Pharmacological methods for ovarian function and fertility preservation in women with cancer:A literature review

Oncofertility is an extremely significant topic that is increasingly being discussed owing to increased evidence indicating that fertility preservation does not affect the treatment outcomes of patients with cancer but significantly contributes to preserving life quality.The effect of chemotherapy can range from minimal effects to complete ovarian atrophy.Limited data are available on the effects of monoclonal antibodies and targeted therapies on the ovaries and fertility.Temporary ovarian suppression by administering a gonadotropin-releasing hormone agonist(GnRHa)during chemotherapy decreases the gonadotoxic effect of chemotherapy,thereby diminishing the chance of developing premature ovarian insufficiency(POI).At present,the concomitant administration of GnRH analogs during chemotherapy is the only accepted pharmacological method for preserving ovarian function.Notably,most randomized studies on the effectiveness of luteinizing hormone-releasing hormone agonists during chemotherapy in preventing POI have been conducted in women with breast cancer,with a considerably small number of studies on patients with hematological malignancies.Furthermore,most randomized controlled trials on breast cancer have revealed a decrease in treatment-induced POI risk,regardless of the hormone receptor status.In addition,studies on hematological malignancies have yielded negative results;nevertheless,thefindings must be interpreted with caution owing to numerous limitations.Current guidelines from the American Society of Clinical Oncology and ESMO Clinical Practice Guidelines recommend sperm,oocyte,and embryo cryopreservation as a standard practice and only offering GnRHa to patients when proven fertility preservation methods are not feasible.In this manuscript,we present a comprehensive literature overview on the application of ovarian suppression with GnRHa during chemotherapy in patients with cancer by addressing preclinical and clinical data,as well as future perspectives in thisfield that upcoming research should focus on.

Immunotherapy:A new standard in the treatment of metastatic clear cell renal cell carcinoma

Renal cell cancer(RCC)represents 2%-3% of all adulthood cancers and is the most common malignant neoplasm of the kidney(90%).In the mid-nineties of the last century,the standard of treatment for patients with metastatic RCC was cytokines.Sunititib and pazopanib were registered in 2007 and 2009,respectively,and have since been the standard first-line treatment for metastatic clear cell RCC(mccRCC).Renal cell cancer is a highly immunogenic tumor with tumor infiltrating cells,including CD8+T lymphocytes,dendritic cells,natural killer cells(NK)and macrophages.This observation led to the design of new clinical trials in which patients were treated with immunotherapy.With the growing evidence that proangiogenic factors can have immunomodulatory effects on the host’s immune system,the idea of combining angiogenic drugs with immunotherapy has emerged,and new clinical trials have been designed.In the last few years,several therapeutic options have been approved[immunotherapy and immunotherapy/tyrosine kinase inhibitors(TKI)]for the first-line treatment of mccRCC.Nivolumab/ipilimumab is approved for the treatment of patients with intermediate and poor prognoses.Several checkpoint inhibitors(pembrolizumab,nivolumab,avelumab)in combination with TKI(axitinib,lenvatinib,cabozantinib)are approved for the treatment of patients regardless of their International mRCC Database Consortium prognostic group and PD-L1 expression.There is no specific and ideal biomarker that could help in selecting the ideal patient for the appropriate first-line treatment.

High dose chemotherapy with stem cell support in the treatment of testicular cancer

Testicular germ cell cancer(TGCC) is rare form of malignant disease that occurs mostly in young man between age 15 and 40. The worldwide incidence of TGCC is 1.5 per 100000 man with the highest rates in North Europe. After discovery of cisplatin cure rates of TGCC are very favorable between 90%-95% and unlike most solid tumors, cure rate for metastatic TGCC is around 80%. Metastatic TGCC is usually treated with 3-4 cycles of bleomycin, etoposide, cisplatinum chemotherapy with or without retroperitoneal surgery and cure rates with this approach are between 41% in poor risk group and 92% in good risk group of patients. Cure rates are lower in relapsed and refractory patients and many of them will die from the disease if not cured with first line chemotherapy. High dose chemotherapy(HDCT) approach was used for the first time during the 1980 s. Progress in hematology allowed the possibility to keep autologous haematopoietic stem cells alive ex-vivo at very low temperatures and use them to repopulate the bone marrow after sub-lethal dose of intesive myeloablative chemotherapy. Despite the fact that there is no positive randomized study to prove HDCT concept, cure rates in relapsed TGCC are higher after high dose therapy then in historical controls in studies with conventional treatment. Here we review clinical studies in HDCT for TGCC, possibilities of mobilising sufficient number of stem cells and future directions in the treatment of this disease.

