Vacunas basadas en neoantígenos y control del cáncer: perspectivas / Neoantigen vaccines and cancer control: perspectives

Resumen La supervivencia global y la calidad de vida son objetivos primarios del tratamiento del cáncer. El desarrollo de terapias blanco promovió el concepto de tratamientos personalizados, los que se han evaluado principalmente mediante desenlaces centrados en el tumor y han tenido foco en tumores de baja frecuencia y estados avanzados. La inmunoterapia rompe esta tendencia y genera expectativa por su efecto en la supervivencia global y su potencial uso en una gama amplia de tumores. Dentro de esta, las vacunas basadas en neoantígenos han mostrado alta eficacia y seguridad debido a su afinidad con células T y su elevada especificidad. Basado en sus principios biológicos se revisa su posible impacto en la carga de enfermedad según la relación entre potencial inmunogénico y prevalencia por tipo de tumor, el posible efecto en la práctica clínica por su combinación con otras modalidades de tratamiento, y el efecto en el acceso al tratamiento dado su proceso de desarrollo y producción y la disponibilidad de información propia.

Abstract Overall survival and quality of life are primary goals of cancer treatment. The recent development of targeted therapies has fostered the concept of personalized treatments, which have been evaluated mainly through tumor-centered outcomes and have focused on low-prevalence tumors and advanced stages. Immunotherapy halts this trend and generates expectation regarding its impact on overall survival and its potential use in a wide range of tumors. As part of immunotherapy, neoantigen vaccines have shown high efficacy and safety due to their affinity with T cells and their high specificity. Based on biological principles, we reviewed their potential impact on the burden of disease given the immunogenicity and prevalence by tumor type, the possible effect on clinical practice due to their combination with other treatment modalities, and the effect on access to treatment, given the process of development and production and the availability of local data.

Outcome of community based planned intervention targeting perceptions, attitudes and health seeking behaviour regarding cancers in New Delhi, India

Background: Cancer prevention and control needs to be based on effective implementation of all approaches. Community as well as individual level interventions to increase knowledge and early reporting have shown effectiveness. A community-based intervention trial was conducted to design, implement and test short-term outcomes of evidence based preventive strategies.Methods: A mixed methods, three phased study was conducted in three districts of Delhi, which were selected by a random process. Two randomly selected districts out of these three were intervention districts while third was the control. A total sample of 500 in each district was studied in quantitative pre and post -intervention phases. Multistage, stratified, cluster sampling was utilized. Pre-tested and validated tools were used.Results: Post intervention, statistically significant higher scores were observed in all domains in intervention districts as compared to control (p<0.01). Though comparison of slum versus non-slum showed significant increment in knowledge and practice scores, with higher scores for non-slum respondents, the attitudes were very similar (p>0.05). The increment score changes between males and females was similar in all classes of society versus control district. Comparison within the intervention and control groups revealed increased scores in intervention districts and decreased scores in control district, in all domains (p<0.05).Conclusions: Our study has helped in understanding the determinants of perceptions, attitude and practices regarding cancer in the community, This, helped in formulating the need-based intervention strategies. Testing the short-term outcome of intervention showed it to be effective.

Cancer control based on six integrations / 中国肿瘤临床

Cancer is an internal disorder, as cancer cells come from normal cells, unlike infectious diseases. Therefore, "War on Can-cer" should be renamed as "Cancer Control War". Cancer Control War would need to emphasize on six integrations: integration of elim-ination and transformation strategies, integration of individual combat and comprehensive treatment, integration of quick decision in battle and lasting strategy, integration of passive treatment and active participation, integration of advanced technology and effi-cient, economical results, and integration of foreign service and Chinese mindset.

Papel de la interculturalidad en el control del cáncer en pueblos indígenas

Pese a su importancia, la población indígena se caracteriza por tener mayor pobreza, menor acceso a educación y a salud, lo que conlleva a reducir su expectativa de vida. Otros aspectos como el elevado nivel de desempleo, la precariedad de servicios sociales, la vulneración de Derechos Humanos y la degradación del ambiente, configuran un desfavorable escenario de discriminación, marginación y exclusión. Aunque es bien conocida la necesidad de ofrecer servicios de salud diferenciales, esto aún no logra materializarse, lo que sumado a la ausencia de información y estrategias apropiadas, lleva a la falta de goce efectivo de la población indígena de los servicios para el control del cáncer que son accesibles al resto de la población. Dado lo anterior, es indispensable la reflexión respecto al estado y papel de la interculturalidad en el control del cáncer.

Despite its importance, the indigenous population is characterized by greater poverty, less access to education and health services, which leads to reduced life expectancy. Other facts such as the high rate of unemployment, the precarious social services, the violation of Human Rights and the environment degradation, constitute an unfortunate scenario of discrimination, marginalization and exclusion. Although the need to offer differential health services is well known, this has not yet materialized, in addition, the lack of information and appropriate strategies, leads to indigenous population unable to enjoy effectively the cancer control services. which are accessible to the rest of the population. According to the above mentioned, it is essential to reflect on the condition and role of interculturality in cancer control.

Apesar de sua importância, a população indígena é caracterizada por maior pobreza, menor acesso à educação e à saúde, o que leva a uma redução da expectativa de vida. Outros aspectos, como o alto nível de desemprego, a precariedade dos serviços sociais, a violação dos direitos humanos e a degradação do meio ambiente, constituem um cenário desfavorável de discriminação, marginalização e exclusão. Embora a necessidade de oferecer serviços diferenciais de saúde seja bem conhecida, isso ainda não é uma realidade, o que, somado à falta de informações e estratégias adequadas, leva à falta de aproveitamento efetivo dos serviços de controle de câncer por parte da população indígena, embora tais serviços são acessíveis para o resto da população. Diante do exposto, é essencial refletir sobre o status e o papel da interculturalidade no controle do câncer.

Cost-effectiveness of two-dose human papillomavirus vaccination in Singapore

<p><b>INTRODUCTION</b>Cervical cancer is the tenth most common cancer and the eighth most frequent cause of death among women in Singapore. As human papillomavirus (HPV) infection is the necessary cause of cervical cancer, the risk of cervical cancer can be substantially reduced through vaccination. This study was conducted to evaluate the cost-effectiveness of two-dose HPV vaccination as part of a national vaccination programme for 12-year-old girls in Singapore, from the perspective of the healthcare payer.</p><p><b>METHODS</b>A lifetime Markov cohort model was used to evaluate the cost-effectiveness of introducing the AS04-adjuvanted HPV-16/18 vaccine (AS04-HPV-16/18v) to the current cervical screening programme in Singapore. Furthermore, the cost-effectiveness of the AS04-HPV-16/18v was compared with the HPV-6/11/16/18 vaccine (4vHPV). Model inputs were derived from local data, where possible, and validated by clinical experts in Singapore.</p><p><b>RESULTS</b>Introduction of the AS04-HPV-16/18v in Singapore was shown to prevent 137 cervical cancer cases and 48 cervical cancer deaths when compared with screening alone. This resulted in an incremental cost-effectiveness ratio of SGD 12,645 per quality-adjusted life year (QALY) gained, which is cost-effective according to the World Health Organization threshold for Singapore. When discounted at 3%, AS04-HPV-16/18v was dominant over 4vHPV, with cost savings of SGD 80,559 and 28 additional QALYs gained. In the one-way sensitivity analysis, AS04-HPV-16/18v remained cost-effective compared with screening alone and dominant compared with 4vHPV.</p><p><b>CONCLUSION</b>AS04-HPV-16/18v is the most cost-effective choice for reducing the burden of cervical cancer through universal mass vaccination for 12-year-old girls in Singapore.</p>

