 
Reviewer ’s report  
 
Title: Pancreatic undifferentiated carcinoma with osteoclast -like giant cells curatively resected 
after pembrolizumab therapy for lung metastases: A case report  
 
Version: 0 Date: 17 Apr 2020  
 
Reviewer: Alessia Nottegar  
 
Reviewer's report:  
 
This is an interesting contribution to this journal, reporting the response to immunotherapy 
(pembrolizumab) of a patient with a pancreatic carcinoma with distant metastasization.  
 
Although I recognize the overall scientific soundness of the present paper, there are also major 
revisions to be fixed, as follows:  
 
- This case is not a true "anaplastic carcinoma of the pancreas", it is an undifferentiated 
carcinoma of the pancreas with osteoclas t-like giant cells, as also highlighted in the Figure 3, and 
following WHO classification. Thus, please change in the text as well as in the title the name of 
the tumor. Indeed, the tumor must be called as "undifferentiated carcinoma of the pancreas with 
osteoclast -like giant cells", and its most used acronym is UCOGC. Please revise accordingly. At 
the same time, all references explaining anaplastic carcinoma must be removed, since it is not an 
anaplastic carcinoma of the pancreas, it is an UCOGC. This is c lear from histology images.  
 
- There are potentially dramatic differences based on IHC method, IHC platform, type of 
used antibody (clone, dilution, factory) in the immunohistochemical analysis for PD -L1, as also 
highlithed in a recent guidelines -paper on this topic (please see: PMID: 31056702). Please report 
all data on this point (regarding the IHC you have adopted) and discuss in the discussion (2 -3 
sentences) the issues related to PD -L1 immunohistochemistry, using also the suggested 
reference.  
 
- Fix Fi gure 3, which is not in line with the text.  
 
- Since this is a case of "undifferentiated carcinoma of the pancreas with osteoclast -like 
giant cells", this tumor entity should be described in the introduction (suggested references 
PMID are: 28722124, 275089 75, 27926359 and 18813118) as well as discussed in the 
discussion, using at least the same seminal references.  
 
- The overall results of the treatment (immunotherapy) should be discussed also in the 
light of the seminal paper on Science on this topic, PMID : 28596308.  
 
Minor points:  
 
- Abbreviations must be explained, please fix this point.  
-       There are some typos to be fixed, too.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to t he authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments t o the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publicati on of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currentl y applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any oth er financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below.  If your reply is yes to any, please give  details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand th at any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
 
Reviewer ’s report  
 
Title: Pancreatic undifferentiated carcinoma with osteoclast -like giant cells curatively resected 
after pembrolizumab therapy for lung metastases: A case report  
 
Version: 0 Date: 17 Apr 2020  
 
Reviewer: Alessia Nottegar  
 
Reviewer's report:  
 
This is an interesting contribution to this journal, reporting the response to immunotherapy 
(pembrolizumab) of a patient with a pancreatic carcinoma with distant metastasization.  
 
Although I recognize the overall scientific soundness of the present paper, there are also major 
revisions to be fixed, as follows:  
 
- This case is not a true "anaplastic carcinoma of the pancreas", it is an undifferentiated 
carcinoma of the pancreas with osteoclas t-like giant cells, as also highlighted in the Figure 3, and 
following WHO classification. Thus, please change in the text as well as in the title the name of 
the tumor. Indeed, the tumor must be called as "undifferentiated carcinoma of the pancreas with 
osteoclast -like giant cells", and its most used acronym is UCOGC. Please revise accordingly. At 
the same time, all references explaining anaplastic carcinoma must be removed, since it is not an 
anaplastic carcinoma of the pancreas, it is an UCOGC. This is c lear from histology images.  
 
- There are potentially dramatic differences based on IHC method, IHC platform, type of 
used antibody (clone, dilution, factory) in the immunohistochemical analysis for PD -L1, as also 
highlithed in a recent guidelines -paper on this topic (please see: PMID: 31056702). Please report 
all data on this point (regarding the IHC you have adopted) and discuss in the discussion (2 -3 
sentences) the issues related to PD -L1 immunohistochemistry, using also the suggested 
reference.  
 
- Fix Fi gure 3, which is not in line with the text.  
 
- Since this is a case of "undifferentiated carcinoma of the pancreas with osteoclast -like 
giant cells", this tumor entity should be described in the introduction (suggested references 
PMID are: 28722124, 275089 75, 27926359 and 18813118) as well as discussed in the 
discussion, using at least the same seminal references.  
 
- The overall results of the treatment (immunotherapy) should be discussed also in the 
light of the seminal paper on Science on this topic, PMID : 28596308.  
 
Minor points:  
 
- Abbreviations must be explained, please fix this point.  
-       There are some typos to be fixed, too.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to t he authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments t o the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publicati on of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currentl y applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any oth er financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below.  If your reply is yes to any, please give  details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand th at any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
 
Reviewer ’s report  
 
Title: Pancreatic undifferentiated carcinoma with osteoclast -like giant cells curatively resected 
after pembrolizumab therapy for lung metastases: A case report  
 
Version: 0 Date: 17 Apr 2020  
 
Reviewer: Alessia Nottegar  
 
Reviewer's report:  
 
This is an interesting contribution to this journal, reporting the response to immunotherapy 
(pembrolizumab) of a patient with a pancreatic carcinoma with distant metastasization.  
 
Although I recognize the overall scientific soundness of the present paper, there are also major 
revisions to be fixed, as follows:  
 
- This case is not a true "anaplastic carcinoma of the pancreas", it is an undifferentiated 
carcinoma of the pancreas with osteoclas t-like giant cells, as also highlighted in the Figure 3, and 
following WHO classification. Thus, please change in the text as well as in the title the name of 
the tumor. Indeed, the tumor must be called as "undifferentiated carcinoma of the pancreas with 
osteoclast -like giant cells", and its most used acronym is UCOGC. Please revise accordingly. At 
the same time, all references explaining anaplastic carcinoma must be removed, since it is not an 
anaplastic carcinoma of the pancreas, it is an UCOGC. This is c lear from histology images.  
 
- There are potentially dramatic differences based on IHC method, IHC platform, type of 
used antibody (clone, dilution, factory) in the immunohistochemical analysis for PD -L1, as also 
highlithed in a recent guidelines -paper on this topic (please see: PMID: 31056702). Please report 
all data on this point (regarding the IHC you have adopted) and discuss in the discussion (2 -3 
sentences) the issues related to PD -L1 immunohistochemistry, using also the suggested 
reference.  
 
- Fix Fi gure 3, which is not in line with the text.  
 
- Since this is a case of "undifferentiated carcinoma of the pancreas with osteoclast -like 
giant cells", this tumor entity should be described in the introduction (suggested references 
PMID are: 28722124, 275089 75, 27926359 and 18813118) as well as discussed in the 
discussion, using at least the same seminal references.  
 
- The overall results of the treatment (immunotherapy) should be discussed also in the 
light of the seminal paper on Science on this topic, PMID : 28596308.  
 
Minor points:  
 
- Abbreviations must be explained, please fix this point.  
-       There are some typos to be fixed, too.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to t he authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments t o the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publicati on of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currentl y applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any oth er financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below.  If your reply is yes to any, please give  details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand th at any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant