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Yeo W, Pang E, Liem GS, Suen JJS, Ng RYW, Yip CCH, Li L, Yip CHW, Mo FKF. Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors. Health Qual Life Outcomes 2020; 18:24. [PMID: 32041627 PMCID: PMC7011454 DOI: 10.1186/s12955-020-1283-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/05/2020] [Indexed: 11/10/2022] [Imported: 08/29/2023] Open
Abstract
Introductions For young premenopausal breast cancer patients, adjuvant chemotherapy may cause menstrual disruptions and premature menopause, which may in turn impair their quality of life (QoL). In this study among young breast cancer survivors who have undergone adjuvant chemotherapy, the objectives were to assess post-treatment menopausal symptoms and their associated factors, and to correlate these symptoms with breast cancer-specific QoL. Methods The study population included premenopausal young Chinese women with early-stage breast cancer who had undergone adjuvant chemotherapy between 3 and 10 years prior to enrolling into this study. At study entry, patients’ characteristics and clinical features were collected; each patient had detail menstrual history collected and each filled in MENQOL and FACT-B + 4 questionnaires. Results Two hundred eighty eligible patients were recruited. For adjuvant chemotherapy, 92% received anthracyclines and 28% received taxanes; 76% received adjuvant tamoxifen. At a median of 5.0 years from initial cancer diagnosis, 49 and 11% had become post- and peri-menopausal respectively. MENQOL at study entry revealed that physical domain score was worse in overweight/obese patients (mean scores for underweight/normal vs overweight/obese: 2.65 vs 2.97, p = 0.0162). Vasomotor domain score was worse in those who received taxanes or tamoxifen (taxane vs non-taxane: 2.91 vs. 2.35, p = 0.0140; tamoxifen vs no tamoxifen: 2.75 vs. 2.34, p = 0.0479). Sexual domain score was worse among those who had become peri/post-menopausal (peri/postmenopausal vs premenopausal: 2.82 vs. 2.29, p = 0.0229). On the other hand, patients who utilized traditional Chinese medicine had significantly worse scores for vasomotor, psychosocial and physical domains. Further, there was a significant association between MENQOL scores and FACT-B + 4 scores; less severe symptoms in the MENQOL domains were associated with better QoL scores in FACT-B + 4 physical, functional, psychosocial and emotional well-being, Breast Cancer Subscale, Arm Subscale and FACT-B total score. Conclusion Among premenopausal breast cancer women who had undergone adjuvant chemotherapy, those who had received taxanes or tamoxifen, were overweight/obese and utilized traditional Chinese medicine had more severe menopausal symptoms. Patients who experienced worse menopausal symptoms were found to have worse breast cancer-specific QoL. Interventional studies with an aim to alleviate menopausal symptoms are warranted to assess if overall QoL of these patients could be improved. Trial registration Not applicable.
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Affiliation(s)
- Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China. .,Hong Kong Cancer Institute, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China.
| | - Elizabeth Pang
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China.,Hong Kong Cancer Institute, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Giok S Liem
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Joyce J S Suen
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Rita Y W Ng
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Christopher C H Yip
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Leung Li
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Claudia H W Yip
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China
| | - Frankie K F Mo
- Department of Clinical Oncology, Prince of Wales Hospital, Sir YK Pao Centre for Cancer, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, NT, Hong Kong, Hong Kong Special Administrative Region, China.,Hong Kong Cancer Institute, State Key Laboratory of Translational Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
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Li L, Mo FK, Chan SL, Hui EP, Tang NS, Koh J, Leung LK, Poon AN, Hui J, Chu CM, Lee KF, Ma BB, Lai PB, Chan AT, Yu SC, Yeo W. Prognostic values of EORTC QLQ-C30 and QLQ-HCC18 index-scores in patients with hepatocellular carcinoma - clinical application of health-related quality-of-life data. BMC Cancer 2017; 17:8. [PMID: 28052758 PMCID: PMC5209840 DOI: 10.1186/s12885-016-2995-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 12/13/2016] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Health-related quality-of-life (HRQOL) assessment with EORTC QLQ-C30 was prognostic for overall survival (OS) in patients with advance-stage hepatocellular carcinoma (HCC), but no data existed for early-stage patients. The HCC-specific QLQ-HCC18 has not been evaluated for prognostic value in HCC patients. Utilization of raw HRQOL data in clinical setting has been impractical and non-meaningful. Therefore we developed index scores of QLQ-C30 and QLQ-HCC18 in an attempt to enable clinical utilization of these HRQOL measurements. This study investigates the prognostic significance