Plan Control del cáncer en Colombia 2012-2021. Un análisis formal / Cancer Control Plan in Colombia 2012-2021. A Formal Analysis / Plano Controle do cancro na Colômbia 2012-2021. Análise formal

Resumen En Colombia el cáncer es un problema de salud pública. Su incidencia y mortalidad afectan tanto a la población adulta como a la población pediátrica. Desde el año 2010 el país se viene preparando para afrontar este problema. El Instituto Nacional de Cancerología (INC) ha realizado investigaciones para caracterizar epidemiológicamente el cáncer, así como otros factores que inciden en su letalidad. Las leyes 1384 y 1388 de 2010 fijaron las bases para el control integral del cáncer y designaron al INC para asesorar al Ministerio de Salud y Protección Social en esta tarea. Se analizó el contenido del plan, con base en una guía elaborada por la Facultad de Salud Pública de la Universidad de Antioquia. Debido a la importancia del problema y la complejidad de la política, se concluye: solo con un sistema estricto de monitoreo, una evaluación permanente de las actividades del plan y la aplicación de correctivos oportunos, Colombia podría alcanzar las metas en el control del cáncer.

Abstract In Colombia, cancer is a public health problem. Its incidence and mortality affects both adult and pediatric population. Since 2010 the country has been preparing to address this problem. The National Cancer Institute (NCI) has conducted research to characterize epidemiologically cancer as well as other factors that influence their lethality. 1384 and 1388 laws of 2010 laid the foundation for comprehensive cancer control and designated the INC to advise the Ministry of Health and Social Protection in this task. We analyzed the contents of the plan, based on a guide developed by the School of Public Health at the University of Antioquia. Because of the importance of the problem and the complexity of the policy concludes: Only a strict monitoring system, continuous evaluation and timely corrective plan of activities, Colombia could reach targets in cancer control.

Resumo Na Colômbia, o câncer é um problema de saúde pública. A incidência e a mortalidade afectar ambos os adultos e a população pediátrica. Desde 2010 o país tem vindo a preparar para resolver este problema. O Instituto Nacional do Câncer (INC) realizou uma pesquisa para caracterizar epidemiologicamente câncer, bem como outros fatores que influenciam sua letalidade. 1384 e 1388 leis de 2010 lançou as bases para o controle integral de câncer eo INC nomeado para assessorar o Ministério da Saúde e Protecção Social nesta tarefa. o conteúdo do plano foi analisado, com base em um guia desenvolvido pela Escola de Saúde Pública da Universidade de Antioquia. Devido à importância do problema e da complexidade da política, ele conclui: Colômbia poderia atingir as metas para o controle do câncer se aplicado rigoroso sistema de monitorização, uma avaliação contínua das actividades do plano ea implementação de medidas corretivas adequadas.

Risk factors related to the sexual dimorphism in gastric cancer incidence / 上海预防医学

Primary gastric cancer (GC) is one of the most frequently diagnosed cancers worldwide.The incidence of GC in male is approximately twice the incidence thereof in female.Before 60 years of age, the male-female ratio of GC incidence has no geographic and ethic differences, and rises with the increase of age.Studies of classic and molecular epidemiology have proved that the sexual dimorphism in GC is due to synergetic effects of various factors including chronic infection, dietary habit, gene mutation, genetic susceptibility, estrogenic effects and differences in lifestyle behaviors, etc.Studies on the above-mentioned factors can not only help clarify the carcinogenesis of GC, but also help improve the strategies of GC control and prevention, and reducing GC incidence subsequently.

Risk factors related to the sexual dimorphism in the incidence and prognosis of hepatocellular carcinoma / 上海预防医学

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide.About 50% of the total number of HCC cases and deaths worldwide occurred in China.Male has high incidence rates of HCC.Epidemiological data showed that ratio between the male incidence of HCC and the female incidence was from 2∶1 to 5∶1 in China.Up to now, risk factors found to be able to give rise to the sexual dimorphism in HCC incidences include infection and mutation of hepatitis B virus, immune genetic susceptibility and functions of hormone receptors.Relevant studies can not only help clarify the specific biological processes of hepatocarcinogenesis, but also uncover the biological indications that associate the incidences and prognoses of HCC with the sexual dimorphism, thus playing an important role in improving the strategies of control and prevention.

