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106,107 Preclinical studies have shown that potent in situ cancer vaccine regimens, such as those combining radiotherapy with intratumoral immunocytokines (e.g., hu14.18IL2) and immune checkpoint blockade (e.g., antiCTLA4), can induce endogenous tumor-specific IgG production and generate humoral immune memory not observed following surgical resection alone

However, clinically overt vitamin B 12 deficiency with classical feature of macrocytic anaemia and neuropathy is infrequently seen in the elderly.2 Very often they have mild, subclinical deficiency, which are usually asymptomatic.2 Clinical manifestations of vitamin B 12 deficiency are usually non-specific and are highly variable according to severity or organ systems involved.9 There is no one clinical feature unique to all patients with vitamin B 12 deficiency

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