of QLQ-C30, QLQ-HCC18 and C30/HCC18 index-scores in patients with newly diagnosed HCC which encompasses all stages. METHODS From 2007-2011, 517 patients were prospectively recruited. HRQOL was assessed at diagnosis using QLQ-C30 and QLQ-HCC18; C30 and HCC18 index-scores were calculated from raw HRQOL data. Cox regression was performed using continuous, dichotomized QLQ-C30 and QLQ-HCC18 variables, or index-scores, together with clinical factors to identify independent factors for OS. Various multivariate models were validated with c-index and bootstrapping for 1000 replications. RESULTS Four hundred and seventy two patients had complete HRQOL data. Their median OS was 8.6 months. In multivariate analysis, independent prognostic HRQOL variables for OS were QLQ-C30 pain (HR 1.346 [1.092-1.661], p = 0.0055), QLQ-C30 physical functioning (HR 0.652 [0.495-0.860], p = 0.0024); QLQ-HCC18 pain (HR 1.382 [1.089-1.754], p = 0.0077) and QLQ-HCC18 fatigue (HR 1.441 [1.132-1.833], p = 0.0030). C30 index-score (HR 2.143 [1.616-2.841], p < 0.0001) and HCC18 index-score (HR 1.957 [1.411-2.715], p < 0.0001) were highly significant factors for OS. The median OS of patients with C30 index-score of 0-20, 21-40, 41-60, 61-100 were 16.4, 7.3, 3.1, 1.8 months respectively (p < 0.0001); while for HCC18 index-score: 16.4, 6.0, 2.8, 1.8 months respectively (p < 0.0001). All the multivariate models were validated, with mean optimism <0.01. The bootstrap validated c-index was 0.78. CONCLUSIONS QLQ-C30 and QLQ-HCC18 were prognostic for OS in patients with newly diagnosed HCC irrespective of stage. Both C30 and HCC18 index-scores were highly significant prognostic factors for OS in newly diagnosed HCC patients. Index-scoring provides an effective way to summarize, analyze and interpret raw HRQOL data, and renders QLQ-C30 and QLQ-HCC18 meaningful and communicable in clinical practice. Index-scores could potentially serve as a standardized tool for future HRQOL research.
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Affiliation(s)
- Leung Li
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Frankie Kf Mo
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Stephen L Chan
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Edwin P Hui
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Nelson Sl Tang
- Department of Chemical Pathology, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Jane Koh
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Linda Ks Leung
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Annette Ny Poon
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Joyce Hui
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Cheuk M Chu
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Kit F Lee
- Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Brigette By Ma
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Paul Bs Lai
- Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Anthony Tc Chan
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Simon Ch Yu
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Winnie Yeo
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
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Chan SL, Mo F, Johnson P, Li L, Tang N, Loong H, Chan AWH, Koh J, Chan ATC, Yeo W. Applicability of BALAD score in prognostication of hepatitis B-related hepatocellular carcinoma. J Gastroenterol Hepatol 2015; 30:1529-35. [PMID: 25968302 DOI: 10.1111/jgh.13005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/29/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND AND AIMS The BALAD score is developed to provide an objective determination of prognosis for hepatocellular carcinoma (HCC) by incorporating five serum markers, namely albumin, bilirubin, alpha-fetoprotein (AFP), agglutinin-reactive alpha-fetoprotein (AFP-L3), and des-γ-carboxy prothrombin. We aim to study the applicability of BALAD score and prognostication of the three tumor markers in hepatitis B virus-related HCC. METHODS Patients with newly diagnosed HCC were prospectively enrolled. All of the baseline characteristics and serum albumin and bilirubin level were documented at baseline. The levels of the three tumor markers (AFP, AFP-L3, and des-γ-carboxy prothrombin) were determined in archival serum samples. Patients were followed up for survivals according to local practice. The prognostic performances of the three markers and BALAD score were studied in association with overall survival (OS). RESULTS A total of 198 patients with hepatitis B-related HCC were recruited. AFP and AFP-L3 levels were independent prognostic factors. The number of elevated tumor markers was also predictive of worse OS. BALAD score could stratify the cohort into different patient groups with distinct median OS. The median OS of BALAD score of 0, 1, 2, 3, and 4 was not reached, 26.6, 8.3, 2.6, and 1.9 months, respectively (P < 0.0001). BALAD score could further stratify outcomes in each Barcelona Clinic Liver Cancer (BCLC) subgroup. In particular, BALAD score of 3-4 had median OS of 2.6 months only in BCLC stage C patients. CONCLUSION BALAD score is applicable in the population of hepatitis B virus-related HCC. The combined use of BALAD score and BCLC staging system could help identify more suitable candidates for clinical trial.
