scholarly journals Current Therapeutic Approaches for osteosarcoma

2021 ◽  
Author(s):  
Recep Öztürk
Keyword(s):  
Systemic Chemotherapy ◽  
Local Therapy ◽  
Standard Of Care ◽  
Appendicular Skeleton ◽  
Current Standard ◽  
Children And Young Adults ◽  
Adjusted Incidence ◽  
Common Primary Malignant Bone ◽  
Second Peak ◽  
Initial Peak

Osteosarcoma is classically defined as a high-grade spindle-shaped neoplasm with malignant cells that produce osteoid. It is the most common primary malignant bone tumor in children and young adults. It is <1% of all cancers diagnosed, approximately 3.4% of all childhood cancers. The age-adjusted incidence of osteosarcoma is bimodal, with an initial peak in adolescence and then a second peak in patients over 60 years of age. Osteosarcoma is divided into two main groups. In most of the osteosarcomas, the etiological agent cannot be determined and it is called primary osteosarcoma. Osteosarcoma, which develops due to etiologies such as Paget’s disease, radiotherapy or osteonecrosis, is called seconder osteosarcoma. Osteosarcomas are most commonly located in the appendicular skeleton. The most common settlement here is the knee circumference. The distal femur and proximal tibia are the most common locations in the knee. A multidisciplinary approach is indicated in the management of osteosarcoma. The treatment is multimodal, including systemic chemotherapy and local therapy. In this section, we will outline the current standard of care for the systemic and surgical approach to osteosarcoma treatment, as well as an overview of current studies.

scholarly journals Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies

2021 ◽  
Vol 10 (6) ◽  
pp. 1182
Author(s):  
Richa Rathore ◽  
Brian A. Van Tine
Keyword(s):  
Standard Of Care ◽  
Current Treatment ◽  
Patient Specific ◽  
High Dose ◽  
Bone Biology ◽  
Current Standard ◽  
Children And Young Adults ◽  
Therapeutic Research ◽  
Common Primary Malignant Bone

Osteosarcoma is the most common primary malignant bone tumor in children and young adults. The standard-of-care curative treatment for osteosarcoma utilizes doxorubicin, cisplatin, and high-dose methotrexate, a standard that has not changed in more than 40 years. The development of patient-specific therapies requires an in-depth understanding of the unique genetics and biology of the tumor. Here, we discuss the role of normal bone biology in osteosarcomagenesis, highlighting the factors that drive normal osteoblast production, as well as abnormal osteosarcoma development. We then describe the pathology and current standard of care of osteosarcoma. Given the complex heterogeneity of osteosarcoma tumors, we explore the development of novel therapeutics for osteosarcoma that encompass a series of molecular targets. This analysis of pathogenic mechanisms will shed light on promising avenues for future therapeutic research in osteosarcoma.

Consolidation therapy using cyberknife radiosurgery in NSCLC patients with low-volume residual disease upon completion of systemic therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18213-18213
Author(s):  
M. P. McLaughlin ◽  
R. Bordoni ◽  
T. Whitaker ◽  
P. Zolty ◽  
M. Andrews ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Residual Disease ◽  
Local Therapy ◽  
Standard Of Care ◽  
Initial Therapy ◽  
Consolidation Therapy ◽  
Current Standard ◽  
End Point ◽  
Ecog Ps

18213 Background: Pts with unresectable IIIB and IV NSCLC with PS 0–1 are usually treated with chemotherapy (CH) ± targeted therapy (TT) with overall survival (OS) improvement. Upon completion, standard of care is observation. Pts eventually progress within 9 to 12 months. If still in good PS, they are treated with salvage CH or TT; otherwise, they receive palliative care. We evaluated 12 patients with PR to initial therapy, found to have small volume residual disease (SVRD) defined as one or two sites to receive “consolidation” local therapy with Cyberknife Radisurgery (CRS). Methods: Since September 2006, 12 pts with NSCLC, stage IIIB unresectable (3) or IV (9), median age 64 (range 61–78), adenocarcinoma (7), squamous cell carcinoma(5), 9 males, all ECOG PS 0–1, were treated with induction CH (carboplatin/paclitaxel ± bevacizumab, cisplatin/gencitabine) with PR. CT/PET imaging showed SVRD. Eight patients had only one site; four had 2. These patients received CRS consolidative therapy to the following areas: lung-9, mediastinal node - 3, adrenal-2, liver-2. CRS dose depended on the disease site. Peripheral lung lesions - 54 Gy in 3 fractions (fx); medistinal lesions - 50 Gy in 4 fx; adrenal - 24 Gy in 3 fx and liver - 16 Gy. in 1 fx. The primary end point was efficacy (response rate, time to progression in or out of the radiosurgical fields, and OS) compared with historical matched controls. The secondary end point was safety and tolerability of CRS. Results: After a median follow up period of 65 days, all evaluable pts are still alive and without clinical or radiological (CT/PET) evidence of disease progression in or outside the sites of CRS. The treatment was well tolerated with no Grade 3–5 complications. PS remained 0–1 in all patients. Conclusions: Patients with advanced NSCLC benefit from systemic therapy with symptoms control and improved QoL and OS. Upon completion of therapy, observation is the current standard or care. Patients with good PS and SVRD tolerated CRS consolidation therapy remarkably well and may benefit with added symptoms control, improved TTP and even OS. At the June meeting efficacy and toxicity data of a projected population of 30+ patients, with a medial follow up of 8 months, will be presented. No significant financial relationships to disclose.

