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Applications of Silica-Based Nanomaterials for Combinatorial Drug Delivery in Breast Cancer Treatment
Published in Yasser Shahzad, Syed A.A. Rizvi, Abid Mehmood Yousaf, Talib Hussain, Drug Delivery Using Nanomaterials, 2022
Mubin Tarannum, Juan L. Vivero-Escoto
Breast cancer (BC) is one of the most frequently diagnosed cancer in women, with 30% of all new cancer diagnoses and is the second leading cause of cancer-related deaths among women in the USA (Kucharczyk et al. 2017). Currently, BC is divided into subtypes based on the molecular heterogeneity: estrogen/progesterone receptor, HER2 receptor, luminal A, luminal B and, triple-negative breast cancer (TNBC). These receptors serve as markers for diagnosis and targeted hormonal therapies. The molecular subtype of BC is an important prognostic variable along with tumor size and nodal size which impact the prognosis and influence the decision making in BC treatment (Prat et al. 2015). For example, the HER2-positive and basal-like subtypes are typically aggressive and suffer from poor outcomes, whereas the Luminal A tumors showed better outcomes. Traditionally, BC therapy involves a multimodal strategy including neoadjuvant chemotherapy, surgery, and radiotherapy accompanied with adjuvant chemotherapy and/or endocrine therapy (Sachdev and Jahanzeb 2016). Systemic neoadjuvant therapy, mostly chemotherapy, may decrease the tumor burden to increase the possibility of surgery usually provides greater chances for breast-conservating surgery. Adjuvant therapy involves local radiation, systemic chemotherapy, molecular targeted therapies, or their combination (Kucharczyk et al. 2017). Adjuvant systemic chemotherapy is a mainstay in the clinic for controlling the disease and improving survival as well as chemotherapy remains the core treatment for metastatic breast cancer (Sachdev and Jahanzeb 2016).
Clinical Management of Pancreatic Cancer
Published in Vittorio Cristini, Eugene J. Koay, Zhihui Wang, An Introduction to Physical Oncology, 2017
The goals of neoadjuvant therapy are to increase the probability of successful surgery and to reduce the risk of local and distant recurrence. Two decades of research have shown this approach to be safe and well tolerated [241]. In addition to identifying patients who have aggressive biology and who would not have benefited from a radical surgery, the preoperative therapy provides some prognostic information for those who do undergo resection, as the extent of pathological response to therapy has been associated with outcomes [242]. However, only a small minority of patients achieve an excellent response to neoadjuvant therapy (less than 10% viable tumor cells), and methods to identify these patients a priori are currently lacking in the clinic. Namely, with the exception of CA19-9 (see “Definition of Technical Terms”), a biomarker with several limitations, there are no viable prognostic or predictive biomarkers for PDAC [243].
Nanoscale Drug Delivery Vehicles for Solid Tumors: A New Paradigm for Localized Drug Delivery Using Temperature Sensitive Liposomes
Published in Mansoor M. Amiji, Nanotechnology for Cancer Therapy, 2006
Chemotherapeutics are designed to kill cancer cells or prevent them from dividing. The major types of cancer drugs include antimetabolites, alkylating agents, antibiotics, antimitotics, hormones, and inorganics (e.g., cisplatin). The National Cancer Institute (NCI) Drug Dictionary contains technical definitions and synonyms for more than 500 agents that are being used in the treatment of patients with cancer or cancer-related conditions.1 However, the magic bullet,* interpreted here as “a drug that is solely specific for cancer cells,” is still not available.2,3 The drugs that have been developed can kill cancer cells, but most of them can also kill normal cells, resulting in a low therapeutic index (ratio of lethal dose to effective dose). This limits their dosage and, ultimately, their efficacy.4 Apart from the success of cisplatin in testicular cancer and methotrexate in choriocarcinoma, systemic chemotherapy has not yet exposed solid tumors to sufficiently high drug concentrations for an adequate period of time to cause meaningful tumor regressions.4 Therefore, surgery† and radiation are the mainstays for local control of tumors.‡ In modern clinical practice, chemotherapy is mostly used as a post-surgical adjuvant to remove microscopic metastases that have spread from the original site. Other applications include neoadjuvant therapy to downsize local tumors before surgery or radiation and palliative care for the incurable patient.4
Radar reflector guided axillary surgery in node positive breast cancer patients
Published in Expert Review of Medical Devices, 2022
Joshua A. Feinberg, Deborah Axelrod, Amber Guth, Leonel Maldonado, Farbod Darvishian, Nakisa Pourkey, Jenny Goodgal, Freya Schnabel
Among the published reports of axillary surgery facilitated by RRL, the majority of patients were previously treated with neoadjuvant therapy [17–19]. In our study, half of the patients underwent successful radar reflector facilitated axillary surgery in the upfront setting. As a result of improvements in systemic therapy and advances in tumor genomic profiling, routine axillary lymph node dissection is no longer indicated to inform adjuvant treatment recommendations [21]. Therefore, an increasing number of patients with node-positive disease will be treated with upfront surgery and sentinel biopsy alone. Techniques such as RRL to ensure excision of the biopsy proven node will be critical for accurate axillary staging in these patients. TAXIS is an ongoing trial aimed at evaluating the optimal management of patients who present with node-positive breast cancer, including those not previously treated with neoadjuvant chemotherapy [22]. The TAXIS trial will investigate the value of tailored axillary surgery (TAS), a new technique that combines SLNB with removal of any preoperatively clipped nodes as well as all palpable suspicious nodes. Consistent with our experience using RRL in the setting of upfront axillary surgery, the TAXIS trial is based on the premise that the clinical benefit of clipped node excision is not limited to patients who have been treated with NAC.
Clinical role of fluorescence imaging in colorectal surgery - an updated review
Published in Expert Review of Medical Devices, 2020
Amandeep Ghuman, Sandra Kavalukas, Stephen P. Sharp, Steven D. Wexner
Yet another endoscopic application of NIR imaging is the ability to detect adenomas at the time of colonoscopy. Due to the morphology of flat adenomas that are observed with Lynch syndrome, adenoma miss rates can be as high as 55% [41]. Fluorescence molecular endoscopy uses the NIR spectrum to visualize a labeled antibody (bevacizumab-800CW) against VEGFA, which is highly up-regulated in colorectal adenomas. Hartmans et al. performed this technique in patients with Familial Adenomatous Polyposis, and detected colorectal adenomas even <3 mm [42]. While this technique is still under investigation, it offers novel techniques of using the near-infrared spectrum to its greatest advantage in pre-cancerous detection. This has also been applied to evaluating rectal cancer response after neoadjuvant therapy. Again, using VEGFA as a target, investigators were able to measure fluorescent tracers in the tissue, with the ability to differentiate between normal rectal tissue with fibrosis and tumor tissue with fluorescence endoscopy [43].
Minimizing re-excision after breast conserving surgery – a review of radiofrequency spectroscopy for real-time, intraoperative margin assessment
Published in Expert Review of Medical Devices, 2021
Vincent J. Reid, Jeffrey S. Falk, Alice M. Police, Calvin A. Ridgeway, Lisa L. Cadena, Stephen P. Povoski
Deeper understanding of the genetic and molecular biology of breast cancer has enabled increased utilization of neoadjuvant therapy prior to BCS. No longer indicated only to shrink the tumor, perhaps to enable lumpectomy instead of mastectomy, today, breast cancer treatment can be individualized with the knowledge that subtypes, for example Her2/neu positive and Triple Negative cancers respond particularly well to neoadjuvant therapy.