Present and future of metastatic colorectal cancer treatment: A review of new candidate targets

In the last two decades, great efforts have been made in the treatment of metastatic colorectal cancer(m CRC) due to the approval of new target agents for cytotoxic drugs. Unfortunately, a large percentage of patients present with metastasis at the time of diagnosis or relapse after a few months. The complex molecular heterogeneity of this disease is not completely understood; to date, there is a lack of predictive biomarkers that can be used to select subsets of patients who may respond to target drugs. Only the RAS-mutation status is used to predict resistance to anti-epidermal growth factor receptor agents in patients with m CRC. In this review, we describe approved targeted therapies for the management of metastatic m CRC and discuss new candidate targets on the horizon.

Novel biomarkers of fibrosis in Crohn's disease

Fibrosis represents a major challenge in Crohn's disease(CD),and many CD patients will develop fibrotic strictures requiring treatment throughout their lifetime.There is no drug that can reverse intestinal fibrosis,and so endoscopic balloon dilatation and surgery are the only effective treatments.Since patients may need repeated treatments,it is important to obtain the diagnosis at an early stage before strictures become symptomatic with extensive fibrosis.Several markers of fibrosis have been proposed,but most need further validation.Biomarkers can be measured either in biological samples obtained from the serum or bowel of CD patients,or using imaging tools and tests.The ideal tool should be easily obtained,costeffective,and reliable.Even more challenging is fibrosis occurring in ulcerative colitis.Despite the important burden of intestinal fibrosis,including its detrimental effect on outcomes and quality of life in CD patients,it has received less attention than fibrosis occurring in other organs.A common mechanism that acts via a specific signaling pathway could underlie both intestinal fibrosis and cancer.A comprehensive overview of recently introduced biomarkers of fibrosis in CD is presented,along with a discussion of the controversial areas remaining in this field.

Complete rectal prolapse in young Egyptian males: Is schistosomiasis really condemned?

AIM To investigate the assumption that schistosomiasis is the main cause of rectal prolapse in young Egyptian males. METHODS Twenty-one male patients between ages of 18 and 50 years with complete rectal prolapse were included in the study out of a total 29 patients with rectal prolapse admitted for surgery at Colorectal Surgery Unit, Ain Shams University hospitals between the period of January 2011 and April 2014. Patients were asked to fill out a specifically designed questionnaire about duration of the prolapse, different bowel symptoms and any past or present history of schistosomiasis. Patients also underwent flexible sigmoidoscopy and four quadrant midrectal biopsies documenting any gross or microscopic rectal pathology. Data from questionnaire and pathology results were analyzed and patients were categorized according to their socioeconomic class.RESULTS Twelve patients(57%) never contracted schistosomiasis and were never susceptible to the disease, nine patients(43%) had history of the disease but were properly treated. None of the patients had gross rectal polypsand none of the patients had active schistosomiasis on histopathological examination. Fifteen patients(71%) had early onset prolapse that started in childhood, majority before the age of 5 years. Thirteen patients(62%) were habitual strainers, and four of them(19%) had straining dating since early childhood. Four patients(19%) stated that prolapse followed a period of straining that ranged between 8 mo and 2 years. Nine patients(43%) in the present study came from the low social class, 10 patients(48%) came from the working class and 2 patients(9%) came from the low middle social class. CONCLUSION Schistosomiasis should not be considered the main cause of rectal prolapse among young Egyptian males. Childhood prolapse that continues through adult life is likely involved. Childhood prolapse probably results from malnutrition, recurrent parasitic infections and diarrhea that induce straining and prolapse, all are common in lower socioeconomic classes.