Rationale: Colorectal mixed neuroendocrine–nonneuroendocrine neoplasms constitute a rare group of gastrointestinal tumors composed by both neuroendocrine and nonneuroendocrine components. Nondiagnostic macroscopic features, specific histological features, and poor awareness of the disease are responsible for the underestimated incidence and conflicting data available. Due to lack of randomized clinical trials and validated clinical guidelines, diagnostic and therapeutic approach are based on the standard of care for pure colorectal neuroendocrine carcinomas or adenocarcinomas. Patient concerns: A 76-year-old caucasian male, without relevant medical or familial history, presented a positive faecal occult blood test during colorectal cancer screening. Diagnosis: Total colonoscopy identified a rectal lesion with biopsy showing a moderate rectal adenocarcinoma staged as cT2N0M0. Interventions: Anterior resection of the rectum with right ileostomy followed by local radiotherapy with radio-sensitising chemotherapy and adjuvant chemotherapy with capecitabine 1000 mg bid plus oxaliplatin 130 mg/m 2 . Due to chronic nodular pulmonary aspergillosis and chemotherapy induced immunosuppression patient was on 400 mg/daily of oral voriconazole. Outcomes: Overall survival of 15 months after progression under first line treatment and under palliative chemotherapy with platinum plus etoposide regimen. Lessons: The reported case illustrates the challenge associated to the management of mixed neuroendocrine–nonneuroendocrine carcinomas due to lack of validated guidelines and scientific evidence. From diagnosis and staging to treatment, all steps must be tailored to individual clinical and histological features.

Objectives The management of individuals with gastric intestinal metaplasia (GIM) includes biopsies for its staging and to diagnose Helicobacter pylori (Hp). Advanced-stage GIM can be estimated by endoscopy through EGGIM, and a new device permits the real-time assessment of ammonia for the identification of Hp infection. The aim of this study was to assess the simultaneous use of EGGIM and real-time assessment of ammonia to avoid biopsies and reduce the burden of care in clinical practice. Methods A multicentre study involving 101 consecutively enrolled patients [52% male; 65(18–85) years]. During endoscopy, gastric juice was aspirated and analysed; EGGIM was determined in real-time. Targeted biopsies were performed and histopathological assessment was used as gold standard. Results Advanced-stage GIM were detected in 14.9% of patients and Hp infection in 18.8%. EGGIM showed for advanced-stage GIM a sensitivity, specificity and NPV of 86.7%, 84.9% and 97.3%, whilst real-time assessment of ammonia, 83.3%, 78.2% and 95.4%, respectively. Gastric juice was insufficient in 5 (5.0%). Overall, 64 (67%) patients were correctly diagnosed by EGGIM and real-time assessment of ammonia. If the 47 (49%) patients negative to both assessments would have avoided biopsies, only 4 (4.2%) would have been missed: two with advanced-stage GIM and two with Hp infection. Conclusion The combination of endoscopic assessment and real-time analysis of Hp allows the exclusion of advanced-stage GIM or Hp infection without the need of biopsies in a significant proportion of individuals. This may allow in specific situations to abstain from biopsies reducing the burden of care.

Representing 15% to 20% of all invasive breast cancers, adjuvant systemic treatment for early-stage, high-risk triple-negative breast cancer (TNBC) is preferentially done in the neoadjuvant setting based on a chemotherapy backbone of anthracyclines and taxanes. Pathological complete response to neoadjuvant treatment constitutes the main objective, regarding its correlation with oncological outcomes. The optimal neoadjuvant regimen to achieve the highest rates of pathological complete response is still under investigation, with the increasing knowledge on the molecular pathways, genomic sequencing, and immunological profile of TNBC allowing for the development of a wide array of new therapeutic options. This review aims to summarize the current evidence and ongoing clinical trials of new therapeutic options for the neoadjuvant treatment of TNBC patients.

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Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.conducted with separate interview guides designed for each participant group. Questions related to the use of VCs in the future, accessing technology, waiting times and communicating issues, wider worries or fears. Participants rated their experiences from 1-5 (1 being low and 5 being high). Interviews were recorded with verbal consent and transcribed verbatim. Data was thematically analysed using NVivo12.Results: A total of 36 patients and 10 clinicians participated. Themes were acceptance, time, technology, purpose of clinic, communication, equipment, benefits and choice. Participants were accepting of the VC with 80.5% of patients (n¼29/36) and 90% of clinicians (n¼9/10) supporting future use. Both groups agreed that VCs are not suited to everyone and the use of the VC should be individualised for the patient based on several criteria including patient preference, reason for consultation and patient characteristics. The average satisfaction rating of the VC was higher among patients (4.45/5) than clinicians (3.75/5), with many clinicians suggesting that support setting up video clinics may improve the score. Conclusions:The study showed the promising use of VCs in the future. Recommendations were suggested to optimise the patient and clinician experience. These include implementing a patient triage system to advise which patients should have a virtual consultation, providing enhanced training and equipment to staff and ensuring the chosen method of VC provided is individualised to the patient's needs.Legal entity responsible for the study: The authors.

