Bogdan Domrachev1, Sitanshu Singh1, Dandan Li2, Udo Rudloff1,2*

1Rare Tumor Initiative, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA

2Thoracic & GI Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA

Cancer stem cells (CSCs) are subpopulations of tumor cells that possess abilities for self-renewal, differentiation, and tumor initiation. These rare but therapy-recalcitrant cells are assumed to repopulate tumors following administration of systemic chemotherapy driving therapy failure, tumor recurrence, and disease progression. In early clinical trials, anti-CSC therapies have found limited success to-date possibly due to the inherent heterogeneity and plasticity of CSCs and the incomplete characterization of essential CSC targets. Here, we review the role of 3-phosphoinositide dependent protein kinase-1 (PDPK1) as an emerging CSC target. While most previous studies have relied on CSC models which are based on lineage and tissue-specific marker profiles to define the relationships between putative target and CSC traits, this review discusses PDPK1 and its role in CSC biology with an emphasis on CSC systems which are based on proposed function like label-retaining cancer cells (LRCCs).

DOI: 10.29245/2578-2967/2021/1.1194 View / Download Pdf

Guler Yavas1*, Huseyin Yılmaz2, Kaan Oysul3, Cagdas Yavas1, Osman Vefa Gul1, Cetin Celik4

1*Selcuk University, Department of Radiation Oncology, Konya, Turkey

2Selcuk University, Department of General Surgery, Konya, Turkey

3Medicana International Ankara, Department of Radiation Oncology, Ankara, Turkey

4Selcuk University, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Konya, Turkey

The management of loco-regional recurrences from endometrial cancer is challenging since there are limited data regarding to management of recurrent endometrial cancer. Therapeutic options are often limited particularly for the patients who received adjuvant radiotherapy (RT). Patients who present with loco-regional recurrence after curative surgery and adjuvant RT are ideal for salvage surgery; However, the salvage surgery is associated with higher rates of mortality and morbidity. Re-irradiation could be an option for selected patients. However, pelvic re-irradiation is challenging and is often approached reluctantly by radiation oncologist due to the tolerance limits of nearby normal tissues which may lead severe chronic toxicities. Herein we report a case of recurrent endometrial cancer who underwent second re-irradiation in addition to multiple cytoreductive debulking surgery.

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Julian N. Kenyon1*

1The Dove Clinic, Twyford, Winchester, Hampshire, SO21 1NT, England

Sono and Photodynamic Therapy (SPDT) is a novel therapeutic modality that utilises a non-toxic photosensitive agent with reported ultrasound-activated properties. SPDT has previously demonstrated significant tumour cell inhibition in animal studies. There has been much research into the efficacy of photodynamic therapy and development in understanding of the underlying mechanism of tumour cytotoxicity. Synergistic ultrasound activation represents a promising development to Photodynamic Therapy, as photo-activation is limited by access and penetrance issues. Ultrasound has been demonstrated to activate a number of sono-sensitive agents allowing the possibility of non-invasive targeted treatment of deeper tumour sites than is currently achievable with photodynamic therapy. This case series of 17 consecutive patients with a variety of cancer diagnoses outlines clinical outcomes over a four-year period of SPDT. The results have been encouraging in that all cases who carried our Circulating Tumour Cell Tests before and after SPDT showed a significant drop in tumour cells post-SPDT. SPDT is worthy of further investigation as an effective and well tolerated treatment for a wide variety of primary and metastatic tumours, including those refractory to Chemotherapy.

DOI: 10.29245/2578-2967/2021/1.1195 View / Download Pdf

Christopher J. La Placa1*, Monika D. Vilardo1, Brittany M. Watts1, Monika D. Polewski1, Siena Tabuena-Frolli1, Malinka Jansson1, Kenneth Emancipator1, Fan Jin1, Burak Gumuscu1, Joy Y. Ge2, Michael DiMaio1, Karina Kulangara1*

1Agilent Technologies, Inc. 6392 Via Real, Carpinteria, California, United States

2Merck & Co., Inc. 2000 Galloping Hill Road, Kenilworth, New Jersey, United States

Objectives: FDA approval of PD-L1 IHC 22C3 pharmDx for use as an aid in identifying head and neck squamous cell carcinoma (HNSCC) patients for treatment with pembrolizumab was based on the results of rigorous analytical and clinical validation testing.

