Anaphylaxis is a sudden, severe and potentially life-threatening allergic reaction. In paediatrics, timely recognition and treatment are crucial. A synoptic chart was developed to support clinicians in emergency management, based on the updated diagnostic criteria by Dribin (2025). The chart emphasises intramuscular adrenaline as the only first-line therapy; antihistamines and corticosteroids have a secondary role. Early fluid resuscitation is highlighted as a key measure in cases of hypotension or shock. By providing clear, practical and evidence-based guidance, this tool aims to reduce delays, unify clinical practice and improve safety in the management of paediatric anaphylaxis.
Malnutrition, a key factor in oncology, affects 20-70% of cancer patients and influences both cancer risk and outcomes, being linked to decreased treatment tolerance, higher toxicity, lower quality of life, and shorter survival. Although international guidelines recommend early and systematic nutritional screening, its adoption in clinical practice remains inconsistent. This study, promoted by the Italian College of Hospital Medical Oncology Directors (CIPOMO), aimed to provide a national snapshot of current organizational practices regarding nutritional screening, assessment, and management in Italian oncology centers. A 15-item survey was sent to 165 centers to investigate organizational practices and awareness of nutrition and physical activity in cancer care. Data were collected and analyzed as overall percentages. A total of 100 centers responded (61%). Although a nutritional assessment is routinely conducted at diagnosis in 67% of centers (n = 67), only 31 centers perform it for all patients. The remaining centers limit nutritional assessment to high-risk or selected patient groups. Moreover, although 86% of centers have dedicated professionals, multidisciplinary integration remains limited. Validated nutritional screening tools are used in 69% of centers, but follow-up reassessment is rarely systematic (15%). However, awareness of the importance of nutrition is high, with nearly all centers supporting educational interventions and dedicated nutritional pathways. Despite this high level of awareness, a significant gap remains between guideline recommendations and daily clinical practice. Standardizing early nutritional screening, enhancing multidisciplinary collaboration, and ensuring equitable and consistent access to nutritional services are crucial to fully integrating nutrition into oncology care and improving patient outcomes.
Background Immune checkpoint inhibitor doublet (ICI–ICI) and ICI plus tyrosine kinase inhibitor (ICI–TKI) regimens are the cornerstone of treatment for metastatic renal cell carcinoma (mRCC), although no head-to-head comparisons are currently available. This study aimed to compare the real-world effectiveness of ICI-ICI vs ICI-TKI combinations in patients with intermediate- and poor-risk mRCC according to International Metastatic RCC Database Consortium (IMDC). Methods The Meet-URO 33 study is a multicentre retrospective-prospective registry collecting real-world data on patients with mRCC. Multivariable logistic and Cox models were built for objective response rate (ORR), PFS and OS, with a propensity score (PS) adjustment for baseline imbalances. Results Among 1497 patients, 755 were intermediate-risk (199 ICI-ICI, 556 ICI-TKI) and 312 poor-risk (77 ICI-ICI, 212 ICI-TKI). Median follow-up was 14.2 months (8.0 months and 14.5 months in poor- and intermediate-risk subgroups, respectively). In poor-risk patients, median OS was 20.3 vs 12.9 months (HR 0.87, 95% CI: 0.59–1.28, p = 0.49), and median PFS was 6.7 vs 8.7 months (HR 1.10, 95% CI: 0.79–1.54, p = 0.53), for ICI–ICI vs ICI–TKI, respectively. In the intermediate-risk patients treated with ICI-ICI vs ICI-TKI, median OS was 37.8 vs 35.5 months (HR: 1.08; 95% CI: 0.77–1.50; p = 0.65), and median PFS was 17.8 vs 18.6 months (HR 1.29, 95% CI: 1.00–1.66, p = 0.050). ORR was 42.9% vs 45.8% in poor-risk patients (OR 0.72, 95% CI: 0.39–1.34, p = 0.303) and 48.1% vs 54.3% in intermediate-risk patients (OR 0.71, 95% CI: 0.48–1.04, p = 0.075). Conclusions No statistically significant differences in survival or response were observed between ICI-ICI and ICI-TKI combinations in patients with IMDC intermediate- and poor-risk mRCC.