Outcomes of a phase II study of intraperitoneal paclitaxel plus systemic capecitabine and oxaliplatin (XELOX) for gastric cancer with peritoneal metastases.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 165-165
Author(s):  
Daryl Chia ◽  
Raghav Sundar ◽  
Guo Wei Kim ◽  
Jiajun Ang ◽  
Jeffrey Lum ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Performance Status ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Peritoneal Metastases ◽  
Conversion Surgery ◽  
Current Standard ◽  
Peritoneal Disease ◽  
Phase 2 Trial

165 Background: The addition of intraperitoneal (IP) paclitaxel (PTX) to systemic chemotherapy comprising taxane/fluoropyrimidine doublet has shown promising results for patients with gastric cancer (GC) and peritoneal metastases (PM). However, this has not been studied in combination with platinum/fluoropyrimidine doublet which is the current standard-of-care for metastatic GC. We conducted a prospective phase 2 trial of IP PTX with capecitabine and oxaliplatin (XELOX) in patients with GCPM. Methods: The trial enrolled 44 patients with GCPM who received treatment comprising IP PTX (40mg/m2 on day 1,8), PO capecitabine (1000mg/m2 twice daily from day 1-14) and IV oxaliplatin (100mg/m2 on day 1) in 21-day cycles. Patients with synchronous GCPM were eligible for conversion surgery comprising radical gastrectomy if they had good response after chemotherapy, negative cytology on 2 consecutive peritoneal fluid assessments, no extraperitoneal metastasis and no peritoneal disease during surgery. The primary endpoint was overall survival and secondary endpoints were progression-free survival and safety. Outcomes from the trial were also compared with a retrospective cohort of 39 patients with GCPM who received identical systemic chemotherapy (SC) comprising platinum/fluoropyrimidine agents alone. Results: The median OS for the IP and SC groups was 14.6 and 10.6 months (HR 0.44; 95% CI, 0.26-0.74; P=0.002). The 1-year OS was 67.8% in the IP group and 32.3% in the SC group (Logrank p<0.001). The median PFS for the IP and SC group was 9.5 and 4.4 months respectively (HR 0.39; 95% CI, 0.25-0.66; P<0.001). Patients in the SC group were younger (IP vs. SC, 61 vs. 56 years, p=0.021) and had better baseline performance status (ECOG 0, IP vs. SC, 47.7% vs. 76.9%, p=0.007) compared to the IP cohort. In the IP group, conversion surgery was performed in 36.1% (13/36) of patients, with a median OS of 24.2 (95%CI 13.1 – 35.3) months and 1-year OS of 84.6%. Wound-related complications requiring the port to be explanted or re-sited occurred in 9% (4/44) of patients. Conclusions: IP PTX with XELOX is a promising treatment option for GCPM patients. For patients with good response, conversion surgery was feasible with favourable outcomes. Clinical trial information: NCT01739894. [Table: see text]

scholarly journals Systemic Treatment of Stage IV Epithelial Ovarian Cancer; A Case Report

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Shoukat Ali
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Systemic Chemotherapy ◽  
Systemic Treatment ◽  
Advanced Disease ◽  
Stage Iv ◽  
Standard Of Care ◽  
Parp Inhibitors ◽  
Gynecologic Malignancy ◽  
Current Standard

Epithelial ovarian cancer is most common gynecologic malignancy in Pakistan. Primary cytoreductive surgery followed by adjuvant chemotherapy is current standard of care for most of the patients with epithelial ovarian cancer, however neoadjuvant chemotherapy followed by surgery is acceptable alternate option for patients presenting with inoperable advanced disease initially. For most of the stage IV ovarian cancer patients, systemic chemotherapy is mainstay of treatment, but other approaches have been emerged for advanced disease including targeted agents, hormonal therapy and PARP inhibitors.

