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.

Combining chemotherapy and targeted therapies in metastatic colorectal cancer

Colorectal cancer remains one of the major causes of cancer death worldwide. During the past years, the development of new effective treatment options has led to a considerable improvement in the outcome of this disease. The advent of agents such as capecitabine, irinotecan, oxaliplatin, cetuximab and bevacizumab has translated into median survival times in the range of 2 years. Intense efforts have focused on identifying novel agents targeting specific growth factor receptors, critical signal transduction pathways or mediators of angiogenesis. In addition, several clinical trials have suggested that some of these molecularly targeted drugs can be safely and effectively used in combination with conventional chemotherapy. In this article we review various treatment options combining cytotoxic and targeted therapies currently available for patients with metastatic colorectal cancer.

Photothermal and Chemotherapy Combined Therapy of B-CuS-DOX Based on/pH Dual Stimulation

Single chemotherapy is difficult to meet the needs of tumor cure. Photothermia combined with chemotherapy is anew and effective anti-tumor therapy. However, the drug loading of nanoparticles and increase in performance of photothermalconversion limits the therapeutic effect of combination therapy. In this study, two-dimensional boron (boron, B) nanoparticles wereprepared by ultrasonic exfoliation, and copper sulfide (CuS) nanoparticles and doxorubicin (DOX) were grown on the surface ofthe nanoparticles to form B-CuS-DOX nanoparticles. B-CuS carrier has high DOX drug loading capacity (864mg/g) and goodphotothermal conversion performance (photothermal conversion efficiency at 808nm is 55.8%). At the same time, it can achievedrug release and good photothermal response at near infrared and pH. The nanoparticles designed in this study are expected toprovide an effective chemotherapy-photothermal therapy strategy for tumor therapy in vivo.

The Clinical Study of Multigene Combination Test to Guide Chemotherapy Combined with Targeted Therapy in Patients with Advanced Gastrointestinal Tumors

Objective:To study the clinical effects of multigene combination test to guide chemotherapy combined with targeted therapy in patients with advanced gastrointestinal tumors.Methods:The samples were selected from 60 patients with advanced gastrointestinal tumors admitted to our hospital from March 2019 to July 2020,and were divided into a study group and a control group using a random number table model;patients in the control group did not undergo genetic testing and FOLLOX4+PD-1 chemotherapy,while patients in the study group underwent TYMS,ERCC1,EGFR,and KRAS and VEGF gene expression levels test,and the sensitive treatment plan was determined based on the test results,and the clinical indexes were compared between the two groups.Results:By comparing the total effective rate,survival time,and time to disease progression of chemotherapy in the two groups,the study group has a significant advantage(P<0.05).Conclusion:The combination of chemotherapy and targeted therapy for advanced gastrointestinal tumor patients can improve the efficiency of chemotherapy and prolong the time of disease progression and survival,which is worthy of comprehensive promotion.

Combination therapy for scalp angiosarcoma using bevacizumab and chemotherapy: a case report and review of literature

Bevacizumab, an angiogenesis inhibitor, is a recombined humanized monoclonal antibody against vascular endothelial growth factor and a promising therapeutic option for angiosarcoma management. This is a ease report and review of the literature using bevacizumab and combination chemotherapy for angiosarcoma. The understanding of the effectiveness of combined therapy of bevacizumab and chemotherapy agents is still limited. The benefits of bevacizumab treatment for angiosarcoma will need to be weighed against the risks of venous thromboembolism in this population.

Hormonal therapy might be a better choice as maintenance treatment than capecitabine after response to first-line capecitabine-based combination chemotherapy for patients with hormone receptor-positive and HER2-negative,metastatic breast cancer

