scholarly journals Innovative strategies in metastatic gastric cancer: a short review

2021 ◽  
Author(s):  
Hannah Christina Puhr ◽  
Aysegul Ilhan-Mutlu
Keyword(s):  
Targeted Therapies ◽  
Treatment Strategies ◽  
Threshold Value ◽  
Short Review ◽  
Metastatic Gastric Cancer ◽  
Paradigm Change ◽  
Gastroesophageal Cancer ◽  
Innovative Strategies ◽  
Specific Subgroup ◽  
The Face

SummaryRecent innovative advances, especially concerning immunotherapeutic agents and targeted therapies, have changed the face of modern oncology. The year 2020 represents a milestone in the treatment of gastroesophageal cancer because several trials showed promising survival benefits, at least for a specific subgroup of patients. Not only immunotherapeutic agents, but also targeted therapies seem to be beneficial, particularly when the target is well defined and the threshold value is selected appropriately. Thus, many new innovative treatment strategies are underway and might lead to a further paradigm change in the therapy of patients with advanced gastric tumors. This review gives a concise overview of these new therapeutic options and recently approved strategies as well as ongoing studies.

scholarly journals Disorders of erythrocyte hydration

Blood ◽  
2017 ◽  
Vol 130 (25) ◽  
pp. 2699-2708 ◽  
Author(s):  
Patrick G. Gallagher
Keyword(s):  
Glucose Transporter ◽  
Cell Function ◽  
Clinical Laboratory ◽  
Hemoglobin Concentration ◽  
Solute Content ◽  
Innovative Strategies ◽  
Clinical Complications ◽  
Anion Transporter ◽  
Cellular Dehydration ◽  
The Face

Abstract The erythrocyte contains a network of pathways that regulate salt and water content in the face of extracellular and intracellular osmotic perturbations. This allows the erythrocyte to maintain a narrow range of cell hemoglobin concentration, a process critical for normal red blood cell function and survival. Primary disorders that perturb volume homeostasis jeopardize the erythrocyte and may lead to its premature destruction. These disorders are marked by clinical, laboratory, and physiologic heterogeneity. Recent studies have revealed that these disorders are also marked by genetic heterogeneity. They have implicated roles for several proteins, PIEZO1, a mammalian mechanosensory protein; GLUT1, the glucose transporter; SLC4A1, the anion transporter; RhAG, the Rh-associated glycoprotein; KCNN4, the Gardos channel; and ABCB6, an adenosine triphosphate–binding cassette family member, in the maintenance of erythrocyte volume homeostasis. Secondary disorders of erythrocyte hydration include sickle cell disease, thalassemia, hemoglobin CC, and hereditary spherocytosis, where cellular dehydration may be a significant contributor to disease pathology and clinical complications. Understanding the pathways regulating erythrocyte water and solute content may reveal innovative strategies to maintain normal volume in disorders associated with primary or secondary cellular dehydration. These mechanisms will serve as a paradigm for other cells and may reveal new therapeutic targets for disease prevention and treatment beyond the erythrocyte.

Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

2021 ◽  
Author(s):  
Sonja Heinzelmann ◽  
Daniel Böhringer ◽  
Philip Christian Maier ◽  
Berthold Seitz ◽  
Claus Cursiefen ◽  
...  
Keyword(s):  
Graft Rejection ◽  
Graft Failure ◽  
Penetrating Keratoplasty ◽  
Treatment Strategies ◽  
Cost Benefit ◽  
Topical Steroids ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Open Questions ◽  
The Face

Abstract Background Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. Objective The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany. Methods Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. Results All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 – 5 times daily) and tapering (2 – 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days. Discussion Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

Cholangiocarcinoma therapeutics: an update

2021 ◽  
Vol 21 ◽  
Author(s):  
Mai Ly Thi Nguyen ◽  
Nguyen Linh Toan ◽  
Maria Bozko ◽  
Khac Cuong Bui ◽  
Przemyslaw Bozko
Keyword(s):  
Treatment Outcome ◽  
Targeted Therapies ◽  
Treatment Strategies ◽  
Favourable Outcome ◽  
High Rate ◽  
Postoperative Treatment ◽  
Clinical Indication ◽  
Tumour Resection ◽  
First Line ◽  
Treatment Methods

