Future Of Cancer Management Research Articles

Immediate clip migration after breast biopsy: a meta-analysis for potential risk factors.

Immediate clip migration following breast biopsy is not a rare condition but its impact on future cancer management can be profound. However, there is limited knowledge on what causes the phenomenon and how to prevent it. A systematic search was performed to identify articles discussing factors associated with clip migration, and a meta-analysis for each risk factor was conducted to determine the risk ratio. The most significant risk factor for immediate clip migration is globally fatty breast (RR = 2.00 [1.43-2.80], P<0.00001), while local heterogeneity has a moderate but insignificant protective effect (RR=0.68 [0.45-1.04], P=0.07). Clips with bioabsorbable carriers and biopsy along the superior/inferior breast axis do not change the rate of clip migration. Intrinsic breast composition is the most important determinant for accurate clip placement. Further research to identify potentially modifiable factors, such as clip design and biopsy techniques, is needed. Fatty breast composition has the highest risk of clip migration. Research on potentially modifiable factors such as clip design and biopsy techniques is needed.

Prognostic prospect of soluble programmed cell death ligand-1 in cancer management.

Aggressive tissue biopsy is commonly unavoidable in the management of most suspected tumor cases to conclusively verify the presence of cancerous cells through histological assessment. The extracted tissue is also immunostained for detection of antigens (tissue tumor markers) of potential prognostic or therapeutic importance to assist in treatment decision. Although liquid biopsies can be a powerful tool for monitoring treatment response, they are still excluded from standard cancer diagnostics, and their utility is still being debated in the scientific community. With a myriad of soluble tissue tumor markers now being discovered, liquid biopsies could completely change the current paradigms of cancer management. Recently, soluble programmed cell death ligand-1 (sPD-L1), which is found in the peripheral blood, i.e. serum and plasma, has shown potential as a pre-therapeutic predictive marker as well as a prognostic biomarker to monitor treatment efficacy. Thus, this review focuses on the emergence of sPD-L1 and promising technologies for its detection in order to support liquid biopsies for future cancer management.

Estimating the future cancer management costs attributable to modifiable risk factors in Canada.

An estimated 33-37% of incident cancers in Canada are attributable to modifiable risk factors. Interventions targeting these risk factors would minimize the substantial health and economic burdens Canadians face due to cancer. We estimate the future health and economic burden of cancer in Canada by incorporating data from the Canadian Population Attributable Risk of Cancer (ComPARe) study into OncoSim, a web-based microsimulation tool. Using the integrated OncoSim population attributable risk and population impact measures, we evaluated risk factor-targeted intervention scenarios implemented in 2020, assuming the targeted risk factor prevalence reduction would be achieved by 2032 with a 12-year latency period. We estimate that smoking will be the largest contributor to cancer-related costs, with a cost of CAD $44.4 billion between 2032 and 2044. An estimated CAD $3.3 billion of the cost could be avoided with a 30% reduction in smoking prevalence by 2022. Following smoking, the next highest cancer management costs are associated with inadequate physical activity and excess body weight, accounting for CAD $10.7 billion ($2.7 billion avoidable) and CAD $9.8 billion ($3.2 billion avoidable), respectively. Avoidable costs for other risk factors range from CAD $90 million to CAD $2.5 billion. Interventions targeting modifiable cancer risk factors could prevent a substantial number of incident cancer cases and billions of dollars in cancer management costs. With limited budgets and rising costs in cancer care in Canada, these simulation models and results are valuable for researchers and policymakers to inform decisions and prioritize and evaluate intervention programs.

Circadian clock associates with tumor microenvironment in thoracic cancers.

The application of cancer chronotherapy is to treat cancers based on at specific times during circadian rhythms. Previous studies have characterized the impact of circadian clock on tumorigenesis and specific immune cells. Here, by using multi-omics computation techniques, we systematically characterized the distinct roles of core circadian clock genes in thoracic cancers including lung adenocarcinoma, lung squamous cell carcinoma, and esophageal carcinoma. Strikingly, a wide range of core clock genes are epigenetically altered in lung adenocarcinomas and lung squamous cell carcinomas but not esophageal carcinomas. Further cancer hallmark analysis reveals that several core clock genes highly correlate with apoptosis and cell cycle such as RORA and PER2. Interestingly, our results reveal that CD4 and CD8 T cells are correlated with core clock molecules especially in lung adenocarcinomas and lung squamous cell carcinomas, indicating that chrono-immunotherapy may serve as a candidate option for future cancer management.

The role of Clusterin in cancer metastasis.

