Real-Life Experience with Neo-Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer and Its Outcome

Objectives: Muscle-invasive bladder cancer (MIBC) has a poor prognosis with a 5-year overall survival rate of 50%. Current guidelines recommend the use of neoadjuvant chemotherapy (NAC) followed by radical cystectomy in these patients. However, its application remains limited and underutilized in clinical practice. This study aims to delineate, in real-life practice, the clinical characteristics and outcomes of patients with muscle-invasive bladder cancer (MIBC) who received NAC and were subsequently candidates for cystectomy. Methods: This study is a retrospective observational analysis of patients with muscle-invasive bladder cancer (stages T2-T4aN0M0 and T1-T4aN1M0) who received neoadjuvant chemotherapy prior to total cystectomy. The data, collected over a six-year period from 2018 to 2024, originates from Hotel Dieu de France University Hospital in Beirut. Various factors were analyzed, including age, sex, history of smoking, stage of disease at diagnosis, presence of carcinoma in situ (CIS), and any prior history of Bacillus Calmette-Guérin (BCG) treatment or T1 or Ta disease. Additionally, the study evaluates renal function prior to neoadjuvant chemotherapy (NAC), specifies the type and number of chemotherapy cycles administered, the pathological complete response (pCR) following cystectomy and calculate both overall survival and disease-free survival rates. Results: A total of 36 patients were analyzed, with a median age of 71.6 years. 77.7% were male, 22.2% were female, and 77.8% were smokers. 55.6% of the patients presented with de novo muscle-invasive bladder cancer (MIBC), 44.4% had a history of Ta or T1 stage tumors and 100% had urothelial histology and lower tract location. Among these 36 patients, 27.8% had received intravesical Bacillus Calmette-Guérin (BCG) treatment, while 72.2% did not. 86.1% of patients had a creatinine clearance greater than 60, whereas 13.9% had a clearance below 60 but still above 50. At the time of diagnosis, 61.1% were at stage II, 13.9% were at stage IIIa, and 25.0% were at stage IIIb. All the patients received the combination of gemcitabine and cisplatin with a median number of 3.9 cycles per patient. Out of the 36 patients, 5 experienced disease progression and did not undergo radical cystectomy, while another 5 opted for trimodal therapy (TMT) after evaluation by cystoscopy showing no residual lesion. The remaining 26 patients proceeded with radical cystectomy. Among these 26 cystectomized, 30.8% demonstrated a complete pathological response. During the follow-up period, 75% of these 36 patients did not experience disease progression, with a median disease-free survival of 9.5 months and a mean disease-free survival of 19.72 months. No deaths were recorded in this study, and overall survival data could not be determined. Conclusion: In our real-world experience, approximately one-third of patients who received gemcitabine and cisplatin NAC followed by radical cystectomy achieved a pathological complete response. Extended follow-up is necessary to assess long-term outcomes, including median overall survival. Future research should focus on investigating and comparing between triple modality therapy and cystectomy, both after neoadjuvant chemotherapy.

A review of the current evidence for the role of minimally invasive pancreatic surgery following neo-adjuvant chemotherapy

