As the backbone of oncological treatments, systemic chemotherapy is still one of the main pawns in cancer care, alone or in combination with newer targeted agents. All chemotherapy agents can be associated with a type of adverse event called an infusion reaction, which can be characterized as unpredictable, non-dose related, and unexplained by the cytotoxic profile of the drug. For some of these events, a certain immunological mechanism can be identified by blood or skin testing. In this case, we can speak of true hypersensitivity reactions that occur as a response to an antigen/allergen. The current work summarizes the main antineoplastic therapy agents and their susceptibility to induce hypersensitivity reactions and also includes a review of clinical presentation, diagnostic methods in hypersensitivity reactions, and perspectives to overcome these negative events in the treatment of patients suffering from various types of cancer.

Lung cancer ranks second worldwide after breast cancer and third in Europe after breast and colorectal cancers when both sexes and all ages are considered. In this context, the aim of this study was to emphasize the power of dual analysis of the molecular profile both in tumor tissue and plasma by NGS assay as a liquid biopsy approach with impact on prognosis and therapy modulation in NSCLC patients. NGS analysis was performed both from tissue biopsies and from cfNAs isolated from peripheral blood samples. Out of all 29 different mutations detectable by both NGS panels (plasma and tumor tissue), seven different variants (24.13%; EGFR L858R in two patients, KRAS G13D and Q61H and TP53 G244D, V197M, R213P, and R273H) were detected only in plasma and not in the tumor itself. These mutations were detected in seven different patients, two of them having known distant organ metastasis. Our data show that NGS analysis of cfDNA could identify actionable mutations in advanced NSCLC and, therefore, this analysis could be used to monitor the disease progression and the treatment response and even to modulate the therapy in real time.

Background: Acrometastasis is an uncommon finding in non-small cell lung cancer and is usually a sign of multimetastatic disease. Few case reports have suggested solitary digital metastasis as the single secondary lesion of oligometastatic non-small cell lung cancer. Case presentation: This case report describes an unusual presentation of a Kirsten rat sarcoma viral oncogene homolog-mutated lung adenocarcinoma with a solitary bone metastasis in the fourth finger medial phalanx, which was also the first sign of the disease, in a 63-year-old Caucasian female patient. Digital surgical amputation was performed. After histopathological confirmation and radiological exclusion of other secondary lesions, chemoimmunotherapy in a first-line setting was initiated. A partial metabolic response in the primary lung lesion was observed after four cycles. Maintenance therapy is currently being continued. Conclusion: Solitary digital metastasis is a rare finding in non-small cell lung cancer. Further studies are needed to investigate the mechanisms behind this particular dissemination process.

In the era of immune checkpoint inhibitors (ICI), managing non-oncogene driven non-small cell lung cancer (NSCLC) with brain metastases (BM) is challenging, especially when brain involvement is the initial sign. Patients with newly diagnosed brain metastatic NSCLC without epidermal growth factor receptor (EFGR) nor anaplastic lymphoma kinase (ALK) alterations were retrospectively included. Twenty-five patients were analyzed; 15 (60%) had symptomatic BM as the first sign (group 1), while 10 (40%) had BM discovered during complementary examinations (group 2). Fourteen patients (56%) had concomitant extracerebral metastases, primarily in group 2. Eight (32%) had oligometastatic disease, with seven in group 1. Over half received chemotherapy and pembrolizumab as first-line treatment. BM surgical resection occurred in twelve (80%) patients in group 1 and one in group 2. Median cerebral progression-free survival was 10 months: 12 in group 1 and 5 in group 2. Median overall survival was 25 months: not reached in group 1 and 6 months in group 2. This case series highlights survival outcomes for patients with inaugural BM, a demographic underrepresented in pivotal trials. Oligometastatic disease and symptomatic BM as initial signs seem associated with better prognosis due to increased use of multimodal local approaches. Combining local approaches with first-line ICI+/− chemotherapy appears to improve survival in brain metastatic NSCLC. A literature review was conducted to explore key questions regarding upfront ICI alone or in combination with systemic drugs or local approaches in brain metastatic NSCLC.

Immunotherapy has transformed the treatment of gas­tro­in­tes­ti­nal cancers, with immune checkpoint inhibitors (ICIs) playing a crucial role in improving survival across va­­rious malignancies. This review systematically analyzed phase II and III randomized clinical trials evaluating im­mune-based therapies in digestive cancers. A literature search was conducted in PubMed, focusing on randomized stu­dies exploring these therapeutic approaches in gas­tric, eso­pha­geal, colorectal, hepatocellular, biliary tract and pan­cre­a­tic cancers. The results highlight that ICIs pro­­vide sig­ni­fi­cant survival benefits in MSI-H/dMMR co­lo­rec­tal cancer, PD-L1-positive gastroesophageal can­cer and he­pa­to­cel­lu­lar carcinoma, with key trials such as Check­Mate 649, KEYNOTE-859, IMbrave150 and TOPAZ-1 es­ta­bli­shing new stan­dards of care. However, their ef­fi­cacy remains limited in microsatellite-stable (MSS) co­lo­rec­­tal and pancreatic can­cers, necessitating com­bi­na­­tion stra­te­gies. Despite their suc­cess, immune-related ad­­verse events, biomarker-driven pa­tient selection, and re­sis­tance me­cha­nisms remain major chal­lenges. With re­cent re­gu­la­to­ry ap­pro­vals in Romania, the access to these therapies is ex­pan­ding, underscoring their growing im­pact in clinical prac­tice. Fu­ture directions should focus on optimizing com­bi­na­tion re­gi­mens, refining pre­dic­tive bio­mar­kers and over­co­ming treat­ment resistance to further en­hance patient out­comes in gas­tro­in­tes­ti­nal on­co­lo­gy.