Challenges, hurdles and possible approaches to improve cancer care in developing countries – A short breakdown of the status quo and future perspective

<p>It was estimated that in 2012, 57% of the incidence and 65% of cancer deaths have occurred in developing countries, and in the future, the incidence of cancer-related mortality is even expected to rise significantly in these countries. Despite this alarming data, there are still significant disparities in access to cancer care and cancer control between developing nations and higher income countries. There are several hurdles for cancer patients in developing countries which impair adequate treatment, including very little access to programs of cancer prevention and screening measures, early diagnosis and adequate surgical and medical tumor treatment. In this review article, we provide a short assessment and breakdown of the main barriers for proper cancer treatment admission and provide a perspective on potential approached and solutions to enhance cancer research and care in developing countries. </p>

Overexpression of Sema3E and Sema5A in pilocytic astrocytoma

<p>We have previously found that <em>Sema5A, </em>a member of the semaphorin gene family, is up-regulated in pediatric pilocytic astrocytomas (PA) at the mRNA level by microarray analysis and real-time RT-PCR. By further analysis of the expression level of all 17 semaphorin genes in the microarray dataset, we found that <em>Sema5A</em> and <em>Sema3E</em> are the only two semaphorin genes that are highly up-regulated in pilocytic astrocytomas. In this study, the up-regulation of <em>Sema3E</em> was further confirmed by real-time RT-PCR. Furthermore, the over-expression of both SEMA3E and SEMA5A proteins were also confirmed by Western blot analysis and immunohistochemistry. Since pilocytic astrocytoma is characterized by extensive vasculature, co-immunofluorescent staining of both CD31 and SEMA3E (or SEMA5A) was performed. The result showed that a higher expression of SEMA3E was around the CD31 positive endothelial cells. Based on semaphorin’s function in angiogenesis and a higher expression of SEMA3E and SEMA5A around endothelial cells in these PA samples, these genes could be potential biological markers and anti-angiogenesis therapeutic targets for pilocytic astrocytomas.<strong></strong></p>

Advances in pediatric neuro-oncology

The field of pediatric neuro-oncology research has undergone succession of rapid advances in the past ten years at an incredible pace. Most of these advances were driven by genomic and epigenomic characterizations of large cohort of samples assembled through international collaboration. As a result of these efforts, robust molecular markers of several types of pediatric brain tumors have been developed for diagnostic and prognostic applications.

Cytolytic tests with hyperimmune patient sera is a good prognostic tool in racotumomab immunotherapy in advanced non-small cell lung cancer

<p>Aberrant accumulation of a specific sialic acid has been shown to exist in many human malignant cell membranes termed as N-glycolyl neuraminic acid (NeuGc). This particular ganglioside do not normally exist in normal human cells, due to the lack of an enzyme (cytidine monophospho-N-acetyl-neuraminic acid) which is responsible for the synthesis of N—glycolyl neurominic acid. The aberrant expression of NeuGcGM3 ganglioside in the cell surface of certain human tumors, made this molecule an attractive target for immunotherapy. By using 14 F7 monoclonal antibody directed to identify NeuGcGM3 in the tumor tissue, it is possible to select patients for anti-NeuGcGM3 immunotherapy. Racotumomab is an anti-idiotype vaccine, being a mirror image of NeuGcGm3 mimics this ganglioside and triggers an immune response. Antibodies reactive to NeuGcGM3 ganglioside in the vaccinated patient’s sera have cytotoxic anti-tumor properties which can be assessed in L1210 cell line, expressing this ganglioside.</p><p>In this study, we monitored 12 patients with advanced non-small cell lung cancer (NSCLC) who are on racotumomab vaccine maintenance following chemotherapy. Cytotoxic tests with vaccinated patients’ sera were performed using L1210 cell lines at the 3^rd, 6^th, 9^th, and 12^th months of vaccination and the results were compared with clinical outcomes. Serum antibodies to NeuGcGm3 ganglioside were also checked before initiation and thereafter with the same intervals. The aim of the study was to investigate the value of antibodies and cytotoxic test as biomarkers for treatment outcome. Our observation confirmed that consistently higher cytotoxicity rates in the cell culture correlated with better progression free survivals of the patients who are on racotumomab maintenance.</p>

