Gustavo Schvartsman

Thymoma recurrence with pleural dissemination remains a therapeutic challenge, often requiring multimodal treatment strategies. Cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy (HITHOC) has emerged as a promising approach for selected patients; however, reports using minimally invasive robotic platforms are limited. We present the case of a 41‐year‐old woman with pleural and lymph node recurrence of type AB thymoma 3 years after robotic extended thymectomy. The patient underwent robotic‐assisted cytoreductive surgery, including complete parietal pleurectomy and resection of pleural, pericardial, and subaortic lymph node lesions, followed by HITHOC with cisplatin and doxorubicin. The procedure was performed safely, with no major perioperative complications. The patient was discharged after 7 days and remained disease‐free at 2‐year follow‐up. This case highlights the feasibility, safety, and potential oncological benefits of combining robotic cytoreductive surgery with HITHOC in the management of recurrent thymoma with pleural involvement. This minimally invasive multimodal strategy may represent a valuable option for carefully selected patients, although further studies with larger cohorts and longer follow‐up are warranted.

Thymic epithelial tumors (TETs) are a diverse group of rare thymic tumors that arise from thymic epithelial cells. The rarity of these tumors has limited therapeutic advancements due to difficulty to enroll patients into Phase II and III clinical trials. Historically surgery, radiotherapy, and chemotherapy have been the mainstay therapeutic options for these patients with the development of new therapeutics hindered by the rarity, histological and molecular heterogeneity, and lack of actionable mutations. However, more recently, innovations in immunotherapy, next-generation tyrosine kinase inhibitors, and hyperthermic intrathoracic chemotherapy (HITHOC) have transformed the therapeutic landscape with more promising therapies currently under investigation. In this review we evaluate the histology and molecular subtypes of TETs, and discuss the therapeutic landscape including the current standard-of-care regimen as well as drugs that are currently in clinical trials.

Highlights PD-L1 expression by immunohistochemistry is positive in more than half on stage III non-small lung cancer. PD-L1 expression by immunohistochemistry had no relationship with clinical characteristics. PD-L1 expression by immunohistochemistry is not related to progression-free or overall survival in patients treated with chemoradiotherapy with or without surgery. ABSTRACT Objective: Currently programmed cell death protein 1 (PD-1) inhibitors in combination with other therapies are being evaluated to determine their efficacy in cancer treatment. However, the effect of PD-ligand (L) 1

Comprehensive genomic profiling is highly recommended for treatment decision in nonsquamous, non-small cell lung cancer (NSCLC). However, rare genomic alterations are still being unveiled, with scarce data to guide therapy. Herein, we describe the treatment journey of a 56-year-old, never-smoker Caucasian woman with a metastatic NSCLC harboring a CD47-MET fusion, initially classified as a variant of unknown significance. She had undergone 3 lines of therapy over the course of 3 years, including chemotherapy, immunotherapy, and anti-angiogenic therapy. After reanalysis of her next-generation sequencing data in our service, the fusion was reclassified as likely oncogenic. The patient was started with fourth-line capmatinib, with a good tolerance so far and a complete metabolic response in the active sites of disease, currently ongoing for 18 months. In conclusion, we highlight the sensitivity of a novel MET fusion to capmatinib and emphasize the need for comprehensive panels in NSCLC and molecular tumor board discussions with specialized centers when rare findings arise.

Lung cancer represents the most commonly diagnosed neoplasm and the leading cause of cancer-related death worldwide, with majority of the patients being histologically categorized as non-small cell lung cancer. We present the case of a 54-year-old male patient, with a smoking history of 30 pack-years and no other comorbidities, with a pulmonary mass in the left lower lobe () incidentally revealed by computed tomography (CT). After pathological confirmation of adenocarcinoma with hilar lymph node metastasis (cT2b pN1 M0, EIIB), the

The incidence of malignant pleural mesothelioma is expected to increase globally. New treatment options for this malignancy are eagerly awaited to improve the survival and quality of life of patients. The present article highlights the results of recent advances in this field, analyzing data from several relevant trials. The heterogeneous tumor microenvironment and biology, together with the low mutational burden, pose a challenge for treating such tumors. So far, no single biomarker has been soundly correlated with targeted therapy development; thus, combination strategies are often required to improve outcomes. Locally applied vaccines, the expansion of genetically engineered immune cell populations such as T cells, the blockage of immune checkpoints that inhibit anti-tumorigenic responses and chemoimmunotherapy are among the most promising options expected to change the mesothelioma treatment landscape.

Frantz tumors or solid pseudopapillary pancreatic neoplasm (SPN) are rare exocrine neoplasms that carry a favorable prognosis; they represent up to 3% of all tumors located in the region of the pancreas and have specific age and gender predispositions. In recent years, the rising curve of diagnosis is entitled to the evolution and access of diagnostic imaging. In this paper, we have retrospectively reviewed and described the clinical course of 40 patients with SPN from three institutions in Brazil, who had their diagnosis between 2005 and 2020, and analyzed the clinicopathological, genetic, and surgical aspects of these individuals. In accordance with the literature, most patients were women, 60% with unspecified symptoms at diagnosis, with tumors mainly located in the body and tail of the pancreas, of whom 70% underwent a distal pancreatectomy with sparing splenectomy as a standard procedure, and none of the cases have experienced recurrence to date. Surgery still remains the mainstay of treatment given the low metastatic potential, but more conservative approaches as observed in this cohort are evolving to become the standard of care. Herein, we present an in-depth analysis of cases focusing on the latest literature and report some of the smallest tumor cases in the literature. To our knowledge, this is the first report evaluating germline genetic testing and presenting a case of detected Li-Fraumeni syndrome.