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Researchers have performed numerous studies on immunotherapy because of the high death rate associated with gastric cancer (GC). GC immunotherapy research has made tremendous progress, and we wanted to provide an update on this topic. On the basis of this update, we suggest performing a new medical evaluation before initiating immunotherapy in patients with GC to increase the success rate of immunotherapies. We propose that before patients start GC immunotherapy, they should be evaluated and given a score of one to two points for the following factors: immunopathological features, molecular and genomic features, potential consequences for bacterial pathogens, potential immunotherapeutic resistance and hyperprogressive illness, and the potential to use biomarkers to gauge their prognosis and immunotherapy responses to optimize immunotherapy following surgery. The proposed scoring system could also help in the diagnosis of GC. With all the advances in genetics, immunology, and microbiology, the diagnosis of GC could be improved, not changed. Currently, patients diagnosed with GC undergo surgical resection as the only permanent solution. Patients who meet the maximum score from the presented proposal could be eligible immediately after diagnosis for immunotherapy. Therefore, immunotherapy could be a first-line option for clinicians. [ABSTRACT FROM AUTHOR]

Simple Summary: The incidence of gastric cancer (GC) is increasing. Many people receive an advanced diagnosis of GC. Furthermore, a large number of patients are surgically inoperable and are unresponsive to preoperative chemotherapy. Patients with GC do not currently have an immunotherapy option. Our study's objective was to provide insight into extracellular vesicles (EVs) and GC. EVs in GC can be studied, as this article explains. EVs screening, which is available for all patients, is an option for combatting GC. Extracellular vesicles, or EVs, are membrane-bound nanocompartments produced by tumor cells. EVs carry proteins and nucleic acids from host cells to target cells, where they can transfer lipids, proteomes, and genetic material to change the function of target cells. EVs serve as reservoirs for mobile cellular signals. The collection of EVs using less invasive processes has piqued the interest of many researchers. Exosomes carry substances that can suppress the immune system. If the results of exosome screening are negative, immunotherapy will be beneficial for GC patients. In this study, we provide an update on EVs and GC based on ongoing review papers and clinical trials. [ABSTRACT FROM AUTHOR]

Many studies on gastric cancer treatment have identified predictors of immunotherapy benefits. This article provides an update on the major developments in research related to predictive factors of immunotherapy for gastric cancer. We used the search term "predictive factors, immunotherapy, gastric cancer" to find the most current publications in the PubMed database related to predictive factors of immunotherapy in gastric cancer. Programmed cell death, genetic, and immunological factors are the main study topics of immunotherapy's predictive factors in gastric cancer. Other preventive factors for immunotherapy in gastric cancer were also found, including clinical factors, tumor microenvironment factors, imaging factors, and extracellular factors. Since there is currently no effective treatment for gastric cancer, we strongly propose that these studies be prioritized. [ABSTRACT FROM AUTHOR]

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Fluoropyrimidines remain some of the most used chemotherapeutics, despite the appearance in the therapeutic arsenal of targeted therapy and immunotherapy. Fluropyrimidines related cardiotoxicity is an undesirable adverse event and affects almost 20% of patients. The mechanisms of fluoropyrimidine toxicity are closely related to deficient allelic variants of DPYD, but considering the low penetrance and interindividual variability, not all adverse reactions are explained by their presence. In this case, we report a patient with recurrent fluoropyrimidine toxicity without a deficient allelic variant and how this case was managed by the oncologist and cardiologist, considering the need to use fluoropyrimidine in the treatment. [ABSTRACT FROM AUTHOR]

COVID‐19 can present with a variety of clinical features, ranging from asymptomatic or mild respiratory symptoms to fulminant acute respiratory distress syndrome (ARDS) depending on the host's immune responses and the extent of the associated pathologies. This implies that several measures need to be taken to limit severely impairing symptoms caused by viral‐induced pathology in vital organs. Opioids are most exploited for their analgesic effects but their usage in the palliation of dyspnoea, immunomodulation and lysosomotropism may represent potential usages of opioids in COVID‐19. Here, we describe the mechanisms involved in each of these potential usages, highlighting the benefits of using opioids in the treatment of ARDS from SARS‐CoV‐2 infection. [ABSTRACT FROM AUTHOR]