Clusterin is a conserved glycoprotein that has been characterized from almost all human tissues and fluids and plays a key role in cellular stress response and survival. Recently, research efforts have been contributed to explore the function of Clusterin in cancer metastasis, which is particularly important to design the strategies for treating metastatic patients. Evidence collected has demonstrated that Clusterin is overexpressed in tumor metastatic patients and experimental metastasis models. Specifically, Clusterin has been shown to have the role in anti-apoptotic capacities, development of therapy resistance and induction of epithelial–mesenchymal transition, all associated with cancer metastasis. Inhibition of Clusterin is known to increase the cytotoxic effects of chemotherapeutic agents and improves advanced cancer patients survival in clinical trials. Our unpublished data have demonstrated that Clusterin is overexpressed in bladder cancer and metformin, a well-known metabolism modulator specifically targets Clusterin by inhibiting migration of bladder cancer cells. In this review, we provide a general view of how Clusterin modulates cancer metastasis and update current understanding of detailed molecular mechanisms underlying of Clusterin for developing cancer management in future.

Molecular Profiling and Significance of Circulating Tumor Cell Based Genetic Signatures.

Cancer kills by metastasizing beyond the primary site. Early detection, surgical intervention and other treatments have improved the survival rates of patients with cancer, however, once metastasis occurs, responses to conventional therapies become significantly less effective, and this remains the leading cause of death. Circulating tumor cells (CTCs) are tumor cells that have preferentially disseminated from the primary tumor mass into the hematological system, and are en route to favorable distant sites where if they survive, can develop into metastases. They may be the earliest detectable cells with metastatic ability, and are gaining increasing attention because of their prognostic value in many types of cancers including breast, prostate, colon and lung. Recent technological advances have removed barriers that previously hindered the detection and isolation of these rare cells from blood, and have exponentially improved the genetic resolution at which we can characterize signatures that define CTCs. Some of the most significant observations from such examinations are described here. Firstly, aberrations that were thought to be unique to CTCs are detected at subclonal frequencies within primary tumors with measurable heterogeneity, indicating pre-existing genetic signatures for metastasis. Secondly, these subclonal events are enriched in CTCs and metastases, pointing towards the selection of a more 'fit' component of tumor cells with survival advantages. Lastly, this component of cancer cells may also be the chemoresistant portion that escapes systemic treatment, or acquires resistance during progression of the disease. The future of cancer management may include a standardized method of measuring intratumor heterogeneity of the primary as well as matched CTCs. This will help identify and target rare aberrations within primary tumors that make them more adept to disseminate, and also to monitor the development of treatment resistant subclones as cancer progresses.

Roles of Natural Compounds from Medicinal Plants in Cancer Treatment: Structure and Mode of Action at Molecular Level.

Every year, cancer takes the life of millions of people. Conventional treatments have produced unsatisfactory results for some types of cancer, and the side effects are extensive, leading to a shift in the focus of treatment towards alternative medicines. Indeed, medicinal plants have long been investigated by scientists for their anti-cancer properties. Some phytochemicals that are important active constituents of plants, including catechins, ursolic acid, silymarin, glycyrrhizin, ellagic acid, gallic acid and various types of flavonoids, have shown promise in future cancer management. The current review covers various aspects of cancer treatment based on medicinal plants at molecular level and sheds light on their structures and modes of action.

In Vivo Tumor Vasculature Targeting of CuS@MSN Based Theranostic Nanomedicine.

Actively targeted theranostic nanomedicine may be the key for future personalized cancer management. Although numerous types of theranostic nanoparticles have been developed in the past decade for cancer treatment, challenges still exist in the engineering of biocompatible theranostic nanoparticles with highly specific in vivo tumor targeting capabilities. Here, we report the design, synthesis, surface engineering, and in vivo active vasculature targeting of a new category of theranostic nanoparticle for future cancer management. Water-soluble photothermally sensitive copper sulfide nanoparticles were encapsulated in biocompatible mesoporous silica shells, followed by multistep surface engineering to form the final theranostic nanoparticles. Systematic in vitro targeting, an in vivo long-term toxicity study, photothermal ablation evaluation, in vivo vasculature targeted imaging, biodistribution and histology studies were performed to fully explore the potential of as-developed new theranostic nanoparticles.

