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Cervical cancer; Checkpoint inhibitor; Immunotherapy Cáncer de cuello uterino; Inhibidor de puntos de control; Inmunoterapia Càncer cervical; Inhibidor de punts de control; Immunoteràpia Objective This phase II clinical trial evaluated the safety and antitumor activity of balstilimab, an anti-PD-1 antibody, in patients with previously-treated, recurrent/metastatic cervical cancer. Methods Eligible patients were 18 years or older with recurrent and/or metastatic cervical cancer and who had relapsed after a prior platinum-based treatment regimen for advanced disease. Balstilimab was administered intravenously at 3 mg/kg once every two weeks, for up to 24 months. The primary endpoint was objective response rate (ORR, RECIST v1.1) as assessed by an independent review committee. Results At data cutoff, 161 women (median age, 53 years [range 25–81]) were enrolled and treated with balstilimab. Of these, 140 had measurable disease at baseline and one prior line of platinum-based therapy in the metastatic, persistent, or recurrent setting; these patients were included in the efficacy analyses. The ORR was 15% (95% CI, 10.0%–21.8%) and included 5 patients with a complete response and 16 with a partial response. The median duration of response was 15.4 months. In patients with PD-L1-positive tumors the ORR was 20%, however patients with PD-L1-negative tumors also responded to balstilimab (ORR, 7.9%). Responses were not restricted to tumors of squamous cell histology, and an ORR of 12.5% was seen in the subset of patients with cervical adenocarcinoma. The disease control rate was 49.3% (95% CI, 41.1%–57.5%). Immune-mediated enterocolitis (3.1%) and diarrhea (1.9%) were the most common grade 3 or higher treatment-related adverse events. Conclusion Balstilimab demonstrated meaningful and durable clinical activity, with manageable safety, in patients with previously-treated, recurrent/metastatic cervical cancer. This study was funded by Agenus Inc.

BACKGROUND Coronavirus disease 2019 (COVID‐19) and cancer are serious public health problems worldwide. However, little is known about the risk factors of in‐hospital mortality among COVID‐19 patients with and without cancer in Brazil. The objective of this study was to evaluate the risk factors of in‐hospital mortality among COVID‐19 patients with and without cancer and to compare mortality according to gender and topography during the year 2020 in Brazil. METHODS This was a secondary data study of hospitalized adult patients with a diagnosis of COVID‐19 by real‐time polymerase chain reaction testing in Brazil. The data were collected from the Influenza Epidemiological Surveillance Information System. RESULTS This study analyzed data from 322,817 patients. The prevalence of cancer in patients with COVID‐19 was 2.3%. COVID‐19 patients with neurological diseases and cancer had the most lethal comorbidities in both sexes. COVID‐19 patients with cancer were more likely to be older (median age, 67 vs 62 years; P < .001), to have a longer hospital stay (13.1 vs 11.5 days; P < .001), to be admitted to the intensive care unit (45.3% vs 39.6%; P < .001), to receive more invasive mechanical ventilation (27.1% vs 21.9%), and to have a higher risk of death (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.83‐2.06; P < .001) than those without cancer. Patients with hematological neoplasia (aOR, 2.85; 95% CI, 2.41‐3.38; P < .001) had a higher risk of mortality than those with solid tumors (aOR, 1.83; 95% CI, 1.72‐1.95; P < .001) in both sexes. CONCLUSIONS Brazilian COVID‐19 patients with cancer have higher disease severity and a higher risk of mortality than those without cancer., Patients with hematological neoplasia (adjusted odds ratio [aOR], 2.85; 95% confidence interval [CI], 2.41‐3.38; P < .001) have a higher risk of mortality than those with solid tumors (aOR, 1.83; 95% CI, 1.72‐1.95; P < .001) in both sexes.

Objectives Compare marital status, household income and labor activity at diagnosis and at 1-year follow-up among cervical cancer (CC) patients in Brazil. Methods LACOG 0215 EVITA is a prospective observational study, within 16 Brazilian sites, including 18 years-old, newly diagnosed, stage I to IV invasive CC patients. We present data collected at baseline and at 1-year follow-up regarding demography, histology, stage, marital status, household income and labor activity. Variables were compared using Chi-square test. Results 593 patients were included in this analysis. 75 (12.6%) were diagnosed in stage I, 452 (76.2%) II-III and 66 (11.2%) IV. Mean age at diagnosis was 57.0, 56.4 and 50.5 years respectively. Squamous cell carcinoma was the most frequent histology. 34.2% of stage I, 30.6% of stage II-III and 24.6% of stage IV patients had 9 or more years of education. About 95% patients had a previous pregnancy history. At 1-year follow-up there was a decrease in the proportion of married patients in stage II-III patients only (53.3% to 47.5%; p-value Conclusions CC may impact patients personal and work life long after diagnosis, even in those diagnosed with curable disease. In this cohort, stage II-III CC face more risk of divorce and job losses. Social support following diagnosis and treatment is essential for CC patients.

The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome. O acometimento leptomeníngeo por metástases tumorais pode ocorrer em tumores sólidos, sendo chamado de carcinomatose meníngea (CM), e também em doenças linfoproliferativas. Tumores de mama, pulmão e melanoma são os principais responsáveis pelos casos, e adenocarcinoma é a histologia mais frequentemente encontrada. A CM é um evento tardio na evolução da doença e caracteriza-se por sinais e sintomas neurológicos multifocais. O diagnóstico se faz pela avaliação conjunta do quadro clínico, neuroimagem e estudo do líquido cefalorraquidiano. O maior controle da doença sistêmica obtido com as novas modalidades terapêuticas e a baixa penetração de drogas no sistema nervoso central, aliados ao desenvolvimento nos métodos de neuroimagem observado nas últimas décadas, são fatores que respondem por um aumento na incidência desta apresentação. A quimioterapia intratecal é o tratamento de escolha, porém, frequentemente paliativo. O prognóstico é reservado, sendo que o melhor performance status pode selecionar um subgrupo de pacientes com melhor evolução.

CONTEXT: Non-small cell lung cancer (NSCLC) progresses to distant metastases in most cases. The most frequent sites for distant metastases are the bones, central nervous system, adrenal glands and liver. Dissemination to the skin, myocardium, thyroid gland and intestine may occur, but is rare. CASE REPORT: We describe a case of squamous cell carcinoma in the lungs, with metastases in the colon and thyroid, in a 66-year-old female patient. The lesion was unresectable and chemotherapy was started. The patient evolved with intestinal subocclusion, and colonoscopy showed the presence of a polyp. Biopsy and immunohistochemical analysis on the polyp showed that it was compatible with squamous cell carcinoma of pulmonary origin. At a follow-up consultation, the patient presented a thyroid nodule. A aspiration biopsy and cellblock immunohistochemistry confirmed the squamous cell carcinoma of pulmonary origin. After third-line chemotherapy, the patient progressed with acute obstructive abdomen due to a retroperitoneal mass. She underwent exploratory laparotomy and died due to surgical complications. Metastases to the thyroid and colon are rarely reported in cases of epidermoid carcinoma of the lungs. Gastrointestinal involvement in pulmonary metastases may affect the stomach, small intestine and colon, and cases of bleeding and perforation have already been reported. Although richly vascularized, the thyroid is an infrequent site for metastases. Such sites reflect poor prognoses for the clinical evolution. We did not find any previous reports in the literature, on lung cancer with metastases concomitantly in the colon and thyroid, in a single patient.