Asia-Pacific journal of clinical oncology最新文献

Aim: Targeted therapy is recommended for lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations. We aimed to investigate clinical efficacy and safety, as well as the potential underlying mechanisms, of Qilian mixture as an adjunct treatment during gefitinib therapy in these patients.

Methods: We conducted a randomized controlled clinical trial in lung adenocarcinoma patients with EGFR mutations between July 2020 and June 2021. Patients received either gefitinib (control group) or Qilian mixture with gefitinib (study group) for 12 weeks. Quality of life, clinical symptoms, Response Evaluation Criteria in Solid Tumors (RECIST), serum tumor markers, and adverse effects were evaluated. We also tested the intestinal flora and performed network pharmacology analysis.

Results: A total of 46 patients were analyzed (23 patients in each group). Intergroup baseline characteristics were comparable. The study group had significantly improved quality of life and clinical symptoms compared with control group. Serum tumor marker levels and incidence of diarrhea were lower in the study group than in the control group. There were no significant intergroup differences in RECIST and other adverse effects. Compared with the control group, the study group exhibited better intestinal flora diversity. Network pharmacology analysis indicated that the Qilian mixture influences carcinogenesis, lipid metabolism and atherosclerosis, calcium homeostasis, and reproductive hormone regulation pathways.

Conclusion: As an adjunct treatment during gefitinib therapy for lung adenocarcinoma patients with EGFR mutations, Qilian mixture safely improved short-term clinical symptoms and quality of life, with future research requiring a large sample size and pharmacological mechanism studies in intestinal flora changes and related signaling pathways.

Trial registration: ClinicalTrials.gov identifier: ChiCTR2100047349.

Aim: Brain metastasis is associated with poor prognosis in patients with breast cancer. Conventional predictive models rely on fixed baseline characteristics and provide limited clinical utility. We aimed to analyze the factors associated with brain metastasis using time-dependent Cox regression.

Methods: We retrospectively reviewed the records of consecutive patients who underwent breast cancer surgery between 2002 and 2020 at a single institution. The number of metastatic organs was defined as a time-dependent covariate. Multivariable Cox regression analysis was performed to identify factors associated with brain metastasis.

Results: Of the 2459 patients included in the study, 58 (2.4%) patients developed brain metastasis during a median follow-up of 62 months. On time-dependent multivariable Cox regression, advanced T stage, hormone receptor negativity, and the number of metastatic organs were independent predictive factors of brain metastasis. Hazard ratios (HRs) increased with metastatic burden: 30.06 for single-organ metastasis, 73.39 for double-organ metastases, 265.10 for triple-organ metastases, and 278.60 for quadruple or more organ metastases. Compared with patients whose first distant metastasis occurred at other sites, those with bone metastasis were less likely to develop brain metastasis (HR, 0.280; 95% confidence interval [CI], 0.099-0.792; p = 0.016), whereas those with soft tissue metastasis were more likely to develop brain metastasis (HR, 4.048; 95% CI, 1.391-11.782; p = 0.010).

Conclusion: The number and site of metastatic organs are key risk factors of brain metastasis. Personalized brain screening may facilitate early detection of brain metastasis in high-risk patients.

Objective: Review outcomes for patients undergoing biliary drainage and stenting via percutaneous transhepatic cholangiography, drainage, and stenting (PTCDS) for malignant hilar biliary obstruction secondary to hepatopancreaticobiliary (HPB) tumors versus other tumor types, to identify factors which predict poor outcomes and assist discussions with patients and clinicians.

Methods: Retrospective search electronic medical records for adult patients who underwent PTCDS for malignant hilar obstruction. The primary endpoint was in-hospital bilirubin reduction, with secondary endpoints of progression to further systemic therapy, length of hospital stay, and overall survival from procedure date.

