Korean journal of clinical oncology最新文献

Approximately 3% to 5% of individuals with oncogenic rearrangements in the anaplastic lymphoma kinase (ALK) gene develop non-small cell lung cancer (NSCLC). Brigatinib, a potent next-generation ALK tyrosine kinase inhibitor (TKI), has demonstrated significant systemic and intracranial responses, as well as improved progression-free survival, with an acceptable safety profile. According to European Society for Medical Oncology guidelines patients with ALK translocation and performance status 0-3 can be offered 1st line treatment with TKI (brigatinib, alectinib, or lorlatinib). To our knowledge, this is the first reported case of cystic or bullous changes in the lungs following incremental dosing of brigatinib. Here, we describe a 37-year-old male, a never-smoker, who developed progressively diffuse cystic changes in the lung parenchyma while receiving brigatinib treatment for NSCLC with intrapulmonary metastases. Clinicians should remain vigilant for this potential atypical pulmonary adverse effect, including the possibility of cystic or bullous transformations in the lung parenchyma.

Cancer immunotherapy represents a transformative strategy in modern oncology, utilizing the body's immune system to recognize and eliminate malignant cells with precision. Unlike traditional therapies, which often directly target the tumor, immunotherapy enhances the immune system's inherent ability to differentiate between healthy and cancerous cells. The advent of immune checkpoint inhibitors (ICIs), particularly those targeting the PD-1/PD-L1 and CTLA-4 pathways, has marked a significant breakthrough in this field. However, the therapeutic landscape is still challenged by issues such as the development of resistance mechanisms, heterogeneity in patient responses, and the limited efficacy of current ICIs across all tumor types. Given these challenges, there is a critical need to identify and validate new immune targets that can synergize with existing therapies or function independently to overcome resistance and improve patient outcomes. This review provides a comprehensive overview of the latest research efforts focused on uncovering novel immune targets. By expanding the repertoire of immune targets, these discoveries aim to enhance the effectiveness of cancer immunotherapy, offering hope for more personalized and resilient treatment options. The integration of these novel targets into clinical practice could not only extend the benefits of immunotherapy to a broader spectrum of cancers but also mitigate some of the current limitations, paving the way for more durable and effective therapeutic strategies in the fight against cancer.

Cancer treatment has undergone significant transformation with the emergence of molecularly targeted drugs, aiming to exploit specific vulnerabilities within cancer cells while sparing normal tissues. One critical aspect of this approach is the identification of druggable targets, proteins or pathways that can be modulated by pharmacological agents to inhibit tumor growth or metastasis. The metastasis-associated protein 1 (MTA1) has emerged as a promising druggable target due to its multifaceted roles in cancer progression, including regulation of gene expression, chromatin remodeling, and promotion of epithelial-mesenchymal transition. This abstract provides an overview of the current landscape of MTA1 as a druggable target in cancer therapy, highlighting its diverse functions across different malignancies and its potential as a predictive biomarker for therapeutic response. Finally, it explores future directions and novel strategies for exploiting MTA1 inhibition in precision oncology. Overall, understanding the druggable potential of MTA1 offers new avenues for the development of innovative cancer treatments with improved efficacy and reduced toxicity, ultimately leading to better clinical outcomes for cancer patients.

Purpose: Breast cancer is one of the most common cancers globally, with an increasing incidence rate. It is a heterogeneous disease, and early metastasis remains a challenge. Tumor budding, defined as single tumor cells or small clusters at the invasive front, has been suggested as a prognostic marker in various cancers, including breast cancer. This study aims to evaluate tumor budding in invasive breast carcinoma using the International Tumor Budding Consensus Conference (ITBCC) scoring system and explore its association with pathological characteristics and prognosis.

Methods: A retrospective study was conducted on 100 mastectomy specimens of histopathologically confirmed invasive breast carcinoma, excluding cases that underwent chemotherapy or radiotherapy. Tumor budding was classified as low, intermediate, or high based on the ITBCC scoring method, and associations with clinicopathological features were analyzed using appropriate statistical tests.

Results: Tumor budding was classified as high in 52% of cases. A significant association was found between high tumor budding and higher tumor grade (P<0.001), negative estrogen receptor and progesterone receptor status (P<0.001), positive HER2neu status (P=0.003), and high Ki-67 levels (P<0.001). High tumor budding was also linked to higher T stage, and dermal lymphovascular invasion (P=0.001). Our findings support previous studies showing that high tumor budding is associated with poor prognostic factors such as higher tumor grade, negative hormone receptor status, and higher T stage.

Conclusion: Tumor budding is a potential prognostic marker in breast cancer, associated with more aggressive tumor characteristics.

Purpose: Endometrial cancer is one of the most common gynecological cancers worldwide, with rising incidence rates. Despite therapeutic advances, it remains a significant cause of cancer-related deaths. Tumor budding (TB), characterized by single cells or small clusters at the invasive tumor front, is a recognized prognostic marker in several cancers but is less studied in endometrial cancer.

Methods: This prospective cohort study included 30 patients with endometrial cancer who underwent surgical resection from January 2022 to June 2023. Formalin-fixed, paraffin-embedded tissue blocks were reviewed by two blinded pathologists. TB at the invasive front was assessed using hematoxylin and eosin staining. Clinical and pathological parameters, including age, histological type, grade, stage, myometrial invasion, lymphovascular space invasion, and nodal involvement, were recorded. Fisher's exact and chi-square tests were used for statistical analyses.

