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New Targets in Advanced Thyroid Cancer Refractory Iodine 晚期甲状腺癌难治碘的新靶点
Pub Date : 2019-04-23 DOI: 10.11648/J.CRJ.20190702.12
Lynda Marianela Vásconez Proaño
The majority of deaths due to thyroid cancer occur in patients with advanced DTC refractory to radioactive iodine. The spectacular advances in molecular medicine of recent years have opened new therapeutic possibilities. Currently, there is general agreement that treatment with Tyrosine Kinase Inhibitors (TKI) should only be considered in patients with differentiated thyroid carcinoma refractory to radioactive iodine, with progressive and / or symptomatic metastatic disease that can not otherwise be treated locally. Most of these "new molecules" are multichannel inhibitors with varied action, which interact on different proteins such as RET, BRAF, cKIT, MET, EGFR, MAPK, PDGFR, etc. In addition, they have the additional advantage that they markedly prevent angiogenesis by acting on VEGFR 1, 2, and 3. TKI are associated with progression-free survival but not curative. Also, causes adverse effects that can affect the quality of life.The prolongation of progression-free survival has been demonstrated with sorafenib and lenvatinib compared with placebo in two phase III trials. These two drugs have been approved by the FDA and the European Medicines Agency for use in patients refractory to radioactive iodine with metastatic disease. Based on the Phase II Trials there are other Tyrosine Kinase Inhibitors (TKI) available such as sunitinib, axitinib or pazopanib that can produce some kind of clinical benefit and therefore need further investigation.
大多数因甲状腺癌导致的死亡发生在对放射性碘难治的晚期DTC患者中。近年来分子医学的惊人进展开辟了新的治疗可能性。目前,人们普遍认为,酪氨酸激酶抑制剂(TKI)治疗仅适用于对放射性碘难治的分化型甲状腺癌患者,以及无法局部治疗的进展性和/或有症状的转移性疾病。这些“新分子”大多是多通道抑制剂,具有多种作用,可作用于RET、BRAF、cKIT、MET、EGFR、MAPK、PDGFR等不同的蛋白。此外,它们还有一个额外的优势,即它们通过作用于VEGFR 1、2和3来显著阻止血管生成。TKI与无进展生存期相关,但不能治愈。此外,还会导致影响生活质量的不良影响。在两项III期试验中,与安慰剂相比,索拉非尼和lenvatinib可以延长无进展生存期。这两种药物已被FDA和欧洲药品管理局批准用于放射性碘难治性转移性疾病患者。基于II期试验,还有其他酪氨酸激酶抑制剂(TKI)可用,如舒尼替尼、阿西替尼或帕唑帕尼,它们可以产生某种临床益处,因此需要进一步研究。
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引用次数: 0
Effect of Second Cycle Pre-induction Chemotherapy in Critically Ill Burkitt’s Lymphoma Children 第二周期诱导前化疗治疗危重儿童伯基特淋巴瘤的效果
Pub Date : 2019-04-18 DOI: 10.11648/J.CRJ.20190701.14
E. Moussa, A. Hamoda, S. Semary, Marwa Romeih, R. Amin, Omneya Hassanin
Advanced stage Burkiit’s lymphoma (BL) is associated with tumor burden. Toxicities from intensive therapies are significant. The objectives of this study were to analyze the outcome of patients who could not receive induction chemotherapy on time, and were given a 2nd pre-phase (CVP), and to measure the impact of delay on disease outcome. It is a retrospective non randomized study included pediatric patients, suffering from Burkitt’s Lymphoma over 8 years period in CCHE. The result showed that, four hundred and eight patients were diagnosed as Burkitt’s Lymphoma from July 2007 till October 2015, 286 patients (70.1%) received induction on time as per protocol, while 122 patients (29.9%) were not fit to receive their induction chemotherapy on due time. The delay ranged from 6-45 days. While forty five patients (36.88%) out of the delayed patients received 2nd CVP, 16 patients (13.1%) showed relapse/progression. OS among delayed patients who received 2nd CVP versus those who were delayed and were able to receive full induction chemotherapy was (76.1%), (88.7%) respectively. OS in patients who were delayed versus those who were not delayed was (84%), (85.9%) respectively. In conclusion, in critically ill patients delay of chemotherapy in induction phase is important to reduce morbidity and mortality. The delay of chemotherapy has no impact on OS in Burkitt’s lymphoma children. A second pre-phase therapy in our opinion should not be adopted for all critical ill patients who will not tolerate intensive therapy during early phases of treatment, but instead we recommend a recovery from organ toxicity and starting intensive therapy (COPADM) rather than giving 2nd CVP with careful surveillance of disease progression.
