Effects of postoperative treatment with chemotherapy and cellular immunotherapy on patients with colorectal cancer

BACKGROUND The outcome of surgical treatment for colorectal cancer(CRC)remains unsatis-factory and warrants further exploration and optimization.AIM To clarify the impact of chemotherapy plus cellular immunotherapy[dendritic cell-cytokine-induced killer(DC-CIK)cell immunotherapy]on patients after CRC surgery and to explore the mediating variables.METHODS A total cohort of 121 patients who underwent CRC surgery between January 2019 and April 2022 were selected.The sample comprised a control group of 55 pa-tients who received the XELOX chemotherapy regimen and a research group of 66 patients who received XELOX+DC-CIK immunotherapy.We performed compa-rative analyses of the clinical and pathological data of the two groups,including efficacy(2-year disease-free survival[DFS]rate),the incidence of adverse events(diarrhea,myelosuppression,gastrointestinal reactions,and peripheral neuritis),serum levels of tumor markers[carcinoembryonic antigens and carbohydrate an-tigens(CA)19-9 and CA242],and T-cell subsets[cluster of differentiation(CD)3+,CD3+CD4+,CD3+CD8+,natural killer(NK),and NK T cells].We also conducted preliminary univariate and mul-tivariate analyses of the variables that affected the efficacy of the treatments.RESULTS We found a significantly higher 2-year DFS rate of treatment efficacy in the research group than in the control group,with a statistically lower incidence of adverse events.Both groups showed a reduction in serum tumor markers after treatment but there was no marked intergroup difference.After treatment,the various T-cell subgroup indicators in the control group were significantly lower than those in the research group.The indices of T-cell subsets in the research group showed no significant change from preoperative levels.Univariate analysis revealed a significant correlation between TNM staging,tumor differentiation,and the rates of nonresponse to treatment in CRC patients after surgery.Multivariate results indicated that the treatment approach significantly affected the efficacy of postoperative CRC treatment.CONCLUSION We concluded that XELOX+DC-CIK immunotherapy for postsurgical CRC patients offers reduced rates of treatment-induced adverse events,extended 2-year DFS,enhanced immunity,and increased physiological antitumor responses.

CLINICAL STUDY ON THE TIME OF TREATING CHEMOTHERAPY INDUCED TOXIC AND SIDE EFFECTS IN MALIGNANT TUMOR PATIENTS BY ACUPOINT INJECTION OF ASTRAGALUS ROOT INJECTION

Objective: To investigate the suitable time of treating virulent and side effects of chemotherapy for malignant tumor by acupoint injection of Astragalus Root injection. Methods: Sixty three patients with malignant tumor were divided into three groups: prevention treatment (PT) group (n=23 cases),post chemotherapy treatment (PCT) group( n=22 cases), Western medicine (WM) group ( n=18 cases). The patients in PT, PCT and WM groups were treated respectively from the fifth day on before chemotherapy and from the first day on after chemotherapy, 18 days in all. The patients in WM group were administered Batilol and Leucogen from the first day on after chemotherapy. Changes of leukocytes and immunoglobulin before and after treatment were observed. Results: 1) Acupoint injection of Astragalus Root injectio could increase the number of leukocytes and immunoglobulin content and its effect was better than that of Western medicine (P<0.05); 2) The effect of PT group was better than that of PCT group in preventing and treating virulent and side effects of chemotherapy (P<0.05). Conclusion: It should be stressed on prevention of malignant tumor by using acupoint injection of Astragalus Root for relieving virulent and side effects of chemotherapy.

