Adjuvant Therapy for Renal Cell Carcinoma

In the past few years, several targeted therapies have been approved by the U.S. Food and Drug Administration for the treatment of advanced renal cell carcinoma. This has led to an improvement in the progression-free survival and quality of life for these patients. Nevertheless, the use of these and other therapies in the adjuvant setting has failed to demonstrate a clear benefit. Immune therapies and hormonal or targeted therapies have been studied in this indication, and there are clinical trials currently enrolling patients with high risk of relapse. This article reviews the available data and the ongoing trials exploring the role of adjuvant therapy for kidney cancer.     

Adjuvant Therapy for High-risk Endometrial Carcinoma

About one-fifth of endometrial cancers are ‘high risk’, which carries a poorer prognosis. Management strategies to optimise their survival have been under investigation for many years. Despite recent advances, their overall survival remains relatively poor. The definition of high risk in endometrial cancers has been based on clinicopathological factors until recently, when molecular profiling has shown greater discrimination. There is, however, poor correlation between traditional clinicopathological factors and their molecular profile. This is the subject of ongoing trials to better individualise adjuvant post-hysterectomy treatment. The management of high-risk tumours is traditionally based on surgery followed by radiotherapy, despite no proven overall survival benefit in early stages. The place of chemotherapy remains under investigation, with recent trials showing benefit in more advanced stages. The Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) and Gynecologic Oncology Group trials support the use of chemoradiation and chemotherapy for stage III and adverse histological subgroups. In addition, there is now early evidence of correlation between benefit from adjuvant chemotherapy based on molecular alterations in the tumour cells. In this review, we look at the current evidence on management strategies in the evolving era of molecular diagnosis and stratification.     

Adjuvant and Neoadjuvant Radiation Therapy for Locally Advanced Bladder Cancer

Local-regional failure for patients with ≥pT3 urothelial carcinoma after radical cystectomy is a significant clinical challenge. Prospective randomised trials have failed to show that chemotherapy reduces the risk of local-regional recurrences. Salvage treatment for local failures is difficult and often unsuccessful. There is promising evidence, particularly from a recent Egyptian National Cancer Institute trial, that radiation therapy plus chemotherapy can significantly reduce local recurrences compared with chemotherapy alone, and that this improvement in local-regional control may translate to meaningful improvements in disease-free and overall survival with acceptable toxicity. In light of the high rates of local failure following cystectomy for locally advanced disease and the progress that has been made in identifying patients at high risk of failure and the patterns of failure in the pelvis, the National Comprehensive Cancer Network guidelines were revised to include postoperative radiotherapy as an option to consider for patients with ≥pT3 disease. Here we review the problem of local-regional failure after cystectomy, identify patients who would probably benefit from adjuvant radiotherapy, review the patterns of pelvic failure after cystectomy, discuss technical details of radiation treatment and review the modern literature on this topic. Adjuvant radiotherapy should be considered as a treatment option for patients with locally advanced disease, especially those with positive margins or squamous cell carcinoma.     

Timing of Adjuvant and Neoadjuvant Therapy in Colorectal Cancers

Surgery remains the only curative therapy for colorectal cancer (CRC); however, several studies have proved that adjuvant chemotherapy improves the curative rate. A growing body of evidence indicates that significant deviations from recommended treatment plans are frequent. Patients may experience delays in the administration of adjuvant chemotherapy that can reduce its survival benefit. To date, few studies have examined factors associated with the timing of adjuvant chemotherapy or have described the effects of delayed therapy on overall survival. In this review, we discuss the extent and predictors of delay in administration of adjuvant chemotherapy as well as the relationship between timing and outcomes in CRC.     

术前新辅助治疗在进展期胃癌中的研究进展

在我国由于进展期胃癌比例较高，手术切除率较低。通过术前治疗的方式，降低肿瘤分期、减少术后转移，逐渐受到关注。术前新辅助化疗已有多项随机对照研究证实其显著疗效，但未能获得标准药物方案；术前放疗研究不多，且互相矛盾，尚缺乏有力证据；而术前放化疗通过众多小样本研究，显示出较高的局控率以及手术切除率，但仍缺少生存时间等远期指标支持，有待进一步研究。     

进展期胃癌的术前新辅助治疗进展

自美国INT0116试验结果发表以后,胃癌术后辅助治疗已经成为局部晚期胃癌的标准治疗方法,但对胃癌术前新辅助治疗的价值,目前还未能达成共识.现临床有大量研究显示:通过术前新辅助治疗,不仅可以提高患者的R0切除率,还可以减少复发转移,提高患者生存期,该文就目前国内外关于进展期胃癌术前新辅助治疗的进展进行综述.     

Treatment Approaches for Melanomas That Relapse After Adjuvant or Neoadjuvant Therapy

Current Oncology Reports - Effective adjuvant treatment with immunotherapy and targeted therapy has significantly improved outcomes for patients with resectable locally advanced or metastatic...     