晚期伯基特淋巴瘤(BL)与肿瘤负荷相关。强化治疗的毒性是显著的。本研究的目的是分析不能按时接受诱导化疗并给予第二期预期(CVP)的患者的结局,并测量延迟对疾病结局的影响。这是一项回顾性非随机研究,纳入了患有伯基特淋巴瘤超过8年的儿童患者。结果显示,2007年7月至2015年10月诊断为Burkitt淋巴瘤的448例患者中,286例(70.1%)患者按方案按时接受诱导化疗,122例(29.9%)患者不适合按时接受诱导化疗。延迟时间从6-45天不等。延迟患者中45例(36.88%)接受第二次CVP治疗,16例(13.1%)出现复发/进展。延迟接受第二次CVP的患者与延迟接受完全诱导化疗的患者的OS分别为(76.1%)和(88.7%)。延迟患者与未延迟患者的OS分别为(84%)和(85.9%)。综上所述,危重患者在诱导期延迟化疗对降低发病率和死亡率至关重要。延迟化疗对伯基特淋巴瘤儿童的OS无影响。我们认为,不应该对所有在早期治疗阶段不能耐受强化治疗的危重患者采用第二次前期治疗,而是建议在器官毒性恢复后开始强化治疗(COPADM),而不是在仔细监测疾病进展的情况下给予第二次CVP。
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引用次数: 0
Treatment Efficiency and Problems of Local Control in Localized Bladder/Prostate Rhabdomyosarcoma 局限性膀胱/前列腺横纹肌肉瘤的治疗效果及局部控制问题
Pub Date : 2019-04-18 DOI: 10.11648/J.CRJ.20190702.11
H. Hafez, E. E. Nadi, A. Younes, Gehad Ahmed, M. Zaghloul, H. Taha, Rania M Labib, S. Fadel, Soha Ahmed
Objectives: To assess the treatment efficiency, outcome and factors affecting the local control of localized bladder/prostate RMS. Patients and methods: Retrospective analysis of 54 patients with localized bladder/prostate RMS treated at Children Cancer Hospital, Egypt between August 2007 and Jan 2017. All patients were treated according to Intergroup Rhabdomyosarcoma Study (IRS -V) and subsequent Children’s Oncology Group COG guidelines. Results: The median age at diagnosis was 3.28 years (range 0.4–13.6). Fifty-one patients (94%) underwent initial biopsy. Complete surgical resection (primary or delayed) was performed in 7 patients (13%). Local control started before/at week 12 in 29 patients (61.7%). Local control methods were: Radiotherapy in 43 patients (79.2%), radiotherapy with surgery in 4 patients (9%), surgery in 1 patient and four patients did not receive local control. With a median follow up of 38.12 months, the 5-year failure-free survival (FFS) and overall (OS) of the whole patients were 60.4 ± 14.5% and 75.4 ± 14.1% respectively. A better 5-year FFS was experienced by those who had early local control (79.2 ± 17% vs. 43.8 ± 25% p= 0.005). Conclusions: Timing of local control and local radiotherapy is crucial and shouldn’t be delayed waiting for further response to the systemic chemotherapy.
