Intern Med J [journal]
- Detection and Clinical Significance of Glomerular M-type Phospholipase A2 Receptor in Patients with Idiopathic Membranous Nephropathy. [JOURNAL ARTICLE]
- Intern Med J 2016 Aug 24.
Glomerular M-type phospholipase A2 receptor (PLA2 R) is important for diagnosing idiopathic membranous nephropathy (IMN). The relation between glomerular PLA2 R expression and response to treatment remained to explore.We conducted the study to explore the positive rate and clinical significance of glomerular M-type PLA2 R in IMN patients.122 IMN patients receiving neither glucocorticoid nor immunosuppressant therapy prior to renal biopsies were included and followed for more than 1 year. Control group comprised 30 patients with secondary membranous nephropathy and 100 patients with non-membranous forms of nephropathy. PLA2 R level and IgG subclasses in glomeruli were detected. Primary endpoint was reduction of proteinuria to less than 50% of baseline value.82.0% patients with IMN had positive glomerular PLA2 R deposits, compared with 16.7% in secondary membranous nephropathy group (P < 0.001). Additionally, PLA2 R-positive expression combined with IgG4 ≥ 2+ was found in 94.3% IMN patients compared with 40.0% in secondary membranous nephropathy patients (P < 0.01). Among IMN patients , the remission rate of proteinuria after either glucocorticoid or glucocorticoid combined immunosuppressant therapy at least 6 month was 83.9% in PLA2 R positive group compared with 54.5% in negative group (P < 0.05).Positive rate of glomerular PLA2 R was more prevalent in IMN patients. Both PLA2 R and IgG4 glomerular deposits may help in discriminating between idiopathic and secondary membranous nephropathy. IMN patients with positive PLA2 R expression probably have a more beneficial response to glucocorticoid and/or immunosuppressant therapy.
- Outcomes of patients with non-melanoma solid tumours receiving self-funded pembrolizumab at Chris O'Brien Lifehouse. [JOURNAL ARTICLE]
- Intern Med J 2016 Aug 24.
Immunotherapy agents show anti-cancer activity in several solid cancers. Efficacy in non-melanoma solid tumours for non-approved indications is unknown.Retrospective review describing outcomes and toxicity of self-funded pembrolizumab in patients with non-melanoma solid cancers at Chris O'Brien Lifehouse.From April 2015 to December 2015, 21 patients received/planned to receive self-funded pembrolizumab. Median age was 50 (16-76), 28% and 10% had an ECOG of 2, and 3-4 respectively. 62% received at least 2-4 lines of prior drug treatment. Median follow-up was 3.0 months (range, 0.4-9.6). Fourteen (67%) patients requested pembrolizumab. Pembrolizumab was clinician offered for 7 (33%) patients. Patients who requested pembrolizumab had worse outcomes. 3 patients died before receiving pembrolizumab. Of the 18 patients that received at least 1 dose, a partial response was observed in 3 (17%). Progressive disease occurred in 83%. 4 patients received only 1 cycle of pembrolizumab and died a median of 27 days (range 13-43) after. Immune related adverse events of any grade occurred in 33%. No grade 3-4 events were observed.Pembrolizumab was well tolerated. Meaningful responses were observed in 17% of treated patients. Response continues after 5-6.5 months follow-up in 11% and >8 months of follow-up for the other responding patient. Financial impact to the patient can be substantial. Outcomes for 33% were poor with 3 patients dying prior to receiving therapy and 4 dying within weeks of receiving one dose. This highlights issues regarding the careful selection of patients, futility of anti-cancer therapy at the end of life and patient's perceived benefit of receiving this therapy.
- Author reply. [Letter]
- Intern Med J 2016 Aug; 46(8):992-3.
- Asthma Cycle of Care uptake among Australian older women with asthma. [Letter]
- Intern Med J 2016 Aug; 46(8):990-1.
- Rheumatoid arthritis heralded by the hypereosinophilic syndrome. [Letter]
- Intern Med J 2016 Aug; 46(8):988-9.