Expert Review of Anticancer Therapy最新文献

Introduction: Bevacizumab and poly (ADP-ribose) polymerase inhibitors (PARPi) administered as maintenance therapies after platinum-based chemotherapy have shown a progression-free survival benefit in patients with ovarian cancer. However, there is no head-to-head trial comparing the quality of life (QOL) between bevacizumab and PARPi. We conducted a Bayesian network meta-analysis to compare the QOL between bevacizumab and PARPi.

Methods: PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. were searched for trials reporting QOL in ovarian cancer treated with bevacizumab or PARPi. The primary outcome was the difference in QOL change between bevacizumab and PARPi.

Results: Eight RCTs with a total of 5822 participants were included in our analyses. We found no significant difference in QOL change between patients treated with bevacizumab and those treated with PARPi (SMD = -0.058, 95%CrI -0.431 to 0.331). Subgroup analyses stratified by treatment setting and BRCA status showed no significant influence on the network estimates.

Conclusions: Both bevacizumab and PARPi demonstrated no significant adverse effects on QOL when compared to standard chemotherapy. There was no clear superiority of one treatment over the other in terms of QOL. The acceptable QOL further supports the benefit of these maintenance treatments for ovarian cancer.

Registration: PROSPERO (CRD42024607491).

Introduction: Hormone receptor-positive and HER2-negative advanced breast cancer is the most prevalent subtype and poses therapeutic challenges. While endocrine therapy remains the cornerstone of management, acquired resistance, particularly stemming from ESR1 mutations, limits long-term efficacy. Consequently, novel endocrine agents with enhanced potency, oral bioavailability, and favorable tolerability are crucial for overcoming resistance and improving patient outcomes.

Areas covered: This review provides a comprehensive evaluation of elacestrant, an orally active selective estrogen receptor degrader that has transformed the treatment paradigm for endocrine resistant disease. The pharmacologic properties, antitumor activity, and clinical outcomes associated with elacestrant are discussed in detail, along with ongoing research exploring its integration into combination regimens and in earlier disease settings.

Expert opinion: Elacestrant has become an important therapeutic option for patients with ESR1-mutated disease, offering durable estrogen receptor suppression and favorable tolerability. Combination therapies targeting CDK4/6 and PI3K-AKT-TOR signaling pathways represent promising directions for extending endocrine sensitivity. With the growing integration of liquid biopsy technologies and molecular monitoring into clinical practice, dynamic treatment adaptation guided by real time molecular profiling is expected to refine therapy selection. Elacestrant is a benchmark in the shift toward individualized endocrine therapy in metastatic breast cancer, bridging molecular precision with clinical practicality.

Introduction: CRISPR-based genome editing and mRNA vaccine technologies have recently converged to offer new opportunities for precise and adaptable cancer immunotherapy. Their combined use may improve tumor antigenicity while enabling rapid induction of tailored immune responses.

Areas covered: This review examines how CRISPR-mediated modulation of oncogenic pathways, immune evasion mechanisms, and antigen presentation can enhance the efficacy of mRNA neoantigen vaccines. A structured literature search using PubMed, Web of Science, and Scopus (2013-2025) was conducted to identify preclinical and clinical studies evaluating CRISPR editing, mRNA cancer vaccines, and integrated combination strategies. Evidence from preclinical models demonstrates that CRISPR-driven tumor sensitization such as checkpoint disruption or antigen restoration amplifies T-cell responses elicited by mRNA vaccination. Early-phase clinical trials in melanoma, non - small-cell lung cancer, and pancreatic cancer indicate that sequential CRISPR editing followed by individualized mRNA vaccination is technically feasible and capable of inducing durable immune activity. Challenges related to delivery systems, safety oversight, and ethical considerations are also evaluated.

Expert opinion: CRISPR - mRNA integration represents a promising path toward adaptive, evolution-aware oncology. As delivery and regulatory frameworks advance, combined genome editing and programmable RNA immunotherapy is likely to become a key pillar of future personalized cancer treatment.

Introduction: The CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) gene-editing tool provides novel therapeutic alternatives by promoting the gene alteration in adaptive T cells or malignant cells to combat Hepatocellular Carcinoma (HCC). More successful cancer treatments are now possible due to the capacity of precisely locating and modifying particular genetic abnormalities that promote malignancy growth and metastasis.

Areas covered: In this review, we address ongoing clinical trials, the possible similarities between CRISPR-based cancer treatments and current therapeutic choices, and how CRISPR technology can improve treatment outcomes for HCC while using the latest safety measures. Additionally, this analysis sheds light on the existing obstacles and potential future possibilities of applying CRISPR technology to the management of HCC, with a final objective of enhancing patient results and completely changing the field of HCC therapies.

Expert opinion: The urgent need for innovative therapies is underscored by the poor prognosis associated with severe hepatocellular carcinoma, despite recent advancements in clinical therapies. Through a special emphasis on invivo cancer cell targeting along with the generation of chimeric antigen receptor (CAR) T cells, including T cell receptor (TCR) T cells, this review analyses the uses of CRISPR methods in the therapy of HCC.

Introduction: Bladder cancer is a prevalent and costly malignancy, with persistent challenges in early detection, accurate staging, and personalized treatment planning. Artificial intelligence (AI) has emerged as a transformative tool with the potential to address these limitations across the bladder cancer continuum.

Areas covered: This review synthesizes findings from 49 studies selected through a comprehensive literature search of PubMed, MEDLINE, Embase, Scopus, and Google Scholar spanning 2005 to 2025. The included studies explore AI applications in cystoscopic lesion detection, radiologic staging using CT and MRI, histopathologic grading, molecular biomarker profiling, treatment response prediction, and survival prognostication.