目的:探讨局限性膀胱/前列腺RMS的治疗效果、预后及影响局部控制的因素。患者和方法:回顾性分析2007年8月至2017年1月在埃及儿童肿瘤医院治疗的54例局限性膀胱/前列腺RMS患者。所有患者均按照组间横纹肌肉瘤研究(IRS -V)和随后的儿童肿瘤组COG指南进行治疗。结果:中位诊断年龄为3.28岁(范围0.4-13.6岁)。51例(94%)患者接受了初始活检。7例(13%)患者进行了完全手术切除(原发性或延迟)。29例患者(61.7%)在第12周前或第12周开始局部控制。局部控制方法为:放疗43例(79.2%),放疗加手术4例(9%),手术1例,未进行局部控制4例。中位随访38.12个月,患者5年无失败生存率(FFS)为60.4±14.5%,总生存率(OS)为75.4±14.1%。早期局部控制患者的5年FFS较好(79.2±17% vs. 43.8±25% p= 0.005)。结论:局部控制和局部放疗的时机至关重要,不应延迟等待对全身化疗的进一步反应。
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引用次数: 0
Localised Prostate Versus Whole Pelvic Irradiation in High Risk Prostate Cancer, Single Institute Experience 高危前列腺癌的局部前列腺照射vs全盆腔照射,单个研究所的经验
Pub Date : 2019-04-01 DOI: 10.11648/J.CRJ.20190701.13
R. Latif, Ghada Ezzat Eladawei
Objectives: Whole pelvic irradiation [WPRT] versus prostate only radiation [PO-RT] in node negative high risk disease is controversial. This study aims to assess survival benefit of PO-RT against WPRT in high risk negative nodes prostate cancer. Patients and Methods: Patients with high risk prostate cancer and negative pelvic lymph nodes treated randomly either with WPRT [arm1] or PORT [arm2] from June-2014-June-2017. Eligible patients were ˃18 years, risk factors selected are ≥T3, GS≥8, or PSA≥20nglml. All patients received hormonal therapy as neo-adjuvant and concurrent with radiation and followed to 2-3 years. Univariate and multivariate analysis are performed. The primary end point was progression free survival [PFS], and the secondary was OAS and toxicity assessment. Results: Ninety four patients included, 48 received WPRT arm and 46 received PORT. With median follow up 26 months there was no significant difference in PFS, or OAS [P=0.994 and 0.505] respectively between both arms. On univariate analysis PFS was significantly better in lower stage [P=0.014], lower GS [P=0.000], lower number of risk factors [P=0.016]. Only 2 cases with late grade 3 gastrointestinal toxicity in observed in WPRT [P=0.044], and one case late grade 3 genitourinary in PORT with no significance [P=0.096]. Conclusion: Addition of pelvic irradiation in high risk node negative prostate cancer has no impact on survival in comparison to PORT.
目的:在淋巴结阴性的高危疾病中,全盆腔放射治疗(WPRT)与仅前列腺放射治疗(PO-RT)存在争议。本研究旨在评估PO-RT对抗WPRT在高危阴性淋巴结前列腺癌患者的生存获益。患者和方法:2014年6月-2017年6月,高危前列腺癌伴盆腔淋巴结阴性患者随机接受WPRT [arm1]或PORT [arm2]治疗。入选患者年龄≥18岁,危险因素选择≥T3、GS≥8或PSA≥20ngml。所有患者均接受激素治疗作为新辅助治疗,并与放疗同时进行,随访2-3年。进行了单变量和多变量分析。主要终点是无进展生存期(PFS),次要终点是OAS和毒性评估。结果:纳入94例患者,WPRT组48例,PORT组46例。中位随访26个月,两组患者PFS和OAS差异无统计学意义[P=0.994和0.505]。单因素分析显示,低分期患者PFS较好[P=0.014], GS较低[P=0.000],危险因素数较低[P=0.016]。WPRT组仅有2例出现3级晚期胃肠道毒性[P=0.044], PORT组仅有1例出现3级晚期泌尿生殖系统毒性[P=0.096],差异无统计学意义。结论:与PORT相比,盆腔放疗对高危淋巴结阴性前列腺癌患者的生存无影响。
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引用次数: 0
High Expression of C-reactive Protein Increases the Risk of Poor Prognosis in Patients with Gastric Cancer: A Meta-analysis c反应蛋白高表达增加胃癌患者预后不良的风险:一项荟萃分析
Pub Date : 2016-12-25 DOI: 10.11648/j.crj.20190703.16
Jing Yang, Fulun Li, Ruijie Chang, Yong-bin Lu
