Current research status of anti-cancer peptides: Mechanism of action, production, and clinical applications

The escalating rate of cancer cases, together with treatment deficiencies and long-term side effects of currently used cancer drugs, has made this disease a global burden of the 21st century. The number of breast and lung cancer patients has sharply increased worldwide in the last few years. Presently, surgical treatment, radiotherapy, chemotherapy, and immunotherapy strategies are used to cure cancer, which cause severe side effects, toxicities, and drug resistance. In recent years, anti-cancer peptides have become an eminent therapeutic strategy for cancer treatment due to their high specificity and fewer side effects and toxicity. This review presents an updated overview of different anti-cancer peptides, their mechanisms of action and current production strategies employed for their manufacture. In addition, approved and under clinical trials anti-cancer peptides and their applications have been discussed. This review provides updated information on therapeutic anti-cancer peptides that hold great promise for cancer treatment in the near future.

Hybrid plaintext attack for a cryptosystem based on interference and the phase-retrieval technique

In this paper, the security strength of an enhanced cryptosystem based on interference and the phase-retrieval technique is evaluated. The security strength of the optical cryptosystem was improved through the phase-retrieval technique used to generate a phase-only mask (POM) as the ciphertext. Due to the complex mathematical model of the phase-retrieval technique, it seems that a silhouette problem existing in the conventional interference-based scheme was removed. However, we noted that the random phase mask (RPM) regarded as the only private key was fixed in the encryption path, which is not related to the plaintext and makes it possible to be recovered using a known-plaintext attack (KPA). Moreover, we also found that the RPM has high key sensitivity, and it should be recovered precisely to retrieve information of plaintexts during the attack. Thus, a hybrid KPA where three pairs of known plaintexts and their ciphertexts are regarded as the amplitude and phase constraints to obtain the precise estimation of the RPM is proposed. Then, with the help of the estimated private key, information of the original plaintexts encoded using the cryptosystem under study could be retrieved from an arbitrarily given ciphertext without any knowledge of the private key. Our cryptoanalysis shows that the cryptosystem based on interference and the phase-retrieval technique is vulnerable to the proposed attack, and there is a security leak in it. Numerical simulations have been carried out to demonstrate the performance of our proposed attack.

First Measurement of the B^{+}→π^{+}π^{0}π^{0} Branching Fraction and CP Asymmetry

We study B^{+}→π^{+}π^{0}π^{0} using 711  fb^{-1} of data collected at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. We measure an inclusive branching fraction of (19.0±1.5±1.4)×10^{-6} and an inclusive CP asymmetry of (9.2±6.8±0.7)%, where the first uncertainties are statistical and the second are systematic, and a B^{+}→ρ(770)^{+}π^{0} branching fraction of (11.2±1.1±0.9_{-1.6}^{+0.8})×10^{-6}, where the third uncertainty is due to possible interference with B^{+}→ρ(1450)^{+}π^{0}. We present the first observation of a structure around 1  GeV/c^{2} in the π^{0}π^{0} mass spectrum, with a significance of 6.4σ, and measure a branching fraction to be (6.9±0.9±0.6)×10^{-6}. We also report a measurement of local CP asymmetry in this structure.

Search for Lepton-Flavor-Violating τ Decays to a Lepton and an Invisible Boson at Belle II

We search for lepton-flavor-violating τ^{-}→e^{-}α and τ^{-}→μ^{-}α decays, where α is an invisible spin-0 boson. The search uses electron-positron collisions at 10.58 GeV center-of-mass energy with an integrated luminosity of 62.8  fb^{-1}, produced by the SuperKEKB collider and collected with the Belle II detector. We search for an excess in the lepton-energy spectrum of the known τ^{-}→e^{-}ν[over ¯]_{e}ν_{τ} and τ^{-}→μ^{-}ν[over ¯]_{μ}ν_{τ} decays. We report 95% confidence-level upper limits on the branching-fraction ratio B(τ^{-}→e^{-}α)/B(τ^{-}→e^{-}ν[over ¯]_{e}ν_{τ}) in the range (1.1-9.7)×10^{-3} and on B(τ^{-}→μ^{-}α)/B(τ^{-}→μ^{-}ν[over ¯]_{μ}ν_{τ}) in the range (0.7-12.2)×10^{-3} for α masses between 0 and 1.6  GeV/c^{2}. These results provide the most stringent bounds on invisible boson production from τ decays.

