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   Table of Contents - Current issue
Coverpage
September-October 2021
Volume 8 | Issue 5
Page Nos. 439-590

Online since Friday, August 27, 2021

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EDITORIAL  

News Update on the Asia-Pacific Journal of Oncology Nursing p. 439
Winnie KW So
DOI:10.4103/apjon.apjon-2150  
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CANCER CACHEXIA PAPERS - EDITORIAL Top

Nursing Management of Cancer Cachexia: A New Frontier Highly accessed article p. 442
Tateaki Naito
DOI:10.4103/apjon.apjon-2133  
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REVIEW ARTICLES Top

Adipose Tissue and Cancer Cachexia: What Nurses Need to Know p. 445
Susan Mcclement
DOI:10.4103/apjon.apjon-2134  
The purpose of this article is to discuss the different types of adipose tissue involved in cachexia and describe their role in contributing to increased energy expenditure and negative energy balance. Armed with this knowledge, nurses will be better positioned to understand the clinical picture of cachexia, appreciate the rationale for proposed therapeutic interventions, and confidently dialogue with patients, families, and members of interdisciplinary health care teams about this prevalent condition.
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The Psychosocial Components of Multimodal Interventions Offered to People with Cancer Cachexia: A Scoping Review p. 450
Jane B Hopkinson
DOI:10.4103/apjon.apjon-219  
The supportive care of people with cancer cachexia is a rapidly evolving field. In the past decade, multimodal treatments have been developed and new multidisciplinary cachexia clinics have been established across the world. This scoping review examines the extent to which psychosocial support has become part of the multimodal management of cancer cachexia. The review draws on a systematic search of Medline, Embase, CINAHL, PsycINFO, and the Cochrane Library for publications about people who have cancer cachexia and receive multimodal interventions. Search limits were the English language, date range January 2013 to March 2021, and adults 18 years and older. The search found 19 papers about multimodal interventions for either cancer cachexia or its defining feature involuntary weight loss that included a psychosocial component. This review found three different ways a psychosocial component of a multimodal intervention can help patients: (1) enable adherence to multimodal therapies; (2) aid emotional adaptation and coping; and (3) treat comorbid anxiety and depression. Recognizing these three different functions of psychosocial support is important because they have different mechanisms of action. Behavioral change techniques are important for enabling adherence, education in coping methods is important to alleviate stress, and cognitive reframing for the treatment of anxiety and depression. The analysis reveals that multimodal interventions for cancer cachexia with a psychosocial component can either focus on physical health or have a more holistic focus. Holistic care is considered the best practice in cancer nursing. Thus multimodal interventions that can address not only physical health problems, but psychosocial issues are consistent with high-quality nursing care.
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Contemporary Insights into Cancer Cachexia for Oncology Nurses p. 462
Deborah A Boyle
DOI:10.4103/apjon.apjon-2151  
Cachexia is a complex, multiorgan phenomenon targeting skeletal muscle resulting from systemic metabolic imbalances. Multifocal in nature, It's ultimate outcome is significant muscle degradation and loss of adipose tissue exhibited as the “wasting syndrome” which is associated with significant functional decline. Currently, there are no approved biomarkers for screening nor therapeutic options to manage cancer cachexia. Furthermore, multiple psychosocial sequelae characterize the patient and family coping paradigm. Heightened education about the pathophysiology of cancer cachexia and awareness of intra-familial emotional distress can enhance oncology nurses' advocacy about, and attentiveness to, this common manifestation of advanced cancer.
