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Editor’s Choice : Nanoradiopharmaceuticals: Development oF Labeling Process for Polymeric Nanoparticles
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Abstract: Nanomedicine, probably, is the future of modern medicine. Hence, there is a global effort being made in the development of nanopharmaceuticals. Among all the nano-pharmaceuticals developed so far, radiopharmaceuticals are the fewest in number of published studies. The development of nanoradiopharmaceuticals is complex but not impossible. In this work we discuss the possibility and the results of developing 4 nanoradiopharmaceuticals based on 3 different types of nanoparticles as alternative drug delivery systems. Also we present the preliminary results in animals. Keywords: Radiopharmaceuticals, nanomedicine, nanobiotechnology, drug delivery system.Download Full Article |
Editor’s Choice : Cancer Screening Among U.S. Medicaid Enrollees with Chronic Comorbidities or Residing in Long-Term Care Facilities
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Abstract: Background: Ensuring appropriate cancer screenings among low-income persons with chronic conditions and persons residing in long-term care (LTC) facilities presents special challenges. This study examines the impact of having chronic diseases and of LTC residency status on cancer screening among adults enrolled in Medicaid, a joint state-federal government program providing health insurance for certain low-income individuals in the U.S. Methods: We used 2000-2003 Medicaid data for Medicaid-only beneficiaries and merged 2003 Medicare-Medicaid data for dually-eligible beneficiaries from four states to estimate the likelihood of cancer screening tests during a 12-month period. Multivariate regression models assessed the association of chronic conditions and LTC residency status with each type of cancer screening. Results: LTC residency was associated with significant reductions in screening tests for both Medicaid-only and Medicare-Medicaid enrollees; particularly large reductions were observed for receipt of mammograms. Enrollees with multiple chronic comorbidities were more likely to receive colorectal and prostate cancer screenings and less likely to receive Papanicolaou (Pap) tests than were those without chronic conditions. Conclusions: LTC residents have substantial risks of not receiving cancer screening tests. Not performing appropriate screenings may increase the risk of delayed/missed diagnoses and could increase disparities; however, it is also important to consider recommendations to appropriately discontinue screening and decrease the risk of overdiagnosis. Although anecdotal reports suggest that patients with serious comorbidities may not receive regular cancer screening, we found that having chronic conditions increases the likelihood of certain screening tests. More work is needed to better understand these issues and to facilitate referrals for appropriate cancer screenings. Keywords: Neoplasms, Medicaid, Mass Screening, Healthcare Disparities, Nursing Homes.Download Full Article |
Editor’s Choice : Clinical and Biochemical Outcomes of High-Risk Prostate Cancer Patients treated with Third Generation Prostate Cryosurgery
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Abstract: Objectives: To report on outcomes after modern-day primary prostate cryosurgery (CS) in D’Amico high-risk (PSA >20 ng/ml, Gleason score ≥8, or tumor stage T2c or T3) localised prostate cancer (PCa) patients treated at a large academic center. Materials and Methods: 730 consecutive cases of total gland prostate CS were reviewed, and 80 men with high-risk disease identified. Clinical data was analyzed, with primary and secondary endpoints being overall survival, cancer-specific survival, biochemical recurrence (BCR), and clinical progression. Results: Median age was 75.8 (55.4-88.1) years, median presenting PSA 20.0 (2.6-236.5) ng/ml, and median Gleason score 8 (6-10). Median follow-up was 49.6 (8.9-159.3) months. There were three PCa related deaths (4%); 34 (43%) and 39 (49%) men had BCR as defined by the Phoenix- and Stuttgart-criteria, respectively; 24 of the 39 (64%) men were re-biopsied. 