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31 pages, 7161 KB  
Review
Antibody–Drug Conjugates in Lung Cancer: Promise, Progress, and Persistent Challenges
by Panagiotis Paliogiannis, Giorgia Fara, Angelo Zinellu, Alessandro Giuseppe Fois and Giuseppe Palmieri
Curr. Issues Mol. Biol. 2026, 48(9), 868; https://doi.org/10.3390/cimb48090868 - 26 Aug 2026
Abstract
Lung cancer is currently the most frequently diagnosed malignancy worldwide, accounting for approximately 12.4% of all cancers and, despite major advances in molecularly targeted therapies and immunotherapy, represents the leading cause of cancer-related mortality, In recent years, antibody–drug conjugates (ADCs) have emerged as [...] Read more.
Lung cancer is currently the most frequently diagnosed malignancy worldwide, accounting for approximately 12.4% of all cancers and, despite major advances in molecularly targeted therapies and immunotherapy, represents the leading cause of cancer-related mortality, In recent years, antibody–drug conjugates (ADCs) have emerged as a novel therapeutic strategy, combining the specificity of monoclonal antibodies with the potent cytotoxic activity of highly active payloads to selectively target tumor cells while limiting systemic toxicity. This narrative review summarizes the current role of ADCs in lung cancer, with particular focus on their structural components, mechanisms of action, and the biological features that determine treatment efficacy. We discuss the rationale for targeting established and emerging antigens in non-small cell and small cell lung cancer, including HER2, TROP2, c-MET, HER3, CEACAM5, DLL3, and other promising targets currently under clinical investigation. The principal mechanisms of primary and acquired resistance are also reviewed, including antigen modulation, altered intracellular trafficking, lysosomal dysfunction, drug efflux, tumor microenvironment-mediated immune suppression, and intratumor heterogeneity. In addition, we provide an overview of the safety profile of ADCs, highlighting the most clinically relevant adverse events and their underlying biological mechanisms. We also examine the evolving landscape of predictive biomarkers beyond antigen expression, including genomic, transcriptomic, proteomic, and liquid biopsy-based approaches, together with emerging spatial and single-cell technologies that may improve patient selection. Finally, we discuss future directions in the field, including novel payloads, next-generation linker technologies, bispecific ADCs, combination strategies, and personalized ADC development. Overall, ADCs are rapidly reshaping the therapeutic landscape of lung cancer. Continued optimization of drug design, biomarker-driven patient selection, and a deeper understanding of resistance mechanisms will be essential to fully realize their clinical potential. Full article
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23 pages, 2290 KB  
Review
The Role of Monoclonal Antibody Targeted Therapy (Panitumumab) in the Treatment of Metastatic Colorectal Cancer—A Narrative Review of Current Evidence and Emerging Therapeutic Strategies
by Lidia Kwiatkowska and Małgorzata Szczuko
Int. J. Mol. Sci. 2026, 27(17), 7559; https://doi.org/10.3390/ijms27177559 - 24 Aug 2026
Viewed by 243
Abstract
Metastatic colorectal cancer (mCRC) remains one of the leading causes of cancer deaths worldwide. Mutations of the RAS and BRAF genes and the location of the primary tumor determine the choice of systemic therapy. Panitumumab—a fully human anti-EGFR monoclonal antibody—is well-established in the [...] Read more.
