Liquid biopsies in lung cancer: The new ambrosia of researchers

In the last decades the approach to cancer patient management has been deeply revolutionized. We are moving from a "one-fits-all" strategy to the "personalized medicine" based on the molecular characterization of the tumor. In this new era it is becoming more and more clear that the monitoring of the disease is fundamental for the success of the treatment, thus there is the need of new biomarker discovery. More precisely in the last years the scientific community has started to use the term "liquid biopsy". A liquid biopsy is a liquid biomarker that can be easily isolated from many body fluids (blood, saliva, urine, ascites, pleural effusion, etc.) and, as well as a tissue biopsy, a representative of the tissue from which it is spread. In this review we will focus our attention on circulating tumor cells, circulating tumor DNA, exosomes and secretomes with the aim to underlie their usefulness and potential application in a clinical setting for lung cancer patient management

Capecitabine (XEL) and oxaliplatin (OX) in combination with bevacizumab (BEV) in the management of elderly patients with advanced colorectal cancer (ACRC): Preliminary outcomes on safety and efficacy.

Background: Older individuals always experience enhanced susceptibility to the side effects of cytotoxic chemotherapy. The aim of the study was to evaluate impact of BEV in combination with OX and XEL in ACRC elderly patients. Methods: 56 (29 male, 27 female) elderly patients with ACRC (median age: 71; range: 66-80) were enrolled. Comprehensive Geriatric Assessment (CGA) was performed to assess eligibility for chemotherapy. The dose of IRI and XEL was adjusted according to Kintzel-Dorr formula. Primary endpoint: clinical response rates (RR) according to WHO criteria. Secondary endpoints: toxicity profile using NCI-CTC v2.0 and quality of life (QoL) score measured through EORTC QLQ-C30 questionnaires. All patients were evaluated for toxicity according to the ECOG Common Toxicity Criteria. BEV adverse reactions were not experienced by any patients. Results: Based on CGA, 48 patients were included into groups I, according to Balducci's classification of frailty and treated with OX (100 mg/m2) + BEV (7.5 mg/Kg) on day 1, and XEL (fixed dose of 1000 mg b.i.d) assumed orally from day 2 to day 15, every 3 weeks for 6 months. None of the pts needed any delay in drugs delivery. Tumor response rates observed were 48% (CR+PR). Clinical benefit, including SD, was 77%. No grade 4 toxicity was experienced. QoL score improvement was noted in all pts after treatment. Conclusions: In elderly ACRC patients the dose reduction of XEL through fixed daily dose administration of 1000 mg b.i.d. allows to reach a good tolerability profile with a significant reduction of all grades toxicity compared to dosage calculated according to patients' body surface. We have employed a fixed dose of XEL to obviate the inherent difficulties in dosing with different tablet sizes and to improve compliance with oral chemotherapy assumption in patients with a worse IADL profile. This regimen seems to be active and safe and authors believe that dose reduction improves tolerability without a decrease in efficacy. DFS and OS is under evaluation

A retrospective molecular epidemiological scenario of carbapenemase-producing Klebsiella pneumoniae clinical isolates in a Sicilian transplantation hospital shows a swift polyclonal divergence among sequence types, resistome and virulome

In this work, we assessed and characterized the epidemiological scenario of carbapenem-resistant Klebsiella pneumoniae strains (CR-Kp) at IRCCS-ISMETT, a transplantation hospital in Palermo, Italy, from 2008 to 2017. A total of 288 K. pneumoniae clinical isolates were selected based on their resistance to carbapenems. Molecular characterization was also done in terms of the presence of virulence and resistance genes. All patients were inpatients from our facility and clinical isolates were collected from several sources, either from infection or colonization cases. We observed that, in agreement with the Italian epidemiological scenario, initially only ST258 and ST512 clade II (but not from clade I) were identified from 2008 to 2011. From 2012 onwards, other STs have been observed, including the clinically relevant ST101 and ST307, but also others not previously observed in other Italian health settings, such as ST220 and ST753. The presence of genes involved in resistance and virulence was confirmed, and a heterogeneous genetic resistance profile throughout the years was observed. Our work highlights that resistance genes are rapidly disseminating between different and novel K. pneumoniae clones which, combined with resistance to multiple antibiotics, can derive into more aggressive and pathogenic multidrug-resistant strains of clinical importance. Our results stress the importance of continuous surveillance of CR Enterobacterales in health facilities so that novel STs carrying resistance and virulence genes that may become increasingly pathogenic can be identified and adequate therapies to adopted to avoid their dissemination and derived pathologies