Side Effects of Chemotherapy in Cancer Patients and Evaluation of Patients Opinion about Starvation Based Differential Chemotherapy

Side-effects associated with the cancer chemotherapy limit the scope of chemotherapeutic drugs and no data was available about these side effects in Pakistan. Moreover starvation based differential chemotherapy has been proved to greatly reduce the side effects of chemotherapy depending on starvation time. The current study was conducted to survey the common side effects of the chemotherapeutic drugs and the role of starvation to reduce them. The study included total 100 subjects with multiple carcinomas. A comprehensive questionnaire about starvation inquiry, chemotherapy side effects and their basic information was filled by interviewers as told by patients. There were 48% patients with breast cancer and 11% with uterine cancer. Out of these patients 30%, 28%, 9% and 9% patients were agreed to starve for 12, 24, 36 and 48 hours respectively. The survey regarding the side effects of chemotherapy showed that 43% patients were suffering from headache, fatigue 90%, weakness 95%, hair loss 76%, nausea 77%, vomiting 75%, diarrhea 31%, abdominal cramps 40%, mouth sores 47%, dry mouth 74%, memory impairment 14%?and numbness 49%. Breast cancer is the most common cancer in Pakistan. Only 18% of the total patients were agreed to starve for more than one day. Chemotherapy-associated side effects vary greatly and it does not depend upon cancer type. But these side effects depend on multiple factors such as the type and dose of chemotherapeutic drug, patient’s health status and stage of cancer.

Evaluation of the Effect of Shenmai Injection on Chemotherapy Efficacy and Side Effects of Acute Leukemia

Objective.To study the effect of Shenmai injection on the efficacy and side effects of chemotherapy in acute leukemia.Methods.Sixty-two patients with acute leukemia admitted to the hospital between February 2018 and June 2019 were enrolled in this study.All patients were divided into observation and control groups according to different treatment methods in chemotherapy.The control group was treated with chemotherapy alone.The observation group was treated Shenmai injection combined with chemotherapy.The treatment effect of the two groups was compared,and the incidence of bone marrow blood and side effects before and after treatment were compared.Results.The therapeutic effect of the observation group was 93.55%which was much higher than that of the control group of 74.19%,P<0.05.The bone marrow blood levels of WBC,PLT and Hb in the observation group before and after treatment were 23.97±3.05,6.76±1.27,69.01±8.15,66.96±9.46,91.07±8.15,89.35±7.46,respectively,compared with the control group.The difference in the situation after treatment was found to be significant.The incidence of toxic side effects such as nausea and vomiting,impaired liver function and renal dysfunction in the observation group was 9.68%,which was lower than that of the control group(32.26%,P<0.05).Conclusion.Shemai injection has significant effects on the efficacy and side effects of chemotherapy in acute leukemia and effectively improves the effect of chemotherapy.

Effects of nutritional and psychological status in gastrointestinal cancer patients on tolerance of treatment

AIM: To assess the effects of poor nutritional and psychological status on tolerance of cancer treatment and the recovery of physical performance status in patients with gastrointestinal cancer. METHODS: An epidemiological survey with respect to nutritional and psychological status in patients with gastrointestinal cancer was conducted among 182 operated patients in four provincial-level hospitals from December 2005 to June 2006. The food frequency survey method, state-trait anxiety inventory (STAI) and depression status inventory (DSI) were used to obtain information about the diet and psychological status in the patients. Nutritional status in the participants was reflected by serum albumin (Alb), hemoglobin (HB) and body mass index (BMI). RESULTS: Alb, protein intake and anxiety were associated with the severity of side effects of treatment. The adjusted relative risk (RR) for Alb, protein intake and anxiety was 3.30 (95% CI: 1.08, 10.10, P = 0.03), 3.25 (95% CI: 1.06, 9.90, P = 0.04) and 1.48 (95% CI: 1.29, 1.70, P < 0.0001), respectively. Moreover, calorie intake, HB and depression were associated with the recovery of physical performance status in the patients. Adjusted relative risk was 2.12 (95% CI: 1.09, 4.03, P = 0.028), 2.05 (95% CI: 1.08, 3.88, P =0.026) and 1.07 (95% CI: 1.02, 1.12, P = 0.007), respectively. CONCLUSION: Both poor nutrition status and psychological status are independent risk factors for severe side effects of cancer treatment, and have impact on the recovery of physical performance status in patients after treatment.

