Search Results (278)

Background: Tyrosine kinase inhibitors (TKIs) are crucial to treating endocrine-related malignancies, including advanced thyroid cancers and neuroendocrine tumors, but their benefit is tempered by cutaneous adverse events (CAEs) that impair adherence and quality of life. Objective: To summarize the dermatologic toxicities of TKIs used in endocrine oncology and provide practical, multidisciplinary guidance for prevention and management. Methods: Narrative synthesis of clinical trial reports, post-marketing studies, and specialty guidelines pertinent to lenvatinib, vandetanib, cabozantinib, and other commonly used TKIs, integrating dermatologic and endocrine perspectives on mechanisms and care pathways. Results: VEGFR-targeted TKIs frequently cause hand–foot skin reaction, xerosis, fissuring, paronychia, and impaired wound healing; multikinase inhibition also produces alopecia, pigmentary changes, and mucositis. Epidermal growth factor receptor (EGFR) and rearranged during transfection (RET) inhibition with vandetanib is associated with acneiform eruption, photosensitivity, and nail fragility. Pathogenesis reflects on-target inhibition of VEGF/EGFR signaling leading to keratinocyte dysfunction, vascular fragility, and altered eccrine mechanics. Early risk stratification, patient education, and bundle-based prophylaxis (emollients, keratolytics, urea-based creams, sun protection) reduce incidence and severity. Grade-based algorithms combining topical corticosteroids/antibiotics, dose interruptions or reductions, and short systemic courses (e.g., doxycycline, antihistamines) enable symptom control while maintaining anticancer intensity. Close coordination around procedures minimizes wound-healing complications. Conclusions: Dermatologic toxicities are predictable, mechanism-linked, and manageable with proactive, multidisciplinary care. Standardized prevention and treatment pathways tailored to specific TKIs—particularly lenvatinib, vandetanib, and cabozantinib—can preserve dose intensity, optimize quality of life, and sustain antineoplastic efficacy. Full article

Cutaneous lymphomas are a heterogeneous group of extranodal non-Hodgkin lymphomas with distinct clinical and biological features, broadly classified into cutaneous T-cell lymphomas (CTCL) and cutaneous B-cell lymphomas (CBCL). With improved survival due to early detection and therapeutic advances, the emergence of second primary malignancies (SPMs) has become a clinical concern. SPMs, defined as new, distinct malignant neoplasms arising synchronously or metachronously with the index cancer, can significantly impair prognosis and quality of life. In this narrative review, we meticulously examine the current literature, to synthesize evidence on SPMs’ incidence and risk factors in patients with primary cutaneous lymphomas. Evidence from population-based and institutional studies consistently demonstrates elevated risks of hematologic and solid tumors in CTCL. By contrast, data on CBCL remain limited, though recent population-based analyses suggest increased risks of certain hematologic malignancies and solid tumors. We further propose development mechanisms for SPMs, including treatment-related mutagenesis, shared genetic susceptibilities, chronic antigenic stimulation, and immune dysregulation. Lastly, we highlight the clinical implications of these findings, underscoring the need for vigilant surveillance, patient education, and tailored screening strategies. Future research should prioritize large-scale, prospective, and molecularly integrated studies to refine risk stratification and guide personalized survivorship care of this vulnerable population. Full article

The brain and the immune system communicate in many ways and interact directly at neuroimmune interfaces at brain borders, such as hippocampus, choroid plexus, and gateway reflexes. The first part of this review described intercellular communication (synapses, extracellular vesicles, and tunneling nanotubes) during homeostasis and neuroimmunomodulation upon dysfunction. This second part compares spatial orientation, learning, and memory function in both systems. The hippocampus, deep in the medial temporal lobes of the brain, is reported to play a central role in all three functions. Its medial entorhinal cortex contains neuronal spatial cells (place cells, head direction cells, boundary vector cells, and grid cells) that facilitate spatial navigation and allow the construction of cognitive maps. Sensory input (about 100 megabytes per second) via engram neurons and top down and bottom up information processing between the temporal lobes and other lobes of the brain are described to facilitate learning and memory function. Output impulses leave the brain via approximately 1.5 million fibers, which connect to effector organs such as muscles and glands. Spatial orientation in the immune system is described to involve gradients of chemokines, chemokine receptors, and cell adhesion molecules. These facilitate immune cell interactions with other cells and the extracellular matrix, recirculation via lymphatic organs (lymph nodes, thymus, spleen, and bone marrow), and via lymphatic fluid, blood, cerebrospinal fluid, and tissues. Learning in the immune system is summarized to include recognition of exogenous antigens from the outside world as well as endogenous blood-borne antigens, including tumor antigens. This learning process involves cognate interactions through immune synapses and the distinction between self and non-self antigens. Immune education via vaccination helps the process of development of protective immunity. Examples are presented concerning the therapeutic potential of memory T cells, in particular those derived from bone marrow. Like in the brain, memory function in the immune system is described to be facilitated by priming (imprinting), training, clonal cooperation, and an integrated perception of objects. The discussion part highlights evolutionary aspects. Full article

