Long-term survival of an ALK fusion lung adenocarcinoma patient with high mutation burden and microsatellite instability high: a case report

Immune checkpoint blockage (ICB) therapy has shown minimal effectiveness in anaplastic lymphoma kinase (ALK)-positive nonsmall cell lung cancer (NSCLC) regardless of Programmed death-ligand 1 expression. ALK fusion accompanied by mismatch repair deficiency or microsatellite instability-high (MMRd/MSI-H) and high tumor mutation burden (TMB-H) are extremely rare in NSCLC, and the efficacy of ALK inhibitors or ICB-based therapies is unclear. Here, we report the case of a 60-year-old female patient with metastatic lung adenocarcinoma accompanied by EML4-ALK fusion, TMB-H, MMRd/MSI-H, and pathogenic mutations in TP53, MLH1, and STK11. The patient experienced progression on initial iruplinalkib and subsequent alectinib therapy within 5 months. After the failure of third-line therapy with cisplatin-pemetrexed combined with bevacizumab, she received sintilimab plus anlotinib which led to a progression-free survival of 6.5 months. She received sintilimab combined with albumin-paclitaxel plus carboplatin and achieved partial response after 6 months. She developed adverse events after one cycle of sintilimab plus albumin-paclitaxel treatment. Then she was continued with sintilimab plus anlotinib as a maintenance therapy due to intolerance to chemotherapy. After progression on ICB-based therapy, the patient was treated with lorlatinib and still under follow-up with overall survival of more than 3 years. Our findings highlight the therapeutic potential of ICB-based regimens in patients with MSI-H and ALK-rearranged NSCLC.

Change in the serum selenium level of patients with non-metastatic and metastatic non-small cell lung cancer (NSCLC) during radiotherapy as a predictive factor for survival

BACKGROUND

Lung cancer remains a serious medical problem. The trace element selenium seems to be a promising prognostic marker or therapeutic option for cancer patients.

METHODS

We enrolled 99 patients with histologically confirmed NSCLC undergoing radiotherapy. The serum selenium level of these patients was determined prior to irradiation (t0), after reaching 20 Gy (t1), and at the end of radiotherapy (t2). Selenium concentrations were measured with total-reflection X‑ray fluorescence (TXRF) spectroscopy. We formed three subgroups according to the change in serum selenium levels across timepoints, and Kaplan-Meier analysis was used to estimate overall survival (OS). Further subgroups were patients with/without metastatic disease. We used adjusted Cox regression models.

RESULTS

The change in selenium concentration was especially significant between t0 and t1 for the whole study group (hazard ratio [HR] = 0.5, p = 0.03) as well as in patients with metastasized NSCLC (HR = 0.3, p = 0.04) after adjustment. The baseline selenium value in patients with non-metastasized NSCLC was associated with overall survival (HR = 0.3, p = 0.04). The change in selenium levels between t0 and t2 was significant in patients with metastatic lung cancer (HR = 0.1, p = 0.03). Patients with increased serum selenium levels during radiotherapy between the start of treatment (t0) and t1 had better OS (HR = 0.46, p = 0.05).

CONCLUSION

Especially patients with increasing selenium levels during radiotherapy showed an improved overall survival. Thus, serum selenium might be a predictive factor for OS in NSCLC patients. The value of supplementation of the trace element is subject to future research.

A Review on the Role of DNA Methylation in Aortic Disease Associated With Marfan Syndrome

Marfan syndrome (MFS) is a genetic disorder primarily affecting the connective tissue, with cardiovascular complications as the leading cause of mortality. While mutations in the FBN1 gene are the primary cause, the severity and progression of the disease can vary significantly among individuals. DNA methylation, a key epigenetic regulatory mechanism, has garnered attention in MFS research, particularly regarding methylation changes in the FBN1 locus and their effects on fibrillin-1 expression. Differential methylation and expression of genes related to inflammation (e.g., interleukin (IL)-10, IL-17) and oxidative stress (e.g., PON2, TP53INP1) have been linked to MFS aortic pathology. These alterations likely contribute to disease progression by influencing inflammatory responses, smooth muscle cell apoptosis, and biomechanical properties of the aorta. The transforming growth factor-beta (TGF-β) signaling pathway plays a central role in MFS pathology, with aberrant methylation of related genes potentially elevating active TGF-β levels and exacerbating aortic lesions. Notably, tissue-specific methylation patterns, especially in smooth muscle cells of the aorta, remain poorly understood. A deeper understanding of DNA methylation's role in MFS could pave the way for early interventions and epigenetic-targeted therapies.

Extracellular Vesicular Delta-Like Ligand 3 and Subtype Transcription Factors for Small Cell Lung Cancer Diagnosis

Small cell lung cancer (SCLC) is associated with high mortality and limited therapeutic options. There is increasing recognition that SCLC harbors molecular heterogeneity. Using a new liquid biopsy assay, it is demonstrated that SCLC subtypes, as determined by patient tumor tissue staining and cell lines, can be accurately identified by measuring the mRNA expression of subtype transcription factors (ASCL1, POU2F3, and NEUROD1) in circulating exosome-rich extracellular vesicles (Exo). Additionally, upregulation of Delta-like ligand 3 (DLL3) mRNA in Exo and its membrane protein (mProtein) in extracellular vesicles associated with tumor (tEV) may distinguish both limited- and extensive-stage SCLC patients from high-risk smokers, with AUC/ROC values of 0.836 and 0.839, respectively. By incorporating Exo-ASCL1 and Exo-POU2F3 mRNA expression with DLL3 Exo-mRNA/tEV-mProtein expression, the classifier enhances the AUC/ROC to 0.912 and 0.963 for limited- and extensive-stage SCLC patients, respectively.

TERT promoter methylation predicts overall survival, immune cell infiltration and response to immunotherapy in clear cell renal cell carcinoma

PURPOSE

Telomerase reverse transcriptase (TERT) is one of the most well-established oncogenes in tumor development and progression. It is widely known that TERT promoter hypermethylation is associated with its transcription activation. Despite its canonical role in maintaining telomere length in cancer cells, TERT is also involved in various oncogenic processes independent of its enzymatic activity. However, the role of TERT in the tumor immune microenvironment has been largely unexplored. Hence, we assessed the associations between TERT promoter methylation and its expression, clinicopathological features, overall survival, immune cell infiltration, and response to immune checkpoint inhibitor therapy in clear cell renal cell carcinoma.

METHODS

A single-sample gene-set enrichment analysis algorithm was used to quantify the relative abundance of each type of immune cell infiltration in the tumor microenvironment (TME) of the TCGA KIRC cohort. We used Spearman's rank correlation to calculate the correlation coefficients between TERT promoter methylation and immune cell infiltration. The relative methylation of cg11625005 in our validation cohort was detected by pyrosequencing and the relative infiltration of CD4 + and CD8 + T cells infiltration in the TME was measured by immunohistochemistry.

RESULTS

The TERT promoter was significantly hypermethylated in clear cell renal cell tumor tissues, which was related to the transcriptional activation of TERT. TERT promoter hypermethylation was significantly correlated with aggressive phenotypes and poor survival in clear cell renal cell carcinoma patients. Furthermore, TERT promoter methylation was significantly positively correlated with CD4 + /CD8 + T cells infiltration and immune checkpoint molecule (CTLA-4, TIGIT, PD-1 and LAG3) expression. And TERT promoter methylation was correlated with the therapeutic response to anti-PD1 immunotherapy.

CONCLUSION

TERT promoter methylation is a promising predictive biomarker of immune cell infiltration, overall survival, clinicopathological characteristics and response to anti-PD1 immunotherapy treatment in clear cell renal cell carcinoma patients.

Clinicopathological Characterization of Squamous Cell Lung Carcinoma Adjacent to Emphysema

The study investigated the clinicopathological features and characteristic immune tumor microenvironment (TME) of lung squamous cell carcinoma (SqCC) adjacent to emphysematous lesions. 184 consecutive patients with peripheral-type SqCC who had undergone complete surgical resection were enrolled. The clinicopathological differences between emphysema-adjacent SqCC (EA-SqCC) and non-emphysema-adjacent SqCC (non-EA-SqCC) were examined. The immune TME, including tumor-infiltrating lymphocytes (TILs) and PD-L1 expression, was also analyzed. EA-SqCC was detected in 132 (71.7%) of the 184 patients. Patients with EA-SqCC had shorter recurrence-free survival (RFS) [median 58.2 months vs. not Reached (NR); hazard ratio (HR) 0.47; 95% CI 0.25-0.81, p < 0.01] and tended to have shorter overall survival (NR vs. NR; HR 0.47; 95% CI 0.27-1.03, p = 0.07) compared to patients with non-EA-SqCC. Evaluation of TILs in the cancer stroma showed the number of Foxp3+ TILs in the EA-SqCC group was significantly higher than that in the non-EA-SqCC group (median number 58 vs. 43, p < 0.01). However, there were no significant differences in the number of CD8 + T cells and the PD-L1 expression between the two groups. Immunosuppressive microenvironment is a characteristic feature of EA-SqCC, which may contribute to the poor prognosis of this disease.