Metastatic colorectal cancer (mCRC) remains one of the leading causes of cancer deaths worldwide. Mutations of the RAS and BRAF genes and the location of the primary tumor determine the choice of systemic therapy. Panitumumab—a fully human anti-EGFR monoclonal antibody—is well-established in the treatment of patients with wild-type RAS and BRAF and left-sided tumor localization. The aim of this review is to summarize the role and potential of targeted therapies for colorectal cancer with monoclonal antibodies such as panitumumab or cetuximab, to provide current evidence on the position of panitumumab in the treatment of mCRC, and to discuss biomarkers and qualification strategies for targeted therapy, including the role of ctDNA in disease monitoring and rechallenge. The work is based on a narrative review of literature from the PubMed, Scopus, Web of Science and Google Scholar databases, including publications available until May 2026. The efficacy of panitumumab was confirmed in phase III studies: first-line (PRIME: prolongation of OS by 5.6 months) and second-line treatment. A key condition for eligibility is complete RAS and BRAF genotyping, assessment of MSI/dMMR status, HER2 amplification, and tumor location. ctDNA analysis enables monitoring of tumor clonal evolution and qualification for rechallenge—the CHRONOS study showed 30% objective responses with liquid biopsy-based selection. Associations with BRAF/MEK and KRAS G12C inhibitors and modulation of the immune microenvironment via the CCL5/CCR5 axis remain promising directions. Panitumumab occupies an important position in the treatment of patients with mCRC, but increasingly precise molecular stratification and dynamic monitoring of disease with ctDNA are becoming the basis for the effective and rational use of the drug. Unlike reviews that selectively focus on individual aspects of anti-EGFR therapy, the following work integrates all aspects: from molecular biology and biomarkers used to qualify patients to clinical data on panitumumab and new strategies in the fight against mCRC. Further development of next-generation sequencing methods and standardization of ctDNA panels will be crucial for the widespread deployment of targeted therapies in everyday clinical practice. The role of panitumumab is well established in appropriately selected patients with RAS wild-type, particularly left-sided, metastatic colorectal cancer (mCRC). Combining panitumumab with immune checkpoint inhibitors warrants further investigation, particularly in patients with MSS/pMMR mCRC. The observed activity of panitumumab in combination with nivolumab and ipilimumab provides a rationale for further clinical evaluation and monitoring. Full article
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27 pages, 916 KB  
Review
Genomics and Multi-Omics to Guide Clinical Management in Thyroid Cancer
by Dhoha Dhieb and Kholoud Bastaki
Int. J. Mol. Sci. 2026, 27(16), 7464; https://doi.org/10.3390/ijms27167464 - 20 Aug 2026
Viewed by 171
Abstract
Thyroid cancer comprises a biologically diverse group of tumors initiated by a limited number of recurrent driver alterations, with additional molecular events promoting dedifferentiation, therapeutic resistance, and aggressive clinical behavior. Advances in tumor sequencing have clarified the molecular architecture of papillary, follicular, oncocytic, [...] Read more.
Thyroid cancer comprises a biologically diverse group of tumors initiated by a limited number of recurrent driver alterations, with additional molecular events promoting dedifferentiation, therapeutic resistance, and aggressive clinical behavior. Advances in tumor sequencing have clarified the molecular architecture of papillary, follicular, oncocytic, poorly differentiated, anaplastic, and medullary thyroid carcinomas, and have already changed management in selected settings. Molecular testing improves diagnostic refinement and risk assessment in cytologically indeterminate thyroid nodules, while alterations involving BRAF, RET, and NTRK can guide targeted therapy in advanced disease. Beyond DNA, transcriptomic, proteomic, epigenetic, metabolomic, immune, spatial, and liquid-biopsy approaches offer functional insight into differentiation state, treatment sensitivity, and resistance, although most remain investigational. Their clinical value depends not only on biological plausibility, but on reproducibility, incremental value beyond established clinicopathological variables, and the ability to alter patient management. Computational tools may further support integration of molecular and clinical data, but their usefulness likewise depends on calibration, external validation, interpretability, and demonstration of decision impact. This review synthesizes the genomic and multi-omics determinants of thyroid cancer management across diagnosis, risk stratification, treatment selection, resistance monitoring, and follow-up, and discusses the practical barriers that continue to limit routine implementation, including assay standardization, cost, access, and real-world feasibility. Progress in precision thyroid oncology will depend on robust validation of emerging biomarkers and clear evidence that they improve patient outcomes. Full article
(This article belongs to the Special Issue Advances in Multi-Omics in Cancer: Second Edition)
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17 pages, 1313 KB  
Review
IDH-Mutant Diffuse Glioma: From Metabolic Origins to Targeted Therapy
by Tadeja Urbanic-Purkart
J. Clin. Med. 2026, 15(16), 6387; https://doi.org/10.3390/jcm15166387 - 18 Aug 2026
Viewed by 163
Abstract
Background/Objectives: Isocitrate Dehydrogenase (IDH)1/2-mutant diffuse gliomas represent a biologically distinct subgroup of adult brain tumors in which eary metabolic reprogramming and accumulation of the oncometabolite D-2-hydroxyglutarate (D-2HG) drive epigenetic, immunologic, and clinical characteristics, including a high burden of glioma-associated epilepsy. This review summarizes [...] Read more.