Expert opinion: AI has demonstrated significant promise in enhancing diagnostic precision, reducing interobserver variability, and enabling individualized treatment strategies. However, widespread clinical adoption remains limited due to challenges in data quality, lack of multicenter validation, integration into electronic health records, and regulatory hurdles. Future research should prioritize explainable AI models, prospective validation, and demonstration of cost-effectiveness and survival benefits. With continued innovation and standardization, AI is poised to become an integral component of precision oncology in bladder cancer care.

Introduction: Nanomedicine offers innovative and less invasive therapies by targeting key biological pathways through specific ligands, enhancing precision and minimizing adverse effects. Among nanocarriers, liposomes stand out for their dual aqueous-organic structure, which enables encapsulation of both hydrophilic and hydrophobic compounds, improving drug stability and bioavailability.

Areas covered: Cancer remains one of the leading causes of death worldwide, with about 9.6 million deaths annually, according to the World Health Organization (WHO). Despite advances in chemotherapy and radiotherapy, major challenges persist, including toxicity and multidrug resistance. Nanoparticles (NPs) have emerged as promising tools for cancer therapy, acting through direct tumor targeting, modulation of the tumor microenvironment, and activation of immune responses. This review summarizes recent preclinical and clinical findings on liposomal formulations used against breast, liver, pancreatic, and prostate cancers, focusing on their therapeutic potential and translational progress.

Expert opinion: Liposome performance depends on molecular surface modifications using carbohydrates, proteins, peptides, aptamers, or monoclonal antibodies. These functionalized liposomes enable ligand-receptor recognition, facilitating endocytosis and controlled intracellular drug release. Consequently, targeted liposomal systems achieve higher specificity and reduced systemic toxicity compared with passively delivered formulations.

Background: Outcomes for pediatric acute myeloid leukemia (AML) have improved substantially in high-income countries through advances in therapy, supportive care, and risk stratification. In Uruguay, results remain poorer despite adopting international protocols. This study evaluates clinical features and outcomes of pediatric AML in Uruguay, establishing a baseline before implementation of the CHIP-AML22 protocol in 2025.

Research design and methods: A retrospective analysis was conducted using data from the National Pediatric Cancer Registry. Patients under 18 years diagnosed with AML between January 2008 and December 2024 were included. Treatment followed St. Jude AML08 and CLCN-UK 2016 protocols. High-risk or relapsed patients received allogeneic stem cell transplantation.

Results: Ninety-two patients were diagnosed with AML, including 7 with Down syndrome and 19 with acute promyelocytic leukemia (APL). Among 66 AML patients, excluding DS and APL, induction failure occurred in 24% (12% early death, 12% refractory disease), relapse in 24%, and treatment-related mortality accounted for 73% of deaths. Five-year overall survival was 50% and event-free survival 38%.

Conclusions: Pediatric AML survival in Uruguay remains below international benchmarks, mainly due to treatment-related mortality during induction. Implementation of CHIP-AML22, together with stronger induction management and supportive care, offers opportunities to improve survival and narrow this gap.

Introduction: The integration of primary systemic therapy (PST) into breast cancer management increasingly shapes locoregional treatment. Rising pathological complete response rates and improved survival have fueled interest in radiation therapy (RT) de-escalation to limit late toxicity while preserving oncological control. Yet the risk of undertreatment and its delayed consequences remains a major concern.

Areas covered: This article appraises evidence supporting response-adapted RT de-escalation after PST. We review key prospective and retrospective studies, including RAPCHEM and NSABP/B-51, outlining their methodological strengths, limitations, and clinical relevance. Evidence was identified through a focused narrative review of major clinical trials, pooled analyses, and meta-analyses addressing locoregional management in the post-PST setting. We further discuss how contemporary systemic therapies, evolving surgery, molecular profiling, and technological advances in RT inform individualized decision-making.

Expert opinion: Early data suggest that RT de-escalation may be feasible for carefully selected patients, but current evidence does not justify unrestricted omission of RT in all pathological complete responders. Decisions should remain grounded in long-term outcomes, accurate pre-treatment staging, and robust validation of predictive biomarkers. Until such evidence matures, RT de-escalation should be undertaken cautiously - preferably within clinical trials or prospective registries and following multidisciplinary review - to minimize the risk of inadvertent locoregional undertreatment.

Introduction: Thyroid cancer management is shifting from morphology-based assessment to precision oncology driven by integrated molecular profiling and computational analytics. This review examines how these advances address overdiagnosis, indeterminate cytology, and radioiodine-refractory disease.

Areas covered: We synthesize recent evidence on multi-analyte next-generation sequencing panels, the prognostic impact of co-occurring mutations, characterization of the tumor immune microenvironment, and therapeutic innovations (targeted agents and immunomodulatory strategies). We also summarize applications of artificial intelligence in ultrasound, cytology, and text mining. Literature was identified through structured searches of PubMed/MEDLINE, Scopus, and Web of Science for English-language studies published between January 2020 and June 2024, prioritizing original research, clinical trials, meta-analyses, and high-quality reviews.

Expert opinion: The field is converging toward an integrated framework that combines genomic architecture, immune contexture, and AI-derived features to refine surgical decisions, guide radioactive iodine use, and select systemic therapy. Near-term priorities include standardizing multi-omic pipelines, validating AI across diverse populations, and expanding access to testing, while emerging tools such as liquid biopsy and patient-derived organoids are poised to enable adaptive, patient-specific management.