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Precision Medicine in Castration-Resistant Prostate Cancer (거세저항성전립선암에서 정밀의학에 대한 고찰)

  • Kim, Won Tae;Yun, Seok Joong;Kim, Wun-Jae
    • The Korean Journal of Urological Oncology
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    • v.16 no.3
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    • pp.97-102
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    • 2018
  • Prostate cancer is usually managed by androgen deprivation therapy after failure of primary treatment. However, such therapies are only temporarily effective in prostate cancer patients, and the most patients experience the progression to castration-resistant prostate cancer (CRPC). Docetaxel chemotherapy is conventional effective treatment for CRPC but has many adverse effects. In CRPC patients, treatment decisions were not typically base on the recognitions of inter-individual differences. Therefore, there are growing interests for precision medicine in CRPC. In this review, we summarized the precision medicine such as candidate target genes and potential therapies in CRPC.

Protective Effect of Astragalus polysaccharides on Liver Injury Induced by Several Different Chemotherapeutics in Mice

  • Liu, Wen;Gao, Fang-Fang;Li, Qun;Lv, Jia-Wei;Wang, Ying;Hu, Peng-Chao;Xiang, Qing-Ming;Wei, Lei
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.23
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    • pp.10413-10420
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    • 2015
  • Side effects are an unavoidable consequence of chemotherapy drugs, during which liver injury often takes place. The current study was designed to investigate the protective effect of Astragalus polysaccharides (APS) against the hepatotoxicity induced by frequently-used chemical therapy agents, cyclophosphamide (CTX), docetaxel (DTX) and epirubicin (EPI)) in mice. Mice were divided into five groups, controls, low or high dose groups ($DTX_L$, $CTX_L$, $EPI_L$ or $DTX_H$, $CTX_H$, $EPI_H$), and low or high dose chemotherapeutics+APS groups ($DTX_L$+APS, $CTX_L$+APS, $EPI_L$+APS or $DTX_H$+APS, $CTX_H$+APS, $EPI_H$+APS). Controls were treated with equivalent normal saline for 28 days every other day; low or high dose group were intraperitoneal (i.p) injected with low or high doses of CTX, DTX and EPI for 28 days every other day; low or high dose chemotherapeutics+APS group were separately intraperitoneal (i.p) injected with chemotherapeutics for 28 days every other day and i.p with APS (100 mg/kg) for 7 days continually from the 22th to the 28th days. The body weight, serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), histopathological features, and ultrastructure morphological change of liver tissues, protein expression level of caspase-3 were estimated at different time points. With high dose treatment of DTX, CTX and EPI, weight gain was inhibited and serum levels of ALT and AST were significantly increased. Sections of liver tissue showed massive hepatotoxicity in $CTX_H$ group compared to the control group, including hepatic lobule disorder, granular and vacuolar degeneration and necrosis in hepatic cells. These changes were confirmed at ultrastructural level, including obvious pyknosis, heterochromatin aggregation, nuclear membrane resolution, and chondrosome crystal decrease. Western blotting revealed that the protein levels of caspase-3 increased in $CTX_H$ group. The low dose groups exhibited trivial hepatotoxicity. More interestingly, after 100 mg/kg APS, liver injury was redecued not only regarding serum transaminase activities (low or high dose chemotherapeutics+APS group), but also from pathological and ultrastructural changes and the protein levels of caspase-3 ($CTX_H$+APS group). In conclusion, DTX, CTX and EPI induce liver damage in a dose dependent manner, whereas APS exerted protective effects.

Comparison of Three Different Induction Regimens for Nasopharyngeal Cancer

  • Kertmen, Neyran;Aksoy, Sercan;Cengiz, Mustafa;Yazici, Gozde;Keskin, Ozge;Babacan, Taner;Sarici, Furkan;Akin, Serkan;Altundag, Kadri;Gullu, H. Ibrahim
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.1
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    • pp.59-63
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    • 2015
  • Background: The standard treatment of local advanced nasopharyngeal cancer is chemoradiotherapy. There is a lack of data concerning induction therapy. In this study we retrospectively examined patients treated with induction therapy and chemoradiotherapy. Materials and Methods: Locally advanced nasopharyngeal cancer patients treated between 1996 and 2013 in our clinic were included in the study. Three different induction regimens were administered to our patients in different time periods. The regimen dosages were: CF regimen, cisplatin $50mg/m^2$ 1-2 days, fluorouracil $500mg/m^2$ 1-5 days; DC, docetaxel $75mg/m^2$ 1 day, cisplatin $75mg/m^2$ 1 day; and DCF, docetaxel $75mg/m^2$ 1 day, cisplatin $75mg/m^2$ 1 day, 5-Fu $750mg/m^2$ 1-5 days. Most of the patients were stage III (36.4%) and stage IV (51.7%). Results: Median follow-up time was 50 months (2-201 months). Three-year progression-free survival (PFS) was 79.3%, and 5-year PFS 72.4% in all patients. Three-year overall survival (OS) was 87.4% and 5-year OS 76% in all patients. In terms of induction therapies, 3-year OS was 96.5% in the DCF group, 86.6% in the DC group and 76.3% in the CF group (p=0.03). Conclusions: There was no significant differences in response rate and PFS between the three regimens. OS in the DCF group was significantly higher than in the other groups. However, this study was retrospective and limited toxicity data were available; the findings therefore need to be interpreted with care.

Efficacy of Taxane-Based Regimens in a First-line Setting for Recurrent and/or Metastatic Chinese Patients with Esophageal Cancer

  • Jiang, Chang;Liao, Fang-Xin;Rong, Yu-Ming;Yang, Qiong;Yin, Chen-Xi;He, Wen-Zhuo;Cai, Xiu-Yu;Guo, Gui-Fang;Qiu, Hui-Juan;Chen, Xu-Xian;Zhang, Bei;Xia, Liang-Ping
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.13
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    • pp.5493-5498
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    • 2014
  • Objective: To compare the efficacy of taxane-based regimens in the first line setting retrospectively in Chinese patients with recurrent and/or metastatic esophageal cancer. Methods: We analyzed 102 recurrent and/or metastatic esophageal cancer patients who received taxanes-based regimens in a first-line setting from January 2009 to December 2013. Sixteen (15.7%) patients were administered Nab-PTX based chemotherapy and 86 patients (84.3%) received paclitaxel (PTX) or docetaxel (DTX) based chemotherapy. Patients in the PTX/DTX group could be further divided into TP (71 patients) and TPF (15 patients) groups. Results: The objective response rate (ORR) of all patients was 20.6%, and the disease control rate (DCR) was 67.6%. The median overall survival (OS) was 10.5 months (95% CI 10.1-16.4) and the median progression-free survival (PFS) was 6.04 months (95% CI 5.09-7.91). The DCR was higher in the TPF group than the TP group (93.3% vs. 59.1%; p = 0.015 ). There were no significant differences in ORR, OS, and PFS among Nab-PTX, TPF and TP groups. Conclusions: The three regimens of Nab-PTX based, TP and TPF proved active in a first line setting of Chinese patients with recurrent and/or metastatic esophageal cancer, and should thus be regarded as alternative treatments.

Comparison of the Efficacy and Safety of EFGR Tyrosine Kinase Inhibitor Monotherapy with Standard Second-line Chemotherapy in Previously Treated Advanced Non-small-cell Lung Cancer: a Systematic Review and Meta-analysis