Background/Objectives: Isocitrate Dehydrogenase (IDH)1/2-mutant diffuse gliomas represent a biologically distinct subgroup of adult brain tumors in which eary metabolic reprogramming and accumulation of the oncometabolite D-2-hydroxyglutarate (D-2HG) drive epigenetic, immunologic, and clinical characteristics, including a high burden of glioma-associated epilepsy. This review summarizes the molecular and metabolic consequences of IDH mutations, their role in glioma-associated epilepsy, and the evolving impact of mutant IDH-targeted therapies in contemporary neuro-oncology. Methods: We conducted a narrative review of key molecular, translational, imaging, and clinical studies on IDH-mutant diffuse gliomas. The literature included the 2021 (World Health Organization) WHO Classification of Tumours of the Central Nervous System, studies investigating D-2HG biology and glioma-associated epilepsy, and prospective clinical trials and real-world evidence evaluating IDH-targeted therapies and contemporary antiseizure management. Particular emphasis was placed on vorasidenib, advanced metabolic imaging, and emerging liquid biopsy approaches. Results: IDH mutations are early driver events that promote D-2HG accumulation, resulting in widespread epigenetic reprogramming, metabolic dysregulation, and an immunosuppressive tumor microenvironment. D-2HG has also been implicated in the development of glioma-associated epilepsy, although the underlying mechanisms remain incompletely understood. Advances in integrated histomolecular diagnostics, magnetic resonance spectroscopy, amino acid positron emission tomography, and cerebrospinal fluid liquid biopsy have improved disease classification and treatment monitoring. Mutant IDH inhibitors, particularly vorasidenib, prolong progression-free survival, delay the need for subsequent treatment, and reduce intratumoral D-2HG concentrations, and have shown encouraging early signals of improved seizure control and preserved health-related quality of life in patients with grade 2 IDH-mutant gliomas, although this evidence remains preliminary and requires confirmation in larger prospective studies. Conclusions: IDH-mutant diffuse gliomas exemplify precision neuro-oncology, in which a single metabolic alteration informs diagnosis, disease monitoring, and targeted therapeutic approach. Additionally, ongoing studies are expected to further define the role of IDH inhibition across different disease stages and in combination with immunotherapy and standard treatments. Lastly, future clinical trials should systematically incorporate seizure outcomes, neurocognitive function, patient-reported outcomes, and immunologic endpoints to optimize both tumor control and quality of life. Full article
(This article belongs to the Special Issue Clinical and Diagnostic Strategies for Glioma Treatment)
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41 pages, 6426 KB  
Review
Comprehensive Review of Extracellular Vesicles in Thyroid Cancer: From Methodological Approaches to Biological Functions and Clinical Applications
by Sonja Šelemetjev, Tijana Išić Denčić and Ninoslav Mitić
Int. J. Mol. Sci. 2026, 27(16), 7337; https://doi.org/10.3390/ijms27167337 - 17 Aug 2026
Viewed by 211
Abstract
Thyroid cancer (TC) is one of the most common endocrine malignancies and ranks among the ten most frequently diagnosed cancers worldwide, highlighting the need for improved diagnostic and monitoring strategies. Extracellular vesicles (EVs) are nano-sized, membrane-enclosed particles released by nearly all cell types [...] Read more.
Thyroid cancer (TC) is one of the most common endocrine malignancies and ranks among the ten most frequently diagnosed cancers worldwide, highlighting the need for improved diagnostic and monitoring strategies. Extracellular vesicles (EVs) are nano-sized, membrane-enclosed particles released by nearly all cell types that carry selectively sorted bioactive cargo capable of influencing the behavior and fate of recipient cells. Although their molecular composition is shaped by their cells of origin, cargo loading is a regulated process that contributes to EV-mediated intercellular communication and cell-specific targeting. In TC, EVs have emerged as important mediators of tumor progression and microenvironment modulation. Recent advances underscore the diagnostic and prognostic value of EVs as non-invasive biomarkers, particularly through the detection of EV-associated non-coding RNAs, proteins, lipids, and other molecular signatures. However, methodological variability and limited clinical validation remain key barriers to clinical translation. Further preclinical and clinical studies are needed to establish the role of EVs in liquid biopsy and personalized targeted therapy for TC. This review provides a comprehensive and systematic overview of EVs in TC, with particular emphasis on methodological factors influencing EV research, including sample-specific isolation and characterization strategies. Based on a systematic literature survey, this review integrates current knowledge on EV-associated cargo, biological functions, biomarker and therapeutic potential while critically evaluating methodological challenges and outlining future directions for clinical translation. Full article
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15 pages, 5948 KB  
Article
Development and Broad Application of a Double Drop-Off ddPCR Assay for Simultaneous Detection of Four FGFR3 Mutations in Tissue and Liquid Biopsy Samples
by Eleni Thanou, Nikos Gavalas, Eleni Kabrani, Foteini Grigoriou, Anna Konstantinou, Vasiliki Malamatini, Christina Chourdaki Peristeri, Evi Lianidou, Aristotelis Bamias and Athina Markou
Cancers 2026, 18(16), 2634; https://doi.org/10.3390/cancers18162634 - 14 Aug 2026
Viewed by 356
Abstract
Background: Fibroblast Growth Factor Receptor 3 (FGFR3) mutations are common and clinically relevant alterations in bladder cancer, with implications for diagnosis, monitoring, and patient selection for targeted therapies. Tissue-based testing is often limited by sample availability, invasiveness, and the need for [...] Read more.