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Affiliation(s)
- Stephen L Chan
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Frankie Mo
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Leung Li
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nelson Tang
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Herbert Loong
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony W H Chan
- Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jane Koh
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony T C Chan
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Winnie Yeo
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Yeo W, Chan SL, Mo FKF, Chu CM, Hui JWY, Tong JHM, Chan AWH, Koh J, Hui EP, Loong H, Lee K, Li L, Ma B, To KF, Yu SCH. Phase I/II study of temsirolimus for patients with unresectable Hepatocellular Carcinoma (HCC)- a correlative study to explore potential biomarkers for response. BMC Cancer 2015; 15:395. [PMID: 25962426 PMCID: PMC4434865 DOI: 10.1186/s12885-015-1334-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 04/22/2015] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Background The oncogenic PI3K/Akt/mTOR pathway is frequently activated in HCC. Data on the mTOR inhibitor, temsirolimus, is limited in HCC patients with concomitant chronic liver disease. The objectives of this study were: (1) In phase I, to determine DLTs and MTD of temsirolimus in HCC patients with chronic liver disease; (2) In phase II, to assess activity of temsirolimus in HCC, and (3) to explore potential biomarkers for response. Methods Major eligibility criteria included histologically confirmed advanced HCC and adequate organ function. In Phase I part of the study, temsirolimus was given weekly in 3-weekly cycle; dose levels were 20 mg (level 1), 25 mg (level 2) and 30 mg (level 3). The MTD was used in the subsequent phase II part; the primary endpoint was PFS and secondary endpoints were response and OS. In addition, exploratory analysis was conducted on pre-treatment tumour tissues to determine stathmin, pS6, pMTOR or p-AKT expressions as potential biomarkers for response. Overall survival and PFS were calculated using the Kaplan-Meier method. Reassessment CT scans were done every 6 weeks. All adverse events were reported using CTCAE v3. Results The Phase I part consisted of 19 patients, 2 of 6 patients at level 3 experienced DLT; dose level 2 was determined to be the MTD. The phase II part consisted of 36 patients. Amongst 35 assessable patients, there were 1 PR, 20 SD and 14 PD. Overall, the median PFS was 2.83 months (95% C.I. 1.63-5.24). The median OS was 8.89 months (95% C.I. 5.89-13.30). Grade ≥ 3 that occurred in > 10% of patients included thrombocytopenia (4) and hyponatraemia (4). Exploratory analysis revealed that disease stabilization (defined as CR + PR + SD > 12 weeks) in tumours having high and low pMTOR H-scores to be 70% and 29% respectively (OR 5.667, 95% CI 1.129-28.454, p = 0.035). Conclusions In HCC patients with chronic liver disease, the MTD of temsirolimus was 25 mg weekly in a 3-week cycle. The targeted PFS endpoint was not reached. However, further studies to identify appropriate patient subgroup are warranted. Trial registration This study has been registered in ClinicalTrials.gov (Id: NCT00321594) on 1 December 2010.