Methods: For the HNSCC indication, the device was validated at Agilent Technologies on the performance of sensitivity and precision using the Combined Positive Score (CPS) ≥ 1 and CPS ≥ 20 cutoffs; external validation studies were performed at three external laboratories. CPS ≥ 1 and CPS ≥ 20 cutoffs were evaluated in KEYNOTE-048, a phase 3 clinical trial.

Results: Analytical validation studies supporting the companion diagnostic indication (CPS ≥ 1) achieved point estimates of > 85% for negative, positive, and overall percent agreement. Clinical validation studies show that HNSCC patients treated with pembrolizumab as a single agent had an overall survival (OS) of 12.3 months at CPS ≥ 1 (95% CI, 10.8-14.9) compared with patients receiving cetuximab, platinum, and 5-fluorouracil (CPS ≥ 1 OS of 10.3 months (95% CI, 9.0-11.5)).

Conclusion: Analytical and clinical validation studies demonstrate that PD-L1 IHC 22C3 pharmDx is a precise companion diagnostic assay, allowing for selection of eligible HNSCC patients for treatment with pembrolizumab.

DOI: 10.29245/2578-2967/2021/1.1190 View / Download Pdf

Justina Ugwah5, Niall Savage1, Walter Messina1, Yineng Wang5, Edel Whelton5, Ann-Marie O’Donovan3, Martin J.O’Sullivan2, Brian D.O. Donnell2,4, Eric J. Moore1,5*

1Life Sciences Interface, Tynadall National Institute, University College Cork, Ireland

2Department of Surgery, Cork University Hospital, Cork

3Department of Pathology, Cork university Hospital, Cork

4Department of Anaesthesia, Cork University Hospital, Cork

5School of Chemistry, University College Cork

Bioimpedance is the opposition to flow of an applied electrical current through biological tissues1. Our research group designed and fabricated bipolar micro-sensors on the tip of a silicone probe, capable of measuring biological tissue impedance. It is known that the bioimpedance of cultured cancer cells differs substantially from that of healthy cell lines. We hypothesised that the bioimpedance of cancer in surgically excised human tissue would be significantly different to surrounding healthy tissue. To test this hypothesis, we designed a study to evaluate the bioimpedance of healthy and diseased breast tissue in surgically excised breast specimens. This manuscript reports the outcome of this study.

DOI: 10.29245/2578-2967/2021/1.1193 View / Download Pdf

Yi-Liu Yang1, Lin-Yong Zhao2*

1West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China

2Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China

The AP-2 family of transcription factors consist of DNA-binding proteins: AP-2α to AP-2ε. Members and homologs of this family are also known in frogs, fish and invertebrates. These proteins have the same central basic region and a helix-span-helix dimerization motif, which is necessary for dimerization and DNA binding. This family have been found to influence facial, limbs and kidney development in embryogenesis while regulating differentiation and apoptosis. These proteins are also involved in regulation of endocrine processes. In addition to their influence on growth and development, this family have also been reported to correlate with tumorigenesis and development of cancer. At present, this family have been related to tumors of ovary, melanoma, lung, nasopharynx, breast, glioma, neuroblastoma, colon, etc. They regulate expression of many cancer-related genes and affect the occurrence, development, invasiveness and therapeutic response of cancers. Different expression levels of AP-2s are also related to different survival rate. These findings may bring new idea to the diagnosis, classification, treatment and prognosis of cancer.

