Immunogenic Cell Death Role in Urothelial Cancer Therapy

Purpose: Bladder cancer is the 13th most common cause of cancer death with the highest lifetime cost for treatment of all cancers. This scoping review clarifies the available evidence on the role of a novel therapeutic approach called immunogenic cell death (ICD) in urothelial cancer of the bladder. Methods: In accordance with the recommendations of the Joanna Briggs Institute, we searched MEDLINE (Ovid), EMBASE, CENTRAL databases, and supplemented with manual searches through the conferences, Google scholar, and clinicaltrials.gov for published studies up to April 2022. We included literature that studied molecular mechanisms of ICD and the role of certain danger-associated molecular patterns (DAMPs) in generating ICD, safety and efficacy of different ICD inducers, and their contributions in combination with other urothelial cancer treatments. Results: Oncolytic viruses, radiotherapy, certain chemo/chemo radiation therapy combinations, photodynamic therapy, and novel agents were studied as ICD-inducing treatment modalities in the included studies. ICD was observed in vitro (murine or human urothelial carcinoma) in ten studies, eight studies were performed on mouse models (orthotopic or subcutaneous), and five clinical trials assessed patient response to ICD inducing agents. The most common studied DAMPs were Calreticulin, HMGB1, ATP, and Heat Shock Proteins (HSP) 70 and 90, which were either expressed on the cancer cells or released. Conclusion: ICD inducers were able to generate lasting antitumor immune responses with memory formation in animal studies (vaccination effect). In clinical trials these agents generally had low side effects, except for one trial, and could be used alone or in combination with other cancer treatment strategies in urothelial cancer patients.

Evaluation of maintenance of the common androgen deprivation therapy with the new antiandrogen therapy in patients with castration-resistant prostate cancer: a systematic review

PURPOSE

Advanced prostate cancer does not respond to traditional androgen deprivation therapy (ADT) at some point in the treatment. The development of new hormonal agents demonstrated clear efficacy and changed the treatment scenario.

OBJECTIVES

To evaluate the use of new antiandrogens alone versus their use in combination with maintenance ADT in patients with advanced castration-resistant prostate cancer.

METHODS

A literature systematic review of randomized clinical trials, cohorts, and real-life studies including patients who received the new antiandrogens with or without ADT due to histologic confirmed advanced castration-resistant prostate adenocarcinoma was carried out.

RESULTS

2181 articles were identified and three studies were included with a total of 246 patients. Two studies were randomized clinical trials, and the third was a retrospective study, which showed similar results for both arms, in relation to PSA response, radiological progression-free survival, and testosterone levels, in addition to cost analysis with savings avoided in the ADT maintenance-free arm. Despite the positive data, it is still not possible to categorically state whether there is a statistical benefit in suspending the ADT during the use of new antiandrogens, due to the heterogeneity of the studies.

CONCLUSION

The literature is limited on the issue. Available data are still immature with no clear benefit of the use of newer antiandrogens alone in the setting of advanced castration-resistant prostate cancer.

Association Between Diabetes and the Risk of Kidney Cancer: Systematic Review and Meta-Analysis

Diabetes is a risk factor for several types of cancer, but the specific relationship between diabetes and kidney cancer is not well understood. We conducted a search strategy in scientific databases for case-control and cohort studies on this topic. We analyzed 17 studies and found that diabetes was significantly associated with the risk of developing kidney cancer and that this risk was slightly stronger for women and for people living in Asia. These findings were not influenced by obesity, cigarette smoking, or hypertension. We conclude that diabetes is an independent risk factor for the development of kidney cancer.

Role of monocarboxylate transporters in the diagnosis, progression, prognosis, and treatment of prostate cancer

Prostate cancer (PCa) is a disease with high morbidity and mortality rates, which requires finding new lines of approach. The significant advances in and interest of molecular biology in this condition have led to the discovery of elements profiled as an essential research target. Accordingly, we consider the importance of studying the role that monocarboxylate transporters (MCTs) play in PCa. These transporters might have a functional characterization, possible diagnostic and therapeutic implications, and influence on the progression and prognosis of this cancer. We reviewed literature published from January 2010 to June 2020 in different databases and search engines to find studies that respond to our question. MCTs have a close correlation with PCa, contributing to their phenotype of glycolytic and acid-resistant metabolism. They determine the maintenance and progression of the disease depending on the expression of different molecular types of the transporter. Thus, MCT2 highlights as a biomarker in early diagnosis and MCT4 in poor prognosis and resistance. Finally, MCT1 and MCT4 profile as a potential therapeutic target by decreasing cell proliferation. In conclusion, MCTs play an essential role in PCa; therefore, they should be taken into account in subsequent studies for finding tools with clinical applicability and contributing to the reduction of the disease burden.

[Report on management of severe renal trauma.]

