Treatment of Chronic Hepatitis C in a Patient Affected by Systemic Sclerosis

The currently recommended treatment for patients infected with hepatitis C virus (HCV) is pegilated interferon α (IFN α) plus ribavirin. Despite the numerous benefits of this therapy, there is an increasing concern regarding his tolerance. Among the most common side effects, interferon may trigger the onset or exacerbation of autoimmune diseases. When chronic hepatitis C coexists with an autoimmune disorder, it is not clear whether using interferon is better than avoiding it. We evaluated the disease state of a 55-year old female affected by sistemic sclerosis (SSc), during and after therapy with IFNα pegilated plus ribavirin for chronic HCV infection. We were worried about the potential worsening of the autoimmune disease during the therapy, but we were confident that we would give our patient a short course of peginterferon and ribavirin. A mild, asymptomatic worsening of lung SSc was observed during IFN administration, without life threatening symptoms. After 24 months follow up we observed the maintenance of the virological response and a good control of the rheumatological disease. Thus, in liver disease at high risk of progression and concomitant SSc, the antiviral therapy with IFNα is a feasible approach

Benefit of continuing trastuzumab beyond progression in her2-positive metastatic breast cancer (mbc) is independent of the chemotherapy partner: message from a single-centre retrospective study

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Which benefit from subsequent chemotherapy lines beyond the second for women with metastatic breast cancer? Evidence from a single-center retrospective analysis of survivorship

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Post-progression evaluation of patients treated with nivolumab for advanced non-small cell lung cancer: A prospective cohort analysis

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Italian real life experience with ibrutinib: Results of a large observational study on 77 relapsed/refractory mantle cell lymphoma

Although sometimes presenting as an indolent lymphoma, mantle cell lymphoma (MCL) is an aggressive disease, hardly curable with standard chemo-immunotherapy. Current approaches have greatly improved patients' outcomes, nevertheless the disease is still characterized by high relapse rates. Before approval by EMA, Italian patients with relapsed/refractory MCL were granted ibrutinib early access through a Named Patient Program (NPP). An observational, retrospective, multicenter study was conducted. Seventyseven heavily pretreated patients were enrolled. At the end of therapy there were 14 complete responses and 14 partial responses, leading to an overall response rate of 36.4%. At 40 months overall survival was 37.8% and progression free survival was 30%; disease free survival was 78.6% at 4 years: 11/14 patients are in continuous complete response with a median of 36 months of follow up. Hematological toxicities were manageable, and main extra-hematological toxicities were diarrhea (9.4%) and lung infections (9.0%). Overall, 4 (5.2%) atrial fibrillations and 3 (3.9%) hemorrhagic syndromes occurred. In conclusions, thrombocytopenia, diarrhea and lung infections are the relevant adverse events to be clinically focused on; regarding effectiveness, ibrutinib is confirmed to be a valid option for refractory/relapsed MCL also in a clinical setting mimicking the real world

Targeted chemotherapy with nanoparticle albumin-bound paclitaxel (-paclitaxel) in metastatic breast cancer: which benefit for which patients?

The therapeutic goals in metastatic breast cancer (MBC) remain palliative in nature, aimed at controlling symptoms, improving or maintaining quality of life and prolonging survival. The advent of new drugs and new formulations of standard agents has led to better outcomes in patients with advanced or metastatic disease. These developments have also allowed a tailored therapeutic approach, in which the molecular biology of the tumour, the treatment history, and patient attitudes are taken into account in the decision-making process. Targeting drug delivery to the tumour is a promising mean of increasing the therapeutic index of highly active agents such as the taxanes, and nanoparticle albumin-bound paclitaxel ( nab -paclitaxel), the first nanotechnology-based drug developed in cancer treatment, is one such advance. Data from randomized trials support the efficacy of single-agent nab -paclitaxel as first-line and further treatment lines in MBC at the registered 3-weekly schedule of 260 mg/m 2 , but emerging evidence suggests its activity as a weekly regimen or combined with other agents in various clinical scenarios. Thus, nab -paclitaxel seems to offer flexibility in terms of dosing schedules, allowing physicians to tailor the dose according to different clinical situations. This paper reviews the clinical trial background for nab -paclitaxel in MBC, focusing on specific ‘difficult-to-treat’ patient populations, such as taxane-pretreated or elderly women, as well as those with triple-negative, HER2-positive and poor-prognostic-factors disease. Moving beyond evidence-based information, ‘real life’ available experiences are also discussed with the aim of providing an update for daily clinical practice