  • Qi, Wei-Xiang;Shen, Zan;Lin, Feng;Sun, Yuan-Jue;Min, Da-Liu;Tang, Li-Na;He, Ai-Na;Yao, Yang
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.10
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    • pp.5177-5182
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    • 2012
  • Purpose: To compare the efficacy and safety of epidermal growth factor receptor tyrosine kinase inhibitormonotherapy (EFGR-TKIs: gefitinib or erlotinib) with standard second-line chemotherapy (single agent docetaxel or pemetrexed) in previously treated advanced non-small-cell lung cancer (NSCLC). Methods: We systematically searched for randomized clinical trials that compared EGFR-TKI monotherapy with standard second-line chemotherapy in previously treated advanced NSCLC. The end points were overall survival (OS), progression-free survival (PFS), overall response rate (ORR), 1-year survival rate (1-year SR) and grade 3 or 4 toxicities. The pooled hazard ratio (HR) or risk ratio (RR), with their corresponding 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials. Results: Eight randomized controlled trials (totally 3218 patients) were eligible. Our meta-analysis results showed that EGFR-TKIs were comparable to standard second-line chemotherapy for advanced NSCLC in terms of overall survival (HR 1.00, 95%CI 0.92-1.10; p=0.943), progression-free survival (HR 0.90, 95%CI 0.75-1.08, P=0.258) and 1-year-survival rate (RR 0.97, 95%CI 0.87-1.08, P=0.619), and the overall response rate was higher in patients who receiving EGFR-TKIs(RR 1.50, 95%CI 1.22-1.83, P=0.000). Sub-group analysis demonstrated that EGFR-TKI monotherapy significantly improved PFS (HR 0.73, 95%CI: 0.55-0.97, p=0.03) and ORR (RR 1.96, 95%CI: 1.46-2.63, p=0.000) in East Asian patients, but it did not translate into increase in OS and 1-year SR. Furthermore, there were fewer incidences of grade 3 or 4 neutropenia, febrile neutropenia and neutrotoxicity in EGFR-TKI monotherapy group, excluding grade 3 or 4 rash. Conclusion: Both interventions had comparable efficacy as second-line treatments for patients with advanced NSCLC, and EGFR-TKI monotherapy was associated with less toxicity and better tolerability. Moreover, our data also demonstrated that EGFR-TKImonotherapy tended to be more effective in East Asian patients in terms of PFS and ORR compared with standard second-line chemotherapy. These results should help inform decisions about patient management and design of future trials.

Electroacupuncture for the Treatment of the Chemotherapy-induced Peripheral Neuropathy in Breast Cancer Patient: A Case Report (전자침술로 호전된 유방암 환자의 항암화학요법 유발 말초신경병증 증례보고)

  • Park, Ji Hye;Lee, Jin Sun;Cho, Chong Kwan;Yoo, Hwa Seung
    • Journal of Korean Traditional Oncology
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    • v.20 no.1
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    • pp.1-9
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    • 2015
  • Objectives : The purpose of this study is to report the effect of electroacupuncture on chemotherapy induced peripheral neuropathy in breast cancer patient. Methods : The patient is a female with chemotherapy induced peripheral neuropathy (CIPN) who was diagnosed with breast cancer and suffering from paresthesia of extremities after chemotherapy of docetaxel. The patient was treated with electroacupuncture (15 minutes per one time) twice a day for 14 days. The clinical outcomes were measured by Patient Neurotoxicity Questionnaire (PNQ) grade and visual analogue scale (VAS). Results : In this case, PNQ Item 1 (numbness) grade was improved from D to C, Item 2 (weakness) grade was from C to B. The score of upper limbs VAS was decreased from 7 to 2, lower limbs was from 7 to 5 respectively. Edema of both extremities was also improved. Conclusions : This case study suggests that electroacupuncture therapy may have significant effects of CIPN in breast cancer patient.

