Is the determination of ctDNA a scientific “spy” that foresees cancer?

Since 1948, circulating tumour DNA(ctDNA) was first identified in human blood. ctDNA is in fact DNA shed by tumour cells from all metastatic tumour locations throughout the whole body, and is thrown into the bloodstream and can then be isolated by a standard blood draw. Using this technique scientists can obtain a wide view of tumour heterogeneity, identify different mechanisms of drug resistance, what is its predominance and the clinical rational of precision cancer medicine become a part of our daily practice. Secondly, early detection of cancer may also contribute to global decrease in cancer mortality.

Case Report: A Long Survivor Patient with Stage IV Gastric Adenocarcinoma

Gastric cancer (GC) is the fifth most common malignancy of the world and third leading cause of cancer death. At diagnosis, 35% of GC patients have distant metastases and in these cases the survival rate is very poor with a median overall survival (OS) inferior to 1 year. We report a case of a 67-year-old woman with gastric carcinoma initially deemed limited stage on diagnosis (cT2N0M0), treated surgically with radical subtotal gastrectomy with Billroth II reconstruction. In the staging CT scan, the patient presented a liver image that was considered benign. Three months later, due to abdominal pain, the patient performed another CT scan and the diagnostic of a large single liver metastasis was made;retrospectively it was observed that the lesion was present at diagnosis and that it had increased. A biopsy was performed which confirmed the metastatic origin. In a multidisciplinary team, the lesion was considered unresectable. She was proposed for first line (1st L) palliative chemotherapy (ChT) with FOLFIRI, with partial response as best response. After 30 cycles of FOLFIRI, bone metastases were diagnosed. The patient was submitted to a cementoplasty of D11-12 and L1-2. Afterwards, she started 2nd L ChT with mFOLFOX6 and at the same time she started zoledronic acid every 28 days. The best response to mFOLFOX6 was stable disease. Since November 2018, the patient has been treated with zoledronic acid every 28 days alone and maintains stable disease without ChT.

Treatment of Chronic Oxaliplatin-Induced Peripheral Neuropathy: A Systematic Review

Introduction: Oxaliplatin is a platinum-derivative chemotherapeutic agent used in digestive tumours, in the adjuvant and metastatic setting. Oxaliplatin can cause a chronic peripheral sensory neuropathy which impacts the quality of life and is dose limiting. To date, no therapeutic strategies have proved effective in the treatment of oxaliplatin-induced peripheral neuropathy (OIPN). Methods: A computerized search of the literature on PubMed database was performed. Publisher original articles were included if they focused on treatment of peripheral neuropathy among patients submitted to oxaliplatin. Eleven out of 242 reviewed papers met our inclusion criteria and were subjected to a 19-item quality checklist. Results: The included studies differed with respect to study design, patient population and sample size, neuropathic symptoms assessment and efficacy measure. Most studies had an adequate quality. Ten trials tested one drug, and one pilot study tested a non-pharmacological treatment—the neurofeedback. Of these, 3 trials included only patients submitted to oxaliplatin-based chemotherapy. Duloxetine showed moderate efficacy in 3 trials. Topical treatment with capsaicin or 10% amitriptyline was promisors in 2 single-arm trials with a few samples. Conclusion: In the last decade, there wasn’t an improvement in the treatment of chronic OIPN. The duloxetine is the unique drug with moderate efficacy on the treatment of OIPN. There is insufficient evidence to support a recommendation for any other treatment.

A Sustained Complete Response in an Elderly Patient with Metastatic Colorectal Adenocarcinoma—A Clinical Case

Background: The increasing life expectancy of people worldwide will signify that oncologists everywhere will be faced with many difficult decisions regarding treatment options in the elderly population with cancer. These patients carry specific challenges that should be discussed. Aim: To report the clinical case of an elderly patient with a metastatic colorectal cancer with a sustained complete response and reflect on the particularities on this special population. Clinical case: In 2009, an 80-year-old man presents with colorectal cancer, undergoes surgery and intraoperatively a peritoneal implant is resected. He is deemed fit for chemotherapy and is treated with 8 cycles of capecitabine. After a 10-year follow-up, he remains with no evidence of disease. Conclusion: Chronological age is insufficient to establish a treatment plan;oncologists must evaluate the patient multidimensionally and develop personalized options for the therapy and follow-up of older individuals.

Could a Cutaneous Lesion Mean Gastric Cancer? Case Report of a Rare Diagnostic Tool and the Management of a Cardiac Complication during Chemotherapy

Cutaneous presentation of gastric cancer is very rare. This case report is about a patient with a metastatic gastric cancer in which the diagnosis was made by a cutaneous biopsy. Following this unusual diagnostic tool, the patient had an intracardiac thrombus, during the chemotherapy regimen, which wasn’t a contraindication for pursuing chemotherapy treatment for over 12 months. This case report is presented to make clinicians aware of a possible atypical sign of presentation of gastrointestinal tract cancer, as well as the importance of clinical suspicion of a well-known problem affecting cancer patients such as venous thromboembolism and its repercussions in the treatment options.

Retrorectal Cystic Hamartoma with Malignant Transformation

Retrorectal cystic hamartomas are rare congenital lesions that can undergo malignant transformation, and adenocarcinoma is the most frequently described histological type. The authors describe a case of a 53-year-old female patient with a localized well-differentiated adenocarcinoma that developed in a retrorectal cystic hamartoma. The patient was submitted to surgery (a Kraske procedure), with an R1 resection, followed by adjuvant radio-chemotherapy. After 23 months of follow up, the patient remains free from disease recurrence. Given the rarity of this entity, this case allows us to reflect on the differential diagnosis, therapeutic approach and patients’ follow-up.

