial lesions. Fourth-line tarlatamab with prophylactic dexamethasone (2 mg/day) and levetiracetam (1000 mg/day) was completed without cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS), resulting in tumor reduction.The SCLC patient with unstable brain metastases avoided CRS and ICANS during treatment with dexamethasone, levetiracetam, and tarlatamab.
Background In Mycobacterium avium complex pulmonary disease (MAC-PD), sputum culture conversion is a key endpoint but does not fully reflect symptom burden. We evaluated the COPD Assessment Test (CAT) as a patient-reported measure of disease severity and treatment response. Methods We retrospectively analyzed 179 treatment episodes in 174 patients with MAC-PD who continued therapy for at least 12 months. CAT scores were assessed at baseline and at 6 and 12 months. We examined associations of baseline CAT scores with chest computed tomography (CT) scores and sputum culture status, and of CAT changes (Δ6 and Δ12) with the 12-month culture-positive versus culture-negative/sputum-unobtainable classification and a study-defined composite incorporating 12-month radiographic response and the microbiologic course through 24 months. Results Baseline CAT scores correlated weakly with CT scores and were higher in baseline culture-positive and poorly controlled episodes. Neither Δ6 nor Δ12 differed by 12-month culture classification. Δ12 was more favorable in well-controlled than in poorly controlled episodes (p = 0.010), but discrimination was limited (area under the curve, 0.646 in all classifiable episodes and 0.682 in those with baseline CAT > 2). In the latter subgroup, an exploratory decrease of at least 3 points showed a sensitivity of 52.0% and a specificity of 71.9%. Conclusions CAT may complement microbiologic and radiographic assessments by capturing patient-reported symptom changes. The limited discriminatory performance does not support the use of CAT alone to classify treatment control.
Background Airway mucus plugs are associated with airflow obstruction and exacerbations in stable chronic obstructive pulmonary disease (COPD); however, their roles during exacerbations remain unclear. This study aimed to examine whether mucus plugs during exacerbations are associated with ventilatory support requirements and prognosis in patients with COPD. Methods This single-center retrospective study included patients with COPD, defined by airflow limitation on spirometry or emphysema on computed tomography (CT), who presented to the emergency department, and were diagnosed with COPD exacerbation. Mucus plugs during exacerbations were visually assessed on CT and analyzed in relation to the need for ventilatory support (primary outcome). Results Of 86 patients with a median mucus plug score of 3.5 (interquartile range, 1–7), 26 (30.2%) received ventilatory support. In multivariable logistic regression analysis, a higher mucus plug score (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.16–1.59) and higher C-reactive protein level were significantly associated with the need for ventilatory support. In a Cox proportional hazards model, a higher mucus plug score (hazard ratio [HR], 1.17; 95% CI, 1.07–1.29) and long-term oxygen therapy use were significantly associated with a shorter time to re-exacerbation or all-cause death within 1 year. Mucus plugs significantly decreased from the exacerbation to the recovery phases in a sub-analysis of 20 patients who underwent CT in both phases. Conclusion A higher mucus plug score was associated with the need for ventilatory support and poorer clinical outcomes, suggesting that mucus plugs may impair ventilation and worsen the prognosis of COPD exacerbations.
