Advances in pharmacotherapies in cancer-related cachexia

Cancer-related cachexia is highly prevalent in patients with advanced cancer, affecting approximately 50%–80% of patients and seriously interfering with active therapy, quality of life, and survival time. There arecurrently no effective treatments for cachexia. Therefore, new therapeutic strategies are required. In recentyears, advances in understanding the mechanisms underlying cachexia have been made, and new drugshave been developed to combat cachexia muscle wasting and weight loss due to cancer. In this systematicreview, we discuss these novel targets and drug treatments.

中国肿瘤支持治疗关键临床技术的发展与进步

近些年,中国肿瘤支持治疗关键临床技术发展已取得多项临床成果:1)支持治疗观念显著改变:充分认识到支持治疗是肿瘤综合治疗的核心措施,并在临床广泛应用。2)明确了支持治疗团队组成及其运作模式:确定了理想支持治疗团队组成,明确了支持治疗"三位一体"运作模式。3)工作范畴日渐明晰:提出了支持治疗七个方面工作范畴,倡导"身心社灵"全人支持治疗模式。开展"无痛、无血、无栓、无饿、无忧"示范病房建设。4)癌痛治疗逐步规范:组建癌痛多学科团队,建立门诊癌痛随访系统,重视癌痛科普教育和政策宣教。5)肿瘤患者营养诊疗体系基本建立:提倡入院患者进行肿瘤和营养不良的双诊断,率先提出肿瘤患者营养不良的三级诊断和五阶梯治疗。6)支持治疗延续和拓展:提出了医院-社区-家庭分级营养管理,构建立体整合营养治疗体系。7)生存质量得到重视:建立新型肿瘤患者生存质量评估方法,构建了终末期肿瘤患者生存预测模型。8)肿瘤患者的护理更加全面:将"灵性"的概念引入肿瘤患者的照护。借助互联网技术和"虚拟现实"技术,研发了延续护理服务管理平台。本文就上述成果进行总结。

恶性肿瘤骨转移及骨相关疾病临床诊疗中国专家共识(英文)

Since 1980s, palliative medicine has been an independent educational project. The development of palliative care in China started in the early 1990s. During the last 18 years, we have seen an increasing allocation of resources to palliative care, the establishment of an academic chair in palliative medicine, and more focused interest and awareness of the need for palliative care in the society at large. So the doctors in China have established principles of treatment on clinical diagnosis and treatment of malignant tumor bone metastases and bone related complications. In order to share our experience with the world, after two years’ preparation, the top-level experts in palliative medicine have written the consensus statement on clinical diagnosis and treatment of malignant tumor bone metastases and bone related complications. The overview includes not only the achievements in the world, but the hands-on experience in clinic, especially the experience in combination of TCM and Western medicine. We hope that the publication of this consensus statement will contribute to the palliative medicine development in this field, thus bring benefits to the majority of patients.

Investigation of quality of life in patients with lung cancer by the EORTC QLQ-C30(V3.0) Chinese version

Objective To explore quality of life(QOL) and its influencing factors in patients with lung cancer.Methods A QOL questionnaire(European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire-Core 30 [QLQ-C30] Chinese version) was used with 138 patients with lung cancer participating in the study. A statistical description of the general characteristics of the patients with lung cancer was performed. The patients' QLQ-C30 scores were compared with the reference value for each dimension. To analyze the influence of QOL in different genders, age groups, and cancer stages, ttests and rank sum tests were used to compare the differences in QOL using a 5% significance level. Results The QLQ-C30 function scores in PF(physical functioning), EF(emotional functioning), SF(social functioning), and GH(global functioning), and symptom scales in NV(nausea and vomiting), DY(dyspnea), SL(insomnia), and FI(financial difficulties) were significantly different(P < 0.05) in comparison to the reference values. Female patients were worse than males(P < 0.05) in EF, NV, and DI(diarrhea). The later the stage of lung cancer, the worse the quality of life became; the functional scales in RF(role functioning), EF, CF, SF, and GH, and symptom scales in PA(pain), AP(appetite), and SL differences were statistically significant(P < 0.05). Conclusion This study aids understanding of the status of the quality of life of Chinese patients with cancer and might be useful for clinical work, theory research, and health policymakers.