Objective: To investigate the correlation between the expression level of C-reactive protein (CRP) and the prognosis of patients with gastric cancer, and its dose-response relationship. Methods: A computer-based online search was performed by using China National Knowledge Infrastructure, Wanfang, PubMed, Embase, and Web of Science database. The cohort studies on the relationship between CRP and the risk of poor prognosis in patients with gastric cancer were selected according to the inclusion and exclusion criteria, and the data were extracted and evaluated. Then Meta-analysis was performed by using STATA 11.0 software. The pooled hazard ratio (HR) and its 95% confidence interval (CI) were calculated. Furthermore, the subgroup analysis, multivariate analysis, sensitivity analysis and publication bias test were performed, respectively. Results: A total of eighteen cohort studies were included, involving 3 656 patients with gastric cancer. Meta-analysis showed a significant association between the expression of CRP and prognosis in patients with gastric cancer (HR = 1.50, 95% CI: 1.24-1.81, P 10 mg/L. Subgroup analysis showed no significant difference when the included studies were divided by the number of samples, follow-up time, TNM staging, and treatment methods (all P > 0.05). According to multivariate analysis, the peritoneal metastasis and recurrence were the independent factors associated with poor prognosis of patients with gastric cancer (both P > 0.05). Conclusion: The level of CRP was significantly associated with the prognosis of patients with gastric cancer in different clinical stages, and the risk of poor prognosis was significantly increased when CRP level > 10mg/L. DOI:10.3781/j.issn.1000-7431.2016.33.662
目的:探讨胃癌患者c反应蛋白(CRP)表达水平与预后的关系及其量效关系。方法:利用中国国家知识基础设施、万方、PubMed、Embase和Web of Science数据库进行计算机在线检索。根据纳入标准和排除标准选择胃癌患者CRP与预后不良风险关系的队列研究,提取数据并进行评价。采用STATA 11.0软件进行meta分析。计算合并风险比(HR)及其95%置信区间(CI)。并分别进行亚组分析、多变量分析、敏感性分析和发表偏倚检验。结果:共纳入18项队列研究,涉及3 656例胃癌患者。meta分析显示,胃癌患者CRP表达与预后有显著相关性(HR = 1.50, 95% CI: 1.24 ~ 1.81, P = 10 mg/L)。亚组分析显示,以样本数、随访时间、TNM分期、治疗方式划分纳入研究,差异均无统计学意义(P > 0.05)。多因素分析显示,腹膜转移和复发是胃癌患者预后不良的独立影响因素(P > 0.05)。结论:胃癌患者不同临床分期CRP水平与预后有显著相关性,当CRP水平> 10mg/L时,预后不良的风险显著增加。DOI: 10.3781 / j.issn.1000-7431.2016.33.662
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引用次数: 0
Reactive Oxygen Species and Serous Epithelial Ovarian Adenocarcinoma. 活性氧与浆液上皮性卵巢腺癌。
Pub Date : 2016-11-01 Epub Date: 2017-01-09 DOI: 10.11648/j.crj.20160406.13
Shakeria Cohen, Sharifeh Mehrabi, Xuebiao Yao, Stephanie Millingen, Felix O Aikhionbare

Serous ovarian cancer (SOC) is usually diagnosed at late stage and stage-adjusted five year survival rate is low. Mortality is relatively heavy on African-Americans/Black (AA) affected with SOC compared to their Caucasian counterparts, though the cause for the disparity remains unclear. DNA damage induced by oxidative stress has been linked to ovarian cancer, but the role of oxidative stress in distinguishing differences in aggressive SOC tumors among patients is yet to be determined. This study aims to determine the levels of reactive oxygen species (ROS), malondialdehyde (MDA), reactive carbonyl