Background:Both hormonal therapy(HT) and maintenance capecitabine monotherapy(MCT) have been shown to extend time to progression(TTP) in patients with metastatic breast cancer(MBC) after failure of taxanes and anthracycline?containing regimens.However,no clinical trials have directly compared the efficacy of MCT and HT after response to first?line capecitabine?based combination chemotherapy(FCCT) in patients with hormone receptor(HR)?positive and human epidermal growth factor receptor 2(HER2)?negative breast cancer.Methods:We retrospectively analyzed the charts of 138 HR?positive and HER2?negative MBC patients who were in non?progression status after FCCT and who were treated between 2003 and 2012 at the Cancer Institute and Hospital,Chinese Academy of Medical Sciences,in Beijing,China.The median number of first?line chemotherapy cycles was 6(range,4–8);combined agents included taxanes,vinorelbine,or gemcitabine.Of these 138 patients,79 received MCT,and 59 received HT.Single?agent capecitabine was administered at a dose of 1250 mg/m2 twice daily for 14 days,followed by a 7?day rest period,repeated every 3 weeks.Of the 59 patients who received HT,37 received aromatase inhibitors(AIs),8 received selective estrogen receptor modulators(SERMs),and 14 received goserelin plus either AIs or SERMs.We then compared the MCT group and HT group in terms of treatment efficacy.Results:With a median follow?up of 43 months,patients in the HT group had a much longer TTP than patients in the MCT group(13 vs.8 months,P ease?free surviv= 0.011).When TTP was adjusted for age,menopausal status,Karnofsky performance status score,disal,site of metastasis,number of metastatic sites,and response status after FCCT,extended TTP was still observed for patients in the HT group(hazard ratio:0.63;95% confidence interval:0.44–0.93;P = 0.020).We also observed a trend of overall survival advantage for patients in the HT group vs.patients in the MCT group,but the difference was not significant(43 vs.37 months,P tients in the MCT g= 0.400).In addition,patients in the HT group gen?erally tolerated the treatment well,whereas paroup experienced grades 3–4 adverse events,the most frequent of which were hand?foot syndrome(15.8%) and hematologic abnormalities(7.6%).Conclusion:For HR?positive and HER2?negative MBC patients,HT might be considered a treatment after response to FCCT but prior to MCT as a long?term administration.

Adjuvant Chemotherapy of Gemcitabine plus Carboplatin versus Paclitaxel plus Carboplatin in Patients with Resected Non-Small Cell Lung Cancer

Background: This retrospective study was to evaluate the efficacy and toxicity of gemcitabine plus carboplatin (GC regimen) and paclitaxel plus carboplatin (PC regimen) combination chemotherapy administered as an adjuvant therapy after complete resection of non-small cell lung cancer. Methods: Forty-four patients (GC regimen, n = 29;PC regimen, n = 15) received gemcitabine at a dose of 1000 mg/m2 on days 1 and 8, and carboplatin with the target dose of area under the curve (AUC) of 4 on day 8 every 28 days and paclitaxel at a dose of 70 mg/m2 on days 1, 8 and 15, and carboplatin with the target dose of AUC of 5 on day 1 every 28 days. Results: A total of 130 cycles of the treatment were administered (averaged, 3.1 in GC arm and 2.7 cycles in PC arm). Forty-three patients (97.7%) completed the scheduled cycles. One patient (2.3%) was discontinued due to grade 4 pneumonia. The dose was reduced in 2 patients (4.5%) due to grade 4 thrombocytopenia. Grade 3/4 neutropenia was significantly observed in the PC group (GC: 12/29, 41.4%;PC: 11/15, 73.3%, p = 0.0443). The nonhematological toxicities were mild. Grade 1/2 alanine aminotransferase and aspartate aminotransferase in the GC group was significantly observed higher compared to those of the PC group (GC: 20/29, 69.0%;PC: 4/15, 26.7%, p = 0.0076). Grade 1/2 alopecia was significantly observed in the PC group (GC: 0/25, 0.0%;PC: 13/15, 86.7%, p 0.0001). There was no treatment-related death. The median survival time (MST) of the entire GC group was 784 days, the 3-year overall survival (OS) was 75.9%, and 3-year recurrence-free survival (RFS) was 65.5%. The MST of the entire PC group was 963 days, the 3-year OS was 80.0%, and the 3-year RFS was 60.0%. Conclusion: These results demonstrate that the GC and PC combination chemotherapies are efficacious and feasible regimens, which should be considered as one of the standard therapies for adjuvant therapy.

Discussion on gemcitabine combined with targeted drugs in the treatment of pancreatic cancer

Pancreatic cancer is a malignant tumor with poor prognosis.The treatment of pancreatic cancer depends on the tumor stage and type,and includes local treatment(surgery,radiotherapy and ablation intervention)and systemic therapy(chemotherapy,targeted therapy and immunotherapy).We read with great interest the review“Effective combinations of anti-cancer and targeted drugs for pancreatic cancer treatment”published on World J Gastroenterol and intended to share some of our perspectives in pancreatic cancer treatment.This review presents the therapeutic effects of the combination of gemcitabine and targeted drugs,which gives us a deeper insight into the combination treatments for pancreatic cancer.

