Neuroendocrine tumors (NETs) are rare neoplasms with a wide spectrum of clinical behavior, from the long survival of well-differentiated NETs to the dismal prognosis of high-grade neuroendocrine carcinomas (NECs), being G3 NETs a recently recognized intermediate entity. While the role of chemotherapy is well established in NECs, data on NETs mostly derives from small studies, experts’ opinions, and extrapolating results from small-cell lung cancer studies. This narrative review aims to summarize available evidence about the use of chemotherapy in the setting of G1-2 NETs and G3 NETs. We performed literature research in PubMed Library for all articles published up to September 2022 about the efficacy of chemotherapy in NETs. Treatment regimens with STZ-5FU, CAPTEM, and anti-metabolite-based treatment are the most active and tolerated in gastroenteropancreatic NETs (GEP-NETs) G1-G2, while platinum-based regimens (FOLFOX/XELOX) and TEM/CAPTEM showed the best activity in thoracic NETs. Solid evidence about chemotherapy efficacy in G3 NETs is still lacking. Literature data support the use of chemotherapy in low-intermediate grade NETs after the failure of other therapies or if tumor shrinkage is needed. Studies assessing G3 NETs independently from NECs are needed to better understand the role of chemotherapy in this setting.

COVID-19 cancer patients (C19-CP) represent a population at high risk for mortality, whose clinical characteristics are still unknown in the second SARS-CoV-2 wave. The aim of this retrospective study was to compare epidemiology and clinical presentation of C19-CP referring to the emergency department (ED) of our institution (San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy), in a 3-week observation period of the first and second COVID-19 waves, starting from the introduction of the corresponding national lockdowns. We retrieved ED admissions from March 9 to 29, 2020, for the first wave, and from October 24 to November 13, 2020, for the second wave. We collected clinical characteristics of consecutive patients with molecularly confirmed SARS-CoV-2 infection. We also considered untested or SARS-CoV-2–negative cancer patients referring to the ED in the reference time frames. C19-CP in the second wave exceeded those in the first wave despite the nonsignificant difference (39 of 576 v 8 of 163; P = .5). Compared with nononcological patients, C19-CP were older (median age 70 years [interquartile range 61-77] v 60 years [interquartile range 45-73]; P = .02) and presented more often with ≥ 2 comorbidities (40.4% v 24.3%; P = .02). Compared with nononcological patients, in C19-CP, respiratory failure (29 of 47 v 321 of 692; P = .049) and hospitalization (37 of 47 v 363 of 692; P = .0004) were higher, with comparable frequencies across the waves. Five of 24 and 10 of 27 hospitalized cancer patients in the first and second waves developed SARS-CoV-2 infection during hospitalization. C19-CP were a vulnerable population, irrespective of the COVID-19 waves. This highlights the need to prioritize vaccinations in oncological patients to safeguard and guarantee optimal anticancer care.

The recognition that axillary surgery in early breast cancer primarily serves as a staging tool rather than a curative treatment, along with the shift from axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB) as the standard procedure for clinically node-negative patients, has paved the way for further de-escalation of axillary treatment. This strategy aims to reduce treatment-related morbidity while preserving survival outcomes. Multiple studies have provided compelling evidence that ALND can be safely omitted in cases of limited SLN involvement. Moreover, even the omission of SLNB in selected low-risk cohorts has been shown not to increase recurrence rates. On the other side, from the oncological perspective, research has moved toward an escalation of adjuvant treatments, aiming to reduce recurrence rates and improve overall survival. Thus, while residual axillary disease does not affect patient outcomes, limited axillary staging may hinder access to certain adjuvant therapies. Here, we aim to critically assess the potential impact of recent advances in axillary surgical de-escalation on adjuvant systemic therapy decision-making especially in hormone receptor positive/HER2 negative early breast cancer, with a particular focus on the appropriate selection of patients for adjuvant chemotherapy, CDK4/6 inhibitors, and PARP inhibitors. We argue that decisions on surgical de-escalation should be carefully tailored, balancing its potential benefits with the need for accurate staging to guide adjuvant therapies. A patient-centered, multidisciplinary approach remains essential to ensure that de-escalation does not impact negatively on adjuvant treatment decision making and long-term survival.

Safety data regarding BNT162b2 in cancer patients (CPs) are scarce. Herein we report the side effects (SEs), the adverse events (AEs), and the patient-reported outcomes (PROs) following BNT162b2 administration in CPs treated at the San Luigi Gonzaga University Hospital. All CPs who agreed to participate in our vaccination campaign received BNT162b2 and were included in the descriptive analysis. An anonymous questionnaire investigating the occurrence of SEs/AEs and PROs was administered to the study population 21 days after the first dose. Pearson’s chi-squared test was used to estimate the risk of experiencing SEs/AEs according to selected variables. A total of 997 patients were included in the study: 62.0% had stage IV cancer, and 68.8% were receiving an active treatment, of whom 15.9% were receiving immunotherapy. SEs/AEs were recorded in 37.1% of cases after the first dose and in 48.5% of cases after the second dose. The most common SEs were muscle pain/local rash (27.9% and 28%, after the first and second dose, respectively). Patients older than 70 years showed lower risk of SEs/AEs, while women showed a higher risk. Before receiving the vaccine, 18.2% of patients felt fearful and/or insecure about the vaccination. After the first dose, 57.5% of patients changed their feelings positively. Our data support the short-term safety of BNT162b2 in CPs, regardless of disease stage and concurrent treatments. Overall, the vaccination showed a positive impact on quality of life.

Background: Glucagonoma is a rare functional pancreatic neuroendocrine tumor. Necrolytic migratory erythema (NME) is a paraneoplastic manifestation of glucagonoma and is often the first presenting symptom. The misdiagnosis of this rare entity can affect the patient’s quality of life and his life expectancy. Case Presentation: We report a case of a 48-year-old man presenting with pruritic scaly rash, ulcerated skin lesions, and periorbital edema, who was diagnosed and treated for atopic eczema for a 7-year period. Despite treatment, his dermatitis and general conditions progressively worsened, until he was admitted to the emergency department due to weight loss and fatigue. An uncontrolled diabetes was found and the computer tomography scan of the abdomen revealed a tumor located in the tail of the pancreas with liver metastases. Subsequently, liver biopsy and high levels of glucagon confirmed the diagnosis of glucagonoma. The patient was treated with short-acting subcutaneous octreotide for 2 weeks and then with intramuscular slow-release octreotide every 28 days, with a significant improvement of the symptoms. Conclusion: This case provides further knowledge about NME, since a timely recognition and treatment of this misleading disease can prevent morbidity from the dermatitis and mortality from the malignancy itself.