groups and antioxidants in primary SOC normal, precancerous (cystadenoma, borderline) and invasive (III/IV) tissue samples obtained from AA and Caucasian subgroups. Additionally, the study seeks to investigate significant changes in the level of ROS between AA and Caucasian SOC samples. A fluorogenic probe, dichlorodihydrofluorescein (DCFH-DiOxyQ), was used to scavenge reactive oxygen species in SOC normal, precancerous and malignant stages III/IV tissue samples. Malondialdehyde (MDA), a lipid peroxidation marker, and reactive carbonyl groups were measured as indicators of oxidative injury. Moreover, antioxidant status was assessed by estimating glutathione peroxidase 3 (GPX3) enzyme levels. Results indicate ROS concentration was approximately 96% higher in the malignant tissues in comparative to the normal non-diseased controls. In addition, ROS concentration among AA women was approximately 9% higher than Caucasian women. MDA levels increased exponentially from non-disease control and precancerous tissues relative to malignant tissues. Furthermore, malignant serous ovarian samples showed significantly higher reactive carbonyl content compared to the non-disease controls (p=0.009), while GPX3 levels decreased considerably in serous cystadenoma and malignant tissue samples, and non-diseased control compared to borderline disease. The results suggest accumulation of ROS and MDA levels may be a causative factor for SOC. Elevated levels of MDA and reactive carbonyl proteins could override the GPX3 enzyme capacity therefore, initiating serous ovarian neoplasm.

浆液性卵巢癌(SOC)通常在晚期诊断,分期调整五年生存率低。与白人相比,患有SOC的非裔美国人/黑人(AA)的死亡率相对较高,尽管造成这种差异的原因尚不清楚。氧化应激诱导的DNA损伤与卵巢癌有关,但氧化应激在区分患者侵袭性SOC肿瘤中的作用尚未确定。本研究旨在测定原发性SOC正常、癌前(囊腺瘤、交界性)和侵袭性(III/IV)组织样本中活性氧(ROS)、丙二醛(MDA)、活性羰基和抗氧化剂的水平。此外,该研究旨在调查AA和高加索SOC样品中ROS水平的显著变化。采用荧光探针二氯二氢荧光素(DCFH-DiOxyQ)清除SOC正常、癌前和恶性III/IV期组织样本中的活性氧。脂质过氧化标志物丙二醛(MDA)和活性羰基作为氧化损伤的指标。此外,通过测定谷胱甘肽过氧化物酶3 (GPX3)酶水平来评估抗氧化状态。结果表明,恶性组织中的ROS浓度比正常非病变对照高约96%。此外,AA女性的ROS浓度比白种人女性高约9%。相对于恶性组织,非疾病对照和癌前组织的MDA水平呈指数增长。此外,与非疾病对照相比,恶性卵巢浆液样本中活性羰基含量显著升高(p=0.009),而与交界性疾病对照相比,浆液性囊腺瘤和恶性组织样本以及非疾病对照中GPX3水平显著降低。结果表明,ROS和MDA水平的积累可能是引起SOC的原因。因此,MDA和活性羰基蛋白水平的升高可以覆盖GPX3酶的能力,从而引发浆液性卵巢肿瘤。
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引用次数: 17
Investigating Molecular Mechanisms of Activation and Mutation of the HER2 Receptor Tyrosine Kinase through Computational Modeling and Simulation. 通过计算模型和模拟研究HER2受体酪氨酸激酶激活和突变的分子机制。
Pub Date : 2011-01-01
Shannon E Telesco, Andrew Shih, Yingting Liu, Ravi Radhakrishnan

Human epidermal growth factor receptor 2 (HER2)/ErbB2 is a receptor tyrosine kinase belonging to the EGFR/ErbB family and is overexpressed in 20-30% of human breast cancers. Since there is a growing effort to develop pharmacological inhibitors of the HER2 kinase for the treatment of breast cancer, it is clinically valuable to rationalize how specific mutations impact the molecular mechanism of receptor activation. Although several crystal structures of the ErbB kinases have been solved, the precise mechanism of HER2 activation remains unknown, and it has been