NIR-IIb-triggered photodynamic therapy combined with chemotherapy platform based on rare-earth-doped nanoparticles

Photodynamic therapy(PDT),with high spatiotemporal selectivity,minimal side effects and less drug resistance,has emerged as a promising approach for the treatment of cancer.However,inadequate penetration depth and poor efficacy seriously restrict its practical application.To address these challenges,we developed a combined therapy platform(RENP@C/D-FA)based on rare-earth-doped nanoparticles(RENPs)with a structure of NaErF_(4):Tm(0.5%)@NaYF_(4),on which photosensitizer Ce6(chlorin e6)and chemo-therapeutic drug(DOX)(doxorubicin)were loaded by encapsulating with an amphiphilic polymer distearoyl phosphatidylethanolamine-polyethylene glycol-folic acid(DSPE-PEG-FA).RENPs with NaErF_(4) as the matrix possess multiple excitation/emission peaks,enabling activation of PDT under near-infrared-Ⅱb(NIR-Ⅱb,1500-1700 nm)excitation and luminescence imaging in NIR-Ⅱb region by absorbing 808 nm near-infrared photons.Furthermore,DOX can be selectively released in the acidic microenvironment of tumors.Benefiting from the tumor targeting capability of folic acid,this platform can successfully ablate tumor cells and inhibit tumor growth by combining PDT and chemotherapy.This innovative approach holds great promise as a powerful tool for cancer treatment,showing the potential to revolutionize PDT.

Immuno-Chemotherapy Using Repeated Vaccine Treatment Can Produce Successful Clinical Responses in Advanced Metastatic Melanoma

Advanced Stage IV and IIIc melanoma has a dismal survival, with or without, standard chemotherapy. New therapies are required to improve survival and reduce morbidity. Repeated vaccine dosing does not appear to have been explored, so Vaccinia Melanoma Cell Lysate (VMCL) vaccine repetitive therapy was tested, either alone, or combined with chemotherapy. 37 patients (31 Stage IV [M1a(6), b(7), c(18)] and 6 Stage IIIc) were studied using intra-dermal VMCL vaccine therapy. If disease progressed, vaccine was continued with standard chemotherapy (DTIC and/or Fotemustine). Overall survival was assessed and clinical responses were also recorded. From vaccine commencement, median overall follow-up was 10 months. Survivals ranged from 4 to 73 months. Median (mean) overall survival was 10 (23.5) months;overall survival at 1, 2 and 3 years was 40.5%, 21.6% and 10.8% respectively. CR and PR occurred in 18.9% (7) and 18.9% (7) of patients;these were durable for up to 6.1 years in 4 patients. Stable disease was noted in a further 17 patients (45.9%). In 6 patients (16.2%) no response to therapy was apparent. Repeated vaccinations with or without chemotherapy produced strong, durable clinical responses with overall survival > 23 months occurring in nearly 25% of advanced melanoma patients. The overall disease control rate (CR, PR and SD) was 83.7%, including CR in very advanced cases. These results, in a largely unselected population of advanced metastatic melanoma patients, compare very favourably with other regimens, and notably were associated with minimal, if any, toxicity. Further analysis of this approach appears warranted.

Advanced hepatocellular carcinoma treatment strategies:Are transarterial approaches leading the way?

Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a promising modality for treating advanced HCC,particularly in Asian clinical practice,its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials.This editorial reviews and comments on the meta-analysis conducted by Zhou et al,which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC.The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments,such as sorafenib and transarterial chemoembolization(TACE).In this work,HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination.HAIC in combination with lenvatinib,ablation,programmed cell death 1 inhibitors,and radiotherapy further enhanced patient outcomes,indicating a synergistic effect.This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC.It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.

Radiofrequency deep hyperthermia combined with chemotherapy in the treatment of advanced non-small cell lung cancer

Background:In the era of precision medicine,chemotherapy is still considered the cornerstone of treatment for lung cancer patients without gene mutations.How to reduce the toxicity and increase the efficiency of chemotherapy is worth exploring.This study aimed to investigate the curative effects and safety of hyperthermia combined with chemotherapy(HCT)for advanced patients with non-small cell lung cancer(NSCLC),especially those with malignant pleural effusion.Methods:We retrospectively evaluated medical records of 93 patients with advanced NSCLC(stage IIIB-IV)from March 2011 to January 2014.The patients were divided into HCT and chemotherapy(CT)groups.The HCT group was treated with gemcitabine and cisplatin(GP)regimen combined with regional radiofrequency deep hyperthermia,while the CT group was treated with GP regimen only.Those with malignant pleural effusion extra underwent thoracentesis and intrapleural injection chemotherapy combined with hyperthermic or not.Clinical treatment results and adverse reactions were compared and analyzed after treatment.SPSS 19.0 software(SPSS Inc.,USA)was used for statistical data processing.P values less than 0.05 were accepted to be statistically significant.Results:Among the 93 patients,HCT group included 48 patients(16 patients with malignant pleural effusion),CT group included 45 patients(10 patients with malignant pleural effusion).There was no significant difference between the two groups in patient characteristics.The overall response rate(ORR)of pleural effusions was much better in HCT group than that in CT group(81.2%vs.40.0%,P=0.046).The patients in HCT group had lower incidence rate of weakness(12.5%us.46.7%,χ^2=13.16,P<0.001)and gastrointestinal(25.0%vs.77.8%,χ^2=25.88,P<0.001)adverse reactions than that in CT group.The objective tumor response and survival showed no significant differences.Conclusions:Hyperthermia combined with chemotherapy might lead to the development of better therapeutic strategy for advanced NSCLC with malignant pleural effusion patients.Also,it could greatly reduce the chemotherapy toxic effects in the incidence of weakness and gastrointestinal adverse reactions in advanced NSCLC patients.