Background: Fibroblast Growth Factor Receptor 3 (FGFR3) mutations are common and clinically relevant alterations in bladder cancer, with implications for diagnosis, monitoring, and patient selection for targeted therapies. Tissue-based testing is often limited by sample availability, invasiveness, and the need for repeated sampling. This study aimed to develop and analytically validate a sensitive double drop-off droplet digital polymerase chain reaction (ddPCR) assay for simultaneous detection of four FGFR3 hotspot mutations in tissue and liquid biopsy samples. Methods: The assay targeted four FGFR3 mutations (S249C, R248C, Y373C, G370C) using reference probes that generate a constant fluorescence signal and wild-type-specific drop-off probes that lose binding when a mutation is present, thereby distinguishing wild-type double-positive droplets from mutant droplets with reduced drop-off fluorescence. Analytical validation was performed using synthetic mutant oligonucleotides, wild-type genomic DNA, and cell-free DNA (cfDNA) from healthy donors (HDs). Specificity, limit of blank (LOB), limit of detection (LOD), and assay precision were evaluated. Performance was compared with next-generation sequencing (NGS) in formalin-fixed paraffin-embedded (FFPE) tissue DNA. FGFR3 mutations were also assessed in matched plasma and urinary cfDNA from bladder cancer patients. Results: The assay demonstrated clear cluster separation, no cross-reactivity, and reliable detection of all mutations down to 0.2% mutant allele frequency (MAF). Strong agreement was observed with a mutation-specific singleplex ddPCR assay for S249C. Concordance with NGS in tissue DNA was 74.2%, with ddPCR identifying additional low-abundance mutations not reported by NGS. FGFR3 mutations were detected in plasma and urinary cfDNA, with complete concordance between matched plasma and urine samples. Conclusions: This ddPCR assay provides a rapid, sensitive, and cost-effective method for detecting clinically relevant FGFR3 mutations and may complement sequencing-based approaches for molecular monitoring using tissue, plasma, and urine specimens. Full article
(This article belongs to the Section Cancer Biomarkers)
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29 pages, 496 KB  
Review
Targeted Therapy in Pancreatic Ductal Adenocarcinoma: Current Advances and Challenges
by Ramy Habib, Erika Arnold, Tasin Obi, Franco J. Vizeacoumar and Shahid Ahmed
Curr. Oncol. 2026, 33(8), 452; https://doi.org/10.3390/curroncol33080452 - 28 Jul 2026
Viewed by 559
Abstract
Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal solid malignancies, with poor survival driven by late presentation, aggressive tumor biology, and limited responsiveness to conventional systemic therapy. Advances in molecular profiling have expanded opportunities for biomarker-guided and targeted therapeutic [...] Read more.
Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal solid malignancies, with poor survival driven by late presentation, aggressive tumor biology, and limited responsiveness to conventional systemic therapy. Advances in molecular profiling have expanded opportunities for biomarker-guided and targeted therapeutic approaches. Methods: A literature review was conducted using PubMed and the Cochrane Library through July 2026, supplemented by abstracts and proceedings from major international oncology conferences. Results: Pancreatic cancer is driven mainly by somatic changes in KRAS, TP53, CDKN2A, and SMAD4. Established precision approaches include maintenance olaparib for selected platinum-sensitive tumors with germline BRCA1 or BRCA2 pathogenic variants, immune checkpoint inhibition for mismatch repair-deficient or microsatellite instability-high tumors, and tropomyosin receptor kinase inhibition for cancers with neurotrophic tyrosine receptor kinase gene fusions. Direct inhibition of KRAS and RAS represents a major therapeutic breakthrough. KRAS G12C inhibitors established proof of concept, while agents targeting the more common KRAS G12D mutation are showing encouraging early activity. In the randomized phase III RASolute 302 trial, the multiselective RAS inhibitor daraxonrasib improved survival compared with chemotherapy in previously treated metastatic disease with oncogenic RAS mutations. Early studies of zoldonrasib combinations have extended this progress to KRAS G12D-mutant disease, although confirmation is required. Molecular profiling, next-generation sequencing, patient-derived organoids, and circulating tumor DNA may further improve treatment selection and monitoring. Conclusions: Precision oncology is becoming clinically relevant in pancreatic ductal adenocarcinoma. KRAS- and RAS-directed therapies are central advances, but resistance, toxicity, limited durability, and access to comprehensive testing remain important challenges. Full article
(This article belongs to the Section Gastrointestinal Oncology)
17 pages, 441 KB  
Review
Ultrasound-Guided Axillary Management in Early-Stage Breast Cancer: From Diagnosis to De-Escalation
by Xiangmin Shen, Zi Yi and Kui Tang
Cancers 2026, 18(15), 2405; https://doi.org/10.3390/cancers18152405 - 26 Jul 2026
Viewed by 390
Abstract
Axillary lymph node management in early-stage breast cancer has undergone a fundamental transformation over the past three decades, shifting from routine radical clearance to precision-guided de-escalation. Ultrasound (US) has emerged as the central imaging modality in this paradigm shift, serving as the first-line [...] Read more.