Structural Distortion of β-Cyclodextrin Plays a Key Role in the pH-dependent Host-Guest Chemistry with Doxorubicin, Evident by the Electrochemical and Molecular Dynamics Approach

β-Cyclodextrin (β-CD) is the potential drug carrier to deliver antitumor drugs like doxorubicin (DOX). However, the mechanism for the inclusion complex formation is still unclear and needs to be explored. This study investigated the effect of pH on the inclusion of DOX into thiolated β-CD (β-CD-SH) by electrochemical and molecular dynamics (MD) simulation. The electrochemical study shows a clear difference at different pH values. The redox peak due to the DOX is strongly influenced by pH. At neutral pH, the peak intensity decreases with time, while slight variation is observed at acidic and basic pH, depicting the association of DOX to the β-CD-SH cavity at neutral pH. Also, due to the association, the charge transfer resistance variation increased with time at neutral pH and decreased at basic and acidic pH. The electrochemical study was further supported by MD simulation, suggesting that the cyclodextrin (CD) ring gets slightly elongated due to the flipping of glucose units, specifically at neutral pH leading to a strong association. Also, another significant result observed that the DOX forms an inclusion complex with β-CD-SH in quinol conformation, not in quinone. Briefly, the study provides the necessary molecular binding information for designing an effective β-CD-based targeted drug delivery system.

Clinical Relevance of Nutrient Foramina of Fibula: A Morphometric Study

Background

The fibula is a long bone located at the lateral aspect of the leg. Diaphysis of fibula is supplied by one or more nutrient arteries through an opening referred to as the nutrient foramen. Mor-phometric studies of the nutrient foramina of fibulae are very sparse in literature.

Materials and Methods

This cross-sectional descriptive study was conducted on 51 dry adult human fibulae housed in the department of anatomy, AIIMS, New Delhi. Total fibular length along with the number and location of all nutrient foramina present were recorded. Foraminal indexes (FI) of the fibulae were calculated as well.

Results

The study revealed that the average length of fibulae was 35.48 ± 1.76 cm. 94% fibulae had a single nutrient foramen and 6 % had two. In fibula with single foramen, the most common location was on the medial crest (50%), followed by between medial crest and posterior border (35%), between the medial crest and interosseous border (8%) and on posterior border (6%). Nutrient foramen was located in middle 1/3rd of shaft in 98 % and in inferior 1/3rd of shaft in 2 % of fibulae. The average foraminal index was 44.85 ± 6.67% with a range of 35.7 to 63.8%.

Conclusion

Most common location of nutrient foramen in fibula is middle 1/3rd of shaft on the medial crest with dual nutrient foramina in 6% of fibulae. These parameters show variability in different geographical location and population groups. These data may be helpful for anthropologists, forensic experts, radiologists and might guide in harvesting vascularised fibular bone graft.

Structural dynamics and mechanistic action guided engineering of lipolytic enzymes

