Expert Review of Anticancer Therapy最新文献

Introduction: Hematopoietic stem cell transplantation (HSCT) is a widely used transplant method for different cancerous and non-cancerous conditions, particularly when conventional treatments fail. Again, Epstein-Barr Virus (EBV), one of the major contributors to gastric carcinoma can cause post-transplantation lymphoproliferative disease (PTLD) after transplantations. However, the global prevalence of EBV infection and associated PTLD in HSCT recipients is yet to be determined.

Methods: This research examined 33 studies selected from 941 articles across three databases (i.e. ScienceDirect, PubMed, and Google Scholar) to investigate the global epidemiology of EBV infection and associated PTLD in HSCT patients.

Results: The overall prevalence was calculated primarily as 27.0%; 95% CI: 24.5-29.5, and 23.7%; 95% CI: 19.3-28.3 after removing outlier studies. The analyzed studies were of high quality. Among different continents, North America was determined to have the highest prevalence rate (33.3%; 95%CI: 12.5-54.1) followed by Europe (27.8%; 95%CI: 23.3-32.2), and Asia (20.7%; 95%CI: 17.4-23.9).

Conclusion: This investigation highlights the need for early detection of EBV infection and associated PTLD, personalized treatment strategies, and continued research into the condition's underlying mechanisms. Addressing these aspects can enhance outcomes for HSCT patients and contribute to advancements in transplant medicine.

Registration: PROSPERO (CRD420250583221).

Background: Mucinous adenocarcinoma of the appendix (MACA) has high metastatic potential and poor prognosis, lacking predictive models. This study aimed to establish models for assessing distant metastasis (DM) risk and survival prognosis of MACA patients with DM.

Research design and methods: SEER database data of MACA patients diagnosed from 2010 to 2021 were collected. Univariate and multivariate logistic regression identified DM risk factors, while Cox regression determined prognostic factors for DM patients. Two nomograms were created and evaluated via ROC curves, calibration curves, and DCA. Results: A total of 1722 patients with MACA were included, and 832 patients had DM at the time of diagnosis. The independent risk factors for DM in patients with MACA include gender, age, tumor size, T stage, and N stage. For MACA patients with DM, age, N stage, and surgical treatment were independent risk factors for overall survival (OS). The diagnostic and prognostic nomograms showed good discriminatory ability and calibration. The independent prognostic factors for MACA patients with DM are age, N stage, and surgery.

Conclusions: The established diagnostic and prognostic models can quantitatively assess the risk and prognosis of MACA with DM, providing more effective guidance for clinical decision-making.

Introduction: Non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer cases and remains the leading cause of cancer-related mortality worldwide. Accurate assessment of predictive biomarkers, such as ALK and PD-L1, is essential for personalized therapy and to guide clinical decisions. Companion diagnostic (CDx) tests play a crucial role in this context.

Areas covered: PD-L1 and ALK are key predictive biomarkers for NSCLC treatment. PD-L1 expression on tumor cells (TCs) helps predict responses to anti - PD-1 and anti - PD-L1 treatments, with assays like 22C3 and SP263. ALK rearrangements, detected by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), helps predict responses to ALK inhibitors like crizotinib. IHC is a practical and cost-effective screening method but combining IHC with molecular techniques such as next-generation sequencing (NGS) or FISH enhances accuracy.

Expert opinion: PD-L1 and ALK are crucial predictive biomarkers for patients with NSCLC. PD-L1 IHC expression predicts response to immune checkpoint inhibitors (ICIs), but its predictive value is not perfect, with some PD-L1-negative patients benefiting from specific therapy. ALK IHC, with confirmatory FISH or NGS, guides tailored treatment. In this context, an integrated predictive approach enables the best clinical and therapeutic management of patients with NSCLC.

Introduction: Hepatocellular carcinoma (HCC), a common and aggressive liver cancer, frequently manifests at an advanced stage, restricting the effectiveness of standard treatments. Recent advancements in nanotechnology, particularly in liposome-based delivery systems, offer promising approaches to enhance treatment efficacy and immunological regulation in hepatocellular carcinoma (HCC).

Areas covered: This study emphasizes the diverse functions of liposomes in augmenting drug solubility, targeting neoplastic tissues, increasing immunological responses, and surmounting biological barriers. It investigates the synergy of liposomal platforms and immunotherapies, including checkpoint inhibitors, and their incorporation with locoregional treatments for advanced-stage hepatocellular carcinoma (HCC).

Expert opinion: Liposomes are a revolutionary approach in cancer immunotherapy. Innovations like PEGylation, surface ligand modification, and dual-drug encapsulation have significantly enhanced treatment outcomes in preclinical and early clinical contexts. Advancements, especially in patient-specific and stimuli-responsive systems, may transform the future of HCC care.

Background: The prognosis for patients with advanced pancreatic cancer (PC) remains extremely poor, underscoring the critical need to explore and optimize systemic treatment strategies. This study aimed to evaluate the efficacy and safety of combining EGFR monoclonal antibodies (Anti-EGFR-mAb) with gemcitabine-based chemotherapy as a first-line treatment for locally advanced or metastatic PC.