DOI: 10.29245/2578-2967/2021/1.1187 View / Download Pdf

Saranya Navaneetha Krishnan1, Jesusa L. Rosales1, Ki-Young Lee1*

1Department of Cell Biology & Anatomy, Arnie Charbonneau Cancer and Alberta Children’s Hospital Research Institutes, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

DOI: 10.29245/2578-2967/2021/1.1189 View / Download Pdf

Cary A. Presant1*, Shanmuga Subbiah1, Gargi Upadhyaya1, Meizi Zheng1

1City of Hope Medical Center, West Covina, CA, USA

In order to determine the frequency of cannabis product (marijuana, THC or CBD) use and determine the patient reported outcomes to control symptoms, an anonymous survey of cannabis product use was conducted in patients who had cancer, non-malignant hematologic disorders or other diseases. Patients reported the degree of control of symptoms using a Likert scale. The use of cannabis products was 23.3% (36 users in 154 patients). This did not vary by age, gender, or disease. Use was predominately CBD in patients over 65, but was either marijuana, THC or CBD in younger patients. Patients reported some degree of control of at least one symptom in 91.9%, and high degree of control in 51.7% of patients. Most patients relied on recommendations of family or friends to try cannabis, but only 4% relied on clinician advice. 53% of patients said they were willing to consider participating in a prospective clinical trial of cannabis products to control symptoms. We conclude that cannabis product use is frequent in cancer patients. Physicians should obtain a detailed history of cannabis product use in patients, and could consider a therapeutic trial of cannabis products in selected patients with symptoms not controlled by usual treatments. Clinicians may need additional education to provide the highest level of evidence-based support for cannabis product use in patients in need of symptom control.

DOI: 10.29245/2578-2967/2020/4.1188 View / Download Pdf

Gerald Zon*

TriLink BioTechnologies, 10770 Wateridge Circle, Suite 200, San Diego, California, 92121, USA

Aptamers, which are short strands of synthetic DNA or RNA selected for binding to target ligands, have proven useful for cell-specific delivery, detection, or both. This mini-review presents selected examples of these applications for cancer published during 2019 – September 2020.

DOI: 10.29245/2578-2967/2020/3.1186 View / Download Pdf

Qianqian Yu1, Zhihuan Li2, Xiaoqi Nie1, Lu Wang1, Chen Gong1, Bo Liu1, Xin Liao3, Ben Zhao1, Qianxia Li1, Mingsheng Zhang1, Hong Qiu1, Xianglin Yuan1*

1Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China.

2Dongguan Enlife Stem Cell Biotechnology Institute, Dongguan 523000, Guangdong, China

3Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China

Irinotecan-based chemotherapy is a fundamental cytotoxic regimen for advanced colorectal cancer. The disposition of irinotecan is known to vary in a fashion partially depending on genetic variations in the drug metabolic pathways. UDP-glucuronosyltransferase (UGT)1A1 is a predominant enzyme that converts the active metabolite of irinotecan to the inactive form via a glucuronidation process. Several UGT1A1 polymorphisms are linked to SN-38 glucuronidation and irinotecan-related adverse events, while the predictive role of UGT1A1 polymorphisms regarding therapeutic outcome is controversial. In this review, we will evaluate the impact of UGT1A1 genotypes on irinotecan-induced toxicity and therapeutic efficacy in colorectal cancer patients receiving irinotecan-based treatment.

DOI: 10.29245/2578-2967/2020/2.1182 View / Download Pdf

Francesca Dionigi1,2*, Valentina Martinelli3, Eugenia Trotti3, Alberta Ferrari2,5, Carlos Alberto Garcia Etienne2, Angelica Della Valle2, Donatella Grasso6, Elisa Ferraris6, Gianpiero Rizzo6, Angioletta Lasagna6, Vincenza Pratico2, Paolo Pedrazzoli, Pierluigi Politi6, Adele Sgarella2,5

1Dottorato di Ricerca in Medicina Sperimentale, Università degli Studi di Pavia, 27100, Pavia, Italy

2Fondazione IRCCS Policlinico “San Matteo”, Unità Operativa Complessa di Chirurgia Generale III a indirizzo Senologico e dei tessuti molli, viale Golgi 19, 27100, Pavia, Italy

