Personalized cancer treatment

  • 文章类型: Journal Article
    白细胞介素-2(IL-2)及其受体(IL-2R)在协调免疫反应中是必不可少的。它们在肿瘤微环境中的功能和表达使其成为免疫疗法的有吸引力的靶标。导致IL-2/IL-2R靶向治疗策略的发展。然而,IL-2/IL-2R与各种免疫细胞之间的动态相互作用及其在促进免疫激活和耐受中的双重作用为临床开发提供了复杂的前景。本文综述了IL-2和IL-2R在肿瘤发生发展中的关键作用。阐明它们作为诊断和预后标志物的潜力以及它们在癌症中的治疗操作。它强调了平衡抗肿瘤活性与调节性T细胞扩增的必要性,并评估了诸如剂量优化和选择性靶向以增强治疗有效性的策略。本文探讨了该领域的最新进展,包括开发基因工程IL-2变异体,将IL-2/IL-2R靶向治疗与其他癌症治疗相结合,以及整合分子谱分析的多维方法的潜在好处,免疫学分析,和临床数据。该综述得出结论,对肿瘤微环境中IL-2/IL-2R相互作用的更深入了解对于实现基于IL-2的疗法的全部潜力至关重要。预示着改善癌症患者预后的希望。
    Interleukin-2 (IL-2) and its receptor (IL-2R) are essential in orchestrating immune responses. Their function and expression in the tumor microenvironment make them attractive targets for immunotherapy, leading to the development of IL-2/IL-2R-targeted therapeutic strategies. However, the dynamic interplay between IL-2/IL-2R and various immune cells and their dual roles in promoting immune activation and tolerance presents a complex landscape for clinical exploitation. This review discusses the pivotal roles of IL-2 and IL-2R in tumorigenesis, shedding light on their potential as diagnostic and prognostic markers and their therapeutic manipulation in cancer. It underlines the necessity to balance the anti-tumor activity with regulatory T-cell expansion and evaluates strategies such as dose optimization and selective targeting for enhanced therapeutic effectiveness. The article explores recent advancements in the field, including developing genetically engineered IL-2 variants, combining IL-2/IL-2R-targeted therapies with other cancer treatments, and the potential benefits of a multidimensional approach integrating molecular profiling, immunological analyses, and clinical data. The review concludes that a deeper understanding of IL-2/IL-2R interactions within the tumor microenvironment is crucial for realizing the full potential of IL-2-based therapies, heralding the promise of improved outcomes for cancer patients.
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  • 文章类型: Journal Article
    UNASSIGNED:无法手术的支气管外或支气管内肿瘤患者不适合根治性放疗,其预后不佳,没有有效的长期治疗选择。揭示我们的计算机优化的间质光动力疗法(I-PDT)在治疗无法手术的支气管外恶性肿瘤或支气管内恶性肿瘤引起中央气道阻塞的患者中是安全且潜在有效的。
    UNASSIGNED:使用高空间分辨率计算机模拟来个性化每个肿瘤的光剂量率和剂量。根据个性化计划,使用带支气管针的支气管内超声将光纤放置在肿瘤内。主要和次要终点是安全性和总生存期,分别。探索性终点评估免疫标志物的变化。
    未经授权:8名患者在计划时接受了I-PDT,其中五个接收了额外的外部波束PDT。另外两名患者接受了外部束PDT。该治疗被宣布为安全的。10名患者中有3名在26.3、12和8.3个月时存活,分别,在I-PDT之后.治疗能够提供规定的光剂量率和剂量87%至100%和18%至92%的肿瘤体积,分别。在7名患者中的4名中,测量到表达程序性死亡配体1的单核细胞衍生的抑制细胞的比例显着增加。
    UNASSIGNED:使用线性支气管内超声针对I-PDT进行图像引导光剂量测定是安全的,并且可能有益于提高患者的总体生存率。I-PDT对免疫反应具有积极作用,包括增加表达程序性死亡配体1的单核细胞髓源性抑制细胞的比例。
    UNASSIGNED: Patients with inoperable extrabronchial or endobronchial tumors who are not candidates for curative radiotherapy have dire prognoses with no effective long-term treatment options. To reveal that our computer-optimized interstitial photodynamic therapy (I-PDT) is safe and potentially effective in the treatment of patients with inoperable extra or endobronchial malignancies inducing central airway obstructions.