Diagnosing Malignant Epithelial Neoplasms of the Lung in Cytological Specimens: Cytomorphology, Ancillary Studies and Management

The World Health Organization's (WHO) Reporting System for Lung Cytopathology intends to standardise the diagnosing and reporting of cytology specimens from the lung and aims at enhancing the communication between clinicians and (cyto)pathologists. It is closely connected to the 5th edition of the WHO Classification of Thoracic Tumours. The system includes five diagnostic categories, among them the 'Malignant' diagnostic category that incorporates both primary malignant tumours and metastases. Advancements in bronchoscopy have notably improved the diagnostic capacity of cytological specimens that represent the sole source of tumour material in approximately 40% of all lung carcinoma cases. An accurate diagnosis of malignancy and treatment-guiding classification into specific tumour types and subtypes can reliably be achieved with cytology specimens. They additionally serve as an excellent source for predictive immunocytochemistry (ICC) and molecular testing for targetable oncogenic alterations. This review article provides an overview of the key cytopathological features defining the 'Malignant' category of the WHO Reporting System for Lung Cytopathology for non-small cell carcinomas, neuroendocrine neoplasms and other specific carcinomas and malignancies which can be encountered in cytological specimens of the lung. It further describes the application of ancillary techniques, such as ICC and molecular testing, that have been successfully incorporated into different cytological sample types using various preparation methods.

COPD patients with non-small cell lung cancer respond better to anti-PD-(L)1 immune checkpoint inhibitors

In studies evaluating the efficacy of anti-programmed cell death 1/ligand 1 immune checkpoint inhibitors (anti-PD-(L)1) among patients with non-small cell lung cancer (NSCLC), smokers tend to have better clinical outcomes than non-smokers. However, it is unclear whether NSCLC patients with co-existing chronic obstructive pulmonary disease (COPD) have better clinical outcomes than patients without COPD, regardless of smoking history. The potential correlation of COPD with an improved response to anti-PD-(L)1 was examined in a large cohort of patients with available pulmonary function test results. Patients with stage IV NSCLC who received a minimum of two doses of anti-PD-(L)1 across various treatment lines from 2015 to 2021 were enrolled. Among the 387 patients, pulmonary function test (PFT) data were available for 234 (61%), 139 (59%) of whom had spirometry diagnosed COPD. A retrospective analysis was conducted to evaluate overall survival (OS) and progression-free survival (PFS) based on the presence or absence of COPD. In the univariate analyses, both PFS and OS significantly improved among patients with COPD, compared with patients who did not have COPD (HR 0.71, 95% CI 0.56-0.89 for PFS; HR 0.69, 95% CI 0.52-0.92 for OS), regardless of smoking status. In the multivariate analyses, PFS and OS remained superior among patients with COPD (HR 0.66, 95% CI 0.51-0.85 for PFS; HR 0.63, 95% CI 0.47-0.85 for OS). Additionally, patients with milder COPD (GOLD 1/2 vs. 3/4) had better clinical outcomes than patients with more severe disease. However, neither lung distension (defined as a total lung capacity > 120%) nor pre-COPD status (defined as a diffusing capacity of lung for carbon monoxide < 70%) had a significant impact on PFS or OS. Our study, conducted in the largest cohort with available PFT data to date, showed that COPD was associated with improved survival outcomes among patients with stage IV NSCLC who received anti-PD-(L)1 treatment, regardless of smoking history. The differences were mainly driven by mild and moderate obstruction (GOLD 1 and 2). The dysregulated PD-1/PD-L1 expression that occurs in COPD may offer insights into the different outcomes and thus warrants further investigation.

Navigating challenging patient factors in systemic therapy for head and neck cancer

Patients with head and neck cancer often present with complex challenges due to a substantial comorbidity burden, including substance use disorders, and the tumor's location in regions that are both cosmetically and anatomically sensitive. These challenges can be categorized into 6 areas, that is, overall health (eg, performance status, biological age), physiological life stages (eg, aging), organ dysfunctions (including autoimmune comorbidities, organ transplants, and psychiatric disorders), previous and concurrent malignancies, previous and current therapies, and adherence to therapy. We provide a practical guide to help physicians understand and address the phenotypic multitude of potential complications in the management of these patients. The process has 4 main phases involving identification of the clinical challenge, understanding the reasons for ineligibility (contraindications), assessment of the risk to benefit ratio, and finally making informed decisions about systemic treatment. Proactive interventions, including prehabilitation, are crucial for optimizing patient outcomes and reversing some ineligibility issues. The evidence supporting contraindications is drawn from both clinical trials and real-world data, each with its strengths and limitations. These contraindications are applied as absolute or relative and further refined by expert opinions and consensus statements. There are 2 main reasons for ineligibility for a given treatment, absence of supporting data or negative outcome data. In these cases, careful interpretation using all levels of clinical evidence, including extrapolation and preclinical rationale, is essential. By mastering these skills, that may in the future be enhanced by artificial intelligence methods, significant advancements in patient care can be achieved.

Unexpected links between cancer and telomere state

Eukaryotes possess chromosome ends known as telomeres. As telomeres shorten, organisms age, a process defined as senescence. Although uncontrolled telomere lengthening has been naturally connected with cancer developments and immortalized state, many cancers are instead characterized by extremely short, genomically unstable telomeres that may hide cancer cells from immune attack. By contrast, other malignancies feature extremely long telomeres due to absence of 'shelterin' end cap protecting factors. The reason for rampant telomere extension in these cancers had remained elusive. Hence, while telomerase supports tumor progression and escape in cancers with very short telomeres, it is possible that different - transfer based or alternative - lengthening pathways be involved in the early stage of tumorigenesis, when telomere length is intact. In this Review, I hereby discuss recent discoveries in the field of telomeres and highlight unexpected links connecting cancer and telomere state. We hope these parallelisms may inform new therapies to eradicate cancers.

[Translated article] Relationship between lactate dehydrogenase and survival in patients with non-small-cell lung cancer receiving immunotherapy

OBJECTIVE

The expression level of programmed death ligand 1 (PD-L1) is the only approved biomarker for predicting response to immunotherapy, yet its efficacy is not always consistent. Lactate dehydrogenase (LDH) has been associated with tumor aggressiveness and poorer prognosis across various cancer types and may serve as a useful biomarker for monitoring treatment response. The objective of this study is to analyze the relationship between LDH levels prior to the start of treatment with immune checkpoint inhibitors (ICIs) and clinical outcomes in patients with non-small cell lung cancer (NSCLC).

METHOD

A retrospective study was conducted including patients diagnosed with NSCLC who were treated with at least 3 cycles of immunotherapy. Data on demographics, clinical and pathological characteristics, treatment received, pretreatment LDH levels, and clinical outcomes such as treatment response and overall survival (OS) were analyzed.

RESULTS

A total of 181 patients diagnosed with NSCLC were included. Elevated pretreatment LDH levels (>244 U/L) were associated with significantly reduced OS. The median survival was 548 days in patients with LDH ≤ 244 U/L, compared to 332 days in those with LDH > 244 U/L (P = .037). Among men, OS was greater in the LDH ≤ 244 U/L group (623 days) versus 332 days in the LDH > 244 U/L group (P = 0.043). In patients with metastatic disease, OS was higher in those with LDH ≤ 244 U/L (474 days) compared to 249 days in those with LDH > 244 U/L (P = .023). In patients receiving both immunotherapy and chemotherapy, OS was greater in those with LDH ≤ 244 U/L (623 days) compared to 281 days in the LDH > 244 U/L group (P = .042).

CONCLUSIONS

High levels of LDH prior to the start of treatment with ICIs are associated with lower treatment efficacy and a worse prognosis of the disease, especially in male, metastatic patients with a PD-L1 expression level <1%.

Are Non-invasive Multi-cancer Early Cancer Detection Tests the Future?

Current cancer screening methods are effective for detecting early stage cancers and even preventing some cancers, but their effectiveness has only been demonstrated for a handful of cancers, and for many cancers, there are no screening tests clinically available. In addition, the majority of the screening methods are not ideal, resulting in suboptimal compliance and the occurrence of preventable cancers. A screening test that is convenient, safe, accurate and that can screen for multiple cancers is an ideal screening test that would address many of the shortcomings of the current tests. Multi-cancer detection tests (MCD) have the potential to meet these challenges and have engendered substantial enthusiasm in light of this. Using advances in DNA sequencing technology, cancer epigenetics and artificial intelligence, they are able to detect a large number of cancers predominantly via the patterns of methylated DNA alterations, DNA sequence alterations, and DNA fragment patterns of cell free DNA in the plasma and can accurately distinguish the cancer site of origin. Of note, some of the tests also combine circulating free DNA (cfDNA) with protein-based markers. However, for the majority of early stage cancers, the sensitivity is modest and below that of most of the current standard of care cancer screening tests. Furthermore, the clinical utility of screening for many of the cancers detectable by MCD tests remains to be proven. Here we describe the features of MCD tests, review the current data supporting their potential to be used in the clinic for cancer screening, and discuss the knowledge gaps surrounding understanding their clinical utility, with a focus on GI cancer screening.