Pathological Complete Response After Neoadjuvant Therapy for Rectal Cancer and the Role of Adjuvant Therapy

Both the addition of neoadjuvant chemoradiation therapy and improvements in surgical techniques have improved local control and overall survival for locally advanced rectal cancer patients over the past few decades. The addition of adjuvant chemotherapy has likely improved outcomes as well, though the contribution has been more difficult to quantify. At present, the majority of resected locally advanced rectal cancer patients receive adjuvant chemotherapy, though there is great variability in this practice based on both patient and institution characteristics. Recently, questions have been raised regarding which sub-groups of patients benefit most from adjuvant chemotherapy. As pathologic complete response (pCR) is increasingly found to be a reasonable surrogate for long-term favorable outcomes, some have questioned the need for adjuvant therapy in this select group of patients. Multiple retrospective analyses have shown minimal to no benefit for adjuvant chemotherapy in this group. Indeed, the patients most consistently shown to benefit from adjuvant therapy both in terms of disease free survival (DFS) and overall survival (OS) are those who achieve an intermediate pathologic response to neoadjuvant treatment. Tumors that have high expression of thymidylate synthetase have also shown to benefit from adjuvant therapy. More study is needed into clinical and molecular features that predict patient benefit from adjuvant therapy.     

Adjuvant Therapy of Renal Cell Carcinoma

Metastatic renal cell carcinoma (RCC) has a highly variable natural history and carries a dismal prognosis. Unlike many other tumors, RCC is generally unresponsive to cytotoxic, hormonal, and radiation adjuvant therapies after cytoreductive surgery. Different modalities of treatment have been tried and tested with modest success. Until recently, only immunotherapies such as interleukin-2 and interferon- α have been shown to provide a response, albeit in a minority of patients and often with severe treatment-associated toxicities. Other adjuvant therapies, such as active specific immunotherapy with Bacillus Calmette-Guerin and autologous renal tumor cell vaccines, have not provided alternative solutions. Recent approaches include heatshock protein peptide complex 96 vaccine and cG250 monoclonal antibody therapy. Novel targeted therapies have been developed using our knowledge of the molecular genetics that belie RCC. This culminated in sorafenib and sunitinib, the first Food and Drug Administration– approved drugs for RCC in more than a decade in the United States. The future will see further trials being carried out in the development of targeted therapies with emphasis placed on patient selection. Staging systems will need to be updated to integrate molecular biomarkers, which could potentially act not just as diagnostic and prognostic predictors, but also as tools for appropriate patient selection for treatment. In the future, this could potentially lead us to our ultimate goal of personalized medicine.     

免疫治疗在胃癌新辅助治疗中的研究进展

胃癌（GC）在我国发病的重要特点是中晚期确诊病例占确诊人数的大多数,早期诊断的患者不足10%。对于进展期的GC患者来说,标准治疗策略是手术联合术后辅助治疗或者术前新辅助+手术联合术后辅助治疗,而近年来免疫治疗成为一种治疗肿瘤的创新方法。如何在新辅助治疗中最大程度地利用免疫治疗,从而取得更好的临床获益值得探讨。本文综述了免疫治疗在GC新辅助治疗中的研究进展,进一步研究新辅助治疗联合免疫治疗对免疫系统功能的影响将有助于提高对GC的治疗水平。     

Neoadjuvant Versus Adjuvant Chemotherapy for Upper Tract Urothelial Carcinoma: A Microsimulation Model

BackgroundUpper tract urothelial carcinoma (UTUC) is clinically understudied, and there are no definitive recommendations regarding timing of perioperative chemotherapy. The objective of this study was to compare 3 treatment pathways in UTUC: nephroureterectomy (NU) alone, neoadjuvant chemotherapy (NAC), and adjuvant chemotherapy (AC) using a microsimulation model.Patients and MethodsAn individual-level state transition model was constructed using TreeAgePro software to compare treatment strategies for patients with newly diagnosed UTUC. The base case was that of a 70-year-old patient with a radiographically localized upper tract tumor. Primary outcome was quality-adjusted life expectancy. Secondary outcomes included crude overall survival, rates of adverse events, and bladder cancer diagnoses.ResultsA total of 100,000 patients were simulated. NAC was preferred, with an estimated quality-adjusted life expectancy of 7.50 years versus 6.79 years with NU alone and 7.23 years with AC. Median crude overall survival was 123 months with NAC, 96 months with NU only, and 111 months with AC. Overall, 40.0% of patients in the AC group with invasive pathology completed chemotherapy. In the NAC group, 83.3% of patients completed chemotherapy. In the NAC group, 37.5% of patients experienced an adverse chemotherapy event compared to 15.1% of patients in the AC group. Bladder cancer recurrence rates were 64.9%, 65.9%, and 67.4% over the patient’s lifetime for the NU, NAC, and AC strategies, respectively.ConclusionThis study supports the increased use of NAC in UTUC until robust randomized trials are completed. The ultimate choice should be based on patient and tumor factors.     

内镜高功率YAG激光治疗食管癌,胃癌的研究

自1986年11月～1987年6月,对14例食管和胃癌病人经内镜高功率YAG激光治疗。其中10例为食管癌,2例为贲门癌,2例胃癌(包括早期胃癌1例)。本文描述了内镜高功率YAG激光对食管癌、胃癌的治疗作用和应用价值。并讨论了内镜激光治疗的适应症和并发症。