Adjuvant therapy

辅助治疗
  • 文章类型: Journal Article
    顺铂仍然是NSCLC的标准疗法。然而,由于耐药性和氧化应激诱导的毒性,它不能完全治愈。耐药性与基质金属蛋白酶(MMPs)的过表达和异常的钙信号有关。我们报道了新型噻唑-三唑杂化物的合成,作为具有T型钙通道阻断和抗氧化作用的MMP-9抑制剂,可使NSCLC对顺铂敏感并改善其毒性。MTT和全细胞膜片钳分析显示,6d具有平衡的细胞毒性特征(IC50=21±1nM,SI=12.14)和T型钙通道阻断活性(在10μM时60%)。它表现出中等的ROS清除活性和纳摩尔MMP-9抑制(IC50=90±7nM),超过NNGH,其中MMP-9超过-2,MMP-10超过-13选择性。对接和MD模拟其受体结合模式。联合研究证实,6d与顺铂(CI=0.69±0.05)协同作用,使其IC50降低6.89倍。总的来说,该研究引入了NSCLC铂类治疗的潜在先导佐剂.
    Cisplatin remains the unchallenged standard therapy for NSCLC. However, it is not completely curative due to drug resistance and oxidative stress-induced toxicity. Drug resistance is linked to overexpression of matrix metalloproteinases (MMPs) and aberrant calcium signalling. We report synthesis of novel thiazole-triazole hybrids as MMP-9 inhibitors with T-type calcium channel blocking and antioxidant effects to sensitise NSCLC to cisplatin and ameliorate its toxicity. MTT and whole cell patch clamp assays revealed that 6d has a balanced profile of cytotoxicity (IC50 = 21 ± 1 nM, SI = 12.14) and T-type calcium channel blocking activity (⁓60% at 10 μM). It exhibited moderate ROS scavenging activity and nanomolar MMP-9 inhibition (IC50 = 90 ± 7 nM) surpassing NNGH with MMP-9 over -2 and MMP-10 over -13 selectivity. Docking and MDs simulated its receptor binding mode. Combination studies confirmed that 6d synergized with cisplatin (CI = 0.69 ± 0.05) lowering its IC50 by 6.89 folds. Overall, the study introduces potential lead adjuvants for NSCLC platinum-based therapy.
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  • 文章类型: Journal Article
    背景:辅助治疗改善了术后黑色素瘤患者的临床预后。然而,在之前的试验中,该疗法对黑色素瘤肢端和粘膜亚型的长期疗效尚未得到充分评估.这项研究评估了黑色素瘤患者的3年无复发生存率和总生存率。包括肢端和粘膜亚型,用抗PD-1抗体(Ab)或BRAF和MEK抑制剂dabrafenib和trametinib的组合治疗。
    方法:我们回顾性分析了120例抗PD-1抗体(Ab)治疗患者的3年复发时间(TTR)和总生存期(OS),或与dabrafenib和trametinib的组合。
    结果:总TTR中位数为18.4个月,范围为0.69到36个月。肢端和粘膜类型的3年TTR分别为28.1%和38.5%,分别。在亚组分析中,基线肿瘤厚度(TT)和肢端类型与TTR相关。此外,在多项分析中,我们将104例肢端和非肢端皮肤患者分为抗PD-1Abs或dabrafenib+trametinib联合治疗队列.肢端亚型和TT是重要的预后因素。在3年操作系统中,在单变量和多重分析中,只有肿瘤溃疡与OS相关.粘膜类型的基线或治疗相关因素没有显着差异(p>0.05)。
    结论:这项研究表明,在3年TTR终点时,非肢端皮肤黑色素瘤的辅助治疗比肢端或粘膜类型更有效。
    BACKGROUND: Adjuvant therapy has improved the clinical prognosis for postoperative melanoma patients. However, the long-term efficacy of this therapy on the melanoma acral and mucosal subtypes has not been fully evaluated in previous trials. This study assessed the 3-year recurrence-free survival and overall survival of patients with melanoma, including the acral and mucosal subtypes, treated with anti-PD-1 antibody (Ab) or with the combination of the BRAF and MEK inhibitors dabrafenib and trametinib.
