Current perspectives in bladder cancer management

More than 350,000 new cases of bladder cancer are diagnosed worldwide each year; the vast majority (> 90%) of these are transitional cell carcinomas (TCC). The most important risk factors for the development of bladder cancer are smoking and occupational exposure to toxic chemicals. Painless visible haematuria is the most common presenting symptom of bladder cancer; significant haematuria requires referral to a specialist urology service. Cystoscopy and urine cytology are currently the recommended tools for diagnosis of bladder cancer. Excluding muscle invasion is an important diagnostic step, as outcomes for patients with muscle invasive TCC are less favourable. For non‐muscle invasive bladder cancer, transurethral resection followed by intravesical chemotherapy (typically Mitomycin C or epirubicin) or immunotherapy [bacillus Calmette‐Guérin (BCG)] is the current standard of care. For patients failing BCG therapy, cystectomy is recommended; for patients unsuitable for surgery, the choice of treatment options is currently limited. However, novel interventions, such as chemohyperthermia and electromotive drug administration, enhance the effects of conventional chemotherapeutic agents and are being evaluated in Phase III trials. Radical cystectomy (with pelvic lymphadenectomy and urinary diversion) or radical radiotherapy are the current established treatments for muscle invasive TCC. Neoadjuvant chemotherapy is recommended before definitive treatment of muscle invasive TCC; cisplatin‐containing combination chemotherapy is the recommended regimen. Palliative chemotherapy is the first‐choice treatment in metastatic TCC.     

肺癌免疫治疗现状分析

肺癌发病率和死亡率已居各种癌症之首位．需要探索新的治疗模式,免疫治疗以其低毒,高特异性等优点有望成为肺癌治疗的重要辅助治疗方式。本文综述了肺癌的过继免疫治疗、单克隆抗体疗法、基因治疗、肿瘤疫苗、细胞因子治疗、生物反应调节剂六个方面现状及最新进展。     

Biomarkers in colorectal cancer: Current clinical utility and future perspectives

Colorectal cancer (CRC) is a major cause of cancer death worldwide. CRC has poor prognosis and there is a crucial need for new diagnostic and prognostic biomarkers to avoid CRC-related deaths. CRC can be considered a sporadic disease in most cases (75%-80%), but it has been suggested that crosstalk between gene mutations (i.e., mutations of BRAF, KRAS, and p53 as well as microsatellite instability) and epigenetic alterations (i.e., DNA methylation of CpG island promoter regions) could play a pivotal role in cancer development. A number of studies have focused on molecular testing to guide targeted and conventional treatments for patients with CRC, sometimes with contrasting results. Some of the most useful innovations in the management of CRC include the possibility to detect the absence of KRAS, BRAF, NRAS and PIK3CA gene mutations with the subsequent choice to administer targeted adjuvant therapy with anti-epidermal growth factor receptor antibodies. Moreover, CRC patients can benefit from tests for microsatellite instability and for the detection of loss of heterozygosity of chromosome 18q that can be helpful in guiding therapeutic decisions as regards the administration of 5-FU. The aim of this review was to summarize the most recent evidence on the possible use of genetic or epigenetic biomarkers for diagnosis, prognosis and response to therapy in CRC patients.     

Current status and perspectives of biologics in the treatment of metastatic colorectal cancer

Since the mid 1990s, colorectal cancer treatment has undergone substantial changes and improvements. Combination chemotherapy in first-line treatment of metastatic colorectal disease is the standard of care. Regimens based on either irinotecan or oxaliplatin given with 5-fluorouracil are prevailing. Recently, bevacizumab has become the routine standard addition to FOLFOX in first-line regimens in Japan. This preference is based on the data from NO16966 study, which resulted in a far less substantial improvement in progression free survival and no benefit in response rate. Other clinical trials indicated that the addition of the anti-EGFR monoclonal antibody confers modest benefit to FOLFOX or FOLFIRI. At present, how to combine the available agents and what the ideal combinations should be remain unclear.     

