Background: Nivolumab efficacy in patients with non-small-cell lung cancer (NSCLC) and performance status (PS) of 2-4 is unclear. We aimed to compare survival, treatment efficacy, and safety in patients with NSCLC with poor PS who received nivolumab plus best supportive care (BSC) with those in patients who received BSC alone in a palliative care unit (PCU). Patients and methods: This retrospective study included 99 consecutive patients with NSCLC who received nivolumab plus BSC or BSC alone between December 2015 and March 2018. Results: In total, 43 patients with PS of 0-1 (good PS group) and 20 patients with PS of 2-4 (poor PS group) received nivolumab plus BSC; the remaining 36 patients received BSC alone in the PCU (PC group). Median overall survival was 32 days [95% confidence interval (CI), 21-43] in the poor PS group and 31 days (95% CI, 25-37) in the PC group (hazard ratio, 0.653; 95% CI, 0.368-1.158; P = 0.137). Moreover, median overall survival in patients with PS of 3 or 4 among the poor PS group was not significantly longer than that in the PC group (HR, 1.235; 95% CI, 0.646-2.360; P = 0.516). The frequency of severe pneumonitis in the poor PS group was significantly higher than that in the good PS group (25% vs. 2%, P = 0.010). Conclusion: Survival benefit of nivolumab in patients with NSCLC with poor PS, especially 3 or 4, was not confirmed. Further studies with larger numbers of patients are required to confirm our results.

Nafamostat mesilate (NM) is used clinically for the prevention and treatment of pancreatitis. Electrolyte monitoring is necessary in geriatric patients receiving NM as it may cause hyperkalemia with the possibility of inducing arrhythmias. We attempted to evaluate the risk of hyperkalemia with aging and its background in this retrospective cohort study. Thirty-six of 290 patients (12.4％) who were receiving NM for the prevention and treatment of pancreatitis experienced hyperkalemia at the Kanazawa Medical Center over the past 2 years. A multiple logistic regression analysis was performed to identify the risk factors for hyperkalemia. The results showed that signi cant predictors of hyperkalemia were increasing age (per 10 years; odds ratio [OR]: 1.41, 95％ con dence interval [CI]: 1.01 -1.96, P < 0.045), fever (OR: 3.11, 95％ CI: 1.25 -7.71, P < 0.015), a high daily dose (per 10 mg/body/day; OR: 1.10, 95％ CI: 1.01 -1.20, P < 0.038), and a high serum potassium level at the start of treatment (per mEq/L; OR: 2.86, 95％ CI: 1.40 -5.83, P < 0.004). Thus, prior to the initiation of treatment with NM, it is necessary to assess the patientʼs medical background and to perform electrolyte monitoring frequently. We suggest that dosage reduction should be considered in the treatment of geriatric patients undergoing long-term treatment with NM.

Declining IADL scores in the shopping and responsibility for own medications categories may be effective indices for predicting early-stage cognitive dysfunction in elderly individuals. Cognitive dysfunction screening at pharmacy counters may be useful.