Background: Mastectomy and breast-conserving surgery are key interventions for breast cancer, a leading cause of cancer-related mortality in women. Many undergoing breast surgery experience postoperative pain compromising their functionality and quality of life. While multiple pain management strategies are available, evidence comparing the erector spinae (ESPB) and serratus anterior plane blocks (SAPB) for improving post-surgical pain management in breast cancer surgery patients is limited. Therefore, we investigated the efficacy and safety of these two regional anesthesia techniques. Methods: After PROSPERO registration, we systematically searched PubMed, Google Scholar, and Cochrane Library until May 2024. Risk ratios (RR) were calculated for dichotomous outcomes and standard mean differences (SMD) or mean differences (MD) were computed for continuous data. RevMan Review Manager 5.4.1 was used for the data analysis and generation of forest plots as well as funnel plots. The Cochrane Risk of Bias tool 2.0 (18) and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines were used to appraise and evaluate the evidence (19). Results: A total of 9 randomized control trials enrolling 550 patients were included. Static pain scores at 0, 6, 8, 12, and 24 h after surgery, dynamic pain scores computed at 0, 8, 12, and 24 h after surgery and area under the curve (AUC) static pain score at all time points between 0 and 24 h (SMD (HKSJ 95% CI) − 0.27 [− 0.99, 0.45]) did not significantly vary with either plane block. Postoperative morphine consumption in the first 24 h and the number of patients requesting analgesia were significantly greater in those receiving SAPB [MD: − 1.41 (95% C.I. − 2.70, − 0.13), p = 0.03] and [RR: 1.28 (95% C.I. 1.00, 1.63), p = 0.05], respectively. The time to first postoperative analgesic use was significantly greater among those administered ESPB [MD: 1.55 h, (95% C.I. 1.02, 2.09), p < 0.01]. Patient satisfaction scores and the incidence of nausea and vomiting were similar across both groups. Conclusions: While pain scores with either block are comparable, ESPB reduces postoperative morphine consumption and may be the favorable option in breast cancer patients undergoing surgery.

The indications for immune checkpoint inhibitor (ICI) use in cancer treatment continue to expand. This is attributable to their proven anticancer activity in addition to their tolerability and favorable toxicity profile as compared to conventional chemotherapeutic agents. ICIs work by blocking the inhibitory signals between tumor cells and T-cells, thereby enhancing the T-cell cytotoxic activity to inhibit tumor growth. Because of their immune-stimulating effect, ICIs are linked to adverse renal outcomes in both native and transplanted kidneys. The risk of kidney allograft rejection in the setting of ICI use has been reported to be around 40%, leading to an increased risk of graft loss. In this report, we review the literature examining outcomes in kidney transplant recipients receiving ICIs for various oncologic indications.

Chemotherapy-induced neutropenia (CIN) is a frequent and clinically significant complication of systemic cancer therapy, associated with increased infection risk, hospitalization, and treatment delays. Granulocyte colony-stimulating factors (G-CSFs) are used to mitigate these risks. Efbemalenograstim alfa (F-627) is a novel long-acting recombinant G-CSF developed as a potential alternative. We conducted a systematic review and meta-analysis to evaluate the comparative safety and efficacy of efbemalenograstim alfa versus standard G-CSFs in patients with non-myeloid malignancies receiving chemotherapy. A comprehensive literature search of six databases identified four randomized controlled trials (RCTs) comparing F-627 with standard G-CSFs. Data from three active-controlled trials were pooled using Review Manager (RevMan) 5.4.1, with risk ratios (RR) calculated for dichotomous outcomes and mean differences (MD) for continuous outcomes; heterogeneity was assessed using the I ² statistic. Narrative synthesis was performed for the placebo-controlled trial and outcomes with insufficient data for meta-analysis. Risk of bias and certainty of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE framework. Pooled analysis demonstrated comparable efficacy between efbemalenograstim alfa and standard G-CSFs in reducing the duration of Grade 4 neutropenia during cycle 1. The incidence of severe neutropenia and febrile neutropenia was also similar between treatment groups. Secondary efficacy outcomes and adverse event profiles, including bone pain and hematologic toxicities, were broadly comparable across treatment arms. Overall, efbemalenograstim alfa demonstrates a safety and efficacy profile comparable to established G-CSFs, supporting its role as a viable option for the prevention of chemotherapy-induced neutropenia in patients with non-myeloid malignancies.