3Dipartimento di Medicina e Sanità Pubblica, Università dell'Insubria, via Ottorino Rossi 9, 21010 Varese, Italy

4Department of Biotechnology and Life Sciences, Università degli Studi dell’Insubria, via Ottorino Rossi 9, 21010, Varese, Italy

5Università degli Studi di Pavia, Pavia, Italy

6Fondazione IRCCS Policlinico “San Matteo”, Unità Operativa Complessa di Oncologia Medica, Pavia, Italy

We present our commentary about the case of a 48-year-old woman diagnosed with early breast cancer, already presented as publication. A candidate for mastectomy, she refused immediate reconstruction. She was referred to a psycho-oncologist for further evaluation and support. Psychological sessions helped reveal a history of intimate partner violence and helped clarify the reason for her refusal to undergo immediate reconstruction and other uncommon behavior about oncological treatment and disease paths. Our experience highlights the importance of a multidisciplinary practice in which collaboration between surgeons, oncologists, and mental health professionals leads to a more in-depth understanding of the apparently paradoxical behaviors of patients, and to better care for their needs.

DOI: 10.29245/2578-2967/2020/2.1181 View / Download Pdf

A. H. M. Zuberi Ashraf1,2, Syeda H. Afroze3, Grace A. Osuji2, Saba Y. Kayani3, Natalie Colon3, Ahmed F. Pantho3, Thomas J. Kuehl3, Kimberly A Pilkinton4, M. Nasir Uddin3,5

1Department of Science & Mathematics, Texas A&M University-Central Texas, Killeen, TX, U.S.A.

2Baylor Scott & White Health, Temple, TX, U.S.A.

3Orion Institute for Translational Medicine, Temple, TX, U.S.A.

4Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX, U.S.A.

5Department of Medical Physiology, Texas A&M University College of Medicine, Temple, TX, U.S.A.

The purpose of this article is to review the role of different epigenetic modifications in ovarian cancer. Epigenetic changes can lead to disease development, malignant transformation, and drug resistance of ovarian cancer. Silencing, methylation, and histone modification of genes contribute to ovarian cancer formation. miRNAs have frequently been found to be dysregulated in ovarian cancer cells. Cancer stem cells possess incredible DNA-repair mechanisms and higher rates of mutation; therefore, making them very invasive and resistant to most chemotherapeutic agents. The pathogenesis of ovarian cancer, types of epigenetic modifications, role of miRNA, and cancer stem cells are discussed, as well as targeting of epigenetic pathways with alternative interventions, and application of combination therapies. Using newly discovered combination therapies, it might be possible to create means to manipulate the detrimental epigenetic pathways which can lead to earlier detection, prevention, and treatment of ovarian cancer.

DOI: 10.29245/2578-2967/2020/2.1179 View / Download Pdf

Ryan Nguyen1, Cody J. Peer1, William D. Figg1*

1Clinical Pharmacology Program, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

Herein, the strengths and weaknesses of a study previously published in Scientific Reports will be discussed. The major aim of this study was to investigate the spatial uptake of enzalutamide by intact prostate tissue using matrix-assisted laser desorption ionization mass spectrometry imaging (MALDI-MSI) and histological staining. Additionally, quantitative analysis of in situ tissue enzalutamide concentration was achieved by conventional liquid chromatography-tandem mass spectrometry (LC-MS/MS). The authors demonstrated that enzalutamide rapidly permeates prostate tissue and accumulates in regions containing high epithelial cell counts. While these findings have potential to inform future pharmacodynamic experimental designs and endpoints, this study is limited in its scope by the current state of MALDI-MSI technology, which is not yet sensitive enough to investigate clinically relevant in situ enzalutamide concentrations.