Chinese experts' consensus on diagnosis, prevention, and treatment of chemotherapyinduced hepatotoxicity

Overview Drug-induced liver injury(DILI)due to acetaminophen overdose and idiosyncratic drug reactions usually occurs 5–90 days after exposure to the causative drug.Ninety percent of DILI cases are acute.As one of the most common non-infectious liver diseases,DILI represents a growing challenge for clinicians.According to data from WHO[1],DILI is the fifth leading cause of liver disease mortality.In China,DILI accounts for 1%–5%of hospitalized patients with liver diseases,10%of patients

Assessing anxiety,depression,and stress among inpatients with cancer

Objective This study aimed to assess anxiety,depression,and stress among inpatients with cancer.Methods Two hundred thirty-five hospitalized patients with cancer were surveyed with the Depression Anxiety Stress Scales(simplified Chinese Version).The software program SPSS 25.0 was used for statistical analysis of the survey data.Results The average scores of depression,anxiety,and stress of inpatients with cancer were 12.17,11.84,and 13.98 respectively,which were higher than the normal range.The scores of anxiety and stress of inpatients with different caregivers were statistically different(P=0.024/0.036).The anxiety and stress scores of inpatients with spouses as caregivers were higher than those of inpatients with children as caregivers.There was a statistically significant difference in the incidence of stress between inpatients with cancer with religious beliefs and inpatients with cancer without religious beliefs(P=0.026),and those with religious beliefs had greater incidence of stress.The score of anxiety was significantly higher for inpatients with children than for inpatients without children(P=0.040).Conclusion The anxiety,depression,and stress levels of inpatients with cancer are relatively high.It is necessary to pay special attention to the psychological status of these patients during clinical diagnosis and treatment to improve their quality of life.

Comparison of intra-pleural injection efficacy between Endostar and Bevacizumab combined with pemetrexed/cisplatin for the treatment of malignant pleural effusion in patients with epidermal growth factor receptor-/anaplastic lymphoma kinase-lung adenocarci

Objective To compare intra-pleural injection efficacy and safety between Endostar and bevacizumab combined with pemetrexed/cisplatin for the treatment of malignant pleural effusion in patients with epidermal growth factor receptor(EGFR)-/anaplastic lymphoma kinase(ALK)-lung adenocarcinoma. Methods Sixty-four pCVatients with EGFR-/ALK-lung adenocarcinoma with malignant pleural effusion(MPE) were admitted to the authors' hospital between January 2016 and June 2017. Patients were randomly divided into two groups: Endostar combined with pemetrexed/cisplatin(Endostar group); and bevacizumab plus pemetrexed/cisplatin(Bevacizumab group). They underwent thoracic puncture and catheterization, and MPE was drained as much as possible. Both groups were treated with pemetrexed 500 mg/m^2, intravenous drip(d1), cisplatin 37.5 mg/m^2 per time, intra-pleural injection(d1, d3). Patients in the Endostar group were treated with Endostar 30 mg per time, intra-pleural injection(d1, 3), and patients in the Bevacizumab group were treated with bevacizumab 5 mg/kg per time, intra-pleural injection(d1). Only one cycle of treatment was applied. MPE was extracted before treatment and on day 7 after treatment. The levels of vascular endothelial growth factor(VEGF) were determined using ELISA. Efficacy and side effects were evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST) version 1.1, and National Cancer Institute Common Terminology Criteria for Adverse Events(CTCAE) version 3.0 criteria. Results The objective response rates in the Endostar and Bevacizumab groups were 50.0% and 56.3%, respectively; there was no statistical difference between the groups(P > 0.05). After one cycle of treatment, the mean VEGF levels in MPE in both groups decreased significantly, and there was no significant difference in the degree of decline between the two groups(P > 0.05). In both groups, pre-treatment VEGF levels for patients achieving complete response were significantly higher than those for patients achieving stable disease + progressive disease(P < 0.05). No specific side effects were recorded. Conclusion Endostar and Bevacizumab demonstrated similar efficacy in controlling MPE in patients with EGFR-/ALK-lung adenocarcinoma through an anti-angiogenesis pathway, with tolerable side effects. The levels of VEGF in MPE could predict the efficacy of intra-pleural injection of anti-angiogenesis drugs.