Objective:Surgical resection of pancreatic cancer remains the only potentially curative treatment for pancreatic ductal adenocarcinoma.The robotic platform has been introduced to surgical practice and recent large studies from national registries have demonstrated similar or improved peri-operative outcomes compared to the standard open approach.Neo-adjuvant chemotherapy is increasingly being offered to patients with borderline resectable/locally advanced disease but this has led to more challenging resections.Numbers of patients undergoing minimally invasive resection following neo-adjuvant chemotherapy remain low.The aim of this review is to assess the current evidence for the peri-operative safety and long-term oncological outcomes associated with minimally invasive pancreatic resection following neo-adjuvant chemotherapy.Methods:Medline,Embase and Cochrane Central Register for Clinical Trials were searched up until 31st October 2021.The search terms include“minimally invasive”,“robotic”,“laparoscopic”,“pancreatectomy”,“pancreatic resection”,“whipple's pancreaticoduodenectomy”,“distal pancreatectomy”,“chemotherapy”,“neo-adjuvant chemotherapy”,“radiotherapy”,“neo-adjuvant chemoradiotherapy”,“induction therapy”,and“conversion surgery”.All studies including patients undergoing pancreatic resections were included.Studies which did not clearly state the approach to resection(minimally invasive or open)were excluded.Results:Seventy-eight studies were identified of which 8 compared open and minimally invasive resection following neo-adjuvant chemotherapy.There was insufficient data to perform a meta-analysis.Robotic surgery was associated with lower blood loss and shorter length of hospital stay.Three-year overall survival rates were similar between patients who underwent robotic or open resection however the robotic approach was associated with higher lymph node yield and a lower R1 resection rate.Conclusion:Currently the evidence for minimally invasive surgery following neo-adjuvant chemotherapy is limited.Long-term oncological outcomes are similar to patients undergoing open resection and there is some evidence to suggest superior peri-operative outcomes.As numbers are limited,future studies analysing national and international databases on minimally invasive pancreatic resection are required to provide sufficient evidence to support the use of minimally invasive pancreatic resection following neo-adjuvant chemotherapy in high-risk groups.

Low-dose immunotherapy as a potentiator to increase the response with neo-adjuvant chemotherapy in oral cancers

Neo-adjuvant chemotherapy(NACT)is utilized in locally advanced oral cancers to reduce the tumor burden and downstage the tumor to be amenable for definitive surgical management.Its long-term results compared to upfront surgical resection was not encouraging.Immunotherapy has now been used not only in recurrence and metastatic setting but also in the locally advanced tumor management regimens.The purpose of this concept paper is to bring forward the rationale to use a fixed low-dose immunotherapy agent as a potentiator to the standard NACT regimen and recommend their future investigation in oral cancer management.

KIF15 expression characteristics: Relevance toneo-adjuvant chemotherapy efficacy in breast cancer

Objective The relationship between the expression of kinesin family member 15 (KIF15) andclinicopathological features in breast cancer (BC) remains controversial. In this study, we aimed to explorethe influence of KIF15 expression on the efficacy of neoadjuvant chemotherapy (NAC) and evaluate itsclinical value in predicting prognosis for BC patients.Methods Immunohistochemistry was used to detect KIF15 expression in 93 BC patients undergoingNAC to analyze the relationship between KIF15 expression and clinical efficacy and analytical parameters.Results Of the 93 BC patients enrolled, 24.73% who underwent NAC had higher KIF15 expression levels,showing positive correlations with ER, HER-2, Ki67, and lymph node metastasis (P < 0.05). The clinicalbenefit of NAC was 70.97%, and the major histological response (MHR) rate was 61.29%. The effectivetherapeutic rate in patients with high KIF15 expression was 95.65%, while the MHR rate was 65.22%.Various molecular BC subtypes with varied clinical and pathological responses exhibited correlation toa large extent. Of all the BC patients studied, 84% of the triple-negative breast cancer (TNBC) patientswere evaluated as clinically effective, and 52% of the TNBC patients were evaluated as pathologicallyeffective, and these values were significantly higher than those of the other molecular types (P < 0.05).The expression of KIF15 in 25 TNBC patients showed positive correlations with lymph node metastasis.Conclusion Overexpression of KIF15 was shown to increase BC sensitivity to chemotherapy anddemonstrated better outcomes.

