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The oral problems of 24 cancer patients on immunotherapy between 2017–2022 and referred by their oncologists, were reported. The age range was 49–80 years, and the median was 64 years. Lung cancer was the most common disease. Three patients a had history of autoimmune disease prior to cancer diagnosis. Patients received immunotherapy for two to 48 months. Prior to immunotherapy, 17 patients received cytotoxic chemotherapy, five angiogenesis inhibitors and one1 radiotherapy to head/neck. During immunotherapy, four patients received chemotherapy, one received bevacizumab, and eight received bone targeting agents, either alone or in combination. Presenting symptoms were oral pain (18 patients, 75%), dental pain (five patients), xerostomia (five patients), burning/itching (seven patients), bleeding (three patients), swelling (three patients), and taste problems (dysgeusia) (three patients). One patient was asymptomatic. Immune-related lesions were observed in 15 patients (62.50%), of which three were exacerbations of prior autoimmune disease. Three patients reported severe deterioration and itching after using a mouthwash. We also observed six (25%) infections (four candidiasis and two herpes simplex), and six (25.00%) cases of medication-related osteonecrosis of the jaw (MRONJ). Five of those MRONJ cases developed among the eight patients with the administration of bone targeting agents and one in a patient with bevacizumab. Two patients presented with more than one lesion. In conclusion, immune-related lesions were most common; oral infections and MRONJ were also observed. Various oral complications might be related to the interplay between immunotherapy and other therapies prior or concurrent to immunotherapy.

Abstract Background Tumor molecular profile analysis by Next Generation Sequencing technology is currently widely applied in clinical practice and has enabled the detection of predictive biomarkers of response to targeted treatment. In parallel with targeted therapies, immunotherapies are also evolving, revolutionizing cancer therapy, with Programmed Death-ligand 1 (PD-L1), Microsatellite instability (MSI), and Tumor Mutational Burden (TMB) analysis being the biomarkers employed most commonly. Methods In the present study, tumor molecular profile analysis was performed using a 161 gene NGS panel, containing the majority of clinically significant genes for cancer treatment selection. A variety of tumor types have been analyzed, including aggressive and hard to treat cancers such as pancreatic cancer. Besides, the clinical utility of immunotherapy biomarkers (TMB, MSI, PD-L1), was also studied. Results Molecular profile analysis was conducted in 610 cancer patients, while in 393 of them a at least one biomarker for immunotherapy response was requested. An actionable alteration was detected in 77.87% of the patients. 54.75% of them received information related to on-label or off-label treatment (Tiers 1A.1, 1A.2, 2B, and 2C.1) and 21.31% received a variant that could be used for clinical trial inclusion. The addition to immunotherapy biomarker to targeted biomarkers’ analysis in 191 cases increased the number of patients with an on-label treatment recommendation by 22.92%, while an option for on-label or off-label treatment was provided in 71.35% of the cases. Conclusions Tumor molecular profile analysis using NGS is a first-tier method for a variety of tumor types and provides important information for decision making in the treatment of cancer patients. Importantly, simultaneous analysis for targeted therapy and immunotherapy biomarkers could lead to better tumor characterization and offer actionable information in the majority of patients. Furthermore, our data suggest that one in two patients may be eligible for on-label ICI treatment based on biomarker analysis. However, appropriate interpretation of results from such analysis is essential for implementation in clinical practice and accurate refinement of treatment strategy.

Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT). Methods. Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50–52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed. Results. All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months. Conclusion. 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies.