Management Of Cancer Patients Research Articles

Imaging Recommendations for Diagnosis, Staging and Management of Treatment-Related Complications in Cancer

AbstractPrecision medicine is becoming increasingly common in oncology, with treatments tailored to individual patients and cancer. By integrating these underlying concepts of health care, chemotherapy and radiotherapy can be tailored to improve safety and efficacy. On the other hand, oncology treatment regimens may result in local and systemic changes and complications depending on the type of treatment. For the proper and prompt management of cancer patients, it is essential to interpret this posttreatment imaging correctly. This article aims at guiding treating physicians to be able to distinguish complications from expected posttreatment changes.

Oxaliplatin-induced hypersensitivity reactions: risk factors and management.

Chemotherapy-related adverse reactions have been steadily increasing in recent years. In patients who develop oxaliplatin-induced hypersensitivity reactions (HSRs), prognosis and quality of life are adversely affected. Proper management of cancer patients enables them to safely receive first-line treatments. This study aimed to assess the risk factors in oxaliplatin-induced HSRs and the effectiveness of the rapid desensitization protocol. In the study, 57 patients treated with oxaliplatin between October 2019 and August 2020 in the Medical Oncology Department of Elazig City Hospital were retrospectively evaluated. We analyzed patients' clinical histories to reveal any associations with the development of oxaliplatin-induced HSRs. Moreover, we re-evaluated 11 patients with oxaliplatin-induced HSRs through infusion time or desensitization procedures. Of 57 patients treated with oxaliplatin, 11 (19.3%) had HSRs. Patients with HSRs were younger and had higher peripheral blood eosinophil counts than those without HSRs (p=0.004, p=0.020, respectively). Prolongation of the infusion time was effective in the re-administration of oxaliplatin in six of the hypersensitive patients. Rapid desensitization protocol was performed for a total of 11 cycles in four patients with recurrent HSRs, and their chemotherapy regimens were successfully completed. This retrospective study has revealed that younger ages and higher peripheral eosinophil counts could be predictive for oxaliplatin-induced HSR. Furthermore, the study confirms that prolongation of the infusion time and rapid desensitization protocol are effective in patients with HSRs.

Cytological Samples: An Asset for the Diagnosis and Therapeutic Management of Patients with Lung Cancer

Lung cancer has become the leading cause of cancer death for men and women. Most patients are diagnosed at an advanced stage when surgery is no longer a therapeutic option. At this stage, cytological samples are often the less invasive source for diagnosis and the determination of predictive markers. We assessed the ability of cytological samples to perform diagnosis, and to establish molecular profile and PD-L1 expression, which are essential for the therapeutic management of patients. We included 259 cytological samples with suspected tumor cells and assessed the ability to confirm the type of malignancy by immunocytochemistry. We summarized results of molecular testing by next generation sequencing (NGS) and PD-L1 expression from these samples. Finally, we analyzed the impact of these results in the patient management. Among the 259 cytological samples, 189 concerned lung cancers. Of these, immunocytochemistry confirmed the diagnosis in 95%. Molecular testing by NGS was obtained in 93% of lung adenocarcinomas and non-small cell lung cancer. PD-L1 results were obtained in 75% of patients tested. The results obtained with cytological samples led to a therapeutic decision in 87% of patients. Cytological samples are obtained by minimally invasive procedures and can provide enough material for the diagnosis and therapeutic management in lung cancer patients.

Development and Validation of a Prognostic Risk Model Based on Nature Killer Cells for Serous Ovarian Cancer.

Nature killer (NK) cells are increasingly considered important in tumor microenvironment, but their role in predicting the prognosis of ovarian cancer has not been revealed. This study aimed to develop a prognostic risk model for ovarian cancer based on NK cells. Firstly, differentially expressed genes (DEGs) of NK cells were found by single-cell RNA-sequencing dataset analysis. Based on six NK-cell DEGs identified by univariable, Lasso and multivariable Cox regression analyses, a prognostic risk model for serous ovarian cancer was developed in the TCGA cohort. This model was then validated in three external cohorts, and evaluated as an independent prognostic factor by multivariable Cox regression analysis together with clinical characteristics. With the investigation of the underlying mechanism, a relation between a higher risk score of this model and more immune activities in tumor microenvironment was revealed. Furthermore, a detailed inspection of infiltrated immunocytes indicated that not only quantity, but also the functional state of these immunocytes might affect prognostic risk. Additionally, the potential of this model to predict immunotherapeutic response was exhibited by evaluating the functional state of cytotoxic T lymphocytes. To conclude, this study introduced a novel prognostic risk model based on NK-cell DEGs, which might provide assistance for the personalized management of serous ovarian cancer patients.

Sticking to the Rules: Outcome and Success Rate of Guideline-Based Diarrhea Management in Metastatic Breast Cancer Patients Treated with Abemaciclib.

In clinical trials testing abemaciclib in patients with hormone-receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer, diarrhea is a very common adverse event (occurring in approximately 85% of patients, any grade). Nonetheless, this toxicity leads to abemaciclib discontinuation in a small proportion of patients (approximately 2%) thanks to the use of effective loperamide-based supportive therapy. We aimed to determine whether the incidence of abemaciclib-induced diarrhea in real-world trials was higher than the one reported in clinical trials, where patients are highly selected, and to evaluate the success rate of standard supportive care in this setting. We conducted a retrospective, observational, monocentric study including 39 consecutive patients with HR+/HER2- advanced breast cancer treated with abemaciclib and endocrine therapy at our institution from July 2019 to May 2021. Overall, diarrhea of any grade occurred in 36 patients (92%), of whom 6 (17%) had diarrhea of grade ≥3. In 30 patients (77%), diarrhea was associated with other adverse events, including fatigue (33%), neutropenia (33%), emesis (28%), abdominal pain (20%), and hepatotoxicity (13%). Loperamide-based supportive therapy was administered to 26 patients (72%). Abemaciclib dose was reduced in 12 patients (31%) due to diarrhea, and treatment was permanently discontinued in 4 patients (10%). In 58% of patients (15/26), diarrhea was effectively managed with supportive care and did not require abemaciclib dose reduction and/or discontinuation. In our real-world analysis, we observed a higher incidence of diarrhea related to abemaciclib compared to data from clinical trials, and a higher rate of permanent treatment discontinuation due to gastrointestinal toxicity. Better implementation of guideline-based supportive care could help to manage this toxicity.

Cancer-associated fibroblasts facilitate DNA damage repair by promoting the glycolysis in non-small cell lung cancer

Radiotherapy is an essential treatment modality for the management of non-small cell lung cancer (NSCLC) patients. Tumor radioresistance is the major factor limiting the efficacy of radiotherapy in NSCLC patients. Our study aimed to reveal whether cancer-associated fibroblasts (CAFs), one main component of the tumor microenvironment, regulated DNA damage response of NSCLC cells following irradiation and clarify the involved mechanisms. We found CAFs inhibited irradiation-induced DNA damage while promoted DNA repair of NSCLC cells and caused cell cycle arrest in the radioresistant S phase. CAFs have the ability of up-regulating and stabilizing c-Myc, leading to the transcription activation of HK2 kinase, a key rate-limiting enzyme in glycolysis by activating Wnt/β-catenin pathway. Attenuation of glycolysis significantly reversed the effect of CAFs on DNA damage response of NSCLC cells. By high-throughput screening of human cytokines/chemokines array, we found CAFs-secreted midkine led to the promotion of glycolysis by activating Wnt/β-catenin pathway in NSCLC cells. In vivo, CAFs caused the radioresistance of NSCLC cells also by promoting the glycolysis in a β-catenin signaling-dependent manner. These findings may provide novel strategies for reversing the radioresistance of NSCLC cells.

Artificial intelligence in liver cancers: Decoding the impact of machine learning models in clinical diagnosis of primary liver cancers and liver cancer metastases

Liver cancers are the fourth leading cause of cancer-related mortality worldwide. In the past decade, breakthroughs in the field of artificial intelligence (AI) have inspired development of algorithms in the cancer setting. A growing body of recent studies have evaluated machine learning (ML) and deep learning (DL) algorithms for pre-screening, diagnosis and management of liver cancer patients through diagnostic image analysis, biomarker discovery and predicting personalized clinical outcomes. Despite the promise of these early AI tools, there is a significant need to explain the ‘black box’ of AI and work towards deployment to enable ultimate clinical translatability. Certain emerging fields such as RNA nanomedicine for targeted liver cancer therapy may also benefit from application of AI, specifically in nano-formulation research and development given that they are still largely reliant on lengthy trial-and-error experiments. In this paper, we put forward the current landscape of AI in liver cancers along with the challenges of AI in liver cancer diagnosis and management. Finally, we have discussed the future perspectives of AI application in liver cancer and how a multidisciplinary approach using AI in nanomedicine could accelerate the transition of personalized liver cancer medicine from bench side to the clinic.

Spontaneous Osteoclastogenesis, a risk factor for bone metastasis in advanced luminal A-type breast cancer patients.

Osteolytic bone metastasis in advanced breast cancer stages are a major complication for patient´s quality life and a sign of low survival prognosis. Permissive microenvironments which allow cancer cell secondary homing and later proliferation are fundamental for metastatic processes. The causes and mechanisms behind bone metastasis in breast cancer patients are still an unsolved puzzle. Therefore, in this work we contribute to describe bone marrow pre-metastatic niche in advanced breast cancer patients. We show an increase in osteoclasts precursors with a concomitant imbalance towards spontaneous osteoclastogenesis which can be evidenced at bone marrow and peripheral levels. Pro-osteoclastogenic factors RANKL and CCL-2 may contribute to bone resorption signature observed in bone marrow. Meanwhile, expression levels of specific microRNAs in primary breast tumors may already indicate a pro-osteoclastogenic scenario prior to bone metastasis. The discovery of prognostic biomarkers and novel therapeutic targets linked to bone metastasis initiation and development are a promising perspective for preventive treatments and metastasis management in advanced breast cancer patients.

Alternative therapies applied to oncological patients for pain management

INTRODUCTION: Alternative therapies consist of a set of techniques and methods used for the treatment or prevention of diseases, especially in the mind, body and person, providing a balance between the environment and the cancer patient. OBJECTIVE: Analyze the application of alternative therapies in cancer patients for pain management. METHODOLOGY: This is a qualitative, cross-sectional bibliographic review, based on articles found in indexed journals of great academic prestige. The analysis of the information aims to publicize each of the alternative therapies that are used in a cancer patient to treat pain. DISCUSSION: Each of the alternative therapies that have been more effective in relieving pain, such as acupuncture and therapeutic massage, are mentioned in comparison to the others; which are based on managing pain in cancer patients and other symptoms during the course of conventional treatment. CONCLUSION: Each said therapy has its own advantages, from which it is concluded that alternative therapies are effective for pain management in patients with oncological diseases despite the fact that there is little scientific evidence.

The Role of Surgery in the Palliative Care of Cancer: A Retrospective Analysis of 22 years

Aim: Surgical procedures in palliative care are common, however the indications, risks and outcomes are not well described. We present a retrospective review of the management of cancer patients. Material and Methods: During the period 2000-2022, 11.700 of cancer cases (abdominal, gynecological, urological and breast) were recorded in our registries and are analyzed. Group A: All 6000 patients (51,3%) included in this group had a therapeutic intent in their management which include surgical procedures ± neoadjuvant and systemic chemotherapy and radiotherapy. Group B: Palliative approach was applied in 2650 cases (22,6%) with both surgical and medical management being performed. Medical management consists of systemic chemotherapy and radiotherapy. Surgical procedures for palliation, include resections, reconstructions, ostomies, functional repairs, tube drainage and biopsies. Group C: Best supportive care was applied in 3050 cases (26,1%) which includes nutritional management with home parenteral or enteral nutrition, pain management, physical and respiratory physiotherapy, and fistulas or ulcers management. Primary end points include survival advantages while Quality of Life (QOL) was set as a secondary benefit. The risk of morbidity and treatment related mortality are also calculated between the different groups. Results: A median follow up of 80 months was observed. The median O.S. for group A was 44,4 ± 16,3 months and for palliative care group (B) was 26,3+11,7 m (p<0,01). On the other hand, the median O.S. for the group C (Best supportive care) was 8,7 ± 5,2 m. More specifically the group of patients with peritoneal metastasis which include 5200 patients (44,5%) of the total cancer patients was subdivided in 4 subgroups. The role of palliative surgery with or without systemic or neoadjuvant chemotherapy, offer a better O.S. when compared with only systemic chemotherapy (13,4 ± 7,5 m vs 71 ± 4,3 m) with acceptable morbidity and mortality rates. Conclusion: In conclusion, the need for holistic palliative care in cases of incurable malignancy is not entirely clear how it is best to integrate into palliative surgical principles. The essential roles of surgical palliation are, initial evaluation of the disease, local control, control of discharge or hemorrhage, control of pain and reconstruction and rehabilitation

Sex differences in the diagnosis, treatment and prognosis of cancer: the rationale for an individualised approach

BackgroundPrecision medicine in oncology aims to identify the most beneficial interventions based on a patient’s individual features and disease. However, disparities exist when providing cancer care to patients based on an individual’s sex.ObjectiveTo discuss how sex differences impact the epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment, with a focus on data from Spain.ResultsGenetic and environmental factors (social or economic inequalities, power imbalances, and discrimination) that contribute to these differences adversely affect cancer patient health outcomes. Increased health professional awareness of sex differences is essential to the success of translational research and clinical oncological care.ConclusionsThe Sociedad Española de Oncología Médica created a Task Force group to raise oncologists’ awareness and to implement measures to address sex differences in cancer patient management in Spain. This is a necessary and fundamental step towards optimizing precision medicine that will benefit all individuals equally and equitably.

Positive Nipple Margins and Oncologic Outcomes of Nipple-Sparing Mastectomy in a Large Community-Based Hospital System.

The American Society of Breast Surgeons recommends sending separate nipple margins (NMs) when performing nipple-sparing mastectomies (NSMs). However, the definition of a positive NM is vague. We evaluated NM management and outcomes in breast cancer patients undergoing NSM from 2010 to 2021 at our community-based hospital system through a retrospective review and descriptive analysis. A total of 619 patients (1086 NSM) were included. Median invasive tumor size was 1.5cm and median follow-up 30 months. Fourteen therapeutic NSMs had tumor within the NMs. Nine were positive using the definition "any tumor within the separate NM," and nipple-areolar complex (NAC) excised. Two were negative when positive was defined as "any tumor on ink," and were observed without recurrence. Our results suggest positive NMs warranting NAC excision could be interpreted as "any tumor on ink" and NSMs can be safely performed with low rates of positive NMs and recurrences in high-volume hospitals.

Ethnobotanical Survey, Physiochemical Composition and Preliminary Cytotoxic Evaluation of some Medicinal Plants with Anticancer Potential from Certain Areas in South-West Nigeria

Aims: Medicinal plants used by traditional medical practitioners (TMP) to treat cancers are considered safe when used alone or combined with conventional therapy to ensure their effectiveness and eliminate the toxic effects of orthodox medicines. Using cytotoxic and antioxidant studies, the study attempted to assess some of the commonly used medicinal plants used to cure cancer among Yoruba people in Ogun, Oyo, Osun, and Lagos (South-West, Nigeria).
 Study Design: Samples of commonly utilized anticancer plants obtained from the chosen areas using physical and virtual oral seminars were studied for physiochemical composition and a possible antioxidant and cytotoxic potential to validate the basis for the use of the selected anticancer plants.
 Methodology: Online academic literature searches were done on the cited plants to identify the already-exploited anticancer plants. The ethanolic extracts of the plant were examined for the presence of bioactive components and their total flavonoid content, with focusing on quercetin detection using thin layer bioautography (TLB) and brine shrimp lethality assay (BSLA) for cytotoxicity. In comparison to quercetin and ascorbic acid, the scavenging of superoxide radical (SOR), hydrogen peroxide, and 2, 2-Diphenyl-2-picrylhydrazyl (DPPH) radical activity by a model (most biologically active) of the anticancer plant was also evaluated.
 Results: There were only twelve anticancer species that were not used in related studies: Lannea egregia, Ficus exasperate, Croton zambesicus, Tetrapleurai tetraptera, Terminalia catappa, Zanthoxylum zanthoxyloides, Plumbago zelanica, Hilleria latifolia, Bryophyllum pinntum, Chromolena odorata, Brysocarpus coccineus and Spondias mombin. The anticancer plants contained bioactive and mineral substances like saponins, protein, lipids, magnesium, calcium, iron, zinc, and a decreased Na/K concentration. The plants had a fair amount of flavonoids and variable levels of cytotoxicity. L. egeregia was regarded as the prototype of the anticancer species due to its profound flavonoid concentration (85.40 µg/mL) and cytotoxicity (9.46 µg/mL) compared to other extracts. The TLB also demonstrated the presence of quercetin, with a dose-dependent antioxidant property. The anticancer model's overall antioxidant activity (34.72 µg/mL) was slightly lower than quercetin (30.44 µg/mL) but higher than ascorbic acid (41.68 µg/mL).
 Conclusion: The results support the traditional use of anticancer species as nutritional and dietary supplements, whose bioactive compounds are relevant in managing cancer patients. The plant’s bioactive principles need to be characterized in future research.

Managing the adverse effects of cytotoxic chemotherapy at the level of primary healthcare

Background: Despite the increased incidence of cancer, more effective cancer drugs are being developed and cancer patient survival expectancy has been prolonged. Here, we discuss the contribution of primary healthcare clinics to managing the side effects of cytotoxic chemotherapy and provide a compilation of what is currently being used in this field.Current Concepts: Loperamide is recommended for active use when diarrhea occurs. In severe cases, octreotide can help control diarrhea by reducing small bowel fluid secretion. Mouthwash mixed with salt and sodium bicarbonate is helpful for controlling mucositis, and transdermal fentanyl patches can be used for severe pain. Limited evidence suggests that pilocarpine may be helpful for xerostomia. Neurokinin-1 receptor antagonists, serotonin receptor antagonists, glucocorticoids, metoclopramide, and olanzapine are used for nausea and vomiting. Opioid-related constipation can be relieved without counteracting the analgesic effect of opioids via peripherally acting μ-opioid receptor antagonists. Granulocyte colony-stimulating factor is recommended to treat neutropenic fever. In cases with neutropenia but no fever, the decision to use it should be based on the patient’s condition. Minoxidil can be used for hair loss, and scalp cooling can also be considered, but its practical applications are limited. Topical steroid ointments are used to treat hand-foot syndrome. Selective serotonin re uptake inhibitors are recommended for depression in cancer patients because they have little interaction with other drugs and are well tolerated.Discussion and Conclusion: Due to an increased cancer patient management burden and limited medical resources, primary healthcare practitioners should know these management strategies for cancer patients receiving cytotoxic chemotherapy.

Mesenchymal stem cell therapy for treatment of osteoradionecrosis of mandible in head and neck surgery patients - A way forward into the future with promising clinical Outcomes.

Managing osteoradionecrosis is an integral part of complication management in head and neck cancer patients. While essentially an infection, the management of this complication has a considerable task for head and neck surgeons. While various measures have been discussed for the management, stem cells injection therapy is a potential management option. Mesenchymal stem cell therapy provides the local tissue with growth factors and proliferative cells that can aid a radiated tissue in the healing process. The article intends to review the bedrock of the pathology, ranging from pathophysiological and the epidemiological concerns to sparking a potential discussion on the use of mesenchymal stem cell therapy in osteoradionecrosis of mandible in head and neck cancer surgery and thus the ensuing future of the regenerative medicine. Moreover, the article has considered the management option in a developing nation thus explaining the procedural as well as the financial pitfalls and has highlighted the potential loop holes to be addressed in the management of osteoradionecrosis with stem cell therapy.

Non-obese or lean non-alcoholic fatty liver disease was associated with increased risk of cancer in patients with type 2 diabetes mellitus

IntroductionRisk of non-obese or lean non-alcoholic fatty liver disease (NAFLD) for cancer in patients with type 2 diabetes mellitus (T2DM) is less known. We aimed to evaluate independent associations of...

Clinical Implications of Pathology Review in Management of Cancer Patients: Audit Data from a Tertiary Care Centre of Eastern India

Clinical Implications of Pathology Review in Management of Cancer Patients: Audit Data from a Tertiary Care Centre of Eastern India

Assessing the impact of predictive biomarkers’ for immunotherapy on the clinical management of gastric cancer patients: a real life cohort

Assessing the impact of predictive biomarkers’ for immunotherapy on the clinical management of gastric cancer patients: a real life cohort

Patient-specific tumor-informed circulating tumor DNA (ctDNA) analysis for molecular residual disease (MRD) detection in surgical patients with stage I-IV colorectal cancer (CRC).