Adaptability of language-related brain network in a low-grade glioma patient

Because functional magnetic resonance imaging can be used for dynamic observation of functional cortical changes after brain injuries, we followed up functional magnetic resonance imaging manifestations of a language-related brain network in a low-grade glioma patient. Disease progression and therapy during a 3-year period were followed up at different time points： before and after reoperation, after radiation therapy, and 1 year after irradiation. During the whole 3-year follow-up period, the patient exhibited no neurological deficits while functional magnetic resonance imaging revealed different topologies of the language-related brain network. During disease progression and after irradiation, the language-related brain network was extended or completely transferred to the nondominant （right） hemisphere. In addition, after reoperation and 1 year after irradiation, language areas were primarily found in the language dominant （left） hemisphere. Our results suggest a high level of adaptability of the language-related cortical network of the bilateral hemispheres in this low-grade glioma patient.

Immunotherapy in the treatment of lymphoma

Relapsed or refractory non-Hodgkin’s lymphomas,especially diffuse large B-cell lymphoma as well as relapsed or refractory Hodgkin lymphomas are hard-to-treat diseases.Patients who do not respond to initial therapy or experience relapse are treated with salvage regimens,and if eligible for aggressive therapy,treatment is continued with high-dose chemotherapy and autologous stem cell transplantation.Current therapy options can cure substantial numbers of patients,however for some it is still an uncurable disease.Numerous new drugs and cell therapies are being investigated for the treatment of relapsed or refractory lymphomas.Different types of immunotherapy options have shown promising results,and some have already become the standard of care.Here,we review immunotherapy options for the treatment of lymphoma and discuss the results,positions,practical aspects,and future directions of different drugs and cellular therapies for the treatment of this disease.

Trichoblastic Fibroma of the Skin Mimicking Primary or Secondary Breast Cancer

We report a case of a 71 -year- old female with trichoblastic fibroma, a rare benign tumor of the skin, found in the left breast, associated with an invasive contralateral breast cancer. On clinical examination, a solitary, firm nodule was found in the subcutaneous tissue of the left breast with no changes in the overlying skin. Radiological examination showed disconcordant results. Conventional mammography and ultrasound suggested benign nature, while magnetic resonance mammography and spectroscopy raised the presumption of the malignant nature of the lesion. After performing excisional biopsy, the diagnosis of trichoblastic fibroma was established. Microscopically, it was composed of fibrous stroma, basaloid germs and strands and lace-like epithelial components, with no obvious connection with overlying epithelium or adjacent adnexal structures.

IS There A Role of 18F-FDG PET/CT for Initial Staging of Rectal Cancer？

Background： The management of the rectal cancer requires accurate initial staging. Besides routinely performed conventional imaging, during the last decade 18F-FDG PET/CT became a popular whole-body metabolic imaging for preoperative TNM classification. The purpose of the study was to evaluate the role of 18F-FDG PET/CT in the rectal cancer staging. Patients and methods： 45 patients with rectal cancer who preoperatively underwent 18F-FDG PET/CT imaging in the period from 2011 to 2014 were analyzed. All patients were referred to the surgery afterwards. Histopathologic findings were used as a standard of reference. Descriptive techniques were used for frequency analyses and sensitivity calculations. The X2 test was used for significance calculation of the contingency tables while Monte Carlo simulation and Fisher＇s exact test were used for the table fields where number of cases was smaller than demanded. Results： The average SUVmax value of the primary tumor for all T stages was 26.02 gm/mL. The average SUVmax values of the lymph nodes in N1 stage and N2 stage were 6.04 gm/mL and 6.33 gm/mL, respectively. PET/CT detected benign lesions in 17 （28.3%） patients with average SUVmax of 15.4 mg/mL. The vaginal wall infiltration was detected in 2 （4.4%） patients. Penetration of mesorectal fascia was detected in 21 （46.7%） of patients. Four patients （8.9%） had liver metastases identified by lSF-FDG PET/CT. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT in T staging was 90.7%, 91.9%, and 90.5%, respectively. The overall sensitivity, specificity and accuracy of 18F-FDG PET/CT in detection of metastatic lymph node was 85.8%, 89.8%, and 89%, respectively. PET/CT shows low sensitivity （77.3%） and specificity （25%） in analyzing mesorectal fascia involvement. The overall sensitivity of 18F-FDG PET/CT in M staging was 100%. Conclusions： 18F-FDG PET/CT is highly sensitive for initial T staging of rectal cancer especially in advanced disease. This imaging modality is highly accurate in detection of metastatic lymph nodes and liver metastases, but it has no role in defining ofmesorectal fascia involvement. Therefore, 18F-FDG PET/CT should be incorporated routinely in preoperative staging together with conventional imaging.