OBJECTIVE

To characterize the clinical condition, the type of therapeutic approach and outcome of patients with severe renal trauma (AAST: 4 and 5) treated in a tertiary hospital. Cali, Colombia.

METHODS

A descriptive observational study was conducted with patients older than 15 years treated between January 1, 2015 and January 1, 2019, with a diagnosis of renal trauma and renal vessel trauma. Demographic, clinical and trauma severity variables were collected. A univariate analysis was carried out with frequency tables, measures of central tendency, depending on type of intervention, associated lesions, use of blood products and severity indices.

RESULTS

71 medical records were analyzed, 82% male, the average age was 25 years (range: 15-55). Regarding renal traumatic grade, 69% of the patients were grade IV and 31% grade V. Penetrating injuries were seen in 87% versus 13% of injuries due to blunt (non-penetrating) mechanism. 54% of the patients weres cored with a trauma severity index >= 25 and 51% of the patients had an abdominal trauma index <= 24. Surgical management was managed in 67% vs. 32% for non-trauma management surgical. The hospital stay was 17 days on average and 16.9% had complications.

CONCLUSIONS

Severe renal trauma is a frequent clinical condition in male patients between the second and third decade of life, in our environment the majority corresponds to penetrating traumas. Most cases were managed with some surgical procedure, however, with asignificant percentage of conservative management with complication rates of less than 30%, which changes the paradigm of treatment of high-grade renal trauma.

Effectiveness of micronutrients supplement in patients with active tuberculosis on treatment: Systematic review/Meta-analysis

BACKGROUND

Multiple researchers have suggested the influence of micronutrients in the cure and survival of tuberculosis.

OBJECTIVE

To determine the effectiveness of micronutrients in the cure and treatment of pulmonary tuberculosis.

METHODS

Systematic search of randomized controlled trials (RCTs) in databases of people under treatment for active pulmonary tuberculosis, that must have received oral micronutrients for at least four weeks compared with placebo. The synthesis of the variables was shown in standardized mean difference (MD) and/or risk difference (RD). The random effects model was used and was reported in forest plot of the estimates of the effect with a 95 % CI.

RESULTS

Sixteen of 246 studies were included, in total 4398 people. Zinc showed (RD, 0.04; 95 % CI, 0.00-0.08) in mortality, increases muscle mass index (MD, 1.20; 95 % CI, 0.04-2.36) and gains weight (MD, 3.10; 95 % CI, 0.66-5.54). Zinc plus vitamin A increases the weight (MD, 3.10; 95 % CI, 2.78-3.42), improving karnofsky scale (MD, 2.50; 95 % CI, 2.22-2.78). Additionally, vitamin D accelerate the sputum conversión time (RD, 0.38; 95 % CI, 0.03-0.73). Hemoglobin (Hb) with vitamin A and zinc achieves statistically significant changes (MD, 0.69; 95 % CI, 0.28-1.09) and (MD, 0.52; 95 % CI, 0.21-0.83) and reduces area of cavitations in chest X-ray (MD, -0.33; 95 % CI, -0.60--0.06).

CONCLUSIONS

The consumption of micronutrients could achieve weight gain, hemoglobin, accelerated sputum conversion and improvement in quality of life. There are no changes in mortality that may be attributable to the suboptimal dose, larger studies are suggested with adequate doses.

Diagnostic accuracy of preoperative urinary smear test in patients with bladder urothelial carcinoma in a high-volume center

OBJECTIVES

To determine diagnostic accuracy of urinary cytology (smear test) in patients with preoperative diagnosis of urothelial bladder carcinoma.

METHODS

Clinical records of the patients with urotelial bladder carcinoma at the Instituto Nacional de Cancerología (Bogotá D.C.,Colombia) from January 2006 to November 2010 were reviewed. Demographic data, pathological reports of preoperative cytology and definitive surgery, tumor classification and time between sample taking for cytology and final pathology were extracted. Descriptive statistics and graphs for continuous and categorical variables were performed.

RESULTS

We included 52 patients, 20 underwent cystectomy and 32 transurethral resection of the bladder tumor (TURB). 41 were male. Mean age was 66.6 ± 10.7 years. 151 smears were obtained before surgery, with a median of 3 smears performed per patient at 2.5 ± 1.8 months before definitive surgery. 107 were negative, 14 low grade positive and 30 high grade positive. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 30.7%, 90.9%, 97.7%, 9.34%, 3.37 and 0.76 respectively. When the high-grade cytology was compared with the high-grade definitive report some characteristics increased (Sensitivity 47.4%, Specificity: 97.8%, Positive Likelihood Ratio: 21.8) and also when compared with muscle invasion (Sensitivity: 73.9, Positive Likelihood Ratio: 7.27 ).

CONCLUSION

Preoperative cytology has sensitivity and specificity similar to those described in other clinical settings. Also noteworthy is that one high-grade preoperative cytology has a high positive likelihood ratio for high-grade tumor and invasive tumor (≥T2).