Trastuzumab guided nanotheranostics: A lipid based multifunctional nanoformulation for targeted drug delivery and imaging in breast cancer therapy

Nowadays, emerging aspects of cancer therapy involve both diagnostic and therapeutic modules in a single setting. Targeted theranostic nanoplatforms have emerged globally as frontier research for the improvement of cancer therapy. Trastuzumab (Tmab), a humanized monoclonal antibody is now being used to target human epidermal growth factor receptor-2 (HER 2) positive cancer cells. In the present study, we have analysed the imaging and theragnosis potentiality of Tmab functionalized lipid based nanoparticles (NPs) loaded with anticancer drug rapamycin and imaging agent (quantum dots) for targeted cancer therapy and imaging. The therapeutic evaluation of drug loaded NPs were evaluated through various in vitro cellular studies. The results showed enhanced therapeutic efficacy of targeted drug loaded NPs over native drug and unconjugated NPs in HER 2 positive SKBR 3 breast cancer cell line. Moreover, exploration of the therapeutic benefits of rapamycin loaded Tmab conjugated NPs (Tmab-rapa-NPs) at molecular level, revealed augmented down regulation of mTOR signalling pathway thereby, inducing more cell death. Above all, our targeted multifunctional NPs have shown an excellent bio-imaging modality both in 2D monolayer and 3D tumor spheroid model. Thus, we can anticipate that such a multimodal nanotheranostic approach may be a useful tool for better cancer management in future.

Radiation Protective Potentiality of Adhatoda vasica.

The present study forecasts the extensive damage caused by radiotherapy and chemotherapy treatment for cancer in the genetic setup of an individual. To counteract this damage, radioprotective potentiality of 50% Methanolic extract of Adhatoda vasica was evaluated through Cyto-Geno analysis.50% Methanolic extract of Adhatoda vasica leaves was used as a drug whose radioprotective potentiality was to be investigated. Human peripheral lymphocytes were cultured using RPMI-1640 media, harvested and observed under microscope for chromosomal aberration assay.Total 200 metaphases were counted for each group. All the metaphases were found to be normal in Control group. The frequency of normal metaphases greatly increased after pretreatment with both low and high drug dose (50mg/Kg body weight and 100mg/Kg body weight) concentration. The average normal metaphase in Radiation Control was 118 out of 200 metaphases but after pretreatment with 50% Methanolic extract of Adhatoda vasica the number of normal metaphase increased to 179 at 50mg/Kg body weight and 184 at 100mg/Kg body weight. It was concluded that 50% Methanolic Extract of Adhatoda vasica with both low and high drug doses have shown its potentiality as a radio protector against the therapeutically induced mutations which can prove to be a contributor in cancer management in future. Such indigenous Indian, herbal, cost effective, poor man friendly drug will definitely be a potential adjuvant to cancer treatments like radiotherapy and chemotherapy since Amifostine a well known radioprotector given to the patients at the time of cancer therapy is expensive and has its own side effects. Keywords: Radiation Protective, Adhatoda vasica, metaphases

Drug-eluting polymer implants in cancer therapy

Background: Drug-eluting polymer implants present a compelling parenteral route of administration for cancer chemotherapy. With potential for minimally invasive, image-guided placement and highly localized drug release, these delivery systems are playing an increasingly important role in cancer management. This is particularly true as the use of labile proteins and other bioactive molecules is likely to increase in the upcoming years. Objective: In this review, we present the current trends in the application of Pre-formed and in situ-forming systems as drug-eluting implants for cancer chemotherapy. Methods: We outline the clinically available options as well as up-and-coming technologies and their advantages and challenges. We also describe ongoing related innovations with image-guided drug delivery, mathematical modeling of implanted delivery systems and implanted drug delivery in combination with other therapies. Results/conclusion: Whether used alone or combined with other minimally invasive procedures, drug-eluting polymeric implants will play a significant role in the future of cancer management.

Targeting cancer stem cells with monoclonal antibodies: a new perspective in cancer therapy and diagnosis

This review discusses some of the impacts that biotechnology, genomics and nanotechnology convergence should have on future cancer management, in particular, the development of innovative diagnostic and therapeutic approaches based on monoclonal antibodies (mAbs) and cancer stem cells. Emergent therapeutic strategies in cancer have been focusing on the use of mAbs to stimulate an immune response against tumors, to block signaling pathways, or to refine delivery of cytotoxic agents. Now that cancer stem cells are being identified and characterized in different tumor types, their relevance to cancer physiopathology is becoming evident, making them natural targets for mAb development. Cancer stem cells are postulated to be responsible for tumor development, metastasis and relapse after conventional therapies. Therefore, mAbs targeting specific antigens and related pathways altered in cancer stem cells should facilitate earlier diagnosis through molecular imaging techniques and more efficient destruction of tumor initiating cells, thus improving clinical outcome.