DOI: 10.29245/2578-2967/2020/2.1183 View / Download Pdf

Juwairiya Arshi1, Feng Yin1*

1Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA

Sarcomatoid transformation in a carcinoma is a rare event but frequently associated with advanced disease stage, aggressive clinical behavior and dismal prognosis. It’s likely a result of stepwise gene mutations in pluripotent stem cell and involves the epithelial to mesenchymal transition (EMT). In this review, we discuss the sarcomatoid transformation in various types of cancers. Sarcomatoid transformation in a carcinoma should always be in the differential when there is a sudden increase in size of the tumor during neoadjuvant therapy. Use of agents that interfere with the tyrosine kinase pathway might be the new potential addition to the chemotherapy regimen in these cases. Precision medicine, a rapidly emerging field, seems to be promising in the management of these cancers.

DOI: 10.29245/2578-2967/2020/2.1178 View / Download Pdf

Saranya NavaneethaKrishnan1, Jesusa L. Rosales1, Ki-Young Lee1*

1Department of Cell Biology & Anatomy, Arnie Charbonneau Cancer and Alberta Children’s Hospital Research Institutes, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

DOI: 10.29245/2578-2967/2020/2.1180 View / Download Pdf

Xianglong Tan1, Mengyang Li2, Zhiming Zhao1*

1The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China

2Department of Hepatopancreatobiliary Surgery, The Fourth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China

Liver metastases occur during the progression of various malignancies. Similar to colorectal cancer, liver metastases of neuroendocrine cancer, gastrointestinal stromal tumor, and pancreatic cancer also determine patient prognosis to some extent. With the development of surgical techniques, pharmaceutical research, and perioperative treatment, therapeutic strategies for non-colorectal cancer liver metastases have improved greatly during the last two decades, inevitably leading to some controversies. Here, we have reviewed the current treatment options for non-colorectal cancer with the aim of enhancing our understanding of the latest developments in this field.

DOI: 10.29245/2578-2967/2020/2.1177 View / Download Pdf

Sruti Chandra1, Hoang Michael Nguyen1, Kylar Wiltz1, Nicholas Hall1, Shanzay Chaudhry1, George Olverson1, Tarun Mandal2, Srikanta Dash3, Anup Kundu1*

1Department of Biology, Xavier University of Louisiana, New Orleans, Louisiana

2Center for Nanomedicine and Drug Delivery, Xavier University College of Pharmacy, New Orleans, Louisiana

3Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana

OBJECTIVE: The MDR of metastatic breast cancer cells is accompanied by the overexpression of P-gp transporter. This study has been focused to determine whether silencing the expression of P-gp by aptamer-labeled siRNA nanoparticles could enhance the delivery of doxorubicin into breast cancer cells in culture.

METHODOLOGY: The nanoparticle F-31 was prepared using DOTAP, cholesterol, and PLGA, and then incorporating Mal-PEG to facilitate aptamer-binding. The nanoparticles were surface-functionalized with aptamer A6, which targets Her-2 receptors overexpressed on the surface of breast cancer cells.

RESULTS: This study has shown that the uptake of Dox by Dox-resistant 4T1-R is significantly less than Dox-sensitive 4T1-S which is partly attributed to the higher expression of drug-efflux pump P-gp on the surface of the resistant cells. The targeted knockdown of P-gp has been enhanced when the particles carrying P-gp siRNA was labeled with aptamer. Concurrently, the uptake of Dox into the Dox-resistant 4T1-R breast cancer cells has increased significantly when the P-gp was silenced by P-gp siRNA-encapsulated aptamer-labeled nanoparticles.

CONCLUSIONS: This preliminary study concludes that downregulating P-gp expression by targeted delivery of P-gp siRNA using aptamer-labeled lipid-based hybrid nanoparticles could effectively increase the intracellular trafficking of doxorubicin in Dox-resistant mouse breast cancer cells.