Background: Background: Cholangiocarcinoma (CCA) is the second most common hepatobiliary cancer and associated with poor prognosis. Only one-third of CCA cases are diagnosed at operable stages. However, a high rate of relapse has been observed post-operatively. Besides screening for operable individuals, efficacious therapeutic for recurrent and advanced CCA is urgently needed. Treatment outcome of available therapeutics is important to clarify clinical indication and facilitate development of treatment strategies. Objective: This review aims to compare the treatment outcome of different therapeutics based on both overall survival and progression-free survival. Methods: Over one hundred peer-reviewed articles were examined. We compared the treatment outcome between different treatment methods, including tumour resection with or without postoperative systematic therapy, chemotherapies including FOFLOX and targeted therapies, such as IDH1, K-RAS and FGFR inhibitors. Notably, the scientific basis and outcome of available treatment methods werecompared with the standard first-line therapy. Results: CCAs at early stages should firstly undergo tumour resection surgery, followed by postoperative treatment with Capecitabine. Chemotherapy can be considered as a preoperative option for unresectable CCAs. Inoperable CCAs with genetic aberrances like FGFR alterations, IDH1 and K-RAS mutations should be considered with targeted therapies. Fluoropyrimidine prodrug (S-1)/Gemcitabine/Cisplatin and nab-Paclitaxel/Gemcitabine/Cisplatin show favourable outcome which hints on the triplet regimen to be superior to Gemcitabine/Cisplatinon CCA. Thetriplet chemotherapeutic should be tested further compared toGemcitabine/Cisplatin among CCAs without genetic alterations.Gemcitabine plus S-1 was recently suggested as the convenient and equivalent standard first line for advanced/recurrent biliary tract cancer. Conclusions: Thisreview provides a comparative outcomebetween novel targeted therapies and currently available therapeutics.

scholarly journals New drug developments in metastatic gastric cancer

2018 ◽  
Vol 11 ◽  
pp. 175628481880807 ◽  
Author(s):  
Aaron C. Tan ◽  
David L. Chan ◽  
Wasek Faisal ◽  
Nick Pavlakis
Keyword(s):  
Gastric Cancer ◽  
Clinical Trials ◽  
Targeted Therapies ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Predictive Biomarkers ◽  
Metastatic Gastric Cancer ◽  
New Era

Metastatic gastric cancer is associated with a poor prognosis and novel treatment options are desperately needed. The development of targeted therapies heralded a new era for the management of metastatic gastric cancer, however results from clinical trials of numerous targeted agents have been mixed. The advent of immune checkpoint inhibitors has yielded similar promise and results from early trials are encouraging. This review provides an overview of the systemic treatment options evaluated in metastatic gastric cancer, with a focus on recent evidence from clinical trials for targeted therapies and immune checkpoint inhibitors. The failure to identify appropriate predictive biomarkers has hampered the success of many targeted therapies in gastric cancer, and a deeper understanding of specific molecular subtypes and genomic alterations may allow for more precision in the application of novel therapies. Identifying appropriate biomarkers for patient selection is essential for future clinical trials, for the most effective use of novel agents and in combination approaches to account for growing complexity of treatment options.

scholarly journals Advances in targeted therapy for esophageal cancer

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Yan-Ming Yang ◽  
Pan Hong ◽  
Wen Wen Xu ◽  
Qing-Yu He ◽  
Bin Li
Keyword(s):  
Esophageal Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Targeted Therapies ◽  
Treatment Strategies ◽  
Growth Factor Receptor ◽  
Immune Checkpoints ◽  
Her 2 ◽  
Epidermal Growth

Abstract Esophageal cancer (EC) is one of the most lethal cancers in the world, and its morbidity and mortality rates rank among the top ten in China. Currently, surgical resection, radiotherapy and chemotherapy are the primary clinical treatments for esophageal cancer. However, outcomes are still unsatisfactory due to the limited efficacy and severe adverse effects of conventional treatments. As a new type of approach, targeted therapies have been confirmed to play an important role in the treatment of esophageal cancer; these include cetuximab and bevacizumab, which target epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF), respectively. In addition, other drugs targeting surface antigens and signaling pathways or acting on immune checkpoints have been continuously developed. For example, trastuzumab, a monoclonal antibody targeting human epidermal growth factor receptor 2 (HER-2), has been approved by the Food and Drug Administration (FDA) as a first-line treatment of HER-2-positive cancer. Moreover, the PD-L1 inhibitor pembrolizumab has been approved as a highly efficient drug for patients with PD-L1-positive or advanced esophageal squamous cell carcinoma (ESCC). These novel drugs can be used alone or in combination with other treatment strategies to further improve the treatment efficacy and prognosis of cancer patients. Nevertheless, adverse events, optimal dosages and effective combinations still need further investigation. In this review, we expound an outline of the latest advances in targeted therapies of esophageal cancer and the mechanisms of relevant drugs, discuss their efficacy and safety, and provide a clinical rationale for precision medicine in esophageal cancer.

scholarly journals Short Review On Varicose Vein And Its Management

2021 ◽  
Vol 12 (1) ◽  
pp. 832-836
Author(s):  
Pranav N ◽  
Anila K N ◽  
Riju.R.Menon
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Inflammatory Responses ◽  
Early Stage ◽  
Treatment Strategies ◽  
Short Review ◽  
Disease Diagnosis ◽  
Treated Group ◽  
Severe Condition

A varicose vein is a condition which affects a large number of people in Western countries and India especially, the northern areas. For curing this proper disease diagnosis, sufficient care for patient and treatment strategies are required, to control the symptoms and signs of varicose vein, the flavonoid group of drugs have been widely used for many years. Under this group, Daflon is the most potent and efficient drug which can be used. This enhances the bioavailability and absorption from the gastrointestinal area. Improved quality of patient's life and efficacy makes this drug therapy more potent and significant. Some of the clinical studies have shown its better action for increased venous tone, lymphatic drainage, decreases cosmetic disfigurement, inflammatory responses occur in microcirculation, protection from free radicals and improved quality of life and efficacy. When compared with other available drugs like Polidocanol, Sotradecol, Asclera, Varithena, Sodium tetradecyl sulfate etc. .clinical benefits of Daflon is more. This drug is useful in the early stage and can be used in severe condition along with sclerotherapy, compression treatment and surgery. Increased patient’s quality of life and increased efficacy were observed in Daflon treated group. Thus it is efficacious as a standard therapy alone and also in combination with other conservative treatment.

Targeted Therapies in Metastatic Gastric Cancer: Challenges and Perspectives

2018 ◽  
Vol 07 (02) ◽  
Author(s):  
Ismail Essadi ◽  
Khalid Sair ◽  
Issam Lalya ◽  
Elomrani Abderrahim ◽  
Mouna Khouchani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Targeted Therapies ◽  
Metastatic Gastric Cancer

scholarly journals Cost-Effectiveness Analysis of Biomarker-Guided Treatment for Metastatic Gastric Cancer in the Second-Line Setting

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Brianna Lauren ◽  
Sassan Ostvar ◽  
Elisabeth Silver ◽  
Myles Ingram ◽  
Aaron Oh ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cost Effectiveness ◽  
Targeted Therapies ◽  
Cost Effective ◽  
Metastatic Gastric Cancer ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Effective Strategy ◽  
Second Line ◽  
Life Years

Background. The 5-year survival rate of patients with metastatic gastric cancer (GC) is only 5%. However, trials have demonstrated promising antitumor activity for targeted therapies/immunotherapies among chemorefractory metastatic GC patients. Pembrolizumab has shown particular efficacy among patients with programmed death ligand-1 (PD-L1) expression and high microsatellite instability (MSI-H). The aim of this study was to assess the effectiveness and cost-effectiveness of biomarker-guided second-line GC treatment. Methods. We constructed a Markov decision-analytic model using clinical trial data. Our model compared pembrolizumab monotherapy and ramucirumab/paclitaxel combination therapy for all patients and pembrolizumab for patients based on MSI status or PD-L1 expression. Paclitaxel monotherapy and best supportive care for all patients were additional comparators. Costs of drugs, treatment administration, follow-up, and management of adverse events were estimated from a US payer perspective. The primary outcomes were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY over 60 months. Secondary outcomes were unadjusted life years (survival) and costs. Deterministic and probabilistic sensitivity analyses were performed to evaluate model uncertainty. Results. The most effective strategy was pembrolizumab for MSI-H patients and ramucirumab/paclitaxel for all other patients, adding 3.8 months or 2.0 quality-adjusted months compared to paclitaxel. However, this strategy resulted in a prohibitively high ICER of $1,074,620/QALY. The only cost-effective strategy was paclitaxel monotherapy for all patients, with an ICER of $53,705/QALY. Conclusion. Biomarker-based treatments with targeted therapies/immunotherapies for second-line metastatic GC patients substantially improve unadjusted and quality-adjusted survival but are not cost-effective at current drug prices.

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