Efficacy and prognostic factors of neoadjuvant chemotherapy for triple-negative breast cancer

BACKGROUND Breast cancer mainly occurs in young and premenopausal women;its incidence is increasing annually. Patients with triple-negative breast cancer(TNBC) have relatively high recurrence and transfer rates during the operation and 3 years after postoperative adjuvant chemotherapy. Currently, the treatment for patients with TNBC is mainly based on a comprehensive combination of surgery and chemotherapy. Therefore, identifying additional effective treatments to improve patient prognosis is important.AIM To explore and discuss the effects and prognostic factors of neoadjuvant chemotherapy in TNBC.METHODS In total, 118 patients diagnosed with TNBC from January 2016 to January 2020 in our hospital were selected and divided into the observation(n = 60) and control(n = 58) groups according to therapeutic regimen. The control group received routine chemotherapy, and the observation group received neoadjuvant chemotherapy. The therapeutic effects of the two groups were observed, and the survival of patients was followed up.RESULTS The karyopherin A2(KPNA2)-positive and SRY-related HMG box-2(SOX2)-positive expression rates of patients with TNBC with intravascular tumor thrombus and tumor-node-metastasis(TNM) stage IV were 92.00% and 91.67% and 96.00% and 95.83%, respectively, which were significantly higher than those of patients with no intravascular tumor thrombus and TNM stage Ⅲ(P < 0.05). KPNA2 was positively associated with SOX2 expression(rs = 0.514, P < 0.50). The short-term curative effect of the observation group was better than that of the control group(P < 0.05), and the total effective rate was 58.33%. After treatment, carcinoembryonic antigen, cancer antigen(CA) 19-9, and CA125 Levels in the observation group were 11.40 ± 2.32 mg/L, 19.92 ± 3.42 kU/L, and 54.30 ± 12.28 kU/L, respectively, which were significantly lower than those in the control group(P < 0.05). The median survival time of the observation group was 33 mo(95%CI: 31.21-34.79), which was significantly longer than that of the control group(P < 0.05). TNM stage, degree of differentiation, lymph node metastasis, KPNA2 and SOX2 expressions, and treatment plan were prognostic factors of TNBC(relative risk = 1.575, 1.380, 1.366, 1.433, 1.411, and 0.581, respectively, P < 0.05).CONCLUSION Neoadjuvant chemotherapy for TNBC treatment can achieve good curative effects. TNM stage, differentiation degree, lymph node metastasis, KPNA2 and SOX2 expressions, and treatment plan are prognostic factors of TNBC.

Efficacy of Oncoxin-Viusid on the Reduction of Adverse Reactions to Chemotherapy and Radiotherapy in Patients Diagnosed with Cervical Cancer and Endometrial Adenocarcinoma

Introduction: Oncoxin-Viusid (OV) has shown antioxidant, immunomodulatory and anti-tumour capabilities in experimental studies on humans and animal subjects. Acute toxicity of Radiation Therapy (RT) and Chemotherapy (CT) in patients with cervical cancer and endometrial adenocarcinoma impact quality of life and, therefore, outcomes of these therapies. Objective: To identify Oncoxin-Viusid’s efficacy in reducing acute toxicity produced by onco-specific treatments in patients with cervical cancer and endometrial adenocarcinoma. Materials and Methods: A controlled, randomised double-blind phase II clinical trial was performed with a sample size of 63 patients distributed into 2 groups: one receiving the standard treatment plus the Oncoxin-Viusid nutritional supplement (OV group) and another receiving the standard treatment and placebo (P group). The primary efficacy variable is the proportion of secondary disruptions to acute adverse reactions produced by RT and CT. Results: The number of patients suffering adverse events from chemotherapy was 20.6% less in the OV group (70.0%) than in the placebo group (90.6%) (p = 0.04). We recorded consistently normal values of haemoglobin (-6.2 OV group vs -8.3 P group, p = 0.009), platelet count (-17.4 OV group vs -27.6 P group, p = 0.009) and leukocytes (-31.8 OV group vs -41.4 P group, p = 0.025) in the OV group, tolerating 4 more cytostatic doses on average than the placebo group. Significant increase in quality of life (QLQ-30) was registered in the OV group with a large effect size on such issues as emotional and social function (Cohen’s d = 0.9), as well as in the reduction of symptoms like dyspnea 60%, insomnia 15% and anorexia 30% (item CX-2), (Cohen’s d = 0.98), which were higher than the placebo group. Conclusions: OV administration reduces onco-specific adverse events and improves quality of life in patients diagnosed with cervical cancer and endometrial adenocarcinoma undergoing radiation therapy and chemotherapy.