The Impact of Chronic Obstructive Pulmonary Disease on Immune Checkpoint Inhibitor Effectiveness in Non-small Cell Lung Cancer: A Population Health Study

SUMMARY

Chronic obstructive pulmonary disease (COPD) and lung cancer are associated diseases. COPD confers a negative prognosis in NSCLC, but the clinical benefit of immune checkpoint inhibitors (ICI) in this population is unclear. A population-level analysis of patients in Ontario, Canada was performed through the ICES (formerly known as the Institute for Clinical Evaluative Sciences) administrative database. Patients with NSCLC and treated with PD-1/PD-L1 immune checkpoint inhibitors between Jan 2010 and Dec 2020 were included. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using Cox proportional hazards regression. Hospitalizations and duration of treatment were compared secondarily using logistic and linear regression. A total of 4306 patients received ICI and 54% of patients had a diagnosis of COPD. Median (95% CI) OS was 9.2 (8.5-9.9) months for patients with COPD and 8.2 (7.3-8.8) for patients without COPD, which was not significantly different (adjusted hazard ratio (aHR) = 0.94, 95% CI, 0.87-1.01, P = 0.092). Similarly, the median time on treatment was not different (85 vs. 99 days, multivariable P = 0.10). However, the 90-day hospitalization rate was decreased in the COPD population (multivariable odds ratio 0.76, 95% CI 0.62-0.94, P = 0.011). Among patients with NSCLC receiving ICI, our data suggest that a diagnosis of COPD does not result in shortened treatment, poorer survival, or higher rates of hospitalization. COPD itself should not be considered a contraindication to ICI.

Towards Recommendations for Cost-Effectiveness Analysis of Predictive, Prognostic, and Serial Biomarker Tests in Oncology

BACKGROUND

Cost-effectiveness analysis (CEA) of biomarkers is challenging due to the indirect impact on health outcomes and the lack of sufficient fit-for-purpose data. Hands-on guidance is lacking.

OBJECTIVE

We aimed firstly to explore how CEAs in the context of three different types of biomarker applications have addressed these challenges, and secondly to develop recommendations for future CEAs.

METHODS

A scoping review was performed for three biomarker applications: predictive, prognostic, and serial testing, in advanced non-small cell lung cancer, early-stage colorectal cancer, and all-stage colorectal cancer, respectively. Information was extracted on the model assumptions and uncertainty, and the reported outcomes. An in-depth analysis of the literature was performed describing the impact of model assumptions in the included studies.

RESULTS

A total of 43 CEAs were included (31 predictive, 6 prognostic, and 6 serial testing). Of these, 40 utilized different sources for test and treatment parameters, and three studies utilized a single source. Test performance was included in 78% of these studies utilizing different sources, but this parameter was differently expressed across biomarker applications. Sensitivity analyses for test performance was only performed in half of these studies. For the linkage of test results to treatments outcomes, a minority of the studies explored the impact of suboptimal adherence to test results, and/or explored potential differences in treatment effects for different biomarker subgroups. Intermediate outcomes were reported by 67% of studies.

CONCLUSIONS

We identified various approaches for dealing with challenges in CEAs of biomarker tests for three different biomarker applications. Recommendations on assumptions, handling uncertainty, and reported outcomes were drafted to enhance modeling practices for future biomarker cost-effectiveness evaluations.

Very Early Health Technology Assessment for Potential Predictive Biomarkers in the Treatment of Advanced Non-Small Cell Lung Cancer

OBJECTIVES

Immune checkpoint inhibitor (ICI)-containing treatment is currently prescribed as first-line treatment for all patients with advanced non-small cell lung cancer (NSCLC) without targetable driver mutations. However, only 30-45% of patients show no progression within 12 months after treatment start. Various biomarkers are being studied to save costly and potentially harmful treatment in non-responders. We evaluated the cost-effectiveness of implementing a hypothetical predictive biomarker for ICI-containing treatment response compared with standard of care (e.g., no implemented biomarker) for pembrolizumab-containing treatment in patients with advanced NSCLC in the Netherlands.

MATERIALS AND METHODS

Standard-of-care-based and predictive-biomarker-based strategies were compared using Markov models for three first-line pembrolizumab-containing treatments depending on a patient's tumor programmed cell death ligand-1 (PD-L1) expression and histology. A Dutch healthcare system perspective was adopted. Assuming a receiver operating characteristic-area under the curve of 1.0 in identifying responders, alternative treatments were offered for non-responders in the predictive-biomarker-based strategy. Parameters and assumptions were based on real-world data from surveys, literature using a targeted search, expert opinion, and registries. Outcomes included differences in costs, survival (life years (LYs)), and survival corrected for health-related quality of life (QoL) quality-adjusted life-years (QALYs) between the predictive-biomarker- and standard-of-care-based strategy.

RESULTS

Implementing a predictive biomarker in pembrolizumab-carboplatin-paclitaxel treatment led to a mean survival reduction of 24 days (- 0.067 LYs) (18 days corrected for QoL (- 0.049 QALYs)), with cost savings of €22,606 compared with standard of care. Pembrolizumab monotherapy and pembrolizumab-pemetrexed-platinum treatments showed survival reductions of 4.5 and 3.9 months, respectively (3.6 and 2.8 months corrected for QoL), with cost savings of €24,345 and €28,456. Sensitivity analyses confirmed consistent cost savings and survival reductions. Survival losses were mainly observed due to the lower survival rates associated with the alternative first-line treatment options available for non-responders in the predictive-biomarker-based strategy within each pembrolizumab-containing treatment regimen. Pembrolizumab-carboplatin-paclitaxel treatment also showed survival gains under certain conditions related to QoL and survival estimates.

CONCLUSIONS

Our study highlights the importance of careful de-implementation of ICI-treatments in advanced NSCLC, balancing costs reductions and side effects without comprising survival. In the pembrolizumab-carboplatin-paclitaxel treatment regimen, the survival loss could be considered negligible. Future research should define acceptable tradeoffs and thresholds for de-implementation, considering factors such as survival of alternative treatments and responder classification to guide predictive biomarker implementation and optimize health resource allocation.

Relationship between Lactate Dehydrogenase and survival in patients with non-small cell lung cancer receiving immunotherapy

OBJECTIVE

The expression level of programmed death ligand 1 (PD-L1) is the only approved biomarker for predicting response to immunotherapy, yet its efficacy is not always consistent. Lactate dehydrogenase (LDH) has been associated with tumor aggressiveness and poorer prognosis across various cancer types and may serve as a useful biomarker for monitoring treatment response. The objective of this study is to analyze the relationship between LDH levels prior to the start of treatment with immune checkpoint inhibitors (ICIs) and clinical outcomes in patients with non-small cell lung cancer (NSCLC).

METHOD

A retrospective study was conducted including patients diagnosed with NSCLC who were treated with at least three cycles of immunotherapy. Data on demographics, clinical and pathological characteristics, treatment received, pre-treatment LDH levels, and clinical outcomes such as treatment response and overall survival (OS) were analyzed.

RESULTS

A total of 181 patients diagnosed with NSCLC were included. Elevated pre-treatment LDH levels (more than 244 U/l) were associated with significantly reduced OS. The median survival was 548 days in patients with LDH less than 244 U/l, compared to 332 days in those with LDH more than 244 U/l (p = 0.037). Among men, OS was greater in the LDH less than 244 U/l group (623 days) versus 332 days in the LDH more than 244 U/l group (p = 0.043). In patients with metastatic disease, OS was higher in those with LDH less than 244 U/l (474 days) compared to 249 days in those with LDH more than 244 U/l (p = 0.023). In patients receiving both immunotherapy and chemotherapy, OS was greater in those with LDH less than 244 U/l (623 days) compared to 281 days in the LDH more than 244 U/l group (p = 0.042).

CONCLUSIONS

High levels of LDH prior to the start of treatment with ICIs are associated with lower treatment efficacy and a worse prognosis of the disease, especially in male, metastatic patients with a PD-L1 expression level less than 1%.

Non-coding RNAs as potential mediators of resistance to lung cancer immunotherapy and chemotherapy

Lung cancer is a common cause of cancer-related death globally. The majority of lung cancer patients initially benefit from chemotherapy and immunotherapy. However, as the treatment cycle progresses and the disease evolves, the emergence of acquired resistance leads to treatment failure. Many researches have shown that non-coding RNAs (ncRNAs) not only influence lung cancer progression but also act as potential mediators of immunotherapy and chemotherapy resistance in lung cancer, mediating drug resistance by regulating multiple targets and pathways. In addition, the regulation of immune response by ncRNAs is dualistic, forming a microenvironment for inhibits/promotes immune escape through changes in the expression of immune checkpoints. The aim of this review is to understand the effects of ncRNAs on the occurrence and development of lung cancer, focusing on the role of ncRNAs in regulating drug resistance of lung cancer.

Treatments and cancer: implications for radiologists

This review highlights the critical role of radiologists in personalized cancer treatment, focusing on the evaluation of treatment outcomes using imaging tools like Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Ultrasound. Radiologists assess the effectiveness and complications of therapies such as chemotherapy, immunotherapy, and ablative treatments. Understanding treatment mechanisms and consistent imaging protocols are essential for accurate evaluation, especially in managing complex cases like liver cancer. Collaboration between radiologists and oncologists is key to optimizing patient outcomes through precise imaging assessments.

Down-regulation of miR-125b by HPV16 E6 might promote cervical cancer progression through TAZ/TEAD

Background

Abnormal gene expression due to the dysregulation of microRNAs (miRNAs) often occurred in the initiation or progression of cancers. In this attempt, we investigate whether miR-125b regulates biological behaviors of cervical cancer caused by HPV16 through TAZ.