Introduction:Bladder cancer is the tenth most common cancer worldwide, with Europe having the highest incidence rates. Regarding the treatment of metastatic disease, first-line treatment for fit patients is cisplatin-containing combination chemotherapy. However, a significant percentage of patients are ineligible for platinum-based chemotherapy, or progress under these regimens. Recently, immune checkpoint blockade has become a treatment option for this group of patients. In this report, we present the case of a male patient diagnosed with metastatic bladder cancer who did not tolerate cisplatin-containing chemotherapy and achieved complete response after treatment with pembrolizumab.Patient concerns:A 58 years-old Caucasian man with a medical history of high-grade urothelial carcinoma pT3bN0R0 under a watchful waiting strategy for 6 months presented to the Medical Oncology appointment with two axillary and cervical adenopathies.Diagnosis:Cervicothoracoabdominal computed tomography confirmed the presence of two large necrotic lymphadenopathies in the cervical and axillary lymphatic chains, and bone scintigraphy revealed dorsal (D11) and lumbar (L5) metastatic lesions. Ultrasonography-guided biopsy of the axillary nodule revealed the presence of metastatic tissue of primary urothelial origin.Interventions:The patient was initiated on a palliative chemotherapy regimen of carboplatin area under the curve 5 plus gemcitabine (1000 mg/m2). During the first cycle of chemotherapy, acute kidney failure akin 2 developed due to nonobstructive toxic acute tubular necrosis with progressive deterioration of kidney function. Therefore, palliative chemotherapy with carboplatin plus gemcitabine was changed to 200 mg of pembrolizumab every 21 days.Outcomes:Overal survival of 57 months with an immune complete response according to the immune Response Evaluation Criteria in Solid Tumours criteria and an excellent quality of life.Conclusion:This case illustrates that second-line therapy with ICIs (pembrolizumab or atezolizumab) has favourable results in achieving an immune complete response after intolerance to cisplatin-based regimens. ICIs provide durable responses that improve overall survival and quality of life.

Introduction: Breast cancer comprises several different pathological entities defined by the presence or absence of hormonal receptors and human epidermal growth factor receptor 2 (HER2). During the disease course, the increase in tumor heterogeneity contributes to the discordant expression of estrogen/progesterone receptors and HER2 status between primary and metastatic lesions. We describe a case that demonstrates the clinical relevance of molecular reassessment during metastatic breast cancer progression. Patient concerns: A 40-year-old Caucasian woman with germline breast cancer gene mutation was referred to a general surgery appointment after breast ultrasound revealed a suspicious nodular lesion in 2012. Diagnosis: Ultrasound-guided microbiopsy revealed an invasive ductal carcinoma of no special type, hormone receptor-positive, and HER2-negative. Interventions: The patient underwent modified radical left mastectomy, adjuvant radiotherapy, chemotherapy, and endocrine therapy. Four years after the diagnosis, HER2 positive lung progression was documented, and the patient received anti-HER2 targeted systemic therapy for 15 months. New disease progression with a triple-negative profile was found, and palli tive systemic treatment was changed to carboplatin for 3 months until new progression. Based on the results of the OlympiAD trial, monotherapy with Olaparib 300 mg twice daily for 28 days was initiated. Outcomes: After seven cycles of treatment, patient showed progressive improvement in quality of life and maintained stable disease without significant adverse events. Conclusion: The clinical relevance of hormone receptor and HER2 status discordance between primary tumors and metastatic lesions has been studied in recent years. This case report illustrates the clinical impact of molecular changes during disease progression and the adaptation of treatment options. This allows for an increase in both survival and quality of life in patients with metastatic breast cancer.

and elevated serum CA19-9 level (>200 ng/mL) were prognostic factors for intrahepatic recurrence, with hazard ratios (HR) of 2.154 (95% confidence interval (CI), 0.893-7.626, P ¼ 0.080) and 3.647, (95% CI, 1.660-8.011, P ¼ 0.001). Conclusion:Preoperative endoscopic nasal biliary drainage (ENBD) and/or endoscopic retrograde biliary drainage (ERBD) procedures may affect intrahepatic tumor recurrence in patients with cholangiocarcinoma after surgical resection. Elevated serum CA 19-9 level also affected intrahepatic tumor recurrence in patients with cholangiocarcinoma after surgical resection.Legal entity responsible for the study: The author.