Expert Opinion on Pharmacotherapy最新文献

Introduction: This review evaluates recent therapeutic advances in colorectal cancer (CRC), with a focus on late-phase clinical trials published between January 2024 and March 2025. The objective was to synthesize emerging data on chemotherapy, immunotherapy, targeted therapy, in metastatic colorectal cancer (mCRC) and locally advanced rectal cancer (LARC).

Areas covered: Notable findings include durable survival with pembrolizumab and nivolumab + ipilimumab in MSI-H/dMMR mCRC, efficacy of fruquintinib in refractory disease, and promising early outcomes with SCRT-based immunochemotherapy in LARC.

Expert opinion: Recent trials support precision oncology in CRC, highlighting durable benefits of targeted and immune therapies. However, heterogeneity in trial designs and underrepresentation of real-world populations limit generalizability.

Introduction: Dermatophytosis is the most common fungal infection encountered by primary care providers and outpatient physicians. In recent years, new patient populations with chronic infections - accompanied by a history of recurrences and relapses - presenting with unusual or severe manifestations have been reported worldwide. This is broadly referred to as recalcitrant dermatophytosis.

Areas covered: Through an electronic literature search spanning the last 25 years, we discuss systemic treatment options for recalcitrant dermatophytosis, including conventional terbinafine and itraconazole treatments, either alone or in combination with topicals. Dosing strategies and treatment durations are summarized along with potential reasons for treatment failure. There is mounting evidence suggesting that dermatophyte resistance is a significant cause of terbinafine nonresponse, making itraconazole the preferred first-line treatment. However, pharmacokinetic variability may cause sub-therapeutic exposure and induce resistance to itraconazole. In some instances, super-bioavailable itraconazole may be a consideration. Corticosteroids should be strictly avoided.

Expert opinion: The current literature is limited by case reports and small case series. Newer triazoles and ketoconazole have been reported as drugs of last resort. Increased advocacy and collaboration are needed to standardize the management of recalcitrant dermatophytosis including antifungal susceptibility testing, especially concerning special populations such as pregnant individuals and children.

Introduction: Effective postoperative pain is a significant challenge for clinicians. Suboptimal pain management can lead to delayed recovery and increased risk of chronic pain. Multimodal analgesia strategies are increasingly adopted but variably implemented.

Areas covered: This review evaluates current and emerging pharmacologic agents for postoperative pain, from established drugs like acetaminophen, NSAIDs, and ketamine to off label and adjunct agents like vitamin C and duloxetine. It also critically appraises novel formulations of local anesthetics, opioids, and emerging agents with promising potential. The review highlights clinical implementation barriers including costs, provider familiarity, and real-world evidence.

Expert opinion: Despite an ever-expanding pharmacologic arsenal, postoperative pain control continues to be hindered by systemic, clinical, and institutional barriers. Although several new agents show promising results in reducing opioid consumption and improving recovery, their widespread adoption is limited by high costs and lack of robust long-term data. Bridging the gap between innovation and clinical practice requires coordinated efforts in research, education, and policy development.

Introduction: Psoriatic arthritis (PsA) is a systemic inflammatory disease affecting joints, entheses, skin, nails, and spine, often accompanied by comorbidities such as obesity, metabolic syndrome, and cardiovascular disease. Despite therapeutic advances, progressive joint damage, functional impairment, and reduced quality of life remain major concerns.

Areas covered: This review highlights recent and emerging therapies in PsA, including newer biologic DMARDs (risankizumab and bimekizumab), tyrosine kinase 2 (TYK2) inhibitors, dual Janus Kinase (JAK) 1/TYK2 inhibitors, interleukin-23 receptor (IL-23 R)-targeted peptides, Affibody® molecules, and IL-17A/IL-17F-inhibiting nanobodies. Metabolic-targeted approaches, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs), offer potential benefits in obesity-driven disease. Evidence from randomized controlled trials (RCTs) and observational studies is summarized, encompassing efficacy across disease domains, safety profiles, and durability of response. Dual-pathway targeting for refractory cases is also discussed.

Expert opinion: Advances in mechanism-based and metabolic-targeted therapies enable more individualized PsA management, improving the likelihood of achieving treatment targets. Ongoing challenges include early recognition, treatment of refractory disease, and long-term safety assessment. Progress in patient-centered therapy selection and precision medicine is expected to enhance outcomes, reduce disease burden, and optimize healthcare resources. Emerging pharmacotherapies continue to expand the treatment landscape, supporting a shift toward more effective, durable, and personalized management strategies.

Introduction: Cholangiocarcinoma (CCA) is a rare, highly lethal biliary malignancy comprising intrahepatic (iCCA), perihilar (pCCA), and distal (dCCA) subtypes, with a rising global incidence. Surgery is the only curative option, yet most patients present with advanced disease, making systemic therapy the mainstay. Molecular profiling has revealed marked heterogeneity, and fibroblast growth factor receptor 2 (FGFR2) fusions in iCCA represent one of the most actionable targets.

Areas covered: An extensive literature search was performed in PubMed/MEDLINE, Embase, and ClinicalTrials.gov to identify preclinical studies, clinical research, and clinical trials evaluating FGFR inhibitor therapy in CCA. This review summarizes FGFR signaling biology, the prevalence and diagnostic challenges of FGFR2 fusions, and clinical evidence for FGFR inhibitors. Resistance mechanisms, diagnostic strategies, toxicity profiles, and ongoing trials are also reviewed.

Expert opinion: FGFR inhibitors are transitioning from experimental to established targeted options, underscoring the need for routine molecular profiling and optimized fusion detection. Key challenges include overcoming resistance, refining patient selection, and defining the role of FGFR inhibition in combination strategies and earlier-line or perioperative settings. Further evidence is needed to clarify long-term clinical benefit in FGFR2-altered CCA.