Analysis of Efficacy of DICE(Dexamethasone,Ifosfamide,Cisplatin and Etoposide)Regimen on Recurrent and Refractory Intermediate and High Grade Non-Hodgkin's Lymphoma

OBJECTIVE Thus far there is no standard salvage regimenfor patients with recurrent and refractory intermediate and highgrade non-Hodgkin's lymphoma (NHL). This study intends toinvestigate the therapeutic efficacy of the DICE (dexamethasone,isofosfamide, cisplatin and etoposide) regimen on the recurrentand refractory NHL, and to observe the related adverse effects.METHODS Clinical records of 22 patients with recurrent andrefractory NHL, who failed to achieve a remission from theCHOP [cyclophosphamide, hydroxydaunomycin/doxorubicin(adriamycin), oncovin, prednisone] regimen within 2 to 6 cyclesof treatment, were reviewed. DICE, as a salvage regimen with amedian course of treatment of 4 cycles (ranging from 2 to 7 cycles),was now used, and evaluation of the therapeutic efficacy andadverse effect of DICE was conducted in all the patients. Of the 22NHL cases, 8 were of T-cell origin and the other 14 B-cell origin.Salvage treatment was performed in the patients, with appraisal,prevention and treatment of the toxic reactions.RESULTS Following DICE treatment in the 22 patients, thetotal effective rate of the regimen was 63.6%, and the completeremission (CR) rate was 40.9%. The effective rates of DICE onthe T and B-cell sourced NHL were 75.0% and 57.1%, and the CRrate were 37.5%, 42.9%, respectively (P >0.05). An increase of thelactate dehydrogenase (LDH) level accompanied by a giant lumpwas the short-term effect on patients with recurrence (mean P <0.05) who were drug resistant. Myelosuppression, digestive systemreaction and alopecia were the commonly-seen complications inthe patients who received DICE regimen. All patients recoveredafter treatment, and no chemotherapy-related death occurred.CONCLUSION DICE regimen is effective in treating refractoryand recurrent NHL.

The effect of Supplementing Qi and Nourishing Yin combined with chemotherapy for lung cancer： a meta-analysis

Objective： To evaluate whether herbs of supplementing Qi and nourishing Yin combined with chemotherapy （versus chemotherapy alone） improve survival, increase tumor response, improve performance status or reduce chemotherapy toxicity in patients with lung cancer. Methods： Searching the randomized controlled trials （RCT） studies from the databases （China HowNet database, Wan Fang database, VIP database, Master Thesis and Pubmed） between January 2013 and January 2017. RevMan 5.3 software was used to evaluate the quality of these collected papers. Results： Of 48 potentially relevant publications, 10 randomized studies representing 691 patients met inclusion criteria with 369 cases in the supplementing Qi and nourishing Yin plus Chemotherapy group （Herbs ＋ Chem group） and 322 cases in Chemotherapy group （Chem only group）. There were significant differences between Herbs ＋ Chem group and Chem only group in improving the treatment efficacy and reducing the side effects of chemotherapy （P 〈 0.001 for all）. There were also significant differences between the two groups in tumor response and quality of life （P 〈 0.001 for all）. Conclusion： Herbs of supplementing Qi and nourishing Yin may increase chemotherapy effectiveness, reduce chemotherapy toxicity and improve the quality of life of patients with lung cancer when combined with chemotherapy.