Role of Neo-Adjuvant Chemotherapy in the Treatment of Osteosarcoma

Osteosarcoma is a tumour characterized by the production of osteoid by malignant cells. The incidence is approximately 1 to 3 million/year. The incidence is slightly higher in males. Onset can occur at any age;however, primary high grade osteosarcoma usually occurs in the second decade of life. Historically patients with osteosarcoma were treated with immediate wide or radical amputation. Despite the treatment, 80% patients with apparently isolated disease died of distant metastases. In recent years the number of patients with osteosarcoma of the limb treated by amputation + chemotherapy has increased. In our study, we divided the patients into two groups. One group (A) was treated with amputation + adjuvant chemotherapy. The other group (B) was treated with neo-adjuvant chemotherapy + amputation followed by adjuvant-chemotherapy. In our study, the margin negativity in post surgical specimen was significantly higher (P-value 0.0007) for the group treated with neo-adjuvant chemotherapy. Local recurrence in the group treated without neoadjuvant chemotherapy was significantly more (P-value 0.0005).The systemic recurrence at the end of 6 months was higher the group treated without neoadjuvant chemotherapy (P-value 0.0169).However systemic recurrence between 6 months -1 year and 1 year - 2 years were not significant(P-values 0.1501 and 0.4902). From the above figures it may be concluded that treatment with neo-adjuvant chemotherapy + amputation + adjuvant chemotherapy had definite advantages over upfront amputation + adjuvant chemotherapy.)

Impact of regular enteral feeding via jejunostomy during neo-adjuvant chemotherapy on body composition in patients with oesophageal cancer

BACKGROUND Malnourishment and sarcopenia are well documented phenomena in oesophageal cancer.Patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy have complex nutritional needs.AIM To examine the effect of regular nutritional support via feeding jejunostomy on overall body composition in patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy for oesophageal cancer.METHODS Retrospective data were collected for 15 patients before and after neo-adjuvant chemotherapy.All patients had feeding jejunostomies inserted at staging laparoscopy prior to neo-adjuvant chemotherapy and underwent regular jejunostomy feeding.Changes in body composition were determined by analysis of computed tomography imaging.RESULTS Patient age was 61.3±12.8 years,and 73%of patients were male.The time between start of chemotherapy and surgery was 107±21.6 d.There was no change in weight(74.5±14.1 kg to 74.8±13.1 kg)and body mass index(26.0±3.8 kg/m^2 to 26.1±3.4 kg/m^2).Body composition analysis revealed a statistically significant decrease in lumbar skeletal muscle index despite regular feeding(45.8±8.0 cm^2/m^2 to 43.5±7.3 cm^2/m^2;P=0.045).The proportion of sarcopenic patients increased(33.3% to 60%).Six patients(40%)experienced dose-limiting toxicity during chemotherapy.CONCLUSION Regular jejunostomy feeding during neo-adjuvant chemotherapy can maintain weight and adipose tissue.Feeding alone is not sufficient to maintain muscle mass.Further insight into the underlying processes causing reduced muscle mass in cancer patients may help to provide targeted interventions.

Accuracy of physical examination, ultrasonography, and magnetic resonance imaging in predicting response to neo-adjuvant chemotherapy for breast cancer

Background Accurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer. Modalities that have been used to monitor response to neo-adjuvant chemotherapy （NAC） include physical examination （PE）, ultrasound （US）, and magnetic resonance imaging （MRI）. The purpose of this study was to evaluate the accuracy of PE, US, and MRI in predicting the response to NAC in patients with breast cancer. Methods According to the response evaluation criteria in solid tumors guidelines, the largest unidimensional measurement of the tumor diameter evaluated by PE, US, and MRI before and after NAC was classified into four grades, including clinical complete response, clinical partial response, clinical progressive disease, clinical stable disease, and compared with the final histopathological examination. Results Of the 64 patients who received NAC, the pathologic complete response （pCR） was shown in 13 of 64 patients （20%）. The sensitivity of PE, US, and MRI in predicting the major pathologic response was 73%, 75%, and 80%, respectively, and the specificity was 45%, 50%, and 50% respectively. For predicting a pCR, the sensitivity of PE, US, and MRI was 46%, 46%, and 39%, respectively, and the specificity was 65%, 98%, and 92% respectively. Conclusions Compared with final pathologic findings, all these three clinical and imaging modalities tended to obviously underestimate the pCR rate. A more appropriate, universal, and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential.

