The advent of precision therapy in gastrointestinal malignancies: Targeting the human epidermal growth factor receptor family in colorectal and esophagogastric cancer

Until recently, systemic therapy for gastrointestinal malignancies was restricted to relatively noncancer-specific cytotoxic chemotherapy. Over the last 15 years targeted therapies have become available, most notably bevacizumab in the case of advanced colorectal cancer. Unfortunately, there are no predictive biomarkers to guide the use of this agent. In this review article, we describe the advent of "Precision Medicine" (in part, the use of patient-specific molecular markers to inform treatment) in gastrointestinal cancers: The use of monoclonal antibodies targeting epidermal growth factor receptor in advanced colorectal cancer, and human epidermal growth factor receptor 2-neu in advanced esophagogastric cancer. In both instances, biomarkers help in selecting appropriate patients for such treatment

Redefining Renal Cell Carcinoma: A Molecular Perspective on Classification and Clinical Implications

Renal cell carcinoma (RCC) is the most common primary tumour of the kidney. RCC is a clinically and pathologically heterogenous entity, which has traditionally been classified under two broad categories: clear-cell and non-clear cell. With improved molecular diagnostic methodologies and genetic testing, the classification of RCC has shifted from a morphological basis to a molecular/genetic focus, and has been systematically updated to reflect these advancements. The new 2022 World Health Organization (WHO) classification of RCC is the most recent of these updates, and contains significant changes, as compared to the previous 2016 classification. The most substantial of these changes is the establishment of a new category of molecularly-defined RCC, including TFE3-rearranged RCC, TFEB-altered RCC, ELOC-mutated RCC, fumarate hydratase-deficient RCC, succinate dehydrogenase-deficient RCC, ALK-rearranged RCC, and SMARCB1-deficient renal medullary carcinoma. In this narrative review, the authors briefly summarise the histopathological characteristics, clinical course, current treatment standards, and future treatment directions of each of these molecularly-defined RCC subtypes

Management of Germ Cell Tumors During the Outbreak of the Novel Coronavirus Disease-19 Pandemic:A Survey of International Expertise Centers

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of whether cancer treatments can be postponed or modified without compromising their efficacy, especially for highly curable cancers such as germ cell tumors (GCTs). MATERIALS AND METHODS: To depict the state-of-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network-Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. RESULTS: Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from Canada. Telemedicine was broadly used; there was high consensus to interrupt chemotherapy in COVID-19-positive patients (I = 75%, C = 55%, and E = 83.3%) and for use of granulocyte colony-stimulating factor primary prophylaxis for neutropenia (I = 65%, C = 62.9%, and E = 50%). The main differences emerged regarding the management of stage I and stage IIA disease, likely because of cultural and geographical differences. CONCLUSION: Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for patients with GCT with few changes in their management during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: Despite the chaos, disruptions, and fears fomented by the COVID-19 illness, oncology care teams in Italy, other European countries, and Canada are delivering the enormous promise of curative management strategies for patients with testicular cancer and other germ cell tumors. At the same time, these teams are applying safe and innovative solutions and sharing best practices to minimize frequency and intensity of patient contacts with thinly stretched health care capacity

Immunobiologic prognostic factors in aggressive non-Hodgkin's lymphoma: The role of proliferative index, host-immune response, and continuous lactate dehydrogenase level in predicting survival in 148 consecutive subjects

grantor: University of TorontoThe prognostic value, with regard to survival, of proliferative index (% cells staining for Ki-67), host T-cell response (% cells staining for CD-4) in B-cell disease, and serum lactate dehydrogenase level (LDH, as a continuous variable), alone and in conjunction with the International Prognostic Index (IPI), was assessed in 148 consecutive subjects with aggressive (International Working Formulation subtypes F, G and H) non-Hodgkin's lymphoma (NHL). Cox proportional hazards regression demonstrated that continuous LDH was a useful prognostic factor in univariate analysis (relative risk of death 1.4, 'P' = 0.001), and modestly enhanced the prognostic value of the IPI on multivariate analysis (likelihood ratio test 'P' = 0.02). Neither Ki-67 nor CD-4 infiltrate provided prognostic information. Receiver operator characteristics (ROC) curve analysis demonstrated no better than poor to moderate discriminative ability in predicting death for the models generated. The reproducbility of the Ki-67 measure used was found to be questionable on reliability testing.M.Sc

Thoracic Sarcoidosis Mimicking Metastatic Testicular Cancer: Three Case Reports

Recurrence of testicular tumors in young males generally prompts rapid investigation and treatment. We report 3 patients with past histories of treated testicular cancer referred with radiographic evidence suggestive of intrathoracic metastases. In each case chest imaging demonstrated mediastinal/hilar lymphadenopathy. In one case pulmonary nodules were also identified. In all three patients further work-up revealed non-caseating granulomas consistent with sarcoidosis. All patients have since been followed and remain free of testicular cancer. No patient has required therapy for sarcoidosis. Although rare, new intra-thoracic lymphadenopathy in previously treated testicular cancer patients can represent sarcoidosis. Tissue diagnosis is essential when the clinical picture remains unclear

The Sarmatian Review, Vol. 19, No. 2

Contents: "SR INDEX"; Maria Dąbrowska, "Nights and Days" (excerpts); Piotr Wilczek, "Catholics and Heretics: Some Aspects of Religious Debates in the Old Polish-Lithuanian Commonwealth"; "BOOKS"; John J. Kulczycki, "Poland and Its Fate" (review); Janet G. Tucker, "A Life of Solitude [on Stanislawa Przybyszewska]" (review); "LETTERS" (Aleksandra Ziółkowska- Boehm, Bogdan Czaykowski); "ANNOUNCEMENTS AND NOTES"; "About the Authors