Introduction: Among diseases, cancer has the second highest mortality rate worldwide. Among cancers, colorectal cancer (CRC) is the third most diagnosed cancer and the second most common cause of cancer-related deaths worldwide. Hereditary non-polyposis CRC syndrome or Lynch syndrome (LS) accounts for 1%-3% of all CRC diagnoses. Knowledge of genetic susceptibility and a better understanding of the genotype/phenotype relationship in patients with LS is leading to more individualized surveillance recommendations. The aim of this paper is to emphasize the importance of genetic testing in the diagnostic process of hereditary CRCs, especially Lynch syndrome. Case Report: The present paper is a case report of a 55-year-old male patient who was diagnosed with synchronous CRC, presenting two different types of cancer appeared independently. One of the tumours was located proximally, at the level of transverse colon: a 5/4 cm cribriform adenocarcinoma pT3N0(0/15)M1aL0V1Pn0Ro stage IVA, the other one distally, at the level of sigmoid colon: a 7/6 cm mucinous adenocarcinoma pT3N2a(5+/18)M0L0V0Pn0Ro stage IIIB. The patient presented a 1.7/1/0.5 cm metastasis in the liver originated from the proximal tumour. Initially, a left hemicolectomy was performed. The immunohistochemical (IHC) profile, taken three weeks after the diagnosis, showed microsatellite instability with positive test for MLH1, PMS2 and MSH6 and Lynch syndrome was suspected. Repeated IHC test after six months showed positive test also for gene PMS2 which confirmed diagnosis of Lynch syndrome. Treatment included alternating different types of chemotherapy medicines and constant administration of Bevacizumab. Tumour markers decreased in a year: CA 19-9 from 106.5 U/ml to 59.13 U/ml and CEA from 74.76 U/ml to 29.08 U/ml. Pulmonary affection was observed due to treatment. Liver metastasectomy was performed. After two years the patient had cancer recurrence. Discussions : Molecular profiling of patients with LS has been shown to guide targeted therapies, such as immunotherapy. We mention that definitive surgical treatment for patients with LS is total colectomy which reduces the appearance of metachronous tumours. Specialists involved in the care of patients with CRC should be familiar with the main hereditary cancer syndromes and refer patients to specialized cancer genetic units for adequate genetic counseling. Conclusions: In conclusion, genetic testing has a key role in identification and management of patients with LS and other hereditary CRCs. Although hereditary CRCs represent a small part of CRC syndromes, healthcare providers should be conscious about them and the importance of their early diagnosis. [ABSTRACT FROM AUTHOR]

Aim. The principle aim is to investigate the relationship between psychological distress, pain syndrome and clinical features in colorectal cancer patients. Methods. The study assessed forty-nine patients undergoing chemotherapy from Cancer Institute “Ion Chiricuta” Cluj-Napoca admitted between 2016 and 2017 with locally advanced or metastatic colorectal cancer. For each patient, pain intensity was evaluated using a visual analogue scale, whereas depression and anxiety levels were evaluated using Beck Depression and State-Trait Anxiety Inventories. All evaluations were determined at their first presentation in the hospital before treatment initiation. Correlations between demographic characteristics, pain evaluation and mental disorders were realized using Chi-squared tests (χ2) and Spearman’s rho. Results. Pain was observed in 76% of patients, 54% of whom had moderate to increased pain. Twenty-nine percent of patients presented with nociceptive pain, whereas 20% had neuropathic pain. In 27% of patients, the pain was mixed. Depression was moderate to severe in 53% of patients, and high levels of anxiety were found in 24% of patients. Levels of anxiety and depression did not correlate with demographic characteristics. There were correlations between the pain type and its level. Neuropathic pain correlated with moderate pain, while mixed pain was correlated with intense pain (p=0.0003). Tumor site was correlated with level of anxiety: colorectal cancer was associated with mild anxiety, rectal cancer was associated with moderate anxiety, and patients with anal canal cancer presented increased anxiety (p=0.026). Conclusion. High pain frequency is associated with high anxiety and depression levels in colorectal cancer patients. Pain intensity is correlated with pain type, while psychological disorders are correlated with tumor site. [ABSTRACT FROM AUTHOR]

Case presentation. This report details the case of a 35-year-old male patient who sought medical attention in June 2023 due to an irregular skin lesion on his right thigh. Following a clinical evaluation, the patient underwent surgery. A sentinel node biopsy confirmed lymph node metastasis of melanoma, and tumor DNA testing detected a mutation in the BRAF V600E gene. Consequently, the patient received a diagnosis of BRAF-positive malignant melanoma, classified as pT4bN1aL1Pn0R0. During the pre-therapeutic assessment, a CT scan was conducted, revealing multiple pulmonary micronodules with a centrolobular/diffuse distribution. Subsequently, bronchoalveolar lavage was performed, and the collected samples were sent for histopathological testing. The immunohistochemical staining for CD8 revealed the presence of lymphocytes, accounting for approximately 40% of the total cell population, alongside a small number of neutrophil and eosinophil polymorphonuclear cells. Notably, there were no indicative features of malignancy. Given the nonspecific nature of the CT scan results, a PET scan was performed. The PET scan did not definitively rule out the possibility of pulmonary and mediastinal sarcoidosis. To further investigate the case, the patient underwent endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA), which revealed a non-necrotizing chronic granulomatous inflammatory reaction. Additional examinations unveiled elevated levels of calciuria (484.5 mg/24 h; upper limit of normal=320 mg/24 h) and increased angiotensin-converting enzyme levels. Discussion. Sarcoidosis is an inflammatory disease that can affect multiple organs in the body, most commonly the lungs and lymph nodes. It is characterized by the formation of granulomas (small clumps of immune cells) in the affected tissues. Sarcoidosis can mimic metastasis, especially in the mediastinum, which can pose a diagnostic challenge. Managing both conditions can be complex and requires a multidisciplinary medical approach. [ABSTRACT FROM AUTHOR]