Radioembolization for Cholangiocarcinoma

2021 ◽  
Author(s):  
Aamir Ali ◽  
Komal Manzoor ◽  
Jeffrey L. Weinstein ◽  
Salomao Faintuch ◽  
Muneeb Ahmed ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Systemic Chemotherapy ◽  
Standard Of Care ◽  
Hepatic Malignancy ◽  
Current Standard ◽  
Transarterial Radioembolization ◽  
Total Cancer ◽  
Localized Disease ◽  
Yttrium 90

AbstractCholangiocarcinoma is the second most common primary hepatic malignancy which accounts for 13% of total cancer mortality worldwide. Surgical resection is the only curative treatment for localized disease; however, the majority of patients present when the tumor is unresectable. The incidence of the intrahepatic subtype of cholangiocarcinoma is increasing worldwide. Current standard of care in patients with unresectable intrahepatic cholangiocarcinoma is systemic chemotherapy; however, yttrium-90 transarterial radioembolization (Y90-TARE) is under investigation for the treatment of intrahepatic cholangiocarcinoma with promising trials and published clinical experience. This review critically evaluates the role of Y90-TARE in the management of intrahepatic cholangiocarcinoma.

Acute Rejection Following Kidney Transplantation: State-of-the-Art and Future Perspectives

2020 ◽  
Vol 26 (28) ◽  
pp. 3468-3496
Author(s):  
Emilio Rodrigo ◽  
Marcio F. Chedid ◽  
David San Segundo ◽  
Juan C.R. San Millán ◽  
Marcos López-Hoyos
Keyword(s):  
Kidney Transplantation ◽  
Acute Rejection ◽  
Rescue Therapy ◽  
Standard Of Care ◽  
Rejection Rate ◽  
New Drugs ◽  
High Dose ◽  
Current Standard ◽  
Antibody Mediated Rejection ◽  
Cellular Rejection

: Although acute renal graft rejection rate has declined in the last years, and because an adequate therapy can improve graft outcome, its therapy remains as one of the most significant challenges for pharmacists and physicians taking care of transplant patients. Due to the lack of evidence highlighted by the available metaanalyses, we performed a narrative review focused on the basic mechanisms and current and future therapies of acute rejection in kidney transplantation. : According to Kidney Disease/Improving Global Outcomes (KDIGO) guidelines, both clinical and subclinical acute rejection episodes should be treated. Usually, high dose steroids and basal immunosuppression optimization are the first line of therapy in treating acute cellular rejection. Rabbit antithymocytic polyclonal globulins are used as rescue therapy for recurrent or steroid-resistant cellular rejection episodes. Current standard-of-care (SOC) therapy for acute antibody-mediated rejection (AbMR) is the combination of plasma exchange with intravenous immunoglobulin (IVIG). Since a significant rate of AbMR does not respond to SOC, different studies have analyzed the role of new drugs such as Rituximab, Bortezomib, Eculizumab and C1 inhibitors. Lack of randomized controlled trials and heterogenicity among performed studies limit obtaining definite conclusions. Data about new direct and indirect B cell and plasma cell depleting agents, proximal and terminal complement blockers, IL-6/IL-6R pathway inhibitors and antibody removal agents, among other promising drugs, are reviewed.

scholarly journals Inhibition of Glycine Re-Uptake: A Potential Approach for Treating Pain by Augmenting Glycine-Mediated Spinal Neurotransmission and Blunting Central Nociceptive Signaling

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 864
Author(s):  
Christopher L. Cioffi
Keyword(s):  
Spinal Cord ◽  
Dorsal Horn ◽  
Therapeutic Potential ◽  
Opioid Analgesic ◽  
Critical Role ◽  
Analgesic Efficacy ◽  
Standard Of Care ◽  
Current Standard ◽  
Glycine Transporters ◽  
Pathological Pain