Advances in the diagnosis and treatment of patients with cancer cachexia

Cachexia is a common complication with an incidence rate of 50%–80% in cancer patients. It is also responsible for 20% of mortality among these patients. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity and adverse effects in cancer patients. This increases the symptom burden in patients, affects their quality of life, and ultimately shortens their survival time. The mechanism underlying the development of cachexia is complex and diverse and involves various factors and pathways, each playing an important role. Treatment approaches for cachexia are multimodal, including nutrition support therapy, appetite stimulants, and therapeutic drugs that specifically target the mechanism behind the disease. In recent years, we have gradually gained a better understanding of cachexia, and significant progress has been made in delineating molecular mechanisms, staging and diagnosis, and therapeutic drug treatment of cancer cachexia. This article reviews the research progress of cancer cachexia based on these contexts.

Recurrent ascites due to spontaneous intraperitoneal bladder rupture after pelvic radiation therapy for cervical cancer

Radiation cystitis is one of the major complications following radiotherapy for cervical cancer. However, spontaneous intraperitoneal bladder rupture as a result of radiation cystitis following radiotherapy for cervical cancer is extremely rare. Case presentation: We report a 52-year-old patient who received radiation therapy for cervical cancer 15 years prior to presentation. Eight years prior to presentation, she developed recurrent abdominal distension, oliguria, and ascites. Following ascites drainage and supportive treatment, all symptoms were relieved. However, all symptoms subsequently recurred every few months. The patient underwent exploratory laparotomy twice. The first exploratory laparotomy in July 2015 found no specific abnormalities. The second exploratory laparotomy in November 2016 found an intraperitoneal bladder rupture, and the patient underwent surgical repair. The ascites subsequently resolved. Conclusion: The occurrence of spontaneous intraperitoneal bladder rupture after radiation therapy for cervical cancer is rare. The prognosis is good when diagnosis and treatment are prompt.

Postoperative sequential chemotherapy and radiotherapy for locally advanced gastric cancer

Objective The aim of the study was to evaluate the role of postoperative sequential chemotherapy and radiotherapy in patients with locally advanced gastric cancer.Methods From January 2003 to December 2010, 146 gastric cancer patients at our institution(Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China) received postoperative sequential chemotherapy and radiotherapy after radical surgery. Radiotherapy was administered as a dose of 4500 cGy in 25 fractions. For patients with positive margins, the dose was raised to 5040 cGy in 28 fractions. Three cycles of m FOLFOX or PF(cisplatin, 5-fluorouracil) chemotherapy regimen were applied before and after radiotherapy. Three-and 5-year survival rates were analyzed; any adverse effects with respect to hematology, hepatic and renal function, or the gastrointestinal tract that occurred during the treatment were evaluated.Results This cohort consisted of non-metastatic patients: 104 men and 42 women with a median age of 51.0 years. The full course of sequential chemotherapy and radiotherapy(4500–5040 cGy) was completed by 129 patients(88.4%). Seventeen regional relapses(9.8%) and 46 distant relapses(23.8%) were recorded. Fifty patients(34.2%) died during follow-up. The 3-and 5-year overall survival rates(OS) were 60% and 54%, and disease-free survival rates(DFS) were 53% and 47%, respectively. There were no significant differences in survival rate with respect to age, sex, histopathology, N stage, site of the tumor, or margin status. Multivariate analysis showed that only the depth of tumor invasion(T stage) was an independent prognostic factor for OS(P = 0.009) and DFS(P = 0.006). The rates of grades 3 and 4 neutropenia and vomiting were 9.6% and 3.4%, respectively, during the treatment.Conclusion Postoperative sequential chemotherapy with an m FOLFOX or PF regimen and radiotherapy were found to be an effective means of treating advanced gastric cancer patients with T3–T4 disease. The adverse effects of this treatment were tolerable.

