Progress and prospect in the clinical translation of cancer nanomedicine / 药学学报

Nanotechnology has shown broad application prospects in the diagnosis and treatment of cancer. Currently, nearly 80 cancer nanomedicines are under clinical investigation, and many have been approved with enhanced anti-tumor efficacy and decreased side effects. However, the presence of various barriers in related basic research, process control and clinical trials lead to extremely low translation rate. From the perspective of clinical commercialization, we summarized the progress, clinical status, challenges and opportunities of cancer nanomedicine, and presented a cutting-edge prospect on the rational design of nanomedicine and clinical trial strategies.

Revisiting ovarian cancer microenvironment: a friend or a foe?

Development of ovarian cancer involves the co-evolution of neoplastic cells together with the adjacent microenvironment. Steps of malignant progression including primary tumor outgrowth, therapeutic resistance, and distant metastasis are not determined solely by genetic alterations in ovarian cancer cells, but considerably shaped by the fitness advantage conferred by benign components in the ovarian stroma. As the dynamic cancer topography varies drastically during disease progression, heterologous cell types within the tumor microenvironment (TME) can actively determine the pathological track of ovarian cancer. Resembling many other solid tumor types, ovarian malignancy is nurtured by a TME whose dark side may have been overlooked, rather than overestimated. Further, harnessing breakthrough and targeting cures in human ovarian cancer requires insightful understanding of the merits and drawbacks of current treatment modalities, which mainly target transformed cells. Thus, designing novel and precise strategies that both eliminate cancer cells and manipulate the TME is increasingly recognized as a rational avenue to improve therapeutic outcome and prevent disease deterioration of ovarian cancer patients.

Experiencias en la aplicación de un instrumento para la estratificación de pacientes con neumonía adquirida en la comunidad / Experiences in the implementation of a tool for the stratification of patients with community-acquired pneumonia

INTRODUCCIÓN: la estratificación de pacientes constituye una importante herramienta gerencial que contribuye a organizar el trabajo asistencial en puntos críticos como es el Departamento de Urgencias. OBJETIVO: presentar las experiencias en la aplicación de un instrumento de estratificación del paciente con neumonía adquirida en la comunidad (IENAC). MÉTODOS: el instrumento se evaluó en 2 series de 394 y 421 pacientes, respectivamente, mediante el empleo de indicadores de proceso y de resultado. RESULTADOS: el índice de estratificación para el total de pacientes fue 87 %, mucho mejor en la segunda serie. En cambio, el índice general de estratificación adecuada fue muy similar en ambas series: 82 % y 84 %, respectivamente; en las dos series un número considerable de pacientes clasificados clase II A pertenecían realmente a la clase II B, lo cual denota la frecuente subestimación por los facultativos del riesgo de complicación posterior. El mayor porcentaje de pacientes perteneció a la clase II B, con amplia diferencia sobre las otras clases de riesgo. La mayoría de los pacientes de ambas series fueron ubicados acorde la recomendación del instrumento de estratificación, aunque no todos los de la clase III A fueron admitidos en UCI. En cambio, el incumplimiento en el tratamiento antimicrobiano propuesto en el instrumento de estratificación del paciente con neumonía adquirida en la comunidad fue muy frecuente en los pacientes con neumonía no grave, determinado por un excesivo uso de ceftriaxona. Se comprobó un aumento progresivo de la letalidad desde la clase II A hasta la clase III B, con resultados consistentes en ambas series; este indicador fue extremadamente alto en esta última clase de riesgo, con diferencias estadísticamente significativas. CONCLUSIONES: el IENAC no solo ha mostrado factibilidad para su aplicación sino también una gran utilidad pronóstica.

INTRODUCTION: stratification of patients is an important management tool that helps organizing the care work at critical points such as the Emergency Department. OBJECTIVE: present the experience with application of an instrument of stratification of patients with community-acquired pneumonia (IENAC). METHODS: the instrument was evaluated in two series of 394 and 421 patients, respectively, through the use of indicators of process and outcomes. RESULTS: stratification index for all patients was 87 %, much better in the second set. However, the overall rate of appropriate stratification was similar in both series: 82 % and 84 %, respectively. In two series, a significant number of patients classified as Class II A really belonged to the class II B, which denotes frequent underestimation by doctors of the risk of further complications. The highest percentage of patients belonged to class II B, with wide lead over other kinds of risk. Most patients of both series were located according to the recommendation of stratification tool, although not all Class III A were admitted to the ICU. However, failure in antimicrobial therapy proposed at IENAC, was very common in patients with non-severe pneumonia, as determined by an excessive use of ceftriaxone. A progressive increase in the lethality from Class II A to Class III B, with consistent results in both series was tested; this indicator was extremely high in the latter class of risk, with statistically significant differences. CONCLUSIONS: IENAC has not only shown feasibility for implementation but also a prognostic value, as well.

Novel Methods for Clinical Risk Stratification in Patients with Colorectal Liver Metastases / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Colorectal cancer patients with liver-confined metastases are classified as stage IV, but their prognoses can differ from metastases at other sites. In this study, we suggest a novel method for risk stratification using clinically effective factors. MATERIALS AND METHODS: Data on 566 consecutive patients with colorectal liver metastasis (CLM) between 1989 and 2010 were analyzed. This analysis was based on principal component analysis (PCA). RESULTS: The survival rate was affected by carcinoembryonic antigen (CEA) level (p < 0.001; risk ratio, 1.90), distribution of liver metastasis (p=0.014; risk ratio, 1.46), and disease-free interval (DFI; p < 0.001; risk ratio, 1.98). When patients were divided into three groups according to PCA score using significantly affected factors, they showed significantly different survival patterns (p < 0.001). CONCLUSION: The PCA scoring system based on CEA level, distribution of liver metastasis, and DFI may be useful for preoperatively determining prognoses in order to assist in clinical decisionmaking and designing future clinical trials for CLM treatment.