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Affiliation(s)
- Winnie Yeo
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Stephen L Chan
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Frankie K F Mo
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Cheuk M Chu
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Joyce W Y Hui
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Joanne H M Tong
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Anthony W H Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Jane Koh
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Edwin P Hui
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Herbert Loong
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Kirsty Lee
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Leung Li
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Brigette Ma
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, State Key Lab in Oncology in South China, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Ka F To
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Simon C H Yu
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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Abstract
In mammalian cells, microtubules are present both in interphase and dividing cells. In the latter, microtubules forming the mitotic spindle are highly dynamic and exquisitely sensitive to therapeutic inhibitors. Developed to alter microtubule function, microtubule-binding agents have been proven to be highly active as an anticancer treatment. Significant development of microtubule-binding agents has taken place in recent years, with newer anti-tubulin agents now showing novel properties of enhanced tumor specificity, reduced neurotoxicity, and insensitivity to chemoresistance mechanisms. Hepatocellular carcinoma remains one of the most difficult cancers to treat, with chemotherapies being relatively ineffective. There is now evidence to suggest that microtubule-binding agents may be effective in the treatment of hepatocellular carcinoma, especially when used in combination with mammalian target of rapamycin inhibitors. Preclinical models have suggested that the latter may be able to overcome resistance to microtubule binding agents. In this review article, recent developments of novel microtubule binding agents and their relevance to the treatment of hepatocellular carcinoma will be discussed.
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Affiliation(s)
- Herbert H Loong
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, State Key Laboratory in Oncology in South China, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Winnie Yeo
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, State Key Laboratory in Oncology in South China, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Chan SL, Yeo W. Development of systemic therapy for hepatocellular carcinoma at 2013: updates and insights. World J Gastroenterol 2014; 20:3135-45. [PMID: 24696599 PMCID: PMC3964385 DOI: 10.3748/wjg.v20.i12.3135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/23/2013] [Accepted: 01/19/2014] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
A growing number of multi-targeted tyrosine kinase inhibitor (TKI) has undergone testing for hepatocellular carcinoma (HCC). Unfortunately, this enthusiasm has recently been discouraged by a number of negative phase III studies on several anti-angiogenic TKIs in HCC. Several postulations have been made to account for this phenomenon, namely the plateau effects of anti-angiogenesis approach, the heterogeneity of HCC in terms of background hepatitis/cirrhosis and tumor biology, as well as the way how clinical trials are designed. Regardless of the underlying reasons, these results suggested that alternative strategies are necessary to further develop systemic therapy for HCC. Several new strategies are currently evaluated: for examples, molecular agents with activities against targets other than vascular endothelial growth factor receptor are being evaluated in on-going clinical trials. In addition, different approaches of targeted agents in combination with various treatment modalities, such as concurrently with another molecular agent, cytotoxic chemotherapy or transarterial chemoembolization, are being developed. This review aims to give a summary on the results of recently released clinical trials on TKIs, followed by discussion on some of the potential novel agents and combinational approaches. Future directions for testing innovative systemic agents for HCC will also be discussed.
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Yeo W, Chen PJ, Furuse J, Han KH, Hsu C, Lim HY, Moon H, Qin S, Yeoh EM, Ye SL. Eastern Asian expert panel opinion: designing clinical trials of molecular targeted therapy for hepatocellular carcinoma. BMC Cancer 2010; 10:620. [PMID: 21062497 PMCID: PMC2989333 DOI: 10.1186/1471-2407-10-620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 11/10/2010] [Indexed: 12/17/2022] [Imported: 08/29/2023] Open
Abstract
The largest burden of hepatocellular carcinoma (HCC) lies in Asia, secondary to hepatitis B virus (HBV) infection. Improved survival with sorafenib has fostered new research but many challenges remain in designing clinical trials. The disease, its management, and populations affected by it are heterogeneous worldwide and within Asia. An expert conference of Eastern Asian oncologists and hepatologists was convened to foster consensus in clinical trial design. The panel identified key areas that need to be addressed to facilitate clinical trials in Asia. Stratification by viral etiology is desirable within Asia and by region in global trials. Antiviral therapy should also be considered as a stratification factor and incorporated into HCC management in trials. The panel agreed that histological diagnosis is not required for trial entry and that Barcelona-Clinic Liver Cancer (BCLC) staging is acceptable for trials as long as portal hypertension can be better defined with standardized methodology. Consensus in treatment must be sought to allow multi-national trials and it must be recognized that first-line sorafenib is not largely feasible in Asia. Finally, Asian nations must be urged to participate in clinical trials, many of which are ongoing, to advance new treatment options in this challenging disease.
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Affiliation(s)
- Winnie Yeo
- Prince of Wales Hospital, Shatin, Hong Kong.
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