suggested that HER2 is unique in its requirement for phosphorylation of Y877, a key tyrosine residue located in the activation loop (A-loop). In our studies, discussed here, we have investigated the mechanisms that are important in HER2 kinase domain regulation and compared them with the other ErbB family members, namely EGFR and ErbB4, to determine the molecular basis for HER2's unique mode of activation. We apply computational simulation techniques at the atomic level and at the electronic structure (quantum mechanical) level to elucidate details of the mechanisms governing the kinase domains of these ErbB members. Through analysis of our simulation results, we have discovered potential regulatory mechanisms common to EGFR, HER2, and ErbB4, including a tight coupling between the A-loop and catalytic loop that may contribute to alignment of residues required for catalysis in the active kinase. We further postulate an autoinhibitory mechanism whereby the inactive kinase is stabilized through sequestration of catalytic residues. In HER2, we also predict a role for phosphorylated Y877 in bridging a network of hydrogen bonds that fasten the A-loop in its active conformation, suggesting that HER2 may be unique among the ErbB members in requiring A-loop tyrosine phosphorylation for functionality. In EGFR, HER2, and ErbB4, we discuss the possible effects of activating mutations. Delineation of the activation mechanism of HER2 in the context of the other ErbB members is crucial for understanding how the activated kinase might interact with downstream molecules and couple to signaling cascades that promote cancer. Our comparative analysis furthers insight into the mechanics of activation of the HER2 kinase and enables us to predict the effect of an identified insertion mutation on HER2 activation. Further understanding of the mechanism of HER2 kinase activation at the atomic scale and how it couples to downstream signaling at the cellular scale will elucidate predictive molecular phenotypes that may indicate likelihood of response to specific therapies for HER2-mediated cancers.

人表皮生长因子受体2 (HER2)/ErbB2是一种属于EGFR/ErbB家族的受体酪氨酸激酶,在20-30%的人乳腺癌中过表达。由于开发用于治疗乳腺癌的HER2激酶药理学抑制剂的努力越来越多,因此理性化特异性突变如何影响受体激活的分子机制具有临床价值。虽然ErbB激酶的几个晶体结构已经被解开,但HER2激活的确切机制仍然未知,并且有人认为HER2是独特的,它需要磷酸化Y877, Y877是位于激活环(a环)中的一个关键酪氨酸残基。在我们的研究中,我们研究了HER2激酶结构域调控的重要机制,并将其与其他ErbB家族成员(即EGFR和ErbB4)进行了比较,以确定HER2独特激活模式的分子基础。我们在原子水平和电子结构(量子力学)水平上应用计算模拟技术来阐明控制这些ErbB成员激酶结构域的机制细节。通过分析我们的模拟结果,我们发现了EGFR、HER2和ErbB4共同的潜在调控机制,包括a环和催化环之间的紧密耦合,这可能有助于在活性激酶中催化所需的残基对齐。我们进一步假设了一种自抑制机制,即通过催化残基的隔离来稳定失活激酶。在HER2中,我们还预测了磷酸化的Y877在桥接氢键网络中的作用,氢键网络将a环固定在其活性构象中,这表明HER2可能是唯一需要a环酪氨酸磷酸化才能发挥功能的ErbB成员。在EGFR、HER2和ErbB4中,我们讨论了激活突变的可能影响。在其他ErbB成员的背景下描述HER2的激活机制对于理解活化的激酶如何与下游分子相互作用并偶联到促进癌症的信号级联是至关重要的。我们的比较分析进一步深入了解了HER2激酶激活的机制,并使我们能够预测已确定的插入突变对HER2激活的影响。进一步了解HER2激酶在原子尺度上的激活机制,以及它如何在细胞尺度上与下游信号传导偶联,将阐明可预测的分子表型,这可能表明对HER2介导的癌症的特异性治疗的反应可能性。
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引用次数: 0
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Cancer Research Journal
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