Gene targeted and immune therapies for nodal and gastrointestinal follicular lymphomas

Follicular lymphoma(FL)is the most common indolent B-cell lymphoma(BCL)globally.Recently,its incidence has increased in Europe,the United States,and Asia,with the number of gastrointestinal FL cases expected to increase.Genetic abnormalities related to t(14;18)translocation,BCL2 overexpression,NF-κB pathway-related factors,histone acetylases,and histone methyltransferases cause FL and enhance its proliferation.Meanwhile,microRNAs are commonly used in diagnosing FL and predicting patient prognosis.Many clinical trials on novel therapeutics targeting these genetic abnormalities and immunomodulatory mechanisms have been conducted,resulting in a marked improvement in therapeutic outcomes for FL.Although developing these innovative therapeutic agents targeting specific genetic mutations and immune pathways has provided hope for curative options,FL treatment has become more complex,requiring combinatorial therapeutic regimens.However,optimal treatment combinations have not yet been achieved,highlighting the importance of a complete understanding regarding the pathogenesis of gastrointestinal FL.Accordingly,this article reviews key research on the molecular pathogenesis of nodal FL and novel therapies targeting the causative genetic mutations.Moreover,the results of clinical trials are summarized,with a particular focus on treating nodal and gastrointestinal FLs.

Clinical evidence of neoadjuvant immunotherapy for resectable locally advanced esophageal carcinoma:A systematic review

Background:Immune checkpoint inhibitors(ICIs)as the neoadjuvant therapy for resectable locally advanced esophageal carcinoma(rlaEC)remains challenging given the poor reports of efficacy and safety.This study aimed to summarize reliable evidence for the preoperative neoadjuvant immunotherapy of rlaEc by analyzing all the published clinical trials on the ICIs as the neoadjuvant therapy for rlaEC.Methods:PubMed,Cochrane Library,Embase and ClinicalTrials.gov were searched from inception until June 1st,2023,for available reports to perform a meta-analysis.The primary endpoints were RO resection,objective response rate(ORR),pathological complete response(pCR)and major pathological response(MPR),as well as treatment-related adverse events(AEs)and postoperative complications.The Stata 14.0 software was employed to estimate pooled effect size.Results:A total of 18 single-arm clinical trials involving 625 patients met the inclusion criteria.Meta-analysis showed that,among these patients with rlaEC,the pooled R0 resection rate was 97.0%(95%CI:94.0%-99.0%),the p0oled ORR was 70.0%(95%CI:64.0%-76.0%),the p0oled pCR and MPR rate were 34.0%(95%CI:29.0%-39.0%)and 56.0%(95%CI:47.0%-65.0%)respectively.The incidence of main treatment-related AEs and postoperative complications was about 6%-45% and 8%-19% respectively.Conclusions:Patients with rlaEC were tolerated to neoadjuvant immunotherapy and it might be beneficial to improve efficacy.But this meta-analysis had limitations and the conclusions still needed to be validated by more rigorous phase II randomized controlled clinical trials.

Neoadjuvant targeted therapy for apocrine carcinoma of the breast:A case report

BACKGROUND Apocrine carcinoma of the breast is a special type of invasive ductal carcinoma of the breast that is rare in clinical practice.Neoadjuvant therapy,especially neoadjuvant targeted therapy,has rarely been reported for apocrine carcinoma of the breast.CASE SUMMARY A 63-year-old woman presented with apocrine carcinoma of the left breast underwent core needle biopsy.The patient was diagnosed with apocrine carcinoma by immunohistochemical staining and negative hormone status(estrogen receptor and progesterone receptor)but showed overexpression of human epidermal factor receptor 2(HER-2).Moreover,positive expression of androgen receptor(approximately 60%)and gross cystic disease fluid protein 15 was observed.The patient was treated with neoadjuvant targeted therapy consisting of the TCH regimen(docetaxel,carboplatin area under curve 6 and trastuzumab)every 21 d.The mass in the left breast was significantly reduced,and pain in the breast and left upper arm also improved.CONCLUSION HER-2 positive apocrine carcinoma of the breast can be improved by neoadjuvant chemotherapy combined with targeted therapy.