213 Background: Identifying molecular residual disease (MRD) with tailored tumor-informed ctDNA-based next-generation sequencing (NGS) assays after curative surgery could facilitate the individualized management of resected colorectal cancer (CRC) patients. Here, we prospectively evaluated the clinical performance of tumor-informed ctDNA mutation analysis using a novel Burning Rock Patient-specific Prognostic and Potential Therapeutic Marker Tracking (brPROPHET) approach for assessing MRD in resected CRC patients. Methods: The brPROPHET assay was designed to track patient-specific somatic variants based on whole-exome sequencing (WES) of the tumor tissue and matched white blood cells (WBCs). Fixed panel with informed calling (FI) and fixed panel with agnostic calling (FA) assays were performed in a subset of patients with a 168-gene panel spanning 273 kb of the human genome for a head-to-head comparison. Results: A total of 117 patients (stage II/III 53[45.0%]/41[35.0%]) were analyzed. 60 (51.0%) patients were treated with adjuvant therapy after surgery. brPROPHET assay was designed to target up to 55 variants per patient. Only 6% (344/5835) of designed variants were included in the fixed panels. 75% (2908/3886) of genes selected for panel design were private to a specific patient. Preoperative ctDNA was detected in 97% (113/117) of the patients with 88% (14/16), 98% (52/53), 98% (40/41), and 100% (7/7) in stage I, II, III and IV, respectively. The median ctDNA levels were observed to be higher in patients with advanced stages and significantly correlated with tumor volume. MRD status was tested postoperatively on day 7 and day 30 with a positivity rate of 18% (21/117) and 15% (14/93), respectively. Due to a short follow-up period, only two patients had recurred, and ctDNA was detected prior to radiological relapse, with a lead time of 1 and 2 months, respectively. Among 74 patients enrolled for parallel comparing three MRD assays, preoperative ctDNA was detected in 97.3%, 75.7%, and 68.9% of patients with brPROPHET, FI and FA fixed panel assays, respectively. 20.3% (15/74) of patients had baseline ctDNA captured by brPROPHET assay only. The ctDNA levels of these patients (median:0.3 mean tumor molecules [MTM] / milliliter [mL]) were lower than those captured by FI/FA fixed panels (median:3.0 MTM/mL, p<0.05). A total of 135 postoperative blood samples were tested by all three assays, the positive rates with brPROPHET, FI and FA fixed panel assays were 14.8%, 8.1%, and 6.7% respectively. Conclusions: This initial study reported the clinical performance of the patient-specific brPROPHET assay in CRC, demonstrating superior sensitivity in detecting preoperative and postoperative ctDNA than the fixed panel assays. The ongoing study including correlation with clinical outcomes and serial testing will be presented.

Clinical Utility and Application of Liquid Biopsy Genotyping in Lung Cancer: A Comprehensive Review.

Precision medicine has revolutionized the therapeutic management of cancer patients with a major impact on non-small cell lung cancer (NSCLC), particularly lung adenocarcinoma, where advances have been remarkable. Tissue biopsy, required for tumor molecular testing, has significant limitations due to the difficulty of the biopsy site or the inadequacy of the histological specimen. In this context, liquid biopsy, consisting of the analysis of tumor-released materials circulating in body fluids, such as blood, is increasingly emerging as a valuable and non-invasive biomarker for detecting circulating tumor DNA (ctDNA) carrying molecular tumor signatures. In advanced/metastatic NSCLC, liquid biopsy drives target therapy by monitoring response to treatment and identifying eventual genomic mechanisms of resistance. In addition, recent data have shown a significant ability to detect minimal residual disease in early-stage lung cancer, underlying the potential application of liquid biopsy in the adjuvant setting, in early detection of recurrence, and also in the screening field. In this article, we present a review of the currently available data about the utility and application of liquid biopsy in lung cancer, with a particular focus on the approach to different techniques of analysis for liquid biopsy and a comparison with tissue samples as well as the potential practical uses in early and advanced/metastatic NSCLC.