MicroRNAs in neuroblastoma differentiation and differentiation therapy

<p class="ArticleTitle"><span lang="EN-US">Neuroblastoma is one of the most common and aggressive types of pediatric cancers, making up about 7% of all childhood cancers. Neuroblastoma arises from the failure of neural crest cell precursors to differentiate, and inducing cell differentiation is one of the most important treatment approaches for neuroblastoma. MicroRNAs regulate gene expression by performing post-transcriptional gene modification by mainly translational suppression and mRNA degradation. The dysregulation of these molecules has been shown to be related to tumor development, tumor metastasis and drug resistance, and the promise of developing microRNA-based therapeutics for cancers has been demonstrated. Many recent studies have also provided evidence for the involvement of microRNAs in differentiation of neuroblastoma cells, suggesting the potential of developing microRNA-based differentiation therapies for neuroblastoma. Here we review the recent findings on the role of microRNAs in regulating cell differentiation, with a main focus on neuroblastoma cells. The investigations on the therapeutic potential of microRNAs in neuroblastoma therapy and differentiation therapy are also reviewed.</span></p>

Taking the road less travelled

<p>We introduce Dr. Carmina Castellano-Tejedor in this issue, to learn more about her research in the budding field of psycho-oncology.</p>

The advancements of genomics and data integration in sarcoma research

<p>In the age of big data, genomics and clinical research have reached a crossroads. A wealth of data is being generated, but it is becoming increasingly complicated to analyze these data to extract meaningful results. The ability to understand biological systems holistically has unprecedented potential to transform how cancers are treated. Recent major advances leading biomedical research towards “systems medicine” have been fueled by high-throughput platforms, such as microarrays and next-generation sequencing, which can capture vast amounts of data in different genomic spaces. Unfortunately, because of high dimensionality and complex relationships among these data, inferring comprehensive and useful biological models has proven computationally and statistically challenging. However, novel bioinformatic methods for data integration of cancer genomic datasets have been developed. In this review, we will describe the applications of various genomic approaches in sarcoma research and introduce bioinformatic methods for data integration. With the continuing evolution of technological and bioinformatic methodologies, the application of big data within clinics and hospitals will ultimately result in significant improvements on how cancers are detected and treated.</p>

Proton therapy – An evolving technology

<p>In the last 25 years, more effective chemotherapy, better surgical and radiotherapy techniques have contributed, at least in part, to improvement in control for most cancers, also increasing the number of patients referred for a second course of radiation<span style="font-size: 8.33333px;">.</span></p>

Successful afatinib treatment through nasogastric tube in a ventilated patient with non-small cell lung cancer

<p class="BodyText1">The majority of lung cancer patients are discovered at advanced stages and some of them may often have complex medical problems in addition to the diagnosis of cancer, such as oncologic emergency requiring assistance in an intensive care unit (ICU). In the last decade, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors have been recognized as key drugs for non-small cell lung cancer (NSCLC) harboring sensitive EGFR mutation. We report a case of stage IV NSCLC with EGFR mutation (exon 19 deletion). He was in a life-threatening stage due to a massive intrathoracic hemorrhage. After chest tube drainage and mechanical ventilation, afatinib was administered through nasogastric tube. Consequently, a dramatic response was obtained and he was able to be discharged from our hospital 11 weeks after the initiation of afatinib. This approach may be of benefit to rescue from life-threatening condition for selected patients.</p>

Overview of Hurthle cell carcinoma of thyroid

<p>The clinical behaviour of Hurthle cell carcinoma (HCC) of the thyroid is variable and there are many controversies in the literature. Here, we summarize an up-to-date review of the literature on genetics, diagnosis (ultrasound scan, fine needle aspiration, frozen section, <em>etc.</em>), and management. At presentation, treatment decision should be made by a multidisciplinary board. Recurrent HCCs are seldom curable despite salvage treatments, which include radioactive iodine ablation, radiofrequency ablation, ethanol ablation, external radiotherapy, and systemic therapy. Further research is needed to develop more efficacious systemic treatments. Currently, lenvatinib, sunitinib, and sorafenib are available. The completed and ongoing clinical trials for HCC are summarized.</p>