    METHODS: We retrospectively analyzed both the 3-year time to relapse (TTR) and overall survival (OS) of 120 patients treated with anti-PD-1 antibody (Ab), or with the combination of dabrafenib and trametinib.
    RESULTS: The overall median TTR was 18.4 months, with a range of 0.69 to 36 months. The 3-year TTR of the acral and mucosal types was 28.1% and 38.5%, respectively. Baseline tumor thickness (TT) and acral type were associated with the TTR in subgroup analysis. Moreover, we classified 104 acral and non-acral cutaneous patients into the anti-PD-1 Abs or dabrafenib plus trametinib combined therapies cohort in multiple analyses. The acral subtype and TT were detected as important prognostic factors. In the 3-year OS, only tumor ulceration was associated with the OS in both univariate and multiple analyses. There was no significant difference in baseline or treatment-related factors of the mucosal type (p > 0.05).
    CONCLUSIONS: This study suggests that adjuvant therapy is more effective with non-acral cutaneous melanoma than either the acral or mucosal types at the 3-year TTR endpoint.
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  • 文章类型: Journal Article
    黑色素瘤是美国第五大最常见的癌症,占所有皮肤癌相关死亡的大多数。使其成为最致命的皮肤恶性肿瘤.IIB-IV期黑色素瘤的系统辅助治疗现已批准用于接受手术切除的患者,考虑到该患者人群中复发和死亡的明显风险。尽管阶段较低,与IIIA/IIIB期相比,高危II期黑色素瘤(IIB/IIC期)通常表现出更积极的病程,因此有理由考虑对这些患者进行辅助治疗。在这次审查中,我们强调目前治疗IIB/C期黑色素瘤的实践标准,重点是由已发表的具有里程碑意义的临床试验支持的辅助疗法,包括抗PD-1治疗。值得注意的是,到目前为止,在该患者人群中批准的辅助疗法已显示出无复发生存率的改善,虽然它们对总体生存率的影响尚未确定。最后,这篇综述重点介绍了目前正在进行的高危临床II期黑色素瘤的研究和治疗可能性的试验和未来方向.
    Melanoma is the fifth most common cancer in the United States and accounts for the majority of all skin cancer-related deaths, making it the most lethal cutaneous malignancy. Systemic adjuvant therapy for stage IIB-IV melanoma is now approved for patients who have undergone surgical resection, given the appreciable risk of recurrence and mortality in this patient population. Despite the lower stage, high-risk stage II melanoma (stage IIB/IIC) can often exhibit an even more aggressive course when compared to stage IIIA/IIIB disease, thus justifying consideration of adjuvant therapy in these patients. In this review, we highlight the current standard of practice for the treatment of stage IIB/C melanoma, with a focus on adjuvant therapies supported by published landmark clinical trials, including anti-PD-1 therapy. Notably, adjuvant therapies approved thus far in this patient population have demonstrated an improvement in recurrence-free survival, while their impact on overall survival is pending. Finally, this review highlights currently ongoing trials and future directions for research and treatment possibilities for high-risk clinical stage II melanoma.