Lipases have been established as important biocatalysts in several industrial applications, owing to their diverse substrate specificity. The availability of data on three-dimensional crystal structures for various lipases offers an opportunity for modulating their structural and functional aspects to design and engineer better versions of lipases. With the aim of investigating the structural components governing the extremophilic behavior of lipases, structural analysis of microbial lipases was performed using advanced bioinformatics and molecular dynamics simulation approaches. In sequences and functionally distinct alkaliphilic and thermophilic lipases were investigated for their functional properties to understand the distinguishing features of their structures. The alkaliphilic lipase from Bacillus subtilis (LipA) showed conformational changes in the loop region Ala132-Met137, subsequently, the active site residue His156 shows two conformations, toward the active site nucleophilic residues Ser77 and away from the Ser77. Interestingly, the active site of LipA is more solvent-exposed and can be correlated with the adoption of an open conformation which might extend and expose the active site region to solvents during the catalysis process. Furthermore, the MD simulation of thermophilic lipase from marine Streptomyces (MAS1) revealed the role of N- and C-terminal regions with disulfide bridges and identified a metal ion binding site that facilitates the enzyme stability. The novel thermo-alkaliphilic lipase can be designed to integrate the stability features of MAS1 into the alkaliphilic LipA. These structural-level intrinsic characteristics can be used for lipase engineering to amend the lipase activity and stability as per the requirements of the industrial processes.

In vitro and in vivo evaluation of efficacy of berberine chloride: phyto-alternative approach against Trypanosoma evansi infection

Current chemotherapy against the Surra organism, Trypanosoma evansi has several limitations in terms of efficacy, toxicity, availability and emerging resistance. These reasons make the search of new chemo-preventive and chemo-therapeutic agent with high potency and low toxicity. Alkaloid phyto-molecules, berberine has shown promising anti-kinetoplastid activity against T. cruzi, T. congolense, T. brucei, Leishmania donovani and L. tropica. However, till date, there is no investigation of therapeutic efficacy of berberine chloride (BC) against T. evansi. The IC₅₀ value of BC for growth inhibition of T. evansi at 24h of culture was calculated as 12.15µM. The specific selectivity index (SSI) of BC was calculated as 19.01 and 10.43 against Vero cell line and Equine PBMC's, respectively. Thirteen drug target genes affecting various metabolic pathways were studied to investigate the mode of trypanocidal action of BC. In transcript analysis, the mRNA expression of arginine kinase 1 remained refractory to exposure with BC, which provides metabolic plasticity in adverse environmental conditions. In contrary, rest all the drug target gene were down-regulated, which indicates that drug severely affect DNA replication, cell proliferation, energy homeostasis, redox homeostasis and calcium homeostasis of T. evansi, leading to the death of parasite in low concentrations. It is the first attempt to investigate in vitro anti-trypanosomal activity of BC against T. evansi. These data imply that phytochemicals as alternative strategies can be explored in the future as an alternative treatment for Surra in animal.

First Observation of Λπ^{+} and Λπ^{-} Signals near the K[over ¯]N(I=1) Mass Threshold in Λ_{c}^{+}→Λπ^{+}π^{+}π^{-} Decay

Using the data sample of 980  fb^{-1} collected with the Belle detector operating at the KEKB asymmetric-energy e^{+}e^{-} collider, we present the results of an investigation of the Λπ^{+} and Λπ^{-} invariant mass distributions looking for substructure in the decay Λ_{c}^{+}→Λπ^{+}π^{+}π^{-}. We find a significant signal in each mass distribution. When interpreted as resonances, we find for the Λπ^{+} (Λπ^{-}) combination a mass of 1434.3±0.6(stat)±0.9(syst)  MeV/c^{2} [1438.5±0.9(stat)±2.5(syst)  MeV/c^{2}], an intrinsic width of 11.5±2.8(stat)±5.3(syst)  MeV/c^{2} [33.0±7.5(stat)±23.6(syst)  MeV/c^{2}] with a significance of 7.5σ (6.2σ). As these two signals are very close to the K[over ¯]N threshold, we also investigate the possibility of a K[over ¯]N cusp, and find that we cannot discriminate between these two interpretations due to the limited size of the data sample.

Impact of restructuring resources and services and their utilization in IIT Roorkee library, India

Purpose

This paper examines the impact of restructuring on the usage of resources and services in the Indian Institute of Technology library, Roorkee. Library users were approached to know their preferences between an electronic and traditional resources and services. Additionally, the study focused to know the extent of change in users' awareness, dependency, usage, frequency and satisfaction from library resources and services after restructuring these due to the availability of abundance of e-resources.

