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Hepatocellular Carcinoma
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Masakazu Yamamoto, Shun-ichi Ariizumi
The Barcelona Clinic Liver Cancer treatment algorithm recommends treatments in consideration of performance status, Child-Pugh class, tumor number, portal vein invasion, and tumor size. Surgery is the first option for a single hepatocellular carcinoma with good liver function without considering tumor size. The algorithm does not consider the patient’s age, comorbidity, or future remnant liver function after surgery [1]. If surgery is not suitable, transarterial chemoembolization, radiofrequency ablation, and liver transplantation should be considered. However, radiofrequency ablation and transarterial chemoembolization were not effective for this patient, and liver transplantation could not be selected due to the patient’s age and the Milan criteria; therefore, external beam radiation therapy and systemic therapy should be considered. Median survival has improved by several months by systemic therapy with Sorafenib and other multikinase inhibitors. However, systemic therapy sometimes cannot be used because of severe side effects and its expensive cost. If hepatocellular carcinomais localized without metastasis, radiation therapy should be considered as another option. There is a lack of evidence of radiation therapy for large hepatocellular carcinoma; however, stereotactic body radiation therapy and proton beam therapy have been reported in patients unsuitable for other established local therapies [5].
Targeted Cytotoxicity
Published in Siegfried Matzku, Rolf A. Stahel, Antibodies in Diagnosis and Therapy, 2019
Uwe Zangemeister-Wittke, Winfried Wels
The advantage of chemotherapy is that, in contrast to surgery and radiotherapy, it can be used for disseminated as well as localized cancer. Unfortunately, examples of long-term survival after chemotherapy represent the minority of cases, typically 5-10% with current treatments. The major limitation for systemic therapy is a lack of tumor specificity, so that agents effective in killing neoplastic cells usually also have detrimental effects on normal tissues. In addition, most metastatic cancers are either constitutive resistant to chemotherapy or respond to chemotherapy, but later recur as cancers that have acquired resistance (Gottesman and Pastan, 1993). Most frequently, the pattern of resistance includes a variety of cytotoxic drugs that do not have a common structure or a common intracellular target. This broad resistance to chemotherapy termed multidrug resistance is mediated by energy-dependent drug transport proteins located in the cell membrane. Although high doses of drugs can overcome multidrug resistance by overstraining the transport mechanisms, further effective treatment of refractory cancer is inevitably limited due to unspecific toxicity in vivo.
Gastrointestinal and liver infections
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Candida oesophagitis occurs in immunocompromised patients, including those with HIV infection, diabetes mellitus, those receiving steroids or broad-spectrum antibiotics and anticancer chemotherapy. Candidiasis in immunocompetent individuals can be treated with nystatin suspension 1-3 million units orally four times daily or clotrimazole 10 mg orally five times daily; these regimens have similar efficacy. Systemic therapy is required for immunocompromised patients. The treatment of choice is oral fluconazole 100-200 mg daily, which will achieve endoscopic clearance in more than 90% of patients.18 Fluconazole is clinically superior to ketoconazole and itraconazole in AIDS patients.18, 19 For fluconazole-resistant candida oesophagitis, combination therapy with itraconazole (100-200 mg daily) and flucytosine (100 mg/kg daily)20 or intravenous amphotericin B 3-5 mg/kg daily, are equally effective options.21
The future of fibroblast growth factor receptor inhibitors and mechanisms of resistance for cholangiocarcinoma
Published in Expert Opinion on Pharmacotherapy, 2023
Samantha M. Ruff, Sameek Roychowdhury, Timothy M. Pawlik
For patients who present with resectable disease, upfront resection with adjuvant capecitabine is the standard of care and results in the longest overall survival. Only about 20% of patients present with resectable disease and, even following curative-intent oncologic resection, many patients will develop recurrence or metastatic disease. For these patients, 5-year survival is only 20–40% [5–7]. For patients who present with advanced or metastatic disease, systemic therapy options are often limited. Currently, gemcitabine and cisplatin are first-line chemotherapy regimens for patients with advanced CCA at any anatomic site. For patients with ICCA, locoregional liver therapies like hepatic artery infusion pump or radioembolization with yttrium-90 are other treatment options [8]. Unfortunately, for patients who present with advanced disease, 5-year survival is only 5–10% [5–7].
Nivolumab with or without chemotherapy for metastatic gastroesophageal cancers and future perspectives
Published in Expert Review of Anticancer Therapy, 2022
Matheus Sewastjanow-Silva, Kohei Yamashita, Ernesto Rosa Vicentini, Meita Hirschmann, Melissa Pool Pizzi, Allison Michelle Trail, Rebecca E Waters, Jane E. Rogers, Jaffer A Ajani
Since early detection strategies are not used in the majority of nations, patients are frequently diagnosed in an advanced GEC stage, reducing the possibility of a surgical resection as part of the treatment. GECs that cannot be surgically removed have a poor prognosis, and they invariably develop resistance to conventional treatment [4]. Systemic therapy is used to treat advanced, unresectable diseases of all histological types to relieve symptoms and increase survival. For patients who can have trimodality therapy and have residual cancer in the surgical specimen, based on the results of CHECKMATE-577, immune checkpoint inhibitors (ICIs), such as nivolumab, an anti-programmed death-1 (anti-PD-1) agent, can prolong disease-free-survival. This review will mainly focus on advanced GECs.
Unmet needs in atopic dermatitis management: an expert consensus
Published in Journal of Dermatological Treatment, 2022
Annalisa Patrizi, Antonio Costanzo, Cataldo Patruno, Valentina Maria Busà, Andrea Chiricozzi, Giampiero Girolomoni
Developing a shared treatment strategy was especially important for AD variants that involve the scalp, face, genital area, and hands (T4, strong agreement). Often, these forms are also considered as difficult to treat (42). Patients thus need to agree with their treatment plan and be properly trained to carry out therapy (43). Moreover, it was considered important to identify subgroups of patients who are candidate for non-steroidal topical therapies (T5, strong agreement). While the decision to initiate systemic therapy can be based on disease severity and response to therapy, it may also be related to impact on quality of life and daily function, satisfaction with the treatment regimen, adverse events, intolerance, drug interactions, and poor adherence (44). Clinicians should establish the goals of systemic therapy and carefully assess the patient prior to its initiation as recently highlighted (44,45).