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Clinical Issue of Myasthenia Gravis Related to Immune Checkpoint Inhibitors. 与免疫检查点抑制剂相关的肌无力临床问题。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-01 DOI: 10.1007/s11912-024-01571-0
Kyoichi Kaira, Atsuto Mouri, Hisao Imai, Ou Yamaguchi, Hiroshi Kagamu

Purpose of review: Immune-related adverse events (irAEs) are pivotal in the management of immune checkpoint inhibitors (ICIs) across various human neoplasms. While common irAEs are manageable by oncologists, the detailed features of rare complications related to ICI therapy remain elusive. Among these, immune-related myasthenia gravis (irMG) stands out as a life-threatening disease.

Recent findings: Research articles published in English between 2017 and 2023 were identified using the PubMed database. Forty-six relevant research studies were examined to collate information for this review. The incidence of ICI-induced MG was found to be less than 1.0%, with approximately 20-30% of irMG patients presenting with overlap syndrome involving myocarditis and myositis. The detection of acetylcholine receptor antibodies (AChR-Ab) and elevated creatinine kinase (CK) levels proved useful in identifying 50-70% and 60-80% of cases, respectively. However, the utility of muscle-specific kinase antibodies (MuSK-Ab) in detecting irMG was limited due to a low positivity rate (0-5.3%). Ptosis emerged as the most common initial symptom of irMG, with an approximate positivity rate of 80%. Recommended treatment for irMG involves high-dose steroids in conjunction with plasmapheresis or immunoglobulins to mitigate the increased mortality associated with irMG. Early initiation of immunosuppressive therapy is imperative to prevent the worsening of irMG. Furthermore, facilitating a fulfilling social life post-hospitalization is crucial. This review sheds light on the clinical aspects and management strategies pertaining to irMG.

综述目的:免疫相关不良事件(irAEs)是治疗各种人类肿瘤的免疫检查点抑制剂(ICIs)的关键。虽然肿瘤学家可以处理常见的 irAEs,但与 ICI 治疗相关的罕见并发症的详细特征仍然难以捉摸。其中,免疫相关性肌无力(irMG)是一种威胁生命的疾病:使用 PubMed 数据库识别了 2017 年至 2023 年间发表的英文研究文章。研究人员对46项相关研究进行了审查,为本综述整理了相关信息。研究发现,ICI诱发的MG发病率低于1.0%,约20-30%的irMG患者会出现心肌炎和肌炎重叠综合征。乙酰胆碱受体抗体(AChR-Ab)的检测和肌酸激酶(CK)水平的升高分别有助于鉴别 50-70% 和 60-80% 的病例。然而,由于阳性率较低(0-5.3%),肌肉特异性激酶抗体(MuSK-Ab)在检测虹膜血管内皮癌方面的作用有限。上睑下垂是虹膜麦格病最常见的初期症状,阳性率约为 80%。推荐的虹膜血管内皮生长因子治疗包括大剂量类固醇与浆细胞分离或免疫球蛋白,以降低与虹膜血管内皮生长因子相关的死亡率。必须尽早开始免疫抑制治疗,以防止虹膜转移性心肌病恶化。此外,促进患者在出院后过上充实的社会生活也至关重要。本综述介绍了有关虹膜格氏病的临床方面和管理策略。
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引用次数: 0
Oral Pre-malignancy: An Update on Novel Therapeutic Approaches. 口腔癌前病变:新型治疗方法的最新进展。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI: 10.1007/s11912-024-01562-1
Shorook Naara, Clara Andrews, Andrew Sikora, Michelle Williams, Mark Chambers, Jeffrey Myers, Moran Amit

Purpose of review: This review aims to provide a comprehensive overview of the current advances in managing and preventing progression of oral potentially malignant disorders (OPMDs), focusing on their histological and clinicopathological features, and management.

Recent findings: Recent studies, including a multicenter cross-sectional study, have identified oral leukoplakia as the most prevalent form of OPMD, comprising over half of the cases examined. Advances in histological grading, specifically the World Health Organization's three-tier system (mild, moderate, and severe dysplasia), have significantly enhanced the accuracy of risk assessment for malignant transformation. Additionally, treatments such as surgical interventions, photodynamic therapy, and chemopreventive and molecularly targeted agents are being evaluated for their safety and efficacy as well as, immune checkpoint inhibitors being evaluated as potential preventive strategies to halt the progression of OPMDs. The management of OPMDs remains challenging due to the lack of standardized screening protocols and varied clinical management approaches. Despite this, recent advancements in diagnostic grading and therapeutic interventions provide a framework for improved treatment outcomes. Continued research into the molecular and cellular mechanisms driving development and progression of OPMDs and innovative treatment trials are essential to optimize strategies that prevent malignant progression and thereby reduce the global health burden of oral cancer.