Targeting triple-negative breast cancer:A clinical perspective

Triple-negative breast cancer(TNBC)is a disease with often an aggressive course and a poor prognosis compared to other subtypes of breast cancer.TNBC accounts for approximately 10%–15%of all diagnosed breast cancer cases and represents a high unmet need in the field.Up to just a few years ago,chemotherapy was the only systemic treatment option for this subtype(1).To date,TNBC is considered a heterogeneous disease.One of the existing classifications is based on the analysis of mRNA expression in 587 TNBC cases,in which Lehman et al.proposed six subtypes of TNBC as follows:two basal-like(BL1 and BL2)subtypes,a mesenchymal(M)subtype,a mesenchymal stem-like(MSL)subtype,an immunomodulatory(IM)subtype,and a luminal androgen receptor(LAR)subtype(2).Later studies have demonstrated that the IM and MSL subtypes do not correlate with independent subtypes but reflect background expression by dense infiltration of tumor-infiltrating lymphocytes(TILs)or stromal cells.According to this finding,the classification of TNBC has been revised into the following four subtypes:basal 1,basal 2,LAR,and mesenchymal subtypes(3).Over the last years,several new strategies have been investigated for the treatment of patients with TNBC.Among them,immunotherapy,antibody drug conjugates,new chemotherapy agents,and targeted therapy have been and are currently being developed.The present article aims to provide an updated overview on the different treatment options that are now available or are still under investigation for patients with TNBC.

Impact of Microstructural and Surface Modifications on the Ti-45Nb Alloy’s Response to Bio-Environment

The Ti-45Nb (mass%) alloy’s corrosive and biocompatible response in simulated physiological conditions was investigated before and after its additional high-pressure torsion (HPT) and laser irradiation processing. The grain size reduction from 2.76 µm to ~ 200 nm and the appearance of laser-induced morphologically altered and highly oxidized surface led to the significant improvement of alloy corrosion resistance and cell–implant interaction. Moreover, an additional increase of the laser pulse energy from 5 to 15 mJ during the alloy irradiation in the air led to an increase in the surface oxygen content from 13.64 to 23.89% accompanied by an increase of excellent cell viability from 127.18 to 134.42%. As a result of the controlled alloy microstructural and surface modifications, the formation of protective bi-modal mixed Ti- and Nb-oxide external scale was enabled. The presence of this surface oxide scale enhanced the alloy’s resistance to corrosion deterioration and simultaneously boosted cell viability and proliferation.

Laser processing effects on Ti−45Nb alloy surface,corrosive and biocompatible properties

The Ti−45Nb(wt.%)alloy properties were investigated in relation to its potential biomedical use.Laser surface modification was utilized to improve its performance in biological systems.As a result of the laser treatment,(Ti,Nb)O scale was formed and various morphological features appeared on the alloy surface.The electrochemical behavior of Ti−45Nb alloy in simulated body conditions was evaluated and showed that the alloy was highly resistant to corrosion deterioration regardless of additional laser surface modification treatment.Nevertheless,the improved corrosion resistance after laser treatment was evident(the corrosion current density of the alloy before laser irradiation was 2.84×10^(−8)A/cm^(2),while that after laser treatment with 5 mJ was 0.65×10^(−8)A/cm^(2))and ascribed to the rapid formation of a complex and passivating bi-modal surface oxide layer.Alloy cytotoxicity and effects of the Ti−45Nb alloy laser surface modification on the MRC-5 cell viability,morphology,and proliferation were also investigated.The Ti−45Nb alloy showed no cytotoxic effect.Moreover,cells showed improved viability and adherence to the alloy surface after the laser irradiation treatment.The highest average cell viability of 115.37%was attained for the alloy laser-irradiated with 15 mJ.Results showed that the laser surface modification can be successfully utilized to significantly improve alloy performance in a biological environment.

Antibacterial, antifungal and cytotoxic activity of terrestrial cyanobacterial strains from Serbia

Cyanobacteria are known to be a rich source of biologically active compounds some of which can have pharmaceutical importance. In this work we present the screening results of cyanobacterial strains for their antibacterial, antifungal, and cytotoxic activity. Cyanobacterial strains were isolated from various soil types in province of Vojvodina and Central Serbia, Republic of Serbia. The screening included 9 strains of Anabaena and 9 strains of Nostoc. Both, extracellular products (from the culture liquid) and cellular crude lipophilic extracts were tested against 13 bacterial strains and 8 fungal strains. Cytotoxic activity was tested against three human cell lines. Methanol extracts were prepared according to ?stensvik. Antibacterial and antifungal activities were determined measuring inhibition zone, 48 h after inoculation. The cytotoxic activity was determined by sulforhodamine B (SRB) colorimetric assay. Of all cyanobacterial strains tested, 52% showed some antifungal and 41% antibacterial activity. Two out of six tested strains possessed cytotoxic activity. The cytotoxic activity of Anabaena strain S12 was found both in culture liquid and crude cell extract. It occurred specifically between the 21st and 42nd day of cultivation against HeLa and MCF7 cells, but had no activity against cell line derived from a healthy tissue. A high percentage of the active strains among the tested strains justify the effort of screening cyanobacteria that are isolated from terrestrial environments. The most promising strains for the fur- ther study are Anabaena strain S12 which showed strong cytotoxic and antibacterial activity and Ana- baena strain S20 which produces a potent antifungal compound. The future work, besides further screening and chemical identification of the active compounds, should also include the development of culture techniques that would lead to more efficient production of biologically active compounds.