Perioperative Treatment in Gastric Cancer—Developments in Patient Selection

Gastric cancer (GC) is a major public health issue. It is considered the 5th most common cancer diagnosed worldwide and it is one of the main causes of malignant disease-associated morbidity and mortality. The cornerstone of curative treatment is still surgery, and since the rate of relapse is high, a multidisciplinary approach is warranted in most developed countries. And while there have been recent developments in the perioperative scenario namely the FLOT regimen, little has advanced considering patient selection. We have reviewed the major trials in this setting and provide some insights from recently reported microsatellite instability (MSI) in a subgroup analysis in the MAGIC trial patients that seem to suggest an opportunity to patient selection. Furthermore, GC subtyping may prove helpful selecting candidates to immunotherapy or even multimodal therapy in the future. As the paradigm is moving towards a precision oncology model, GC patient selection remains one the biggest challenges in oncology but seems closer to clinical practice reality as new developments are being reported.

Multiple Synchronous Tumours:A Peculiar Clinical Case

Background: Due to improvements in diagnosis, the better outcomes of oncological patients and the increase in the average age, the incidence of synchronous tumours is likely to increase. Aim: To reflect on the challenges of a case with multiple integrated diagnostic and therapeutic approaches and to bring to consideration the increasing prevalence of similar situations. Case Presentation: In this clinical case, the authors describe the evolution of an asymptomatic patient with several synchronous tumours (a GEJ primary adenocarcinoma, a low grade urothelial carcinoma in situ, a localized squamous cell lung carcinoma and 2 IPMNs). Conclusion: The challenge of this case lies in the difficult diagnostic approach, the assembly of a multidisciplinary and time-sensitive treatment plan and the individualized follow-up, due to lack of guidelines. More research is needed in this area.

A New Era in the Adjuvant Treatment of Pancreatic Adenocarcinoma

Pancreatic adenocarcinoma is currently a major public health problem, being the 7th cause of death worldwide. Incidence is increasing and unfortunately nowadays the incidence is almost overlapping to mortality. The cornerstone of curative treatment is still surgery, but adjuvant treatment is critical to decreasing the risk of recurrence.

A Single Case of Two Synchronous Metastatic Tumours

The incidence of multiple primary tumours increases with age and due to multiple other factors as environmental and genetic predisposition. The authors describe a case of a 77-year-old female patient with diagnosis in September 2009 of colon mucinous adenocarcinoma. She was submitted to surgery, considered R1 and adjuvant chemotherapy. Six months after treatment she had abdominal recurrence on a nodular lesion in peritoneal fat. The patient was submitted to surgery and did multiple courses of systemic treatment. She underwent cytoreductive surgery with hyperthermic chemotherapy, too. In December 2014 she presented a nodular lesion on the bladder and after excision, the histology confirmed a high-grade transitional cell carcinoma and she maintains treatment with endovesical BCG instillations. After that, she had no evidence of peritoneal disease progression. Besides the bad prognosis associated to peritoneal disease, our case report describes a long survival (5 years with no disease progression) in a patient with high risk at diagnosis to peritoneal recurrence. This case shows the importance of multimodal approach and the impact of locoregional treatment in localized metastatic disease.

Impact of simulated in vitro gastrointestinal digestion on bioactive compounds,bioactivity and cytotoxicity of melon (Cucumis melo L. inodorus) peel juice powder

The objectives of this research work were to evaluate the effect of in vitro gastrointestinal digestion (GIT) on melon peel juice (MPJ) powder from fruit processing industry by-products,considering (i) the recovery and accessibility indexes,(ii) the changes on antioxidant activity,and (iii) the prebiotic effect.Throughout exposition to GIT conditions a decrease on the total phenolic content (TPC = 65.31%) and antioxidant activity by ABTS = 39.77% and DPPH = 45.91% were observed.However,these both parameters exhibited stable accessibility,accounting with 81.89%,76.55%,and 54.07% for TPC,ABTS and DPPH,respectively.After gastrointestinal digestion,the non-absorbed fraction exhibited a positive impact on the growth of Bifidobacterium and Lactobacillus strains,possibly associated with the high content of simple sugar (glucose and fructose).This fraction also showed to be safe on Caco-2 intestinal cells.These findings suggest that MPJ might be used as a potential food functional ingredient.

Pancreatic neuroendocrine tumor liver metastasisin a patient with previously diagnosed pancreatic adenocarcinoma: an unexpected diagnosis

Locally advanced pancreatic carcinoma has an usually poor prognosis despite multimodal approaches and sequential chemotherapy.The authors present a case of a long-term survivor with stage III pancreatic adenocarcinoma achieving partial response after a multimodal approach including local and systemic treatments.However,three years after diagnosis and amidst several episodes of cholangitis,hepatic metastasis were suspected.Despite pancreatic adenocarcinoma being the obvious culprit for metastization,a hepatic biopsy was considered at that time given a stable primary disease and presenting three years since the initial diagnosis.At this point,a biopsy could have specific diagnostic,prognostic and therapeutic implications and after it was performed,an unexpected diagnosis of pancreatic neuroendocrine tumor was made.Therefore,we urge clinicians to consider hepatic biopsy in similar cases-generally when it may change prognosis and treatment strategies-and perform histological confirmation of metastatic disease whenever feasible,even if the answer may seem obvious at first impression.