    UNASSIGNED: High-spatial resolution computer simulations were used to personalize the light dose rate and dose for each tumor. Endobronchial ultrasound with a transbronchial needle was used to place the optical fibers within the tumor according to an individualized plan. The primary and secondary end points were safety and overall survival, respectively. An exploratory end point evaluated changes in immune markers.
    UNASSIGNED: Eight patients received I-PDT with planning, and five of these received additional external beam PDT. Two additional patients received external beam PDT. The treatment was declared safe. Three of 10 patients are alive at 26.3, 12, and 8.3 months, respectively, after I-PDT. The treatments were able to deliver a prescribed light dose rate and dose to 87% to 100% and 18% to 92% of the tumor volumes, respectively. A marked increase in the proportion of monocytic myeloid-derived suppressor cells expressing programmed death-ligand 1 was measured in four of seven patients.
    UNASSIGNED: Image-guided light dosimetry for I-PDT with linear endobronchial ultrasound transbronchial needle is safe and potentially beneficial in increasing overall survival of patients. I-PDT has a positive effect on the immune response including an increase in the proportion of programmed death-ligand 1-expressing monocytic myeloid-derived suppressor cells.
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  • 文章类型: Journal Article
    新抗原在细胞膜上的呈递是大多数癌症免疫疗法的基础。由于它们的丰度极低,分析临床样本中的新抗原在技术上是困难的,阻碍了基于新抗原的治疗方法在全球范围内更广泛地用于治疗多种癌症的发展。这里,我们描述了一个集成系统,\"Valid-NEO\",通过直接观察,从微量的临床样本中揭示了患者特异性癌症新抗原治疗靶标,没有基于计算机的预测,在一个敏感的,快速,和可重复的方式。整个四小时程序涉及通过用HLA抗体回收HLA分子从肿瘤样品中纯化的新抗原的质谱分析。有效的NEO可适用于癌症患者中呈递的新抗原的鉴定和定量,特别是当只有有限的样品是可用的。
    The presentation of neoantigens on the cell membrane is the foundation for most cancer immunotherapies. Due to their extremely low abundance, analyzing neoantigens in clinical samples is technically difficult, hindering the development of neoantigen-based therapeutics for more general use in the treatment of diverse cancers worldwide. Here, we describe an integrated system, \"Valid-NEO\", which reveals patient-specific cancer neoantigen therapeutic targets from minute amounts of clinical samples through direct observation, without computer-based prediction, in a sensitive, rapid, and reproducible manner. The overall four-hour procedure involves mass spectrometry analysis of neoantigens purified from tumor samples through recovery of HLA molecules with HLA antibodies. Valid-NEO could be applicable to the identification and quantification of presented neoantigens in cancer patients, particularly when only limited amounts of sample are available.
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  • 文章类型: Case Reports
    血管生成抑制剂(AGI)目前不用于治疗胃癌。该报告表明,血管生成抑制剂可以安全有效地与细胞毒性抗癌剂联合用于治疗胃癌。
    Angiogenesis inhibitors (AGI) are not presently used for the treatment of gastric cancers. This report demonstrates that angiogenesis inhibitor can be safely and effectively used in combination with cytotoxic anti-cancer agents for treatment of Gastric cancers.
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  • 文章类型: Journal Article
    Bacteriophage-eukaryotic cell interaction provides the biological foundation of Phage Display technology, which has been widely adopted in studies involving protein-protein and protein-peptide interactions, and it provides a direct link between the proteins and the DNA encoding them. Phage display has also facilitated the development of new therapeutic agents targeting personalized cancer mutations. Proteins encoded by mutant genes in cancers can be processed and presented on the tumor cell surface by human leukocyte antigen (HLA) molecules, and such mutant peptides are called Neoantigens. Neoantigens are naturally existing tumor markers presented on the cell surface. In clinical settings, the T-cell recognition of neoantigens is the foundation of cancer immunotherapeutics. This year, we utilized phage display to successfully develop the 1st antibody-based neoantigen targeting approach for next-generation personalized cancer therapeutics. In this article, we discussed the strategies for identifying neoantigens, followed by using phage display to create personalized cancer therapeutics-a complete pipeline for personalized cancer treatment.