Results: A total of 11 studies were included, with a total sample size of 806 patients with locally advanced or metastatic PC. Meta-analysis results showed that the objective response rate (ORR) for first-line treatment of advanced PC with Anti-EGFR-mAb combined with gemcitabine was 15% (95% CI: 10-22%), and the disease control rate (DCR) was 58% (95% CI: 49-67%). Compared with gemcitabine-based chemotherapy, combination therapy did not improve progression-free time (PFS) (HR = 0.93, 95%CI: 0.81-1.04, p = 0.057) or overall survival (OS) (HR = 0.90, 95%CI: 0.78-1.02, p = 0.04). The incidence of severe adverse events (sAEs) caused by combination therapy was 31% (95% CI: 14-50%).

Conclusions: Anti-EGFR-mAb combined with gemcitabine chemotherapy has shown a good efficacy to first-line treatment of advanced PC, it did not provide a significant survival benefit compared to chemotherapy alone. Additionally, combination therapy was associated with a high incidence of AEs, highlighting safety concerns that warrant special attention.

Registration: PROSPERO (CRD420250652874).

Introduction: Deep learning (DL) is transforming cancer research by enabling data-driven drug discovery. However, its clinical translation, particularly in endometrial cancer (EC), faces significant challenges.

Areas covered: This review discusses recent DL applications across drug discovery stages in EC, including target identification, virtual screening, and de novo drug design. We highlight key obstacles that hinder clinical translation, such as data scarcity, limited model explainability, biological validation gaps, and regulatory uncertainty, and propose practical solutions. Literature was sourced from PubMed, Web of Science, and relevant AI repositories, with an emphasis on peer-reviewed studies from the past five years.

Expert opinion: Despite early success, DL must overcome multiple translational bottlenecks to impact EC therapeutics meaningfully. A multidisciplinary approach that incorporates data quality improvements, functional validation, regulatory engagement, and clinician-focused decision support is essential to fully realize the clinical promise of DL-driven drug discovery in EC.

Introduction: Human papilloma virus positive (HPV+) OPSCC has a favorable prognosis compared to its HPV- carcinomas but a significant proportion of patients will experience disease recurrence and death. Enhancement of surveillance strategies after treatment for primary HPV + OPSCC is of great importance.

Areas covered: The aim of this paper is to provide an updated synthesis of the current state of evidence on the surveillance of HPV+ OPSCC and provide guidance on future directions on this topic. Basic and clinical research efforts are directed on various aspects of surveillance, including but not limited to patterns of recurrence, radiology, circulating tumor HPV DNA, and follow-up strategies.

Expert opinion: The majority of OPSCC recurrences are detected by patients or during follow-up imaging. Rarely, recurrences are detected during the visits. Routine clinical surveillance can be scheduled once every 3 months in the first year, once every 6 months in the second year, and then annually up to year 5. Regarding imaging surveillance, positron emission tomography-computed tomography (PET-CT) of the head, neck, and chest is the most widely recommended modality. Current guidelines recommend one imaging at 3 months post-treatment, with subsequent imaging at the discretion of the clinician. Circulating HPV-DNA is an emerging technology that can be integrated soon into daily clinical practice.

Introduction: There is limited research on the real-world use of medicines for the management of pediatric cancers, with insufficient understanding of the varied approaches toward treatment across the globe. This scoping review aimed to identify publications focusing on systematic anti-cancer therapy (SACT), along with supplementary medicines, for pediatric patients with hematological malignancies in routine clinical practice globally to provide insights into current practice and identify gaps in the literature.

Areas covered: A scoping review methodology, following the Joanna Briggs Institute guidance, was used to identify observational studies, published between January 2013 and February 2023 in PubMed, Embase, and Scopus databases. A total of 82 studies were identified, describing the use of 50 SACT agents and 74 supplementary care medicines. Findings highlighted the implementation of multi-drug therapeutic plans to treat hematological malignancies and the diversity of treatments across settings. Cancer treatment was commonly complemented by the administration of various supplementary medicines.

Expert opinion: Further observational studies should be conducted to provide additional insights into pharmacological interventions in under-researched therapeutic areas; in addition, descriptive drug utilization studies would be beneficial from clinical settings where pediatric cancer patients are commonly included in clinical trials to address knowledge gaps on treatments in these settings.

Introduction: Breast sarcomas (BS) are considerably less prevalent than breast carcinomas. Nevertheless, they are often aggressive, resulting in substantial morbidity and mortality. Despite advances and the introduction of targeted therapies, the treatment continues to rely on cytotoxic chemotherapy. Given their rarity, this review comprehensively examines recent developments in BS therapies and explores how novel treatments may be integrated into the current standard of care. It also highlights emerging trends in adjuvant treatment for localized disease and targeted therapies for specific histologic subtypes in metastatic cases.

Areas covered: This review synthesizes recent developments in BS and integrates novel therapies into the existing treatment paradigm. It underscores the heterogeneity among BS subtypes and discusses emerging trends in adjuvant therapies and targeted agents. Current literature was reviewed by a systematic search using PubMed, focusing on high-impact clinical trials, guidelines, and recent reviews published up to January 2025.

Expert opinion: Although there is a growing understanding of genomic abnormalities associated with specific sarcoma subtypes, this knowledge has yet to be fully applied to personalized treatment strategies. Future research should focus on integrating genomic insights, enhancing trial design to improve patient's outcome. Robust interdisciplinary collaboration - combined with real-world data collection - is critical in improving treatment outcomes.