Design/methodology/approach

The study adopted survey-based research design, for which a questionnaire was used as the principal instrument for data collection. This questionnaire was distributed to the library users when they physically visited the library. Notably, all the questionnaires distributed were returned, yielding thereby a cent percent response rate. One questionnaire was administrative on the librarian for getting the data regarding the changes made in the subscription of e-resources and services. The collected data were further analyzed with appropriate statistical techniques of Statistical Package for Social Sciences (SPSS) as chi-square test, mean and standard deviation.

Findings

The results showed that the use of both restructured resources and services had increased, and was found to be helpful for users. Also, the users' dependency on library had increased, showing thereby an upward trend for usage in the future. However, although the users’ awareness, usage and frequency of e-resources and ICT-based services have positively changed, and partially been satisfied, the study suggests that further revision is needed for further strengthening e-resources and services as per user's needs satisfaction.

Practical implications

This study would create interest in rethinking library resources and services among librarians that tend to respond positively to user satisfaction and library functions; it also provides a strategic position of a library per se for its users in the future. Importantly, the assessment of the usage of restructuring resources and services, vis-a-vis their impact on users, may also serve as a key tool, which possibly could be applied to both public libraries and other types of higher education libraries.

Originality/value

Many libraries find it difficult to balance between electronic and printed materials, especially in the fields of science and technology, due to the preferences of the users. Thus far, there have not been too many studies that have looked to assess restructuring of library resources and services, vis-a-vis their impact on library users. Therefore, the results of this study would provide a clear understanding to the library profession as to how users use e-resources and services in the digital age, and how much they are actually influenced by these.

Comprehensive metabolomics and antioxidant activity of Allium species viz. Allium semenovii, A. sativum and A. cepa: An important spice

Allium is one of the most extensively consumed spices in most parts of the world. While Allium cepa and A. sativum have wide spread cultivation, A. semenovii is only found in high altitude areas. Increasing utilization of A. semenovii needs a comprehensive understanding of its chemo-information, and health benefits in comparison to well explored Allium species. The present study compared metabolome and antioxidant activity in tissues extracts (Ethanol, 50% ethanol and water) of leaves, roots, bulbs, and peels of the three Allium species. All samples showed significant polyphenols (TPC: 167.58-0.22 mg GAE/g and TFC: 164.86-2.2 mg QE/g) content with higher antioxidant activity in A. cepa and A. semenovii than A. sativum. UPLC-PDA based targeted polyphenol also showed highest content in A. cepa (peels, roots, and bulbs) and A. semenovii (leaves). Further, 43 diversified metabolites including polyphenols and sulphur containing compounds were identified using GC-MS and UHPLC-QTOF-MS/MS. The statistical analysis (Venn-diagram, Heatmap, stacked charts, PCA, PCoA) of identified metabolites in different samples revealed the similarities and discriminations among different species of Allium. The current finding illustrated potential of A. semenovii for utilisation in food and nutraceuticals.

68 Ga-DOTA.SA.FAPI as a Potential, Noninvasive Diagnostic Probe for Recurrent and Metastatic Adrenocortical Carcinoma : A Head-to-Head Comparison With 18F-FDG

ABSTRACT

Metastatic or recurrent adrenocortical carcinoma (ACC) is a potentially fatal malignancy, which poses major challenges in disease management owing to lack of effective systemic therapies. The drastically reduced survival rates require prompt identification of selective molecules for development of targeted therapeutics. We evaluated the squaric acid containing FAPI derivative, DOTA.SA.FAPI (FAPI), as a potential diagnostic probe in 2 cases of histopathologically proven metastatic and recurrent ACC. Both patients underwent 18 F-FDG and 68 Ga-FAPI PET/CT scans for comparative analysis. 68 Ga-DOTA.SA.FAPI emerged as an excellent diagnostic agent for ACC and performed similar to 18 F-FDG.

