Current oncology reports
-
Current oncology reports · Jun 2019
ReviewRadiomics: an Introductory Guide to What It May Foretell.
To briefly review the radiomics concept, its applications, and challenges in oncology in the era of precision medicine. ⋯ Over the last 5 years, more than 500 studies have evaluated the role of radiomics to predict tumor diagnosis, genetic pattern, tumor response to therapy, and survival in multiple cancers. This new post-processing method is aimed at extracting multiple quantitative features from the image and converting them into mineable data. Radiomics models developed have shown promising results and may play a role in the near future in the daily patient management especially to assess tumor heterogeneity acting as a whole tumor virtual biopsy. For now, radiomics is limited by its lack of standardization; future challenges will be to provide robust and reproducible metrics extracted from large multicenter databases.
-
Current oncology reports · May 2019
ReviewSystemic Histiocytosis (Langerhans Cell Histiocytosis, Erdheim-Chester Disease, Destombes-Rosai-Dorfman Disease): from Oncogenic Mutations to Inflammatory Disorders.
Provide an overview of recent progress in decoding the pathogenesis and treatment of systemic histiocytoses. ⋯ Advances in molecular techniques over the last few years, enabling the identification of several MAPK mutations in lesion histiocytes, have revolutionized our understanding of histiocytosis that led to a revised classification and new treatments. Since the 2010 discovery of the BRAFV600E mutation in 57% of Langerhans cell histiocytosis (LCH) lesions, several other kinase mutations have been found, mostly in the MAPK pathway, and also in other key signaling pathways, in LCH, Erdheim-Chester Disease (ECD) and, less frequently, Destombes-Rosai-Dorfman disease (RDD). Those revolutionary breakthroughs enhanced our understanding of the pathogenesis of histiocytosis and led to trials with targeted therapies that demonstrated notable efficacy.
-
Current oncology reports · May 2019
ReviewTargeted Therapies for the Treatment of Glioblastoma in Adults.
Targeted therapies are part of biomarker-driven strategies that exploit actionable molecular targets and have gained traction following survival benefits demonstrated in various systemic malignancies. In glioblastoma, where therapeutic options remain scarce and prognosis poor, targeted therapies offer an attractive treatment alternative and are actively examined in clinical trials. In this review, we summarize the targeted therapies, including traditional small molecule inhibitors and monoclonal antibodies as well as immunotherapeutic approaches that are examined in clinical trials, and discuss the challenges of using them for the treatment of glioblastoma. ⋯ Despite initial speculations, phase II/III trials of targeted therapies in adult patients with glioblastoma have largely failed. Recent trials have focused on improving patient stratification, drug-tissue penetration, and target and compensatory pathway inhibition to optimize treatment response. In contrast to traditional small molecule and monoclonal antibody therapies, cancer immunotherapy may target specific molecular or immune checkpoint target(s) to trigger immune responses against glioblastoma. Early phase clinical trials of immunotherapy have shown encouraging results, and larger randomized trials are ongoing. Targeted therapies are being actively studied in clinical trials. Patients with glioblastoma should be prioritized for clinical trial participation.
-
Current oncology reports · Mar 2019
ReviewChimeric Antigen Receptor-Engineered T Cell Therapy in Lymphoma.
Chimeric antigen receptor (CAR) T cells are a form of adoptive therapy employing autologous T cells engineered with an artificial receptor, able to recognize tumor antigens through an HLA-independent mechanism. We will review data on safety and efficacy outcomes with CAR T cell therapy in lymphomas. ⋯ Multicenter trials evaluating three CAR T cell products targeting CD19 have shown that they are highly effective and induce durable remissions in a substantial proportion of patients with relapsed or refractory aggressive B cell non-Hodgkin lymphoma (NHL). The most common toxicities were cytokine release syndrome and neurotoxicity. Two anti-CD19 CAR T cell products were approved by the FDA for the treatment of patients with relapsed or refractory aggressive B cell NHL. Ongoing research is aimed at investigating their use in earlier lines of therapy and in other B cell lymphomas, improving CAR T cell efficacy and safety, and evaluating novel targets.
-
Patients with hematologic malignancies get more aggressive treatment and the end-of-life, more ICU deaths, and prolonged hospital stays. In comparison to solid tumors, their access to palliative care and hospice is less. ⋯ Multiple factors seem to play a role including curative goals, different treatment options, stronger relationship between patients and oncologist, symptom burden, and limitations of hospice care. Improving the perception of palliative care in these patients, characterizing their needs, and more education can help to increase referrals and access to palliative care. Innovative ways to improve integration between hematology-oncology and palliative care are needed.