Background: Colorectal cancer (CRC) is one of the most threatening tumors in the world, and chemotherapy remains dominant in the treatment of metastatic CRC (mCRC) patients. The purpose of this study was to develop a biomarker panel to predict the response of the first line chemotherapy in mCRC patients. Methods: Totally 190 mCRC patients treated with FOLFOX or XEOLX chemotherapy in 3 different institutions were included. We extracted the plasma extracellular vesicle (EV) RNA, performed RNA sequencing, constructed a model and generated a signature through shrinking the number of variables by the random forest algorithm and the least absolute shrinkage and selection operator (LASSO) algorithm in the training cohort (n = 80). We validated it in an internal validation cohort (n = 62) and a prospective external validation cohort (n = 48). Results: We established a signature consisted of 22 EV RNAs which could identify responders, and the area under the receiver operating characteristic curve (AUC) values was 0.986, 0.821, and 0.816 in the training, internal validation, and external validation cohort respectively. The signature could also identify the progression-free survival (PFS) and overall survival (OS). Besides, we constructed a 7-gene signature which could predict tumor response to first-line oxaliplatin-containing chemotherapy and simultaneously resistance to second-line irinotecan-containing chemotherapy. Conclusions: The study was first to develop a signature of EV-derived RNAs to predict the response of the first line chemotherapy in mCRC with high accuracy using a non-invasive approach, indicating that the signature could help to select the optimal regimen for mCRC patients.

A minority of intra-abdominal desmoid tumors is associated with Gardner’s syndrome in which desmoid tumors become an important cause of morbidity and mortality if they are surgically unresectable. Here, we report two cases of intestinal perforation during chemotherapy in patients with Gardner’s syndrome-associated intra-abdominal desmoids. One female and one male patients who developed inoperable desmoids were given the chemotherapeutic regimen of doxorubicin plus dacarbazine, followed by meloxicam. Significant tumor regression was observed clinically. However, intestinal perforation happened in both patients. They were subjected to emergency surgery, follow-up management, and survived up to now. The doxorubicin plus dacarbazine chemotherapy is an effective treatment for intra-abdominal demoid tumors in patients with Gardner’s syndrome. On the other hand, given severe adverse events might occur, clinicians should pay more attention that tumor quick regression may cause intestinal perforation in which urgent surgical intervention is necessary.

Background: Ovarian cancer (OC) is the seventh most common newly diagnosed cancer in women worldwide. Ovarian clear cell carcinoma (OCCC) is a specific type of epithelial ovarian cancer with a poor prognosis. It has been revealed that human epidermal growth factor receptor 2 (HER2)-positive (2+/3+) has been observed in 6.7% to 45.6% of patients with OCCC. Anti-HER2 therapy has been demonstrated to be an effective strategy for the treatment of HER2-positive breast cancer. However, the role of anti-HER2 therapy in OC remains largely unknown. This case report is the first report suggesting a 28-month PFS of pyrotinib in HER2-positive OCCC. Case Description: A 67-year-old female patient with HER2-positive OCCC was admitted to our hospital because of fever, who benefited greatly from treatment with pyrotinib, an irreversible HER2 antagonist conditionally approved for patients with advanced or metastatic HER2-positive breast cancer in China. The patient, who had previously been diagnosed with stage I_A OCCC [according to the International Federation of Gynecology and Obstetrics (FIGO)] and undergone radical surgery with standard adjuvant chemotherapy on May 15, 2017, was diagnosed with HER2-positive OCCC at FIGO stage III_C. She was treated with oral pyrotinib (400 mg/day in 21-day cycles) starting on November 27, 2018. Imaging assessments were conducted every 2 to 4 treatment cycles. Best response by response evaluation criteria in solid tumors (RECIST) 1.1 were partial response. However, on March 30, 2021, the patient was assessed using contrast-enhance CT and found to have progressive disease with liver metastases. Subsequently, on April 26, 2021, the patient underwent liver microwave ablation and ultrasound-guided liver biopsy. The immunohistochemistry results of the liver biopsy showed the origin of the disease to be ovarian. Therefore, the disease was identified as HER2-positive OCCC at FIGO stage IV_B. Conclusions: Progression-free survival (PFS) in second-line chemotherapy for patients with recurrent OC ranges from 3.8 to 11.3 months. In the case of this patient, treatment with pyrotinib yielded a PFS of 28 months, which was a promising result for the use of pyrotinib in treating HER2-positive OC.

Immunotherapy and radiotherapy are important means for treating solid tumors. Both treatment methods can potentially cause neurologic injuries. Timely identification, diagnosis, and early treatment play a crucial role in the recovery from neurologic damage. This case report describes a 69-year-old woman with esophageal and oropharyngeal cancer who developed neurological complications after radiotherapy and immunotherapy. She experienced radiation-related motor impairment and symptoms returned after treatment with bevacizumab and corticosteroids. Later, she developed a rare demyelinating neuropathy, diagnosed as MOG antibody-associated disease (MOGAD), likely triggered by immune checkpoint inhibitors, which is a very rare adverse drug reaction. Her condition improved with cessation of immunotherapy and the administration of steroid pulse therapy. Despite treatment interruptions due to side effects, her survival period was favorable, suggesting that reduced-dose therapy in elderly patients may not diminish its antitumor effect. This case emphasizes the need for vigilance in recognizing rare complications and rational antitumor treatment intensity in geriatric oncology.