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  • 文章类型: Journal Article
    由于存在远处转移的风险,因此开发新的治疗策略以改善碳离子放疗(CIRT)后头颈部粘膜恶性黑色素瘤(MMHN)的预后至关重要。因此,我们的目的是评估免疫检查点抑制剂(ICI)治疗的结局,以证明其纳入CIRT后的治疗方案的合理性.将34例接受CIRT作为初始治疗的患者纳入分析,并分为三组:未接受ICIs的患者(A组),复发或转移后接受ICIs的患者(B组),以及在CIRT后接受ICIs作为辅助治疗的患者(C组)。总的来说,62%的患者(n=21)接受了ICIs。所有患者的2年局部控制率和总生存率(OS)分别为90.0%和66.8%,分别。A组患者的2年OS率,B,C为50.8%,66.7%,100%,分别。在A组和B组(p=0.192)与B组和C组(p=0.112)之间没有观察到显著差异。然而,A组和C组之间存在显著差异(p=0.017).MMHN的CIRT辅助治疗可能是一种有希望的治疗方式,可以延长患者的生存期。
    The development of new treatment strategies to improve the prognosis of mucosal malignant melanoma of the head and neck (MMHN) after carbon ion radiotherapy (CIRT) is essential because of the risk of distant metastases. Therefore, our objective was to evaluate the outcomes of immune checkpoint inhibitor (ICI) treatment to justify its inclusion in the regimen after CIRT. Thirty-four patients who received CIRT as an initial treatment were included in the analysis and stratified into three groups: those who did not receive ICIs (Group A), those who received ICIs after recurrence or metastasis (Group B), and those who received ICIs as adjuvant therapy after CIRT (Group C). In total, 62% of the patients (n = 21) received ICIs. The 2-year local control and overall survival (OS) rates for all patients were 90.0% and 66.8%, respectively. The 2-year OS rates for patients in Groups A, B, and C were 50.8%, 66.7%, and 100%, respectively. No significant differences were observed between Groups A and B (p = 0.192) and Groups B and C (p = 0.112). However, a significant difference was confirmed between Groups A and C (p = 0.017). Adjuvant therapy following CIRT for MMHN may be a promising treatment modality that can extend patient survival.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    光动力疗法(PDT)是一种微创治疗方式,已在临床上用于早期和无法手术的癌症。文献中记载了这种无创伤疗法在骨坏死(ORN)和颌骨坏死(ONJ)中的成功使用。这篇综述的目的是系统评估光动力疗法在ORN和ONJ中的作用。
    两位独立的审阅者在PubMed中进行了精心的搜索,GoogleScholar和Cochrane的CENTRAL数据库在PDT上作为ORN/ONJ的独立或辅助治疗发表,直到2022年6月。本研究基于系统评价和荟萃分析的首选报告项目。人口统计数据,颌骨坏死的类型和阶段,site,PDT协议,评估愈合时间和随访时间。根据最终分析的纳入和排除标准,共纳入18篇文章。
    本综述共纳入94例患者,其中男性36例,女性58例。5项研究报道了在ORN中使用PDT作为辅助治疗。13项研究报告了ONJPDT的成功结果。86/94(91.48%)患者使用PDT±其他佐剂实现了完全上皮化。在本研究中,使用PDT治疗病变消退所需的时间为4天至12个月。
    综述的研究证明了PDT的有效性,作为辅助治疗,管理ORN和ONJ的各个阶段。
    UNASSIGNED: Photodynamic therapy (PDT) is a minimally invasive treatment modality that has been used clinically for early stage and inoperable cancers. Successful use of this atraumatic therapy in osteoradionecrosis (ORN) and osteonecrosis of the jaws (ONJ) has been documented in the literature. The aim of this review was to systematically evaluate the role of photodynamic therapy in ORN and ONJ.
    UNASSIGNED: Two independent reviewers conducted an elaborate search in PubMed, Google Scholar and Cochrane\'s CENTRAL database for studies published on PDT as stand-alone or adjuvant therapy in ORN/ONJ until June 2022. The present study was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Demographic data, type and stage of necrosis of the jaws, site, PDT protocol, time to heal and follow-up were evaluated. Eighteen articles were included totally based on the inclusion and exclusion criteria for final analysis.
    UNASSIGNED: A total of 94 patients were included in the present review out of which 36 were males and 58 were females. Five studies reported the use of PDT as an adjuvant therapy in ORN. Thirteen studies reported successful outcomes with PDT in ONJ. Complete epithelialization was achieved with PDT ± other adjuvants in 86/94 (91.48%) patients. The time taken for regression of the lesion ranged between 4 days and 12 months with PDT in the present study.
