BackgroundTo compare the efficacy and toxicity of anti-programmed cell death receptor 1 (PD-1) and anti-programmed cell death ligand 1 (PD-L1) versus docetaxel in previously treated patients with advanced non-small cell lung cancer (NSCLC).Materials and methodsPhase III randomised clinical trials (RCTs) were identified after systematic review of databases and conference proceedings. A random-effect model was used to determine the pooled HR for overall survival (OS), progression-free survival (PFS) and duration of response. The pooled OR for overall response and treatment-related side effects were calculated using the inverse-variance method. Heterogeneity was measured using the τ2 and I2 statistics.ResultsAfter the systematic review, we included four phase III RCTs (n=2737) in this meta-analysis. The use of anti-PD-1/anti-PD-L1 agents (atezolizumab, nivolumab and pembrolizumab) was associated with better OS in comparison with docetaxel alone (HR: 0.69; 95% CI 0.63 to 0.75; p<0.00001). Similarly, the PFS and duration of response was significantly longer for patients receiving immunotherapy (HR: 0.85; 95% CI 0.75 to 0.96; p=0.007 and HR:0.32; 95% CI 0.24 to 0.43; p<0.00001, respectively) versus single agent chemotherapy. The overall response rate was also higher for patients who received any anti-PD-1/anti-PD-L1 therapy in comparison with docetaxel (OR: 1.77; 95% CI 1.26 to 2.50; p=0.001). Regarding treatment-related side effects grade 3 or higher, patients who received immunotherapy experienced less events than patients allocated to docetaxel (OR: 0.19; 95% CI 0.12 to 0.30; p<0.00001)ConclusionThe use of anti-PD-1/anti-PD-L1 therapy in patients with progressive advanced NSCLC is significantly better than the use of docetaxel in terms of OS, PFS, duration of response and overall response rate.

Background: Methylnaltrexone Bromide (MB) is a selective antagonist of opioid binding at the mureceptor (m or MOR receptor). Constipation is a quite common side effect in Non-Small-Cell-Lung-Cancer (NSCLC) patients receiving opioids for chronic pain, usually due to skeletal metastases. We set out to investigate if MB is effective in those patients who received opioids and complained of constipation. Method: Forty six NSCLC patients with a life expectancy of at least three months were recruited for our study after providing written consent. All patients received either fentanyl as a transdermal patch, in its inhaled form or per os. Patients were randomized (1:1) to four weeks of treatment with either MB 12mg/0.6ml (n¼22) administered subcutaneously (sc) or a placebo, on alternate days. We recorded the number of patients who defecated within four hours of the MB or placebo injection, and the number of patients needing a second dose of MB or placebo within six hours from the first dose. We recorded the side effects of this treatment. Patients were not allowed to use other laxatives. Results: In the MB group after one injection, thirty five patients (76%) had a bowel movement within four hours compared with six placebo patients (13%), p¼0.02. Ten patients in the MB group had a bowel movement after two or more doses of MB, raising the percentage of patients who responded to MB to 98%. The more severe the constipation, the higher the response with MB. The overall rate of adverse events was similar in the MB (42%) and placebo groups (41%). In the MB group, the most commonly reported adverse events were abdominal pain (17%), flatulence (16%), vomiting (10%), and nausea (13%). Most treatment related adverse events were rated as mild or moderate by the patients. Discontinuation due to adverse events occurred in 5% and 6% of patients in the MB and placebo groups, respectively.Conclusion: Methylnaltrexone Bromide has been shown to be superior to placebo in achieving defecation within a short time, in NSCLC patients with opioid-induced constipation, The more severe the constipation, the higher the response with MB. There were no serious adverse events. We conclude that Methylnaltrexone Bromide is effective and safe.

, all patients diagnosed with SCLC and NSCLC treated with chemotherapy at National Institute of Oncology at Asuncion-Paraguay were analyzed retrospectively. Demographic information, treatment modalities, tumor response, were recorded .SPSS 19 was used to analyze the data with p <0.05 as significance. Results: We studied 370 subjects, 28% received chemotherapy, 14,8% chemotherapy plus radiotherapy, 1,1% surgery plus chemotherapy. At IIIA stage NSCLC 18,2% was treated with PTX and CBDCA 1cycle and18,2% with PTX+CBDCA 4cycles (p <0.05). IIIB stage NSCLC 17,6% patients received PTX+CBDCA 4cycles and 22,1% PTX+CBDCA 6 cycles (p<0.05). At IIIA stage NSCLC received PTX + CBDCA 4 cycles.(p<0.05). SCLC has no statistical significance relation between stage and type of chemotherapy. The tumor response to first-line chemotherapy shows 47,5% has no response. 32,4% has response (p<0.05). 17,6% abandoned treatment (p <0.05).Patients who received PTX+CBDCA show a high percentage of abandoned treatment as 20% and patients receiving CDDP +VP-16 had a high abandoned treatment of 80% (p<0.05). 59.8% patients treated with chemotherapy were from countryside places and 40,2% from urban places (p>0.05), 25,6% of patients receiving chemotherapy and 29,6% were receiving chemotherapy and radiotherapy were farmers (p<0.05). 80,4% patients receiving chemotherapy were smokers (p<0.05). 45,1% patients consumed alcohol regularly (p<0.05). Only 12,7% patients had family lung cancer genetic precedence (p<0.05). 43,1% patient under chemotherapy had exposure to toxic environmental agents (p <0.05). 53,5% patient receiving chemotherapy had a stage 2 of ECOG Performance Status (p <0.05). Tumor response to chemotherapy at NSCLC show: 100% patients who received dFdC+CDDP 4cycles; 65,5% with PTX+CBDCA 4 cycles; 42,9% CDDP+VP-16 4 cycles; 65% PTX + CBDCA 6 cycles; 100% of CDDP+ VP16 6 cycles; 100% of dFdC 6 cycles (p <0.05) SCLC has no statistical significance at this analysis. At Second line chemotherapy to NSCLC 23,8% received dFdC+ CDDP 1 cycle and 14,3% PTX+CBDCA 1 cycle. Only 3 patients received third line