Search

Background: Fluoropyrimidines are metabolized in the liver by the enzyme dihydropyrimidine dehydrogenase (DPD), encoded by the DPYD gene. About 7% of the European population is a carrier of DPYD gene polymorphisms associated with reduced DPD enzyme activity., Aim: To assess the prevalence of DPYD polymorphisms and their impact on fluoropyrimidine tolerability in Italian patients with gastrointestinal malignancies., Methods: A total of 300 consecutive patients with a diagnosis of gastrointestinal malignancy and treated with a fluoropyrimidine-based regimen were included in the analysis and divided into two cohorts: (1) 149 patients who started fluoropyrimidines after DPYD testing; and (2) 151 patients treated without DPYD testing. Among the patients in cohort A, 15% tested only the DPYD2A polymorphism, 19% tested four polymorphisms ( DPYD 2A, HapB3, c.2846A>T, and DPYD 13), and 66% tested five polymorphisms including DPYD 6., Results: Overall, 14.8% of patients were found to be carriers of a DPYD variant, the most common being DPYD 6 (12.1%). Patients in cohort A reported ≥ G3 toxicities ( P = 0.00098), particularly fewer nonhematological toxicities ( P = 0.0028) compared with cohort B, whereas there was no statistically significant difference between the two cohorts in hematological toxicities ( P = 0.6944). Significantly fewer chemotherapy dose reductions ( P = 0.00002) were observed in cohort A compared to cohort B, whereas there was no statistically significant differences in chemotherapy delay., Conclusion: Although this study had a limited sample size, it provides additional information on the prevalence of DPYD polymorphisms in the Italian population and highlights the role of pharmacogenetic testing to prevent severe toxicity., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.)

Breast cancer is the most frequently diagnosed cancer in women worldwide. Actually CDK4/6 inhibitor Ribociclib is approved for the treatment of metastatic hormone-positive and human epidermal growth factor receptor 2 (HER 2)-negative breast cancer, but comorbidities like infectious or cardiovascular diseases may limit its use., Case Report: A 45-year-old woman was diagnosed with metastatic breast cancer in September 2021; also, her hepatitis screening resulted positive for hepatitis B infection. Patient assumed eradicative therapy for hepatitis and bit after started oncological therapy with Ribociclib., Outcome: Frequent check of hepatological function was observed since start of eradicative therapy; liver transaminases and bilirubin kept to not rise despite start of oncological treatment with Ribociclib. Patient's Performance Status was also not compromised and revaluation at 4, 9 and 13 months showed partial response and then stable disease., Discussion: hepatotoxicity of Ribociclib is reported as a possible side effect, and often positivity for hepatitis is cause of exclusion from therapy; in our case, no hepatotoxicity was noted and patient obtained response in terms of control of both infectious and oncological diseases., Competing Interests: MG reports consulting fees for Consulting or advisory Role: Lilly, Novartis, Pfizer, AstraZeneca; Speaker’s Bureau: Lilly, Novartis, Pfizer, Eisai, Roche, AstraZeneca, Daichii Sankyo, MSD; Travel, accommodation, expenses: Novartis, Pfizer, Roche. CD reports personal fees from Roche, AstraZeneca, Lilly, GSK, Novartis, Seagen and Pfizer, Advisory Board for Roche, AstraZeneca, Lilly, GSK, Novartis, Seagen and Pfizer, support for attending meetings and/or travel Roche, AstraZeneca, Lilly, GSK, Novartis, Celgene and Pfizer, grants from Novartis. GA reports personal fees from Novartis; personal fees from Lilly, grants and personal fees from Roche, grants, personal fees and non-financial support from Pfizer, grants, personal fees and non-financial support from AstraZeneca, personal fees from Daichi, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Di Costanzo, Carrano, Iengo, Cefaliello, Cossiga, Morisco, Giuliano, De Angelis and Arpino.)

Background/aim: Lung cancer is one of the most common malignant neoplastic diseases and by far the leading cause of cancer death worldwide. Recently, immune checkpoint inhibitors (ICIs) have received increasing attention for playing a crucial role in non-small cell lung cancer (NSCLC). Biomarkers, such as programmed cell death-ligand 1 (PD-L1) and tumor mutational burden (TMB), seemed to be helpful in selecting patients who are more likely to benefit from ICI treatment: however, their role has not yet been fully clarified., Patients and Methods: In this retrospective study, we evaluated the relationship between pre-treatment peripheral blood neutrophil-to-lymphocyte ratio (NLR) and survival in 252 patients suffering from advanced NSCLC who had received pembrolizumab as their first-line immunotherapy., Results: Compared to their NLR low counterparts who had a median overall survival (OS) of 34.8 months, patients with NLRs above 4.8 had a median OS of 7.6 months (HR=3.26, 95%Cl=2.3-4.6, p-value<0.0000001). In multivariate Cox regression analysis, alongside other variables, such as metastatic sites, age, and sex, NLR and PD-L1 predicted progression-free survival and OS; furthermore, a very high NLR - over 10 - seemed to forecast a very dismal prognosis in patients undergoing immunotherapy, with sudden deaths in the days immediately following therapy (median OS=3.8 months)., Conclusion: NLR acts as a valuable and reliable prognostic factor in non-small cell lung carcinoma patients undergoing first line immunotherapy with pembrolizumab. Additional investigation is necessary to fully elucidate the underlying biological rationale, which can be found in myeloid derived suppressor cells, a heterogeneous population of cells with neutrophil-like immunophenotypic features., Competing Interests: The Authors have no conflicts of interest to declare in relation to this study., (Copyright 2023, International Institute of Anticancer Research.)

The use of tunneled central venous catheters (CVCs) has grown exponentially in recent years. It has increased particularly for elderly patients, patients with severe heart failure, and patients on chronic hemodialysis. In such patients there is a great risk of infection. This led us to search for a new-generation antibiotic able to resolve infection rapidly and effectively. In our experience, administration of daptomycin resulted in rapid resolution of infection without the necessity of CVC removal or its replacement by another system.

Many of the patients hospitalized for congestive heart failure have concurrent renal failure. Most patients with heart failure present NYHA class III dysfunction, but when the heart failure progresses to NYHA class IV, replacement therapy may be necessary to remove the salt and water overload and mitigate the clinical, prevalently respiration-related symptoms. We report the clinical cases of 8 patients with NYHA class IV heart failure resistant to multidrug treatment and high-dose diuretics who were treated with sustained low efficiency dialysis (SLED). We evaluated the survival rates of the patients, their clinical improvement and cardiac performance. The obtained results suggested that treatment with SLED is the most indicated in NYHA class IV heart failure.