Impact of methylene blue staining in the retrieval of lymph nodes in resected colorectal cancer specimens.

Adequate lymph node harvest in resected colorectal cancer (CRC) specimens is important in staging and choosing appropriate therapeutic options. The yield of lymph nodes and metastatic nodes by methylene blue dye injection in 30 randomly selected resected CRC specimens was compared with an equal number of CRC specimens (control) with matched grade and stage.The mean number of lymph nodes retrieved in the study group was 22 ± 9 compared to 17 ± 8 in the control group which was statistically significant (P = 0.04).Methylene blue technique is an effective aid in increasing the yield of lymph nodes in the resected CRC specimens.

Comparison between the 7th edition of International Union Against Cancer staging system and the Chinese 2008 staging system for nasopharyngeal carcinoma and suggestions for the updating of the staging system / 中华放射肿瘤学杂志

Objective To compare the 7th edition of International Union Against Cancer ( UICC) staging system with the Chinese 2008 staging system for nasopharyngeal carcinoma ( NPC) , and to provide evidence for further updating of the staging system. Methods A retrospective analysis was performed among 767 patients who were pathologically and newly diagnosed with non?metastatic NPC and treated with intensity?modulated radiotherapy from 2006 to 2012. Based on the main prognostic indices, overall survival ( OS) , locoregional failure?free survival( LFFS) local relapse?free survival ( LRFS) , and distant metastasis?free survival ( DMFS) rates, the value of T stage, N stage, and clinical stage in prognostic prediction was compared between the two staging systems. The Kaplan?Meier method was used for calculating survival rates. The log?rank test was used for survival difference analysis. The Cox model was used for multivariate prognostic analysis. Results In terms of T stage, the Chinese 2008 staging system was a significantly better predictor of the OS and LRFS rates than the 7th edition of UICC staging system. In terms of N stage, they were comparable in the prediction of the OS and DMFS rates. In terms of clinical stage, the 7th edition of UICC staging system was a significantly better predictor of the OS rate than the Chinese 2008 staging system. For the new staging system proposed based on the statistical results, the T, N, and clinical staging gave significantly better prognostic prediction. Conclusions The 7th edition of UICC staging system and the Chinese 2008 staging system for NPC have their own advantages in prognostic prediction. The new staging system proposed in this study could contribute to the updating of the current staging system for NPC.

Cancer Control Programs in East Asia: Evidence From the International Literature / 예방의학회지

Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East.

Necessity for a National Carcinogen List in Korea, Based on International Harmonization

Cancer has been the leading cause of death in Korea for the last 30 years. Cancer patients' 5-year survival rate between 2005 and 2009 was 62.0%, representing a highly advanced standard of care, as much as developed countries in the EU and the US. The Korean government formulated its first 10-year plan for cancer control in 1996 and has been carrying out a second 10-year plan for cancer control since 2006. But despite the Korean government's efforts, the cancer burden in Korea continues to increase. Many separate laws have gone into effect concerning the management of carcinogen exposure. However, there are no integrated regulatory laws or management systems against carcinogen exposure in Korea. Dead zones remain where carcinogen exposure cannot be controlled properly in Korea. In this paper, we suggest the need to establish a national carcinogen list based on international harmonization as a prerequisite for a paradigm shift in cancer control policy from treatment to primary prevention.

Head and neck cancer in India: Need to formulate uniform national treatment guideline.

