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Introduction and Objectives. Urothelial carcinomas in the advanced stage is usually initially treated with platinum salts in the case of eligible patients or carboplatin and gemcitabine in the case of those with a significant degree of renal insufficiency, only when the disease progresses and becomes unresponsive the current trials of immunotherapy treatment have shown encouraging result regarding its use. Materials and Methods. This is a case of a 67 years old male patient, smoker, who underwent left total nephroureterectomy with perimeatic cystectomy and excision of a left ilioobturator adenopathy of the first intention due to the fact that the patient had hematuria with secondary anemia, the histopathological result being invasive urothelial carcinoma, high grade of malignancy, high grade of anaplasia (G3), pT3N1M3, who developed tumor recurrence which ultimately showed significant results of regression under immunotherapy with Pembrolizumab. Results. Nephroureterectomy performed with perimeatic cystectomy and tumor lymph node excision showed the histopathological result of invasive urothelial carcinoma pT3N1 high grade, but the degree of renal insufficiency established after the operation required the initial use of adjuvant treatment consisting of Carboplatin + Gemcitabine, the patient not being eligible for salts of platinum, and external radiotherapy. Follow-up serial imaging showed the progression of the disease, which is why, following the genetic tests performed, the patient showed positive expression for PD-L1, thus beginning treatment with Pembrolizumab, under which a significant regression of the lesions was observed. Conclusions. The treatment with Pembrolizumab has proven its effectiveness both through imaging and clinical data and brings one more argument in the use and result of immunotherapy in urothelial carcinoma. [ABSTRACT FROM AUTHOR]

Breast cancer is a very heterogeneous disease, both at the molecular level and at the histological level. Initially, five normal subtypes were described - Luminal-A, Luminal- B, HER2+, Triple Negative/Basal (TNBC) - and then expanded to seven subtypes, with Basal-like-1 and 2 types. Triple-negative breast cancer is described as an aggressive, heterogeneous subtype, lacking expression of the estrogen receptor, the progesterone receptor and the HER2 receptor. Although genetic and epigenetic changes are key pathogenic events, the immune system plays a significant role in promoting progression and metastasis. In this paper we have proposed to discuss the extent to which immune system cells can be detected in the tumor micro-environment, as well as their prognostic role in the triple negative subtype. [ABSTRACT FROM AUTHOR]

Bladder cancer is the seventh cause of cancer death in men and the tenth in women. In metastatic disease, the prognosis remains poor, with a median survival of 15 months. Chemotherapy has remained standard systemic therapy over the past 15 years for patients with recurrent or metastatic disease. The therapeutic regimens recommended by guides in metastatic disease, as the first treatment line, are the combination of gemcitabine and platinum salts or the MVAC combination. Currently, there is no second-line standard systemic therapy for patients with tumor relapse after first-line chemotherapy. Therefore, the treatment of advanced and metastatic urothelial tumors remains a challenge for oncologists. Following radical cystectomy, more than half of patients with invasive urothelial carcinoma will develop recurrent disease. The excellent results obtained in the treatment of other solid tumors using targeted therapies such as tyrosine kinase inhibitors or CTLA-4 anti-CTL-4 or PD1 inhibitor immunotherapy have led to the idea that these therapies could be used with promising results in the treatment of metastatic bladder cancer. The acquisition of mutations in the PI3K/AKT/mTOR intracellular signal transduction pathway has been demonstrated in over 40% of bladder cancers, suggesting that blocking the mTOR pathway would be a promising target therapy in this pathology. Starting from this idea, there are currently several phase I and II studies of mTOR inhibitors like temsirolimus or sirolimus, the preliminary results being encouraging. In terms of immunotherapy in metastatic bladder cancer, there are currently several phase I or phase II studies testing anti-CTLA-4 therapy (ipilimumab) or PD1 inhibitors (nivolumab). Besides these molecules, there are studies that test new molecules such as MPDL3280A, MEDI4736 and MK3475 (lambrolizumab). All preliminary data show the efficacy of these new therapies in metastatic urothelial carcinoma. Our paper aims to review these new therapies by presenting the undergoing studies for recurrent and metastatic urothelial carcinoma with the preliminary results and safety profile of these new agents. In the future, we will have a new standard in the systemic treatment of advanced and metastatic urothelial carcinomas. [ABSTRACT FROM AUTHOR]

Hepatorenal syndrome (HRS) is a serious complication of liver cirrhosis with critically poor prognosis. The pathophysiologic hallmark is severe renal vasoconstriction, resulting from complex changes in splanchnic and general circulations as well as systemic and renal vasoconstrictors and vasodilators. Rapid diagnosis and management are important, since recent treatment modalities including vasoconstrictor therapy can improve short-term outcome and buy time for liver transplantation, which can result in complete recovery.