Results: Within the cohort of 50 patients, PTCDS led to a statistically significant reduction in bilirubin (p < 0.0001). The median overall survival was 81.9 days, with a median hospital stay of 11.5 days. Nineteen patients had further systemic therapy. There was no significant difference in bilirubin improvement between different cancer types, and bilirubin improvement was positively correlated with survival and with having further systemic therapy (p = 0.016). There was no significant difference in overall survival between patients with HPB cancers versus other cancers (p = 0.49). Background cirrhosis of the liver (p = 0.03) and the presence of more than one liver lesion (p = 0.02) independently negatively impacted survival. There was no impact of any covariate on the length of hospital stay.

Conclusion: PTCDS for malignant biliary obstruction has a beneficial role in the palliative management of cancer patients, but should only be pursued with very significant caution in those with background liver cirrhosis and in those with a large burden of hepatic disease.

Introduction: Colorectal cancer (CRC) remains a major contributor to cancer-related mortality worldwide, with survival influenced by many prognostic factors. This study aims to evaluate survival outcomes and prognostic factors for patients diagnosed with CRC at the Northern Hospital between 2016 and 2021, with a focused subgroup analysis of patients with metastatic disease.

Methods: A retrospective review was performed using data from the Bowel Cancer Outcomes Registry (B-COR) and electronic patient records. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-Meier survival modeling. Univariate and multivariate cox proportional hazards analysis was used to determine independent prognostic factors.

Results: A total of 518 patients were included. Median OS was 93.1 months, with a 1-year OS of 92.4% and a 5-year OS of 67.1%. Age, stage at diagnosis, abnormal CEA, and primary tumor resection were independently associated with survival. In Stage III disease, chemotherapy was a positive prognostic factor. In metastatic disease, patients with lung-only metastasis had the best 5-year survival at 46.0%. The receival of curative-intent chemotherapy and metastasectomy independently improved survival in this group. The timing of metastasis (synchronous vs. metachronous), primary tumor site, and primary tumor resection did not influence survival.

Conclusion: This study indicates comparable survival outcomes at the Northern Hospital to other high-income countries. AJCC staging and CEA are key prognostic markers and should guide risk stratification. In metastatic disease, curative-intent approaches can dramatically improve survival. These findings support the necessity for early detection and multimodal treatment in patients with CRC.

Aim: Diabetes mellitus (DM) is associated with impaired response to neoadjuvant chemoradiotherapy in rectal cancer. Metformin may enhance treatment response by improving tumor oxygenation and inhibiting cell growth and proliferation through activation of AMP-activated protein kinase and downstream inhibition of mTOR and HIF-1α pathways. However, the impact of DM and metformin use in patients receiving total neoadjuvant therapy (TNT) for advanced rectal cancer remains unknown.

Objective: This study evaluates the effect of DM and metformin use on overall complete response (oCR) after TNT.

Methods: This multicenter, retrospective cohort study included consecutive rectal cancer patients treated with TNT with curative intent at three South Australian hospitals between 2019 and 2025. Patients were grouped by diabetes status and metformin use. The primary outcome was the oCR rate, encompassing both clinical complete response (cCR) and pathological complete response (pCR) rates. The main secondary outcome was response at distant sites (complete M1 response).

Results: Among 244 patients who completed TNT, 44 (18.0%) were diabetic and 31 (12.7%) patients used metformin. No significant differences in response rates were observed between diabetic and nondiabetic groups: oCR (47.7%vs. 41.5%, p = 0.450), cCR (40.9% vs. 37.5%, p = 0.673), pCR (12.5% vs. 8.3%, p = 0.457), and M1 complete response (50% vs. 36.2%, p = 0.873). Similarly, no significant differences in oCR, cCR, pCR, or complete M1 response were observed between metformin users and non-users. However, subgroup analysis of diabetic patients demonstrated that those taking metformin had a significantly higher oCR rate than those not taking metformin (58.1% vs. 23.1%, p = 0.049).

Conclusion: Diabetes and metformin use did not significantly affect tumor response rates in the overall cohort of patients with advanced rectal cancer treated with TNT. However, among diabetic patients, metformin use was associated with improved response to TNT. Given the retrospective design and limited sample size, large-scale prospective studies are required to validate these findings.