    UNASSIGNED: The reviewed studies demonstrate the effectiveness of PDT, as an adjuvant therapy, in managing various stages of ORN and ONJ.
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  • 文章类型: Case Reports
    原发性非霍奇金淋巴瘤在具有免疫能力的患者中伴有多次颅外和颅内延伸而没有全身扩散是极为罕见的。它们通常伪装成脑膜瘤,并可表现为颅内压升高的肿块。
    我们报告了一例原发性弥漫性大B细胞淋巴瘤(DLBCL)的年轻女性,涉及头皮,右额区硬脑膜受累,左顶骨,和后颅窝,在临床和放射学上都模仿为脑膜瘤。她接受了手术治疗。组织学检查显示提示DLBCL(生发中心型)的特征。她计划接受辅助治疗。然而,手术后2个月,她因全身受累而死亡。
    DLBCL在神经外科手术中很少见。它们可以表现为具有邻近的颅外和颅内肿块的肿瘤。它们构成了诊断挑战,因为它很容易与脑膜瘤混淆。进行肿瘤切除术以确认诊断,并适用于颅内压升高的患者。化疗是首选治疗方法,辅助治疗应及早开始。
    UNASSIGNED: Primary non-Hodgkin\'s lymphoma with multiple extra- and intra-calvarial extensions without systemic spread in an immunocompetent patient is extremely rare. They masquerade commonly as meningioma and can present as mass lesions with raised intracranial pressure.
    UNASSIGNED: We report one such case of primary diffuse large B-cell lymphoma (DLBCL) in a young female involving the scalp, dural involvement in the right frontal region, left parietal, and posterior fossa and mimicking both clinically and radiologically as meningioma. She was managed surgically. Histological examination showed features suggestive of DLBCL (germinal center type). She was planned for adjuvant therapy. However, at 2 months following surgery, she succumbed due to systemic involvement of the disease.
    UNASSIGNED: DLBCL is seen rarely in neurosurgical practice. They can present as tumors with adjacent extra- and intra-cranial masses. They pose a diagnostic challenge as it can be easily confused with meningioma. Tumor resection is performed to confirm diagnosis and in patients who present with raised intracranial pressure. Chemotherapy is the preferred treatment, and adjuvant therapy should be started early.
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  • 文章类型: Journal Article
    背景:LARC患者通常接受辅助治疗,然而,隐藏的微转移仍然限制了OS的改善。本研究旨在探讨VASN对直肠癌肺转移的影响,了解其潜在的分子机制,以指导辅助化疗的选择。
    方法:对中山大学肿瘤防治中心(SYSUCC)直肠癌肺转移患者的测序数据和公开数据进行细致分析。在体内和体外验证了VASN在肺转移中的功能作用。共免疫沉淀(co-IP),免疫荧光,并进行了救援实验,以揭示VASN的潜在分子机制。此外,检查肿瘤样本中的VASN表达水平,并分析其与肺转移状态的相关性。肿瘤分期,辅助化疗获益,和生存结果。
    结果:我们的研究揭示了LARC患者VASN高表达与肺转移之间的显著关联。体内外实验证明VASN能促进细胞增殖,转移,结直肠癌的耐药性。机械上,VASN与NOTCH1蛋白相互作用,导致同时激活NOTCH和MAPK通路。临床上,在90%的VASN阳性患者和53.5%的VASN高患者中观察到肺转移和晚期肿瘤分期,分别,高VASN患者的五年生存率低于低VASN患者(26.7%vs.83.7%)。此外,Cox分析和OS分析表明,VASN是OS的独立预后因素(HR=7.4,P值<0.001),也是直肠癌辅助治疗疗效的预测因子.