Immunotherapy for esophageal cancer:Where are we now and where can we go

Immune checkpoint inhibitor therapy has dramatically improved patient prognosis,and thereby transformed the treatment in various cancer types including esophageal squamous cell carcinoma(ESCC)in the past decade.Monoclonal antibodies that selectively inhibit programmed cell death-1(PD-1)activity has now become standard of care in the treatment of ESCC in metastatic settings,and has a high expectation to provide clinical benefit during perioperative period.Further,anti-cytotoxic T-lymphocyte–associated protein 4(CTLA-4)monoclonal antibody has also been approved in the treatment of recurrent/metastatic ESCC in combination with anti-PD-1 antibody.Well understanding of the existing evidence of immune-based treatments for ESCC,as well as recent clinical trials on various combinations with chemotherapy for different clinical settings including neoadjuvant,adjuvant,and metastatic diseases,may provide future prospects of ESCC treatment for better patient outcomes.

Immune status and combined immunotherapy progression in Kirsten rat sarcoma viral oncogene homolog(KRAS)-mutant tumors

Kirsten rat sarcoma viral oncogene homolog(KRAS)is the most frequently mutated oncogene,occurring in various tumor types.Despite extensive efforts over the past 40 years to develop inhibitors targeting KRAS mutations,resistance to these inhibitors has eventually emerged.A more precise understanding of KRAS mutations and the mechanism of resistance development is essential for creating novel inhibitors that target specifically KRAS mutations and can delay or overcome resistance.Immunotherapy has developed rapidly in recent years,and in-depth dissection of the tumor immune microenvironment has led researchers to shift their focus to patients with KRAS mutations,finding that immune factors play an essential role in KRAS-mutant(KRAS-Mut)tumor therapy and targeted drug resistance.Breakthroughs and transitions from targeted therapy to immunotherapy have provided new hope for treating refractory patients.Here,we reviewed KRAS mutation-targeted treatment strategies and resistance issues,focusing on our in-depth exploration of the specific immune status of patients with KRAS mutations and the impact of body immunity following KRAS inhibition.We aimed to guide innovative approaches combining RAS inhibition with immunotherapy,review advances in preclinical and clinical stages,and discuss challenges and future directions.

Approaches and challenges in cancer immunotherapy pathways

Cancer immunotherapy is an effective with critical approaches in the treatment of oncological patients.Whilst numerous research and clinical trials are underway to develop endogenous immunotherapy approaches,it is necessary to focus on fundamental issues and identify barriers to basic clinical progress.Addressing these challenges and the new pathways will require researchers and clinicians to join forces to accelerate the understanding of the complex interactions between cancer and the immune system and focus resources on developing better treatments for patients.

Clinical challenges in neoadjuvant immunotherapy for non-small cell lung cancer

Immune checkpoint inhibitors(ICIs),a type of immunotherapy,have become one of the most important therapeutic options for first-and second-line treatment of advanced non-small cell lung cancer(NSCLC).Recent clinical studies have shown that immunotherapy can offer substantial survival benefits to patients with early-stage or resectable advanced NSCLC.However,considering the importance of timing when using ICIs and their associated adverse events(AEs),the advantages and disadvantages of using these agents need to be weighed carefully when deciding the use of a combined treatment.In addition,the inconsistency between imaging assessment and pathological results poses further challenges to the evaluation of efficacy of neoadjuvant immunotherapy.It is also important to develop new methodologies and discover suitable biomarkers that can be used to evaluate survival outcomes of immunotherapy and identify patients who would benefit the most from this treatment.In this review,we aimed to summarize previous results of ongoing clinical trials on neoadjuvant immunotherapy for lung cancer and discuss the challenges and future perspectives of this therapeutic approach in the treatment of resectable NSCLC.

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.

Neoadjuvant chemotherapy for metastatic colorectal cancer to the liver: from chemotherapy to targeting therapy

Despite the advances in surgical techniques, adjuvant chemotherapy and targeted therapy, approximately 40%-70% of patients with progressive colorectal cancer will develop liver metastases, of whom one-third are found at the time of diagnosis.[1] Surgical resection is now the standard treatment and also the only potentially curative treatment for resectable lesions.