Among the myriad of cellular and molecular processes identified as contributing to pathological pain, disinhibition of spinal cord nociceptive signaling to higher cortical centers plays a critical role. Importantly, evidence suggests that impaired glycinergic neurotransmission develops in the dorsal horn of the spinal cord in inflammatory and neuropathic pain models and is a key maladaptive mechanism causing mechanical hyperalgesia and allodynia. Thus, it has been hypothesized that pharmacological agents capable of augmenting glycinergic tone within the dorsal horn may be able to blunt or block aberrant nociceptor signaling to the brain and serve as a novel class of analgesics for various pathological pain states. Indeed, drugs that enhance dysfunctional glycinergic transmission, and in particular inhibitors of the glycine transporters (GlyT1 and GlyT2), are generating widespread interest as a potential class of novel analgesics. The GlyTs are Na+/Cl−-dependent transporters of the solute carrier 6 (SLC6) family and it has been proposed that the inhibition of them presents a possible mechanism by which to increase spinal extracellular glycine concentrations and enhance GlyR-mediated inhibitory neurotransmission in the dorsal horn. Various inhibitors of both GlyT1 and GlyT2 have demonstrated broad analgesic efficacy in several preclinical models of acute and chronic pain, providing promise for the approach to deliver a first-in-class non-opioid analgesic with a mechanism of action differentiated from current standard of care. This review will highlight the therapeutic potential of GlyT inhibitors as a novel class of analgesics, present recent advances reported for the field, and discuss the key challenges associated with the development of a GlyT inhibitor into a safe and effective agent to treat pain.

scholarly journals Updated Insights on EGFR Signaling Pathways in Glioma

2021 ◽  
Vol 22 (2) ◽  
pp. 587
Author(s):  
Alexandru Oprita ◽  
Stefania-Carina Baloi ◽  
Georgiana-Adeline Staicu ◽  
Oana Alexandru ◽  
Daniela Elise Tache ◽  
...  
Keyword(s):  
Signaling Pathways ◽  
Treatment Strategies ◽  
Growth Factor Receptor ◽  
Standard Of Care ◽  
Egfr Signaling ◽  
Current Standard ◽  
Egfr Amplification ◽  
Epidermal Growth ◽  
New Diagnosis ◽  
Clear Clinical Benefit

Nowadays, due to recent advances in molecular biology, the pathogenesis of glioblastoma is better understood. For the newly diagnosed, the current standard of care is represented by resection followed by radiotherapy and temozolomide administration, but because median overall survival remains poor, new diagnosis and treatment strategies are needed. Due to the quick progression, even with aggressive multimodal treatment, glioblastoma remains almost incurable. It is known that epidermal growth factor receptor (EGFR) amplification is a characteristic of the classical subtype of glioma. However, targeted therapies against this type of receptor have not yet shown a clear clinical benefit. Many factors contribute to resistance, such as ineffective blood–brain barrier penetration, heterogeneity, mutations, as well as compensatory signaling pathways. A better understanding of the EGFR signaling network, and its interrelations with other pathways, are essential to clarify the mechanisms of resistance and create better therapeutic agents.

A comparison between 25-gauge and 22-gauge Franseen needles for endoscopic ultrasound-guided sampling of pancreatic and peripancreatic masses: a randomized non-inferiority study

Endoscopy ◽  
2021 ◽  
Author(s):  
Dongwook Oh ◽  
Joonseog Kong ◽  
Sung Woo Ko ◽  
Seung-Mo Hong ◽  
Hoonsub So ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Care Center ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Adverse Event Rate ◽  
Current Standard ◽  
Fine Needle

Abstract Background Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) are the current standard of care for sampling pancreatic and peripancreatic masses. Recently, a 22G EUS-FNB needle with Franseen geometry was developed, and this device was also introduced in a 25G platform. We compared the performance of the 25G and 22G Franseen needles for EUS-guided sampling of pancreatic and peripancreatic solid masses. Methods We conducted a parallel-group randomized non-inferiority trial at a tertiary-care center from November 2018 to May 2019. The primary outcome was the quality of the histologic core assessed using the Gerke score. The optimal histologic core is indicated by a Gerke score of 4 or 5, which enables optimal histologic interpretation. The overall diagnostic accuracy and adverse event rate were also evaluated. Results 140 patients were enrolled and randomized (1:1) to the 25G and 22G groups. Tissue acquisition by EUS-FNB was successful in all patients. The optimal histologic core procurement rate was 87.1 % (61/70) for the 25G needle vs. 97.1 % (68/70) for the 22G; difference −10 % (95 % confidence interval −17.35 % to −2.65 %). High quality specimens were more frequently obtained in the 22G group than in the 25G group (70.0 % [49/70] vs. 28.6 % [20 /70], respectively; P < 0.001). The overall diagnostic accuracy did not differ between the groups (97.4 % for 25G vs. 100 % for 22G). Conclusions The 25G Franseen needle was inferior to the 22G needle in histologic core procurement. Therefore, for cases in which tissue architecture is pivotal for diagnosis, a 22G needle, which procures relatively higher quality specimens than the 25G needle, should be used.

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