Objective: This study aimed to report the treatment and outcomes of a patient with primary malignant melanoma of the breast parenchyma using mastectomy as the main treatment.
Patient and methods: A 67-year-old female presented with a palpable lump approximately 2 cm in diameter in the lower inner quadrant of the left breast, and underwent ultrasound guided cutting needle biopsy. Cytological examination identified a malignant melanoma of the breast, and she received treatment with a modified radical mastectomy. Further assessment was carried out using a positron emission tomography/computed tomography, which negated the presence of a primary lesion in either adjacent or distant sites.
Results: After three years of follow-up with ultrasonography (USG) and mammography annually and a complete physical examination every six months in the clinic, the patient remained alive with no evidence of local or distant recurrence.
Conclusion: The surgical management of this case is appropriate according to the available literature up to the present. We recommend BRAF mutation testing and melanocytic marker testing for all patients to ensure the correct focus when selecting biomarker-based immunotherapy.
Objective: Cancer patients have a 4–7-fold increased risk of thrombotic complications due to cancer as well as chemotherapy-induced hypercoagulable state. This study compared the different risk assessment models (Khorana, PROTECHT, CONKO, and COMPASS-CAT scores) that help predict venous thromboembolism (VTE) in ambulatory cancer patients. Early identification of high-risk patients would benefit from thromboprophylaxis, thereby improving the mortality and morbidity due to thrombotic events.
Methods: This is a single-center, prospective, cross-sectional study on ambulatory patients with solid malignancy. The study was conducted over six months, from March 2022 to August 2022. Data on VTE predictors were gathered from 230 ambulatory cancer patients undergoing chemotherapy.
Results: Among the 230 patients receiving chemotherapy, 20 were diagnosed with VTE, with the majority of this population being either diagnosed with gynecological cancer or lung cancer, constituting 25% of VTE-diagnosed patients. The Khorana score, with a VTE accuracy of 83.04%, was found to be the highest, followed by the CONKO (80.00%), PROTECHT (69.57%), COMPASS-CAT Ⅱ (54.35%), and COMPASS-CAT Ⅰ (38.26%) scores. The cumulative incidence of VTE among high-risk patients showed that the PROTECHT score had the highest cumulative incidence (CI = 14.28), and the CONKO score had the lowest (CI = 9.40).
Conclusion: The Khorana score was the most accurate, followed by the CONKO, PROTECHT, and COMPASS-CAT Ⅱ scores, while the COMPASS-CAT Ⅰ score was the least accurate. Hence, the Khorana scoring is essential for diagnosing VTE in patients with ambulatory cancer treated with chemotherapy.
Objective: This study aimed to investigate the accuracy of needle insertion and dosimetric parameters in three-dimensional printing template (3D-PT)-assisted computed tomography (CT)-guided radioactive iodine-125 (125I) seed implantation (RISI) for the treatment of peripheral locally recurrent rectal cancer (pLRRC).
Materials and methods: A total of 37 patients with pLRRC who underwent 3D-assisted CT-guided RISI treatment at Peking University Third Hospital between January 2016 and November 2019 were included in this study. All patients underwent preoperative assessment, CT simulation positioning, preoperative plan design, 3D template printing, 3D template reduction, needle and seed implantation, postoperative dosimetry evaluation, post-operative care, and regular follow-up. The preoperative and postoperative needle position, angle, and tip distance were compared. The dosimetric parameters, including D90 (the dose to 90% of the target volume), D100, V100 (the volume receives 100% of the prescribed dose), V150, V200, conformal index (CI), external index (EI), and homogeneity index (HI), were compared among preoperative plan, intraoperative plan, and postoperative plan. The perioperative complications were assessed.
Results: The total number of needles was 595. The depths of needle insertion in preoperative and intraoperative plans were 109.87 ± 1.33mm and 108.46 ± 1.26 mm, respectively, with no significant difference (p > 0.05). The angles of needle insertion in preoperative and intraoperative plans were (93.55 ± 2.05)° and (92.04 ± 1.99)°, respectively, with no significant difference (p > 0.05). The average deviation of the needle insertion distance was 1.99 ± 0.08 mm. There were no differences in preoperative, intraoperative, and postoperative parameters, including D90, D100, V100, V150, V200, CI, EI, and HI. All patients were closely followed up during the perioperative period (from seven days before surgery to seven days after surgery). No patients experienced severe perioperative complications. A total of eight patients (21.6%) experienced grade 1–2 complications. Among all patients, six individuals (16.2%) experienced pain, one patient (2.7%) had a fever, and one patient (2.7%) suffered from a hemorrhage. All patients recovered after conservative treatment.