Axillary lymph node management in early-stage breast cancer has undergone a fundamental transformation over the past three decades, shifting from routine radical clearance to precision-guided de-escalation. Ultrasound (US) has emerged as the central imaging modality in this paradigm shift, serving as the first-line tool for preoperative nodal assessment, guidance for biopsy and clip placement, monitoring of response to neoadjuvant chemotherapy (NAC), and localization of marked nodes for targeted axillary dissection (TAD). This review systematically examines the evolution of axillary management in early-stage breast cancer through a US-centric lens. We summarize the historical transition from Halstedian axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB), critically appraise the landmark trials—Z0011, AMAROS, OTOASOR, and SOUND—that have progressively de-escalated axillary surgery, and detail the role of US in preoperative staging (including conventional B-mode, superb microvascular imaging, contrast-enhanced US, elastography, and AI-assisted diagnostics), US-guided biopsy and node marking, and post-NAC TAD. We further explore the integration of US with liquid biopsy, multigene profiling, and molecular subtype-guided systemic therapy to enable individualized decision-making. Finally, we propose a stepwise US-centric clinical algorithm and discuss future directions, including AI-powered real-time interpretation, imaging-omics, and US-guided targeted therapy. This review provides a comprehensive framework for incorporating ultrasound as a key component of multidisciplinary decision-making—alongside pathological, surgical, radiotherapeutic, and molecular inputs—in contemporary axillary management. Full article
(This article belongs to the Section Cancer Therapy)
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28 pages, 1297 KB  
Review
Pharmacologic Resistance in Soft Tissue Sarcomas: Mechanisms, Biomarkers, and Translational Therapeutic Strategies
by Dorian Yarih García-Ortega, Gabriela Alamilla-García, Kevin Fernando Reyna-Pérez, Jessica Baldriche-Acosta, Luis Alonso Herrera-Montalvo and Carlo César Cortés-González
Cancers 2026, 18(14), 2364; https://doi.org/10.3390/cancers18142364 - 22 Jul 2026
Viewed by 592
Abstract
Soft tissue sarcomas are rare, biologically diverse mesenchymal malignancies in which pharmacologic resistance cannot be explained by a single unifying mechanism. In this narrative review, resistance is conceptualized as a dynamic, multilayered process shaped by histologic subtype, genomic architecture, transcriptional plasticity, the tumor [...] Read more.
Soft tissue sarcomas are rare, biologically diverse mesenchymal malignancies in which pharmacologic resistance cannot be explained by a single unifying mechanism. In this narrative review, resistance is conceptualized as a dynamic, multilayered process shaped by histologic subtype, genomic architecture, transcriptional plasticity, the tumor microenvironment, and treatment-driven selective pressure. Resistance to conventional chemotherapy arises through both intrinsic and acquired mechanisms, including altered drug transport and metabolism, enhanced DNA damage responses, impaired apoptotic signaling, clonal selection, and the emergence of therapy-persistent cellular states. By contrast, resistance to targeted and epigenetic therapies more often reflects adaptive bypass signaling, lineage reprogramming, and incomplete identification of subtype-specific dependencies than secondary on-target alterations alone. The tumor microenvironment further contributes to therapeutic failure through hypoxia, extracellular matrix-mediated barriers, abnormal vascularization, myeloid-dominant immunosuppression, and immune exclusion, thereby helping explain the modest and histology-dependent activity of immune checkpoint inhibitors in soft tissue sarcoma. This review also differentiates baseline predictive biomarkers from dynamic resistance-monitoring tools, underscoring the potential—despite still limited clinical maturity—of pharmacogenomic markers, immune signatures, tertiary lymphoid structures, circulating tumor DNA, and circulating methylation-based approaches. Finally, emerging strategies to overcome resistance are examined, including mechanism-based combinations, biomarker-guided treatment selection, synthetic lethality, functional precision platforms, and adaptive histology-specific trial designs. Collectively, these observations support a view of resistance in soft tissue sarcoma as a context-dependent biological process that demands integrated, subtype-aware, and translationally grounded therapeutic strategies. Full article
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43 pages, 3787 KB  
Review
Precision Therapeutics in Pancreatic Cancer: Emerging Targeted, Immune, and Antibody–Drug Conjugate Strategies Exemplified by Adagrasib, Dostarlimab, and Trastuzumab Deruxtecan
by Piotr Kawczak, Katarzyna Kawczak and Tomasz Bączek
J. Clin. Med. 2026, 15(14), 5521; https://doi.org/10.3390/jcm15145521 - 14 Jul 2026
Viewed by 960
Abstract
Pancreatic cancer remains one of the most aggressive and lethal malignancies, characterized by late-stage diagnosis, profound molecular heterogeneity, and limited responsiveness to conventional cytotoxic therapies. Recent advances in molecular diagnostics and biomarker-driven treatment stratification have accelerated the development of precision therapeutic approaches aimed [...] Read more.
