Clinical and translational implications of immunotherapy in sarcomas.

Immunotherapy has emerged as promising treatment in sarcomas, but the high variability in terms of histology, clinical behavior and response to treatments determines a particular challenge for its role in these neoplasms. Tumor immune microenvironment (TiME) of sarcomas reflects the heterogeneity of these tumors originating from mesenchymal cells and encompassing more than 100 histologies. Advances in the understanding of the complexity of TiME have led to an improvement of the immunotherapeutic responsiveness in sarcomas, that at first showed disappointing results. The proposed immune-classification of sarcomas based on the interaction between immune cell populations and tumor cells showed to have a prognostic and potential predictive role for immunotherapies. Several studies have explored the clinical impact of immune therapies in the management of these histotypes leading to controversial results. The presence of Tumor Infiltrating Lymphocytes (TIL) seems to correlate with an improvement in the survival of patients and with a higher responsiveness to immunotherapy. In this context, it is important to consider that also immune-related genes (IRGs) have been demonstrated to have a key role in tumorigenesis and in the building of tumor immune microenvironment. The IRGs landscape in soft tissue and bone sarcomas is characterized by the connection between several tumor-related genes that can assume a potential prognostic and predictive therapeutic role. In this paper, we reviewed the state of art of the principal immune strategies in the management of sarcomas including their clinical and translational relevance.

The Experience of Oncology Healthcare Providers in the Central Italy during the COVID-19 Lockdown.

While the emotional response of healthcare providers during the COVID-19 pandemic has been extensively investigated in countries in the Far-East, little is known about the psychological impact and the associated emotional distress of healthcare providers in Italy, especially with regard to different regions. The aim of the "VIRARE" survey, which was addressed to all the healthcare providers in the Lazio region (central Italy) and, in particular, to those working in the oncology field, is to analyze their opinion on the impact and management of the pandemic, to better understand the level of their psychological distress. A global good psychological response of healthcare providers to the pandemic has emerged, independently from their different occupations in the oncology field. Healthcare providers show a high degree of resilience, identifying the major causes of distress the difficulty of the management of this situation, the obstacles in their working activity and expressing a high degree of dissatisfaction with how Italian institutions handled this situation. This survey also provides a direct comparison between COVID-19-infected (or directly in contact with COVID-19-infected patients) and uninfected healthcare providers, identifying the sub-category of infected professionals that reported signs of depression as particularly vulnerable.

[Analysis of the European Consensus on the treatment of opioid-induced constipation analgesic drugs.] / Analisi del consensus europeo sul trattamento della stipsi indotta da farmaci analgesici oppiacei.

Until recently, conclusive data on clinical presentation, diagnosis and therapy of the opioid-induced constipation (OIC) were not available. Lately, some phase II and III prospective studies, evaluating the efficay of several old and new laxatives in cancer and non-cancer patients, make their mechanisms of action easier to understand and lead healthcare institutions to determine homogeneous guidelines for OIC, with the use of diagnostic and treatment algorithms. On May 2018, management recommendations from a panel of 7 European experts on OIC was published on United European Gastroenterology Journal. They discussed on different aspects of OIC: (a) definitions and diagnostic criteria; (b) pathophysiology; (c) clinical evaluation; (d) patient reported outcome measures; (e) initial standard laxatives; (f) specific treatments; (g) pragmatic recommendations. Later, a multi-disciplinary panel consisting of experts in neurogastroenterology, oncology and palliative medicine gave their external input. This statement will help clinicians to harmoniously treat OIC, according to clear guidelines, resulted from phase II and III prospective studies. Nevertheless, the constipation is rarely due to opioids consumption alone. More often, different factors contribute to induce constipation, including diet, immobility, other drugs, pain during evacuation, comorbidities, gastrointestinal obstacles, especially in advanced cancer patients. Therefore, management of OIC always needs to be tailored to the individual patient based on their overall clinical picture.

Pegylated liposomal doxorubicin as third-line chemotherapy in patients with metastatic transitional cell carcinoma of urothelial tract: results of a phase II study.

Until the recent approval of vinflunine, no standard second-line chemotherapy existed for advanced transitional cell carcinoma (TCC). Few data exist about third-line chemotherapy for metastatic disease. Although administered in up-front regimens, anthracyclines were never evaluated beyond second-line treatment. This study assessed the activity of pegylated liposomal doxorubicin (PLD) in patients with advanced TCC previously treated with two chemotherapy regimens. From May 2005 to June 2009, 23 patients with metastatic TCC were recruited: median age was 62 years (49-76 years) with a median ECOG PS of 1. Patients received PLD 35 mg/m(2) every 21 days. All patients were evaluable for efficacy and toxicity. No patient showed complete response. Three patients (13 %) had partial response; seven patients (30 %) showed stable disease for a disease control rate of 43 %. The median time to progression (TTP) was 4.1 months with a median survival time (MST) of 6.3 months. Treatment was well tolerated: no patient developed grade 4 toxicities. This is the first study which evaluated the role of anthracyclines as third-line chemotherapy in metastatic TCC. Despite its manageable profile of toxicity, PLD showed modest activity. Beyond second-line chemotherapy, supportive care still represents the best therapeutic option for patients with metastatic TCC.