Ipilimumab in non-small cell lung cancer and small-cell lung cancer: new knowledge on a new therapeutic strategy

The challenge of finding a lasting cure for autoimmune disease(s) has not been met. Although the use of systemic anti-inflammatory agents still dominates the treatment of these diseases, there is a push towards developing novel and more specific strategies. In addressing autoimmunity, there is the intrinsic need to understand the mechanisms that lead to the development and maintenance of immunological tolerance to self-antigens. Experimental evidence has shown that directed antigen expression in the thymus can induce immunological tolerance to that antigen. This forms the cornerstone of one strategy directed towards the cure of autoimmunity. In this strategy, individuals with autoimmune disease are transplanted with bone marrow stem cells that have been genetically modified and in this way allow expression of the self-antigen in the thymus.     

Current perspectives and future direction of palliative medicine for cancer patients in Japan

Role of palliative medicine for cancer patients has been expanding to even in earlier stage of disease. We have various new drugs in palliation of symptoms and signs, such as severe pain due to tumor invasion, depression, nausea and vomiting, chemotherapy-induced anemia and neutropenia, etc. Recently pharmacogenomics and drug metabolism became to be focused in cancer treatment. It may cause unexpected toxicity due to drug-drug interaction and may raise unreasonably lower effect due to individual heterogeneity of drug metabolism. To facilitate and maintain better-quality palliative medicine allover Japan, a well-organized educational system and multi-institutional research groups should be established on the basis of a large academic and clinical association. The Japanese Society of Palliative Medicine (JSPM) is one of the candidate of these tasks. The JSPM consists with more than 4,900 members of doctors, nurses and other health professionals who are working in palliative cancer medicine. They have conducting to make guidelines for each symptom control and to increase lobby action to establish efficient networks of palliative cancer medicine in each district of Japan within several years.     

Current perspectives of psycho-oncology in Japan

The Japanese Psycho-Oncology Society (JPOS) was founded in 1987, while the Japanese Society of General Hospital Psychiatry (JSGHP) in 1988. Inspired by the International Congress of Psycho -Oncology Society (IPOS) meeting which was held in 1995 in Kobe, many general hospital psychiatrists joined to the activity of the JPOS. In these ten years, many studies were conducted on the following topics: truth-telling, psychiatric co-morbidity, psychosocial intervention, etc. And recently, the activity of palliative care team including a psychiatrist has been reimbursed, which will be hopefully a new step to the progress of psycho-oncology in Japan. Also, a collaboration between the JPOS and the JSGHP will be strongly needed to make a remarkable progress.     

Patient and carer perspectives: a man with inoperable lung cancer

Background: Palliative care professionals have recognized the importance of hope for their patients. However, they sometimes experience hope as a barrier for end-of-life communication, for instance when patients have unrealistic hope. A hope communication tool (HCT) may help them to address hope during clinical encounters but has not been developed yet. The objective of this study was to examine the feasibility of a HCT for palliative care professionals.

Method: Based on synthesis studies of hope, a hope communication tool (HCT) was developed. Palliative care professionals were asked to use and evaluate the tool by making use of a written evaluation scheme, mainly consisting of open-ended questions. Similarities and differences between participants and suggestions for revisions were thematically analyzed and discussed within the research team.

Results: Fourteen healthcare professionals (nine females; mean age 50.9 years) participated in the study: nine nurses, three physicians and two chaplains. The HCT helped participants to reach depth and address end-of-life issues. Most participants used it for other reasons than described in the tool. They used it when they faced difficulties that related to patients’ hope or hope-related themes, such as unrealistic hope or fear. Participants also gave feedback on the open or abstract character of questions, the assumptions of questions, and the distinctions between categories.

Discussion: The HCT is feasible and helps to reach depth and address end-of-life issues. The findings lead to a revised HCT. Future research should examine the impact of the use of this revised tool on patients.     