Conclusion: The needle insertion in 3D-PT-assisted CT-guided RISI showed good accuracy for treating pLRRC.
Objective: This study aimed to describe patients with melanoma initiating treatments with dabrafenib plus trametinib (Dab + Tram) or encorafenib plus binimetinib (Enco + Bini) in a real-world setting in Japan.
Methods: Data were extracted from the Japanese Medical Data Vision (MDV) insurance claims database. Patients diagnosed with melanoma between 2012 and 2021 and prescribed with Dab + Tram or Enco + Bini were included in three cohorts: non-adjuvant Dab + Tram, adjuvant Dab + Tram, and Enco + Bini. Data were extracted on patient characteristics at treatment initiation. During follow-up, all changes in melanoma treatments were documented. Treatment adherence was determined as the proportion of prescription days covered (PDC) and treatment dose intensity as the relative dose intensity (RDI).
Results: Sixty-seven patients were included in the non-adjuvant Dab + Tram cohort (55 first-line treatments), seven in the adjuvant Dab + Tram cohort (six first-line treatments), and 16 in the Enco + Bini cohort (four first-line treatments). The mean age was 61.3 ± 13.5 years and 56.1% were men. Twenty-seven patients with non-adjuvant Dab + Tram or Enco + Bini in first line (45.8%) switched to a second line. The median treatment duration was 11.8 months for Dab + Tram and 8.1 months for Enco + Bini. A PDC ≥ 80% was observed for 85.7% of patients with adjuvant Dab + Tram, 68.7% for non-adjuvant Dab + Tram, and 75.0% for Enco + Bini. Median RDI was 1.0 for adjuvant Dab + Tram, 0.9 for non-adjuvant Dab + Tram, and 0.6 for Enco + Bini.
Conclusion: Dab + Tram is used consistently with clinical practice guide-lines in the adjuvant setting, but adherence in the non-adjuvant setting is suboptimal, as is the prescribed dose of Enco + Bini. Prescribers should ensure that these therapies are used in an optimal way to improve outcomes in melanoma.
Background: Platinum-based chemotherapy in addition to the non-platinum agent etoposide is the standard of care for extensive-stage small cell lung cancer (ES-SCLC). However, the front-line chemotherapy regimen is not known. Therefore, we aimed to perform this review comparing irinotecan/carboplatin (IC) and etoposide/carboplatin (EC) in patients of extended disease small cell lung cancer (ED-SCLC).
Methods: We searched three databases, that is, PubMed, Embase, and Cochrane Library. The outcomes for complete response (CR), median overall survival (OS), and progression-free survival (PFS) were evaluated. In addition, adverse events such as leukopenia, thrombocytopenia, anemia, diarrhea, and infections were also assessed. RevMan 5.4.1 was used to perform the statistical analysis.
Results: Three randomized controlled trials (RCTs) with 676 patients were included. There was a significant difference between IC and EC arms in terms of CR (risk ratio [RR] = 2.52; 95% confidence interval [CI]: 1.20–5.32; p = 0.02, I2 (i.e., the percentage of the total variance that is due to between-study heterogeneity) = 0%), leukopenia (RR = 0.47; 95% CI: 0.23–0.97; p = 0.04; I2 = 90%), amimia (RR = 0.55; 95% CI: 0.38–0.78; p = 0.0008; I2 = 0%), thrombocytopenia (RR = 0.51; 95% CI: 0.39–0.68; p = 0.00001; I2 = 0%), and diarrhea (RR = 4.88; 95% CI: 1.64–14.49; p = 0.004; I2 = 33%). There was no statistically significant difference between IC and EC arms in terms of median OS (hazard ratio [HR] = 1.16; 95% CI: 0.84–1.62; p = 0.37; I2 = 74%), PFS (HR = 1.04; 95% CI: 0.69–1.56; p = 0.85; I2 = 77%), nausea (RR = 1.70; 95% CI: 0.76–3.81; p = 0.19; I2 = 0%), infection (RR = 0.97; 95% CI: 0.64–1.48; p = 0.89; I2 = 0%), and treatment-related deaths (RR = 0.58; 95% CI: 0.24–1.42; p = 0.23; I2 = 0%).