Pancreatic cancer remains one of the most aggressive and lethal malignancies, characterized by late-stage diagnosis, profound molecular heterogeneity, and limited responsiveness to conventional cytotoxic therapies. Recent advances in molecular diagnostics and biomarker-driven treatment stratification have accelerated the development of precision therapeutic approaches aimed at improving outcomes in selected patient populations. This review highlights three mechanistically distinct yet complementary therapeutic strategies that illustrate the evolving landscape of personalized pancreatic cancer management. Adagrasib represents targeted inhibition of oncogenic KRAS G12C signaling, reflecting recent progress in directly targeting historically “undruggable” driver mutations. Dostarlimab illustrates the tissue-agnostic application of immune checkpoint blockade in pancreatic cancers harboring mismatch repair deficiency (dMMR) or high microsatellite instability (MSI-H), highlighting the growing importance of biomarker-defined immunotherapy-responsive subsets despite the limited pancreatic cancer-specific clinical evidence currently available. Trastuzumab deruxtecan represents a next-generation HER2-directed antibody–drug conjugate (ADC) and demonstrates the potential of HER2-targeted therapy in the small subgroup of patients with HER2-positive pancreatic cancer, although the available evidence is derived primarily from basket trials and tumor-agnostic clinical development. Collectively, these therapeutic approaches underscore the expanding role of biomarker-guided treatment strategies integrating targeted inhibition, immunotherapy, and precision cytotoxic payload delivery. This review summarizes the molecular rationale, available clinical evidence, therapeutic limitations, and resistance mechanisms associated with these approaches while discussing emerging directions in translational research, rational combination strategies, liquid biopsy applications, and precision oncology that may further refine individualized treatment algorithms for pancreatic cancer. Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer: Diagnosis and Therapy)
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22 pages, 1709 KB  
Review
Overcoming Resistance to Anti-EGFR Therapies: Mechanisms of Cetuximab and Panitumumab Resistance and Emerging Combination Strategies
by Gabriela Henrykowska, Dorota Bartusik-Aebisher, Klaudia Dynarowicz, Tamil Selvan Ramesh, Barbara Smolak and David Aebisher
Pharmaceuticals 2026, 19(7), 1041; https://doi.org/10.3390/ph19071041 - 3 Jul 2026
Viewed by 628
Abstract
Cetuximab and panitumumab are anti-EGFR monoclonal antibodies widely used for the treatment of colorectal cancers. However, due to various mechanisms of resistance to these targeted therapies, the patients’ responses vary. These resistances remain a major obstacle in treatment and overcoming them has become [...] Read more.
Cetuximab and panitumumab are anti-EGFR monoclonal antibodies widely used for the treatment of colorectal cancers. However, due to various mechanisms of resistance to these targeted therapies, the patients’ responses vary. These resistances remain a major obstacle in treatment and overcoming them has become a key emphasis of current therapeutic strategies. Intrinsic and acquired resistance often lead to reactivation of downstream signaling pathways, mainly the RAS-RAF-MEK-ERK (MAPK pathway) and PI3K-AKT axes. Prior existing mutations in KRAS, NRAS, and BRAF result in primary resistance by constantly activating the signals, irrespective of EGFR inhibition. That said, acquired resistance manifests under therapeutic burden through the process of clonal evolution via KRAS and BRAF alterations, restoring MAPK pathway activity despite EGFR inhibition. In addition to those mutations, tumor cells exploit mechanisms independent of EGFR, such as the pathway bypass, which includes amplification of ERBB family receptors like HER2 (ERBB2) and activation of MET signaling. To overcome these resistances, novel strategies have emerged, which target multiple nodes within the oncogenic networks. Such methods include vertical pathway inhibition, multi-kinase inhibition, liquid-biopsy-guided therapy, and anti-EGFR rechallenge. Reactivation driven by secondary mutation can be prevented by targeting multiple nodes within the MAPK cascade simultaneously, which is referred to as the vertical pathway inhibition. Overall, this review underscores that overcoming therapeutic resistance requires a multidimensional approach that integrates molecular profiling, rational combination therapies, and adaptive treatment. Finally, these advances underscore the shift toward precision oncology, where therapy is tailored to tumor evolution, leading to improved response and patient outcome. Full article
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25 pages, 9789 KB  
Review
The Genomic Revolution in Pulmonary Medicine: A Comprehensive Narrative Review of Genomic and Multi-Omic Technologies in Respiratory Conditions
by Arihant Surana and Aditya Singh
DNA 2026, 6(3), 32; https://doi.org/10.3390/dna6030032 - 2 Jul 2026
Viewed by 440
Abstract
Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung diseases (ILDs), represent a major global health burden. Their significant clinical and biological heterogeneity complicates diagnosis and limits the efficacy of traditional, one-size-fits-all management approaches. The advent of high-throughput genomic [...] Read more.
Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung diseases (ILDs), represent a major global health burden. Their significant clinical and biological heterogeneity complicates diagnosis and limits the efficacy of traditional, one-size-fits-all management approaches. The advent of high-throughput genomic and multi-omic technologies has initiated a paradigm shift from syndromic classification to molecular-based endotyping. A narrative review of the literature was performed, synthesising foundational and recent research in the genomics, epigenomics, and multi-omics of chronic respiratory diseases. Key studies were selected based on their relevance to genetic architecture, biomarker development, and translational applications in precision medicine. We discuss the complex genetic architecture of pulmonary conditions, highlighting the contribution of both rare, high-penetrance variants, such as SERPINA1, CFTR, and BMPR2, and polygenic risk from many common variants, such as HHIP, FAM13A, and IL33. We provide detailed analyses of polygenic risk scores (PRSs) for COPD and asthma, including their construction, validation across ancestries, and predictive performance. We detail how integrative multi-omic approaches, including transcriptomics, proteomics, and metabolomics, are successfully defining molecular endotypes, such as Type 2-high asthma, which, in turn, inform the use of targeted biologic therapies. Finally, we review the development of molecular diagnostics, including metagenomic sequencing of infections and liquid biopsies for lung cancer and the development of prognostic biomarkers. The genomic revolution is transforming pulmonary medicine through the discovery of novel disease pathways, precise molecular classification, and the recognition of new therapeutic targets. Despite major challenges in functional interpretation, data integration, and clinical–translational equity, these technologies hold the key to a new era of personalised respiratory health and precision medicine. Full article
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15 pages, 5825 KB  
Review
Peritoneal Metastasis as a Distinct Biological Entity: Mechanisms, Microenvironment, and Therapeutic Implications
by Serdar Gumus, Uğur Topal, Ibrahim Cogal and Cem Kaan Parsak
Int. J. Transl. Med. 2026, 6(3), 27; https://doi.org/10.3390/ijtm6030027 - 29 Jun 2026
Viewed by 826
Abstract
For decades, peritoneal metastases (PM) have been regarded as a terminal manifestation of advanced malignancies and managed primarily with palliative intent because of limited sensitivity to systemic therapies. Accumulating clinical, molecular, and immunological evidence now supports the view that PM is not merely [...] Read more.
For decades, peritoneal metastases (PM) have been regarded as a terminal manifestation of advanced malignancies and managed primarily with palliative intent because of limited sensitivity to systemic therapies. Accumulating clinical, molecular, and immunological evidence now supports the view that PM is not merely an anatomic pattern of spread but a distinct metastatic niche with characteristic biological, microenvironmental, and therapeutic features. This review summarizes the major routes of PM development—transcoelomic, lymphatic, and hematologic dissemination—and emphasizes how these pathways converge through shared biological programs. Core mechanisms include epithelial–mesenchymal transition (EMT), adhesion signaling, extracellular matrix remodeling, and tumor–immune cell interactions. A central focus is the peritoneal tumor microenvironment: mesothelial-to-mesenchymal transition, cancer-associated fibroblast activity, adipocyte-derived metabolic support, macrophage polarization, and regulatory T-cell enrichment collectively shape an immunotolerant and treatment-resistant niche on the peritoneal surface. In addition, evidence from pre-metastatic niche biology suggests that primary tumor-derived exosomes and epitranscriptomic regulation can prime the peritoneal environment before overt implantation. These features provide a biological rationale for locoregional strategies such as cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, as well as emerging intraperitoneal modalities and microenvironment-targeted approaches. Finally, organoid platforms, liquid biopsy-based minimal residual disease monitoring, and theranostic technologies may enable more personalized, biology-driven management of PM. Full article
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21 pages, 2136 KB  
Conference Report
Hermione Exchange Educational Program: How to Integrate Multidisciplinary Approaches to Manage HR+/HER2- Metastatic Breast Cancer
by Marina Elena Cazzaniga, Nicola Fusco, Alessandra Fabi, Umberto Malapelle and Paolo Vigneri
Cancers 2026, 18(13), 2087; https://doi.org/10.3390/cancers18132087 - 27 Jun 2026
Viewed by 594
Abstract
Background/objective: Given the increasing complexity of the luminal breast cancer landscape, a proper characterization is required in everyday clinical practice, and the recurrence after the standard first-line treatment with CDK4/6 inhibitors with/without endocrine therapy should be managed. Method: The Hermione Exchange Educational Program [...] Read more.