13 of 80 (16%) had biopsy proven recurrent PCa. Nine (11%) subsequently underwent salvage CS. Six of the 39 (15%) men with BCR had metastatic disease on bone scan; 19 of 34 (49%) men with BCR received anti-androgen therapy, 18 (95%) of whom had also received neoadjuvant hormonal therapy. Conclusions: Prostate CS is a controversial treatment for high-risk patients, and our early experience revealed low cancer-specific mortality and morbidity, with encouraging biochemical and local control rates for these high-risk patients. In our series the incidence of metastases was less than that reported by Bolla et al. post-EBRT and hormones, and we therefore believe that prostate CS be strongly considered for these high-risk patients, and mandate that further study of CS for high-risk disease is warranted. Keywords: Prostate cancer, high-risk, cryosurgery, biochemical recurrence, overall survival, cancer-specific survival.Download Full Article |
Editor’s Choice : Hepatocellular Carcinoma Microvessel Density Quantitation with Image Analysis: Correlation with Prognosis
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Abstract: Hepatocellular carcinoma (HCC) has a progression considered to be dependent on angiogenesis. Intratumoral microvessel density (MVD) has been associated with metastasis and recurrence risk; however, selection bias, counting errors, and lack of standardized assessment criteria have limited the clinical utility of angiogenesis quantitation. Therefore, we analyzed HCC angiogenesis with image cytometry using different methods and determined the correlation to prognosis. Tissue microarrays with 135 HCCs were CD31 and CD34 immunostained and quantitated with the Dako ACIS III Image Cytometer labeling index (LI) and Aperio Scanscope XT and MVD algorithm. LI and MVD were compared to each other and to pathologic features and prognosis (recurrence free survival). Using median cutoffs of microvesselquantitation, survival curve analysis showed a statistically significant difference between CD31 MVD algorithm measurement and prognosis (low MVD mean survival = 56.6 months and high MVD mean = 26.5 months; Log-Rank P = 0.0076). Survival was not significantly related to CD31 LI, CD34 LI or CD34 MVD. By linear regression, a direct correlation was observed between CD31 and CD34 using MVD (r = 0.45, P <0.0001), between CD31 MVD and CD31 LI (r = 0.55, P < 0.0001), and between CD31 LI and CD34 LI (r = 0.51, P < 0.0001). In addition, there was a weak but statistically significant relationship between CD31 MVD and CD34 LI (r = 0.25, P = 0.0050). Together, this data confirms previous studies linking angiogenesis to disease prognosis and suggests the utility of MVD image analysis algorithms. Keywords: Hepatocellular carcinoma, microvessel density, immunohistochemistry, prognosis.Download Full Article |
Editor’s Choice : Phase II Study of Irinotecan in Combination with Capecitabine on a 3-Weekly Schedule as First-Line Chemotherapy for Patients with Metastatic or Locally Advanced Colorectal Cancer
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Abstract: Background: Capecitabine has demonstrated non inferiority efficacy and improved safety compared with 5-fluorouracil (5-FU)/leucovorin (LV) in metastatic colorectal cancer (mCRC) without the inconvenience of an infusional therapy. The aim of the present study was to evaluate the efficacy and safety of capecitabine plus irinotecan (CPT-11) given every 3 weeks (XELIRI regimen) as first-line treatment in locally advanced (LA) or mCRC, in order to improve patient tolerability and quality of life. Patients and methods: Patients with LA or mCRC received CPT-11 225 mg/m2 (180 mg/m2 if > 65 years old) on day 1 and capecitabine 1000 mg/m2 (750 mg/m2 if > 65 years old) twice daily on days 2-15 every 3 week. Primary endpoints were objective response rate (ORR) and toxicity of the chemotherapeutic regimen. Secondary endpoints of overall survival (OS), progression-free survival (PFS), response duration and quality of life were also evaluated.
Results: Ninety-one patients were included. In an intention-to-treat analysis, complete response was achieved in 3 patients and partial response in 27, for an ORR of 33%. The disease control rate (ORR + stable disease) was 72.5%. Median time to progression and OS were 9.3 and 17.1 months respectively. Grade 3/4 neutropenia and diarrhea were the most commonly reported adverse vents. Conclusion: The XELIRI regimen given every 3 weeks, as first-line therapy of LA or mCRC was effective and well tolerated, including elderly patients. Severe gastrointestinal toxicities and hematological events were manageable. Keywords: CPT-11, Capecitabine, Irinotecan, XELIRI regimen, Colorectal cancer.Download Full Article |