Non‐small cell lung cancer (NSCLC) accounts for 75-80% of all lung cancer cases. Stage III NSCLC represents a highly heterogenous stage characterized by different disease presentations and a wide range of treatment options. For patients with good performance status and unresectable-stage III NSCLC with programmed death-ligands 1 (PD-L1) tumor proportion score (TPS) ≥1%, durvalumab consolidation immunotherapy after a platinum-based chemo-radiotherapy is strongly recommended. However, age, poor performance status, underlying comorbidities may represent contraindications for chemotherapy to be used in a subgroup of patients. Herein, we report a case of an 80-year-old male affected by a stage IIIB lung adenocarcinoma with overexpression of PD-L1 (TPS 90%) treated with pembrolizumab, an immune checkpoint inhibitor targeting PD-1/PD-L1 pathways, which shows a complete resolution of lung lesion after four cycles of treatment. Although randomized controlled trials are required, this case report may suggest the potential role of pembrolizumab for chemotherapy unsuitable patients with overexpressing PD-L1 unresectable-stage III NSCLC.

Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic–hypercapnic respiratory failure. The aim of the present study is to evaluate the efficacy of HFNC in chronic hypercapnic respiratory failure associated with stable COPD. Methods: In this retrospective single-center longitudinal observational study, 40 patients treated with HFNC at home followed at the COPD Clinic of Respiratory Diseases (University of Campania L. Vanvitelli Monaldi Hospital, Naples) were included. All patients are re-assessed at our clinic at T0, T3, T6 and T12 months through functional respiratory tests and blood gas analysis. Results: After 12 months, significant reductions in pCO₂ (arterial partial pressure of carbon dioxide) (from 58.5 to 48.0 mmHg) and lactates (from 1.60 to 0.90 mmol/L) were observed, and MIP and MEP improved significantly. Patients receiving HFNC flows ≥50 L/min experienced greater reductions in pCO₂ and fewer exacerbations. Multivariate analysis identified HFNC flow rate (p = 0.0046), hours of use/day (p = 0.0157), lactate levels (p = 0.0301), and FEV₁ (forced expiratory volume in 1 s) (p = 0.0491) as independent predictors of reduction in PaCO₂. Higher BMI and greater airway obstruction were associated with a reduced response. Conclusions: Treatment with HFNC represents a reasonable therapeutic choice to reduce AEs-COPD and reduce PaCO₂ and lactates in stable COPD patients.

Stage III unresectable non-small cell lung cancer (NSCLC) represents a heterogeneous group, for which consolidation immunotherapy with durvalumab, after chemo-radiotherapy, is currently considered the standard of treatment by all national and international guidelines, based on data from the PACIFIC trial. Regarding adverse reactions, pulmonary toxicities represent the most difficult to diagnose and manage. It is planned to include 123 patients at 28 sites in Southern Italy experiencing lung cancer in this observational study. The recruitment phase is scheduled to last 24 months (from October 1, 2024, to October 1, 2026) and the followup phase is scheduled to last 24-36 months after durvalumab discontinuation. Retrospective data collection can be considered from 09/01/2023. The duration of the study will be 60 months. We propose to estimate the incidence and grading of pulmonary toxicity from radiation therapy and immunotherapy, according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0 and to investigate the correlation of pulmonary toxicity with pulmonary function tests (PFTs), with a particular focus on forced expiratory volume in one second (%FEV1) and forced vital capacity (%FVC) based on spirometry, diffusing capacity of the lung for carbon monoxide (%DLCO), partial pressure of arterial oxygen (PaO2) based on arterial blood gas (ABG) sampling and maximal distance that patients can walk at their own pace in 6 min and minimal oxygen saturation (SpO2) during the 6-minute walking test (6MWT). Pulmonary function tests (basal spirometry, DLCO, 6MWT, ABG) are evaluated at Time 0 (baseline), at Time 1 (post- RT), at Time 2 (after 6 cycles of immunotherapy) and at Time 3 (end of treatment). At data cut-off (31 mar 2025), 45 patients were enrolled and 10 patients were screened failure. Among the 45 patients enrolled, there were 7 cases of pulmonary toxicity (15.5 %). All of the cases showed post-actinic pneumonia (4 cases of grade 2, 2 cases of grade 3 and one case of grade 4 pneumonia). PRELUDIO trial is a study in stage III NSCLC undergoing consolidation immunotherapy with durvalumab, after chemo-radiotherapy, with the aim to estimate the incidence and grading of pulmonary toxicity according to CTCAE and to investigate the correlation of pulmonary toxicity with pulmonary function tests (PFTs), performed per clinical practice.