OBJECTIVES:The most prognostically important complications after cardiac surgery to target for prevention remain uncertain. We aimed to assess the relationship between postoperative complications and mortality at 30 days and 1 year after cardiac surgery and rank the complications by their contribution to mortality. METHODS:We completed an analysis of 15,550 patients from the Vascular Events in Surgery Patients Cohort Evaluation (VISION) Cardiac Surgery Prospective Cohort Study, which enrolled 15,971 patients who underwent cardiac surgery from 24 centers in 12 countries. The primary outcome was all-cause mortality at 30 days and 1 year. Population attributable fractions (PAFs) were calculated to estimate the proportion of deaths potentially attributable to each complication. RESULTS:All-cause mortality occurred in 460 patients (3.0%) at 30 days and in 399 (2.6%) between 31 days and 1 year, totaling 859 deaths (5.5%) at 1 year. The 4 complications occurring within 30 days with the largest PAFs for 30-day mortality were acute kidney injury (2612 patients [16.8%]; adjusted hazard ratio [aHR], 4.47; 95% CI, 3.52-5.67; PAF, 37%), bleeding (1491 patients [9.6%]; aHR, 2.39; 95% CI, 1.87-3.06; PAF, 12%), infection (2260 [14.5%]; aHR, 1.95; 95% CI, 1.47-2.57; PAF, 12%), and myocardial injury after cardiac surgery (1686 patients [10.8%]; aHR, 2.01; 95% CI, 1.58-2.54; PAF, 10%). CONCLUSIONS:This international study suggests that approximately 1 in 3 deaths after cardiac surgery are associated with acute kidney injury. Targeted prevention of acute kidney injury, infections, bleeding, and myocardial injury holds promise for reducing mortality in patients after cardiac surgery.
TPS3647 Background: Circulating tumor DNA (ctDNA) testing has emerged as a transformative tool for detecting molecular residual disease (MRD). Multiple prospective trials have demonstrated the potential of ctDNA in guiding treatment decisions for stage II-III CC pts. Numerous ongoing randomized clinical trials (RCTs) are adjusting adjuvant chemotherapy (ACT) intensity based on MRD status. However, data from ctDNA-guided trials, including PEGASUS (NCT04259944), reveal that intensified ACT is curative in only a small proportion of MRD cases. To address this limitation, the SAGITTARIUS RCT was designed to evaluate whether combining ctDNA detection with targeted agents selected on the basis of tissue-based comprehensive genomic profiling (CGP) can optimize treatment in high risk (i.e. MRD+) pts while sparing low risk (i.e. MRD−) from unnecessary toxicity. Methods: SAGITTARIUS is a Phase III RCT evaluating ctDNA and tissue-guided personalized post-surgical management in resected stage III and high-risk stage II CC pts. Tumor-informed, personalized ctDNA test (Signatera, Natera, Inc.) and CGP (TruSight™ Oncology Comprehensive EU, Illumina, Inc.) are used to determine MRD status and tumor genomic landscape, respectively, including genetic mutation (mut) and amplification (ampl), tumor mutational burden (TMB) and microsatellite instability (MSI) status. Pts are stratified based on post-surgery (3-5 weeks) ctDNA status into two embedded RCTs:Trial-1)ctDNA-positive (ctDNA+) ptsare further stratified based on MSI and RAS/RAF status and randomized 1:1 to standard 6-month ACT (CAPOX/FOLFOX) or personalized treatment (PT) guided by CGP biomarkers with reassessment of ctDNA status to guiding subsequent therapies (chemotherapy regimens in ctDNA+ or maintenance and follow-up in seroconverted; Trial-2) ctDNA-negative (ctDNA−) ptsare randomized 1:1 to a physician-choice strategy or observation with ctDNA reassessed at 2 and 4 months and, in cases of positivity, cross over to Trial-1. PT include 3-month CAPOX followed by FOLFIRI or TEMIRI based on MGMT status (RAS/RAFmut), Ipilimumab + nivolumab (MSI and TMB-high POLEmut), pertuzumab + trastuzumab (HER2ampl), FOLFOX + panitumumab (RAS/RAF/HER2 wild-type). The primary endpoint (EP) is 2-year recurrence-free survival (RFS) in ctDNA+ pts. Secondary EPs include 2-year RFS in ctDNA− pts, 3- and 5-year overall survival, and ctDNA conversion rate. Quality of life and health costs data are collected for cost effectiveness analysis. Biospecimens, including archival tumor tissue, serial blood samples, and buccal swabs, are collected for exploratory analyses. To detect a hazard ratio of 0.6325 for ctDNA-guided PT vs standard ACT, 200 ctDNA+ pts will be randomized in Trial-1. Recruitment began in October 2024 across 26 institutions in Italy, Spain, and Germany. Clinical trial information: NCT06490536 .