DOI: 10.29245/2578-2967/2020/1.1176 View / Download Pdf

Dexter P. Mendoza1, Subba R. Digumarthy1*

1Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, USA

DOI: 10.29245/2578-2967/2019/4.1174 View / Download Pdf

Alberto Romão Sineque1,2*, Filomena Rosa Dos Anjos3, Custódia Lina Macuamule4

1Department of Biological Science, Faculty of Science, Eduardo Mondlane University, Mozambique

2DREAM Laboratory, Comunidade de Sant’Egídio, Maputo, Mozambique

3Department of Animal Nutrition, Faculty of Veterinary, Eduardo Mondlane University, Mozambique

4Department of ParaClinicas, Faculty of Veterinary, Eduardo Mondlane University, Mozambique

Aflatoxins have gained increased recognition worldwide as several researches reveal the negative impacts on health, food security and trade. Major staple foods in Mozambique are prone to aflatoxin contamination, posing health risks to consumers, including the development of liver cancer and the progression of some infectious diseases. Aflatoxin contamination is mainly reported in peanuts, maize and their products. Nevertheless, some studies had reported the presence of aflatoxins and its metabolites in some foodstuffs of animal origin. Surprisingly, some of the contaminated foods had levels greater than the Codex permissible limits adopted by the Mozambican Government Authorities. Lack of awareness of occurrence and risks of mycotoxins, legislation enforcement, poor agricultural practices and undiversified diets predispose populations to dietary aflatoxin exposure. Regular surveys on aflatoxin contamination of food and exposure assessment through the measurement of aflatoxin biomarkers in human biological samples are not yet being performed. Regardless of these findings, the more important task is to monitor and control humans from being exposed to aflaoxins. Dietary assessment, clinical measurements and the enforcement of law should be immediately implemented as preventive strategies. With the current research on aflatoxin in Mozambique, both national and global networking for research collaboration is needed to expand the knowledge and disseminate the information to the global scientific community.

DOI: 10.29245/2578-2967/2019/4.1139 View / Download Pdf

Erin Schwab1, Justin A. Chen1, Jasmine C. Huynh1, Jingran Ji1, Mili Arora1, May Cho1, Edward J. Kim1*

1Department of Internal Medicine, University of California Davis, USA

Based on the well-established importance of dysregulated apoptosis as a hallmark of cancer, there has been robust interest in development of targeted drugs to promote cancer cell apoptosis. A promising target for promoting apoptosis is the Bcl-2 family of proteins. Bcl-2 family proteins are crucial in maintaining balance between cell survival and death through regulation of apoptotic signaling pathways via pro-survival and pro-apoptotic family members. To date, there has been limited efficacy with Bcl-2 inhibition alone in clinical development with benefit restricted to hematologic malignancies. However, combination approaches to inhibition of Bcl-2 and other oncogenic signaling pathways have provided evidence for potential anti-tumor synergy. We review herein the current evidence for targeting Bcl-2 family proteins as a cancer therapeutic strategy across both hematologic and solid organ malignancies.

DOI: 10.29245/2578-2967/2019/4.1172 View / Download Pdf

Qin Ye1, Jiayang Liu2, Ke Xie1*

1Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, P.R. China

2State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, P.R. China

The B7 family of proteins is commonly divided into three classes according to their structure and the type of receptor they bind to. The B7 proteins exhibit both positive and negative functions with regard to the immune response and are known to be co-inhibitory or co-stimulatory ligands that regulate antitumor immune responses. They are also involved in the regulation of cancer progression via non-immunological functions such as accelerating metabolism, promoting proliferation, and facilitating chemoresistance. Given the dynamic interaction between cancer cells and B7 family proteins, each member has been considered as a novel biomarker or therapeutic target that may well improve the effectiveness of cancer diagnosis and treatment. In this review, we summarize the characteristics of B7 proteins and their immunological and non-immunological roles in cancer progression.