Origin of triple right coronary with separate ostium

This report highlights a coronary artery anomaly (CAA) involving three right coronary arteries (RCAs) arising from the anterior aortic sinus and a single left coronary artery (LCA) from the left posterior aortic sinus. Furthermore, each of the three RCAs originated with separate ostia. The 1st RCA was the right conus artery which originated through the anterior ostium. The 2nd RCA from the middle ostium mimicked a typical RCA. The 3rd RCA that originated from the posterior ostium had an initial retro-aortic course and then ran between the ascending aorta and atria. It eventually terminated as the circumflex artery after reaching the left end of the posterior coronary sulcus. The LCA was normal anatomically except that it did not give the circumflex branch. The knowledge of this type of unusual branching pattern of the coronary artery may be useful to clinicians.

Polyhydroxybutyrate (PHB) in nanoparticulate form improves physical and biological performance of scaffolds

Polyhydroxyalkanoates (PHAs) are natural polyesters produced by microorganisms as a source of intracellular energy reserves. Due to their desirable material characteristics, these polymers have been thoroughly investigated for tissue engineering and drug delivery applications. A tissue engineering scaffold serves as a substitute of the native extracellular matrix (ECM) and plays a crucial role in tissue regeneration by providing temporary support for cells during natural ECM formation. In this study, porous, biodegradable scaffolds were prepared using native polyhydroxybutyrate (PHB) and PHB in nanoparticulate form using salt leaching method, to investigate the differences in the physicochemical properties such as crystallinity, hydrophobicity, surface morphology, roughness, and surface area and biological properties of the prepared scaffolds. As per the BET analysis, PHB nanoparticles-based (PHBN) scaffolds presented a significant difference in the surface area as compare to PHB scaffolds. PHBN scaffolds showed decreased crystallinity and improved mechanical strength as compared to PHB scaffolds. Thermogravimetry analysis shows delayed degradation of PHBN scaffolds. An examination of Vero cell lines' cell viability and adhesion over time revealed enhanced performance of PHBN scaffolds. Our research suggests that scaffold made of PHB nanoparticles could serve as a superior material for tissue engineering applications than its native form.

Observation of e^{+}e^{-}→ωχ_{bJ}(1P) and Search for X_{b}→ωϒ(1S) at sqrt[s] near 10.75 GeV

We study the processes e^{+}e^{-}→ωχ_{bJ}(1P) (J=0, 1, or 2) using samples at center-of-mass energies sqrt[s]=10.701, 10.745, and 10.805 GeV, corresponding to 1.6, 9.8, and 4.7  fb^{-1} of integrated luminosity, respectively. These data were collected with the Belle II detector during special operations of the SuperKEKB collider above the ϒ(4S) resonance. We report the first observation of ωχ_{bJ}(1P) signals at sqrt[s]=10.745  GeV. By combining Belle II data with Belle results at sqrt[s]=10.867  GeV, we find energy dependencies of the Born cross sections for e^{+}e^{-}→ωχ_{b1,b2}(1P) to be consistent with the shape of the ϒ(10753) state. These data indicate that the internal structures of the ϒ(10753) and ϒ(10860) states may differ. Including data at sqrt[s]=10.653  GeV, we also search for the bottomonium equivalent of the X(3872) state decaying into ωϒ(1S). No significant signal is observed for masses between 10.45 and 10.65  GeV/c^{2}.

Ossification of Superior Transverse Scapular Ligament - Incidence, Embryology and Association with Suprascapular Neuropathy

Introduction

Suprascapular notch is present at superior border of scapula just medial to coracoid process. This is covered by superior transverse scapular ligament (STSL). Suprascapular nerve passes below this ligament while suprascapular vessels pass above it. STSL ossification is a rare finding with variable incidences in different population groups.