Tracing and targeting cancer stem cells:New venture for personalized molecular cancer therapy

Tumors consist of a mixture of heterogeneous cell types. Cancer stem cells(CSCs) are a minor sub-population within the bulk cancer fraction which has been foundto reconstitute and propagate the disease and to be frequently resistant to chemotherapy, irradiation, cytotoxic drugs and probably also against immune attack. CSCs are considered as the seeds of tumor recurrence, driving force of tumorigenesis and metastases. This underlines the urgent need for innovative methods to identify and target CSCs. However, the role and existence of CSCs in therapy resistance and cancer recurrence remains a topic of intense debate. The underlying biological properties of the tumor stem cells are extremely dependent on numerous signals, and the targeted inhibition of these stem cell signaling pathways is one of the promising approaches of the new antitumor therapy approaches. This perspective review article summarizes the novel methods of tracing CSCs and discusses the hallmarks of CSC identification influenced by the microenvironment or by having imperfect detection markers. In addition, explains the known molecular mechanisms of therapy resistance in CSCs as reliable and clinically predictive markers that could enable the use of new targeted antitumor therapy in the sense of personalized medicine.

Radiotherapy for Carcinoma of the Esophagus: Progress of Treatment and Research in China

Carcinoma of the esophagus is a common malignancy in China. Radiotherapy is one of the most important modalities of treatment. This article provides a review of the natural history of this disease, the results of radiotherapy for esophageal cancer and the recent advances in radiation techniques in China. Significant progress has been made in this area of research and treatment. Combined treatment modalities and new therapies are being evaluated and may be expected to contribute to improved patient outcomes and better palliation of symptoms in the future.

弥漫内生型脑桥胶质瘤放化疗及靶向治疗单中心研究

目的探索弥漫内生型脑桥胶质瘤(DIPG)的有效治疗方法及生存影响因素。方法回顾分析2021年4月至2024年1月首都医科大学附属北京天坛医院采用放射治疗联合替莫唑胺和尼妥珠单抗化疗或放射治疗联合ACT001化疗的14例儿童DIPG患者的临床和影像学信息及生存资料,采用Kaplan⁃Meier生存曲线计算中位无进展生存期和总生存期,多变量Cox比例风险回归分析各项因素对无进展生存期和总生存期的影响。结果共14例患儿的客观缓解率为10/14,中位无进展生存期7.83个月,中位总生存期8.30个月。基线影像学无强化是无进展生存期延长的保护因素(RR=0.052,95%CI:0.006~0.416;P=0.005);男性(RR=0.085,95%CI:0.009~0.764;P=0.028)、年龄较大(RR=0.631,95%CI:0.423~0.942;P=0.024)、无脑神经受累表现(RR=0.116,95%CI:0.017~0.781;P=0.027)和基线影像学无强化(RR=0.046,95%CI:0.005~0.413;P=0.006)是总生存期延长的保护因素。结论女性、诊断时年龄较小、发病时脑神经受累、基线影像学强化是影响DIPG患儿生存的危险因素。

儿童胶质瘤诊断与治疗要点及进展

儿童胶质瘤异质性突出,具有独特的分子病理学特征,并非成人胶质瘤的“缩小版”。本文强调儿童胶质瘤手术治疗、放射治疗和药物化疗的基本要点,介绍其与成人胶质瘤靶向治疗的异同,阐述儿童胶质瘤涉及的重要驱动基因异常及其对应的靶向治疗策略,重点描述组蛋白H3突变致儿童弥漫性高级别胶质瘤的表观遗传学治疗策略,并展望儿童胶质瘤诊断与治疗的未来工作。