Efficacy of 5-Fluorouracil and High-Concentration Cisplatin Suspended in Lipiodol by Short-Term Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Background: Since advanced hepatocellular carcinoma (HCC) is potentially fatal, and patients’ quality of life (QOL) often deteriorates during their treatment, improving the prognosis and QOL of patients given chemotherapy is very important. In addition, cost-effective treatments are highly desirable when chemotherapy must be given repeatedly. The aim of this study was to evaluate the efficacy and usefulness of 5-fluorouracil (5-FU) and high-concentration cisplatin by short-term hepatic arterial infusion chemotherapy (3-day FPL) in advanced HCC patients. Methods: Thirty patients with unresectable advanced HCC were enrolled. The patients underwent hepatic arterial infusion chemotherapy via the implanted port system with 5-FU on days 1 - 3 and a fine-powder formulation of cisplatin in suspended pre-warmed lipiodol on day 2 every 4 to 10 weeks. Tumor response was assessed one month later with CT. Results: All patients had evidence of portal vein invasion (Vp2-4). Four patients achieved a complete response (CR), 8 patients achieved a partial response (PR), and 7 patients had stable disease (SD). The median progression-free survival (PFS) and overall survival (OS) were 198 days and 452 days, respectively. The OS was significantly longer in the successful disease control group (CR, PR, and SD) than in the progressive disease group (P < 0.005). Conclusions: Three-day FPL was effective and tolerable in advanced HCC patients due to its shorter time of administration than conventional FP therapy. Therefore, repetitive 3-day FPL appears useful and contributes to improving the prognosis and QOL of patients with advanced HCC. In addition, this protocol is a cost-effective treatment.

EFFECT OF ACUPUNCTURE ON IMMUNE FUNCTION OF PATIENTS TREATED WITH RADIOTHERAPY AND CHEMOTHERAPY

In comparison with the normal people group, values of blood CD2+ and CD4+ in pa-tients with mallgnant tumors treated with radiotherapy and chemotherapy were significantly lower andthe ratio of CD助+ and CD8+ decreased obviously （all P【0.001）; CD8+ had no apparent change （P】0.05）. Following acupunctural treatment, values of CD2+,CD4+ and the ratio of CD4+ to CD8+ increasedobviously （all P【0.001）; while those of the medicinal control group had no significant change aftertreatment（P】0. 05）. Values of IgG, IgA and IgM in patients’ serum presented an abnormal de-creasing or increasing tendency, and C3 in minority of patients were raised. Results indicated thatthere was a biphasic regulatory effect of acupuncture on the disturbance of humoral immunity andcould correct the deviation of C3 level; and its effect was better than or similar to that of the medicinecontrol group. It demonstrates that acupuncture can enhance and regulate. the immune function of pa-tients treated with radiotherapy

The Role and Safety of Personalized Care in Improving Thrombocytopenia after Lymphoma Chemotherapy

Objective:To explore and analyze the effect and safety of personalized nursing in improving thrombocytopenia after lymphoma chemotherapy.Methods:80 lymphoma patients with thrombocytopenia after lymphoma chemotherapy in the Department of Hematology of our hospital from May 2021 to May 2023 were selected as the research objects,and they were divided into an experimental group and reference group by random drawing,with 40 cases in each group.The experimental group received individualized nursing,and the reference group received routine nursing.The platelet count,platelet-related indicators,incidence of adverse reactions,and life scores were compared between the two groups.Results:Before the intervention,there was no significant difference in platelet count between the groups(P>0.05);after the intervention,the platelet count in the experimental group was significantly higher compared to the reference group(P<0.05).In the experimental group,the duration for platelet decline and the time for platelets to normalize were notably shorter compared to the reference group(P<0.05).Moreover,the personality group displayed a significantly lower incidence of adverse reactions than the reference group(P<0.05).Prior to the intervention,there were no statistically significant differences(P>0.05)in the life scores between the two groups,such as functional condition,symptom manifestation,and health scores among the groups.However,post-intervention,the personality group exhibited a significant improvement in those scores compared to the reference group(P<0.05).Conclusion:Individualized nursing can optimize the platelet level in thrombocytopenia after lymphoma chemotherapy,improve symptoms,and reduce the occurrence of adverse reactions.