Methods

Through the application of bioinformatics analysis techniques, differentially expressed miRNAs relevant to cervical cancer were identified. Cervical tissue specimens were collected from 15 patients with HPV16-positive cervical squamous cell carcinoma (stages IA-IIA), 15 patients with high-grade squamous intraepithelial lesion (HSIL), and 10 patients experiencing chronic cervical inflammation at the Second Hospital of Shanxi Medical University between May 2022 and May 2023. The quantitative assessment of miR-125b expression was conducted via real-time quantitative reverse transcription PCR(RT-qPCR). The potential regulatory relationship between miR-125b and TAZ was assessed using a dual-luciferase reporter assay. Within cervical squamous cell carcinoma SiHa cells, models were established using miR-125b mimic and inhibitor constructs to scrutinize cellular physiological processes and assess the expression profiles of miR-125b, TAZ, TEAD, and E6. Additionally, an HPV16 E6 overexpression cellular model was generated, and the expression patterns of miR-125b and its downstream targets were analyzed by RT-qPCR.

Results

Tissue validation corroborated these findings, demonstrating a significant reduction in miR-125b expression levels in HSIL and cervical squamous cell carcinoma compared to normal cervical tissue (P < 0.05). Functional assays using a miR-125b mimic revealed inhibited proliferation, migration, and invasion of SiHa cells along with enhanced apoptosis, concomitant with decreased expression of HPV16 E6, TAZ, and TEAD mRNA. Conversely, these effects were reversed upon introduction of a miR-125b inhibitor. Notably, overexpression of HPV16 E6 was associated with suppressed miR-125b expression (P < 0.05) and enhanced TAZ and TEAD expression (P < 0.05), as corroborated by western blot analysis.

Conclusion

HPV E6 promotes the malignant progression of cervical cancer cells by downregulating miR-125b, which targets TAZ, thus regulating the Hippo pathway. Consequently, miR-125b emerges as a promising therapeutic target for HPV-induced cervical cancer.

Blood-based machine learning classifiers for early diagnosis of gastric cancer via multiple miRNAs

BACKGROUND

Early screening methods for gastric cancer (GC) are lacking; therefore, the disease often progresses to an advanced stage when patients first start to exhibit typical symptoms. Endoscopy and pathological biopsy remain the primary diagnostic approaches, but they are invasive and not yet widely applicable for early population screening. miRNA is a highly conserved type of RNA that exists stably in plasma. Dysfunction of miRNA is linked to tumorigenesis and progression, indicating that individual miRNAs or combinations of multiple miRNAs may serve as potential biomarkers.

AIM

To identify effective plasma miRNA biomarkers and investigate the clinical value of combining multiple miRNAs for early detection of GC.

METHODS

Plasma samples from multiple centres were collected. Differentially expressed genes among healthy controls, early-stage GC patients, and advanced-stage GC patients were identified through small RNA sequencing (sRNA-seq) and validated via real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR). A Wilcoxon signed-rank test was used to investigate the differences in miRNAs. Sequencing datasets of GC serum samples were retrieved from the Gene Expression Omnibus (GEO), ArrayExpress, and The Cancer Genome Atlas databases, and a multilayer perceptron-artificial neural network (MLP-ANN) model was constructed for the key risk miRNAs. The pROC package was used to assess the discriminatory efficacy of the model.

RESULTS

Plasma samples of 107 normal, 71 early GC and 97 advanced GC patients were obtained from three centres, and serum samples of 8443 normal and 1583 GC patients were obtained from the GEO database. The sRNA-seq and RT-qPCR experiments revealed that miR-452-5p, miR-5010-5p, miR-27b-5p, miR-5189-5p, miR-552-5p and miR-199b-5p were significantly increased in early GC patients compared with healthy controls and in advanced GC patients compared with early GC patients (P < 0.05). An MLP-ANN model was constructed for the six key miRNAs. The area under the curve (AUC) within the training cohort was 0.983 [95% confidence interval (CI): 0.980-0.986]. In the two validation cohorts, the AUCs were 0.995 (95%CI: 0.987 to nearly 1.000) and 0.979 (95%CI: 0.972-0.986), respectively.

CONCLUSION

Potential miRNA biomarkers, including miR-452-5p, miR-5010-5p, miR-27b-5p, miR-5189-5p, miR-552-5p and miR-199b-5p, were identified. A GC classifier based on these miRNAs was developed, benefiting early detection and population screening.

Immune checkpoint expression and therapeutic implications in IDH1-mutant and wild-type glioblastomas

Programmed cell death protein 1 (PDCD1) and cluster of differentiation 274 (CD274) expression is implicated in escaping tumors from immune surveillance. Immune checkpoint inhibitors show promise in cancer therapy, yet their efficacy in glioblastomas, particularly with IDH1 mutations, remains unclear. This study analyzed two independent NGS datasets (n = 577 and n = 153) from TCGA to investigate the expression of PDCD1 and CD274 in glioblastomas and their relationship with IDH1 mutations. We used cBioPortal for mutation analysis, RNA seq for expression analysis, miRDB and miRabel for differential expression of miRNAs, and Kaplan-Meier for survival prediction. We found that 5.4% of glioblastomas harbored IDH1 mutations, correlating with improved overall survival (OS) (p = 2.196e-3). Different glioblastoma cohorts showed a diverse IDH1 mutational prevalence (4-31%). Despite this, IDH1Mu was consistently associated with better OS (p = 8.235e-5). Notably, PDCD1 and CD274 were statistically significantly highly expressed in both IDH1Wt (p < 0.0001) and IDH1Mu tumors (p < 0.0001), with higher expression linked to poorer survival outcomes (PDCD1: p = 0.009; CD274: p = 0.02). Differential co-expression analyses revealed distinct gene and miRNA profiles for IDH1Wt and IDH1Mu glioblastomas, with specific upregulation of PTEN and downregulation of MUC16 in IDH1Wt, and upregulation of PIK3R1 in IDH1Mu. Additionally, PIK3R1 and ITGB2 emerged as critical druggable targets. Our findings indicate that PDCD1 and CD274 are highly expressed irrespective of IDH1 mutation statuses, suggesting that glioblastomas could benefit from immunotherapy. Moreover, IDH1Mu glioblastomas may require a combination of PI3K/AKT/mTOR inhibitors and immunotherapy due to PIK3R1 overexpression.

Association of cardiovascular disease and CIRS‑G and ACE‑27 comorbidity indices with pathological complete response of non‑small cell lung cancer to neoadjuvant chemoimmunotherapy

Neoadjuvant chemoimmunotherapy (NCIO) is a new and effective treatment for cancer, but its efficacy in treating certain patients is unclear. We previously found that comorbidity was an independent factor associated with the pathological complete response (pCR) of non-small cell lung cancer (NSCLC) to NCIO. However, we did not address which comorbidities or comorbidity indices were associated with pCR. The present study retrospectively collected the data for NSCLC patients who underwent NCIO after surgery at The Second Xiangya Hospital of Central South University (Hunan, China) between January 2019 and July 2022. The associations between comorbidities/comorbidity indices and pCR rates/clinicopathological factors were analyzed. In total, 101 eligible patients with stage IIB-IIIC NSCLC were enrolled. Comorbid hypertension [odds ratio (OR)=0.321(0.110-0.937)], vascular disease [OR=0.275 (0.111-0.677)] and cardiovascular disease [OR=0.272 (0.114-0.646)] were all significantly associated with pCR (all P<0.05). The comorbidity indices Cumulative Illness Rating Scale-Geriatric (CIRS-G) ≥2 [OR=0.360 (0.154-0.840)], CIRS-G ≥3 [OR=0.404 (0.179-0.912)], CIRS-G ≥4 [OR=0.293 (0.105-0.817)] and Adult Comorbidity Evaluation-27 (ACE-27) ≥2 [OR=0.427 (0.192-0.950)] were all significantly associated with pCR (all P<0.05). Cardiovascular disease was the only independent risk factor for pCR [adjusted OR=0.272 (0.114-0.646); P=0.003] according to multivariate logistic analysis. In conclusion, cardiovascular comorbidities and the CIRS-G and ACE-27 indices were associated with the effectiveness of NCIO and clinicopathological factors. These results could help to screen for the most suitable NSCLC patients for NCIO.

The association between postdiagnosis smoking cessation and survival in advanced non-small cell lung cancer patients in Southern Taiwan: A retrospective cohort study

Objectives

Smoking is a major lung cancer risk factor. Studies show that smoking after lung cancer diagnosis is associated with an increased risk of developing other cancers and shorter survival. The purpose of this study was to examine the association between postdiagnosis smoking cessation and survival in patients with advanced non-small cell lung cancer (NSCLC).

Materials and Methods

A retrospective cohort study was conducted. Data were collected between January 2014 and December 2019 in three hospitals in Southern Taiwan. Patient data were collected from the hospitals' databases, and the correlation between smoking status and patient survival was analyzed using Kaplan-Meier curves and Cox proportional hazards regression modeling.