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Review of the Effects and Safety of Traditional Chinese Medicine in the Treatment of Cancer Cachexia p. 471
Binbin Xu, Qinqin Cheng, Winnie KW So
DOI:10.4103/apjon.apjon-2130  
Cancer cachexia is characterized by weight loss, anorexia, asthenia, and anemia among cancer patients and can lead to their decreased physical function, poor quality of life, and reduced survival. Progestins have been reported to have beneficial effects on appetite improvement in patients with cancer; however, serious complications have been reported as a result of their use. Traditional Chinese medicine (TCM) is a complementary and alternative system of medicine that may be effective in treating cancer cachexia. This review aims to identify existing evidence on the efficacy and safety of traditional Chinese herbs and common TCM technologies in treating cancer cachexia. We searched six databases – the Cochrane Library, PubMed, EMBASE, CINAHL, China National Knowledge Infrastructure, and Wan Fang Database, using medical subject headings and free text. The search was performed in January 2021, and the reference lists of relevant articles were also searched. A total of 4685 citations were identified, and 20 studies were included. The results showed that traditional Chinese herbs can improve appetite, weight, biomarkers, the Karnofsky performance status, cachexia-related symptoms, and quality of life in patients with cancer cachexia. Some traditional Chinese herbs may have superiority in curative effects and safety, compared with progestins. Interestingly, acupuncture can improve appetite, nausea, constipation, and quality of life among patients with cancer cachexia but cannot increase body weight. However, high-quality evidence regarding the effect of TCM technologies in treating cancer cachexia is limited. It would be beneficial to explore the use of moxibustion and other TCM technologies in future studies.
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The Role of Nurse in the Multidisciplinary Management of Cancer Cachexia p. 487
Yiyuan Zhao, Dong Pang, Yuhan Lu
DOI:10.4103/apjon.apjon-2123  
Cancer cachexia is a complex syndrome for which multidisciplinary management through collaboration has the potential to improve patient outcomes and efficiency of care, through the integration of nursing into practice. These authors conducted a literature review of PubMed, EBSCO, OVID, and ProQuest for publications on the roles and responsibilities of nurses who are working in multidisciplinary teams for the management of cancer cachexia. We limited our search parameters for the literature review such that: (1) the included papers were published in the English language from January 2000 to February 2021 and (2) the included papers featured an adult patient population. Based on this review, cancer cachexia can be characterized as an involuntary loss of body weight that is combined with a dysregulation in the control of energy homeostasis and protein loss, which leads to poor clinical outcomes in patients. Cancer cachexia has been recognized as having multidimensional etiologies that are related to the nutritional and metabolic systems, as well as other physical and physiological systems, and to symptoms that manifest concurrently to the cachexia. While the clinical identification and taxonomic classification of cancer cachexia are usually associated with an observable degree of weight loss and muscular atrophy in a patient, clinical evidence of inflammation and related symptoms should be considered (in addition to the weight loss and muscular atrophy) in the diagnosis and evaluation of cancer cachexia, as will be argued in this paper. Early diagnosis, appropriate clinical assessment, and evaluation of cancer cachexia are crucial to predicting the onset of the condition and managing its symptoms when it occurs. Various tools have been developed for the clinical evaluation and diagnosis of cancer cachexia which reflect the multitudinous manifestations of the condition. Due to the diversity of its manifestations, multimodal therapy has gained popularity for the management of cancer cachexia. Multimodal therapy includes combined pharmacologic intervention, nutrition supplements, nutritional consultation, physical exercise, and symptom control. As these authors will demonstrate in this paper, this mode of multidisciplinary team management is increasingly supported by scientific evidence and as such, can be seen as essential for high-quality cancer cachexia management. Nursing plays an important role in the multidisciplinary care team model for cancer cachexia management, as nurses are well situated to perform screening, referral, coordination, nutritional consultation, physical exercise consultation, direct nutritional nursing, psychosocial support, symptom control, and hospice care. However, an increased focus on education, skills training, and tool development (as well as adoption of tools) on the part of nurses and other multidisciplinary team members is required to meet the goal of efficient care and improved outcomes for patients with cancer cachexia. These authors demonstrate that increasing roles and responsibilities for nurses in the management of cancer cachexia is a valuable area to explore in the literature and to implement in clinical practice. Our review aims to summarize the etiology and epidemiology, mechanisms-of-action, and multitudinous manifestations of cancer cachexia, the therapies that are used in cancer cachexia care and the management approaches by which this care is organized. Finally, these authors emphasize nurses' responsibilities in this mode of cancer cachexia multidisciplinary team management, which represents a fruitful benefit both in the research literature and in clinical settings.
