Evolution of adjuvant chemotherapy for breast cancer

Food therapy of scutellarein ameliorates pirarubicin‑induced cardiotoxicity in rats by inhibiting apoptosis and ferroptosis through regulation of NOX2‑induced oxidative stress

Pirarubicin (THP) is one of the most commonly used antineoplastic drugs in clinical practice. However, its clinical application is limited due to its toxic and heart‑related side effects. It has been reported that oxidative stress, inflammation and apoptosis are closely associated with cardiotoxicity caused by pirarubicin (CTP). Additionally, it has also been reported that scutellarein (Sc) exerts anti‑inflammatory, antioxidant, cardio‑cerebral vascular protective and anti‑apoptotic properties. Therefore, the present study aimed to investigate the effect of food therapy with Sc on CTP and its underlying molecular mechanism using echocardiography, immunofluorescence, western blot, ROS staining, and TUNEL staining. The in vivo results demonstrated that THP was associated with cardiotoxicity. Additionally, abnormal changes in the expression of indicators associated with oxidative stress, ferroptosis and apoptosis were observed, which were restored by Sc. Therefore, it was hypothesized that CTP could be associated with oxidative stress, ferroptosis and apoptosis. Furthermore, the in vitro experiments showed that Sc and the NADPH oxidase 2 (NOX2) inhibitor, GSK2795039 (GSK), upregulated glutathione peroxidase 4 (GPX4) and inhibited THP‑induced oxidative stress, apoptosis and ferroptosis. However, cell treatment with the ferroptosis inhibitor, ferrostatin‑1, or inducer, erastin, could not significantly reduce or promote, respectively, the expression of NOX2. However, GSK significantly affected ferroptosis and GPX4 expression. Overall, the results of the present study indicated that food therapy with Sc ameliorated CTP via inhibition of apoptosis and ferroptosis through regulation of NOX2‑induced oxidative stress, thus suggesting that Sc may be a potential therapeutic drug against CTP.

Effect of anthracyclines/ifosfamide-based adjuvant chemotherapy for soft tissue sarcoma: a conventional and network Meta-analysis

The objective of this study is to assess the effect of anthracyclines/ifosfamide-based adjuvant chemotherapy for soft tissue sarcoma (STS) and provide a relative ranking of regimens for STS. We pooled the hazard ratios of overall survival (OS) and relapse free survival (RFS) by conventional meta-analysis to appraise whether adjuvant chemotherapy benefits STS and performed a network meta-analysis using a Bayesian model to establish the relative ranking of regimens. Nine studies were included in our meta-analysis. The pooled hazard ratios were 0.68 (95%CI: 0.53-0.86) and 0.65 (95%CI: 0.52-0.83) for OS and RFS, respectively. Doxorubicin was indicated as best regimen to benefit OS (probability: 30.2%), while cyclophosphamide + vincristine + doxorubicin + dactinomycin was indicated as the best regimen for RFS (probability: 37.1%). This meta-analysis confirms the positive effect of anthracyclines/ifosfamide-based adjuvant chemotherapy in STS for both OS and RFS.

Four cycles of docetaxel and cyclophosphamide as adjuvant chemotherapy in node negative breast cancer: A real-world study

Introduction

The optimal number of cycles of adjuvant docetaxel and cyclophosphamide (DC) in patients with node negative breast cancer is not known. We aimed to analyse the survival outcomes of patients with node negative and human epidermal growth factor receptor (HER2)-negative breast cancer treated with four cycles of DC.

Methods

Patients with node negative and HER2-negative breast cancer treated with four cycles of DC after surgery in a large Canadian province from 2008 to 2012 were identified. We analysed the 4-year and 9-year invasive disease free survival (iDFS) and overall survival (OS). Cox regression models were constructed to examine the associations of clinical characteristics with survival outcomes.

Results

A total of 657 patients were eligible for the current analysis. The median age was 53 years and 71.2% of patients had hormone receptor-positive breast cancer. Approximately three-fourths of patients had grade III tumours. At a median follow-up of nine years, the 4-year iDFS and OS were 91.0% and 95.5% and the corresponding 9-year rates were 80.5% and 88.0%, respectively. On multivariable Cox regression analysis, grade III tumour predicted worse iDFS (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.09–4.21; P = 0.026) and OS (HR, 3.15; 95% CI, 1.18–8.45; P = 0.022).

Conclusions

Adjuvant chemotherapy with four cycles of DC in a select population of node negative breast cancer was associated with encouraging long-term survival. In the absence of a randomized comparison between four and six cycles of DC, this study presents real-world evidence to consider four cycles of DC as a reasonable option.

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Non-anthracycline adjuvant chemotherapy administered in node negative breast cancer.

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Not known if four or six cycles of docetaxel and cyclophosphamide is optimal.

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Long-term survival rates in this real-world study using four cycles are encouraging.

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In absence of randomized comparison, four cycles is a reasonable option.

Target delivery selective CSF-1R inhibitor to tumor-associated macrophages via erythrocyte-cancer cell hybrid membrane camouflaged pH-responsive copolymer micelle for cancer immunotherapy

Tumor-associated macrophages (TAMs) is a promising therapeutic target for cancer immunotherapy, while TAMs targeting therapy using nano-sized drug delivery system (NDDS) is a great challenge. To overcome these drawbacks, a novel erythrocyte-cancer cell hybrid membrane camouflaged pH-responsive copolymer micelle (dextran-grafted-poly (histidine) copolymer) was prepared to target deliver a selective CSF-1R inhibitor: BLZ-945 (shorten as DH@ECm) to TAMs for TAMs depletion. The prepared DH@ECm possessed favorable particle size (~190 nm) preferable immune camouflage and tumor homologies targeting characteristic when it was intravenously administrated into blood system. In tumor acidic microenvironment, DH@ECm possessed pH-responsive characteristic and unique "membrane escape effect" to facilitate recognition and internalization by TAMs via dextran-CD206 receptor specific interaction (about 3.9 fold than free drug), followed by TAMs depletion in vitro. For in vivo studies, DH@ECm could reverse tumor immune-microenvironment with the elevation of CD8⁺ T cells and possess sufficient tumor immunotherapy (inhibition rate: 64.5%). All the in vitro and in vivo studies demonstrated the therapeutical potential of DH@ECm for tumor immunotherapy.