Application of Aidi Injection (艾迪注射液) in the Bronchial Artery Infused Neo-Adjuvant Chemotherapy for stage ⅢA Non-small Cell Lung Cancer before surgical Operation

Objective： To study the effect of Aidi Injection （艾迪注射液,ADI） applied in the bronchial artery infused （BAI） neo-adjuvant chemotherapy for stage ⅢA non-small cell lung cancer （NSCLC） before surgical operation.Methods： The 60 patients with NSCLC stage ⅢA underwent two courses BAI chemotherapy before tumor incision were assigned to two groups,the treatment and the control groups,using a random number table,30 in each group.ADI （100 mL） was given to the patients in the treatment group by adding into 500 mL of 5% glucose injection for intravenous dripping once daily,starting from 3 days before each course of chemotherapy,and it lasted for 14 successive days,so a total of 28 days of administration was completed.The therapeutic effectiveness and the adverse reaction that occurred were observed,and the levels of T-lymphocyte subsets,natural killer cell activity,and interleukin-2 in peripheral blood were measured before and after the treatment.Results： The effective rate in the treatment group was higher than that in the control group （70.0% vs.56.7%,P〈0.05）.Moreover,as compared with the control group,the adverse reaction that occurred in the treatment group was less and mild,especially in terms of bone marrow suppression and liver function damage （P〈0.05）.Cellular immune function was suppressed in NSCLC patients,but after treatment,it ameliorated significantly in the treatment group,showing significant difference as compared with that in the control group （P〈0.05）.Conclusion： ADI was an ideal auxiliary drug for the patients in stage ⅢA NSCLC received BAI neo-chemotherapy before surgical operation;it could enhance the effectiveness of chemotherapy,ameliorate the adverse reaction and elevate patients＇ cellular immune function;therefore,it is worthy for spreading in clinical practice.

Response and Long-Term Effect of Patients with Triple-Negative Breast Cancer Receiving Neo-Adjuvant Anthracycline-Based Chemotherapy

OBJECTIVE The breast cancer lack of expression of estrogenreceptor (ER), progesterone receptor (PR), and human epidermalgrowth factor receptor 2 (HER-2) is defined as the Triple-negativebreast cancer (TNBC). Our purpose is to compare the responseand long-term effect of the TNBC and non-TNBC patientsreceiving neo-adjuvant anthracycline-based chemotherapy, and toinvestigate the mechanisms of TNBC affecting the survivals.METHODS Data of long-term follow-up (median, 5.4 years)of 326 patients who received neo-adjuvant chemotherapy withanthracycline-based regimen, during a period from 2000 to 2003,were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 andE-cadherin were determined using immunohistochemical stainingmethod. A multivariate Cox regression analysis was used toanalyze independent prognostic factors affecting the relapse-freesurvival (RFS) and overall survival (OS) rates. Clinical effects ofthe neo-adjuvant anthracycline-based chemotherapeutic regimenand the RFS and OS rates were compared between the patientswith TNBC and non-TNBC, and the correlations among the triple-negative phenotype (TNP), tumor grading and the expressions ofP53, Ki-67 and E-cadherins were analyzed.RESULTS TNP, TNM staging, histological grades, clinicalresponse of the neo-adjuvant chemotherapy and pathologicalcomplete remission (pCR) rate were the independent prognosticfactors affecting the survival rates. Furthermore, 70 (21.5%) of the326 patients suffered TNBC. Compared with the subjects in non-TNBC group, the patients with TNBC had a significantly higherpCR rate (P = 0.046) and clinical response rate (P = 0.037), but alsodecreased 5-year RFS (P = 0.001) and OS (P = 0.004) rates. TheRFS and OS rates were not improved in the TNBC patients whoachieved a clinical remission after the neo-adjuvant chemotherapy.The triple-negative phenotype was positively correlated with thelevel of P53, Ki-67 expression (P = 0.007, P = 0.028), but negativelycorrelated with level of E-cadherin (P = 0.034).CONCLUSION Both clinical remission rate and pCR rate ofthe TNBC patients receiving neo-adjuvant anthracycline-basedchemotherapy are high, however, the long-term effect is poor.The mechanism may relate to a strong potential of proliferationand invasive metastasis, as well as lack of an effective therapeutictarget in the TNBC patients.

