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Clinical Practice Points • Immune checkpoint inhibitors (ICIs) are associated with the development of unique immune-related adverse events (irAEs), which emerged primarily during post-marketing surveillance. Oral irAEs have already been reported, with the most common manifestations being mucositis and xerostomia. It has been suggested that a T-cell activation, similar to that observed in autoimmune conditions, may play a role. • Here, we report a case of black hairy tongue (BHT) in a patient receiving first-line pembrolizumab for advanced non–small-cell lung cancer (NSCLC). Although the BHT was symptomatic for burning mouth and dysgeusia, ICI use was continued due to its clinical and radiological benefit, which persisted for a long time. • BHT is characterized by hypertrophy and lengthening of the filiform papillae. Despite being a rare benign condition, it can often result in a significant burden on quality of life. • Many predisposing factors have been described, and cancer patients represent a population particularly at risk. Based on the temporal association and excluding possible alternative causes, we proposed that, in our patient, BHT was likely ICI related through the development of xerostomia, which represents a key factor in BHT pathogenesis. • To the best of our knowledge, this is the first report of BHT after ICI use, suggesting that it may represent an atypical oral irAE. To date, the oral irAEs have not been well explored, and further studies are needed to elucidate the underlying mechanisms and possible associations with anti-tumor responses, with significant implications on prognosis and quality of life. In the present context, our case emphasizes the need to remain vigilant for atypical and new irAEs.

We are witnessing a silent revolution in the treatment of early stage non-small cell lung cancer (NSCLC), with a series of practice-changing clinical trials enriching the therapeutic perspectives of lung cancer patients with potentially curable disease. The ADAURA study marked the advent of precision medicine and biomarker testing to the early stages setting. The IMPower-010 trial interrupted the negative trend of adjuvant lung cancer immunotherapy, paving the way to the application of immune-checkpoint inhibition in the resected disease. The ITACA trial definitively established no role for tailored adjuvant chemotherapy in NSCLC, while the Lung Art data questioned the efficacy of post-operative radiotherapy for pN2 resected disease. Growing evidence is supporting MRD as effective adjuvant prognostic biomarker to stratify disease's recurrence risk after radical interventions and select best candidates to the adjuvant strategies. This work summarizes the recent major breakthroughs in lung cancer adjuvant treatment, and provides a snapshot of the current real-world scenario, discussing the upcoming challenges and opportunities featuring the clinical management of early stage NSCLC patients.

Four different types of "focaccia" (Italian flat bread) prepared with the same dough and the same extra virgin olive oil but with different seasonings, were analyzed. Lipids were extracted from each sample using the Folch method. The indices commonly used to assess oil quality, the amounts of trans fatty acids and compounds of triglyceride polymerization, oxidation and hydrolysis, were determined in all the samples to better assess the degree of oxidation and hydrolysis of the oils. The findings showed that, once baked, the oil sampled from the different types of focaccias could not be included in the virgin category. The level of oxidation of the baked samples was greater than that in the uncooked oil. However the results obtained showed that the level of degradation of the extracted oils was lower than that found in edible refined oils and it seemed to be influenced by the topping used to flavour the focaccias. © 2007 Elsevier Ltd. All rights reserved.

Olives (Olea europaea cv. Coratina) used for oil production were stored for 30 days at three different temperatures and under different atmospheres (ambient temperature, 5 °C with a flux of humidified air, 5 °C with a flux of 3%O2 + 5%CO2). The olives were kept in jars used for fruit storage, each with a capacity for 1.5 kg of olives. Conventional analyses (acidity, peroxide value, specific extinction coefficient at 232 nm and 270 nm) and non conventional (polar compounds) analyses were carried out in order to measure the hydrolytic and oxidative degradation of the oils obtained from the olives. Storage at 5 °C, both under a flow of humidified air and a flow of 3%O2 + 5%CO2, produced oils that maintained their initial chemical qualities until the end of the experimentation; whereas storage of olives at room temperature led to their deterioration after 15 days of storage.

Forty olive oil samples (refined olive oil plus virgin olive oil) were tested to check the possibility of using recent non-conventional analytical parameters to assess quality. The routine analyses prescribed by the EEC Reg. No 2568/91 and subsequent extensions were carried out on all samples. The analytical techniques used included silica gel column chromatography for the separation of polar compounds from oil, and their subsequent high performance size-exclusion chromatography (HPSEC) analysis to quantify the oxidation, polymerisation and hydrolysis product classes. Based on the results obtained, it seems logical to use the percent oligopolymer content to measure the level of oxidation in commercial class olive oil. The diglyceride level can provide information about the extent of hydrolytic degradation.

Aim: FOLFIRINOX represents an active regimen in first-line treatment of advanced pancreatic adenocarcinoma (PDAC) patients (pts) with good performance status (PS). Currently, there are no accepted standard regimens in second-line therapy for patients with disease progression and data about efficacy of chemotherapy after FOLFIRINOX failure are lacking. Methods: We retrospectively investigated clinical and laboratory characteristics (including blood count, LDH, CEA and CA19.9) of PDAC pts treated between June 2011 and April 2014 in four Italian institutions with either doublet or single agent as second-line therapy after FOLFIRINOX failure. Survival estimates were quantified using Kaplan Meier curves, and differences between groups were compared with the log-rank test. Results: Among 96 pts treated with FOLFIRINOX as first-line chemotherapy, 50 pts received second-line treatment (52%). Median age at diagnosis was 60 years (range 36-76); 66 pts were males (72%). PDAC was locally advanced in 15 (30%) and metastatic in 35 pts (70%). Patients who received second line single agent (gemcitabine, docetaxel or nab-paclitaxel) or doublets (gemcitabine with either abraxane, capecitabine, cisplatin or docetaxel) were 24 (48%) and 26 (52%), respectively. According to RECIST criteria, 2 pts achieved PR (4%), 10 (20%) SD for ≥9 wks and 38 (76%) PD. Median progression-free survival (PFS) was 2.7 months and median overall survival (OS) was 3.4 months. No differences were found in terms of OS (5.0 vs 3.1, p = 0.489) or PFS (4.0 vs 2.7 p = 0.182) between patients treated with single-agent or doublets as second-line. At multivariate analysis, ECOG ≥ 2 was the only independent prognostic factor for worst OS (p = 0.002) and PFS (p = 0.020). Conclusions: Our findings suggest that the choice of second line therapy in patients treated with first-line FOLFIRINOX should be carefully evaluated. ECOG ≥ 2 was significantly associated with poor prognosis, while pre-treatment CA 19-9, LDH, Hb, neutrophil and platelet counts were not prognostic factors for OS, although these data should be confirmed in perspective studies. Disclosure: All authors have declared no conflicts of interest.