Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE).

Objectives- Despite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients. Materials and methods- This retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes. Results- A total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR=2.1 95%CI[1.1-4.8], p=0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months,<0.0001), a lumen occlusion >65% (6.6 VS 2.9 months,<0.001), and lacking the involvement of left bronchus (7 VS 2.3 months,<0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p=0.03), symptom-free interval (p=0.02), and onset of atelectasis (p=0.01). Conclusions- In patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention

Fishing for ALK with immunohistochemistry may predict response to crizotinib

Background. ALK (anaplastic lymphoma kinase) gene rearrangement is a novel oncogenic driver in non-small cell lung cancer (NSCLC) against which a selective inhibitor, namely crizotinib, is effective. Fluorescence in situ hybridization (FISH) is considered the reference method in selecting patients with ALK-positive tumors for treatment with crizotinib. Case report. We report the case of a 42-year-old non-smoking woman with an advanced pulmonary ALK FISH-negative adenocarcinoma characterized by strong immunohistochemical expression of ALK fusion protein. The patient received targeted therapy with crizotinib in compassionate use and experienced a long-lasting clinical response. Conclusion. FISH testing should not be considered the only method to select patients for therapy with ALK inhibitors and the use of multiple ALK-detecting techniques could be helpful in screening ALK-positive patients more appropriately

Monitoring of irrigation water use in Italy by using IRRISAT methodology: The INCIPIT project

The INCIPIT project (INtegrated Computer modeling and monitoring for Irrigation Planning in ITaly) focuses on the development of a methodological framework to monitor irrigation water uses at different spatial scales and under different hydro-meteorological conditions in six Italian regions (Apulia, Campania, Emilia Romagna, Lombardia, Sardinia, and Sicily). The objective of the INCIPIT project is to fill the wide gap between research and application in order to meet the requirements of sustainable waterrelated policies – such as the Water Framework Directive (WFD), and the MIPAAF Ministry Decree of July 31, 2015- where a specific set of obligations of measurement and estimation of the irrigated areas and irrigation water volumes is defined. For this purpose, the ESA Sentinel-2 (S2) satellites provide a very valuable source of information for mapping irrigated areas and estimating spatially-distributed irrigation water requirements. This study illustrates the results achieved using the IRRISAT methodology. In detail, the quantification of the irrigation water abstraction was achieved using the one-step approach, based on the Penman–Monteith equation, and properly adapted with canopy parameters namely crop height, Leaf Area Index (LAI), and surface albedo derived from S2 data. The quantification of the irrigated areas was performed by using pre-existing maps, unsupervised (clustering), and supervised classification (Machine Learning Algorithms) applied to dense temporal series of vegetation indices. The analysis was performed for the irrigation seasons 2019 and 2020 in seven irrigated areas, which differ in size, type of irrigation schemes, farm delivery, irrigation methods, and crop types

CDX-2 homeobox gene and MUC2 expression identifies true mucinous (so-called colloid) carcinoma of the lung and justifies its indolent outcome

CDX-2/MUC2 coordinated expression may be helpful in distinguishing mucinous carcinoma from mucinous bronchioloalveolar carcinoma, a lung cancer frequently associated with recurrences and multicentricity

EGFR and K-ras mutations along the spectrum of pulmonary epithelial tumors of the lung and elaboration of a combined clinicopathologic and molecular scoring system to predict clinical responsiveness to EGFR inhibitors.

We tested 418 neoplasms along the whole spectrum of primary lung tumor histotypes for epidermal growth factor receptor (EGFR) and K-ras mutations. Clinicopathologic data from 154 patients undergoing treatment with EGFR tyrosine kinase inhibitors (TKIs) were retrospectively studied. A scoring system assigning a score for each positive or negative characteristic (+1, female sex, nonsmoking status, adenocarcinoma histotype, Asian ethnicity, and EGFR mutation; −1, current smoker and K-ras mutation; and 0, male sex, ex-smoker, nonadenocarcinoma histotype, and no mutations) was elaborated and tested with EGFR-TKI response.Salivary gland–type, mucin-rich, and neuroendocrine tumors do not harbor EGFR mutations. A subset of nonmucinous adenocarcinomas, not necessarily of the bronchioloalveolar type, is related to EGFR mutations. Three probability groups significantly correlating with response to EGFR-TKIs were identified. Of note, the addition of molecular results did not significantly change the predictive value obtained by the combination of clinicopathologic characteristics alone in this scoring system. K-ras mutations, significantly associated with the mucin-secreting type of adenocarcinoma, consistently predict lack of response in white patients