Pancreatic adenocarcinoma:Beyond first line,where are we?

Pancreatic cancer is considered one of the most aggressive cancers,with an increasing incidence in recent years.To date,chemotherapy is still the standard of care for advanced metastatic disease,unfortunately providing only a slight advantage in terms of survival.The molecular and cellular characteristics of pancreatic cancer cells,as well as the cells that characterize the pancreatic tumour microenvironment,are the basis of the mechanisms of resistance to treatment.After progression during first-line treatment,few patients are eligible for secondline treatment due to the loss of performance status.To date,a clear survival advantage has not yet been demonstrated for second-line chemotherapy.Precision medicine could be the key to increasing responses to cancer treatment and finally impacting survival in this difficult-to-treat disease.In this review,we analyze current recommendations in the second-line setting and potential future prospects.

New drugs for the treatment of metastatic colorectal cancer

Colorectal cancer(CRC)represents one of the most frequent malignancies in terms of incidence and mortality,thus representing the third leading cause of cancer death worldwide.In the last decade,few drugs have enriched the treatment landscape of metastatic CRC and have significantly affected prognosis.Unlike other neoplasms,metastatic CRC patients who have exhausted treatment options often still maintain a good performance status.There are many challenges to increasing potential treatment options,notably a better understanding of disease biology and the mechanisms of resistance underlying cancer treatment failure.The development of new drugs for metastatic CRC certainly represents one of the most important challenges in medical oncology.This article discusses the main limitations in the development of new drugs and potential future scenarios.In particular,we addressed three questions:(1)The main limitations of targeted therapy in the treatment of metastatic CRC(mCRC);(2)New target armamentarium that could escape primary and secondary resistance and lead to more personalized mCRC therapy;and(3)Future directions.

Tocilizumab as treatment for COVID-19:A systematic review and meta-analysis

BACKGROUNDThe majority of patients with coronavirus disease 2019 (COVID-19) have goodprognoses, but some develop a critical illness that can lead to death. Evidenceshows severe acute respiratory syndrome is closely related to the inducedcytokine storm. Interleukin-6 is a key player;its role in systemic inflammation iswell known.AIMTo evaluate the effect of tocilizumab (TCZ), an interleukin-6 receptor antagonist,on the outcomes for patients with COVID-19 pneumonia.METHODSPubMed, EMBASE, SCOPUS, Web of Science, MedRxiv, Science Direct, and theCochrane Library were searched from inception to 9th June 2020 for observationalor prospective studies reporting results of hospitalized adult patients withCOVID-19 infection treated with TCZ. Effect sizes were reported as odds ratios(ORs) with 95% confidence intervals (CIs), and an OR less than 1 was associatedwith a better outcome in those treated with TCZ.RESULTSOverall 13476 patients (33 studies;n = 3264 received TCZ) with COVID-19pneumonia and various degree of severity were included. Outcome wasimproved with TCZ. In the primary analysis (n = 19 studies reporting data),mortality was reduced in patients treated with TCZ (OR = 0.64, 95%CI: 0.47-0.87;P < 0.01). In 9 studies where risk of death with TCZ use was controlled for othervariables mortality was reduced by 57% (OR = 0.43, 95%CI: 0.27-0.7;P < 0.01).Intensive care need (mechanical ventilation) was also reduced (OR = 0.36, 95%CI:0.14-0.89;P = 0.02).CONCLUSIONIn COVID-19-infected patients treated with TCZ, outcome may be improvedcompared to those not treated with TCZ.