Hodgkin's lymphoma is commonly treated with a combination of chemotherapy drugs including doxorubicin, bleomycin, vinblastine, and dacarbazine. Antibody-drug conjugates such as brentuximab vedotin are now being used to treat Hodgkin's lymphoma that has not responded to standard treatment. Brentuximab vedotin is a monoclonal antibody that selectively delivers a cytotoxic agent, monomethyl auristatin E, which targets cells expressing surface CD30 markers, a protein that may be found in high amounts in some cancer cells including lymphoma cells. Common adverse effects of the drug include diarrhea, nausea, anemia, and fatigue. We present a case of a patient with diabetic ketoacidosis and profound insulin resistance secondary to brentuximab. Diabetic ketoacidosis is a rare but serious adverse reaction in this growing class of antibody-drug conjugates.

Oral cancer (OC) is increasing worldwide, and it is mostly present to clinic in the late-stage of disease. Cancer of the lips, tongue, hard palate, upper and lower gingiva, buccal mucosa, and retromolar trigone are all included in the category of oral cavity cancer. Disease symptomatology and pathological grading decides the course of treatment. Several treatment modalities either alone in combinations may be utilized for oral squamous cell carcinoma (OSCC), including surgery, radiotherapy (external beam radiotherapy/brachytherapy), and adjuvant systemic therapy (chemotherapy or immunotherapy). Cancer patients also face a greater risk of oral side effects from chemotherapy, such as slowed tissue healing, bone, and salivary gland damage and disintegration, and disruption of the normal bacterial balance in the mouth. Consequently, the economic burden of the salivary gland, oral cavity, and oropharyngeal cancers must be also known for budget allocation, designing different programs and management strategies targeting oral cancers by any healthcare institutes. This article provides a summary of the most recent research that supports the use of chemotherapy for patients with advanced illness both alone and in conjunction with radiation including its adverse events and cost burden for oral cancers.

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Introduction Acute cholangitis (AC) is a hepatobiliary infection that requires prompt antibiotic therapy. Providers have to rely on empiric antibiotic guidelines, before receiving culture results. These antibiotic guidelines require routine surveillance of the biliary microbial flora and resistance patterns found in cultures to increase accuracy and appropriateness of empiric therapy. This is particularly essential in cancer patients who are more likely to be exposed to various antibiotics, potentially creating unique bactobilia, and fungobilia selection pressures that are different from the general patient population and require empiric therapy to halt AC progression to septicemia, shock, or mortality. This unique population is poorly researched and primary literature is relatively scarce. Methodology A retrospective chart review was performed to identify all patients between the age of 18 and 85 years who met the criteria for positive biliary culture and were treated for AC using empiric antibiotic treatment at the H. Lee Moffitt Cancer Center and Research Institute from January 2012 to January 2019. The patient information and laboratory results were analyzed to identify the microbial spectrum and drug resistance in bile cultures of cancer patients. Aim The aim of the study is to review the microbial patterns and characteristics of AC in immunocompromised patients with cancer. Results Pancreatic carcinomas and cholangiocarcinoma were most prevalent malignancies among patients. Although most bile cultures were polymicrobial, further analysis indicated Enterococcus species. Streptococcus species, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans were the most common isolates. Conclusions Cholangitis in cancer patients develops because of cholestasis from cancer obstructing the biliary flow mostly because of pancreatic cancer, cholangiocarcinoma, and metastatic cancer to the porta hepatis. Empiric antibiotic therapy should include broad-spectrum coverage for usual enteric flora.

Pulmonary Hypertension (PH) is defined as a disorder in which the mean Pulmonary Arterial Pressure (mPAP) is greater than 20 mmHg at rest. Pulmonary Arterial Hypertension (PAH) is considered when mPAP is > 20 mmHg and pulmonary vascular resistance (PVR) is ⩾ 3 WU. PAH is a chronic progressive disease resulting in right heart failure and premature death. It is postulated to be due to an inactivating mutation of a gene named bone morphogenetic protein receptor type 2 (BMPR2), whose predominant function is halting vascular proliferation. It has a lamentable prognosis if not rapidly diagnosed and adequately treated. Treatment of PAH has evolved in the past few decades since many related pathways and potential therapeutic targets have been explored. Parenteral prostanoids are the most effective therapeutic options for PAH. Epoprostenol is a synthetic analog of prostacyclin and a potent vasodilator that was Food and Drug Administration (FDA)-approved in December 1995 for intravenous use to treat PAH. It has also been used to treat different PAH subtypes, including connective tissue-related PAH like lupus and systemic sclerosis, congenital heart disease, and drug-induced PAH. It is effective in reducing mortality rates and improving survival rates. Although the use of Epoprostenol for PAH is challenging, it has been one of the most successful therapies used. In this manuscript, we review the pathophysiology of PAH and the risk stratification tool. We also discuss the mechanism of action of PAH-targeted therapies while focusing on the role of epoprostenol that has been investigated in many clinical trials. Finally, we discuss two ongoing clinical trials which highlight some potential therapeutic options.