A case of primary neuroendocrine breast carcinoma that responded to neo-adjuvant chemotherapy

Primary neuroendocrine breast carcinoma （NEBC） is a very rare type of breast cancer. Two characteristic biomarkers, namely, CgA and Syn, should be immunohistochemically detected to diagnose NEBC. In this study, a 43-year-old woman with a large mass of 8.3 cm × 2.9 cm in her right breast was reported. The patient was pathologically diagnosed with NEBC after specific markers, including CgA and Syn, as well as few differential markers, such as CK7, ER, PR, C-erbB-2, NSE, and E-cadherin, were immunohistochemically detected. The patient showed a remarkable response to four cycles of neo-adjuvant chemotherapy （partial response based on RECIST criteria） and sequentially underwent modified radical mastectomy. Moreover, the diagnosis and treatment of NEBC based on this case and available related literature were discussed.

Complete response of gallbladder cancer treated with gemcitabine and cisplatin chemotherapy combined with durvalumab:A case report and review of literature

BACKGROUND Gallbladder cancer(GBC)is the most common and aggressive subtype of biliary tract cancer(BTC)and has a poor prognosis.A newly developed regimen of gemcitabine,cisplatin,and durvalumab shows promise for the treatment of advanced BTC.However,the efficacy of this treatment for GBC remains unclear.CASE SUMMARY In this report,we present a case in which the triple-drug regimen exhibited marked effectiveness in treating locally advanced GBC,thus leading to a long-term survival benefit.A 68-year-old man was diagnosed with locally advanced GBC,which rendered him ineligible for curative surgery.Following three cycles of therapy,a partial response was observed.After one year of combined therapy,a clinical complete response was successfully achieved.Subsequent maintenance therapy with durvalumab monotherapy resulted in a disease-free survival of 9 months for the patient.The patient experienced tolerable toxicities of reversible grade 2 nausea and fatigue.Tolerable adverse events were observed in the patient throughout the entirety of the treatment.CONCLUSION The combination of gemcitabine and cisplatin chemotherapy with durvalumab was proven to be an effective treatment approach for advanced GBC,with manageable adverse events.Further research is warranted to substantiate the effectiveness of the combined regimen in the context of GBC.

Effects of Shenqi Xiangyi granules in advanced gastric cancer chemotherapy

BACKGROUND Owing to the absence of specific symptoms in early-stage gastric cancer,most patients are diagnosed at intermediate or advanced stages.As a result,treatment often shifts from surgery to other therapies,with chemotherapy and targeted therapies being the primary options for advanced gastric cancer treatment.A total of 116 patients with advanced gastric cancer,admitted from January 2021 to December 2023,were selected and divided into two groups of 58 each using the random number table method.The control group received FOLFOX4 chemothe-rapy(oxaliplatin+calcium+folinate+5-fluorouracil)combined with intravenous sindilizumab.The observation group received the same treatment as the control group,supplemented by oral administration of Senqi Shiyiwei granules.Both groups underwent treatment cycles of 3 weeks,with a minimum of two cycles.The therapeutic efficacy,immune mechanisms,and treatment-related toxicity and side effects were compared between the groups.The objective remission rate in the observation group(55.17%)was higher than that of the control group(36.21%)(P<0.05).After two treatment cycle,CD3+,CD4+,and CD4+/CD8+levels were higher in the observation group compared to the control group,while CD8+,regulatory T cells,and natural killer cells were lower(P<0.05).Additionally,the incidence of leukopenia,nausea,and vomiting was lower in observed group(P<0.05).No significant differences were observed in the incidence of other adverse reactions(P>0.05).CONCLUSION Adjuvant therapy with Shenqixian granules may enhance the efficacy of simudizumab combined with FOLFOX4 chemotherapy in advanced gastric cancer and the immune function by increasing immune cell counts,making it a valuable option in clinical treatment.