Weight Changes according to the Period of Chemotherapy Treatments for Breast Cancer (유방암 환자의 화학요법 치료시기에 따른 체중변화)

  • Park, Yun Hee;Yoo, Kyung Hee
    • Journal of Korean Biological Nursing Science
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    • v.18 no.2
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    • pp.94-101
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    • 2016
  • Purpose: This study aimed to evaluate weight changes in women during the period of TAC (docetaxel-doxorubicin-cyclophosphamide) chemotherapy after breast surgery and the differences in weight changes by disease characteristics among Korean women with breast cancer. Methods: The design of this study was retrospective survey research. The subjects of this study were 130 patients with fully completed TAC chemotherapy between January 2012 and April 2015. Body weight before their operation, and at 3 weeks, 6 weeks, 9 weeks, 12 weeks, 15 weeks, and 18 weeks after surgery, as well as general and disease characteristics, were reviewed via their medical charts. Results: The mean age of the patients was 51.2 years. The preoperative (baseline) mean weight was $59.4{\pm}8.44$. Significant weight losses were observed in the initial (1st 3 week) period of TAC chemotherapy compared to the baseline and significant weight losses were observed with the exception of the period 6 weeks after breast surgery. There were significant differences in mean weight changes according to the stage of breast cancer, radiotherapy, and hormone therapy among disease characteristics. Conclusion: It is necessary to study weight changes after breast surgery for the long periods of TAC chemotherapy. Through the accumulated results of studies, nursing programs for breast cancer patients must be developed for the prevention of weight gain in the periods of TAC chemotherapy.

Survival Following Non Surgical Treatments for Oral Cancer: a Single Institutional Result

  • Larizadeh, Mohammad Hasan;Shabani, Mohammad
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.8
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    • pp.4133-4136
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    • 2012
  • Aim: To report the results of radiotherapy with or without chemotherapy in the patients with oral cancer. Methods: Over the 2003-2009 periods, a total number of 69 patients with squamous cell carcinoma of the oral cavity that refused surgery or had unresectable tumor were enrolled in this study. A total dose of 60 to 70 Gy (2 Gy per day) was given to the primary tumor and clinically positive nodes. In the patients with locoregionally advanced disease (57 patients with $T_3$, $T_4$ lesions and/ or $N^+$) induction chemotherapy following by concomitant chemoradiation was used. Induction chemotherapy consisted of 3 cycles of Cisplatin and 5-Flourouracil with or without Docetaxel. Weekly cisplatin was used in concomitant protocol. Kaplan-Meier method was used to calculate overall survival. Log-rank test and Cox regression model were used for comparison purposes. Results: Median follow-up was 32 months. The mean age of the patients was 59.2 years. The overall response rate after induction chemotherapy was 68.4%. Actuarial overall survival rates after 2 and 3 years were 38% and 26%, respectively. Clinical stage emerged as the only independent predictor of survival. Conclusion: Outcome of the patients with oral cancer is poor. Presenting with an advanced stage lesion contributed to this result. The role of chemotherapy in advanced cases remains to be defined.

Anti-VEGF Therapy with Bevacizumab - Limited Cardiovascular Toxicity

  • Yu, Jing;Cao, Xu-Fen;Zheng, Ye;Zhao, Rong-Cheng;Yan, Li-Qiu;Zhao, Lei;Wang, Jia-Wang
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10769-10772
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    • 2015
  • Purpose: This analysis was conducted to evaluate cardiovascular toxicity of commonly used anti-VEGF therapeutic agent, bevacizumab, in treating patients with cancer. Methods: Clinical studies evaluating the efficacy and safety of bevacizumab-based regimens on response and safety for patients with cancer were identified using a predefined search strategy, allowing cardiovascular toxicity and other side effects of treatment to be estimated. Results: In bevacizumab based regimens, 4 clinical studies including 282 patients with advanced cancer (including gliomas, cervical, breast and ovarian cancer) were considered eligible for inclusion. These bevacizumab-based regimens included docetaxel, irinitecan and carboplatin. Systematic analysis suggested that, of 282 patients treated by bevacizumab based regimens, hypertension and thrombo-embolism occurred in 2.5% (7/282), while only 3 patients reported cardiovascular events (1.1%). No treatment related death occurred in bevacizumab based treatment. Conclusion: This systemic analysis suggests that bevacizumab based regimens are associated with reasonable and accepted cardiovascular toxicity when treating patients with gliomas, cervical, breast and ovarian cancer.