Higher baseline TSH levels predict early hypothyroidism during cancer immunotherapy

BACKGROUND AND PURPOSE

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that enhance the immune response against cancer cells. ICIs are generally well tolerated, although endocrine immune-related adverse events (irAEs) are common. We investigated the risk factors for thyroid irAEs in patients treated with ICIs. Moreover, we evaluated the clinical outcome of subjects who became hypothyroid compared to euthyroid patients.

PATIENTS AND METHODS

We retrospectively analyzed a series of 195 consecutively subjects treated with ICIs for metastatic tumors at the University of Naples "Federico II" between January 2014 and March 2020. Only subjects tested for thyroid function before and during the treatment with ICIs were included.

RESULTS

In the 96 patients treated with ICIs who were included [66 males, median age: 62 years (27-87)], thyroid irAEs occurred in 36 (37.5%), 16 (16.7%) a transient thyrotoxicosis, and 20 (20.8%) an hypothyroidism (in nine subjects hypothyroidism was preceded by a transient thyrotoxicosis). Only baseline TSH levels above 1.67 mIU/L and positive anti-thyroid antibodies (Ab-T) were associated with a higher risk of hypothyroidism. Patients with hypothyroidism during ICI treatment showed an improved 2-year PFS (HR = 0.82 CI 0.47-1.43; p = 0.0132) and OS (HR = 0.38 CI 95% 0.17-0.80; p = 0.011) compared to euthyroid patients.

CONCLUSIONS

Baseline TSH levels above 1.67 mIU/L and presence of Ab-T are risk factors for the development of thyroid irAEs. Patients affected by thyroid irAEs showed a longer survival than patients who remained euthyroid.

Optimization of biochar quality and yield from tropical timber industry wastes

The conversion of timber industry waste to biochar was investigated, based on residues from local tropical hardwoods in Cameroon. Closed and flow reactors, loaded with few grams of the sample and fluxed with different inert gases, were used with the aim of converting these wood residues to a safe and efficient solid fuel that can be exploited by the local community for cooking purposes. The pyrolysis temperature had the highest impact on the process up to approximately 700 °C as biochar yields decreased from 87 to 23.5% while increasing the temperature. A significant concentration of carbon required temperatures greater than 500 °C for the biochar to become a good solid fuel, approaching the heating value of coal. The role of heating rate appeared marginal even in a broad range: 0.1 to 70 °C/min. The dwell time (in the range 0.5 to 5 h) at maximum temperature revealed to be of little influence on the charring which occurred mostly during the first few minutes of the isothermal phase. Thus, actual production time can be <1 h/batch (up to 500 °C at 10 °C/min). Stepwise heating revealed a sequence of devolatilization reactions following their activation energies. Use of CO₂ as inert gas increased the char yield. The inert gas flow rate had two contrasting effects on the biochar yield, in relation to volatile components residence time and the biomass temperature. The reactivity of biochar in combustion suggests a trade-off between heating content and reactivity. Charring in a closed, pressurized reactor produced biochar of low value as fuel, with tars absorbed in the porous solid residue.

Diagnostic Salivary Tests for SARS-CoV-2

The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.

Gastric Xanthomatous Hyperplastic Polyps – Just an Incidental Endoscopic Finding?

Background: Laparoscopic sleeve gastrectomy (LSG) progressively became the preferred procedure worldwide for the treatment of morbid obesity. Occasionally, unknown gastrointestinal diseases may be incidentally discovered during the procedure or on the histologic gastric specimen. Gastric xanthomas are uncommon lesions of the lamina propria, composed by foamy macrophages and mixed inflammatory infiltrate. Rarely, xanthoma cells develop within a gastric hyperplastic polyp. Although usually benign, they may be associated with pre-malignant conditions or even gastric cancer, making advisable an appropriate workup. Case Presentation: A hyperplastic polyp with xanthomatous proliferation was discovered in the gastric specimen of a young man, suffering from severe obesity and metabolic syndrome. The patient had been treated with proton pump inhibitors for gastric discomfort for years. After the surgical procedure, the gastric discomfort rapidly disappeared. Conclusion: Obesity is often complicated by gastrointestinal abnormalities discovered during ultrasound or endoscopic procedures. Incidental findings of unknown gastric lesions are common occurrences during sleeve gastrectomy. Although xanthelasmas per se are harmless, they might coexist with pre-malignant/ malignant lesions, especially when associated with gastric polyps. Thus, prompt intra-operative recognition and adequate work-up are mandatory. Although cases of gastric polyps or xanthomas are not a novelty, to our knowledge, this is the first case reporting about the discovery of a gastric hyperplastic polyp with xanthomatous proliferation on gastric histological piece. From the discussion of this case and of similar reports in the literature, we advocated for the importance of endoscopic screening in obese patients admitted for bariatric surgery to address the proper surgical approach and follow-up.