Advancing treatment strategies:Insights from network meta-analysis of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma

This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.

Evaluation of Clinical and Radiological Tumour Response during Neo-Adjuvant Breast Cancer Chemotherapy at Yalgado Ouedraogo University Hospital

Background: Neoadjuvant chemotherapy (NAC) is one of the treatment options for breast cancer. Its aim is to significantly reduce the size of the tumour in preparation for surgery. The aim of this work is to analyze the conditions of clinical and radiological evaluation of NAC at the Yalgado Ouédraogo University Hospital (CHUYO). Patients and Methods: This was a descriptive cross-sectional study based on the medical records of patients followed up in the cancer department of the CHUYO from 1 January 2013 to 31 December 2021. All patients followed for histologically proven, non-metastatic breast cancer and having received at least one course of NAC were included in this study. The variables were related to the socio-demographic characteristics of the patients, the indications, the protocols of NAC and the sequences of evaluation of the tumour response (clinical, radiological and anatomopathological). Results: We collected 105 cases. The average age of the patients concerned was 44 years. The most frequent histological type was non-specific invasive carcinoma in 97.1% of cases. Immunohistochemically, triple-negative patients accounted for 51.4%. At the initial stage, all patients underwent clinical exploration. Clinical measurement of the tumour was performed in 70.5% of cases. The radiological size of the tumour was determined by ultrasound in 59.1% of cases. One patient had a breast MRI. Thirty-one patients were lost to follow-up after the initial evaluation. At mid-term and at the end of treatment, clinical tumour size was performed in 38.6% and 45.6% of cases respectively. There was no breast imaging performed at mid- and end-of-treatment. CT scans were performed in all cases at baseline, mid-term and end of treatment for extension assessment but did not mention the breast tumour. The tumour response rate was not recorded. Conclusion: Clinical assessment of tumour response is almost always empirical and not quantified. Medical imaging examinations are prescribed sparingly so as not to compromise the regularity of treatment and patient assessment.

Perioperative chemotherapy strategies in diffuse gastric cancer

This study reviews the findings of a recent study by Li et al,which demonstrated that perioperative chemotherapy benefits patients with diffuse-type gastric cancer compared to surgery alone.Despite potential biases,the study supports the inclusion of perioperative chemotherapy in treatment guidelines.Neoadjuvant and adjuvant chemotherapy may also provide similar survival outcomes,allowing for flexible treatment planning.

Harnessing multi-omics approaches to elucidate the role of Chinese herbal compounds in chemotherapy-induced gastrointestinal damage

In this editorial,we discuss the findings reported by Wang et al in the latest issue of the World Journal of Gastrointestinal Oncology.Various research methodologies,including microbiome analysis,assert that the Tzu-Chi Cancer-Antagonizing and Life-Protecting II Decoction of Chinese herbal compounds mitigates inflammatory responses by inhibiting the NF-κB signaling pathway.This action helps maintain the dynamic equilibrium of the intestinal microecology and lessens chemotherapy-induced gastrointestinal damage.The efficacy of these compounds is intimately linked to the composition of intestinal microbes.These compounds regulate intestinal microecology by virtue of their specific compatibility and effectiveness,thereby enhancing the overall therapeutic outcomes of cancer chemotherapy.Nonetheless,the exact mechanisms underlying these effects warrant further investigation.Multi-omics technologies offer a systematic approach to elucidate the mechanisms and effectiveness of Chinese herbal compounds in vivo.This manuscript reviews the application of multi-omics technologies to Chinese herbal compounds and explores their potential role in modulating the gastrointestinal microenvironment following cancer chemotherapy,thus providing a theoretical foundation for their continued use in adjunct cancer treatment.