Mental health status of cancer caregivers,assessment tools,and psychological interventions

Many studies pointed out that psychological pain is not limited to the cancer patients themselves,but their caregivers also experience different levels of psychological problems such as depression,anxiety,and stress.This article attempts to review the mental health status,assessment tools,and psychological interventions of the caregivers of cancer patients,and calls on social and medical workers to pay attention to the mental and physical health status of the caregivers of cancer patients.

Research progress on immune checkpoint inhibitors in neoadjuvant therapy for gastric cancer

In recent years,immune checkpoint inhibitors(ICIs)have become an important treatment strategy for advanced gastric cancer.Immunotherapy has gradually transitioned from a later-line to a first-line treatment for advanced gastric cancer.Simultaneously,more and more researchers have begun to pay attention to whether immunotherapy can be used for resectable gastric cancer.The current use of ICIs in the neoadjuvant treatment of gastric cancer is still in its exploratory stage,with a number of clinical trials currently underway.However,the available data show good application prospects.This article reviews the research progress on ICIs in the neoadjuvant therapy for gastric cancer and evokes some unresolved problems.

胃印戒细胞腺癌化疗后乳腺糜腹水1例并文献复习(英文)

Chylous ascites, a rare clinical condition resulting from the disruption of the abdominal lymphatic system, usually diagnosed by paracentesis when the patients suffer ascites as primary symptom. The conditions, in which chylous ascites arise after chemotherapy of solid tumor, are rarely reported. In this paper we present a quite rare case of chylous ascites arising after chemotherapy of gastric signet ring cell carcinoma.

乳腺浸润性导管癌组织中HMGB1表达的临床意义(英文)

Objective: Exploring the clinical signification of high-mobility group box 1 protein(HMGB1) expression in infiltrating ductal carcinoma(IDC) breast tissue. Methods: The expression of HMGB1 protein in IDC breast tissue was detected by immunohistochemistry, and the relations among size of tumour, lymph node metastasis, clinical staging, estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor receptor 2(HER-2) were also analyzed. Results: Fortysix cases out of 60 cases of IDC breast tissue showed positive or strong positive HMGB1 expression(76.67%), statistical significance was observed between HMGB1 expression with clinical staging(P < 0.01), lymph node metastasis(P < 0.01), breast cancer ER(P < 0.05) and HER-2(P < 0.05), however same conclusion can not be drawn between HMGB1 with either size of tumour or PR expression(P > 0.05) in IDC breast tissue. Spearman analysis showed negative correlation between HMGB1 expression and ER, and positive correlation between HMGB1 expression and clinical staging, lymph node metastasis together with HER-2. Conclusion: It's promising that HMGB1 expression in IDC tissue can be one of biological indicators of poor prognosis.

肿瘤化疗患者使用G-CSF的现况调查(英文)

Objective: The purpose of the study was to survey current G-CSF use in cancer patients, investigate whether the use of granulocyte colony-stimulating factor(G-CSF) is standardized. Methods: From July 2012 to October 2012, patients in a third-grade class-A hospital were investigated by self-designed questionnaires, according to ASCO's recommendations for white blood cell growth factors in 2006 and NCCN myeloid growth factors guideline in 2012. Results: Two hundred and twenty-two patients treated with 724 courses of chemotherapy were included. In prophylactic use, 259(35.8%) cases used G-CSF that the guideline doesn't recommend, which belonged to excessive use, the dose were 274 700 μg, accounting for 59.7% of the totle prophylactic use; 105(14.5%) didn't use while the guideline recommend, belonging to lack of use. 89.0% of the prophylactic use were 24–72 h after chemotherapy, only a few(5.4%) on the day of chemotherapy. In therapeutic use, only 3.1% were standardized, with the dose of 23 000 μg, accounting for 7.4% of the total. So 92.6% were excessive. 14.2% of the therapeutic use were 24–72 h after chemotherapy, 21.2% on the day of chemotherapy. Conclusion: More than 50% use of G-CSF weren't standardized, especially the excessive use.