Preoperative neoadjuvant chemotherapy in patients with breast cancer evaluated using strain ultrasonic elastography

BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing.The annual breast cancer incidence in China is 39.2 million,accounting for two-thirds of the urban population.In China,breast cancer is the fifth most common malignant tumor overall and the most common in women,accounting for 17%of female malignant tumors.AIM To investigate the accuracy of strain ultrasound elastography(SUE)on the evaluation of preoperative neoadjuvant chemotherapy(NAC)in breast cancer.METHODS Overall,90 patients with breast cancer treated at our hospital between January 2018 and February 2019 were selected for this study.The patients received six cycles of NAC with docetaxel,epirubicin,and cyclophosphamide.Surgical treatment was also performed,and pathological reactivity was assessed.The patients were evaluated using conventional ultrasonography and SUE before biopsy.The differences between groups were analyzed to calculate the mean and standard deviation with significance measured using a t-test,while multivariate analysis was performed using logistic regression analysis.RESULTS Of the patients analyzed,20 had a pathological complete remission(pCR)while 70 did not achieve pCR after NAC.The ratio of the elastic strain ratio(SR)and elastic score of 4–5 in patients with pCR were 5.5±1.16 and 15.00%,respectively;these were significantly lower than those in patients without pCR(85%)and significantly higher than in patients without pCR(14%).SR and elastic score 4–5 were independent factors influencing NAC efficacy(OR=0.644,1.426 and 1.366,respectively,P<0.05).SR was positively correlated with elasticity score(rs=0.411,P<0.05).The area under the receiver operator characteristic curve of SR and SR combined with elastic score in predicting patients without pCR was 0.822 and 0.891,respectively(P<0.05).CONCLUSION Strain ultrasonic elastography may be used to evaluate the effects of preoperative NAC in patients with breast cancer.

Risk Factors for Cancer Chemotherapy-Induced Hiccups (CIH)

Background: Hiccups are common somatic side effects of medication. Our previous analysis of the clinical risk factors for hiccups identified chemotherapy as a factor related to hiccup risk. Therefore, in the present study, we investigated the risk factors for hiccups associated with chemotherapy. Methods: We included all patients who received cancer chemotherapy and were hospitalized at the Musashino Red Cross Hospital between April 2014 and December 2014. We investigated patient demographics, physical characteristics, and other clinical factors to identify the risk factors for chemotherapy-induced hiccups (CIH). We conducted univariate and multivariable analysis to compare the CIH group and the non-CIH and determined risk factors of CIH. Results: Hiccups were identified in 48 of 292 patients with an incidence rate of 16.4%. Univariate analysis revealed that the male gender, pain, and nausea and vomiting were related to CIH. It also showed that cisplatin, pemetrexed, gemcitabine, etoposide, dexamethasone, and metoclopramide were related to CIH.A correlation which was found with doses of cisplatin, pemetrexed, gemcitabine, and etoposide. Multivariable analysis identified male gender (OR, 72.69;95% CI, 6.95 - 757.64), nausea and vomiting (OR, 52.01;95% CI, 3.93 - 447.13), dexamethasone (OR, 4.55;95% CI, 1.12 - 16.91), cisplatin (OR, 3.84;95% CI, 1.52 - 9.70), and etoposide (OR, 3.72;95% CI, 1.14 - 12.11) as independent risk factors for hiccups. Conclusions: The present study is the first one to report risk factors for the development of CIH. Our results suggest that male gender, having nausea, and the drugs dexamethasone, cisplatin, and etoposide are important risk factors for CIH. These results may assist in elucidation of the underlying mechanisms and guide therapy to reduce hiccup risk.