综述目的:本综述旨在全面概述目前在管理和预防口腔潜在恶性疾病(OPMDs)恶化方面取得的进展,重点关注其组织学和临床病理学特征以及管理:最近的研究(包括一项多中心横断面研究)发现,口腔白斑病是口腔潜在恶性疾病中最常见的形式,占受检病例的一半以上。组织学分级的进步,特别是世界卫生组织的三级系统(轻度、中度和重度发育不良),大大提高了恶性转化风险评估的准确性。此外,手术干预、光动力疗法、化学预防和分子靶向药物等治疗方法的安全性和有效性正在接受评估,免疫检查点抑制剂作为潜在的预防策略也在接受评估,以阻止 OPMD 的发展。由于缺乏标准化的筛查方案和不同的临床管理方法,OPMD 的管理仍然充满挑战。尽管如此,诊断分级和治疗干预方面的最新进展为改善治疗效果提供了框架。要优化预防恶性进展的策略,从而减轻口腔癌对全球健康造成的负担,就必须继续研究驱动 OPMD 发展和恶化的分子和细胞机制,并进行创新性治疗试验。
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引用次数: 0
Epidemiology of Cancer in Older Adults: A Systematic Review. 老年人癌症流行病学:系统回顾
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-04 DOI: 10.1007/s11912-024-01567-w
Sophie Pilleron, Esther Bastiaannet

Purpose of review: What are the prevalence, incidence and mortality rates of cancer among individuals aged 60 or older on a national, regional, and global scale? What factors affect differences in cancer survival between older and younger adults?

Recent findings: The epidemiological literature on cancer in older adults, particularly in low- and middle-income countries (LMICs) and that focusing on the oldest adults, is expanding. These studies consistently show increasing global cancer incidence rates in older populations. Recent research also highlights a widening survival gap between middle-aged and older adults, with the stage at diagnosis being the primary driver. More research is needed to describe the cancer burden in older adults, especially focusing on the oldest population and LMICs, to better understand global healthcare challenges. Additionally, further exploring patient-related, clinical, and tumour-related factors which drive age-related survival differences could improve cancer outcomes in older adults.

审查目的:在国家、地区和全球范围内,60 岁或以上人群的癌症流行率、发病率和死亡率如何?哪些因素会影响老年人和年轻人癌症生存率的差异?有关老年人,尤其是中低收入国家(LMICs)老年人癌症的流行病学文献以及以最年长的成年人为研究对象的文献正在不断增加。这些研究一致表明,全球老年人癌症发病率不断上升。最近的研究还突出表明,中老年人之间的生存率差距正在扩大,而诊断时所处的阶段是主要的驱动因素。需要开展更多的研究来描述老年人的癌症负担,特别是关注最年长的人群和低收入和中等收入国家,以便更好地了解全球医疗保健面临的挑战。此外,进一步探索导致年龄相关生存差异的患者相关、临床相关和肿瘤相关因素,可以改善老年人的癌症治疗效果。
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引用次数: 0
Options for Rescue Treatment of Patients with AL Amyloidosis Exposed to Upfront Daratumumab. 对暴露于前期达拉单抗的 AL 淀粉样变性患者进行挽救性治疗的选择。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-19 DOI: 10.1007/s11912-024-01561-2
Claudia Bellofiore, Giovanni Palladini, Paolo Milani

Purpose of review: This review aims to assess the therapeutic strategies available for relapsed/refractory patients with immunoglobulin light chain (AL) amyloidosis who received upfront daratumumab-based regimens.

Recent findings: The treatment landscape of AL amyloidosis has changed radically thanks to the introduction in the upfront setting of daratumumab in combination with bortezomib, cyclophosphamide and dexamethasone (DaraCyBorD) which improved patients' outcomes increasing the rate of hematologic and organ responses. However, many patients eventually relapse or are refractory to daratumumab and the best salvage therapy is not well defined yet. In this contest, we reviewed the available therapeutic options after daratumumab failure, and we look towards the current advances in Bcl-2 inhibitors, novel immunotherapeutic agents as chimeric antigen receptor (CAR-T) therapy and bispecific antibodies (bsAbs). Relapsed/refractory AL amyloidosis represent an unmet clinical need and novel targeted drugs require urgent prospective assessment.