DOI: 10.29245/2578-2967/2019/4.1171 View / Download Pdf

Sonia Bouri1, John P Martin1

1Charing cross hospital, Imperial College London

Iron deficiency anaemia (IDA) is a common condition. The finding of IDA should be given urgent attention as 8-15% of patients will be diagnosed with a gastrointestinal cancer and patients requiring urgent investigation should be identified. IDA is defined as a haemoglobin below the normal range with iron studies that indicate the presence of iron deficiency. This article will discuss the causes of IDA, interpretation of iron studies, and initial investigations for IDA. In the presence of infection or inflammation, the ferritin can be up to 100µg/l even in the presence of IDA and these patients should be considered as having IDA if the other iron studies are supportive. Patients of all ages with IDA should have urinalysis and a Coeliac screen. Patients above 60 years and symptomatic patients of any age should be offered a colonoscopy and gastroscopy within 2 weeks. Men and women younger than 60 years, who are asymptomatic can have routine colonoscopy and gastroscopy. Pre-menopausal women should undergo the relevant endoscopy if they have symptoms or a family history of cancer. If initial bi-directional endoscopies do not show cancer, cancer should be considered in patients who do not respond to iron supplementation, which can indicate ongoing blood loss from the small bowel, or from extra-gastrointestinal sources.

DOI: 10.29245/2578-2967/2019/3.1167 View / Download Pdf

Karen A Fitzner1*, Milda Plioplys2

1FH Consultants, 554 Hillcrest Dr, Sawyer, MI, USA

2Clinical & Human Research Protections, City of Hope, Duarte, CA, USA

A chapter, Impact of cost on the safety of cancer pharmaceuticals, by Fitzner and Oteng Mensah in a recent book, Cancer Policy: Pharmaceutical Safety1, aims to inform readers about the economics associated with the interplay between safety, costs of cancer treatment, and outcomes of cancer care. That chapter includes a general discussion of safety-related costs, cancer care expenditures, and processes that aim to ensure drug safety. It also identifies the negative effects of the high cost of care on patients with cancer and their families. The authors’ focus on safety and cost of cancer pharmaceuticals, while appropriate for the book in which it appears, is limited. Pharmaceutical costs and their impact are only part of the safety story. A more holistic approach to thinking about patient safety can be constructive.

DOI: 10.29245/2578-2967/2019/2.1168 View / Download Pdf

Sunjida Ahmed1, Christopher Schwartz1, M. Zahidunnabi Dewan1, Ruliang Xu1*

1Department of Pathology, NYU Langone Medical Center, New York, NY 10016, USA

The transforming growth factor β (TGF-β) superfamily includes a group of structurally related cytokines that regulate a wide variety of biological processes. The diversity of its action depends on the dynamic tissue microenvironment, and interplays among the factors involving in the signaling pathway. Although its expression is tightly regulated in normal tissue, overexpression of TGF-β has been identified in multiple tumor types, including pancreatic adenocarcinoma. In pancreatic tumorigenesis, TGF-β acts initially as a tumor suppressor through phosphorylation and activation of SMAD4/DPC4 gene. Mutation of SMAD4/DPC4 gene results in carcinogenesis and tumor progression in many cancers like lung, colon, and pancreatic cancer. SMAD4 mutation is now recognized in >50% of pancreatic ductal carcinomas. This review is to evaluate the diagnostic and prognostic value targeting the TGF-β/SMAD4 pathway in pancreatic ductal adenocarcinoma.

DOI: 10.29245/2578-2967/2019/2.1141 View / Download Pdf

Steven S. Coughlin1,2*, Lee Caplan3, Jessica Lynn Stewart4, Lufei Young5

1Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA

2Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, GA

3Morehouse College of Medicine, Department of Community Health and Preventive Medicine, Atlanta, GA

4College of Allied Health Sciences, Augusta University, Augusta, GA

5College of Nursing, Augusta University, Augusta, GA

Although they have been widely studied, important questions remain about the impact of breast cancer survivorship care plans on improving health outcomes. The goal of this article was to review published studies on the impact of cancer survivorship care plans on health outcomes and health care delivery among breast cancer survivors. A total of 111 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 7 studies met the eligibility criteria. All of the studies had a randomized controlled design. Early trials of the efficacy of breast cancer survivorship care plans generally showed little or no improvement in health outcomes. The positive findings of recent studies suggest that survivorship care interventions that empower and activate patients to self-manage their follow-up care and improve patient-provider communication may be especially promising.

DOI: 10.29245/2578-2967/2019/1.1166 View / Download Pdf