Effects of the number of neoadjuvant therapy cycles on clinical outcomes, safety, and survival in patients with metastatic colorectal cancer undergoing metastasectomy

The controversial outcomes in patients with metastatic colorectal cancer(mCRC)highlight the need for developing effective systemic neoadjuvant treatment strategies to improve clinical results.The optimal treatment cycles in patients with mCRC for metastasectomy remain undefined.This retrospective study compared the efficacy,safety,and survival of cycles of neoadjuvant chemotherapy/targeted therapy for such patients.Sixty-four patients with mCRC who received neoadjuvant chemotherapy/targeted therapy following metastasectomy were enrolled between January 2018 and April 2022.Twenty-eight patients received 6 cycles of chemotherapy/targeted therapy,whereas 36 patients received≥7 cycles(median,13;range,7–20).Clinical outcomes,including response,progression-free survival(PFS),overall survival(OS),and adverse events,were compared between these two groups.Of the 64 patients,47(73.4%)were included in the response group,and 17(26.6%)were included in the nonresponse group.The analysis revealed chemotherapy/targeted therapy cycle and pretreatment serum carcinoembryonic antigen(CEA)level as independent predictors of the response as well as overall survival and chemotherapy/targeted therapy cycle as an independent predictor of progression(all p<0.05).Furthermore,our results revealed shorter operation time,lower estimated operative blood loss,higher response rate,lower progression rate,and higher survival rate in≥7 cycles of chemotherapy/targeted therapy group(all p<0.05),but no statistical differences in adverse events were observed between the two groups(all p>0.05).The median OS and PFS were 48 months(95%CI,40.855–55.145)and 28 months(95%CI,18.952–37.48)in the≥7-cycle group and 24 months(95%CI,22.038–25.962)and 13 months(95%CI,11.674–14.326)in the 6-cycle group,respectively(both p<0.001).The oncological outcomes in the≥7-cycle group were significantly better than those in the 6-cycle group,without significant increases in adverse events.However,prospective randomized trials are mandatory to confirm the potential advantages of cycle numbers of neoadjuvant chemotherapy/targeted therapy.

Advances in targeted therapies for gastric cancer:a mini-review

The incidence of gastric cancer ranks 4th in malignant tumors,and the mortality rate ranks 3rd in malignant tumors.Most patients with gastric cancer are already at the advanced stage when diagnosed.Although chemotherapy is the main treatment for patients with advanced gastric cancer,it can extend the overall survival.But adverse reactions are more prominent.With the rise of targeted therapy,the molecular mechanism of gastric cancer occurrence and development continues to develop,and molecular targeted therapy of gastric cancer has gradually emerged.The current targets for gastric cancer mainly include endothelial growth factor receptor,HER2,vascular endothelium growth factor,vascular endothelium growth factor receptor,mammalian rapamycin receptor,hepatocellular growth factor,et al.,but the clinical efficacy is still not satisfactory.At present,most of the studies on molecular targeted drugs for gastric cancer have ended in failure.The heterogeneity between patients and the prognosis of tumors in different parts may be different.It is suggested that screening targeted drugs according to the patient's pathological characteristics and molecular typing,and individualized treatment is the inevitable way of targeted treatment of gastric cancer.

Recent advances in targeted therapy for ovarian cancer

The global burden of ovarian cancer is gradually increasing while patients still suffer from relatively limited treatment options.With recent advances in the decoding of the molecular landscape of ovarian cancer,more options in targeted strategy were offered and can therefore be tailored in different clinical settings for individual patient.Targeting of the abnormal angiogenesis process is the first significant clinical breakthrough which revolutionized the treatment of advanced ovarian cancer,followed by the advent of poly-(ADP)-ribose polymerase(PARP)inhibitors.These two strategies represented by bevacizumab and olaparib respectively underwent tests of numerous clinical trials.In recent years,immune checkpoint inhibitors(ICIs)have been incorporated into the blueprint of ovarian cancer treatment though the effectiveness still left much to be desired.Herein,we systematically outlined recent advances in targeted therapy for ovarian cancer and summarized the landmark clinical trials for each targeted therapy including angiogenesis inhibitors,PARP inhibitors and ICIs.