Paclitaxel-etoposide-carboplatin/cisplatin versus etoposidecarboplatin/cisplatin as first-line treatment for combined small-cell lung cancer: a retrospective analysis of 62 cases

Objective: To compare the efficacy and adverse effects of paclitaxel-etoposide-carboplatin/cisplatin(TEP/TCE) regimen with those of etoposide-carboplatin/cisplatin(EP/CE) regimen as first-line treatment for combined small-cell lung cancer(CSCLC).Methods: A retrospective study was conducted on 62 CSCLC patients who were treated at Tianjin Medical University Cancer Institute and Hospital from July 2000 to April 2013 and administered with TEP/TCE regimen(n=19) or EP/CE regimen(n=43) as first-line CSCLC treatment. All patients received more than two cycles of chemotherapy, and the response was evaluated every two cycles. The primary endpoint was overall survival(OS), and the secondary endpoints were progression-free survival(PFS), objective response rate(ORR), disease control rate(DCR), and adverse effects. Results: ORR between the TEP/TCE and EP/CE groups showed a statistical difference(90% vs. 53%, P=0.033). Both groups failed to reach a statistical difference in DCR(100% vs. 86%, P=0.212). The median PFS and OS of the TEP/TCE group were slightly longer than those of the EP/CE group, although both groups failed to reach a statistical difference(10.5 vs. 8.9 months, P=0.484; 24.0 vs. 17.5 months, P=0.457). However, stratified analysis indicated that the PFS of patients with stages III and IV CSCLC showed marginally significant difference between the TEP/TCE and EP/CE groups(19.5 vs. 7.6 months; P=0.071). Both rates of grade IV bone marrow depression and termination of chemotherapy in the TEP/TCE group were significantly higher than those in the EP/CE group(26.3% vs. 7.0%, P=0.036; 31.6% vs. 14.7%, P=0.004). Conclusion: The TEP/TCE regimen may not be preferred for CSCLC, and this three-drug regimen requires further exploration and research. To date, the EP/CE regimen remains the standard treatment for CSCLC patients.

Tumor-feeding artery diameter reduction is associated with improved short-term effect of hepatic arterial infusion chemotherapy plus lenvatinib treatment

BACKGROUND Recently,hepatic arterial infusion chemotherapy(HAIC)plus lenvatinib has been frequently used to treat unresectable hepatocellular carcinoma(uHCC)in China.In the clinic,the hepatic arteries of some patients shrink significantly during this treatment,leading to improved short-term efficacy.AIM To investigate the relationship between the shrinkage of hepatic arteries and the short-term effect of HAIC plus lenvatinib treatment.METHODS Sixty-seven participants with uHCC were enrolled in this retrospective study.The patients received HAIC every 3 wk,followed by oral lenvatinib after the first HAIC course.Hepatic artery diameters were measured on CT before treatment and after 1 and 2 mo of treatment.Meanwhile,the changes in tumor capillaries were also examined on pathological specimens before and after 1 mo of treatment.The antitumor response after 1,3,and 6 mo of treatment was assessed using the modified Response Evaluation Criteria in Solid Tumors(mRECIST).The relationship between the changes in vessel diameters and the short-term effect of the combination treatment was evaluated by receiver-operating characteristic and logistic regression analyses.RESULTS The hepatic artery diameters were all significantly decreased after 1 and 2 mo of treatment(P<0.001),but there was no difference in the vessel diameters between 1 and 2 mo(P>0.05).The microvessel density in the tumor lesions decreased significantly after 1 mo of combination treatment(P<0.001).According to mRECIST,46,41,and 24 patients had complete or partial responses after 1,3,and 6 mo of treatment,respectively,whereas 21,21,and 32 patients had a stable or progressive disease at these times,respectively.Shrinkage of the tumor-feeding artery was significantly associated with the tumor response after 1,3,and 6 mo of treatment(P<0.001,P=0.004,and P=0.023,respectively);however,changes in other hepatic arteries were not significantly associated with the tumor response.Furthermore,shrinkage of the tumor-feeding artery was an independent factor for treatment efficacy(P=0.001,P=0.001,and P=0.002 and 1,3,and 6 mo,respectively).CONCLUSION The hepatic arteries shrank rapidly after treatment with HAIC plus lenvatinib,and shrinkage of the tumor-feeding artery diameter was closely related to improved short-term efficacy.