Results

A total of 681 patients with advanced NSCLC were included in this study. The numbers (percentage) of ex-smokers and current smokers were 334 (49%) and 347 (51%), respectively. More than half of the patients in this study continued to smoke postdiagnosis advanced NSCLC. Furthermore, ex-smokers had lower mortality risk, even though this was not statistically significant (P = 0.212). The results of this study suggest that older than 65 years, men, Eastern Cooperative Oncology Group performance score of 3 and higher, history of chronic disease, receive chemotherapy, and targeted therapy are correlated with and have predictive effects on advanced NSCLC survival.

Conclusion

There is no significant difference between postdiagnosis smoking cessation and survival in patients with advanced NSCLC. The reason for this finding may be due to lower survival rates after diagnosis with advanced NSCLC, and the benefits of smoking cessation cannot be seen immediately.

EXT1 and Its Methylation Involved in the Progression of Uterine Corpus Endometrial Carcinoma Pathogenesis

Uterine corpus endometrial carcinoma (UCEC) is one of the most common gynecologic tumors. Due to the high recurrence and metastasis of UCEC, it is crucial for patients to find new biomarkers for diagnosis and therapy. In this study, R software and the TCGA database were used to screen candidate UCEC predictive markers. Western blot and RT-qPCR were performed to detect protein and mRNA expression of EXT1 in UCEC cell lines. In addition, MTT assay, flow cytometry, transwell assay, and wound healing assay were conducted to assess the cell viability, apoptosis, invasion, and migration in UCEC cells. Overlap-extension PCR technique was employed to construct the vector targeting the deletion of the methylated segment of EXT1. The results showed that a total of 11 candidate genes were obtained and EXT1 was identified as a potential target. The expression and methylation levels of EXT1 were both increased in UCEC tissues and cell lines, as well as elevated EXT1 was closely related to the poor prognosis of patients. Besides, the knockdown of EXT1 significantly inhibited the malignant biological behaviors in UCEC cells. Additionally, the current study also found that the deletion of 1559-2146 bp CpG island segment upregulated EXT1 expression and promoted malignant biological behaviors in UCEC cells. Furthermore, the presence of m7G RNA methylation in UCEC cells also was found. In conclusion, the methylation of EXT1 influenced the gene expression, thereby affecting the malignant biological behaviors in UCEC cells and regulating the pathological progression of UCEC.

The role of the JunD-RhoH axis in the pathogenesis of hairy cell leukemia and its ability to identify existing therapeutics that could be repurposed to treat relapsed or refractory disease

Hairy cell leukemia (HCL) is an indolent malignancy of mature B-lymphocytes. While existing front-line therapies achieve excellent initial results, a significant number of patients relapse and become increasingly treatment resistant. A major molecular driver of HCL is aberrant interlocking expression of the transcription factor JunD and the intracellular signaling molecule RhoH. Here we discuss the molecular basis of how the JunD-RhoH axis contributes to HCL pathogenesis. We also discuss how leveraging the JunD-RhoH axis identifies CD23, CD38, CD66a, CD115, CD269, integrin β7, and MET as new potential therapeutic targets. Critically, preclinical studies have already demonstrated that targeting CD38 with isatuximab effectively treats preexisiting HCL. Isatuximab and therapeutics directed against each of the other six new HCL targets are currently in clinical use to treat other disorders. Consequently, leveraging the JunD-RhoH axis has identified a battery of therapies that could be repurposed as new means of treating relapsed or refractory HCL.

The Role of Eosinophils, Eosinophil-Related Cytokines and AI in Predicting Immunotherapy Efficacy in NSCLC Cancer

Immunotherapy and chemoimmunotherapy are standard treatments for non-oncogene-addicted advanced non-small cell lung cancer (NSCLC). Currently, a limited number of biomarkers, including programmed death-ligand 1 (PD-L1) expression, microsatellite instability (MSI), and tumor mutational burden (TMB), are used in clinical practice to predict benefits from immune checkpoint inhibitors (ICIs). It is therefore necessary to search for novel biomarkers that could be helpful to identify patients who respond to immunotherapy. In this context, research efforts are focusing on different cells and mechanisms involved in anti-tumor immune response. Herein, we provide un updated literature review on the role of eosinophils in cancer development and immune response, and the functions of some cytokines, including IL-31 and IL-33, in eosinophil activation. We discuss available data demonstrating a correlation between eosinophils and clinical outcomes of ICIs in lung cancer. In this context, we underscore the role of absolute eosinophil count (AEC) and tumor-associated tissue eosinophilia (TATE) as promising biomarkers able to predict the efficacy and toxicities from immunotherapy. The role of eosinophils and cytokines in NSCLC, treated with ICIs, is not yet fully understood, and further research may be crucial to determine their role as biomarkers of response. Artificial intelligence, through the analysis of big data, could be exploited in the future to elucidate the role of eosinophils and cytokines in lung cancer.

Leveraging innovative diagnostics as a tool to contain superbugs

The evolutionary adaptation of pathogens to biological materials has led to an upsurge in drug-resistant superbugs that significantly threaten public health. Treating most infections is an uphill task, especially those associated with multi-drug-resistant pathogens, biofilm formation, persister cells, and pathogens that have acquired robust colonization and immune evasion mechanisms. Innovative diagnostic solutions are crucial for identifying and understanding these pathogens, initiating efficient treatment regimens, and curtailing their spread. While next-generation sequencing has proven invaluable in diagnosis over the years, the most glaring drawbacks must be addressed quickly. Many promising pathogen-associated and host biomarkers hold promise, but their sensitivity and specificity remain questionable. The integration of CRISPR-Cas9 enrichment with nanopore sequencing shows promise in rapid bacterial diagnosis from blood samples. Moreover, machine learning and artificial intelligence are proving indispensable in diagnosing pathogens. However, despite renewed efforts from all quarters to improve diagnosis, accelerated bacterial diagnosis, especially in Africa, remains a mystery to this day. In this review, we discuss current and emerging diagnostic approaches, pinpointing the limitations and challenges associated with each technique and their potential to help address drug-resistant bacterial threats. We further critically delve into the need for accelerated diagnosis in low- and middle-income countries, which harbor more infectious disease threats. Overall, this review provides an up-to-date overview of the diagnostic approaches needed for a prompt response to imminent or possible bacterial infectious disease outbreaks.

Development of 3D Cell-Based Fluorescent Reporter Assay for Screening of Drugs Downregulating Telomerase Reverse Transcriptase

A fluorescent cell-based assay was developed for the screening of chemicals repressing the expression of human telomerase reverse transcriptase (hTERT). hTERT is reactivated during carcinogenesis and is overexpressed in more than 90% of cancers but is almost silent in normal tissue cells. Because of its critical role in cancer, hTERT is a target in various therapeutic strategies for cancer treatment. In this study, the hTERT promoter was cloned in MCF7 breast cancer cells and used to control the expression of enhanced green fluorescent protein (EGFP). The fluorescence of EGFP indicated the activity of the hTERT promoter, and, in the presence of an hTERT repressor, the EGFP fluorescence signal was reduced as compared to the EGFP fluorescence controlled by the human cytomegalovirus (CMV) promoter, which was not affected by changes in culture conditions and worked as a control. The EGFP reporter cells were cultivated in three-dimensional (3D) microbioreactors to resemble the in vivo tumor physiology and provide in vivo-like responses. The assay's predictability was demonstrated with three known hTERT inhibitors, pristimerin, epigallocatechin gallate, and n-butylidenephthalide, and further evaluated with five widely used anticancer compounds, doxorubicin, cisplatin, paclitaxel, blasticidin, and tamoxifen. The results showed overall accuracy of over 83.3%, demonstrating the feasibility of using the hTERT promoter with EGFP as a reporter for the screening of potential cancer drugs targeting hTERT.

A Review on Radiologic Hot Cross Bun Sign and Related Clinical Conditions

The hot cross bun (HCB) sign is a cruciform-shaped hyperintensity on axial T2 weighted-image magnetic resonance imaging (MRI), mostly reported with multiple system atrophy (MSA). However, several other diagnoses were reported with this radiologic manifestation as well. This review investigates the wide spectrum of disorders in which the HCB sign has been reported as a positive radiologic manifestation. This narrative review was conducted using the PubMed database. Studies reporting the HCB sign in their manuscript are included in this manuscript. 83 studies with available full text met the inclusion criteria for this review. The total number of reported patients with HCB sign is addressed in the manuscript. In addition to MSA, the HCB sign has been reported in various other disorders, including spinocerebellar ataxia, malignancies, infections, autoimmune disorders, and some vascular and ischemic changes. Any disorder involving the pontocerebellar fibers can manifest the HCB sign following the gliosis changes or infarction-mediated damage to the region, whether due to gliosis changes. The range of diseases linked to the HCB sign is broader than previously recognized, as numerous disorders affect the transverse pontocerebellar fibers and cause radiologic HCB manifestation. MSA remains the most common condition; however, clinicians should consider alternate differential diagnoses in patients displaying the HCB sign in whom clinical presentation is not typical of MSA.