Cluster familiare di mesotelioma da esposizione residenziale

Introduzione. Il mesotelioma maligno, storicamente legato all’esposizione professionale all’asbesto, continua a rappresentare un’importante sfida per la Medicina del Lavoro nonostante ogni attività di estrazione, produzione e commercio del minerale sia stata bandita dalla legge n.257 del 27 marzo 1992; oggi, dopo più di 30 anni, sono ancora numerose le segnalazioni di patologie correlate alla esposizione a fibre di asbesto. Il VII Rapporto del Registro nazionale dei mesoteliomi (ReNaM) del 2021 descrive i risultati della sorveglianza epidemiologica dei casi incidenti di mesotelioma maligno rilevati dalla rete dei Centri Operativi Regionali con diagnosi fino al 31/12/2018. Dal rapporto si rivela che la maggior parte (69.1%) dei casi è legata ad esposizione lavorativa, mentre il 9.4% è legato ad esposizioni ambientali e/o familiari. Obiettivi. Descrizione di un cluster di mesotelioma da esposizione residenziale in una famiglia di Casale Monferrato (AL), dove dal 1907 al 1986 operò la principale industria italiana produttrice di manufatti in cemento-amianto e dove tuttora si registra un’alta incidenza di mesotelioma maligno. Metodi. Paziente valutata in seguito a richiesta di consulenza interna in regime di ricovero. La raccolta anamnestica è stata effettuata tramite somministrazione di questionario sulla storia di lavoro e sulle abitudini di vita. Risultati. Caso venuto alla nostra attenzione per richiesta di consulenza di Medicina del Lavoro in donna di 76 anni, degente presso il reparto di Oncologia medica dell’IRCCS Maugeri di Pavia, per accertamenti in merito al riscontro di ispessimento pleurico dell’apice polmonare destro sospetto in senso eteroproduttivo. Anamnesi patologica remota positiva per ipotiroidismo in esiti di tiroidectomia totale per neoplasia tiroidea, ipertensione arteriosa e diabete mellito tipo II di nuova insorgenza. Non note pregresse pneumopatie. Nega abitudine tabagica. Dalla raccolta dell’anamnesi familiare riscontro di casi di mesotelioma maligno in un fratello e una sorella (deceduti); neoplasia ovarica in una sorella (deceduta); leucemia nas in una sorella (deceduta); neoplasia gastrica e della lingua in una sorella (vivente). Ha svolto attività lavorativa con la mansione di operaia dai 17 aa fino ai 37 aa, in seguito cuoca in asilo comunale. Non nota esposizione lavorativa ad amianto. Fino ai 29 anni ha vissuto presso Casale Monferrato (AL). L’esame istologico della lesione pleurica parasternale destra risultava compatibile con mesotelioma desmoplastico, con profilo immunoistochimico positivo per CKCAM5.2, Vimentina, HBME1, GATA-3, Podoplanina (D2-40). Seguiva denuncia alle autorità competenti e segnalazione al Centro Operativo regionale di competenza. Conclusioni. Negli ultimi anni stiamo assistendo alla massima incidenza di mesoteliomi sul territorio nazionale, tenuto conto della lunga latenza della malattia. La casistica da noi descritta mette in luce la necessità di approfondire, durante la raccolta anamnestica, oltre alla storia lavorativa, anche gli aspetti relativi alla storia residenziale. Inoltre si inserisce nell’attuale panorama di ricerca di eventuali aberrazioni/mutazioni genetiche predisponenti l’insorgenza di malattia, a tutt’oggi ancora poco investigate

Benefit of continuing trastuzumab beyond progression in her2-positive metastatic breast cancer (mbc) is independent of the chemotherapy partner: message from a single-centre retrospective study

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Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review

The differential diagnosis of non-coeliac enteropathies (NCEs) is challenging and includes a wide range of aetiologies. Drug-induced NCEs are relatively common and characterized by duodenal villous atrophy, which resolves upon suspension of the offending drug. Immune-checkpoint inhibitors (ICIs), targeting molecules involved in the activation of cytotoxic T cells by targeting, for example, PD-1, PD-L1 and CTLA4, are increasingly used for many types of cancers. Adverse events occurring in the gastrointestinal tract have been described, predominantly in the form of immune-mediated colitis mimicking inflammatory bowel disease. Small bowel involvement whilst on ICI therapy is also possible, though less well described. Herein, we describe two cases of enteropathy with villous atrophy and negative coeliac serology due to ICIs: a 65-year-old man affected by stage IV pulmonary adenocarcinoma under treatment with pembrolizumab and an 18-year-old woman affected by stage IV auricular melanoma who was treated with nivolumab. We also provide a review of the current literature describing small bowel involvement during therapy with ICIs, alone or in combination, for different types of solid tumours. Implications for clinical practice include considering the possibility of small bowel involvement in oncological patients treated with ICIs and the inclusion of ICIs amongst the iatrogenic causes of NCE with villous atrophy. Enteropathies due to ICIs may also represent a pathogenetic model for the understanding of the molecular mechanisms leading to villous atrophy in NCE