Biomarkers of systemic inflammation/nutritional status have been associated with outcomes in advanced-stage non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). However, most of them were not tested in cohorts of patients treated with ICIs in combination with chemotherapy (CT) (ICI + CT) or with CT alone, making it impossible to discriminate a predictive from a prognostic effect. We conducted a single-center retrospective study to search for associations between various baseline biomarkers/scores that reflected the systemic inflammation/nutritional status (Lung Immune Prognostic Index, Modified Lung Immune Prognostic Index, Scottish Inflammatory Prognostic Score, Advanced Lung Cancer Inflammation Index, EPSILoN, Prognostic Nutritional Index, Systemic Immune-Inflammation Index, Gustave Roussy Immune Score, Royal Marsden Hospital Prognostic Score, Lung Immuno-oncology Prognostic Score 3, Lung Immuno-oncology Prognostic Score 4, score published by Holtzman et al., and Glasgow Prognostic Score) and outcomes in metastatic NSCLC treated in a first-line setting either with ICI in monotherapy (cohort 1; n = 75), ICI + CT (cohort 2; n = 56), or CT alone (cohort 3; n = 221). In the three cohorts, the biomarkers/scores were moderately associated with overall survival (OS) and progression-free survival (PFS). Their prognostic performance was relatively poor, with a maximum c-index of 0.66. None of them was specific to ICIs and could help to choose the best treatment modality. The systemic inflammation/nutritional status, associated with outcomes independently of the treatment, is therefore prognostic but not predictive in metastatic NSCLC.

Introduction: Central diabetes insipidus is a heterogeneous condition characterized by decreased release of antidiuretic hormone by the neurohypophysis resulting in a urine concentration deficit with variable degrees of polyuria. The most common causes include idiopathic diabetes insipidus, tumors or infiltrative diseases, neurosurgery and trauma. Temozolomide is an oral DNA-alkylating agent capable of crossing the blood-brain barrier and used as chemotherapy primarily to treat glioblastoma and other brain cancers. Cases: Two men (aged 38 and 54 years) suddenly developed polyuria and polydispsia approximately four weeks after the initiation of temozolomide for a glioblastoma. Plasma and urine parameters demonstrated the presence of a urinary concentration defect. Management: The clinical and laboratory abnormalities completely resolved with intranasal desmopressin therapy, allowing the continuation of temozolomide. The disorder did not relapse after cessation of temozolomide and desmopressin and relapsed in one patient after rechallenge with temozolomide. Discussion: Our report highlights the importance of a quick recognition of this exceptional complication, in order to initiate promptly treatment with desmopressin and to maintain therapy with temozolomide.

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Sampling peripheral lung nodules are challenging during bronchoscopy, as they are not reachable by standard bronchoscopes [1]. To obtain direct visualization of nodules located as far as the outer third of the lungs, Iriscope®, an ultrathin video probe of 1.7 mm that can be inserted into the working channel of bronchoscopes and navigation catheters, was created. Moreover, it can provide a direct vision of peripheral lung. We report a direct vision and description of emphysema seen through Iriscope®, during an electromagnetic navigation bronchoscopy (ENB) guided by cone-beam computed tomography (CBCT). A 78-year-old male, ex-smoker with emphysema, underwent transbronchial cryobiopsies guided by ENB, CBCT, and Iriscope® for a peripheral lung nodule, in the left upper lobe. The nodule was in the middle of an emphysematous area (Fig. 1). The Iriscope® was pushed through the navigation catheter that was first guided with ENB and CBCT (Fig. 2). The nodule was not clearly identified on the images captured but when pushing the Iriscope®, it entered in an area composed by large empty spaces separated by bundles of tissue, corresponding to emphysema close to the nodule (Fig. 3). The pathological examination of the nodule revealed adenocarcinoma. Although direct visualization of emphysema had already been reported with a bronchoscope through a transthoracic airway bypass [2], the miniaturization of vision probes such as the Iriscope® or the ones used during robotic bronchoscopy allows to endoscopically penetrate deeper into the peripheral bronchial tree. Further practice will be required to better interpret the abnormalities detected. This study protocol was reviewed and approved by the Hospital-Faculty Ethics Committee of Hôpital Erasme, approval number P2022/231. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.Benjamin Bondue, Olivier Taton, and Dimitri Leduc have stock options in Lys Medical Society and received consultancy fee from Lys Medical Society. The Iriscope® was developed and provided by Lys Medical (Waterloo, Belgium). Cédric Mahiat: collected, analyzed, and interpreted the data, wrote the first draft of the manuscript, and approved the final version. Benjamin Bondue, Dimitri Leduc, and Olivier Taton: collected, analyzed, and interpreted the data, revised the manuscript, and approved the final version.The data analyzed in this case are included in the article and its online supplementary material files. Further information can be asked to the corresponding author.

The optimal management strategy for metastatic or advanced-stage non-small-cell lung cancer (NSCLC) after 2 years of immune checkpoint inhibitor (ICI) remains unclear. We conducted a single-center retrospective observational study to characterize the management of patients who received at least 2 years of ICI in the first-line setting for a metastatic or advanced-stage NSCLC. Among the 254 patients that received ICI in the first-line setting, 39 (15%) achieved 2 years of treatment (ICI in monotherapy, n = 14; ICI with chemotherapy, n = 25). ICI was discontinued after 2 years (<30 months) in 31 (79%) of the cases. During the first 2 years, 29 patients (74%) had no disease progression (2 complete radiological responses, 25 partial radiological responses, and 2 stable diseases) and 10 patients (26%) experienced at least one oligo-progression, which was treated with local ablative treatment (LAT), allowing continuation of ICI up to 2 years. A positron emission tomography (PET) scan was performed at 2 years for 37 patients (95%), revealing a complete metabolic response (CMR) in 16 individuals (43%). None of these patients progressed subsequently (median follow-up: 13 months). After 2 years of ICI, the 12-month progression-free survival was 100% in case of CMR versus 49% (95% CI, 29-91) in the absence of CMR (p = 0.00037). A CMR at 2 years of ICI is associated with a favorable prognosis. Further studies are needed to better establish the role of PET scan at 2 years, the relevance of LAT and the optimal duration of ICI.