Role of Soluble Cytokine Receptors in Gastric Cancer Development and Chemoresistance

Gastric cancer is among the top five most important malignancies in the world due to the high burden of the disease and its lethality. Indeed, it is the fourth most common cause of death worldwide, characterized by a poor prognosis and low responsiveness to chemotherapy. Multidrug resistance limits the clinical management of the patient. Among these, the role of chronic activation of inflammatory pathways underlying gastric tumorigenesis should be highlighted. Furthermore, the gastric immunosuppressive TME influences the response to therapy. This review discusses the role of soluble cytokine receptors in the development and chemoresistance of gastric cancer, considered as a molecular marker and target of strategies to overcome resistance.

Uncovering the rewired IAP-JAK regulatory axis as an immune-dependent vulnerability of LKB1-mutant lung cancer

Harnessing the power of immune system to treat cancer has become a core clinical approach. However, rewiring of intrinsic circuitry by genomic alterations enables tumor cells to escape immune surveillance, leading to therapeutic failure. Uncovering the molecular basis of how tumor mutations induce therapeutic resistance may guide the development of intervention approaches to advance precision immunotherapy. Here we report the identification of the Liver Kinase B1 (LKB1)-Inhibitor of Apoptosis Protein (IAP)- Janus Kinase 1 (JAK1) dynamic complex as a molecular determinant for immune response of LKB1-mut lung cancer cells. LKB1 alteration exposes a critical dependency of lung cancer cells on IAP for their immune resistance. Indeed, pharmacological inhibition of IAP re-establishes JAK1-regulated Stimulator of interferon genes (STING) expression and DNA sensing signaling, enhances cytotoxic immune cell infiltration, and augmentes immune-dependent anti-tumor activity in an LKB1-mutant immune-competent mouse model. Thus, IAP-JAK1-targeted strategies, like IAP inhibitors, may offer a promising therapeutic approach to restore the responsiveness of immunologically-cold LKB1-mutant tumors to immune checkpoint inhibitors or STING-directed therapies.

Biological and clinical significance of tumour-infiltrating lymphocytes in the era of immunotherapy: a multidimensional approach

Immune-checkpoint inhibitors (ICIs) have improved clinical outcomes across several solid tumour types. Prominent efforts have focused on understanding the anticancer mechanisms of these agents, identifying biomarkers of response and uncovering resistance mechanisms to develop new immunotherapeutic approaches. This research has underscored the crucial roles of the tumour microenvironment and, particularly, tumour-infiltrating lymphocytes (TILs) in immune-mediated tumour elimination. Numerous studies have evaluated the prognostic and predictive value of TILs and the mechanisms that govern T cell dysfunction, fuelled by technical developments in single-cell transcriptomics, proteomics, high-dimensional spatial platforms and advanced computational models. However, questions remain regarding the definition of TILs, optimal strategies to study them, specific roles of different TIL subpopulations and their clinical implications in different treatment contexts. Additionally, most studies have focused on the abundance of major TIL subpopulations but have not developed standardized quantification strategies or analysed other crucial aspects such as their functional profile, spatial distribution and/or arrangement, tumour antigen-reactivity, clonal diversity and heterogeneity. In this Review, we discuss a conceptual framework for the systematic study of TILs and summarize the evidence regarding their biological properties and biomarker potential for ICI therapy. We also highlight opportunities, challenges and strategies to support future developments in this field.

The progress of tumor vaccines clinical trials in non-small cell lung cancer

BACKGROUND

Non-small cell lung cancer (NSCLC) remains a significant global health challenge, with high mortality rates and limited treatment options. Tumor vaccines have emerged as a potential therapeutic approach, aiming to stimulate the immune system to specifically target tumor cells.

METHODS

This study screened 283 clinical trials registered on ClinicalTrials.gov through July 31, 2023. After excluding data that did not meet the inclusion criteria, a total of 108 trials were assessed. Data on registered number, study title, study status, vaccine types, study results, conditions, interventions, outcome measures, sponsor, collaborators, drug target, phases, enrollment, start date, completion date and locations were extracted and analyzed.

RESULTS

The number of vaccines clinical trials for NSCLC has continued to increase in recent years, the majority of which were conducted in the United States. Most of the clinical trials were at stages ranging from Phase I to Phase II. Peptide-based vaccines accounted for the largest proportion. Others include tumor cell vaccines, DNA/RNA vaccines, viral vector vaccines, and DC vaccines. Several promising tumor vaccine candidates have shown encouraging results in early-phase clinical trials. However, challenges such as heterogeneity of tumor antigens and immune escape mechanisms still need to be addressed.

CONCLUSION

Tumor vaccines represent a promising avenue in the treatment of NSCLC. Ongoing clinical trials are crucial for optimizing vaccine strategies and identifying the most effective combinations. Further research is needed to overcome existing limitations and translate these promising findings into clinical practice, offering new hope for NSCLC patients.

Diagnosis and Excision of Glomangioma of the Lower Extremity

Glomangiomas are rare, benign vascular tumors originating from the specialized arteriovenous structure known as the glomus body. These tumors typically occur in subungual or digital locations, such as the fingers and toes. However, extradigital glomangiomas, which develop in other areas of the body, are much less common. When present in atypical sites, these lesions often mimic more prevalent subcutaneous abnormalities, such as sebaceous cysts, lipomas, or dermatofibromas, posing significant diagnostic challenges for clinicians. The nonspecific clinical features of extradigital glomangiomas, particularly the absence of hallmark symptoms like severe localized pain or hypersensitivity, can further complicate the diagnostic process. This case report describes a 67-year-old male who presented with a 1-cm soft, mobile, and asymptomatic lesion near the right knee, initially presumed to be a sebaceous cyst. Following unsuccessful drainage attempts, the lesion was surgically excised. Histopathological examination confirmed the diagnosis of a glomangioma, with glomus cells arranged around branching vascular channels and positive staining for smooth muscle actin and vimentin. Glomangiomas should be considered in the differential diagnosis of persistent subcutaneous masses in unusual locations. Greater recognition of these rare lesions can facilitate timely and appropriate management.

Development and First-in-Human evaluation of a Site-Specific [18F]-Labeled PD-L1 nanobody PET radiotracer for noninvasive imaging in NSCLC

Immunohistochemistry (IHC) for PD-L1 detection is limited by its invasiveness and heterogeneity of tumors. To address these challenges, a new PD-L1-targeted nanobody-based immune-PET radiotracer [18F]AlF-APN09 was developed using the site-specific radiolabeling method with the complexing agent (Mal-RESCA) under mild conditions. [18F]AlF-APN09 was prepared at room temperature (pH 4.6-4.8) within 20 min with satisfactory radiochemical yields (45.8 ± 4.48 %, non-decay corrected), high radiochemical purity (>98 %) and moderate apparent molar activity (15-35 GBq/μmol), and remained stable in both PBS and 5 % HSA after 4 h (>90 %). Cell uptake studies indicated variable levels of surface PD-L1 expression in the following order: A549PD-L1 > H1975 > A549. In micro-PET/CT imaging, A549PD-L1 and H1975 tumors were distinctly visualized in a 6.0:1 and 3.2:1 ratios over PD-L1-negative A549 tumors in vivo. Ex vivo biodistribution studies showed tumor uptake values of 6.47 ± 1.06 %ID/g (A549PD-L1) and 2.27 ± 0.19 %ID/g (H1975), significantly higher than 0.90 ± 0.28 %ID/g in A549 tumors. The estimated effective radiation dose in humans was 8.65E-03 mSv/MBq, lower than that of conventional [18F]FDG. First-in-human imaging was conducted on a single resectable non-small cell lung cancer (NSCLC) subject without any adverse reactions. The radiotracer exhibited renal excretion with minimal hepatobiliary clearance. Tumor uptake reached SUVmax 4.20 at 2 h post-injection, demonstrating high contrast and rapid clearance. After PD-1 inhibitor immunotherapy and chemotherapy, the subject showed a therapeutic response and postoperative pathological specimens confirmed a major pathological response (MPR). These results suggest that we have successfully developed a new PD-L1-targeted nanobody PET tracer using the site-specific labeling method with the complexing agent (Mal-RESCA) within 20 min under mild conditions and [18F]AlF-APN09 is a promising noninvasive PET radiotracer for visualizing PD-L1 expression in tumors, offering rapid tumor targeting, excellent signal-to-noise ratios, and favorable clearance properties.

Correlation between exosomal PD-L1 and prognosis in patients with cancer: a systematic review and meta-analysis

BACKGROUND

The predictive role of exosomal programmed cell death ligand l (exoPD-L1) in prognosis has been studied extensively; however, there is still no consensus.

METHODS

Three databases, including EMBASE, PubMed, and Web of Science, were searched through January 4, 2024. The pooled hazard ratios (HRs) with 95% confidence intervals (95%CIs) were used to identify the relationship between circulating exoPD-L1 and prognosis.

RESULTS

15 studies with 1091 patients with cancer were included in this statistical analysis. High exoPD-L1 level was correlated with shorter progression-free survival (PFS) (HR = 2.58, 95% CI: 1.75-3.81) and overall survival (OS) (HR = 1.61, 95% CI: 1.32-1.98). Meanwhile, we found that dynamic upregulation of circulating exoPD-L1 in the early stages of immunotherapy was a favorable factor for prognosis (PFS: HR = 0.34, 95% CI: 0.23-0.51; OS: HR = 0.21, 95% CI: 0.13-0.26).