Background: In a large and diverse country like India, there is a wide variation in the availability of infrastructure and expertise to treat head-neck cancer patients. Lack of consistent adherence to evidence-based management is the biggest problem. Aims: There is an unmet need to evaluate the existing treatment practices to form the basis for development of effective and uniform treatment policies. Settings and Designs: Prospective case series. Materials and Methods: A group of previously treated, potentially curable patients presenting to our institution (from April 2009 to March 2011) were evaluated for appropriateness of initial treatment based on National Comprehensive Cancer Network or Tata Memorial Hospital guidelines. Data regarding treatment center, protocol and accuracy of delivered treatment and their eventual outcome were analyzed. Statistical Analysis: Descriptive. Results: Amongst 450 newly registered patients, 77(17%) were previously treated with curative intent and 69(89%) of them were inappropriately treated. Seventeen (25%) patients were treated in clinics while 12(17%) in cancer centers and 34(50%) in corporate hospitals. Fourteen (20%) patients received chemotherapy, 22(32%) received radiotherapy and 14(20%) underwent surgery while 19(28%) patients received multimodality treatment. Disease stage changed to more advanced stage in 40(58%) patients and curative intent treatment could be offered only to 33(48%) patients. Amongst 56 patients available for outcome review, 18(32%) patients were alive disease-free, 20(36%) had died and 18(32%) were alive with disease. Conclusion: Large numbers of potentially curable patients are inappropriately treated and their outcome is significantly affected. Many initiatives have been taken in the existing National Cancer Control Program but formulation of a uniform national treatment guideline should be prioritized.

Evaluation of hela cell lineage response to β radiation from Holmium-166 embedded in ceramic seeds

This work studied the effects of β radiation of Ho-166 embedded in ceramic seeds on HeLa cells. Methodology consisted in the production of ceramic seeds with holmium-165 by sol-gel route. Chemical and physical characterizations of the seeds were performed. Subsequently, nuclear characterization was performed by gamma spectrometry. Experimental and theoretical activities were defined and initial dose rate were evaluated by MIRD (Medical Internal Radiation Dose Committee) methodology. The seeds were placed in confluent culture flasks and remained for six radionuclide half-lives. Biological results were represented by a clean 6 mm diameter area around the seed where the tumour cells were killed. The initial dose rate was 15.5 Gy. h-1. The maximum absorbed dose was 591.3 Gy. The features of the Ho-166 seeds suggested that such ceramic seeds were suitable for high dose rate brachytherapy.

As campanhas educativas contra o câncer / Cancer education campaigns

Discute a trajetória das campanhas educativas contra o câncer, seu papel na política de controle da doença e sua evolução entre 1920 e 1950. Através das imagens pode-se perceber a permanência de conceitos do campo da cancerologia surgidos no início do século XX. Diagnóstico precoce e tratamento médico especializado formavam o binômio que embasava os argumentos médicos sobre a alta possibilidade de cura da doença. A esses termos somava-se uma noção de prevenção que preconizava: evitar as causas externas de irritação dos tecidos seria a principal forma de proteção. Embora a estética dessas campanhas se tenha transformado ao longo dos anos, buscando atrair o público e chamar sua atenção para os perigos da doença, a base de sua concepção permaneceu a mesma.

The article explores the history of cancer education campaigns, their role in disease control policies, and the changes they underwent between 1920 and 1950. Through images, we see how concepts that arose in the early twentieth century have persisted in the field of cancerology. Medical arguments about the great likelihood of curing the disease were grounded on two things: early diagnosis and specialized medical treatment. The notion of prevention also figured in, with the main form of protection believed to be avoidance of any external cause of tissue irritation. Although the aesthetics of these campaigns has shifted over time, including efforts to attract the public and call their attention to the dangers of the disease, their conceptual basis has remained the same.

