Colorectal cancer (CRC) remains a leading cause of cancer-related deaths in the United States. Although immunotherapy has dramatically changed the landscape of treatment for many advanced cancers, the benefit in CRC has thus far been limited to patients with microsatellite instability high (MSI-H):DNA mismatch repair–deficient (dMMR) tumors. Recent studies in the refractory CRC setting have led to US Food and Drug Administration approvals for pembrolizumab as well as nivolumab (with or without ipilimumab) for tumors harboring an MSI-H:dMMR molecular profile. Several randomized controlled trials are underway to move immunotherapy into the frontline for metastatic cancer (with or without chemotherapy) and the adjuvant setting. Awareness of these studies is critical given the relatively low incidence (approximately 3%–5%) of MSI-H:dMMR in advanced or metastatic CRC to support study completion, because the results could be potentially practice changing. The real challenge in this disease is related to demonstrating the benefit of immunotherapy for the vast majority of patients with CRC not harboring MSI-H:dMMR. Given the rapid pace of scientific changes, this article provides a narrative review regarding the current landscape of immunotherapy for CRC. Particular attention is paid to the currently available data that inform today’s clinical practice along with upcoming randomized controlled trials that may soon dramatically change the treatment landscape for CRC.

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Background: 5-Fluorouracil (5-FU) is an antimetabolite chemotherapy used for a variety of solid tumors. It has the potential to cause a wide spectrum of cardiotoxicity, ranging from asymptomatic electrocardiographic changes to cardiomyopathy and subsequent cardiac failure. Main body of the abstract: We present two descriptive cases of new-onset severe cardiomyopathy induced by 5-FU followed by a review of the literature. Conclusion: Our case series emphasizes the importance of early recognition of this rare complication and prompt cessation of 5-FU, as cardiac dysfunction in this context is potentially reversible.

Gastrointestinal stromal tumors (GISTs) are rare tumors of gastrointestinal (GI) tract with mesenchymal cell origin. Extragastrointestinal stromal tumors (EGISTs) are unusual tumors that exhibit the same immunohistochemical and genetic abnormalities as GISTs and most commonly affect the omentum and mesentery. EGISTs of the pelvis and the female reproductive system are exceedingly rare and a frequent diagnostic pitfall. In this report, we present two cases of EGISTs along with a review of the literature.

Background Colon cancer (CC) incidence in young adults (age 20-49 years), termed early-onset CC (EO-CC), is increasing. Methods Individual patient data on 35 713 subjects with stage III colon cancer from 25 randomized studies in the Adjuvant Colon Cancer ENdpoint database were pooled. The distributions of demographics, clinicopathological features, biomarker status, and outcome data were summarized by age group. Overall survival, disease-free survival, time to recurrence, and survival after recurrence were assessed by Kaplan-Meier curves and Cox models stratified by treatment arms within studies, adjusting for sex, race, body mass index, performance status, disease stage, grade, risk group, number of lymph nodes examined, disease sidedness, and molecular markers. All statistical tests were 2-sided. Results Using a 5% difference between age groups as the clinically meaningful cutoff, patients with stage III EO-CC had similar sex, race, performance status, risk group, tumor sidedness, and T stage compared with patients with late-onset CC (age 50 years and older). EO-CC patients were less likely to be overweight (30.2% vs 36.2%) and more commonly had 12 or more lymph nodes resected (69.5% vs 58.7%). EO-CC tumors were more frequently mismatch repair deficient (16.4% vs 11.5%) and less likely to have BRAFV600E (5.6% vs 14.0%), suggesting a higher rate of Lynch syndrome in EO-CC. Patients with EO-CC had statistically significantly better overall survival (hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.74 to 0.89; P < .001), disease-free survival (HR = 0.91, 95% CI = 0.84 to 0.98; P = .01), and survival after recurrence (HR = 0.88, 95% CI = 0.80 to 0.97; P = .008) in the analysis without molecular markers; however, age at onset of CC lost its prognostic value when outcome was adjusted for molecular markers. Conclusion Tumor biology was found to be a more important prognostic factor than age of onset among stage III colon cancer patients in the Adjuvant Colon Cancer ENdpoint database.

In the past decade, targeted therapy with VEGF and mTOR inhibition has significantly improved the outcome of renal cell carcinoma. However, the management of metastatic renal cell carcinoma still remains challenging as most patients eventually progress on targeted therapy, and long-term survivors are still relatively uncommon. There has recently been a resurgence of interest in cancer immunotherapy with the development of checkpoint inhibitors. Here we discuss the best methods to optimize the current standard of care with targeted therapy, and describe select emerging targeted therapies and immunotherapies with anti programmed death-1 pathway inhibitors in the management of metastatic renal cell carcinoma.

Posaconazole is widely used for prophylaxis against invasive fungal infections in patients undergoing myeloablative therapy. Disseminated fusariosis is a serious invasive mold infection in such patients. Preclinical and clinical studies indicate activity of posaconazole against Fusarium. We describe two cases of disseminated fusariosis that occurred despite posaconazole prophylaxis. CASE REPORTSCase report 1. A 47-year-old female was diagnosed with acute myelogenous leukemia (AML) 6 years after a failed allogeneic haploidentical sibling donor allogeneic hematopoietic stem cell transplant (HSCT) for sickle cell anemia. She began standard induction chemotherapy with cytarabine and idarubicin and was placed on posaconazole (200 mg by mouth three times daily) for antifungal prophylaxis. She was also started on vancomycin for Corynebacterium striatum bacteremia. Piperacillin-tazobactam was empirically added 10 days later for persistent fever and was changed to ceftazidime after another 4 days because she did not defervesce. Following this, she became afebrile for 2 days, only to develop a low-grade fever again. Blood cultures remained negative after initiation of antibacterial therapy. Three weeks after the initiation of chemotherapy, the patient developed multiple tender, erythematous papular skin lesions scattered over her trunk, extremities, and face. Biopsy of these showed numerous intravascular/perivascular fungal hyphae, consistent with disseminated fungal infection. At the same time, blood from her indwelling intravenous port grew Fusarium species with MICs of 4 g/ml, 2 g/ml, and 4 g/ml for amphotericin B (AmB), posaconazole, and voriconazole, respectively (by the broth microdilution method). Posaconazole was stopped, and she was treated with liposomal AmB (5 mg/kg of body weight intravenously [i.v.] every 24 h) and voriconazole (6 mg/kg i.v. for two doses 12 h apart, followed by 4 mg/kg every 12 h). She also received one granulocyte transfusion as part of the Reduction of Infections in Neutropenia with Granulocytes (RING) study. She received granulocyte colony-stimulating factor (G-CSF) briefly, and it and vancomycin and ceftazidime were stopped when the neutropenia resolved. Her skin lesions began to heal with crusting, blood cultures became and remained negative, and she became afebrile. A repeat bone marrow biopsy showed no evidence of persistent AML, and she was discharged on liposomal AmB and oral voriconazole 3 weeks after the diagnosis of disseminated fusariosis. She was readmitted 17 days later for consolidation chemotherapy. AmB was stopped due to worsening renal function, and voriconazole was continued. Chemotherapy with cytarabine was administered once her renal function stabilized, and she was discharged. Unfortunately, 11 days after her second hospital discharge, she presented with hypotension, dyspnea, dehydration, and renal failure, and she died within 24 h of overwhelming pneumococcal septic shock.Case report 2. A 42-year-old male was diagnosed with AML after presenting with a scrotal abscess,...

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