On the Road to Conquering Cancer with You: Notes on the New Look of Our Publication

With all the vigor of a fresh breeze blowing in your face or the surge of a spring tide in this season of renewal,The Chinese-German Journal of Clinical Oncology has been renamed Oncology and Translational Medicine in 2015.We bid a fond farewell to the past and embrace the future with a new vision.Since its first issue in 1984,as it has transitioned from German Medicine

Effects of p38 MAPK inhibitor on the rat pain behavior and proinflammatory cytokines in a metastatic bone cancer pain model

Objective:To observe the effects of p38 mitogen activated protein kinase(MAPK) inhibitor SB203580 by intra-thecal injection on the pain behavior and the spinal proinflammatory cytokines in a rat model of bone cancer pain induced by breast cancer cells. Methods:Eleven rats were used to establish the models of bone cancer pain,six rats were treated by intrathecal SB203580 injection,and the other 5 were as the controls. The paw withdrawal latency(PWL),histology and the spinal levels of IL-1β and TNF-α were detected. Results:All the 11 rats presented evident bone destruction and thermal hyperalgesia after intra-tibial injection of breast cancer cells. No effect of SB203580 on the bone destruction was observed. However,following intrathecal injection of SB203580,the left PWLs(12.12 ± 1.26 s at 16 days and 12.99 ± 1.65 s at 19 days) were significant higher than that of controls(9.05 ± 1.08 s at 16 days and 8.55 ± 1.60 s at 19 days),P < 0.05. Meanwhile,intrathecal injection of SB203580 evidently reduced the levels of spinal IL-1β and TNF-α. Conclusion:Intrathecal injection of SB203580 in a rat model of bone cancer pain cannot prevent the tibial destruction but significantly depress the thermalgia sensitivity,which might result from inhibiting intracellular p38 MAPK signaling transduction,and thereby reducing the release of the proinflammatory cytokines.

Mental distress evaluation and intervention for cancer patients

Mental distress is prevalent among cancer patients.Many measurements have been developed to screen and evaluate such distress.About one-third of the persons with cancer will experience significant levels of distress,requiring targeted psychosocial intervention.Mental distress has been endorsed as the sixth vital sign by the International Psycho-Oncology Society(IPOS) in 2009.The need for effective screening and psychological interventions is well recognized as a necessary,integral part of oncology care.This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress and the applicable intervention methods.

Adenocarcinoma transformed into squamous cell carcinoma in non-small cell lung cancer

Non-small cell lung cancer(NSCLC)is the most common form of lung cancer which remains the deadliest malignancy worldwide(Siegel et al.,2019).In general,NSCLC can be divided into several subtypes,including adenocarcinoma(ADC),squamous cell carcinoma(SCC),adeno-squamous cell carcinoma(AD-SCC)and large cell carcinoma(LCC).

Correlativity study between expression of DNA double-strand break repair protein and radiosensitivity of tumor cells

DNA double-strand break(DSB)is generally regarded as the most lethal of all DNA lesions after radiation.Ku80,DNA-PK catalytic subunit(DNA-PKcs)and ataxia telangiectasia mutated(ATM)proteins are major DSB repair proteins.In this study,survival fraction at 2Gy(SF2)values of eight human tumor cell lines(including four human cervical carcinoma cell lines HeLa,SiHa,C33A,Caski,three human breast carcinoma cell lines MCF-7,MDA-MB-231,MDA-MB-453,and one human lung carcinoma cell line A549)were acquired by clone formation assay,and western blot was applied to detect the expressions of Ku80,DNA-PKcs and ATM protein.The correlativity of protein expression with SF2 value was analyzed by Pearson linear correlation analysis.We found that the expression of the same protein in different cell lines and the expression of three proteins in the same cell line had a significant difference.The SF2 values were also different in eight tumor cell lines and there was a positive correlativity between the expression of DNA-PKcs and SF2(r=0.723,P=0.043),but Ku80 and ATM expression had no correlation with SF2(P>0.05).Thesefindings suggest that the expression level of DNA-PKcs protein can be an indicator for predicting the radiosensitivity of tumor cells.