Gut microbiota plays an essential role in host homeostasis.It is involved in several physiological processes such as nutrients digestion and absorption,maintenance of intestinal epithelial barrier integrity and immune...Gut microbiota plays an essential role in host homeostasis.It is involved in several physiological processes such as nutrients digestion and absorption,maintenance of intestinal epithelial barrier integrity and immune system self-tolerance.Especially the gut microbiota is assumed to play a crucial role in many gastrointestinal,pancreatic and liver disorders.Its role in hepatic carcinogenesis is also gaining increasing interest,especially regarding the development of therapeutic strategies.Different studies are highlighting a link between some bacterial strains and liver disease,including hepatocellular carcinoma(HCC).Indeed,HCC represents an interesting field of research in this perspective,due to the gut-liver axis,to the implication of microbiota in the immune system and to the increasing number of immunotherapy agents investigated in this tumour.Thus,the assessment of the role of microbiota in influencing clinical outcome for patients treated with these drugs is becoming of increasing importance.Our review aims to give an overview on the relationship between microbiota and HCC development/progression and treatment.We focus on potential implications on the available treatment strategies and those under study in the various stages of disease.We highlight the pathogenic mechanisms and investigate the underlying molecular pathways involved.Moreover,we investigate the potential prognostic and/or predictive role of microbiota for target therapies,immune checkpoint inhibitors and loco-regional treatment.Finally,given the limitation of current treatments,we analyze the gut microbiota-mediated therapies and its potential options for HCC treatment focusing on fecal microbiota transplantation.展开更多
The evaluation of circulating tumor DNA(ctDNA)is increasingly integrated into the management of diagnosis and treatment of gastrointestinal cancer as it represents an innovative and minimally invasive biomarker that c...The evaluation of circulating tumor DNA(ctDNA)is increasingly integrated into the management of diagnosis and treatment of gastrointestinal cancer as it represents an innovative and minimally invasive biomarker that could allow us to reach clinical needs not met yet in randomized clinical trials.Recent research provided an interesting overview of the role of circulating tumor DNA in gastric,biliary,liver,pancreatic,and colorectal cancer.Data regarding upper gastrointestinal tumors are currently not practice changing.Tumor detection rates are low in the early stages,while in advanced stages ctDNA is useful for molecular tracking evaluation.Most of the evidence comes from colorectal cancer studies,where ctDNA was evaluated both in the early and advanced stages with the postsurgery minimal residual disease assessment and the response assessment,respectively.ctDNA qualifies as a promising tool in the era of precision medicine,with potential applications in the entire management of gastrointestinal cancer patients.Further evidence is needed to establish which setting may be influenced greatly by liquid biopsy in clinical practice.展开更多
As underlined in the minireview by Blomstrand et al,given the poor prognosis and the paucity of data on a therapeutic sequence in pancreatic ductal adenocarcinoma(PDAC),additional randomized controlled trials and real...As underlined in the minireview by Blomstrand et al,given the poor prognosis and the paucity of data on a therapeutic sequence in pancreatic ductal adenocarcinoma(PDAC),additional randomized controlled trials and real-world evidence studies addressing current and novel regimens are needed.The real-world outcomes of first-line chemotherapy regimens such as FOLFIRINOX and gemcitabine/nab-paclitaxel are thoroughly reviewed and seem to be largely generalizable in a real-world context.Regarding second-line chemotherapy,the key question about the optimal sequence of regimens remains uncertain.Precisely in this setting,it is therefore useful to encourage the implementation of clinical studies that may contribute to the scarcity of data available up to now.We report our experience with a small group of patients treated with second-line liposomal irinotecan(nal-IRI)plus 5-fluorouracil and leucovorin.To improve the treatment of patients affected by PDAC,it is useful to identify subgroups of patients who may benefit from target treatments(e.g.,BRCA mutant)and it is also important to focus on any prognostic factors that may affect the survival and treatment of these patients.展开更多
文摘Gut microbiota plays an essential role in host homeostasis.It is involved in several physiological processes such as nutrients digestion and absorption,maintenance of intestinal epithelial barrier integrity and immune system self-tolerance.Especially the gut microbiota is assumed to play a crucial role in many gastrointestinal,pancreatic and liver disorders.Its role in hepatic carcinogenesis is also gaining increasing interest,especially regarding the development of therapeutic strategies.Different studies are highlighting a link between some bacterial strains and liver disease,including hepatocellular carcinoma(HCC).Indeed,HCC represents an interesting field of research in this perspective,due to the gut-liver axis,to the implication of microbiota in the immune system and to the increasing number of immunotherapy agents investigated in this tumour.Thus,the assessment of the role of microbiota in influencing clinical outcome for patients treated with these drugs is becoming of increasing importance.Our review aims to give an overview on the relationship between microbiota and HCC development/progression and treatment.We focus on potential implications on the available treatment strategies and those under study in the various stages of disease.We highlight the pathogenic mechanisms and investigate the underlying molecular pathways involved.Moreover,we investigate the potential prognostic and/or predictive role of microbiota for target therapies,immune checkpoint inhibitors and loco-regional treatment.Finally,given the limitation of current treatments,we analyze the gut microbiota-mediated therapies and its potential options for HCC treatment focusing on fecal microbiota transplantation.
文摘The evaluation of circulating tumor DNA(ctDNA)is increasingly integrated into the management of diagnosis and treatment of gastrointestinal cancer as it represents an innovative and minimally invasive biomarker that could allow us to reach clinical needs not met yet in randomized clinical trials.Recent research provided an interesting overview of the role of circulating tumor DNA in gastric,biliary,liver,pancreatic,and colorectal cancer.Data regarding upper gastrointestinal tumors are currently not practice changing.Tumor detection rates are low in the early stages,while in advanced stages ctDNA is useful for molecular tracking evaluation.Most of the evidence comes from colorectal cancer studies,where ctDNA was evaluated both in the early and advanced stages with the postsurgery minimal residual disease assessment and the response assessment,respectively.ctDNA qualifies as a promising tool in the era of precision medicine,with potential applications in the entire management of gastrointestinal cancer patients.Further evidence is needed to establish which setting may be influenced greatly by liquid biopsy in clinical practice.
文摘As underlined in the minireview by Blomstrand et al,given the poor prognosis and the paucity of data on a therapeutic sequence in pancreatic ductal adenocarcinoma(PDAC),additional randomized controlled trials and real-world evidence studies addressing current and novel regimens are needed.The real-world outcomes of first-line chemotherapy regimens such as FOLFIRINOX and gemcitabine/nab-paclitaxel are thoroughly reviewed and seem to be largely generalizable in a real-world context.Regarding second-line chemotherapy,the key question about the optimal sequence of regimens remains uncertain.Precisely in this setting,it is therefore useful to encourage the implementation of clinical studies that may contribute to the scarcity of data available up to now.We report our experience with a small group of patients treated with second-line liposomal irinotecan(nal-IRI)plus 5-fluorouracil and leucovorin.To improve the treatment of patients affected by PDAC,it is useful to identify subgroups of patients who may benefit from target treatments(e.g.,BRCA mutant)and it is also important to focus on any prognostic factors that may affect the survival and treatment of these patients.
