Different peripheral blood parameters have emerged as prognostic biomarkers in breast cancer (BC), but their predictive role in Human Epidermal growth factor Receptor 2 positive (HER2+) advanced BC (aBC) patients receiving dual anti-HER2 blockade remains unclear. We evaluated the impact of the Pan-Immune-Inflammatory Value (PIV), defined as the product of peripheral blood neutrophil, platelet, and monocyte counts divided by lymphocyte counts, on the prognosis of HER2+ aBC patients treated with first line trastuzumab-pertuzumab-based biochemotherapy. We also evaluated the association between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the monocyte to lymphocyte ratio (MLR) and clinical outcomes. Cox regression models were used to estimate the impact of these variables, as well as of other clinically relevant covariates, on patient survival. We included 57 HER2+ aBC patients treated with taxane-trastuzumab-pertuzumab in our Institution. High baseline MLR, PLR, and PIV were similarly predictive of worse PFS at univariate analysis, but only high PIV was associated with a trend toward worse PFS at multivariable analysis. Regarding OS, both high PIV and MLR were associated with significantly worse patient survival at univariate analysis, but only the PIV was statistically significantly associated with worse overall survival at multivariable analysis (HR 7.96; 95% CI: 2.18–29.09). Our study reveals the PIV as a new and potent predictor of OS in HER2+ aBC patients treated with first line trastuzumab-pertuzumab-containing biochemotherapy. Prospective studies are needed to validate this new prognostic parameter in HER2+ aBC.

Background: Global migration has led to an increasing number of migrant patients receiving cancer diagnoses in foreign countries. These individuals often experience worse outcomes due to advanced disease at diagnosis and limited access to specialized care. When palliative care becomes the primary option, many express a wish to return to their home country for End-of-Life care. However, no guidelines or care pathways currently address this sensitive issue. Case presentation: This case series describes three migrant patients who wished to return to their home countries for End-of-Life care. The first case highlights the critical role of early communication, administrative challenges, and disparities in palliative care availability. The second case demonstrates that even highly disabled patients can undertake a final journey if clinically stable, provided appropriate accommodations and support are in place. Both cases followed a similar framework: identifying a palliative care provider in the home country and having a Mini-Team member accompany the patient. In contrast, the third case underscores the difficulty of fulfilling this wish when clinical deterioration progresses rapidly, preventing repatriation Conclusion: Fulfilling the desire of migrant oncology patients to return to their home countries for End-of-Life care presents various challenges. These obstacles may arise from differences in national healthcare systems, administrative issues, and the patient’s clinical condition. It is crucial for the Mini-Team to identify this wish as early as possible to secure appropriate arrangements in the patient’s home country. Additionally, having a member of the Mini-Team accompany the patient during the journey can provide significant support.

Background: Soft tissue and bone sarcomas may carry a considerable symptom burden, which typically worsens in the final weeks of life. To help clarify personalized palliative care needs, we investigated discrepancies in end-of-life management between patients with sarcoma and those with the most common carcinomas. Patients and methods: This retrospective cohort study enrolled all sarcoma patients who died between 1 January 2018 - 31 October 2023, either in the palliative care unit or in medical oncology units, at a large cancer hospital in northern Italy. Each patient with sarcoma was matched with up to three randomly selected patients with carcinoma. Matching was based on age, year of death and unit. Electronic health records were reviewed. Results: Thirty-six patients with sarcoma were matched with 96 patients with carcinoma (44 lung cancer, 40 breast cancer and 12 colorectal cancer). Patients with sarcoma had a significantly higher chance of palliative sedation compared with patients with carcinoma (OR=32.5). The most common refractory symptom in patients with sarcoma was dyspnea (50%), followed by pain (26%). The average opioid dose difference between patient groups during sedation was as high as 220 mg. The final recorded Richmond Agitation-Sedation Scale score (RASS) was on average -4.4 for patients with sarcoma who died in hospice compared to -2.5 for those who died in an oncology unit. Conclusions: In our series, patients with sarcoma had a substantially higher risk of experiencing refractory symptoms requiring palliative sedation compared to patients with the most common cancers. Pain and dyspnea were the most common refractory symptoms in patients with sarcoma, resulting in higher dosages of opioids and possibly impacting sedation deepness. This study suggests that patients with sarcoma may pose special challenges to end-of-life care.