HIF-1α signaling: Essential roles in tumorigenesis and implications in targeted therapies

The hypoxic microenvironment is an essential characteristic of most malignant tu-mors.Notably,hypoxia-inducible factor-1 alpha(HIF-1a)is a key regulatory factor of cellular adaptation to hypoxia,and many critical pathways are correlated with the biological activity of organisms via HIF-1a.In the intra-tumoral hypoxic environment,HIF-1αis highly expressed and contributes to the malignant progression of tumors,which in turn results in a poor prog-nosis in patients.Recently,it has been indicated that HiF-1αinvolves in various critical pro-cesses of life events and tumor development via regulating the expression of HiF-1a target genes,such as cell proliferation and apoptosis,angiogenesis,glucose metabolism,immune response,therapeutic resistance,etc.Apart from solid tumors,accumulating evidence has re-vealed that HiF-1αis also closely associated with the development and progression of hemato-logical malignancies,such as leukemia,lymphoma,and multiple myeloma.Targeted inhibition of HiF-1a can facilitate an increased sensitivity of patients with malignancies to relevant ther-apeutic agents.In the review,we elaborated on the basic structure and biological functions of HIF-1a and summarized their current role in various malignancies.It is expected that they will have future potential fortargeted therapy.

Neoadjuvant treatment of esophageal cancer

The management of esophageal cancer has been evolving over the past 30 years. In the United States, multimodality treatment combining chemotherapy and radiotherapy (RT) prior to surgical resection has come to be accepted by many as the standard of care, although debate about its overall effect on survival still exists, and rightfully so. Despite recent improvements in detection and treatment, the overall survival of patients with esophageal cancer remains lower than most solid tumors, which highlights why further advances are so desperately needed. The aim of this article is to provide a complete review of the history of esophageal cancer treatment with the addition of chemotherapy, RT, and more recently, targeted agents to the surgical management of resectable disease.

Targeted therapies for lupus nephritis:Current perspectives and future directions

Lupus nephritis(LN),a severe manifestation of systemic lupus erythematosus,poses a substantial risk of progression to end-stage renal disease,with increased mortality.Conventional therapy for LN relies on broad-spectrum immunosuppressants such as glucocorticoids,mycophenolate mofetil,and calcineurin inhibitors.Although therapeutic regimens have evolved over the years,they have inherent limitations,including non-specific targeting,substantial adverse effects,high relapse rates,and prolonged maintenance and remission courses.These drawbacks underscore the need for targeted therapeutic strategies for LN.Recent advancements in our understanding of LN pathogenesis have led to the identification of novel therapeutic targets and the emergence of biological agents and small-molecule inhibitors with improved specificity and reduced toxicity.This review provides an overview of the current evidence on targeted therapies for LN,elucidates the biological mechanisms of responses and failure,highlights the challenges ahead,and outlines strategies for subsequent clinical trials and integrated immunomodulatory approaches.

Platelet-based bioactive systems guided precision targeting and immune regulation for cancer therapy

The antitumor effects of conventional drug carriers are often attenuated and limited in application by biological barriers associated with tumor heterogeneity and resistance brought about by low tumor immunogenicity.With the rapid development of nanotechnology,naturally derived bioactive materials,and live cell carriers,a promising strategy emerges for targeting the tumor microenvironment(TME)for precision cancer therapy.The unique injury-targeting properties of platelets can significantly extend functional activity,which cannot be achieved with conventional nanocarriers.In this review,three strategies based on platelet-engineered materials are systematically described,namely nanoparticles for platelet membrane camouflage,engineered activated platelets,and targeted-platelets nanosystems.Platelet-based nanomaterials can effectively coordinate local and distant tumor-host crosstalk with controlled active tumor site recognition and killing effects due to the presence of specific membrane proteins on the surface and the self-secretion of a large number of particles.Further advances in platelets for effectively overcoming biological barriers and reducing immune resistance in cancer immunotherapy applications will be discussed in future clinical practice.This review provides an overview of recent research advances in platelet-based bioactive material-directed immunotherapy and chemotherapy to inform future antitumor combination therapies.

Research status on immunotherapy trials of gastric cancer

The breakthrough of immune checkpoint inhibitor(ICI)therapy has created extensive opportunities for cancer immunotherapy.Especially,the block of programmed death-1/programmed death ligand 1(PD-L1)axis using ICIs has become a new therapeutic strategy to treat advanced gastric cancer(GC).However,in the past decade,single-arm and randomized trials for single-drug ICI therapy showed that the therapeutic effect was not satisfactory,including clinical trials for advanced GC.However,after selecting suitable predictive biomarkers and developing a combination of anti-angiogenic targeted drugs and other chemotherapeutic drugs,the objective response rate and progression-free survival of patients with gastric cancer were improved significantly.The United States Food and Drug Administration has approved treatment with pembrolizumab for patients with advanced GC with PD-L1 expression or microsatellite instabilityhigh/mismatch repair deficiency.In this review,the updated data from the latest trial results of combination immunotherapy for GC are presented.Based on the outcome of combination therapy,we discuss its possible molecular mechanism and summarize effective predictive biomarkers.We also discuss possible problems stemming from results of other clinical trials of ICI treatment and propose other directions for ICI therapy.

