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There is still room for improvement but our experience shows that it is possible to create and operate services to accompany the patient through the path of illness and guarantee the right to be cared for.

There is still room for improvement but our experience shows that it is possible to create and operate services to accompany the patient through the path of illness and guarantee the right to be cared for.Lung cancer is a disease extremely heterogeneous in the molecular aspect and knowing the mutational profile of patients is essential in order to initiate the most appropriate treatment. In 2018, alectinib was approved in Italy for the first-line treatment of patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC), becoming a new therapeutic option for this patient group which constitutes approximately 3-7% of patients with NSCLC. On October 26th a virtual meeting was held in which 10 clinicians from various oncology centers in Lazio took part on the management of therapy of patients with Alk translocation, directed by Dr. Maria Rita Migliorino. The aim of the meeting was to share their clinical experience and to provide a series of practical that can help clinicians during treatment with target therapies in ALK-positive NSCLC.The ALK gene (anaplastic lymphoma kinase) encodes a highly conserved tyrosine kinase receptor whose physiological function has not yet been fully established; in particular the fusion of ALK (mainly EML4-ALK) is the gene alteration that most frequently involves 3-7% of all non-small cell lung cancers. Neuroblastoma in adults (NB) is a rare tumor that can present somatic activating mutations in the ALK gene in 8-9% of patients (and up to 14% of high-risk NBs); these mutations occur in the tyrosine kinase domain in three key positions (F1174, F1245 and R1275), which account for approximately 85% of all ALK mutations in NB. In this article, we report the case of an adult patient with advanced mutation-positive NB treated with an ALK inhibitor ceritinib showing a therapeutic opportunity due to the molecular diagnostic techniques now available.Among solid tumors, non-small cell lung cancer (NSCLC) represents the paradigm of the application of precision medicine to clinical practice. Understanding many biomolecular mechanisms in the determinism of NSCLC has ensured the development of small molecules targeting specific genetic mutations with key roles in tumor disease progression. The ATLAS IALSC guidelines recommend carrying out screening for rearrangement of the ALK gene in all patients with advanced NSCLC, mainly for the histological type adenocarcinoma or with an adenocarcinoma component. The use of next generation sequencing (NGS) panels applied to liquid biopsy provides a powerful method for the genetic profiling of NSCLC for both standard treatment options and clinical trials. Liquid biopsy represents a powerful non-invasive methodology to provide clinically useful information in defining the therapeutic process of patients with translocated ALK NSCLC.The treatment of cutaneous melanoma harboring BRAF mutation has been greatly enriched. BRAF/MEK inhibitors can improve the outcome of patients with this disease. On the other hand, immunotherapy can also be effective. A focus on the role of immune checkpoint inhibitors in advanced melanoma with BRAF mutation has been performed.The introduction of anti-PD-1 drugs as an adjuvant treatment for high risk melanoma has radically changed the everyday clinical practice, with an impact on the reduction of the risk of relapse close to 50%, as observed in phase 3 clinical trials. In patients whose tumors harbor a BRAF mutation, the combination of BRAF plus MEK inhibitors is also a valuable option, with outcomes in terms of 3-year RFS similar to those observed with anti-PD-1 immunotherapy. However, numerous questions remain unanswered, particularly which is the best treatment in BRAF-mutant patients. The aim of this review was to analyze the results of randomized phase 3 clinical trials, with a focus on some hot topics and discussing the role of immunotherapy for the adjuvant treatment of BRAF-mutant melanoma.The second pandemic wave flooded Italy and Europe. There are many reasons to be concerned but, as health care workers, we want to emphasize something particular. We reacted with enormous sacrifices during the first pandemic wave, despite the uncertainty, despite the inexperience, despite the structural and managerial inadequacies (partly unavoidable). In the following months the overwhelming wave turned into a slow but continuous dripping, we had to deal with. The World Health Organization (WHO) introduced the term "pandemic fatigue" to indicate the widespread feeling of distress in the entire population as a reaction to a prolonged state of crisis whose end cannot be foreseen. Health workers are no stranger to the general population, although they perceive the world from a particular standpoint. The first concern is that doctors and nurses might not be able to make up for the flaws (largely avoidable at this point) of the health care system in case of further waves. Because the strengths are breaking down and because public support, crucial in previous months, is waning. UNC0638 The second concern relates to the discomfort that could affect a large part of health care workers. A state of discontent and anger never seen before between doctors and nurses is spreading all around us. The fear that "pandemic fatigue" will turn into "pandemic consumption" is real and alarming.In 2019, we admitted two non-smoking patients with severe dyspnea from invasion of the main airway due to lung cancer. The patients were 57 and 67 years old; both presented with critical stenosis due to infiltration of the right main bronchus and in both cases, due to severe respiratory insufficiency, an indication of unclogging of the right stenotic main bronchus with rigid bronchoscope and Laser yttrium aluminum perovskite (YAP)-Nd in the operating room was given. At the end of the recanalization operation, a tracheobronchial prothesis, the GSS-Y 40x30x30 mm by Novatech, was positioned in Case 1; a nitinol self-expanding prothesis, the SILMET® 14x40 mm by Novatech, was positioned in Case 2. Once the histological diagnosis of EGFR-mutated adenocarcinoma was established, we started first-line treatment with afatinib 40 mg die tablets.