肺癌治疗药物的现状及展望

肺癌是最常见的恶性肿瘤,对于那些已失去手术机会的晚期肺癌患者,药物治疗是其主要的治疗手段,也是其最后的希望。本文主要从肺癌化疗药物、靶向药物治疗的现状及肺癌治疗药物进展三个方面对肺癌治疗药物作一概述。     

Current perspectives in polycystic ovary syndrome

Polycystic ovary syndrome has been viewed primarily as a gynecologic disorder requiring medical intervention to control irregular bleeding, relieve chronic anovulation, and facilitate pregnancy. A large body of evidence has demonstrated an association between insulin resistance and polycystic ovary syndrome. The former condition has an established link with long-term macrovascular diseases such as type 2 diabetes mellitus, hypertension, and atherosclerotic heart disease, consequences that also are observed in women with polycystic ovary syndrome. In addition, chronic anovulation predisposes women to endometrial hyperplasia and carcinoma. The purpose of this review is to examine the clinical course of this syndrome, which spans adolescence through menopause, and suggest a simple and cost-effective diagnostic evaluation to screen the large numbers of women who may be affected. Therapy, which should be individualized, should incorporate steroid hormones, antiandrogens, and insulin-sensitizing agents. Weight loss by way of reduced carbohydrate intake and gentle exercise is the most important intervention; this step alone can restore menstrual cyclicity and fertility, and provide long-term prevention against diabetes and heart disease. Treatment alternatives should be directed initially toward the most compelling symptom. Longitudinal care is of paramount importance to provide protection from long-term sequelae.     

Current perspectives in treatment of angina pectoris

Intravenous immunoglobulin is an important method of treating idiopathic thrombocytopenic purpura, especially when a rapid platelet response is desired. Dr Besa explains how to use this therapy in acute and chronic purpura in both children and adults. He also describes the four preparations available and discusses efficacy, cost, and safety.     

Current perspectives in treatment of angina pectoris

The most appropriate treatment for a patient with angina pectoris depends on the underlying pathophysiologic process and whether any associated illness is present. Each patient's clinical history must be carefully reviewed so the hemodynamic process responsible for the clinical picture is understood. If symptoms are produced mostly by an increase in myocardial oxygen demand, efforts should be directed toward reducing the demand or improving coronary blood flow to meet the demand. If symptoms appear to occur secondary to vasospasm, treatment should be directed toward relief of spasm with potent vasodilating agents, such as calcium channel blockers. Most patients have a clinical picture consistent with mixed angina and may require combination therapy. Treatment of associated illnesses and the safety of pharmacologic agents used in their presence should be carefully considered. Finally, if treatment is to successfully reduce the incidence of serious cardiac events and prolong life, the goal of therapy should be relief of the total ischemic burden on the heart.     

PD-1/PD-L1 antagonists in gastric cancer: Current studies and perspectives

Immune checkpoints release suppressive signals for T cells, which enable the tumors to escape from immune destruction and provide a new concept that uses the capabilities of the immune system as a therapeutic target for tumors. At present, programmed death receptor 1 (PD-1)/programmed death ligand-1 (PD-L1) has become the most promising therapeutic target. PD-1/PD-L1 blockades exhibit long-lasting antitumor efficacy and safety in patients with various cancers, such as melanoma and non-small-cell lung cancer. Moreover, PD-L1 is highly expressed in the peripheral blood and tumor specimens of patients with cancer, and the expression of PD-L1 is positively correlated with various pathological features and may serve as a predictor of poor prognosis or a diagnostic tool. Clinical trials have verified that PD-1/PD-L1 blockade therapy benefits patients with advanced gastric cancer or gastroesophageal junction cancer. Furthermore, there are many molecules involved in the regulation of PD-1/PD-L1 expression, and the modification of these molecules via drugs and combinations with PD-1/PD-L1 inhibitors may further improve the efficacy of immunotherapy for gastric cancer. In this review, the efficacy, safety, and possible combination treatment options of PD-1/PD-L1 in gastric cancer are reviewed in experimental and clinical settings.     

肺癌外科治疗现状及进展

近年来,肺癌外科治疗适应证不断扩大,随着微创治疗理念的不断深入,以电视胸腔镜手术为主的微创胸外科的兴起使得肺癌外科治疗快速发展。从传统开胸手术到胸腔镜手术,肺癌外科治疗从手术切口与手术方式上进行了不断地优化与改进。外科手术是肺癌综合治疗的重要组成部分,对不同分期、不同治疗意愿的患者提供个体化治疗策略是肺癌外科治疗的目标。