Despite a great success of immunotherapy in cancer treatment, a great number of patients will become resistant. This review summarizes recent reports on immune checkpoint inhibitor retreatment or rechallenge in order to overcome primary resistance. The systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was performed using PubMed, Web of Science and Scopus. In total, 31 articles were included with a total of 812 patients. There were 16 retreatment studies and 13 rechallenge studies. We identified 15 studies in which at least one parameter (overall response rate or disease control rate) improved or was stable at secondary treatment. Interval treatment, primary response to and the cause of cessation for the first immune checkpoint inhibitors seem to be promising predictors of secondary response. However, high heterogeneity of investigated cohorts and lack of reporting guidelines are limiting factors for current in-depth analysis.

INTRODUCTION Non‑small cell lung cancer (NSCLC) is the most common lung tumor. Conventional conservative treatment in medically inoperable patients with early stage NSCLC has poor outcome. To improve treatment efficacy, stereotactic ablative radiotherapy (SABR) has been developed, which enables the delivery of high‑dose radiation to the tumor. OBJECTIVES This prospective study was conducted to test the hypothesis that a sudden death of cancer cells after SABR may lead to changes in systemic immune response. PATIENTS AND METHODS We enrolled 89 treatment‑naive patients with stage T1/2aN0 NSCLC. All patients received SABR, in accordance with treatment standards at our department. Blood samples were collected 3 times: before treatment (n = 89), and then at 2 (n = 86) and 12 weeks (n = 75) after treatment completion to assess the proportion of CD4(+) and CD8(+) T cells, and the expression of T‑lymphocyte transcription factors: T‑bet, GATA‑3, ROR‑γt, and FoxP3. Serum C‑reactive protein (CRP) levels, absolute neutrophil count (ANC), absolute lymphocyte count, and white blood cell (WBC) count were measured to exclude the impact of nonspecific inflammatory reaction. The expression levels of lymphocyte antigens were measured by flow cytometry. RESULTS Serum CRP levels, ANC, and WBC count remained stable during the study. We observed slight lymphopenia, which correlated with irradiated lung volume. After SABR, the proportion of CD8(+), CD4(+), as well as the proportion of CD4(+) T cells expressing GATA‑3(+), T‑bet(+), or ROR‑γt(+) increased, while the number of CD4(+)FoxP3(+) cells (specific for regulatory T cells) decreased. CONCLUSIONS Our findings may suggest that SABR enhances the systemic immune response by increasing the proportion of proinflammatory T‑cell subpopulations.

The aim of this prospective study was to evaluate the level of anxiety, depression, and quality of life (QoL) in medically inoperable patients with early stage non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy (SABR). Prolonged survival is equally important as maintaining high QoL and good psychological functioning during the treatment of lung cancer. Nowadays available SABR has markedly changed clinical care and outcomes in the group of medically inoperable patients. To our knowledge, analysis of QoL and psychological state has not been performed in Polish patients with early NSCLC treated with SABR. Research group consisted of medically inoperable, early NSCLC (T1-2aN0M0) patients qualified to SABR. Patients were asked to complete Polish versions of the European Organization for Research and Treatment of Cancer Quality of Life - Core Questionnaire (EORTC QLQ-C30) with the Lung Cancer Questionnaire (LC13) and Hospital Anxiety and Depression Scale (HAD). These questionnaires were repeated 2 weeks and then 3 months after treatment completion. We enrolled 51 patients who met the inclusion criteria. SABR did not deteriorate QoL and psychological functioning. On the contrary, clinically meaningful improvement was observed in emotional functioning, level of insomnia, anxiety and depression. Significantly worse improvement was shown in patients with chronic obstructive pulmonary disease (COPD). Our results confirm that SABR is well tolerated and does not have a deleterious effect on QoL and psychological state. Results of our study indicate the importance of additional psychological care in the group of patients with COPD.

Paraganglioma and pheochromocytoma are rare medical conditions. Thus, there are still a small number of studies, clinical trials, and evidence-based data in this field. This makes clinical decisions more difficult. In this study, we present a case report enriched with a short review of available essential clinical data, indicating the need for constant metoxycatecholamine level observation and a proper diagnostic imaging approach, especially in terms of ongoing pandemics. Our research also provides a summary of the molecular background of these diseases, indicating their future role in clinical management. We analyzed the ClinicalTrials.gov dataset in order to show future perspectives. In this paper, the use of the PET-CT before MRI or CT is proposed in specific cases during diagnosis processes contrary to the guidelines. PET-CT may be as effective as standard procedures and may provide a faster diagnosis, which is important in periods with more difficult access to health care, such as during the COVID-19 pandemic.