Abstract This narrative review paper examines the use and potential benefits of histone deacetylase inhibitors (HDACis) in pancreatic ductal adenocarcinoma (PDAC) as a combinational therapy. The paper provides a concise overview of the epigenetic events and their effects on gene expression in PDAC, followed by a summary of selected preclinical and clinical studies, demonstrating the efficacy of HDACis as combinatorial treatments. The current therapeutic approach in PDAC includes low-efficacy combination therapies, mainly as a palliative treatment, due to delayed diagnosis, rapid disease progression, and development of metastases. The tumor mutational burden and several epigenetic modifications shape tumor characteristics, regulate the gene expression, and alter the cell cycle. Epigenetic modifications at lysine residues of histones, including acetylation, are mediated by histone acetyltransferases and counteracted by HDACs. HDACis are approved as monotherapy in cutaneous T-cell lymphoma and are potentially effective when administered in combination with other therapies in solid tumors. In particular, combinations of HDACis with tyrosine kinases inhibitors, MEK inhibitors, PI3K inhibitors, 13-cis-retinoic acid, EZH2 inhibitors, and BET inhibitors appear to suppress epithelial–mesenchymal transition, promote apoptosis, and increase overall survival in patients with PDAC.

Abstract Medullary carcinoma (MC) of the colon is one of the rarest types of colon adenocarcinoma with distinct phenotype and clinical outcomes. Annual incidence is noted to be around five to eight out of 10,000 cases of colon cancer, which is partly can be attributed to lack of understanding of these tumors for many years that has resulted in incorrect diagnosis. Comprehensive pathological examination is important along with immunohistochemical staining for accurate diagnosis of MC of the colon. It is usually diagnosed at stage 2 or 3, where surgery is the mainstay of treatment. Given the rarity of the tumor, there are no specific guidelines to direct adjuvant treatments. Most of the recommendations are inherited from colon adenocarcinoma guidelines. Here, we report a case report of elderly gentleman with early-stage medullary carcinoma of the colon and its prognosis, pathological findings, and treatment implications.

Abstract Background Primary breast adenocarcinoma arising in ectopic breast tissue within the vulva is an exceedingly rare occurrence, posing significant diagnostic challenges due to its unusual presentation. Differentiating it from other vulvar neoplasms is crucial for prompt and appropriate management. Case Description We present the case of a 55-year-old female with a history of negative medical and family history, presenting with an atypical vulvar lesion with extensive bone metastasis. Even though normal findings were obtained on mammogram and breast ultrasound, biopsy revealed undifferentiated carcinoma. Further immunohistochemical analysis supported a diagnosis of mammary carcinoma originating from malignant accessory breast tissue. Treatment involved paclitaxel and carboplatin chemotherapy along with zoledronic acid infusions and pelvic bone radiotherapy, which resulted in an initial complete response. However, a subsequent vulvar lesion recurrence necessitated hormonal therapy, leading to another complete response. Conclusion This case highlights the diagnostic complexity and therapeutic challenges associated with primary breast adenocarcinoma in vulvar ectopic breast tissue. Comparison with similar cases underscores the importance of meticulous evaluation, precise immunohistochemistry, and interdisciplinary collaboration for accurate diagnosis and tailored treatment.

Abstract Immune checkpoint inhibitors (ICIs), while revolutionizing cancer treatment, can lead to a spectrum of side effects due to their broad impact on the immune system. Common side effects include fatigue, skin reactions and gastrointestinal issues. However, ICIs can also induce immune-related adverse events (irAEs), affecting various organs, such as the lungs, liver and endocrine system. Severe irAEs, though infrequent, can include myocarditis, colitis and neurologic complications such as neuropathy and myasthenia gravis. Vigilant monitoring and collaborative management by healthcare providers are essential to balance the anti-tumour effects of ICIs with the potential autoimmune consequences. We describe a case of ICI-induced myasthenia gravis, myocarditis, myositis and hepatitis that was recognized and managed in the broader context of myasthenia gravis. It is essential that patients on ICIs to be regularly monitored for irAEs during treatment for their malignancies due to the risk of potentially fatal complications.

Abstract Background Squamous cell carcinoma of the sigmoid colon is an exceedingly rare and often late-diagnosed form of colon cancer. It presents diagnostic and therapeutic challenges due to its rarity and nonspecific symptoms. This case report aims to enhance understanding and awareness of this uncommon malignancy. Case Presentation We present the case of a 59-year-old female with advanced stage squamous cell carcinoma of the sigmoid colon, accompanied by metastases to regional lymph nodes, peritoneum, and omentum. Initial imaging and colonoscopy confirmed the diagnosis, and due to the absence of established treatment guidelines, a unique chemotherapy regimen combining paclitaxel, carboplatin, and bevacizumab was initiated. Remarkably, the patient exhibited a significant improvement in performance status and achieved complete remission following 16 weeks of treatment. Conclusion This case highlights the diagnostic challenges and therapeutic complexities associated with squamous cell carcinoma of the sigmoid colon. The exceptional response to tailored chemotherapy underscores the importance of individualized treatment approaches in rare malignancies. Further research and clinical trials are warranted to establish effective therapeutic strategies and improve patient outcomes in similar cases.