Conclusion: This meta-analysis provides valuable evidence supporting the superiority of IC regimens over EC regimens in terms of CR and toxicity profile for ED-SCLC.
Background: Classification of breast cancer based on gene expression has emerged as the standard approach in its management, owing to the distinct prognoses and treatment responses observed among different subtypes. The aim of this study was to prospectively assess the imaging features of the molecular subtypes of breast cancer using multiparametric magnetic resonance imaging (mMRI) with the combined assessment of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), and MR spectroscopy (MRS).
Methods: This was a prospective observational single-center cohort study, which included women with BI-RADS 4–5 lesions on mammography/ultrasound (US) who subsequently underwent 1.5 T MRI (encompassing DCE-MRI, DWI, and MRS). The histological subtypes of breast cancer were assessed. Estrogen receptor (ER), progesterone receptor (PR), Ki-67 status, and human epidermal growth receptor-2 (HER2) expression, assessed by immunohistochemistry (IHC), defined four molecular subtypes: luminal A, luminal B, HER2-enriched (Her2en), and triple-negative breast carcinoma (TNBC). Statistical associations between the four molecular subtypes and MRI features were investigated.
Results: Fifty patients were included in the study. Circumscribed margins were significantly correlated with triple-negative tumors compared to others (78% versus 6%, p < 0.001). Spiculated margins were observed in nontriple negative tumors. Rim enhancement was significantly correlated to triple-negative tumors compared to all other subtypes (71.4% versus 25%, p = 0.035). Mean apparent diffusion coefficient (ADC) values were significantly lower for luminal subtypes compared to non-luminal subtypes (p < 0.001). The total choline (tCho) signal-to-noise ratio (SNR) was higher in triple-negative tumors. A combined algorithm using DCE-MRI, DWI, and MRS can predict TNBC and Her2en with specificity of 86.6% and 100%, respectively, and sensitivity of 100% and 85.37%, respectively.
Conclusion: The combination of mMRI with DCE-MRI, DWI, and MRS can accurately differentiate the molecular subtypes of breast carcinoma.
Background: Cancer-associated fibroblasts (CAFs), the main matrix components in the tumor microenvironment (TME), play a crucial role in tumor progression. Extracellular vesicles (EVs) as main mediators in intercellular communication can be regulated by hypoxia or radiation.
Methods: CAFs were extracted from head and neck squamous cell carcinoma (HNSCC) tissues and CAF-derived EVs were collected by ultracentrifugation. Bioinformatics analysis determined the role of poly (U)-specific endonuclease (ENDOU) on HNSCC progression and confirmed that ENDOU inhibited HNSCC progression by overexpressing ENDOU in HNSCC. Dual-luciferase activity report assay confirmed that miR-23b-5p was involved in the regulation of ENDOU expression. The migration and invasion of HNSCC cells were verified by transwell assay. Furthermore, tumor-bearing mouse models were used to demonstrate the potential of EVs loaded with miR-23b-5p in HNSCC to promote tumor progression.
Results: Our results showed that ENDOU was downregulated in HNSCC and inhibited HNSCC migration and invasion. Hypoxia and radiotherapy reversed CAF-derived EVs to promote migration and invasion of HNSCC. Mechanically, hypoxia and radiation downregulated miR-23b-5p in CAF-derived EVs and then restored ENDOU expression in HNSCC. Finally, CAF-derived EVs carrying miR-23b-5p promoted the progression of HNSCC cells in vivo by regulating ENDOU expression.
Conclusion: This study demonstrated that hypoxia combined with radiation reverses the promoting effect of CAFs on HNSCC migration and invasion by reducing the delivery of miR-23b-5p by CAF-derived EVs to decrease the inhibitory effect of ENDOU expression in HNSCC. The results provide a new perspective for better understanding the role of stromal components in TME in tumor regulation. Furthermore, the results provide a strong basis for the possibility of ENDOU as a biomarker for HNSCC.
