Martina Violati

Early and loco-regionally advanced oral tongue squamous cell carcinoma (OTSCC) can be treated by surgery alone or followed by adjuvant radiotherapy or chemoradiotherapy. Nevertheless, up to 40% of patients develop tumour relapse. The aim of our study is to investigate the clinical and pathological features associated with reduced disease-free survival (DFS) in a cohort of surgically-resected OTSCC patients. One hundred and six patients surgically resected for OTSCC were retrospectively identified from clinical records. DFS was calculated according to the Kaplan-Meier method and differences between variables were assessed with Log-Rank test. A multivariable Cox regression model was used to analyse the impact of different prognostic factors on DFS. After a median of follow-up of 8.9 years, 22 events, including 11 deaths, were observed. Overall, the 5-year DFS-rate was 87.4%. The presence of extra-nodal extension (p = 0.023) and perineural invasion (p = 0.003) were significantly correlated with shorter DFS (in univariate analysis). In multivariable analysis, extra-nodal extension and perineural invasion confirmed their role as independent prognostic factors associated with an increased risk of disease recurrence [hazard ratio (HR) 2.87, 95% CI 1.11 -7.42, p = 0.03; HR 3.85, 95% CI 1.49 -9.96, p = 0.006, respectively]. p16 and p53 expressions in tumour cells were detected in 12% (n = 9) and 46% (n = 40) of cases, respectively. No differences in DFS were observed between p16+ and p16-(p = 0.125) and between p53+ and p53-tumours (p = 0.213). In conclusion, radical surgery, eventually followed by adjuvant radiotherapy or chemo-radiotherapy, can achieve high cure rates in OTSCC. After long-term follow-up, perineural invasion and extra-nodal extension confirmed their role as prognostic factors associated with reduced DFS in OTSCC patients. KEY WORDS: Oral cancer Tongue cancer Head and neck

Background: Immunotherapy with anti PD-1 antibodies (mAbs) is the standard of care for the treatment of advanced Non-Small-Cell Lung Cancer (NSCLC). A conspicuous group of patients with advanced NSCLC are more than 75 years old. However, no randomized controlled trial exploring anti PD-1 therapy in older individuals has been published until now and few experiences in clinical practice have been reported. We therefore performed a multicenter retrospective analysis on NSCLC elderly patients treated with anti PD-1 therapy. Methods: We collected data from seven centers. Inclusion criteria were a diagnosis of advanced NSCLC, age ≥75 years, and treatment with anti-PD-1mAbs (pembrolizumab or nivolumab) in first or following lines. Primary end-points of the study were efficacy, in terms of Disease Control Rate (DCR), Overall Response Rate (ORR), Progression-Free Survival (PFS), and safety, by means of immune-related adverse events (irAEs). Results: The Clinical records of 72 patients followed since 2015 were analyzed. Median age was 77 years (75-86), males ware more frequently represented (60/72, 83%). A current or previous smoking history was found in 67/72 (93%) patients. Very old individuals (> 80 years old) were 21/72 (29%) and ECOG PS was 0-1 for 49/72 patients (63%). Non-squamous histology was prevalent 45/72, (62%). Brain metastases were found in 6/72 (8%) patients. Most of the patients (58/72, 81%) received nivolumab. For 68 patients, data on DCR, ORR were available. 39/68 (54%) had a DCR, while 17/68 (24%) had an ORR. Less than 10% of the patients had oligoprogression or pseudoprogression (8,3 and 9,7 % respectively). Overall immune-related adverse events occurred in 9/72 (14%) of individuals, 4/10 (40%) of them grade 3/4, being hematological and liver toxicities the most frequent ones (4 and 3%, respectively). At time of analysis, median PFS was 4,4 months (0.5-25 SD 5,53). In the Cox regression analysis, PFS was significantly influenced by DCR and smoking status (p = 0,0001, OR 17 95% CI 5,4 -52,3 and p = 0,001, OR 11 95% CI 2,6-45, respectively). Conclusions: In our cohort of elderly patients, anti PD-1 agents demonstrated to have a good toxicity profile and an efficacy comparable with the younger population. Legal entity responsible for the study: I conducted the study recording and collecting clinical data from other colleagues and computing statistical part with other specialists of the San Paolo Hospital in Milan. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Skin toxicity is a frequent complication of anti-epidermal growth factor receptor therapy, which can be an obstacle in maintaining the dose intensity and may negatively impact on the clinical outcome of cancer patients. Skin lesions depend on the disruption of the keratinocyte development pathways and no treatment is clearly effective in resolving the cutaneous alterations frequently found during anti-epidermal growth factor receptor therapy. Among systemic treatments, oral tetracycline proved to be useful in preventing skin manifestations. We describe the case of a patient affected by metastatic colorectal cancer, for whom a combination of chemotherapy and cetuximab was used as second-line treatment. The patient developed a symptomatic papulopustular skin rash that disappeared completely after a twice-daily application of a hydrating and moisturizing cream, mainly consisting of a mixture of paraffin, silicone compounds, and macrogol. The marked cutaneous amelioration allowed the patient to continue cetuximab without any further symptoms and was associated with a partial radiological response.