The present study aimed to develop and evaluate β-cyclodextrin (β-CD)-coated mesoporous silica nanoparticles (MSNs) for the controlled delivery of paclitaxel (PTX) to improve its aqueous solubility, stability, and anticancer efficacy. MSNs were synthesized by a sol-gel method using cetyltrimethylammonium bromide as a structure-directing agent and tetraethyl orthosilicate as a silica precursor, followed by PTX loading via solvent-evaporation and β-CD surface modification through physical adsorption. The synthesized nanocarriers were characterized by DLS, SEM, TEM, XRD, FTIR, BET, TGA, and DSC analyses to confirm morphology, particle size, crystallinity, porosity, and chemical interactions. β-CD-coated PTX-MSNs exhibited an average particle size of ∼137 nm with a narrow polydispersity index (0.189) and near-neutral zeta potential (-17.2 mV), indicating colloidal stability and successful surface functionalization. BET and DSC analyses confirmed drug encapsulation and amorphization within the silica matrix. In vitro drug-release studies revealed sustained release (≈69% over 72 h) governed by diffusion-controlled kinetics (Higuchi model, R² = 0.991). MTT assays on MCF-7 breast-cancer cells demonstrated markedly enhanced cytotoxicity of β-CD-PTX-MSN (IC₅₀ = 2.48 µg/mL, 48 h) compared with uncoated PTX-MSN and free PTX, attributed to improved cellular uptake (≈2.3-fold) and apoptosis induction. Furthermore, the formulation displayed negligible hemolysis (< 5%), confirming excellent hemocompatibility. Overall, β-CD-functionalized MSNs provide a promising nanoplatform for safe and sustained PTX delivery in breast-cancer chemotherapy.

Background: Sentinel lymph node biopsy (SLNB) reduces morbidity in breast cancer (BC) surgery compared to axillary lymph node dissection. Standard tracers such as vital blue dye (VBD), methylene blue (MB), and radioisotopes (RIs) are effective but costly and logistically challenging. Gentian violet (GV), a low-cost alternative, offers a potential solution for resource-constrained settings.

Methods: We conducted a single-center retrospective study at Cancer Foundation Hospital, analyzing 40 BC patients who underwent SLNB using GV and RI (January-December 2024). Sentinel lymph node (SLN) detection rates, concordance between GV and RI, and safety profiles were assessed. Detection was compared across tumor grade, histopathology, receptors, and chemotherapy status.

Results: The median patient age was 52 years, with most patients having a BMI between 21 and 30 (72.5%). T2 tumors were the most common (60%), followed by T3 (17.5%). Stage II disease predominated (75%), and invasive ductal carcinoma (IDC) was the most frequent histological subtype (70%). Among the cohort, 60% were estrogen/progesterone receptor-positive, 22.5% were triple-positive, and 10% were triple-negative. GV dye successfully identified SLNs in 97.5% of cases, with GV detecting more nodes than RI in 32.5% of patients, while both methods identified the same number in 50% of cases. The false-negative rate for GV was 2.5%. Detection rates were consistent across tumor subtypes, grades, and receptor statuses, with no statistically significant differences (p > 0.05). Neoadjuvant chemotherapy (NACT) did not impact SLN detection (p = 0.803). GV dye exhibited a favorable safety profile, with no intraoperative or postoperative complications reported at Days 0, 3-7, and 30. No cases of staining-related reactions, dermatitis, tattooing, or skin necrosis were observed.

Conclusions: Gentian violet is a safe, effective, and affordable alternative to MB for SLNB in BC. It demonstrates high detection rates and excellent safety, particularly suitable for resource-limited settings. Larger studies are warranted to validate these findings and support broader clinical adoption.

Objectives: This study quantifies global nasopharyngeal cancer (NPC) mortality and disability-adjusted life years (DALYs) across socio-demographic index (SDI) groups from 1990 to 2021 using Global Burden of Disease Study (GBD) 2021 data.