综述目的:本综述旨在评估接受达拉单抗前期治疗方案的免疫球蛋白轻链(AL)淀粉样变性病复发/难治患者的治疗策略:由于达拉单抗联合硼替佐米、环磷酰胺和地塞米松(DaraCyBorD)在前期治疗中的引入,AL淀粉样变性病的治疗前景发生了根本性的改变。然而,许多患者最终会复发或对达拉单抗难治,最佳的挽救疗法尚未明确。在本次竞赛中,我们回顾了达拉单抗治疗失败后的可用治疗方案,并展望了 Bcl-2 抑制剂、嵌合抗原受体(CAR-T)疗法和双特异性抗体(bsAbs)等新型免疫治疗药物的最新进展。复发/难治性AL淀粉样变性代表着一种尚未得到满足的临床需求,新型靶向药物急需进行前瞻性评估。
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引用次数: 0
Current Status on Management of Primary Plasma Cell Leukemia. 原发性浆细胞白血病的管理现状。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-02 DOI: 10.1007/s11912-024-01563-0
Zimu Gong, Meera Khosla, Sreeraj Vasudevan, Meera Mohan

Purposeof review: Plasma Cell Leukemia (PCL) is a very rare and highly aggressive form of plasma cell dyscrasia. This review seeks to evaluate the outcomes of PCL in the context of combination novel agent therapy and stem cell transplant (SCT) protocols.

Recent findings: The diagnostic criteria for PCL have now evolved to include patients with 5% circulating PC. While management remains challenging, the incorporation of novel agent-based induction regimen has significantly improved early mortality and reduced attrition of patients proceeding to SCT. In recent prospective clinical trials, patients with PCL demonstrated an overall response rates of 69% to 86%, with progression-free and overall survival ranging from 13.8 to 15.5 months and 24.8 to 36.3 months, respectively. B-cell lymphoma 2 (BCL2) inhibitors, such as venetoclax present a targeted intervention opportunity for patients with PCL with t(11;14). Dedicated clinical trials tailored to PCL are crucial, integrating newer therapies in the frontline setting to further optimize responses and enhance overall outcomes.

综述目的:浆细胞白血病(PCL)是一种非常罕见、侵袭性极强的浆细胞异常。本综述旨在评估PCL在新药联合治疗和干细胞移植(SCT)方案中的疗效:PCL的诊断标准现已发展到包括5%循环PC的患者。虽然治疗仍具有挑战性,但基于新型制剂的诱导方案已显著改善了早期死亡率,并减少了进行SCT患者的流失。在最近的前瞻性临床试验中,PCL 患者的总体反应率为 69% 至 86%,无进展生存期和总生存期分别为 13.8 至 15.5 个月和 24.8 至 36.3 个月。Venetoclax等B细胞淋巴瘤2(BCL2)抑制剂为t(11;14)型PCL患者提供了靶向干预的机会。专门针对 PCL 的临床试验至关重要,它将更新的疗法整合到一线治疗中,以进一步优化反应并提高总体疗效。
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引用次数: 0
Nasal Cavity and Paranasal Sinus Cancer: Diagnosis and Treatment. 鼻腔和副鼻窦癌:诊断与治疗。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 10.1007/s11912-024-01566-x
Frodita Jakimovska, Igor Stojkovski, Elena Kjosevska

Purpose of review: The purpose of this review is to analyze the diagnosis and treatments of the sinonasal malignant tumors throw systematic reviewed literature. The systematic review of the literature was performed according to PRISMA guidelines.

Recent findings: Total 11,653 cases of five article were analyzed. The cohort of 3824 cases received appropriate treatment. The most frequent histotype of the group of sinonasal malignancies was squamous cell carcinoma. Squamous cell carcinoma was represented by 54%. The other histopathological subtypes were esthesioneuroblastoma with 9,9%, melanoma 9,8%, adenocarcinoma 7,5%, sarcoma 7,3%, adeno cystic carcinoma 7,1%, sinonasal undifferentiated carcinoma 3,9%, sinonasal neuroendocrine carcinoma 2,8% respectively. All 772 cases of total 3824 were treated only surgically. All 62 cases of total 3824 were treated without surgery, 20 cases with proton technique and SFUD, and 42 cases with proton technique and IMRT. The other 2990 cases of total 3824 were treated with multimodality treatment. The diagnosis and treatment of sinonasal cancers require a interdisciplinary approach and multimodality treatment.