Results: Most patients (60%) were aged 51-60 years, with 93.3% diagnosed with endometrioid adenocarcinoma. Tumors were graded as 40% grade 1, 43.3% grade 2, and 16.7% grade 3. Staging showed 36.7% FIGO IA, 36.7% IB, 16.7% II, and 10% III. TB was classified as low (70%), intermediate (23.3%), and high (6.7%). Higher TB levels were significantly associated with higher tumor grade (P=0.03), advanced stage (P=0.02), and nodal involvement (P=0.01).

Conclusion: TB correlates with adverse features in endometrial cancer, including higher grade, advanced stage, and nodal involvement. These findings underscore TB's potential as a prognostic marker, warranting validation in larger studies and exploration of its molecular basis to guide personalized treatments.

Purpose: Colorectal cancer (CRC) remains a significant global health burden, necessitating innovative approaches for prevention and treatment. This study proposes a multiepitope vaccine targeting carcinoembryonic antigen (CEA) and insulin-like growth factor-1 receptor (IGF-1R), two prominent biomarkers associated with CRC progression.

Methods: Sequences of CEA and IGF-1R proteins were retrieved from NCBI databank, the sequences were aligned on the MEGA5 tool to identify conserved regions. Immunological and structural predictive analysis which include antigenic potential prediction, cytotoxic T-lymphocytes (CTLs), helper-T lymphocytes (HTLs), B-cell epitopes predictions, and prediction of the vaccine secondary and tertiary structure were performed. The vaccine was evaluated to validate its physiochemical and immunological properties. To determine the binding energy and domain, the tertiary structure of the vaccine was docked to Toll-like receptor 4, and viewed on PyMOL and LigPlot+ tools.

Results: CEA and IGF-1R were revealed to be highly antigenic, and non-allergens demonstrating the capacity to elicit robust immune responses, which include CTLs, HTLs, and B cells activation. The secondary structure revealed a conformation closely resembling native protein, with alpha helices, beta sheets, and coils, indicative of favorable interactions. Tertiary structure prediction predicted five models, model 0 was selected and validated due its highest confidence, and validation revealed that 87.5% of residues were within favored regions, with a z-score of 4.03. Molecular docking predicted strong binding complex with low binding energy.

Conclusion: Based on our analysis, the proposed multiepitope vaccine holds promise as an effective preventive measure against colorectal cancer development.

This article presents two cases of extrahepatic portal vein anomalies that can be challenging during lymph node (LN) dissection in gastric cancer surgery. The first case was a participant for a clinical trial assessing the completeness of D2 LN dissection. The trial utilized near-infrared (NIR) lymphangiography with indocyanine green only after completing dissection of a certain topological LN station to detect any residual lymphatic tissue. However, the patient was excluded from the trial due to an unexpected extrahepatic portal vein confluence anomaly and aberrant common hepatic artery. Consequently, continuous lymphatic navigation with NIR imaging was utilized for remaining surgery. The second case featured a patient with an anteriorly positioned splenic vein, hindering LN dissection along the left gastric artery. Preoperative identification of great vessel anomalies around the stomach is critical to prevent life-threatening complications during LN dissection in gastric cancer surgery. Augmented imaging technology can be a valuable tool in ensuring oncologic safety and precision.

Purpose: This study aimed to evaluate the impact of declining surgical residency program enrollment on patient care and outcomes in colorectal cancer surgeries.

Methods: This retrospective observational study included 676 patients (410 males; median age: 69 years) who underwent colorectal cancer surgery at Pusan National University Hospital between January 2018 and June 2024. Patients were divided into Group A (before December 31, 2023; with residents) and Group B (after January 1, 2024; without residents). All surgeries were performed by a single attending surgeon.

Results: Preoperative variables were comparable between groups. Group A had more emergency and open surgeries, and a higher proportion of advanced-stage cancers. Overall complication rates were similar, but Group B had a longer hospital stay (9.72 days vs. 11.95 days). Specific complications such as anastomotic leakage and surgical site infections differed significantly. The overall number of surgical procedures declined markedly in 2024 compared to 2018 (77.1% vs. 49.9%).

Conclusion: The absence of residents did not increase overall complication rates but was associated with longer hospital stays and shifts in clinical practice. Greater reliance on attending surgeons contributed to more defensive decision-making and conservative patient management. Addressing these issues requires systemic reforms, including multidisciplinary collaboration and legal protections to improve surgical care.

Cancer immunotherapy uses the body's immune system to combat cancer, marking a significant advancement in treatment. This review traces its evolution from the late 19th century to its current status. It began with William Coley's pioneering work using bacterial toxins to stimulate the immune system against cancer cells, establishing the foundational concept of immunotherapy. In the mid-20th century, cytokine therapies like interferons and interleukins emerged, demonstrating that altering the immune response could reduce tumors and highlighting the complex interplay between cancer and the immune system. The discovery of immune checkpoints, regulatory pathways that prevent autoimmunity but are exploited by cancer cells to evade detection, was a pivotal development. Another major breakthrough is CAR-T cell therapy, which involves modifying a patient's T cells to target cancer-specific antigens. This personalized treatment has shown remarkable success in certain blood cancers. Additionally, cancer vaccines aim to trigger immune responses against tumor-specific or associated antigens, and while challenging, ongoing research is improving their efficacy. The historical progression of cancer immunotherapy, from Coley's toxins to modern innovations like checkpoint inhibitors and CAR-T cell therapy, underscores its transformative impact on cancer treatment. As research delves deeper into the immune system's complexities, immunotherapy is poised to become even more crucial in oncology, offering renewed hope to patients globally.

The COVID-19 pandemic, which emerged in the light of day toward the end of 2019, has changed almost every field of health care basically, and oncology is no exception. After reflecting on events of the past 2 years, it becomes evident that while the pandemic has put several difficulties in the way of cancer diagnosis, treatment, and research, it has also brought about a few positive changes and once again highlighted how strong the global cancer care community is.