Lung cancer is the leading malignancy among males and ranks the second in females, with an estimated two million new diagnoses annually. It ranks the first in cancer-related deaths among men and the second, following breast cancer, among women. The most significant risk factor for lung cancer is smoking. There are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), with about 85% of cases falling into the NSCLC category. Even with a combination of treatments for NSCLC, such as surgical intervention, chemotherapy, radiation therapy, and immunotherapy, the 5-year survival rates for those diagnosed with advanced NSCLC have not reached satisfactory levels, with chemotherapy continuing to be the main therapeutic approach. In advanced NSCLC treatment, gemcitabine and platinum-based agents are applied as first-line therapy. However, acquired or pre-existing drug resistance can prevent chemotherapeutic agents from achieving the expected effect on patients and increasing the drug dose can lead to an increase in side effects. In recent years, for these reasons, there has been an increased interest in phytochemicals to enhance the cytotoxic effects of therapeutic agents on cancer cells while minimizing their toxic effects on healthy tissues. One of the most studied phytochemicals is curcumin. Despite its anticancer effects on NSCLC cells, its low stability and poor pharmacokinetics have led to unsatisfactory results in studies. Therefore, a variety of analogs have been synthesized. This review explores the impact of curcumin and its analogs on the pathways of cell death in NSCLC.
Radiotherapy (RT) plays a crucial role in tumor treatment and is an indispensable therapeutic approach. However, ionizing radiation often damages the normal tissues surrounding the tumor. Therefore, there is an urgent need for effective methods to improve the precision of RT. Nanotechnology has shown potential in enhancing the efficacy and safety of tumor RT. With the continuous development of multifunctional nanomaterials, various nanomaterials have been designed and investigated as radiation enhancers. Metallic nanomaterials are considered as promising radiosensitizers with potential for clinical translation. High atomic number (high-Z) metal nanoparticles (NPs), such as gold and bismuth, have garnered increasing attention for their ability to enhance the radiation effect, as they can potentially improve RT outcomes. New nanomedicine strategies may help to advance RT. This paper concisely explains the radiation enhancement mechanisms of high-Z metal NPs. It also enumerates several commonly studied high-Z metallic nanomaterials used in tumor RT and discusses their potential clinical applications.
Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has radically transformed the field of oncological therapy. However, immune‐related adverse events (irAEs) associated with the treatment might affect the life quality and even threaten the life of cancer patients. Immunotherapy-mediated colitis (IMC) is one of the most prevalent irAEs, especially in anti-cytotoxic T lymphocyte antigen 4 antibody (CTLA4) therapy. Current management of IMC includes administering immunosuppressants and discontinuing the treatment, which might affect the therapeutic efficacy. In this review, we briefly summarize the development of ICIs in cancer immunotherapy and the incidence, diagnosis, and management of IMC. Recent insights into the cellular and molecular pathways that underpin IMC, perspective research, and promising therapeutic strategies are highlighted. Further understanding of IMC and its implications will assist clinicians in optimizing treatment strategies to mitigate this side effect while maximizing the benefits of ICIs.
Objective: This study aimed to report the treatment and outcomes of a patient with advanced gastric cancer (GC) using a combination of a targeted molecular therapy and chemotherapy.
Patients and methods: A 40-year-old woman presented with abdominal metastatic nodules and peritoneal effusion. Biopsy and cytology identified signet ring cell carcinoma. Ten months after the onset of initial symptoms, gastroscopy confirmed signet ring cell carcinoma of the gastric body. Genetic testing revealed amplification of the fibroblast growth factor receptor (FGFR) gene. Consequently, the patient received FGFR inhibitor pemigatinib in addition to a chemotherapy regimen of albumin paclitaxel plus 5-fluorouracil.
Results: During the treatment, the patient experienced recurrent liver function abnormalities and intestinal obstruction, which were managed with symptom-specific medications and supportive therapies. The combined treatment regimen resulted in a progression-free survival (PFS) period of ten months.
Conclusion: The integration of FGFR inhibitor pemigatinib with standard chemotherapy showed promising results in prolonging PFS in a patient with advanced GC characterized by FGFR gene amplification, despite the occurrence of manageable side effects.
Background: Population-based cancer survival is a key metric in evaluating the overall effectiveness of health services and cancer control activities. Advancement in information technology enables accurate vital status tracking through multi-source data linkage. However, its reliability for survival estimates in China is unclear.
Methods: We analyzed data from Dalian Cancer Registry to evaluate the reliability of multi-source data linkage for population-based cancer survival estimates in China. Newly diagnosed cancer patients in 2015 were included and followed until June 2021. We conducted single-source data linkage by linking patients to Dalian Vital Statistics System, and multi-source data linkage by further linking to Dalian Household Registration System and the hospital medical records. Patient vital status was subsequently determined through active follow-up via telephone calls, referred to as comprehensive follow-up, which served as the gold standard. Using the cohort method, we calculated 5-year observed survival and age-standardized relative survival for 20 cancer types and all cancers combined.
