Complete and Durable Response to Nivolumab in Recurrent Poorly Differentiated Pancreatic Neuroendocrine Carcinoma with High Tumor Mutational Burden
Round 1
Reviewer 1 Report
Dear Authors
This is a very interesting case reports focusing on "Complete and Durable Response to Nivolumab in Recurrent Poorly 1 Differentiated Pancreatic Neuroendocrine Carcinoma with High 2 Tumor Mutational Burden". I recommend for publication. Nonetheless, there are some weak points that should be resolved prior to final decision
1) In the abstract and case presentation, please add ethnicity of this patient.
2) In figure 1, please remove the diameter of lesion and imaging information. Please use asterisk or arrow to point out the lesion that can help reader easily to follow.
3) In figure 1, please add image of plain, arterial phase, portal venous phase, and delayed phased images. That is truly important.
4) In figure 3, please remove imaging information. Please use asterisk or arrow to point out the lesion that can help reader easily to follow.
5) Figure 4 is introduced in a very unprofessional way. (A) is larger than (B) and (C) is larger than (A). They are not in the same line. Please make them same size and same line.
6) In the discussion, please add more information related to below recent publication
Hypovascular pancreatic neuroendocrine tumor with hepatic metastases: A case report and literature review. Radiol Case Rep. 2021 Apr 10;16(6):1424-1427. doi: 10.1016/j.radcr.2021.03.024. PMID: 33912257; PMCID: PMC8063702.
7) In the last paragraph, even authors mention about this case but not recommend a clinical workflow for future entity for clinicians. Please introduce your dramatical point to enhance the workflow related to pancreatic neuroendocrine tumor.
8) Your citation format is corrected but your reference format is wrong. Please revise all of them as MDPI format.
Sincerely
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
The authors present an interesting case report, showing that some patients with NEC can benefit from monotherapy with checkpoint-inhibition.
The quality of the manuscript und the figures is high. Of course, it is not the first case presenting an overall promising course under immunotherapy in NEC patients.
Comments:
- pathology: the exact Ki-67 und morphology of the tumor has to mentioned, large cell or small cell tumor, Ki-67 below oder higher than 55%, otherwise it could be also a NET G3 tumor
- since Ki-67 was appr. 20%, was there a Ga68 PET/CT initiated?
- did the authors check for MSI-high, e.g. via immunohistochemistry?
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
My questions have been addressed.
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