Materials and Methods

We observed 60 dry bony scapulae, 30 prosected formalin fixed upper limbs with scapula and 10 embalmed cadavers for the presence of ossified STSL.

Results

There were complete ossification of STSL in two dried bony specimens of sacpula.

Conclusion

Ossified STSL may be the causative factor for suprascapular neuropathy. The mainstay of management in cases of neuropathy or compression of suprascapular nerve is release of suprascapular ligament by either open or arthroscopic surgical approach. So, it is extremely important to know this type of variation to minimize any damage to related structure and plan the management accordingly.

An Atypical Case of Meckel's Diverticulum with Small Bowel Obstruction: Surgical Anatomy, Embryology and Clinical Implications

Abstract

Meckel's diverticulum (MD) is the most frequent congenital anomaly of the gastrointestinal (GI) tract. Atypical presentations with life threatening complications include intestinal obstruction, intussusceptions, peritonitis, foreign body lodgement in the MD, perforated viscera etc. which require prompt diagnosis. Ectopic gastric and pancreatic tissues are found in up to half of the cases which can escalate the complications. However clinical diagnosis is not easy especially when the presentation is atypical. A high index of clinical suspicion is required to diagnose elusive MD with associated complications. Surgical resection is safe and the gold standard treatment for complicated MD. A case of Meckel's diverticulum with concomitant mesodiverticular band (MDB) in a 13 years old male child presented as intestinal obstruction to emergency department is described which was promptly managed surgically with required pre-operative investigations. The aim of this report is to make clinicians aware about a complicated MD with MDB clinically presenting as small bowel obstruction.

18 F-FDG PET Brain Findings in a Case of Idiopathic Benign Rolandic Epilepsy of Childhood

Idiopathic benign rolandic epilepsy, also known as benign childhood epilepsy with centrotemporal spikes (BCECTS), is one of the commonly seen electroclinical epilepsy syndromes of childhood with a generally favorable long-term prognosis. We describe a 5-year-old female child who presented with recurrent focal seizures involving right side of face since the age of 6 months. She had no perinatal or postnatal insults, had normal development, and her neurological examination was unremarkable. Electroencephalogram showed rolandic spikes, suggesting BCETCS. Her seizures remained refractory to two appropriately dosed antiepileptic drugs. Magnetic resonance imaging of the brain did not reveal any structural lesion. Interictal fluorodeoxyglucose ¹⁸ F-positron emission tomography brain showed hypometabolism in the left lower rolandic region.

Measurement of the Λ_{c}^{+} Lifetime

An absolute measurement of the Λ_{c}^{+} lifetime is reported using Λ_{c}^{+}→pK^{-}π^{+} decays in events reconstructed from data collected by the Belle II experiment at the SuperKEKB asymmetric-energy electron-positron collider. The total integrated luminosity of the data sample, which was collected at center-of-mass energies at or near the ϒ(4S) resonance, is 207.2  fb^{-1}. The result, τ(Λ_{c}^{+})=203.20±0.89±0.77  fs, where the first uncertainty is statistical and the second systematic, is the most precise measurement to date and is consistent with previous determinations.

Search for a Dark Photon and an Invisible Dark Higgs Boson in μ^{+}μ^{-} and Missing Energy Final States with the Belle II Experiment

The dark photon A^{'} and the dark Higgs boson h^{'} are hypothetical particles predicted in many dark sector models. We search for the simultaneous production of A^{'} and h^{'} in the dark Higgsstrahlung process e^{+}e^{-}→A^{'}h^{'} with A^{'}→μ^{+}μ^{-} and h^{'} invisible in electron-positron collisions at a center-of-mass energy of 10.58 GeV in data collected by the Belle II experiment in 2019. With an integrated luminosity of 8.34  fb^{-1}, we observe no evidence for signal. We obtain exclusion limits at 90% Bayesian credibility in the range of 1.7-5.0 fb on the cross section and in the range of 1.7×10^{-8}-200×10^{-8} on the effective coupling ϵ^{2}×α_{D} for the A^{'} mass in the range of 4.0  GeV/c^{2}<M_{A^{'}}<9.7  GeV/c^{2} and for the h^{'} mass M_{h^{'}}<M_{A^{'}}, where ϵ is the mixing strength between the standard model and the dark photon and α_{D} is the coupling of the dark photon to the dark Higgs boson. Our limits are the first in this mass range.