Background/objective: Given the increasing complexity of the luminal breast cancer landscape, a proper characterization is required in everyday clinical practice, and the recurrence after the standard first-line treatment with CDK4/6 inhibitors with/without endocrine therapy should be managed. Method: The Hermione Exchange Educational Program was held in Milan, Italy, between September 2024 and January 2025. Two questionnaires were proposed regarding the use of targeted treatment or chemotherapy after progression from CDK4/6 inhibitors. The lecture and use cases enhanced the discussion during the workshops. Results: From the surveys, it emerged that most participants (69%) considered liver metastases at CDK4/6-inhibitor progression as a key reason to initiate chemotherapy, while lung progression influenced this choice for 50% of participants. Liver involvement guided the use of targeted therapy for 56%, and attitudes were divided on whether the duration of first-line CDK4/6 therapy should affect decisions (44% in agreement vs. 38% in disagreement). The willingness of patients to receive chemotherapy (88%) and comorbidities (81%) were significant drivers. Almost all participants agreed that both the duration of response and the molecular status were key aspects to consider when choosing a second line of therapy, along with the general clinical condition of the patient. In the lecture, tissue and liquid biopsy are considered powerful tools to describe tumor molecular features over time; such complexity should be harnessed by a close dialogue between oncologists, molecular biologists, and pathologists to optimize the therapeutic choice according to the mutational status of patients. The use cases illustrate three patients with visceral progression, non-visceral progression within 12 months, and non-visceral progression after 12 months following CDK4/6 inhibitors. Conclusion: Genomic testing should be considered at diagnosis and repeated during treatment to monitor the disease. The clinical experience acquired over the years must be integrated with new molecular knowledge. Full article
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18 pages, 503 KB  
Review
Immune Cell Therapy Promises More Effective Cure for Medulloblastoma
by Marco Agostini, Pietro Traldi and Mahmoud Hamdan
J. Pers. Med. 2026, 16(6), 326; https://doi.org/10.3390/jpm16060326 - 18 Jun 2026
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Abstract
Medulloblastoma is one of the most prevalent pediatric brain tumors. Currently, existing therapies for this devastating type of cancer can only prolong survival time with severe side-effects and relapse. These therapies are not curative for almost a third of treated patients, while most [...] Read more.
Medulloblastoma is one of the most prevalent pediatric brain tumors. Currently, existing therapies for this devastating type of cancer can only prolong survival time with severe side-effects and relapse. These therapies are not curative for almost a third of treated patients, while most survivors are condemned to a poor quality of life. The addition of immune checkpoint inhibitors (ICIs) to immune therapy has given some hope to those suffering from this type of cancer. Although ICIs provide a valuable contribution to immunotherapy, the exploitation of immune checkpoint inhibition within existing therapeutic strategies to cure Medulloblastoma remains understudied. However, the identification of the main molecular subgroups of medulloblastoma is considered one of the success stories of oncology. This advancement in molecular profiling of MB paved the way to subgroup-directed clinical trials, which may lead to efficacious immune-targeted therapy. However, this relatively new development is still hampered by a substantial biological heterogeneity of the disease and the absence of a full understanding of the various mechanisms behind its resistance to existing therapeutic modalities. The inclusion of chimeric antigen receptor (CAR) T and CAR NK cell therapy within various therapeutic strategies and ongoing clinical trials has given fresh hope those suffering from this fatal disease. However, ongoing clinical trials suggest that this highly promising therapy can be impaired by a number of serious limitations, including cytokine release syndrome, Graft-versus-host disease, the scarcity of target antigens, and severe adverse events. Some of the ongoing clinical trials also suggest that CAR NK is less prone to some of these limitations. This review also highlights the contribution of mass spectrometry-based proteomics, and the increasing role of liquid biopsy rather than tissue biopsy. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Neuro-Oncology)
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