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  • 文章类型: Journal Article
    To systematically review literature exploring experiences of cancer patients regarding their understanding of treatment-focused genomic testing as well as their information needs and related themes.
    Six databases were searched for the original studies published in English language that explored patients\' understanding of the information related to the genomic testing and its implications for treatment of cancer. The Mixed-Method Assessement Tool was used to examine the methodological quality of selected articles.
    There were 14 studies (5 qualitative and 9 quantitative) that met inclusion and exclusion criteria. The majority of studies revealed that a considerable proportion of cancer patients lacked good undertstanding of treatment-focused genomic testing and wanted to be better informed. Some of the factors associated with poor knowledge about genomic testing were low education, older age, low income, and unemployment. The majority of people with cancer preferred face-to-face communication with their oncologists to discuss and ask questions about genomic testing and treatment. Most also wanted to receive simple, easy to understand written information about treatment-focused genomic testing.
    Genomic testing and its implications for treatment emerge as an important aspect of health care across different types of cancer. The evidence indicates that cancer patients want to understand and be well informed about treatment-focused genomic testing in order to be part of decision-making process. Further studies addressing ways to improve cancer patients\' understanding and knowledge of genomic testing are needed.
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  • 文章类型: Journal Article
    RESILIENT (CTRI/2018/02/011808) was a single arm, open label, phase II/III study to test if label agnostic therapy regimens guided by Encyclopedic Tumor Analysis (ETA) can offer meaningful clinical benefit for patients with relapsed refractory metastatic (r/r-m) malignancies. Patients with advanced refractory solid organ malignancies where disease had progressed following ≥2 lines of systemic treatments were enrolled in the trial. Patients received personalized treatment recommendations based on integrational comprehensive analysis of freshly biopsied tumor tissue and blood. The primary end points were Objective Response Rate (ORR), Progression Free Survival (PFS) and Quality of Life (QoL). Objective Response (Complete Response + Partial Response) was observed in 54 of 126 patients evaluable per protocol (ORR = 42.9%; 95% CI: 34.3%-51.4%, p < 0.0001). At study completion, Disease Control (Complete Response + Partial Response + Stable Disease) was observed in 114 out of 126 patients evaluable per protocol (CBR = 90.5%; 95% CI: 83.9% - 95.0%, p < 0.00001) and Disease Progression in 12 patients. Median duration of follow-up was 138 days (range 31 to 379). Median PFS at study termination was 134 days (range 31 to 379). PFS rate at 90 days and 180 days were 93.9% and 82.5% respectively. The study demonstrated that tumors have latent vulnerabilities that can be identified via integrational multi-analyte investigations such as ETA. This approach identified viable treatment options that could yield meaningful clinical benefit in this cohort of patients with advanced refractory cancers.
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  • 文章类型: Journal Article
    This paper reports the process by which a personalized cancer treatment system was built, following a user-centered approach. We give some background on personalized cancer treatment, the particular tumor chemosensitivity assay supported by the system, as well as some quality and legal issues related to such health systems. We describe how Contextual Design was applied when building the system. Contextual design is a user-centered design technique involving seven steps. We also provide some details about the system implementation. Finally, we explain how the Think-Aloud protocol and Heuristic Evaluation methods were used to evaluate the system and report its results. A qualitative assessment from the users perspective is also provided. Results from the heuristic evaluation indicate that only one of ten heuristics was missing from the system, while five were partially covered and four were fully covered.