    结论:我们的研究强调了VASN在降低药物敏感性和激活NOTCH和MAPK通路中的作用。导致肿瘤发生和肺转移。实验和临床数据均支持活检中检测到VASN过表达的直肠癌患者肺转移和辅助化疗耐药的风险更高。
    BACKGROUND: LARC patients commonly receive adjuvant therapy, however, hidden micrometastases still limit the improvement of OS. This study aims to investigate the impact of VASN in rectal cancer with pulmonary metastasis and understand the underlying molecular mechanisms to guide adjuvant chemotherapy selection.
    METHODS: Sequencing data from rectal cancer patients with pulmonary metastasis from Sun Yat-sen University Cancer Center (SYSUCC) and publicly available data were meticulously analyzed. The functional role of VASN in pulmonary metastasis was validated in vivo and in vitro. Coimmunoprecipitation (co-IP), immunofluorescence, and rescue experiments were conducted to unravel potential molecular mechanisms of VASN. Moreover, VASN expression levels in tumor samples were examined and analyzed for their correlations with pulmonary metastasis status, tumor stage, adjuvant chemotherapy benefit, and survival outcome.
    RESULTS: Our study revealed a significant association between high VASN expression and pulmonary metastasis in LARC patients. Experiments in vitro and in vivo demonstrated that VASN could promote the cell proliferation, metastasis, and drug resistance of colorectal cancer. Mechanistically, VASN interacts with the NOTCH1 protein, leading to concurrent activation of the NOTCH and MAPK pathways. Clinically, pulmonary metastasis and advanced tumor stage were observed in 90% of VASN-positive patients and 53.5% of VASN-high patients, respectively, and VASN-high patients had a lower five-year survival rate than VASN-low patients (26.7% vs. 83.7%). Moreover, the Cox analysis and OS analysis indicated that VASN was an independent prognostic factor for OS (HR = 7.4, P value < 0.001) and a predictor of adjuvant therapy efficacy in rectal cancer.
    CONCLUSIONS: Our study highlights the role of VASN in decreasing drug sensitivity and activating the NOTCH and MAPK pathways, which leads to tumorigenesis and pulmonary metastasis. Both experimental and clinical data support that rectal cancer patients with VASN overexpression detected in biopsies have a higher risk of pulmonary metastasis and adjuvant chemotherapy resistance.
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  • 文章类型: Journal Article
    皮肤鳞状细胞癌(cSCC)是全球第二大最普遍的非黑色素瘤皮肤癌,约占所有皮肤恶性肿瘤的20%。确定其确切发生率带来了挑战;然而,报告显示其患病率在全球范围内增加。在诊断的时候,大多数CSCC都是本地化的,导致良好的5年治愈率超过90%。然而,一部分患者(3-7%)遭遇局部晚期或转移性cSCC,导致大量的发病率和死亡率。转移的风险范围为0.1%至9.9%,相关死亡风险为2.8%。影响复发的因素,转移,疾病特异性死亡率强调了神经周浸润(PNI)作为关键指标的重要性.PNI患者可能表现出PNI的临床症状和/或放射学体征,虽然大多数人没有症状,和PNI经常在组织学检查中被识别。尽管与其他癌症类型相比,其频率较低,PNI是公认的cSCC不良预后因素。手术是这些患者的选择性治疗,虽然辅助放疗(ART)的作用仍存在争议,尚未得到最终评估,特别是在清晰的手术边缘。需要进行前瞻性比较研究,以全面评估cSCC和PNI患者ART的益处和风险。
    UNASSIGNED: Cutaneous squamous cell carcinoma (cSCC) stands as the second most prevalent non-melanoma skin cancer worldwide, comprising approximately 20% of all cutaneous malignancies. Determining its precise incidence poses challenges; however, reports indicate a global increase in its prevalence. At the time of diagnosis, the majority of cSCCs are localized, resulting in favorable 5-year cure rates surpassing 90%. Nevertheless, a subset of patients (3-7%) encounters locally advanced or metastatic cSCC, leading to substantial morbidity and mortality. The risk of metastasis ranges from 0.1% to 9.9%, carrying an associated mortality risk of 2.8%. Factors influencing recurrence, metastasis, and disease-specific mortality underscore the significance of perineural invasion (PNI) as a key indicator. Patients with PNI may manifest clinical symptoms and/or radiologic signs of PNI, while the majority remain asymptomatic, and PNI is frequently identified upon histologic examination. Despite its lower frequency compared to other cancer types, PNI serves as a recognized adverse prognostic factor for cSCC. Surgery is the elective treatment for these patients, while the role of adjuvant radiotherapy (ART) is yet contentious and have not been conclusively assessed, particularly in clear surgical margin. Prospective comparative studies are required to comprehensively evaluate the benefit and the risks of ART for cSCC and PNI patients.