CONCLUSION

Circulating exoPD-L1 may be a valuable prognostic indicator for patients with cancer and monitoring its changes in the early stages of immunotherapy might be used to predict tumor response and clinical outcome. This conclusion may not apply to superficial tumors.

Lung Cancer-Epidemiology, Pathogenesis, Treatment and Molecular Aspect (Review of Literature)

Lung cancer is one of the most common malignant cancers in most countries and is the leading cause of death among cancer diseases worldwide. Despite constant progress in diagnosis and therapy, survival rates of patients diagnosed with lung cancer remain unsatisfactory. Numerous epidemiological and experimental studies conducted as early as the 1970s confirm that the most important risk factor for the development of lung cancer is long-term smoking, which remains valid to this day. In the paper, the authors present the latest data on the epidemiology, pathogenesis, treatment and molecular aspects of this cancer. In the last decade, many molecular alterations that are effective in the development of lung cancer have been discovered. In adenocarcinoma, tyrosine kinase inhibitors were developed for EGFR mutations and ALK and ROS1 translocations and were approved for use in the treatment of advanced stage adenocarcinomas. In the case of squamous cell carcinoma, the evaluation of these mutations is not yet being used in clinical practice. In addition, there are ongoing studies concerning many potential therapeutic molecular targets, such as ROS, MET, FGFR, DDR-2 and RET. Constant progress in diagnostic and therapeutic methods gives rise to hopes for an improved prognosis in patients with lung cancer.

Exploring manzamine a: a promising anti-lung cancer agent from marine sponge Haliclona sp

Manzamine A (MA), a bioactive compound derived from the marine sponge Haliclona sp., shows considerable therapeutic potential, particularly in the treatment of various cancer types. Extracted with acetone and purified through chromatography, MA exhibits a bioavailability of 20.6% when administered orally in rats, underscoring its feasibility for therapeutic use. This compound disrupts key cellular mechanisms essential for cancer progression, including microtubule dynamics and DNA replication enzymes, demonstrating strong anti-proliferative effects against multiple cancer cell lines while sparing normal cells. Additionally, network pharmacology and molecular docking studies reveal MA's interactions with important targets related to lung cancer progression, such as EGFR and SRC, bolstering its potential as a novel anti-lung cancer agent. Pathway analyses further indicate that MA influences critical signaling pathways involved in tumor growth and metastasis. Given the urgent need for effective treatments against drug-resistant cancers and the limited toxicity profile of MA, further exploration of its pharmacological benefits and mechanism could pave the way for new therapeutic strategies in lung cancer.

A Critical Role of Intracellular PD-L1 in Promoting Ovarian Cancer Progression

Disrupting the interaction between tumor-cell surface PD-L1 and T cell membrane PD-1 can elicit durable clinical responses. However, only about 10% of ovarian cancer patients respond to PD-1/PD-L1 blockade. Here, we show that PD-L1 expression in ovarian cancer-patient tumors is predominantly intracellular. Notably, PARP inhibitor treatment highly increased intracellular PD-L1 accumulation in both ovarian cancer-patient tumor samples and cell lines. We investigated whether intracellular PD-L1 might play a critical role in ovarian cancer progression. Mutating the PD-L1 acetylation site in PEO1 and ID8Brca1-/- ovarian cancer cells significantly decreased PD-L1 levels and impaired colony formation, which was accompanied by cell cycle G2/M arrest and apoptosis induction. PEO1 and ID8Brca1-/- tumors with PD-L1 acetylation site mutation also exhibited significantly reduced growth in mice. Furthermore, targeting intracellular PD-L1 with a cell-penetrating antibody effectively decreased ovarian tumor-cell intracellular PD-L1 level and induced tumor-cell growth arrest and apoptosis, as well as enhanced DNA damage and STING activation, both in vitro and in vivo. In conclusion, we have shown the critical role of intracellular PD-L1 in ovarian cancer progression.

Cost-effectiveness analysis of a first-line treatment with cadonilimab plus platinum-based chemotherapy with or without bevacizumab for persistent, recurrent, or metastatic cervical cancer in China: COMPASSION-16 trial

Background

The addition of cadonilimab to first-line platinum-based chemotherapy with or without bevacizumab significantly improved progression-free survival (PFS) and overall survival (OS) in patients with persistent, recurrent, or metastatic cervical cancer. However, the economic value of using this novel therapy for this indication is currently unknown. The aim of this study is to evaluate the cost-effectiveness of the addition of cadonilimab to first-line standard chemotherapy for patients with persistent, recurrent, or metastatic cervical cancer from the perspective of Chinese healthcare system.

Methods

A partitioned survival model was constructed to compare the cost-effectiveness of cadonilimab versus placebo in patients enrolled in the COMPASSION-16 trial. Cost, life-year, quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), and incremental net monetary benefit (INMB) were calculated for 2 treatment strategies. Sensitivity, scenario, and subgroup analyses, and value of information analysis (EVPI) were performed.

Results

Cadonilimab provided an additional 1.18 QALYs and $89,528.64 compared with placebo, which resulted in an ICER of $75,944.56/QALY. At the willingness-to-pay threshold of $38,042.49/QALY, INHB was estimated to be -1.17 QALYs, while INMB amounted to -$44,681.55 and EVPI was calculated as $71.40/person. Sensitivity analyses revealed that the model was most sensitive to hazard ratio (HR) for OS and PFS, and the probability of cadonilimab being cost-effective was 0.70%. To achieve cost-effectiveness, the price of cadonilimab must be reduced by approximately 50%. Subgroup analysis found that all subgroups unfavored cadonilimab by varying the HR for OS and PFS. Scenario analyses showed using life-year as effectiveness, altering time horizon and selection of survival analysis did not reverse results.

Conclusions

Although the use of cadonilimab resulted in clinical benefit, it was not deemed cost-effective as a first-line therapy for persistent, recurrent, or metastatic cervical cancer in China. Lowering the price of cadonilimab may enhance its cost-effectiveness.

NON-SMALL-CELL LUNG CANCER: Real-World Population-Based Cohorts' Study

INTRODUCTION

This retrospective follow-up study evaluates patient outcomes and treatment costs in two cohorts of incident NSCLC patients recorded in the population-based cancer registry of the Veneto Region in 2017 and 2019.

METHODS

This study examines two cohorts of incident NSCLC patients recorded by the Regional Veneto cancer registry in 2017 (493 patients) and 2019 (557 patients). Cancer patients were followed for three years after diagnosis to assess the disease's outcomes and analyze the overall treatment-related costs. Overall survival and cancer-specific mortality were evaluated using Cox regression models. The log-transformed overall treatment costs for the 3 years following diagnosis were analyzed using linear regression.

RESULTS

The overall mortality risk significantly lowered in the 2019 cohort (HR 0.84; 95% CI 0.72-0.98, p = 0.024). Stage III patients were not associated with a significant overall survival rate (HR 0.71; 95% CI 0.50-1.02; p = 0.065) but were associated with significantly higher cancer-specific survival (HR 0.61; 95% CI 0.41-0.91; p = 0.015). Overall, the 2019 cohort showed significantly higher costs (coefficient 0.16; 95% CI 0.02-0.30, p = 0.025), particularly as a result of increases in the costs of drug administration, outpatient services, and medical devices. However, during the same 3-year follow-up period, this cohort featured lower average costs for hospice care and hospitalizations.

CONCLUSIONS

These results revealed notable differences in clinical outcomes and patient-related costs in incident NSCLCs in 2017 and 2019. The study highlights the importance of monitoring clinical outcomes and management costs in real-world oncology practice.

A novel automated IHC staining system for quality control application in ALK immunohistochemistry testing

The establishment of positive and negative controls in immunohistochemistry (IHC) screening for anaplastic lymphoma kinase (ALK) rearrangements is essential in the treatment of lung adenocarcinoma. However, positive control of patient tissue is rare and comes with ethical issues. A novel automated solution for ALK IHC quality control management was investigated by comparison with the established D5F3 antibody on the VENTANA system in 87 lung adenocarcinoma specimens with known ALK status re-analyzed by fluorescence in situ hybridization. The BP6165 concentrated antibody on the LYNX480 PLUS platform demonstrated excellent sensitivity and specificity (98.30% and 100%, respectively) in 87 biopsy specimens. The ALK controls in liquid form (CLFs) applied in an automated way showed a more regular circular shape and better cell distribution than those applied manually. In addition, the novel controls can show changes in the same pattern as tissue controls under different antibody concentrations and antigen retrieval conditions. The automated solution for ALK IHC quality control management provides a convenient solution without the consumption of scarce tissue for IHC testing in day-to-day pathology practice. The availability of standardized protocols for the detection of ALK rearrangements using the BP6165 concentrated antibody on the LYNX480 PLUS platform will expand the number of laboratories that can reliably and consistently determine the eligibility of patients with lung adenocarcinoma for treatment with ALK tyrosine kinase inhibitors.

