Landscape of Combination Therapy Trials in Breast Cancer Brain Metastasis.
- 作者列表："Fares J","Kanojia D","Rashidi A","Ulasov I","Lesniak MS
:Combination therapy has become a cornerstone in cancer treatment to potentiate therapeutic effectiveness and overcome drug resistance and metastasis. In this work, we explore combination trials in breast cancer brain metastasis (BCBM), highlighting deficiencies in trial design and underlining promising combination strategies. On October 31, 2019, we examined ClinicalTrials.gov for interventional and therapeutic clinical trials involving combination therapy for BCBM, without limiting for date or location. Information on trial characteristics was collected. Combination therapies used in trials were analyzed and explored in line with evidence from the medical literature. Sixty-five combination therapy trials were selected (n=65), constituting less than 0.7% of all breast cancer trials. Most trials (62%) combined ≥2 chemotherapeutic agents. Chemotherapy with radiation was main-stay in 23% of trials. Trastuzumab was mostly used in combination (31%), followed by lapatinib (20%), and capecitabine (15%). Common strategies involved combining tyrosine kinase inhibitors with thymidylate synthase inhibitors (6 trials), dual HER-dimerization inhibitors (3 trials), and microtubule inhibitors and tyrosine kinase inhibitors (3 trials), and HER-dimerization inhibitors and tyrosine kinase inhibitors (3 trials). The combination of tucatinib and capecitabine yielded the highest objective response rate (83%) in early phase trials. The triple combination of trastuzumab, tucatinib, and capecitabine lowered the risk of disease progression or death by 52% in patients with HER2-positive BCBM. Combining therapeutic agents based on biological mechanisms is necessary to increase the effectiveness of available anti-cancer regimens. Significant survival benefit has yet to be achieved in future combination therapy trials. Enhancing drug delivery through blood-brain barrier permeable agents may potentiate the overall therapeutic outcomes. This article is protected by copyright. All rights reserved.
: 联合治疗已成为癌症治疗的基石，以增强治疗效果，克服耐药性和转移。在这项工作中，我们探讨了乳腺癌脑转移 (BCBM) 的组合试验，强调了试验设计中的不足，强调了有希望的组合策略。2019年10月31日，我们检查了 ClinicalTrials.gov 涉及 BCBM 联合治疗的介入和治疗临床试验，但不限于日期或地点。收集试验特征信息。根据医学文献的证据，对试验中使用的联合疗法进行了分析和探讨。选择了 65 项联合治疗试验 (n = 65)，占所有乳腺癌试验的不到 0.7%。大多数试验 (62%) 联合 ≥ 2 种化疗药物。放疗化疗是主要的-在 23% 的试验中停留。曲妥珠单抗主要联合使用 (31%)，其次是拉帕替尼 (20%) 和卡培他滨 (15%)。常见策略包括将酪氨酸激酶抑制剂与胸苷酸合成酶抑制剂 (6 项试验) 、双 HER-二聚化抑制剂 (3 项试验) 以及微管抑制剂和酪氨酸激酶抑制剂 (3 项试验) 相结合, 和 HER-二聚化抑制剂和酪氨酸激酶抑制剂 (3 项试验)。在早期临床试验中，tuctinib 和卡培他滨联合治疗的客观缓解率最高 (83%)。曲妥珠单抗、图卡替尼和卡培他滨的三联疗法使 HER2-positive BCBM 患者的疾病进展或死亡风险降低了 52%。结合基于生物机制的治疗药物是必要的，以增加可用的抗癌方案的有效性。在未来的联合治疗试验中尚未达到显著的生存获益。通过血脑屏障渗透性药物增强药物递送可能增强整体治疗结果。本文受版权保护。保留所有权利。
METHODS::In colorectal cancer (CRC), hepatic arterial infusion (HAI) chemotherapy may convert primarily unresectable CRC liver metastases (CLM) into resectability, although the risk of metastatic recurrence remains high after CLM ablation. We investigated the role of antitumour immunity invoked by first-line oxaliplatin-HAI for long-term CLM outcome. In a prospective study cohort of primarily unresectable CLM, we assessed patients' fms-related tyrosine kinase 3 ligand (FLT3LG) in serum, reflecting opportune intratumoural immune activity, at baseline and following 1-3 sequences of oxaliplatin-HAI. The end points were CLM resectability and overall survival. Patients who presented an immediate twofold increment of circulating FLT3LG during the treatment and at its completion were scored as CLM resectable (16.4% with both features), were alive at final follow-up 8-12 years later. All patients experienced FLT3LG increase during the treatment course, but those who remained unresectable or had the disease converted but presented a slow and gradual FLT3LG accretion, later died of the metastatic disease. These data provide further support to our previous findings that tumour-directed immunity invoked by oxaliplatin-containing therapy predicts excellent outcome of early advanced CRC if macroscopic tumour ablation is rendered possible by the 'classic' tumour response to the cytotoxic treatment.
METHODS::Prostate cancer is one of the primary causes of death around the world. As an important drug, flutamide has been used in the clinical diagnosis of prostate cancer. However, the over dosage and improper discharge of flutamide could affect the living organism. Thus, it necessary to develop the sensor for detection of flutamide with highly sensitivity. In this paper, we report the synthesis of lanthanum cobaltite decorated halloysite nanotube (LCO/HNT) nanocomposite prepared by a facile method and evaluated for selective reduction of flutamide. The as-prepared LCO/HNT nanocomposite shows the best catalytic performance towards detection of flutamide, when compared to other bare and modified electrodes. The good electrochemical performance of the LCO/HNT nanocomposite modified electrode is ascribed to abundant active sites, large specific surface area and their synergetic effects. Furthermore, the LCO/HNT modified electrode exhibits low detection limit (0.002 μM), wide working range (0.009-145 μM) and excellent selectivity with remarkable stability. Meaningfully, the developed electrochemical sensor was applied in real environmental samples with an acceptable recovery range.
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