综述目的:本综述旨在分析鼻窦鼻腔恶性肿瘤的诊断和治疗方法。根据 PRISMA 指南对文献进行了系统回顾:共分析了五篇文献中的 11653 个病例。其中 3824 例接受了适当的治疗。鼻窦恶性肿瘤中最常见的组织类型是鳞状细胞癌。鳞状细胞癌占 54%。其他组织病理学亚型包括:血管神经母细胞瘤(9.9%)、黑色素瘤(9.8%)、腺癌(7.5%)、肉瘤(7.3%)、腺囊性癌(7.1%)、鼻窦未分化癌(3.9%)、鼻窦神经内分泌癌(2.8%)。在总共 3824 个病例中,有 772 个病例只接受了手术治疗。在总共 3824 个病例中,有 62 例未经手术治疗,20 例采用质子技术和 SFUD 治疗,42 例采用质子技术和 IMRT 治疗。另外 3 824 例中的 2 990 例采用了多模式治疗。鼻窦癌的诊断和治疗需要跨学科方法和多模式治疗。
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引用次数: 0
Perioperative Blood Transfusions and Cancer Progression: A Narrative Review. 围手术期输血与癌症进展:叙述性综述。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-07 DOI: 10.1007/s11912-024-01552-3
Layal Abou Daher, Olivia Heppell, Ileana Lopez-Plaza, Carlos E Guerra-Londono

Purpose of review: To examine the most recent evidence about known controversies on the effect of perioperative transfusion on cancer progression.

Recent findings: Laboratory evidence suggests that transfusion-related immunomodulation can be modified by blood management and storage practices, but it is likely of less intensity than the effect of the surgical stress response. Clinical evidence has questioned the independent effect of blood transfusion on cancer progression for some cancers but supported it for others. Despite major changes in surgery and anesthesia, cancer surgery remains a major player in perioperative blood product utilization. Prospective data is still required to strengthen or refute existing associations. Transfusion-related immunomodulation in cancer surgery is well-documented, but the extent to which it affects cancer progression is unclear. Associations between transfusion and cancer progression are disease-specific. Increasing evidence shows autologous blood transfusion may be safe in cancer surgery.

综述目的:研究关于围手术期输血对癌症进展影响的已知争议的最新证据:实验室证据表明,输血相关的免疫调节可通过血液管理和储存方法改变,但其强度可能低于手术应激反应的影响。临床证据质疑输血对某些癌症进展的独立影响,但支持输血对其他癌症的影响。尽管手术和麻醉发生了重大变化,但癌症手术仍是围手术期血液制品使用的主要因素。仍需要前瞻性数据来加强或反驳现有的关联。癌症手术中与输血相关的免疫调节已得到充分证实,但其对癌症进展的影响程度尚不清楚。输血与癌症进展之间的关联是针对特定疾病的。越来越多的证据表明,自体输血在癌症手术中可能是安全的。
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引用次数: 0
From Detection to Cure - Emerging Roles for Urinary Tumor DNA (utDNA) in Bladder Cancer. 从检测到治愈--尿液肿瘤 DNA (utDNA) 在膀胱癌中的新作用。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-05 DOI: 10.1007/s11912-024-01555-0
Joshua A Linscott, Hiroko Miyagi, Prithvi B Murthy, Sijie Yao, G Daniel Grass, Aram Vosoughi, Hongzhi Xu, Xuefeng Wang, Xiaoqing Yu, Alice Yu, Logan Zemp, Scott M Gilbert, Michael A Poch, Wade J Sexton, Philippe E Spiess, Roger Li

Purpose of review: This review sought to define the emerging roles of urinary tumor DNA (utDNA) for diagnosis, monitoring, and treatment of bladder cancer. Building from early landmark studies the focus is on recent studies, highlighting how utDNA could aid personalized care.

Recent findings: Recent research underscores the potential for utDNA to be the premiere biomarker in bladder cancer due to the constant interface between urine and tumor. Many studies find utDNA to be more informative than other biomarkers in bladder cancer, especially in early stages of disease. Points of emphasis include superior sensitivity over traditional urine cytology, broad genomic and epigenetic insights, and the potential for non-invasive, real-time analysis of tumor biology. utDNA shows promise for improving all phases of bladder cancer care, paving the way for personalized treatment strategies. Building from current research, future comprehensive clinical trials will validate utDNA's clinical utility, potentially revolutionizing bladder cancer management.