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Barriers in Nursing Practice in Cancer Cachexia: A Scoping Review p. 498
Rika Sato, Tateaki Naito, Naoko Hayashi
DOI:10.4103/apjon.apjon-2152  
This scoping review aims to identify the barriers in practice and clinical trials for oncology nurses in cancer cachexia. We used the framework proposed by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Studies written in English and published between 2008 and 2021 were retrieved from five databases: MEDLINE, Cochrane Library, CINAHL, PsycINFO, and EMBASE. A total of 1075 studies were identified, and 34 full-text studies were assessed for eligibility by three researchers. Seventeen studies met the inclusion criteria. This review revealed several barriers to nursing practice and clinical trials in cancer cachexia. First, health-care professionals, including nurses, faced individual barriers (insufficient understanding and skills for diagnosis and management) and environmental barriers (lack of standardized screening tools or treatment options, difficulties in collaboration with other professions, and limited human resources) in practice. Second, studies on nurse-led interventions for cancer cachexia were relatively few and different in objectives, making it challenging to integrate the outcomes. Finally, there were no established educational programs for nurses that explicitly focused on cancer cachexia. This scoping review revealed individual and environmental barriers in nursing practice. In addition, there have relatively few clinical trials involving oncology nurses in cancer cachexia. Continuing education for nurses should cover cancer cachexia to improve the quality of oncology care in the future. It is also necessary to standardize practical assessment tools that are easy to assess daily and lead to interventions and develop nurse-led multidisciplinary care.
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Revisiting Cancer Cachexia: Pathogenesis, Diagnosis, and Current Treatment Approaches p. 508
Mudasir Rashid Baba, Sajad Ahmad Buch
DOI:10.4103/apjon.apjon-2126  
The objective of this article is to group together various management strategies and to highlight the recent treatment modifications that attempt to target the multimodal etiological factors involved in cancer cachexia. The contemporary role of nursing fraternity in psychosocial and nutritional assessment of cancer patients is briefly discussed. Cachexia is a syndrome of metabolic disturbance, characterized by the inflammation and loss of muscle with or without loss of adipose tissue. In cancer cachexia, a multifaceted condition, patients suffer from loss of body weight that leads to a negative impact on the quality of life and survival of the patients. The main cancers associated with cachexia are that of pancreas, stomach, lung, esophagus, liver, and that of bowel. The changes include increased proteolysis, lipolysis, insulin resistance, high energy expenditure, and reduced intake of food, all leading to impaired response to different treatments. There is no standardized treatment for cancer cachexia that can stabilize or reverse this complex metabolic disorder at present. The mainstay of cancer cachexia therapy remains to be sufficient nutritional supplements with on-going efforts to explore the drugs that target heightened catabolic processes and complex inflammation. There is a need to develop a multimodal treatment approach combining pharmacology, exercise program, and nutritional support to target anorexia and the severe metabolic changes encountered in cancer cachexia.
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Oral Equilibrium in Cachexia p. 519
Deepthi Darwin, Renita Lorina Castelino, Gogineni Subhas Babu, Mohamed Faizal Asan, Anand Shankar Sarkar, Soundarya Shaktivel
DOI:10.4103/apjon.apjon-2139  
Oral cancer, a part of head-and-neck cancer (HNC), is associated with a high risk of cancer-associated weight loss causing cachexia which is still an understudied illness. Cachexia is a host-phagocytic syndrome caused by the multiple factors, resulting in the severity of heterogenic fashion. For the current review, a bibliographic search was done in PubMed and other databases for the English articles published from the year 1980 to 2021. Recent studies have revealed that cachexia associated with 35%–60% of all the oral cancer patients is either due to the implication of the tumor or obstruction of food intake for which a strong need for nutritional assistance and hydration is desired. The health of cancer individuals undergoing chemotherapy or bone marrow transplant is negatively affected by poor oral health and reduced dentition status. The impact of a deficient oral condition is not clearly understood to date, possibly due to the limited number of studies and a lack of widely accepted clinical trials to prevent cachexia. The masticatory function of such patients is drastically affected thus contributing to the decreased nutritional status causing wasting of tissues. The aim of this article is to provide substantial evidence that poor oral hygiene with an altered dentition status negatively influences the energy balance of oral cancer patients who experience wasting.