Poor prognosis in carcinoma is associated with a gene expression signature of aberrant PTEN tumor suppressor pathway activity.

Pathway-specific therapy is the future of cancer management. The oncogenic phosphatidylinositol 3-kinase (PI3K) pathway is frequently activated in solid tumors; however, currently, no reliable test for PI3K pathway activation exists for human tumors. Taking advantage of the observation that loss of PTEN, the negative regulator of PI3K, results in robust activation of this pathway, we developed and validated a microarray gene expression signature for immunohistochemistry (IHC)-detectable PTEN loss in breast cancer (BC). The most significant signature gene was PTEN itself, indicating that PTEN mRNA levels are the primary determinant of PTEN protein levels in BC. Some PTEN IHC-positive BCs exhibited the signature of PTEN loss, which was associated to moderately reduced PTEN mRNA levels cooperating with specific types of PIK3CA mutations and/or amplification of HER2. This demonstrates that the signature is more sensitive than PTEN IHC for identifying tumors with pathway activation. In independent data sets of breast, prostate, and bladder carcinoma, prediction of pathway activity by the signature correlated significantly to poor patient outcome. Stathmin, encoded by the signature gene STMN1, was an accurate IHC marker of the signature and had prognostic significance in BC. Stathmin was also pathway-pharmacodynamic in vitro and in vivo. Thus, the signature or its components such as stathmin may be clinically useful tests for stratification of patients for anti-PI3K pathway therapy and monitoring therapeutic efficacy. This study indicates that aberrant PI3K pathway signaling is strongly associated with metastasis and poor survival across carcinoma types, highlighting the enormous potential impact on patient survival that pathway inhibition could achieve.

The future of cancer management: translating the genome, transcriptome, and proteome.

Predicting who will develop cancer and how the cancer will behave and respond to therapy after diagnosis are some of the potential benefits of the ongoing genetic revolution that can be envisioned within the next decade. Translational applications of genomic-based research efforts may actually precede the development of effective therapeutic agents that can exploit the vast amounts of data derived from these efforts. In the future, understanding the wealth of information generated by high-throughput molecular efforts and how it can be applied to clinical problems will likely be critical to the surgeon who guides the multidisciplinary care of the cancer patient. This review will discuss the advances in our understanding of the human genome (DNA), its derived transcriptome (RNA), and its translated proteome (proteins) and will focus on the translation of this information into routine clinical practice. In particular, we will focus on the potential for clinical application of microarray-based gene-expression profiling to the diagnosis, prognosis, and therapy of malignancies.

Molecular characterization as a target for cancer therapy in relation to orphan status disorders (Review).

The long-term effort in investigating chemical methods to eliminate only cancer cells has improved our knowledge and has led to the development of new drugs. The targets for cancer treatment may be large polymeric molecules such as DNA or microtubules as well as regulatory pathways for tumor development and cell survival preservation or tyrosine kinase activity. Examples of new agents are: trastuzumab (Herceptin), a humanized monoclonal antibody that blocks the HER-2/neu proto-oncogene in combination with cytotoxic agents, is used in a percentage of breast cancer patients; signal transduction inhibitor of abl tyrosine kinase STI 571 (Glivec) has been shown to be an active treatment for chronic myeloid leukemia and GISTs; epidermal growth factor receptors in certain tumors have been targeted with agents such as C225 (Cetuximab) and ZD 1839 (IRESSA); an adenosine deaminase analogue of deoxyadenosine, Cladribine (2-chloro-2 deoxy-adenosine) has shown high effectiveness in hairy-cell leukemia and the multitargeted antifolate (Premetrexed) and several vaccines have been studied and are in clinical trials for resistant cancers. These new drug developments represent a promising field for future cancer management.

Polymerase chain reaction in the staging of solid tumors.

Polymerasechain reaction (PCR) is a molecular biology technique that holds great promise as a way to perform molecular staging of cancer by detecting very early metastatic disease. Significant data suggest that PCR analysis may play an important role in the management of colorectal cancer in the future. However, for PCR staging of breast cancer, progress awaits identification of gene markers that have sufficient sensitivity and specificity. Within the next few years, the results of the Sunbelt Melanoma Trial and other ongoing studies will determine whether PCR evaluation of sentinel lymph nodes and peripheral blood cells has prognostic relevance in melanoma. The future of cancer management will likely revolve around the molecular staging of tumors, and PCR is but one method that may better define subgroups of patients that are appropriate candidates forvarious anticancer therapies.