Pancreatic cancer is a highly aggressive and lethal cancer characterized by high invasiveness, local and extensive dissemination at time of diagnosis and resistance to treatment. Few therapies have shown efficacy in the past and even standard of care therapies yield only modest improvements in the mortality of patients with advanced or metastatic disease. Efforts have been undertaken to study the pancreatic tumor microenvironment and have established its complex and immunosuppressive nature which could explain the high resistance to chemotherapy. Novel therapies targeting the tumor microenvironment with an aim to decrease this resistance, improve immune tolerance and increase the efficacy of the current treatment have shown some promising preliminary results in preclinical and clinical trials. We review the current advances in the field of immunotherapy and their effectiveness as a potential treatment strategy in the pancreatic cancer.

Background Timely and accurate diagnosis of influenza remains a challenge, but is critical for patients who may benefit from antiviral therapy. This study determined the test characteristics of provider diagnosis of influenza, final ED electronic medical record (EMR) diagnosis of influenza, and influenza like illness (ILI) in patients recommended to receive antiviral treatment according to Centers for Disease Control and Prevention (CDC) guidelines. Additionally, we evaluated the compliance with CDC antiviral guidelines. Methods A prospective cohort of adults presenting to a tertiary care ED with an acute respiratory illness who met CDC criteria for recommended antiviral treatment were enrolled and tested for influenza. A clinical diagnosis of influenza was assessed by asking the clinician: “Do you think this patient has influenza?” ILI was defined according to current CDC criteria. Results In this cohort of 270 subjects, 42 (16%; 95% CI 11-20%) had influenza. Clinician diagnosis had a sensitivity of 36% (95% CI 22-52%) and specificity of 78% (95%CI 72-83%); EMR final ED diagnosis had a sensitivity of 26% (95% CI 14-42%) and specificity of 97% (95% CI 94-99%); ILI had a sensitivity of 31% (95% CI 18-47%) and specificity of 88% (95% CI 83-92%). Only 15 (36%) influenza positive patients received antiviral treatment. Conclusion Clinician diagnosis, final ED EMR diagnosis and ILI have low sensitivity for diagnosing influenza, and there is overall poor compliance with CDC antiviral treatment recommendations. Improved methods of influenza diagnosis are needed to help guide management in the clinical setting.

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