Pancreatic cancer(PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk fact...Pancreatic cancer(PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease.展开更多
Gastric cancer is the third leading cause of cancer death worldwide.Even though during these last decades gastric cancer incidence decreased in Western countries,it remains endemic and with a high incidence in Eastern...Gastric cancer is the third leading cause of cancer death worldwide.Even though during these last decades gastric cancer incidence decreased in Western countries,it remains endemic and with a high incidence in Eastern countries.The survival in advanced and metastatic stage of gastric cancer is still very poor.Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients.Indeed,the key point is still the selection of patients for the right treatment,on basis of molecular tumor characterization.Since chemotherapy reached a plateau of efficacy for gastric cancer,the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity.Currently,Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erb B2 positive patients,whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer.New perspectives for an effective treatment derived from the immunotherapeutic strategies.Here,we report an overview on gastric cancer treatments,with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.展开更多
Over 50% of patients diagnosed with non-smallcell lung cancer(NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to pro...Over 50% of patients diagnosed with non-smallcell lung cancer(NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to progressive reduction of organ function and age-related co-existing pathologies. Due to this reason elderly are usually excluded from platinum-based chemotherapy, which still represent the standard of care for advanced NSCLC. In every-day practice, single-agent schedule with a third-generation drug is the recommended option for elderly patients with advanced NSCLC. A modest increase in toxicity for elderly patients has been demonstrated by subgroup analyses concluding for platinum-based combination chemotherapy being similar in young patients and fit elderly. Even though the cited evidence, feasibility of chemotherapy based on platinum remains an open question. Prospective randomised trials are warranted in order to change guide lines and give the clinicians a new therapeutic option. Recent emerging role of molecular target in selecting patients for new targeted therapies suggest dedicated trials for elderly patients. The same is for more accurate evaluation of elderly patients with increasing evidence for a comprehensive geriatric assessment as a valid tool for customized treatment in NSCLC elderly patients. Suitable evidences for the treatment of elderly patients affected by advanced NSCLC together with more appropriate and validated tools for patients selection are reviewed along the manuscript.展开更多
文摘Pancreatic cancer(PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease.
基金Supported by CRT Foudationand by the Italian Ministry of Health:Ricerca Sanitaria Finalizzata e Giovani Ricercatori 2009,No.GR 2009-1584485
文摘Gastric cancer is the third leading cause of cancer death worldwide.Even though during these last decades gastric cancer incidence decreased in Western countries,it remains endemic and with a high incidence in Eastern countries.The survival in advanced and metastatic stage of gastric cancer is still very poor.Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients.Indeed,the key point is still the selection of patients for the right treatment,on basis of molecular tumor characterization.Since chemotherapy reached a plateau of efficacy for gastric cancer,the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity.Currently,Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erb B2 positive patients,whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer.New perspectives for an effective treatment derived from the immunotherapeutic strategies.Here,we report an overview on gastric cancer treatments,with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.
文摘Over 50% of patients diagnosed with non-smallcell lung cancer(NSCLC) are 65 years old while 30% exceed 70 years old. Comparing elderly patients to their younger counterpart they poorly tolerate chemotherapy due to progressive reduction of organ function and age-related co-existing pathologies. Due to this reason elderly are usually excluded from platinum-based chemotherapy, which still represent the standard of care for advanced NSCLC. In every-day practice, single-agent schedule with a third-generation drug is the recommended option for elderly patients with advanced NSCLC. A modest increase in toxicity for elderly patients has been demonstrated by subgroup analyses concluding for platinum-based combination chemotherapy being similar in young patients and fit elderly. Even though the cited evidence, feasibility of chemotherapy based on platinum remains an open question. Prospective randomised trials are warranted in order to change guide lines and give the clinicians a new therapeutic option. Recent emerging role of molecular target in selecting patients for new targeted therapies suggest dedicated trials for elderly patients. The same is for more accurate evaluation of elderly patients with increasing evidence for a comprehensive geriatric assessment as a valid tool for customized treatment in NSCLC elderly patients. Suitable evidences for the treatment of elderly patients affected by advanced NSCLC together with more appropriate and validated tools for patients selection are reviewed along the manuscript.
