Azienda USL di Bologna

Maintenance therapy is frequently proposed to patients with unresectable metastatic colorectal cancer (mCRC). However, the optimal regimen has not been defined, and studies have failed to characterize the patients who benefit from the maintenance strategy.

A systematic search of studies of maintenance was performed. Prospective studies that evaluated the progression-free survival (PFS) from the start of induction to progression and reported overall survival (OS) were selected. The efficacy of induction + maintenance therapy was assessed by the PFS/OS ratio. Twenty-one baseline variables were extracted and a linear regression was performed, separating cohorts in which maintenance included antiangiogenic agent (AAG)-based or fluoropyrimidine (FP)-based regimen.

Twenty-three study cohorts related to 18 trials were selected. Analysis of variables versus PFS/OS ratio showed a significant relationship with sex (23 cohorts; β = -0.0082, p-value = 0.016). In the 19 cohorts that received an AAG-based regimen, a benefit was found for females, patients receiving longer oxaliplatin-based induction chemotherapy, lung metastases, while in the 17 cohorts that received an FP-based treatment only patients without a previous primary tumor resection reported higher PFS/OS.

Despite the heterogeneity of the studies, female sex was associated with a more pronounced effect of maintenance regimens, particularly AAG-based.

The European Resuscitation Council has produced these First Aid Guidelines based on the 2025 International Consensus on Science with Treatment Recommendations on First Aid of the International Liaison Committee on Resuscitation (ILCOR), reviews of the expert group composed to write these recommendations, and available selected peer-reviewed literature after discussion and agreement within this experts' group. General topics include expectations of a first aid provider, first aid courses, contents of a first aid kit, how to approach a person with impaired responsiveness, recovery position, use of a pulse oximeter and administration of oxygen. Medical emergencies include anaphylaxis, choking, asthma, chest pain, hypoglycaemia, opioid overdose, recognition of stroke, and suicidal thoughts. Trauma-related emergencies include cervical spinal motion restriction, control of life-threatening bleeding, management of open chest wounds, concussion and preservation of an amputated body part. Environmental emergencies include drowning, hypothermia, hyperthermia and snake bite. First aid procedures for the prevention and management of life-threatening conditions that could progress to cardiac arrest, have been included. The management of cardiac arrest is described in the 2025 ERC Guidelines Basic Life Support.

Immunotherapy with or without chemotherapy has become standard first line treatment in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC), altering the second-line treatment landscape. After progression to first line no standardized systemic treatments have been identified. Advanced lines of therapy in pre-immune checkpoint inhibitors (ICIs) era led to very modest clinical impact.

We carried out a systematic review and meta-analysis of the literature assessing observational and interventional trials assessing the impact of advanced lines of treatment in HNSCC previously treated with ICIs. Primary outcome were progression free survival rate at 6 (PFS-6) and 12-months (PFS-12) and Overall Survival rate at 6 (OS-6) and 12-months (OS-12).

We identified 17 relevant studies for a total of 925 patients. In this population a second line therapy led to a PFS-6 and PFS-12 of 47% (95%CI; 37-56%) and 23% (95%CI; 16-33%) respectively. The pooled OS-6 and OS-12 rate were 70% (95%CI; 63-76%) and 41% (95%CI; 35-47%), respectively. All analyses performed presented a significant level of heterogeneity.

Advanced line of systemic treatment in patients progressed to ICIs should be proposed since potentially associate to survival improvement.