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Understanding Cachexia in Head and Neck Cancer p. 527
Sivaramakrishnan Muthanandam, Jananni Muthu
DOI:10.4103/apjon.apjon-2145  
One of the major comorbidities of cancer and cancer therapy is posing a global health problem in cancer cachexia. Cancer cachexia is now considered a multifactorial syndrome that presents with drastic loss of body weight, anorexia, asthenia, and anemia. Head and neck cancer (HNC) patients are at a greater risk for development and severity of cachexia syndrome as there is direct involvement of structures associated with nutritional intake. Yet, the scientific evidence, approach, and management of cachexia in HNCs are yet to be largely explored. The article aims to succinctly review the concepts of cancer cachexia with relevance to HNCs and summarizes the current findings from recent research.
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Role of Complementary and Alternative Medicine in the Management of Cancer Cachexia p. 539
Abhishek Shankar, Deepak Saini, Shubham Roy, Sachidanand Jee Bharati, Seema Mishra, Pritanjali Singh
DOI:10.4103/apjon.apjon-2149  
Cancer cachexia is an important concern in cancer patients in view of advanced stage at presentation. The treatment goal for cachexia is the reversal of the loss of body weight and muscle mass with a variety of pharmacological agents. Various treatment guidelines focus on patients with advanced cancer who are likely to suffer from refractory cachexia. There is a paucity of data on research directed to cancer cachexia on cancer patients. Complementary and alternative medicines (CAMs) are widely use at some or other point of time by the majority of cancer patients in spite of little or no evidence to support that. There are many CAM which have been tried in different set up for cancer cachexia. These medicines are well accepted in view of lesser side effects and easy to use. There is a need for more randomized controlled trials with larger sample size with longer follow-up to generate more evidence in support to the use of CAM in cancer and cancer cachexia.
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ORIGINAL ARTICLE Top

Relationship of Cachexia with Self-Care Agency and Quality of Life in Cancer Patients: The Case of Turkey p. 547
Hatice Demirag, Nurşen Kulakaç, Sevilay Hintistan, Dilek Çilingir
DOI:10.4103/apjon.apjon-2135  
Objective: This study aims to determine the effects of cachexia, causing major problems in the world and Turkey, on self-care agency and quality of life in cancer patients. Methods: The population of this cross-sectional and relationship-seeking study consisted of cancer patients in Turkey from April 1 to April 20, 2021. Using the snowball sampling method, 174 patients were sampled. “Patient Information Form,” “The European Organization for Research and Treatment of Cancer C30 Cancer Quality of Life Scale,” and “Exercise of Self-Care Agency Scale” were used as data collection tools. Results: In the study, 52 patients (29.9%) were found to have cachexia. Function, general well-being, symptom (except insomnia), and self-care agency, which are subdimensions of the quality-of-life scale, were found to be significantly lower in patients with cachexia than patients without cachexia (P < 0.001). It was determined that there was a significant negative correlation between the cachexia status of the patients and the five basic functions in the functional scale (physical, role, emotional, cognitive, and social function), general well-being, and self-care agency, and there was a significant positive correlation between the cachexia status of the patients and the symptom scale (P < 0.001). According to the results of multiple linear regression analysis, it was found that the factor that significantly affected the cachexia status of the patients was their self-care agency (P < 0.001). Conclusions: It was determined that cachexia caused significantly lower self-care agency and quality of life in cancer patients. Furthermore, quality of life was related to self-care agency.