O controle do câncer no Brasil na primeira metade do século XX / Cancer control in Brazil in the first half of the twentieth century

Discute as ações públicas para o controle do câncer no país, entre a década de 1920 e o final dos anos 1940. Trata da criação da Inspetoria de Profilaxia da Lepra e das Doenças Venéreas, no âmbito do Departamento Nacional de Saúde Pública, primeira ação pública relacionada à doença. Embora de pouco alcance, seu surgimento permite a compreensão do campo profissional, relacionado à doença, existente à época. Observa o papel da difusão da eletrocirurgia na ampliação do interesse médico pelo câncer e na criação do Centro de Cancerologia do Distrito Federal. Discute a criação e a primeira década de atuação do Serviço Nacional de Câncer, aproximando seu perfil inicial das questões que nortearam sua trajetória.

The article discusses public efforts to control cancer in Brazil from the 1920s to the close of the 1940s. It examines the process which brought about creation of the Inspectorship to Combat Leprosy, Venereal Diseases, and Cancer within the National Department of Public Health. Creation of the Inspectorship was the first public action to target cancer and, while it was not far-reaching, its emergence enables us to understand the professional field of cancer at that time. The text also points to the role played by the diffusion of electrosurgery in expanding medical interest about cancer and in the founding of the Cancerology Center in the Federal District. It discusses the establishment and first decade of activities of the National Cancer Service, endeavoring to link the Service's initial profile with the issues that guided its history.

Erratum: Global Activity of Cancer Registries and Cancer Control and Cancer Incidence Statistics in Korea / 예방의학회지

No abstract available.

Global Activity of Cancer Registries and Cancer Control and Cancer Incidence Statistics in Korea / 예방의학회지

The World Health Organization (WHO) reported that cancer killed 7.6 million people in the world in 2005, and that 40% of all cancer deaths can be prevented. According to the WHO Global Action Plan Against Cancer (GAPAC), monitoring of cancer patients is the essential part of cancer control, and should be conducted through cancer registration. Originally, cancer registries were primarily concerned with the description of cancer patterns, trends of cancer occurrence, and etiology of cancer. In the last 20 years, cancer registries provided not only information on the incidence and characteristics of specific cancers, but also supplied the source of cancer control planning and evaluation and the care of individual cancer patients with survival. Cancer Incidence in Five Continents (CI5) presents incidence data from populations all over the world every five year. Volume IX in the series (data for 1998-2002) has recently (November 2007) been published online at International Agency for Research on Cancer (IARC). Nine data from Korea Central Cancer Registry (National data), Seoul, Busan, Daegu, Gwangju, Incheon, Daejeon, Usan, Jejudo regional cancer registries were included in that volume. In this paper, the editorial process, the characteristics of national data, and quality indices in CI5 IX are being described. In addition, cancer control activities related to cancer registration in some selected countries are also presented.

Cancer control in the Philippines: The role of the private practitioners and surgeons

1. In this paper I have presented the cancer-control plan in America, together with a list of successful treatments by American surgeons and radiologists, for the purpose of achieving as many cases of five-year cures as possible. The cancerologists of America are convinced that cure in cancer by surgeons and radiologists can not be attained without a well organized control plan, in towns and countries consisting of early diagnosis and prevention, so that the slogan in cancer control should be: "Cancer is curable, provided it is diagnosed and treated early."2. I have pointed out to you that cancer control in the Philippines consists only of cancer cure and that we do not have the most important implement - namely, the systematic organization for cancer diagnosis and prevention in the provinces. Although the agencies of provincial hospitals and laboratories could be used, there is lack of cancer clinics from which cancer-consciousness among private practitioners and among the people could be disseminated3. As there are many advanced cancers not detected in the early stage, the surgeons of our country are not given the opportunity to achieve a large number of five-year cures through operation and irradiation; and the majority of the advanced cases operated on and irradiated recur, metastasize, and die within five years4. There is a large number of advanced cancers that are over-crowding the general hospitals of the provinces and cities, especially Manila. This is a problem in accommodation. It is also the cancer control problem of the medical profession of the Philippines in general and of the College of Surgeons in particular, because the surgeons of our country are adversely affected by the successful results of their operations in cancer. (Summary)