HAIC联合仑伐替尼和PD-1抗体对比HAIC联合仑伐替尼转化治疗肝细胞癌的回顾性研究

目的回顾性分析65例中晚期肝细胞癌患者分别使用HAIC联合仑伐替尼和PD-1抗体与HAIC联合仑伐替尼转化切除的疗效及预后。方法回顾性收集中山市人民医院自2020年3月至2023年3月期间获得成功转化切除的65例肝细胞癌患者,根据治疗方案不同分为联合组(HAIC联合仑伐替尼和PD-1抗体)和对照组(HAIC联合仑伐替尼),对两组患者的总生存期(OS)、无疾病进展生存期(PFS)、治疗相关的不良反应进行统计分析。结果65例肝细胞癌患者根据RECIST 1.1和mRECIST标准分别评估治疗,mRECIST标准,联合组PR 29例(74.4%),ORR 35例(89.7%),DCR 37例(94.9%);对照组,PR 9例(74.4%),ORR 17例(65.4%),DCR 24例(92.3%);总体中位生存时间约36个月,总体中位无复发生存期约28个月。其中联合组患者的中位生存时间为40个月,中位无复发生存期为32个月。对照组患者的中位生存时间为29个月、中位无复发生存期为25个月。联合组的PR、ORR、PR、OS、RFS均明显高于对照组(P<0.005)。结论HAIC联合仑伐替尼和PD-1抗体可为中晚期HCC患者带来更显著的生存优势,有效延长其生存期,改善其生存质量。

DNA损伤与肿瘤免疫治疗的联合策略——现状与展望

免疫治疗,尤其是免疫检查点抑制,已成为癌症治疗的重要手段。然而,大多数癌症中仅有少数患者对免疫检查点阻断有反应。随着对肿瘤免疫治疗认识的深入,DNA损伤与修复机制在肿瘤免疫逃逸中的作用愈发显著。基因组不稳定性和DNA损伤应答的缺陷,尤其是在放射治疗和化学治疗的背景下,能够增强免疫检查点阻断的疗效。尽管研究已取得积极进展,但如何精准地调控DNA损伤应答以及优化联合治疗策略,提高疗效和减少毒副作用,仍是未来研究的重点。本文详细讨论放射治疗和化学治疗等传统基因毒性治疗与免疫检查点阻断联合治疗策略的免疫调节机制,探讨干扰素基因刺激因子激动剂和DNA损伤应答抑制剂在联合治疗中的潜力,还提出基于DNA损伤应答靶向抑制与免疫治疗联合应用的新策略,强调了结合传统治疗和新型免疫调节策略以及开发生物标志物的重要性。

儿童型低级别胶质瘤药物化疗及靶向治疗进展

儿童型低级别胶质瘤是儿童最常见的中枢神经系统肿瘤,大多数呈非侵袭性,预后较好。手术全切除是重要的预后影响因素,可达到长期生存。然而对于位于脑干、视觉传导通路等脑深部结构的肿瘤,无法手术全切除,药物化疗是临床症状恶化或影像学进展时的首选辅助治疗方法;近年除传统药物化疗外,靶向治疗药物的研发和应用也取得显著进展。本文综述儿童型低级别胶质瘤药物化疗及靶向治疗进展及所面临的挑战,以指导临床实践。

经肝动脉灌注化疗或化疗栓塞术联合酪氨酸激酶抑制剂及卡瑞利珠单抗治疗不可切除肝细胞癌的对比研究

目的探索经导管动脉化疗栓塞(transarterial chemoembolization,TACE)及肝动脉灌注化疗(hepatic artery infusionchemotherapy,HAIC)联合酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKI)及免疫检查点抑制剂(immune checkpoint inhibitors,ICI)治疗中晚期肝细胞癌(HCC)的疗效及安全性。方法纳入2021年1月至2022年10月哈尔滨医科大学附属肿瘤医院HCC患者101例,其中50例患者接受TACE+TKI+ICI治疗,51例患者接受HAIC+TKI+ICI治疗。比较两组的OS、PFS,并对不良事件进行分析以评估方案的安全性。结果TACE+TKI+ICI组中位PFS为12.0个月,HAIC+TKI+ICI组为11.0个月(P=0.030)。TACE+TKI+ICI组中位OS未达到,HAIC+TKI+ICI组为14.6个月(P=0.005)。TACE+TKI+ICI组最常见的不良反应是总胆红素升高(46.0%)及肝功能损伤(26.0%),HAIC+TKI+ICI组则为白蛋白降低(62.7%)、乏力(39.2%)及胃肠道反应(31.4%)。结论TACE+TKI+ICI方案有着更佳的远期生存获益,而HAIC+TKI+ICI方案能更好地维持患者的肝功能储备,两种方案均未出现意外的毒性反应,安全性较高。