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NON CANCER CACHEXIA PAPERS - PERSPECTIVE Top

Empowering Oncology Nurses through Knowledge and Practice to Improve Transitions Following Treatment and Survivorship Care p. 555
Linda Watson, Christine Maheu, Sarah Champ, Margaret I Fitch
DOI:10.4103/apjon.apjon-215  
Following cancer treatment, individuals can be left with physical, emotional, and practical consequences which influence their quality of life. Cancer survivors frequently require added knowledge and skills to handle the demands of everyday living after treatment. Oncology nurses are in an ideal position to address the needs of cancer survivors. This article describes an online interactive workshop for oncology nurses to introduce Canadian data on unmet needs of cancer survivors, highlight the contribution oncology nurses can make to survivorship care, and introduce a self-learning resource for survivor care. Didactic presentations and small group discussions were used and feedback from participants was positive. Online learning can be an effective approach for learning with international nursing colleagues and could be utilized for nurses with limited access to cancer nursing education.
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NON CANCER CACHEXIA PAPERS - ORIGINAL ARTICLES Top

Husband Support Mediates the Association between Self-Efficacy and Cervical Cancer Screening among Women in the Rural Area of Indonesia p. 560
Juwitasari , Ririn Harini, Achmad Ainur Rosyad
DOI:10.4103/apjon.apjon-2085  
Objective: Standard cervical cancer screening is seen as the most efficient way of preventing cases of cervical cancer. This study aimed to test indirect husband support pathways and the use of self-efficacy and Visual Inspection with Acetic Acid (VIA) testing among women in Indonesian rural areas. Methods: The research implemented a cross-sectional design carried out in East Java, Indonesia, a remote county. The inclusion criteria were women between the ages of 30 and 50 years, married or women having experienced of having sexual intercourse, have been utilized VIA test at least 3 years ago. The Self-Efficacy Scale and the Husband Help Survey were used to test the interest variable. A structural equation modeling was used to assess the relationship between husband help and VIA test self-efficacy. Results: The study was followed by a total of 219 respondents. Women's mean age was 33.03 years (standard deviation [SD]: 6.44), and the mean age for the husband was 37.51 (SD: 7.45). Just 7.31% had a year ago VIA test, and most (65.75%) had a VIA test within 4 years. A husband's help had the greatest direct impact on the use of Papanicolaou tests, with a 0.312 direction coefficient (P < 0.001). The mediator between the husband's help and the use of VIA tests was self-efficacy (standardized coefficients of the path: 0.123, P < 0.001). Conclusions: Our analysis revealed a route through which husband help influences the use of VIA tests among women in Indonesian rural areas. Providers must consider the effect of husband support on VIA testing in promoting the use of VIA tests among females in Indonesia. One potential communication approach is that providers make improvements to improve the use of VIA tests in supporting self-efficacy.
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Unmet Supportive Care Needs of Jordanian Patients with Colorectal Cancer: A Cross-Sectional Survey p. 565
Raya Yousef Al-Husban, Rana Obeidat, Omar Shamieh
DOI:10.4103/apjon.apjon-2110  
Objective: Colorectal cancer (CRC) is ranked the second most common cancer diagnosed in both men and women in Jordan. This paper aims to explore the unmet supportive care needs (USCNs), and their predictors among Jordanian survivors with CRC. Methods: A cross-sectional descriptive correlational research design with a convenience sample of 180 patients with CRC was conducted. Participants completed the Supportive Care Needs Survey-Short Form 34. Results: Jordanian patients with CRC reported their highest perceived level of need in the information and psychological domains. Multiple linear regression revealed that income and the number of chemotherapy sessions were significant predictors in the physical and daily living domains. Age, type of surgical treatment, and type of clinical setting were significant predictors of USCN in the psychological, patient care and support, and the health system and information domains. Conclusions: The health-care systems should work to meet all the supportive care needs for patients with CRC, particularly the informational and psychological needs domains where patients express unmet needs. Special care should be given according to age, type of surgery, and the doses of chemotherapy received. This study further confirms a disparity in the care and support provided to Jordanian cancer patients with different health-care settings in the country.