Role of chemokines in the hepatocellular carcinoma microenvironment and their translational value in immunotherapy

The difficulty of early diagnosis,high tumor heterogeneity,and high recurrence and metastasis rates lead to an unsatisfactory treatment status for hepatocellular carcinoma(HCC).HCC is a typical inflammation-driven tumor.Chronic inflammation allows nascent tumors to escape immunosurveillance.Chemokines are small,soluble,secreted proteins that can regulate the activation and trafficking of immune cells during inflammation.Several studies have shown that various chemokines with overarching functions disrupt the immune microenvironment during the initiation and progression of HCC.The dysregulated chemokine network in HCC contributes to multiple malignant processes,including angiogenesis,tumor proliferation,migration,invasion,tumor low response,and resistance to immune therapy.Here,we summarize the current studies focusing on the role of chemokines and their receptors in the HCC immune microenvironment,highlighting potential translational therapeutic uses for modulating the chemokine system in HCC.

Mn-based cGAS-STING activation for tumor therapy

Immunotherapy has efficiently revolutionized the treatment of human neoplastic diseases.However,the overall responsive rate of current immunotherapy is still unsatisfactory,benefiting only a small proportion of patients.Therefore,significant attention has been paid to the modulation of tumor microenvironment(TME)for the enhancement of immunotherapy.Interestingly,recent studies have shown that cyclic GMP-AMP synthasestimulator of interferon gene(cGAS-STING)was initially found as an innate immune sensor to recognize cytoplasmic DNA(such as bacterial,viral,micronuclei,and mitochondrial).It is a promising signaling pathway to activate antitumor immune responses via type I interferon production.Notably,Mn^(2+)was found to be a critical molecule to sensitize the activation of the cGAS-STING pathway for better immunotherapy.This activation led to the development of Mn^(2+)-based strategies for tumor immunotherapy via the activation of the cGAS-STING pathway.In this critical review,we aimed to summarize the recent progress of this field,focusing on the following three aspects.First,we briefly introduced the signaling pathway of cGAS-STING activation,and its regulation effect on the antitumor immunity cycle has been discussed.Along with this,several agonists of the cGAS-STING pathway were introduced with their potential as immunotherapeutic drugs.Then,the basic biological functions of Mn^(2+)have been illustrated,focusing on its critical roles in the cGAS-STING pathway activation.Next,we systematically reviewed the Mn^(2+)-based strategies for tumor immunotherapy,which can be classified by the methods based on Mn^(2+)alone or Mn^(2+)combined with other therapeutic modalities.We finally speculated the future perspectives of the field and provided rational suggestions to develop better Mn^(2+)-based therapeutics.

联合抗血管生成、免疫检查点抑制剂与化疗在局部进展期胃癌新辅助治疗中的临床意义

联合抗血管生成、免疫检查点抑制剂(ICIs)与化疗(靶-免-化)方案在胃癌的综合治疗中已取得初步成效。实验研究表明,在肿瘤免疫治疗的各种决定因素中,肿瘤微环境(TME)影响ICIs疗效至关重要。导致免疫抑制性TME生物学机制是多因素且十分复杂,但其中较明确和重要的机制之一是肿瘤异常新血管生成的影响。使用小剂量靶向肿瘤血管生成药物(抗VEGF/VEGFR单抗等)有望促使肿瘤血管正常化,逆转免疫抑制性TME为免疫支持性TME,以更好地发挥ICI与化疗药物的协同、互补与增效抗肿瘤作用。对局部进展期胃癌(LAGC)病人开展积极的围术期综合治疗,已成为胃癌外科综合治疗中不可或缺的重要手段。近年来,临床上联合抗血管生成、免疫检查点抑制剂与化疗(靶-免-化)方案应用在LAGC围术期治疗上,初步疗效[病理完全缓解(pCR)、主要病理缓解(MPR)、肿瘤退缩分级(TRG)与治疗相关不良事件(TRAEs)等]显示出令人鼓舞的结果。本文复习有关临床研究结果,作汇总与分析。