Alexandru Grigorescu

Introduction. The transition from curative treatment to palliative care is one of the most complex decisions we face in medical practice. Methodology. In this review, we have selected the most frequently used tools by medical oncologists and palliative care specialists to detect the moment in cancer evolution when it is necessary to pass from the active treatment of cancer to palliative care. Discussion. In the ESMO booklet A User’s Manual for Oncology Clinicians, one of the most important chapters is: “Hoping for the best and preparing for the worst”. In this guideline, the authors present the situation when the treatment does not bring any benefit, and this situation should be explained to the patient. “Almost all clinicians find it very difficult to explain to patients that they are unlikely to benefit from ongoing anti-tumor therapies. Indeed, this is so difficult that in many cases oncologists avoid these discussions and continue chemotherapy well beyond a time that has any biological value”. In this respect, we present tools to predict the overall survival and the disease prognosis which can help clinicians to understand the evolution of the disease and try to explain this situation to the patient. Conclusions. The transition from curative treatment to palliative care is a challenge for oncologists and for specialists in palliative care. For diagnosing the condition of a patient who needs this transition, it is im­por­tant to use suitable tools. To explain the condition to the pa­tients, there are necessary communication abilities.

Introduction. The association of lung cancer with prostate cancer is little studied. On the Medscape site, there is no reference to this association. Materials and method. We have collected data from three concrete cases regarding this association, and we evaluated their characteristics. We also made a literature review regarding the particularities of the patients, that was based on articles recommended by artificial intelligence (AI). We did not refer to possible genetic determinations, but from the current data, identical genetic modifications for these two types of cancer have not been investigated. Results. We followed 10 articles selected by AI regarding the association of lung cancer with prostate cancer. From the analysis of these studies and the case presentations, we drew several conclusions. Thus, from the articles we analyzed, it emerges that this association is rare. Most authors studied pulmonary metastases of prostate cancer, and not the association of lung cancer with prostate cancer. The articles studied mainly present the metachronous association of prostate cancer with small cell lung cancer (SCLC), while our case series was represented by cases with non-small cell lung cancer (NSCLC). The articles also show that lung cancer is usually the second cancer that appears in the evolution of patients, while our cases had a reverse sequence of appearance of the two cancers, the first being lung cancer. Conclusions. Physicians should know the most frequent combinations and time intervals of multiple metachronous and synchronous primary cancers, in order to make an early detection and to start the most appropriate treatment. This review reveals that the association between lung cancer and prostate cancer is rare, and the only common aspects are the epigenetic features.

This short review analyzes the definition and measurement of quality of life in oncological patients, both during active antitumor therapy and during palliative care. Regarding the quality of life during curative treatments, the quality of life plays an important role both in routine clinical practice and in clinical trials that substantiate the therapeutic effect of an antineoplastic drug both through response rate and survival, and through the assessment of patients’ quality of life. We have described the main instruments for assessing quality of life and their scope of application in oncology. In conclusion, the quality of life is a particularly complex notion, no questionnaire being complex enough to assess it. New studies based on mathematical formulas or artificial intelligence are necessary for a more efficient assessment of the quality of life of oncological patients.

The incidence of breast and colorectal cancers is well established in studies, but the synchronous occurrence of the two types of tumors is a rarity. In general, they are discovered during screening investigations following the diagnosis of an initial tumor. Objective: Our aim is to describe the main diagnostic and therapeutic challenges for synchronous breast and colorectal tumors. Materials and methods: We performed a systematic review of the literature for cases or case series, using established keywords (synchronous breast and colon tumor and synonyms) for the period of 1970–2023. Five reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The results were processed according to the PRISMA 2020 guidelines. Results: A total of 15 cases were included in the study, including 2 males (age 50 and 57) and 13 females (median age 60, with range from 40 to 79). In a vast majority of the cases, the diagnosis of synchronous tumor was prompted by the first tumor’s workup. The first diagnosed tumor was colorectal in nine cases and a breast tumor in six cases. The most common histopathological type of breast tumor was invasive ductal carcinoma, and the colon tumors were exclusively adenocarcinomas. All cases had a surgical indication for both breast and colorectal tumor, except one case, in which the breast tumor had multiple metastasis. In four cases, the surgery was performed concomitantly (colectomy and mastectomy). In three cases, surgery was initially carried out for the breast tumor, followed by colon surgery. Oncological treatment was indicated depending on the tumor stage. Conclusions: For the treatment of synchronous tumors, the Tumor Board (T.B) decision is mandatory and must be personalized for each patient. Developing new methods of treatment and investigation may play an important role in the future for understanding synchronous tumor development, incidence, and outcome.