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Effect of Postsurgical Nurse-led Follow-ups on Quality of Life in Head-and-Neck Cancer Patients: A Pilot Randomized Controlled Trial p. 573
Garima Khantwal, Suresh K Sharma, Ruchika Rani, SP Agarwal
DOI:10.4103/apjon.apjon-2112  
Objective: Burden of head-and-neck cancer is disproportionately bigger in India and can be regarded as “tip of iceberg” situation. Postoperatively, head-and-neck cancer patients report tremendous challenges conversely, affects quality of their life. Oncology nurses contribute significantly in supportive care issues encountered by patients in the postoperative period. However, there is a paucity of the literature on effect of nurse-led postsurgical education program on quality of life (QOL) of head-and-neck cancer patients. Methods: In this pilot randomized controlled, parallel group trial, 64 head-and-neck cancer patients; who were electively planned for surgery were randomized in experimental (n1 = 32) and control group (n2 = 32). In the experimental group, participants received structured nurse-led postsurgical education program through virtual mode and control group participants received standard of care. The QOL as an outcome variable was assessed through face-to-face interview at baseline on first postoperative day and postoperative day-4, 15, and 30 follow-ups by using standardized instruments, i.e., EORTC QLQ-C30 and H and N35 questionnaire. Results: The experimental group had a significant improvement in global health (P = 0.02), role functioning (P = 0.02), emotional functioning (P = 0.01), swallowing (P = 0.01), and opening mouth (P = 0.02). Postoperative pain and speech problems were most distressing symptoms in participants of both groups. Conclusions: The nurse-led postsurgical virtual education programme was found effective to improve the selected domains of QOL and may be used as an adjuvant intervention for head-and-neck cancer patients.
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NON CANCER CACHEXIA PAPERS - CASE REPORTS Top

Nursing of a Non-Hodgkin's Lymphoma Patient with a Facial Malignant Fungating Wound p. 581
Miaoning You, Shiyi Zhang, Xiaoxiao Ma, Huimin Liu, Yuhan Lu, Yue Li
DOI:10.4103/apjon.apjon-2119  
Malignant fungating wounds are severe skin lesions caused by any primary tumor, causing patient suffering and disturbing their family members. In this article, we summarize the experience of nursing a patient with non-Hodgkin's lymphoma complicated with a facial malignant wound. Initially, a chemotherapy regimen was formulated as the main treatment for the patient. Throughout the patient's treatment course, we evaluated the patient holistically, conducting debridement, anti-infection, and drainage management under the guidance of moist wound healing. Throughout the entire process, psychological nursing and health education were provided to the patient and family. Eventually, the patient's wound symptoms were well controlled, and the wound healed completely.
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Maintenance Therapy with Pembrolizumab after Platinum-Doublet Chemotherapy Leading to Hyperprogression in a Patient with Metastatic Bladder Cancer p. 586
Yangchun Gu, Huiying He, Mopei Wang
DOI:10.4103/apjon.apjon-2142  
The anti-programmed cell death receptor 1 (anti-PD-1) immunotherapy has been recommended in several treatment scenarios of metastatic urothelial cancer (UC), including as a maintenance therapy after first-line chemotherapy. However, the PD-1 inhibitor accelerates tumor growth occasionally, causing hyperprogressive disease (HPD). We presented here a case of HPD in a 43-year-old male Chinese patient with bladder UC, metastasizing to liver and bone, and harboring amplification of Murine Double Minute gene 2, cyclin-dependent kinase 4, fibroblast growth factor receptor substrate 2, ERBB3, and Enhancer of Zeste Homolog 2. After achieving partial remission with the traditional platinum doublet chemotherapy, he sought PD-1 inhibitor (pembrolizumab) for maintenance therapy in another hospital. After 3 doses of pembrolizumab in <2 months, his liver metastasis dramatically increased both in size and number. Liver biopsy confirmed genuine progression. He died from liver failure 6 months later. This case alerted us about HPD again in the scenario of maintenance therapy, enhanced the importance of selecting appropriate patients.
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