Cost-effectiveness analysis of colon cancer treatments from MOSIAC and No.16968 trials

AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis. RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $ 19884.96 +/- 4280.30 and $ 18113.25 +/- 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $ 204.75 +/- 16.80 for the XELOX group, and $ 873.72 +/- 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $ 18495.00 for the XELOX group and $ 21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $ 3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $ 8047.30 in the XELOX group, which was $ 900.98 less than in the FOLFOX4 group ($ 8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4. CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China. c 2014 Baishideng Publishing Group Inc. All rights reserved.

Enhanced permeability and retention effect based nanomedicine, a solution for cancer

Tumor-targeting is becoming more and more important for cancer chemotherapy. Though many molecular-target drugs have been developed in the past two decades which shed some light on targeted tumor therapy,clinical results of those molecular-target drugs are not so encouraging especially for solid tumors, problems mostly relating to the heterogeneity and mutations of target molecules in human solid tumors. More general tumor-targeting strategy is thus anticipated. In this regard, the enhanced permeability and retention(EPR) effect which is a unique phenomenon of solid tumors based on the anatomical and pathophysiological nature of tumor blood vessels, is receiving more and more attentions. This EPR effect now served as a standard for tumor-targeted macromolecular anticancer therapy, namely nanomedicine. Many nanoplatforms have been developed as targeted drug delivery systems, including liposome, polymeric micelles, polymer conjugate, nanoparticles. Ample macromolecular drugs are now approved for clinical use or in clinical stage development, all of which by taking advantage of EPR effect, show superior in vivo pharmacokinetics and remarkable tumor selectivity, resulting in improved antitumor effects with less adverse effects. We thus believe EPR-based nanomedicine will be a solution for cancer in the future, whereas further consideration of factors involved in EPR effect and strategies to augment/improve EPR effect are warranted.

Protease expression by microorganisms and its relevance to crucial physiological/pathological events

The treatment of infections caused by fungi and trypanosomatids is difficult due to the eukaryotic nature of these microbial cells,which are similar in several biochemical and genetic aspects to host cells.Aggravating this scenario,very few antifungal and anti-trypanosomatidal agents are in clinical use and,therefore,therapy is limited by drug safety considerations and their narrow spectrum of activity,efficacy and resistance. The search for new bioactive agents against fungi and trypanosomatids has been expanded because progress in biochemistry and molecular biology has led to a better understanding of important and essential pathways in these microorganisms including nutrition,growth, proliferation,signaling,differentiation and death.In this context,proteolytic enzymes produced by these eukaryotic microorganisms are appointed and,in some cases,proven to be excellent targets for searching novel natural and/or synthetic pharmacological compounds,in order to cure or prevent invasive fungal/trypanosomatid diseases.With this task in mind,our research group and others have focused on aspartic-type proteases,since the activity of this class of hydrolytic enzymes is directly implicated in several facets of basic biological processes of both fungal and trypanosomatid cells as well as due to the participation in numerous events of interaction between these microorganisms and host structures.In the present paper,a concise revision of the beneficial effects of aspartic protease inhibitors,with emphasis on the aspartic protease inhibitors used in the anti-human immunodeficiency virus therapy,will be presented and discussed using our experience with the following microbial models:the yeast Candida albicans,the filamentous fungus Fonsecaea pedrosoi and the protozoan trypanosomatid Leishmania amazonensis.