Results: Compared to comprehensive follow-up, single-source data link-age overestimated 5-year observed survival by 3.2% for all cancers combined, ranging from 0.1% to 8.6% across 20 cancer types. Multi-source data linkage provided a relatively complete patient vital status, with an observed survival estimate of only 0.3% higher for all cancers, ranging from 0% to 1.5% across 20 cancer types.
Conclusion: Multi-source data linkage contributes to reliable population-based cancer survival estimates in China. Linkage of multiple databases might be of great value in improving the efficiency of follow-up and the quality of survival data for cancer patients in developing countries.
Background: The effects of programmed cell death protein 1/programmed cell death ligand 1 (PD-1/PD-L1) immune checkpoint inhibitors (ICIs) in patients with squamous and nonsquamous non-small cell lung cancer (NSCLC) remain controversial. We conducted a meta-analysis to summarize the existing evidence on this topic.
Methods: We searched PubMed, Medline, and Embase for studies published before December 1, 2022, comparing PD-1/PD-L1 ICIs with docetaxel in squamous and nonsquamous NSCLC patients in any language. The different hazard ratio (HR) values for overall survival (OS) and progression-free survival (PFS) were calculated in this study.
Results: A total of seven studies were identified. In a summary analysis of all studies, the HR values of OS in patients with nonsquamous and squamous NSCLC were 0.73, 95% confidence interval (CI): 0.67–0.79 and 0.70, 95% CI: 0.62–0.79, respectively. In patients with PD-L1 expression levels of 1% or higher, the HR values of OS in nonsquamous and squamous NSCLC patients were 0.60, 95% CI: 0.49–0.74 and 0.72, 95% CI: 0.54–0.96, respectively. The HR values of OS in nonsquamous and squamous NSCLC patients with PD-L1 expression levels of 5% or higher were 0.46, 95% CI: 0.35–0.59 and 0.55, 95% CI: 0.39–0.79, respectively. In nonsquamous and squamous NSCLC patients with PD-L1 expression levels of 10% or higher, the HR values of OS were 0.42, 95% CI: 0.32–0.54, and 0.53, 95% CI: 0.36–0.78, respectively.
Conclusion: The meta-analysis demonstrated possible evidence that there was different efficacy of PD-1/PD-L1 ICIs on OS in squamous and nonsquamous NSCLC patients with different PD-L1 expression levels. Subgroup analysis showed that there was a greater OS benefit in patients with nonsquamous NSCLC.
Background: This study aimed to explore the impact of patient-specific factors on the effectiveness of platinum-based chemotherapy in ovarian cancer patients. Specifically, we investigated the relationship between estrogen receptor (ER) and progesterone receptor (PR) expression levels and platinum sensitivity, and how this influenced treatment outcomes and prognosis. We conducted a survival analysis on patients who underwent surgical treatment for serous ovarian cancer and received platinum-based adjuvant therapies.
Methods: This study was a retrospective observational analysis of 171 patients with high-grade serous ovarian cancer. We extracted and analyzed the patients’ clinical data, focusing on platinum sensitivity concerning hormone receptor expression. We also assessed survival outcomes based on receptor expression and platinum resistance.
Results: Our findings revealed that 78.4% (n = 134) of the patients were platinum-sensitive, while 21.6% (n = 37) were platinum-resistant. The expression of hormone receptors showed significant associations with platinum sensitivity, particularly among ER-positive patients (p<0.05). Age, disease stage, preoperative carbohydrate antigen 125 (CA125) levels, and residual tumor size were identified as notable factors influencing both progression-free survival (PFS) and overall survival (OS). In terms of PFS, 88.5% of patients remained free from disease progression after one year, but this percentage dropped to 21% after five years. The average duration of PFS was 35.3 months. As for OS, 93.5% of patients were still alive after one year, but this percentage decreased to 50.5% after five years. The average survival duration was 64 months. Furthermore, platinum resistance was found to be a significant risk factor for disease progression, with a more than fivefold increase in risk (p < 0.001).
Conclusion: Our study identified disease stage progression, ER negativity, and platinum resistance as the primary factors influencing OS. We also found that ER and PR expression played a crucial role in determining the sensitivity to platinum-based chemotherapy in patients with serous ovarian cancer.