(1) Background: Uveal melanoma (UM) is a common malignant intraocular tumor that presents with significant genetic differences to cutaneous melanoma and has a high genetic burden in terms of prognosis. (2) Methods: A systematic literature search of several repositories on uveal melanoma diagnosis, prognosis, molecular analysis, and treatment was conducted. (3) Results: Recent genetic understanding of oncogene-initiation mutations in GNAQ, GNA11, PLCB4, and CYSLTR2 and secondary progression drivers of BAP1 inactivation and SF3B1 and EIF1AX mutations offers an appealing explanation to the high prognostic impact of adding genetic profiling to clinical UM classification. Genetic information could help better explain peculiarities in uveal melanoma, such as the low long-term survival despite effective primary tumor treatment, the overwhelming propensity to metastasize to the liver, and possibly therapeutic behaviors. (4) Conclusions: Understanding of uveal melanoma has improved step-by-step from histopathology to clinical classification to more recent genetic understanding of oncogenic initiation and progression.

Colon cancer is one of the most common localizations of cancer in our time. In this short presentation, I will present some aspects of the systemic therapy of advanced colon cancer. Not being able to have an exhaustive approach, I consider that emphasizing the importance of ctDNA determination in the therapeutic indication and the involvement of precision medicine in the treatment of this cancer are of first importance. Also, colon cancer is found especially at advanced ages, and I considered it necessary to emphasize the role of geriatric consultation in these patients. This review also presents a practical aspect in chemotherapy for the elderly, namely the stability of the indication for cytostatic oxaliplatin treatment which in certain patients does not bring any benefit.

Lung cancer remains the leading cause of cancer-related deaths globally, with non-small cell lung cancer (NSCLC) being the most prevalent subtype. Epidermal growth fac­tor re­cep­tor mutations (EGFRm) contribute to a poorer prognosis, due to ag­gres­sive disease progression and treatment re­sis­­­tance. Over the past decade, significant advancements have been made in the development of EGFR tyrosine ki­na­se inhibitors (TKIs), culminating in the introduction of osimertinib, a third-generation TKI with improved ef­fi­ca­cy and safety pro­files. Clinical trials, such as ADAURA, LAURA and FLAURA, have demonstrated osi­­­me­­r­ti­­nib’s sub­stan­tial benefits across various stages of NSCLC, including early stage, unresectable stage III, and me­ta­sta­tic disease. These studies have shown significant im­prove­ments in pro­gres­sion-free survival and overall sur­vi­val, establishing osimertinib as a standard of care in these settings. On­going re­search aims to further enhance its efficacy through com­bi­na­tion therapies and address resis­tance mechanisms, po­ten­tially broadening its appli­ca­tion in the NSCLC treat­ment.

In this review, we have reproduced the main recom­men­da­tions of the most important medical societies around the world regarding palliative care, especially at the end of life. Thus, we presented the recommendations of the World Health Organization, United Nations, ASCO, ESMO, EAPC, and the European Society of Emergency Medicine. The conclusion is that all health facilities with beds must have doctors specialized in end-of-life therapy, and this the­ra­py must be discussed in a medical board. The decision to declare the end of life and the necessary therapy in these cases cannot be taken by a single doctor.

Taking into account the effect on brain lesions, I believe that the study combination (amivantamab plus carboplatin-pemetrexed) can be put into practice even before the survival data. The role of lazertinib is not clear.

The results of the study will change the therapeutic standard if a gain in survival is recorded.