Background: The majority of NSCLC patients treated with immunecheckpoint inhibitors (ICI) develop acquired resistance. Conventional cytotoxic chemotherapy remains the treatment of choice for those patients. There are case reports on re-administration of ICIs for advanced NSCLC; however, these case series are difficult to draw definitive conclusions. We therefore retrospectively reviewed the efficacy of retreatment with ICI in our hospital. Method: Patients with pathologically confirmed advanced NSCLC who were treated with ICI in Kindai University hospital were retrospectively reviewed from December 2015 to July 2017. Among 212 NSCLC patients treated with ICIs, 10 patients (4.7 %) were retreated with ICI. Result: Number of patients treated with Nivolumab, Pembrolizumab and Atezolizumab were four, five and one, respectively. The best response of initial treatment with ICIs among 10 patients were five partial response (PR), two stable disease (SD) and three progressive disease (PD). Whereas, three patients (30%) showed SD and the others (70%) had PD to ICI retreatment. No severe adverse events attributable to the ICIs were noted. Conclusion: In the limited number of retrospective study, we could not find good responders for retreatment with ICIs. Best overall response during the previous treatment period is not related to the efficacy of retreatment with ICIs. At present, former responder to ICI therapy may not be the proper candidate for ICI re-challenge treatment strategy. Further biomarker analysis and treatment strategy is warranted for the patients and physicians to retreat with ICIs.

This article reviewed international research to obtain an improved understanding of the role defined in the literature as the specialist palliative care community nurse (SPCCN). Developments in cancer treatment and palliative care have lead to improved symptom control and increased prognosis for palliative care patients. In response, there has been a change to the role of the SPCCN indicating a move from a generalized, to specialist, community nurse who provides a consultancy service, thus causing role ambiguity. Within the literature, three themes emerged in defining the role of the community palliative care nurse: communication and collaboration; a clarification of the role; and the role of referral. This review found that there was a blurring of professional boundaries amongst the palliative care team and that the SPCCN has a capacity to coordinate and provide expertise in delivering complex symptom control to patients and their families.

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