The role of BIM gene deletion in ALK-mutated Non-small cell lung cancer treated with alectinib

Alectinib, as a first-line therapeutic option for advanced ALK mutation-positive non-small-cell lung cancer (NSCLC), is now widely used in the clinic. However, the associated mechanisms of resistance are unknown. The first documented case of ALK-mutated NSCLC's resistance to alectinib is herein reported in relation to BIM gene deletion status. In particular, cell inhibition assay (CCK8 assay), cell transfection, fluorescence microscopy, RT-PCR, cell proliferation assay, cell migration assay and western blotting were undertaken for exploring the link between BIM status and alectinib resistance. Clinical cases showed that the BIM gene was absent in alectinib-resistant tumor tissues. Further experimental validation yielded that NSCLC with deleted BIM genes were less sensitive to aleitinib. BIM gene deletion can increase resistance to alectinib, and the potential efficacy of a combination of BIM sensitizer and alectinib to overcome alectinib resistance can be explored.

Transfer Learning-Based Integration of Dual Imaging Modalities for Enhanced Classification Accuracy in Confocal Laser Endomicroscopy of Lung Cancer

BACKGROUND/OBJECTIVES

Lung cancer remains the leading cause of cancer-related mortality, underscoring the need for improved diagnostic methods. This study seeks to enhance the classification accuracy of confocal laser endomicroscopy (pCLE) images for lung cancer by applying a dual transfer learning (TL) approach that incorporates histological imaging data.

METHODS

Histological samples and pCLE images, collected from 40 patients undergoing curative lung cancer surgeries, were selected to create 2 balanced datasets (800 benign and 800 malignant images each). Three CNN architectures-AlexNet, GoogLeNet, and ResNet-were pre-trained on ImageNet and re-trained on pCLE images (confocal TL) or using dual TL (first re-trained on histological images, then pCLE). Model performance was evaluated using accuracy and AUC across 50 independent runs with 10-fold cross-validation.

RESULTS

The dual TL approach statistically significant outperformed confocal TL, with AlexNet achieving a mean accuracy of 94.97% and an AUC of 0.98, surpassing GoogLeNet (91.43% accuracy, 0.97 AUC) and ResNet (89.87% accuracy, 0.96 AUC). All networks demonstrated statistically significant (p < 0.001) improvements in performance with dual TL. Additionally, dual TL models showed reductions in both false positives and false negatives, with class activation mappings highlighting enhanced focus on diagnostically relevant regions.

CONCLUSIONS

Dual TL, integrating histological and pCLE imaging, results in a statistically significant improvement in lung cancer classification. This approach offers a promising framework for enhanced tissue classification. and with future development and testing, iy has the potential to improve patient outcomes.

To construct and validate a risk score model of angiogenesis-related genes to predict the prognosis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with high morbidity and mortality worldwide. Angiogenesis is essential for HCC progression and metastasis. Some angiogenesis-related genes promote this process, whereas other antiangiogenic genes inhibit HCC growth and metastasis. Therefore, finding new potential biomarkers for HCC prognosis prediction and treatment is essential. Public RNAseq and clinical data from TCGA and GEO database, download angiogenesis-related genes from the GeneCards, MSigDB database, through the single factor analysis of Cox, LASSO build risk score-Cox regression analysis model and external validation verified from the GEO. Cox regression analysis, Kaplan Meier (KM) curve, ROC curve, and decision-curve analysis will be used to evaluate and examine the risk score prediction effect of the model. GSVA analysis was used to assess the variation of gene sets between groups, and ClBERSOFT, ESTIMATE, and TIMER databases were used to analyze the immune infiltration in the single-cell level analysis of gene expression differences between cells. Finally, in the three pairs of HCC tissues and tissue adjacent to carcinoma by real-time fluorescent quantitative PCR (qRT_PCR) and western blotting (WB) to evaluate angiogenesis-related genes (ATP2A3 AEBP1 PNMA1, PLAT) expression level in HCC, and AEBP1 was knocked out in HCCLM3 cells, which is to study AEBP1 biological function in HCC. We established a prognostic risk assessment model based on 13 significant genes associated with HCC prognosis by Cox analysis and LASSO-Cox regression analysis. The median was used to divide these patients into high-risk and low-risk groups, and the prognosis of the high-risk group was worse than that of the low-risk group. Through the multivariate Cox regression analysis, it was found that the risk score was an independent predictor of overall survival (OS). The GSVA analysis suggested that the predicted high-risk population showed higher activity in the purine, pyrimidine, and riboflavin metabolic pathways. Compared with the low-risk group, the tumor microenvironment in the high-risk group showed a reduction in the number of cells promoting anti-tumor immunity and an increase in the number of cells inhibiting anti-tumor immunity, as well as a reduction in overall immune infiltration and matrix components. On the single-cell level, it was confirmed that the key genes (AEBP1, ATP2A3, PLAT, and PNMA1) expressed differently between liver cancer and adjacent tissue cell groups. Finally, qRT_PCR and WB results showed that ATP2A3, AEBP1, PNMA1, and PLAT were highly expressed in liver cancer tissue compared to adjacent tissue, and the proliferation, migration, and invasion of HCCLM3 cells were inhibited after knocking out AEBP1. We constructed novel risk score models as prognostic biomarkers for HCC, which has the potential to guide the development of more personalized treatment strategies for HCC patients. In addition, AEBP1 is a potential therapeutic target for HCC.

SLC7A11 is a potential therapeutic target and prognostic biomarker correlated with immune cell infiltration in cervical cancer

BACKGROUND

SLC7A11 is importantly in both ferroptosis and disulfidptosis which participated in human development and homeostasis. By utilizing bioinformatics and in vitro validation, we explored SLC7A11's role in cervical cancer.

METHODS

From the TCGA database, we analyzed SLC7A11 expression profiles and validated its promoting role in cervical cancer by in vitro. Patients were divided into two subgroups according to SLC7A11 expression levels, and differentially expressed genes (DEGs) were identified between these groups. Then SLC7A11's mechanism was then clarified by function enrichment analysis. The association between SLC7A11 and the immune microenvironment was investigated. Finally, we explore potential drugs by oncoPredict.

RESULTS

Our findings suggest that SLC7A11 could serve as a valuable prognostic biomarker in cervical cancer. Besides, SLC7A11 was positively regulated cervical cancer cells' proliferation, migration and invasion. We identified 113 DEGs between two subgroups. Functional enrichment analysis revealed that these DEGs are linked to immune-related pathways. The SLC7A11 high expression group showed greater enrichment of resting NK cells, neutrophils, M0 macrophages, and activated mast cells, whereas the SLC7A11 low expression group had higher levels of resting dendritic cells, resting mast cells, and follicular helper T cells. Besides, there were higher TMB scores in patients with high SLC7A11 expression. Finally, we explore 37 kinds of drugs may improve prognosis.

CONCLUSION

SLC7A11, correlated with immune pathway, is a risk factor affecting the prognosis of cervical cancer. We also explore 37 kinds of drugs that may benefit cervical cancer patients.

MicroRNA155 in non-small cell lung cancer: a potential therapeutic target

Lung cancer (LC) is the second most commonly diagnosed cancer among both men and women, and it stands as the leading cause of cancer-related mortality, characterized by high rates of morbidity and mortality. Among its subtypes, non-small cell lung cancer (NSCLC) is the most prevalent and one of the most challenging malignant tumors to treat. To date, various therapeutic approaches, including surgery, radiotherapy, and chemotherapy, have been employed in the management of lung cancer; however, due to its aggressive nature, the survival rates remain low. Consequently, exploring novel treatment strategies is of paramount importance. MicroRNAs (miRNAs), a large family of non-coding RNAs, play crucial roles in regulating several key biological processes, including cell proliferation, differentiation, inflammation, and apoptosis. Among these, microRNA155(miR-155) is one of the most conserved and versatile miRNAs, predominantly overexpressed in various diseases, including malignant tumors. This review elucidates the biological functions and roles of miR-155 in NSCLC and discusses its potential significance as a therapeutic target for future research directions and clinical applications.

The Recruitment and Immune Suppression Mechanisms of Myeloid-Derived Suppressor Cells and Their Impact on Bone Metastatic Cancer

BACKGROUND

MDSCs are immature neutrophils and monocytes with immunosuppressive potentials, involving mononuclear MDSCs (M-MDSCs) and polymorphonuclear MDSCs (PMN-MDSCs).

RECENT FINDINGS

They are significant components of the tumor microenvironment (TME). Besides, recent studies also verified that MDSCs also facilitated the progression of bone metastasis by regulating the network of cytokines and the function of immune cells.

CONCLUSION

It is necessary to summarize the mechanisms of MDSC recruitment and immunosuppression, and their impact on bone metastasis.

Nanobody-Oligonucleotide Conjugates (NucleoBodies): The Next Frontier in Oligonucleotide Therapy

As of now, more than 15 oligonucleotide drugs, primarily small interfering RNAs and antisense oligonucleotide classes, have been approved by the US FDA for therapeutic use, and many more are under clinical trials. However, safe and effective delivery of the oligonucleotide-based drugs to the target tissue still remains a major challenge. For enhanced plasma half-life, effective endosomal release, and other multiple functionalities, various carrier molecules have been used over the years. The successful therapeutic application of antibody-drug conjugates has made antibodies a popular choice for the delivery of oligonucleotide payloads into the target tissues. Single-chain variable domains of heavy chain antibodies (nanobodies) have proven a promising alternative to antibodies in recent years due to their small size, high affinity for the target, cell-penetrating potency, simple and easy production. The present review highlights the oligonucleotide drug types and their conjugation with nanobodies called NucleoBodies for effective targeted delivery, detection and diagnostics.