Metastatic Urachal Carcinoma Treated With Several Different Combined Regimens: A Case Report.

Urachal carcinoma is a rare bladder malignance. This study presents a case of an elderly patient with urachal carcinoma who was found to have pulmonary metastases 1 year after 5 recurrent resections. The patient was treated with up to 7 different chemotherapy regimens, including a VEGF monoclonal antibody and anti-PD-1 antibody. This is the first report of PD-1 antibody being used in patients with urachus, although the disease progressed after only four cycles of the application. The patient's disease was controlled by the FOLFIRI combined with the VEGF monoclonal antibody regimen. The most prominent issues at present are the difficulty of obtaining drugs for rare cancers and the lack of late-stage clinical trials to guide therapeutic decisions.

Correlations of recurrence of gastric cancer in patients after radical surgery with serum gastrointestinal hormones, vascular endothelial growth factors and serum anti-helicobacter pylori IgG antibody.

PURPOSE: To study the correlations of the recurrence of gastric cancer in patients after radical surgery with serum gastrointestinal hormones, serum anti-Helicobacter pylori (anti-HP) immunoglobulin G (IgG) antibody and vascular endothelial growth factors (VEGFs). METHODS: According to whether gastric cancer recurred within five years after surgery, the patients were divided into recurrence group (RE group, gastric cancer recurred within five years after surgery, n=78) and non-recurrence group (NR group, gastric cancer did not recur within five years after surgery, n=69). Differences in lymph node metastasis, gastrointestinal hormones, VEGFs, anti-HP IgG antibody and the tumor-node-metastasis (TNM) stage between RE group and NR group were detected and compared, so as to analyze the correlations of these factors with the recurrence of gastric cancer in patients after radical surgery. RESULTS: The levels of gastrin (GAS) and motilin (MTL) after meals in RE group and NR group were slightly higher than those before meals. The levels of GAS and MTL in RE group were higher than those in NR group in the two periods (p<0.05). Besides, compared with NR group, RE group had lower pepsinogen (PG) I, PG II and PG I/II ratio (PGR), but a higher positive value of anti-HP IgG antibody (p<0.05) and higher levels of VEGF-A, VEGF-C and VEGF-D (p<0.05). Moreover, there were markedly more cases of gastric cancer in stage III, remarkably few cases of gastric cancer in stage I and obviously more cases of lymph node metastasis in RE group than those in NR group (p<0.05). Multivariate analysis showed that gastrointestinal hormones, lymph node metastasis, VEGFs, the TNM stage of gastric cancer and anti-HP IgG antibody were all risk factors for the recurrence of gastric cancer after radical surgery (p<0.05). CONCLUSIONS: The recurrence of gastric cancer in patients after radical surgery is related to the TNM stage of gastric cancer, gastrointestinal hormones, VEGFs, lymph node metastasis, anti-HP IgG antibody and other factors.

EGFR inhibitors and autophagy in cancer treatment.

Epidermal growth factor receptor (EGFR) inhibitor treatment is a strategy for cancer therapy. However, innate and acquired resistance is a major obstacle of the efficacy. Autophagy is a self-digesting process in cells, which is considered to be associated with anti-cancer drug resistance. The activation of EGFR can regulate autophagy through multiple signal pathways. EGFR inhibitors can induce autophagy, but the specific function of the induction of autophagy by EGFR inhibitors remains biphasic. On the one hand, autophagy induced by EGFR inhibitors acts as a cytoprotective response in cancer cells, and autophagy inhibitors can enhance the cytotoxic effects of EGFR inhibitors. On the other hand, a high level of autophagy after treatment of EGFR inhibitors can also result in autophagic cell death lacking features of apoptosis, and the combination of EGFR inhibitors with an autophagy inducer might be beneficial. Thus, autophagy regulation represents a promising approach for improving the efficacy of EGFR inhibitors in the treatment of cancer patients.