综述的目的:本综述旨在确定尿液肿瘤 DNA(utDNA)在诊断、监测和治疗膀胱癌方面的新作用。在早期标志性研究的基础上,重点关注近期的研究,突出utDNA如何帮助个性化治疗:最近的研究强调,由于尿液和肿瘤之间的持续接触,utDNA 有可能成为膀胱癌的首要生物标志物。许多研究发现,utDNA 比其他膀胱癌生物标记物更有参考价值,尤其是在疾病的早期阶段。utDNA有望改善膀胱癌治疗的各个阶段,为个性化治疗策略铺平道路。在目前研究的基础上,未来的综合临床试验将验证 utDNA 的临床实用性,从而有可能彻底改变膀胱癌的治疗方法。
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引用次数: 0
Multiple Options: How to Choose Therapy in Frontline Metastatic Melanoma. 多种选择:如何选择前线转移性黑色素瘤的治疗方法?
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-05 DOI: 10.1007/s11912-024-01547-0
Lucy Boyce Kennedy, April K S Salama

Purpose of review: Given the rapid development of multiple targeted and immune therapies for patients with advanced melanoma, it can be challenging to select a therapy based on currently available data. This review aims to provide an overview of frontline options for metastatic melanoma, with practical guidance for selecting a treatment regimen.

Recent findings: Recently reported data from randomized trials suggests that the majority of patients with unresectable melanoma should receive a PD-1 checkpoint inhibitor as part of their first line therapy, irrespective of BRAF mutation status. Additional data also suggests that combination immunotherapies result in improved outcomes compared to single agent, albeit at the cost of increased toxicity, though to date no biomarker exists to help guide treatment selection. As the number therapeutic options continue to grow for patients with advanced melanoma, there is likely to be a continued focus on combination strategies. Defining the optimal treatment approach in order to maximize efficacy while minimizing toxicity remains an area of active investigation.

综述的目的:鉴于针对晚期黑色素瘤患者的多种靶向和免疫疗法发展迅速,根据现有数据选择一种疗法可能具有挑战性。本综述旨在概述转移性黑色素瘤的一线治疗方案,为选择治疗方案提供实用指导:最近报道的随机试验数据表明,无论BRAF突变状态如何,大多数无法切除的黑色素瘤患者都应接受PD-1检查点抑制剂作为一线治疗的一部分。其他数据还表明,与单药相比,联合免疫疗法的疗效更好,但代价是毒性增加,尽管迄今为止还没有生物标志物来帮助指导治疗选择。随着晚期黑色素瘤患者可选治疗方案的不断增加,联合疗法可能会继续受到关注。确定最佳的治疗方法,以最大限度地提高疗效,同时最大限度地降低毒性,仍然是一个需要积极研究的领域。
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引用次数: 0
Screening and Testing for Homologous Recombination Repair Deficiency (HRD) in Breast Cancer: an Overview of the Current Global Landscape. 乳腺癌同源重组修复缺陷(HRD)的筛查和检测:全球现状概览。
IF 4.7 2区 医学 Q1 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-01 DOI: 10.1007/s11912-024-01560-3
Gordon R Daly, Sindhuja Naidoo, Mohammad Alabdulrahman, Jason McGrath, Gavin P Dowling, Maen M AlRawashdeh, Arnold D K Hill, Damir Varešlija, Leonie Young

Purpose of review: Homologous recombination repair deficiency (HRD) increases breast cancer susceptibility and influences both prophylactic and active management of breast cancer. This review evaluates HRD testing and the therapeutic implications of HRD in a global context.

Recent findings: Ongoing research efforts have highlighted the importance of HRD beyond BRCA1/2 as a potential therapeutic target in breast cancer. However, despite the improved affordability of next-generation sequencing (NGS) and the discovery of PARP inhibitors, economic and geographical barriers in access to HRD testing and breast cancer screening do not allow all patients to benefit from the personalized treatment approach they provide. Advancements in HRD testing modalities and targeted therapeutics enable tailored breast cancer management. However, inequalities in access to testing and optimized treatments are contributing to widening health disparities globally.

综述的目的:同源重组修复缺陷(HRD)会增加乳腺癌的易感性,并影响乳腺癌的预防和积极治疗。本综述评估了全球范围内的 HRD 检测和 HRD 的治疗意义:正在进行的研究工作凸显了除 BRCA1/2 之外,HRD 作为乳腺癌潜在治疗靶点的重要性。然而,尽管下一代测序技术(NGS)的经济性有所改善,而且发现了 PARP 抑制剂,但由于 HRD 检测和乳腺癌筛查方面的经济和地理障碍,并非所有患者都能从其提供的个性化治疗方法中获益。HRD 检测模式和靶向治疗方法的进步使乳腺癌的治疗变得量身定制。然而,在获得检测和优化治疗方面存在的不平等正在导致全球健康差距的扩大。
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引用次数: 0
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Current Oncology Reports
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