Lung cancer is the leading cause of cancer death in Canada and a significant cause of morbidity for patients and their loved ones. There have been rapid advances in preventing, screening and treating this disease. Here, we present a contemporary review of treatment of non-small cell lung cancer in Canada based on current best practices. The focus of this review is to highlight recent data in screening for lung cancer, management of patients with early and locally-advanced non-small cell lung cancer, as well as management of patients with metastatic disease. There is a special focus on the incorporation of immunotherapy into practice and its associated toxicities.

BACKGROUND. Multiple immunologic parameters have provided useful prognostic and assessment significance in different cancers, including head and neck squamous cell carcinoma. We sought to identify whether pre-treatment inflammatory markers could prognosticate recurrence in patients with advanced (stage III or IV) head and neck squamous cell carcinomas that underwent therapy with curative intent in a tertiary care center between January 2010 and December 2012.METHODS. We registered patient demographics, primary tumor characteristics, Human papillomavirus (HPV) status, pre-therapeutic inflammatory markers including body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and serum albumin; therapy received, date of relapse, death or last follow up. The main outcome was relapse free survival (RFS). Overall survival (OS) was a secondary outcome.RESULTS. 235 charts were reviewed, 118 were included. Of these, 86 were oropharyngeal (50 HPV related, 18 were non-HPV related, 17 not available) and 32 non-oropharyngeal (19 HPV related, 7 non-HPV related, and 6 not available). Median follow-up was 2.45 years (IQR, 1.65-3.3). With regards to RFS, HPV positive status had an adjusted HR of 0.357 (95% CI 0.173-0.776, p=0.0087) and for NLR >=5, the raw HR was 1.637 (95% CI 0.673-3.983, p=0.2771). For OS, the raw HR for NLR >=5 was 2.997 (95% CI 1.280-7.018-, p=0.0114), and for HPV positive status, the raw HR was 0.514 (95% CI 0.226-1.169, p=0.1125). Only 54 patients had CRP available for analysis. For RFS, CRP >=8 had a raw HR of 2.350 (95% CI 1.1062-5.198, p=0.0349) and a raw HR of 1.455 (95% CI 0.497-4.260, p=0.4940) for OS. When adjusting NLR for age, gender and p16 positive status, NLR had a decreased hazard ratio of 2.352 (95% CI= 0.945-5.853, p=0.0659) for overall survival.CONCLUSIONS. NLR>=5 at presentation is not associated with a higher risk of relapse but is associated with a higher risk of death in patients with squamous cell carcinoma of the head and neck. CRP >=8 was associated with a higher risk of relapse but not death. Lastly, HPV positive status was protective with a lower risk of relapse but not death. Interestingly, we found that when adjusting NLR for age, gender and HPV positive status, NLR had a decreased hazard ratio and therefore potentially protective status for overall survival.

Introduction. Malignant pleural mesothelioma (MPM) is associated with a poor prognosis. Palliative platinum-based chemotherapy may help to improve symptoms and prolong life. Since 2004, the platinum is commonly partnered with a folate antimetabolite. We performed a review investigating if survival had significantly changed before and after the arrival of folate antimetabolites in clinical practice. Methods. All MPM patients from January 1991 to June 2012 were identified. Data collected included age, gender, asbestos exposure, presenting signs/symptoms, performance status, histology, stage, bloodwork, treatment modalities including chemotherapy, and date of death or last follow-up. The primary endpoint was overall survival. Cox models were applied to determine variables associated with survival. Results. There were 245 patients identified. Median overall survival for all patients was 9.4 months. After multivariate analysis, performance status, stage, histology, leucocytosis, and thrombophilia remained independently associated with survival. Among all patients who received chemotherapy, there was no difference in overall survival between the periods before and after folate antimetabolite approval: 14.2 versus 13.2 months (P = 0.35). Specifically receiving combined platinum-based/folate antimetabolite chemotherapy did not improve overall survival compared to all other chemotherapy regimens: 14.1 versus 13.6 months (P = 0.97). Conclusions. In this review, we did not observe an incremental improvement in overall survival after folate antimetabolites became available.

The purpose of this study was to firstly present the maiden case of tamoxifen-induced acute cutaneous lupus erythematosus (ACLE), and secondly, to broaden the discussion into a systematic review of the various tamoxifen-related skin changes documented in patients with breast cancer. We searched PubMed, Cochrane, Embase, CancerLit, Scopus, Web of Science, and Google Scholar databases using keywords to identify reported cases of tamoxifen-related cutaneous adverse events. Outcomes captured included type of cutaneous reaction, time to adverse event, pathologic mechanism, and possible treatment. From 17 clinical studies identified, over ten distinct types of adverse reactions of the skin were itemized. The character of these cutaneous events ranged from the relatively common hot flashes to the rare, but potentially life-threatening, Steven Johnson syndrome. Overall, tamoxifen is generally a well-tolerated hormone therapy with decades of supporting safety data. Based on current medical literature, we present the first case of tamoxifen-induced ACLE. Our clinical experience of managing this case revealed that despite its broad use and the frequency of associated skin reactions, there is a lack of concise information detailing the cutaneous adverse events associated with tamoxifen. The absence of summarized information concerning tamoxifen-related skin changes prompted us to perform a review herein.