Introduction. Non-small cell lung carcinoma (NSCLC) represents a percentage of 80-90% of total lung cancers, with a change in the distribution of histology marked by the increase in the rate of adenocarcinoma and decrease in the rate of squamous cell carcinoma. Moreover, NSCLC tumorigenesis may be classified into two mechanisms, one of them being the oncogene-addicted pathway with the most frequent mutations harbored in the EGFR and KRAS proto-oncogenes. Case presentation. In 2018, a 74-year-old patient, known as a nonsmoker, with no exposure to toxins, was admitted to the “Ion Chiricuță” Institute of Oncology, Cluj-Napoca, after being diagnosed with a lung adenocarcinoma of the left lobe, stage IV (right lung, pleural and pericardial involvement, left breast, axillary, abdominally and peritoneal lymph nodes, left adrenal gland), PD-L1 negative, with EGFR and ALK mutations in work. The patient was WHO 2 on account of the aggravation of dyspnea despite the thoracocentesis. While the mutational panel was not finalized, after the exclusion of another left breast primary, chemotherapy with carboplatin/ gemcitabine was initiated, with the amelioration of symptoms after one cycle. Due to the radiological partial response after three cycles, the regimen was continued for six cycles, but at the end of it, a progression disease by peritoneal involvement was objectified on the CT scan. Having the notion of an EGFR mutation, a targeted therapy by erlotinib was initiated, with a partial response for seven months, until the aggravation of the respiratory symptoms and a new multisite progression. As a consequence of the rapid change of the ECOG status from 1 to 2, a liquid biopsy was performed (patient not fit for a tissue biopsy) and a new third line was initiated with Taxotere®, because of the urgency of quick amelioration of symptomatology. Unfortunately, neither a significant clinical benefit, nor a radiological response was achieved, but the liquid sample proved the presence of T790M mutation in the exon 20 which permitted the initiation of osimertinib in the fourth line, with a remarkably clinical response and a radiological amelioration at third cycles. After seven months of treatment, she was admitted to the neurology department with the diagnosis of stroke due to a cerebral multisite progression. Not being eligible for surgery or stereotactic radiotherapy, whole-brain radiotherapy was conducted. Conclusions. This classical case perfectly exemplifies the importance of being aware – from the moment of diagnosis – of the mechanisms involved in oncogenesis, and the concomitant existence of resistance mechanisms to TKIs and their method of detection by liquid/tissue biopsy. This emphasizes the need to have reliable, easy and rapid methods and protocols to detect the possible oncogenes by PCR and NGS to help choosing the most efficient therapy. Regarding the resistance mechanisms and their occurrence, until nowadays we still do not know which one of them – liquid versus tissue biopsies – should be performed, due to the absence of comparison between the methods. Research in this domain must be continued and improved. [ABSTRACT FROM AUTHOR]

Introduction. There is a growing awareness regarding gender influences on the response of cancer to immunotherapy that is reflected by an increasing number of studies in many cases of tumors, including melanoma. A new revolution was marked by immunotherapy in this setting, but neither predictive factors were identified in response, nor selection criteria for targeted therapy of immunotherapy. Materials and method. A retrospective study was initiated with the hypothesis of comparing the impact of gender for response in cancer patients diagnosed with metastatic melanoma. For the inclusion, the patients were selected independent of BRAF status, treated with the combination checkpoint inhibitor drugs PD-1 inhibitor/ CTLA-4 inhibitor: nivolumab/ipilimumab. For each patient, at the inclusion, the performance status was assessed, along with the neutrophils/lymphocytes ratio, thrombocytes/neutrophils ratio, and the value of LDH. Every patient was evaluated after four cycles of double immunotherapy and then every three months during the maintenance treatment. Statistical analyses will be performed to evaluate if there exists a statistical gender difference in response to double immunotherapy. Conclusions. The limited number of patients is not sufficient to validate the hypothesis, and more studies must be conducted on a larger cohort of patients to affirm the predictive value of the clinical and biological markers. [ABSTRACT FROM AUTHOR]

Background and aims. The aim of this study was to investigate the value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) correlated with some tissue molecules as predictive markers for recurrence in colon cancer. Methods. A total of 30 patients diagnosed with colon cancer stage II or III who underwent optimal surgery were enrolled in study. Tumor markers CEA and CA 19-9 were determined before surgery. Tumor samples were prepared using tissue microarray kit (TMA) then stained for different cellular markers (Ki 67, HER2, BCL2, CD56, CD4, CD8) and analyzed using Inforatio programme for quantitative determination. All patients received standard adjuvant treatment, which consisted of eight cycles chemotherapy type XELOX. The patients were followed up for 3 years. Results. Upon 3 years follow-up, 67% of patients developed tumor relapse, the most common site of metastasis being the liver. No correlations were observed between either serum or tissue tumor markers and the risk of tumor relapse. Conclusion. Over 50% of patients with colon cancer who had optimal treatment developed metastasis. No statistically significant predictive value for investigated molecules was found. Future studies are needed to confirm the use of molecular markers in monitoring patients with colorectal cancer. [ABSTRACT FROM AUTHOR]