Prognostic Impact of MCPyV and TIL Subtyping in Merkel Cell Carcinoma: Evidence from a Large European Cohort of 95 Patients

Merkel cell carcinoma is a rare (∼ 2000 cases/year in the USA) but aggressive neuroendocrine neoplasm of the skin. In 2008, the Merkel cell polyomavirus (MCPyV) was found to be clonally integrated in approximately 80% of Merkel cell carcinomas. The remaining 20% have large numbers of UV-associated mutations. Importantly, both the UV-induced neoantigens in virus-negative Merkel cell carcinoma and the Merkel cell polyomavirus oncogenes that are required for virus-positive tumor growth are highly immunogenic. Indeed, antigen-specific T cells detected in patients are frequently "dysfunctional/exhausted," and the inhibitory ligand PD-L1 is often expressed by Merkel cell carcinoma cells. These data led to point our attention on the quantity and the quality of the immune response in Merkel cell carcinoma. Here, we found CD8+ lymphocytes are the only singly evaluated lymphocyte subclass that strongly influenced overall survival and disease-specific survival in Merkel cell carcinoma. In addition, we highlighted as Merkel cell polyomavirus is a strong prognostic factor and as it prompts a host immune response involving various lymphocyte subclasses (CD3, CD8, FoxP3, and PD-L1 positive) in MCC. For this reason, we proposed a novel eye-based "immunoscore" model, obtained by tumor infiltrating lymphocytes subtyping (CD3, CD8, FoxP3, and PD-L1) that could provide additional prognostic information in Merkel cell carcinoma.

Local ablative therapy of oligoprogressive TKI-treated thyroid cancer

Metastatic cancer patients generally respond well to treatment with tyrosine kinase inhibitors (TKIs). However, TKI resistance occurs in almost all cases and often leads to a change in treatment. Recent guidelines, including thyroid cancer, raised the possibility of locally treating TKI-resistant oligoprogressive disease, i.e., one or a few progressing lesions in an otherwise treatment-responsive metastatic cancer, thereby obviating the need to change the ongoing TKI. To determine the benefits of this intervention, we reviewed studies on the use of LAT for TKI-treated oligoprogressive cancers. We found that in non-small cell lung cancer at least, LAT prolongs disease control and the duration of exposure to a TKI irrespective of the LAT used. Moreover, we reviewed the local ablative therapies (LATs) that are feasible for the local control of oligoprogressive thyroid cancer. Lastly, we report two illustrative cases of patients with oligoprogressive thyroid cancer treated with two different LATs while on therapy with TKIs. Both LATs extended the duration of disease control and the time of exposure to the ongoing TKI, thereby indicating that LAT is a favorable option for TKI-treated oligoprogressive thyroid cancer. Prospective randomized studies are needed to verify the benefit of LATs in terms of progression-free and overall survival in this increasingly frequent clinical setting.

Inherited cancer syndromes in 220 Italian ovarian cancer patients

BACKGROUND

A subsets of ovarian carcinomas (OCs) are related to inherited conditions including Hereditary Breast and Ovarian Cancers (HBOC) and Lynch Syndrome (LS). The identification of inherited conditions using genetic testing might be a strategic model for cancer prevention that include benefits for the ovarian cancer patients and for their family members.

METHODS

We describe a retrospective Italian experience for the identification of inherited conditions in 232 patients affected by OCs using both somatic and germline analyses.

RESULTS

Immunohistochemical and microsatellite analyses performed on OCs identified 20 out of 101 MMR defective cancers and 15 of these were from patients carriers of the MMR germline pathogenetic variants. BRCA1 and BRCA2 testing offered to 198 OC patients revealed 67 (34%) pathogenetic variant carriers of BRCA1/2 genes. Interestingly LS patients revealed a mean age of OC onset of 45.4 years, which was significantly lower than the mean age of OCs onset of HBOC patients.

CONCLUSIONS

Somatic and germline analyses offered to OC patients has proved to be an efficient strategy for the identification of inherited conditions involving OC also in absence of suggestive family histories. The identification of LS and HBOC syndromes through OC patients is an effective tool for OC prevention.

Aerobic exercise and Orexin A: role of sympathetic activity and redox system

Aerobic exercise is associated with the sympathetic activation evoking adaptive responses to sustain muscle engagement. Physical exercise can cause alterations in the cardiovascular activity and cellular stress may occur which could be marked by either heart rate (HR), or galvanic skin response (GSR). Moderate plasma levels of reactive oxygen species (ROS) are considered as health markers, absolving to important roles such as adaptive cellular responses to exercise. Orexin A, a hypothalamic peptide, causes a widespread stimulation of the sympathetic nervous system, playing a role in many physiological functions.