Abstract The global burden of cancer continues to rise, with projections indicating a 47% increase in new cases by 2040. The integration of oncology and palliative care has emerged as a vital approach to address the complex needs of cancer patients. This position paper, endorsed by the Palliative Care Working Group of the Hellenic Society of Medical Oncology (HeSMO), emphasizes the significance of early integration of palliative care with cancer-directed therapies. It highlights the benefits of this approach, including improved quality of life, symptom control, emotional well-being, and enhanced survival rates for patients. The paper also addresses the challenges of palliative care provision in Greece and advocates for comprehensive education for health-care professionals, especially oncologists and nurses, to effectively manage palliative care needs. The importance of multidisciplinary teams (MDTs), survivorship care plans (SCPs), home-based palliative care, and end-of-life care discussions is underscored. By aligning with international guidelines and recommendations, HeSMO strives to establish a supportive health-care system in Greece that offers equitable access to high-quality palliative care for all cancer patients, thus ensuring their well-being throughout their cancer journey.

Abstract Aim The purpose of this research is to analyze the neutrophil-to-lymphocyte ratio (NLR) to define prognostic factors in patients with breast cancer and to analyze the NLR values among stages, grades, and fractions. Methods The data retrieval period was from October 2018 to June 2020. The study included 56 patients who were part of the research. The mean age of patients was 53.42 years. Results On average, NLR after radiotherapy was higher than before treatment. Moreover, the 5-year overall survival rate for breast cancer patients treated with radiotherapy was 81%. Conclusions Based on the NLR results for patients with breast cancer, it is confirmed that the ratio of patients with poor prognosis compared to those with good prognosis is 3.3 to 1. Specifically, all stages of breast cancer showed an increase in NLR after treatment. The exception was stage III, which showed lower NLR values after treatment and, consequently, a better prognosis of the disease.

Abstract Purpose Hyperglycemia is an overlooked triggering factor for cancer, despite being critical to the survival and growth of cancer cells through a unique process known as the “Warburg effect.” Therefore, blocking glycolysis by using antidiabetic agents is an attractive approach for impeding cancer growth and enhancing their responsiveness to cancer treatments, while leaving healthy cells unaffected. This review aims to explore the potential of antidiabetics as cytotoxic agents for cancer treatment through their role as glucose deprivation candidates and the clinical considerations of using antidiabetics with their risk as carcinogenic in cancer therapy. Methods PubMed, Cochrane Library, and Google Scholar were explored by applying the main topic-relevant keywords to consider articles that had been published up to February 2024 and which met our selection criteria. Results The potential of antidiabetic agents to modify the risk of cancer is an exciting area of research in cancer therapy. Some classes of antidiabetics, such as biguanide, sulfonylureas, dipeptidyl peptidase 4 (DPP4) inhibitors, and sodium–glucose co-transporter 2 (SGLT2) inhibitors, have a direct cytotoxic effect on cancer cells, while others, such as glucagon-like peptide 1 (GLP-1) agonists and thiazolidinediones, have an indirect cytotoxic effect on cancer cells. Conclusion Antidiabetic agents differ in their cytotoxic effectiveness toward cancer cells through several mechanisms. Apart from their potential effects on carcinogenicity, these medications hold promise for future cancer treatment. However, not all antidiabetic agents were good candidates for repurposing because of the well-documented carcinogenicity risk.

Abstract Background Various molecular cancer variables, including K-RAS, B-RAF, and HER2/neu, are essential in the growth and advancement of tumors. Matrix metalloproteinase-9 (MMP-9) is suggested as a biomarker that is excessively produced in different types of malignancies and plays a critical role in chemotherapy resistance that leads to tumor progression and metastasis. Patients and Methods The study used two different methods to evaluate the expression level of MMP9. First, we sought to find its expression and interaction with other proteins or genes using in slico techniques. Second, we evaluated the protein levels of MMP-9 in 80 metastatic patients with breast, colon, and lung cancer using enzyme-linked immunosorbent assay (ELISA) techniques. Results In silico techniques showed a high expression of MMP9 gene in all three types of cancer. Furthermore, genes and proteins that interact the most with MMP9 were discovered using Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) and Human Protein Atlas (HPA). It was found that the genes associated with MMP9 gene in colon, lung, and breast cancers are MMP2 and TIMP2, along with MAPK, PI3K, and NF-κB pathways as the most significant genes and pathways across all three types of cancer that could be linked to the MMP9 gene in cancer metastasis. In addition, ELISA techniques showed that MMP9 was at the highest level in metastatic colon cancer patients at 0.62 ± 0.25, followed by breast and lung metastatic patients. Conclusion MMP9 appears to play a crucial role in progression of particularly colon metastatic cancer and could be targeted alongside other genes as a possible therapeutic target for this type of cancer in patients with chemotherapy resistance and metastasis.