Immune checkpoint inhibitors are monoclonal antibodies that are used to treat over one in three cancer patients. While they have changed the natural history of disease, prolonging life and preserving quality of life, they are highly active in less than 40% of patients, even in the most responsive malignancies such as melanoma, and cause significant autoimmune side effects. Licenced biomarkers include tumour Programmed Death Ligand 1 expression by immunohistochemistry, microsatellite instability, and tumour mutational burden, none of which are particularly sensitive or specific. Emerging tumour and immune tissue biomarkers such as novel immunohistochemistry scores, tumour, stromal and immune cell gene expression profiling, and liquid biomarkers such as systemic inflammatory markers, kynurenine/tryptophan ratio, circulating immune cells, cytokines and DNA are discussed in this review. We also examine the influence of the faecal microbiome on treatment outcome and its use as a biomarker of response and toxicity.

Is total neoadjuvant therapy (TNT) the new standard of care for patients with locally advanced rectal cancer (LARC) ¹? It is clear that the primacy of good-quality surgery and clear margins are key ^2–6. Yet even after neoadjuvant chemoradiotherapy (CRT), total mesorectal excision and adjuvant chemotherapy, distant metastatic disease arises in as many as half of patients with LARC ⁷. Of course, choosing the right patient for neoadjuvant therapy is essential ⁸, so it is crucial to achieve excellence in MRI staging as it is possible to predict those at risk of relapse ⁹. This has been highlighted by the recent focus on extramesorectal nodal metastatic burden, and how it should be managed with combination therapy and surgery ^{10, 11}. Prognosis may be affected more by surgical complications than by chemotherapy issues ^2–12, so why not consider TNT to improve oncological outcomes?

To the Editor, Myxofibrosarcoma (MFS) is a soft tissue malignant neoplasm, seen predominantly in older people often occurring in the limbs but also rarely on the trunk, head and neck [1–3]. It has ...