Ping-Chi Liu

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) exacerbations affect health and mortality, yet current risk assessments based on previous events have limitations and are less preventative. This study used metabolomics to assess if amino acid profiles are linked to higher COPD exacerbation risk, compared to an amino acid-based panel to standard risk stratification methods, and explored its clinical decision-making and prevention potential. Methods: This prospective cohort study measured plasma concentrations of 19 amino acids in 88 individuals with COPD using ultra-performance liquid chromatography. Participants were observed for 2.5 years to track occurrences of moderate and severe COPD exacerbations. Results: During follow-up, 44 participants (50%) had an exacerbation. Tyrosine and hsCRP were independently linked to exacerbations in multivariable analysis and formed the basis of the “COPDAE score.” This score independently predicted future exacerbations after adjusting for Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications. A COPDAE score above 1.73 correlated with lower event-free survival in several subgroups: GOLD group A (log-rank = 13.7, p < 0.001), groups A and B (log-rank = 5.0, p = 0.025), and groups A and C (log-rank = 15.2, p < 0.001). Conclusions: Tyrosine and hsCRP together form a biomarker panel to assess and stratify COPD exacerbation risk. This score can help identify stable patients at risk, even with mild symptoms or few prior events, enabling earlier, more personalized interventions.

Real-world clinical experience of using anti-programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs) combined with chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer (SCLC) patients has rarely been reported. In this study, we aimed to perform a retrospective multicenter clinical analysis of extensive-stage SCLC patients receiving first-line therapy with anti-PD-L1 ICIs combined with chemotherapy. Between November 2018 and March 2022, 72 extensive-stage SCLC patients receiving first-line atezolizumab or durvalumab in combination with chemotherapy, according to the cancer center databases of Linkou, Chiayi, and Kaohsiung Chang Gung Memorial Hospitals, were retrospectively included in the analysis. Twenty-one patients (29.2%) received atezolizumab and fifty-one (70.8%) received durvalumab. Objective response (OR) and disease control (DC) rates of 59.7% and 73.6%, respectively, were observed with first-line ICI plus chemotherapy. The median progression-free survival (PFS) was 6.63 months (95% confidence interval (CI), 5.25–8.02), and the median overall survival (OS) was 16.07 months (95% CI, 15.12–17.0) in all study patients. A high neutrophil-to-lymphocyte ratio (NLR; >4) and a high serum lactate dehydrogenase (LDH) concentration (>260 UL) were identified as independent unfavorable factors associated with shorter OS in the multivariate analysis. Regarding safety, neutropenia was the most common grade 3 treatment-related adverse event (AE), but no treatment-related deaths occurred in the study patients. First-line anti-PD-L1 ICIs combined with chemotherapy are effective and safe for male extensive-stage SCLC patients. Further therapeutic strategies may need to be developed for patients with unfavorable outcomes (e.g., baseline high NLR and serum LDH level).