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  • 文章类型: Journal Article
    新辅助治疗可提高局部晚期非小细胞肺癌患者的生存获益,但可增加组织密度,给外科医生带来挑战。
    比较新辅助靶向治疗(NTT)和新辅助化学免疫疗法(NCI)在手术复杂性和短期预后结果方面的差异。
    这项研究纳入了中国国家癌症中心的106例患者,这些患者在2020年1月至2023年12月期间接受了新辅助治疗后的根治性手术。评估了两个新辅助治疗队列之间手术复杂性和短期预后结果的差异。然后分析病理反应率和淋巴结升/降分期等病理指标。
    总共,33例患者术前接受NTT,73例患者术前接受NCI。接受NTT的患者显示出更高的微创手术率(84.8%对53.4%,p<0.01),手术时间更短(144分钟对184分钟,p<0.01),转化率较低(3.3%对17.8%,p=0.03),术后引流量减少(第3天:140对200mL,p=0.03),术后并发症包括心律失常的发生率较低(6.1%对26%,p=0.02)。NTT和NCI组的病理应答率分别为70%和75%,分别,后一组显示出更高的完全病理应答率。两组在主要病理反应和淋巴结病理反应率方面无明显差异。
    接受NTT治疗的患者比接受NCI治疗的患者对外科医生的手术挑战更少,手术结果也更好。两个队列之间的病理反应率相当。因此,NTT是具有突变状态的患者的优选诱导方案。
    UNASSIGNED: Neoadjuvant therapy improves survival benefits in patients with locally advanced non-small cell lung cancer but increases tissue density, presenting challenges for surgeons.
    UNASSIGNED: To compare the differences in surgical complexity and short-term prognostic outcomes between neoadjuvant targeted therapy (NTT) and neoadjuvant chemoimmunotherapy (NCI).
    UNASSIGNED: This study enrolled 106 patients underwent curative surgery after neoadjuvant therapy between January 2020 and December 2023 at the National Cancer Center of China. Differences in surgical complexity and short-term prognostic outcomes between the two neoadjuvant therapy cohorts were evaluated. The pathological indicators such as pathological response rate and lymph node upstaging/downstaging were then analyzed.
    UNASSIGNED: In total, 33 patients underwent NTT and 73 underwent NCI preoperatively. Patients who received NTT showed a higher minimally invasive surgery rate (84.8% versus 53.4%, p < 0.01), shorter operative time (144 versus 184 min, p < 0.01), lower conversion rate (3.3% versus 17.8%, p = 0.03), less postoperative drainage (day 3: 140 versus 200 mL, p = 0.03), and lower incidence of postoperative complications including arrhythmias (6.1% versus 26%, p = 0.02). The pathological response rate in the NTT and NCI groups was 70% and 75%, respectively, with the latter group showing a higher complete pathological response rate. The two groups had no significant differences in major pathological response and lymph node pathological response rate.
    UNASSIGNED: Patients who received NTT presented fewer surgical challenges for surgeons and had better surgical outcomes than those who received NCI therapy, with comparable pathological response rates between the two cohorts. Accordingly, NTT is the preferred induction regimen for patients harboring mutation status.
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