Methods: Age-standardized rates (ASRs) and estimated annual percentage change (EAPC) were analyzed to assess trends, with Mann-Whitney U tests comparing SDI groups.

Results: Global NPC mortality and DALYs declined significantly (EAPC: -2.17 for deaths; -2.29 for DALYs). Age-standardized death rates (ASDRs) dropped from 1.52 (1990) to 0.87 (2021). Males had higher ASDRs than females (1.30 vs. 0.48 in 2021). The 55-59 age group saw the largest decline in death rates (4.96 to 2.64) and DALYs (168.39 to 90.17). East Asia showed the steepest reductions (EAPC: -3.87 for DALYs; -3.80 for deaths), while the Caribbean had slight increases (EAPC: +0.43 for DALYs; +0.39 for deaths). Southeast Asia had the highest DALYs ASR (50.77), whereas Andean Latin America had the lowest (3.47). Malaysia exhibited the highest burden (DALYs ASR: 158.23; death ASR: 4.76), and Ghana the lowest (DALYs ASR: 0.46; death ASR: 0.01). Higher SDI regions (> 0.8) had significantly greater ASDRs and DALYs than lower SDI areas.

Conclusion: Despite global declines in NPC burden, disparities persist, with males and high-SDI regions experiencing higher rates. Targeted interventions are critical to address these inequities.

Aim: Ovarian cancer (OC) is a complex disease with challenges such as delayed diagnosis and development of chemoresistance. Exosomes play a crucial role in intercellular communication within the tumor microenvironment and have been reported to transmit drug-resistant traits and promote proliferation and metastasis. We aimed to investigate the role of exosomal miRNAs in OC, focusing on their involvement in chemoresistance, immune evasion, and metastasis.

Methods: We investigated the expression levels of miR-182, miR-9, miR-130a, miR-20a, and miR-23b, which are implicated in chemoresistance, immune evasion, and metastasis in OC. We used real-time PCR to assess the expression of these miRNAs in different exosomal and non-exosomal fractions isolated from the serum of 20 chemo naive, 20 chemotreated, and 20 healthy women.

Results: Our results revealed that ovarian tumors release higher levels of EpCAM-positive exosomes, which carry specific miRNAs that reflect the tumor's influence on the exosomal cargo. Elevated levels of miR-182, and miR-9 were found in EpCAM-positive exosomes from OC patients, with miR-182 being associated with disease relapse and the FIGO stage. In addition, miR-20a was found to be elevated in exosomes from chemotherapy-treated OC patients, indicating chemotherapy's impact on the exosomal miRNA profile. Notably, the miRNA expression in EpCAM-negative exosomes remained unchanged, highlighting the selective loading of miRNAs in EpCAM-positive exosomes.

Conclusion: Overall, the study highlights a probable mechanism for miRNA packaging and release in OC through EpCAM-positive exosomes, offering potential biomarkers for monitoring disease progression and relapse.

Aim: Molecular tumor profiling (MTP) aims to link biomarker targets to corresponding treatments, usually via clinical trials. The usefulness of offering MTP for patients in a regional/rural setting is unknown, including assessment of outcomes of commencement on a clinical trial and potential cost savings.

Methods: Patients with advanced or rare cancers at a regional cancer center underwent MTP of their biopsy specimens, which was organized and conducted by a central laboratory, as part of the Garvan Research Institute Cancer Molecular Screening and Therapeutics Program (MoST) research study. Treating clinicians then received a report of mutations, alongside potential clinical trials, after discussion of the case at a molecular tumor board. Available trials were then offered to patients. The cost of potentially travelling to a tertiary center was compared to travelling locally for the patients who went on a clinical trial.

Results: Potential clinical trials were found for 69 of 89 participants as a result of MTP. Eleven patients accepted a trial, with 10 of these being a trial delivered locally. The average cost saving to a patient on average for a return trip to a regional center rather than a metropolitan center was $592.04.

Conclusion: While somatic mutations are common and trials are available for patients with advanced and/or rare cancer, trials administered locally are favored, and cost savings may contribute to this.