Hepatic artery infusion chemotherapy:A resurgence

In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.

Anticipation for hepatic arterial infusion chemotherapy in the treatment of hepatocellular carcinoma

Hepatic arterial infusion chemotherapy (HAIC) is an advanced targeted therapeuticapproach for hepatocellular carcinoma (HCC), the most common type ofprimary liver cancer. HAIC has demonstrated significant potential in managingadvanced HCC, particularly in regions with high prevalence rates. Despite itspromise, several challenges and areas for future research remain. Clinical studieshave substantiated the efficacy of HAIC in enhancing survival outcomes forpatients with advanced hepatic carcinoma. Notably, combination therapiesinvolving immune checkpoint inhibitors, such as lenvatinib and programmeddeath-1 inhibitors, have shown substantial improvements in median overallsurvival and progression-free survival compared to systemic chemotherapy.These combination therapies have also exhibited superior response rates anddisease control, with manageable and often less severe adverse events relative tosystemic treatments. This article is based on the review by Zhou et al and aims todiscuss the current status and future directions in the treatment of HCC, emphasizingthe role of HAIC and its integration with novel therapeutic agents.

Identification of patients with advanced pancreatic cancer who might benefit from third-line chemotherapy

BACKGROUND Survival rates of patients with advanced pancreatic cancer(APC)have been improved with palliative chemotherapy series.The current preferred first-line regimen consists of combination therapy of 5-fluorouracil(5-FU)/leucovorin(LV),irinotecan,and oxaliplatin(FOLFIRINOX)or gemcitabine plus albumin-bound paclitaxel(GNP).After failure of first-line chemotherapy,there are a few options for subsequent therapy including switch to the unused first-line regimen or nanoliposomal irinotecan and 5-FU/LV.However,there are limited studies on the efficacy of third-line chemotherapy after failure of second-line chemotherapy.AIM To identify patients with APC who might benefit from third-line chemotherapy.METHODS Medical records from a single tertiary hospital were retrospectively reviewed between 2012 and 2021.The study included patients with histologically or cytologically confirmed metastatic or locally APC who underwent first-line FOLFIRINOX or GNP and subsequently received third-line chemotherapy.Overall survival(OS)after diagnosis and OS after third-line chemotherapy(OS3)were defined as the interval from the diagnosis to all-cause death and the time between the initiation of the third-line chemotherapy to all-cause death,respectively.RESULTS A total of 141 patients were enrolled.The median patient age at diagnosis was 61.8 years(36.0-86.0),and 54.9%were male.The first-line regimen was FOLFIRINOX(67.4%)or GNP(32.6%).The second-line regimen was FOLFIRINOX(27.0%),GNP(52.5%),or other(20.6%).The median OS was 19.0 months,and the median OS3 and progression-free survival after third-line treatment were 15.3 and 7.3 weeks,respectively.With regard to the best tumor response during third-line chemotherapy,1.4%had partial response,24.8%had stable disease,and 59.6%had progressive disease.The following clinical factors before third-line chemotherapy affected OS3:Good performance status(PS),serum carbohydrate antigen 19-9(CA19-9)level<1000 U/mL,duration of second-line chemotherapy≥19 weeks,and no peritoneal seeding.CONCLUSION This study identified that patients with good PS,CA19-9<1000 U/mL,second-line chemotherapy≥19 weeks,and no peritoneal seeding before starting third-line treatment may benefit more from third-line chemotherapy.

Hepatic arterial infusion pump chemotherapy for colorectal liver metastases: Revisiting traditional techniques to explore new frontiers

Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.