Radiochemical quality control of the radiopharmaceutical, 89SrCl2 produced in FBTR

⁸⁹SrCl₂ radiopharmaceuticals is mainly used for bone pain palliation in the cancer patients, is being produced in FBTR via ⁸⁹Y(n, p)⁸⁹Sr using yttria target. The irradiated yttria target is chemically processed in high pure quartz distilled nitric acid medium in hot cell facility, to avoid the corrosion of components of hotcell due to chloride ions while using HCl medium. Being ionic species, the purified ⁸⁹Sr(II) cation in aqueous solution containing bulk nitrate and other trace anions, exists as SrX_n species where X: F^-, Cl^-, Br^-, NO₃^-, PO₄^3- and SO₄^2-, n: stoichiometric anion content. The aim of the manuscript is to standardise an efficient ultra-low level anion purification method (ppb range) for the conversion of SrX_n to SrCl₂ and estimate the residual anionic impurities as recommended by the appropriate source specifications for its medical application. Various methods were standardised for the removal of anions in the SrCl₂ source produced by the above process which include evaporation, calcination, anion exchange column, cation exchange column as well as its combination with pre-concentration column of ion chromatography (IC) technique using ⁸⁹Sr tracers as well as FBTR produced ⁸⁹Sr solution. Assay of ⁸⁹Sr and other anions including nitrate for the above study were accomplished using Cerenkov counting and ion chromatography respectively. Thus evaporation-calcination-column chromatography mode was finalised to obtain pure SrCl₂ source free from nitrate and other anionic impurities. This is the first ever systematic study for the Radiochemical quality control of nca ⁸⁹SrCl₂ radiopharmaceutical produced in a fast reactor. This study also finds its application to any analytical lab as well as industry where there is a requirement of anion purification in the ppb level.

The Predictive Value of the G8 Questionnaire in Older Patients with Lung Cancer or Mesothelioma before Systemic Treatment

AIMS

The standard evaluation of older lung cancer or mesothelioma patients for systemic anti-cancer treatment, based on performance status, is inaccurate. We used the G8 questionnaire to assess a patient's fitness for chemotherapy and explored the correlations between G8 scores, treatment decisions and clinical outcomes.

MATERIALS AND METHODS

In total, 201 older patients (≥70 years) with advanced lung cancer or mesothelioma were prospectively assessed by standard clinical methods and a G8 questionnaire. Treatment decisions before and after reviewing the G8 score were documented. Patients were divided into low (<11), intermediate (11-14) and high (>14) G8 score groups. Patients' characteristics, treatment plans and clinical outcomes among each G8 score group were compared. Similar analyses were compared between good (<2) and poor (≥2) performance status.

RESULTS

10.1% of patients' treatment plans changed after oncologists reviewed G8 scores. The G8 score correlated inversely with performance status. More patients with low G8 scores (22.5%) were offered the best supportive care compared with 4.5% in intermediate and 1.9% in high G8 score groups. More patients (30.1%) with low G8 scores had treatment changed from chemotherapy to best supportive care on the planned day of their treatment, compared with intermediate (7.5%) and high (6.1%) G8 score groups. High G8 score patients received higher chemotherapy intensity and survived longer than patients with intermediate or low G8 scores.

CONCLUSIONS

The G8 score with two cut-off values can predict functional status, chemotherapy tolerability and prognosis in older patients with lung cancer or mesothelioma, thus supporting oncologists on treatment decisions for this population.