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  • 文章类型: Clinical Trial
    预测晚期癌症患者治疗反应的新型生物标志物的发现需要获得高质量的肿瘤样品。随着癌症的发展,理想的是在每次治疗开始之前获得组织。最好,样品是新鲜冷冻的,可以通过下一代DNA/RNA测序(NGS)进行分析,也可以使其他新兴的系统技术,例如蛋白质组学和代谢组学成为可能。这里,我们描述了在荷兰(个性化癌症治疗中心)的大型合作中收集的第一批469例图像引导活检,并显示了这些标本在NGS分析中的实用性。
    在晚期癌症患者中进行图像引导的肿瘤活检。样品是新鲜冷冻的,估计了重要的肿瘤细胞数量,在肿瘤丰富区域的宏观解剖后分离DNA。通过在活检程序后14天内报告严重不良事件来评估图像引导活检程序的安全性。
    活检程序通常耐受良好。主要并发症发生率为2.1%,最常见的是疼痛。在7.3%的经皮肺活检中,发生需要引流的气胸。大多数样本(81%)含有至少30%的重要肿瘤百分比,其中至少500ngDNA可以分离出91%。鉴于我们预设的标准,74%的样品具有足够的生物标志物发现质量。该队列中的NGS结果与其他组的结果一致。
    用于发现生物标志物以实现个性化癌症治疗的图像引导活检程序是安全可行的,并产生了非常有价值的生物样本库。肿瘤学家2017;22:33-40实践意义:这项研究表明,执行图像引导活检程序以获得新鲜的冷冻肿瘤样本是安全的,并且在荷兰多中心合作中使用这些活检用于生物标志物发现目的是可行的。从大多数样本中,可以产生足够的DNA来进行下一代测序。这些结果表明,该方法为财团前瞻性地收集新鲜的冷冻肿瘤组织铺平了道路。
    The discovery of novel biomarkers that predict treatment response in advanced cancer patients requires acquisition of high-quality tumor samples. As cancer evolves over time, tissue is ideally obtained before the start of each treatment. Preferably, samples are freshly frozen to allow analysis by next-generation DNA/RNA sequencing (NGS) but also for making other emerging systematic techniques such as proteomics and metabolomics possible. Here, we describe the first 469 image-guided biopsies collected in a large collaboration in The Netherlands (Center for Personalized Cancer Treatment) and show the utility of these specimens for NGS analysis.
    Image-guided tumor biopsies were performed in advanced cancer patients. Samples were fresh frozen, vital tumor cellularity was estimated, and DNA was isolated after macrodissection of tumor-rich areas. Safety of the image-guided biopsy procedures was assessed by reporting of serious adverse events within 14 days after the biopsy procedure.
    Biopsy procedures were generally well tolerated. Major complications occurred in 2.1%, most frequently consisting of pain. In 7.3% of the percutaneous lung biopsies, pneumothorax requiring drainage occurred. The majority of samples (81%) contained a vital tumor percentage of at least 30%, from which at least 500 ng DNA could be isolated in 91%. Given our preset criteria, 74% of samples were of sufficient quality for biomarker discovery. The NGS results in this cohort were in line with those in other groups.
    Image-guided biopsy procedures for biomarker discovery to enable personalized cancer treatment are safe and feasible and yield a highly valuable biobank. The Oncologist 2017;22:33-40Implications for Practice: This study shows that it is safe to perform image-guided biopsy procedures to obtain fresh frozen tumor samples and that it is feasible to use these biopsies for biomarker discovery purposes in a Dutch multicenter collaboration. From the majority of the samples, sufficient DNA could be yielded to perform next-generation sequencing. These results indicate that the way is paved for consortia to prospectively collect fresh frozen tumor tissue.
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  • 文章类型: Journal Article
    Preclinical research in gynecologic malignancies has largely relied upon cloned cancer-derived cell lines and tumor xenografts derived from these cell lines. Unfortunately, the use of cell lines for translational research has disadvantages because genetic and phenotypic alterations from serial passaging have resulted in expression profiles that are different from the original patient tumors. The patient-derived xenograft (PDX) model derived from human tumor not previously cultured has shown better representation of the heterogeneity of gynecologic malignancies and the human tumor microenvironment with preservation of cytogenetics, cellular complexity, and vascular and stromal tumor architecture. Studies have shown promise with these models to analyze tumor development and adaptation, test drug efficacy, and predict clinical outcomes. Their ultimate value may be seen with preclinical drug screening including novel targeted therapies, biomarker identification, and the development of individualized treatment plans. This article reviews PDX model development, current studies testing chemotherapeutics and targeted therapies, and limitations of the PDX model in gynecologic malignancies.
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