KEAP1 negatively regulates the cytoprotective factor NRF2 and is commonly inactivated in lung cancer cells. Loss-of-function KEAP1 mutations in cancer cells contribute to NRF2 activation and tumor immune evasion through immunosuppression and drug resistance. Counterintuitively, treatment with synthetic oleanane triterpenoids, potent NRF2 activators, reduces the pre-clinical tumor burden. This suggests the functional target of these drugs in cancer models is not the cancer cells but another tumor immune microenvironment (TIME) cell population. The anti-tumor potential of cells within the TIME, particularly macrophages, is potentiated by triterpenoid treatment in cancers with wild-type KEAP1 status. As KEAP1-mutant cancers show reduced tumor immune responses, triterpenoid-mediated immune stimulation may particularly benefit these cases, but this has not been investigated. To characterize the immunomodulatory effects of triterpenoids in KEAP1-mutant lung cancer, we studied tumor-educated bone marrow-derived macrophages (TE-BMDMs) and lung cancer models treated with the triterpenoids CDDO-Me or omaveloxolone. RNA-sequencing of TE-BMDMs cultured in KEAP1 KO compared to WT cancer-conditioned media had enhanced tumor-promoting phenotypes, which reversed with CDDO-Me treatment. Similarly, subcutaneous KEAP1 KO tumors were larger and more immune-suppressed compared to WT tumors. Both CDDO-Me and omaveloxolone reduced the tumor burden and improved immune cell phenotypes within the TIME independent of KEAP1 mutational status. Full article

Therapeutic strategies targeting “tumor-educated platelets” (TEPs) and platelet–tumor interactions by key signaling pathways (ITAM, P2Y12) may reduce metastasis and cancer. Using a TEP gene expression dataset originally created to study swarm intelligence-enhanced detection of lung cancer cells (GSE89843), we did perform extensive transcriptome analysis to integrate these data with directed protein–protein interactions and build a TEP-specific signaling network. We analyze network topology and controllability and identify critical and indispensable nodes, as well as high-weight, usually high-score nodes. We reconstruct (pharmacological) controllable subnetworks of TEP signaling, which we then explore for drugs targets. We found 111 upregulated and 108 downregulated genes compared to control platelets, enriched in pathways related to extracellular matrix interactions, cytoskeleton organization, immune signaling, and platelet activation. Ribosomal function, apoptosis, and immune signaling were among the downregulated processes, highlighting unique TEP profiles in non-small-cell lung cancer (NSCLC). Our integrative analysis of TEPs in NSCLC reveals key transcriptional and network-based alterations harmful for the cancer patient. Using four complementary strategies, we identified five high-confidence genes (Gene symbols always given throughout the paper), ITGA2B, FLNA, GRB2, FCGR2A, and APP, as central to TEP signaling. These can be targeted by FDA-approved drugs. Fostamatinib, an SYK inhibitor, emerged as the top candidate drug to disrupt ITAM-mediated platelet activation selectively; metastasis-promoting metalloprotease and cytoskeletal targets influencing adhesion were also identified. A low-dose combination therapy of fostamatinib, Aducanumab, and acetylsalicylic acid (aspirin) may control TEP effects. In conclusion, our preclinical in silico approach revealed FDA-approved drugs that allow therapeutic targeting of metastasis-promoting TEPs and target NSCLC at the same time. Full article

Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer death worldwide. Early detection of lung cancer can lead to identification of the cancer at its initial treatable stages and improves survival. Low-dose CT scan (LDCT) is currently the gold standard for lung cancer screening in high-risk individuals. Despite the observed stage migration and consistently demonstrated disease-specific overall survival benefit, LDCT has inherent limitations, including false-positive results, radiation exposure, and low compliance. Recently, new techniques have been investigated for early detection of lung cancer. Several studies have shown that liquid biopsy biomarkers such as circulating cell-free DNA (cfDNA), microRNA molecules (miRNA), circulating tumor cells (CTCs), tumor-derived exosomes (TDEs), and tumor-educated platelets (TEPs), as well as volatile organic compounds (VOCs), have the power to distinguish lung cancer patients from healthy subjects, offering potential for minimally invasive and non-invasive means of early cancer detection. Furthermore, recent studies have shown that the integration of artificial intelligence (AI) with clinical, imaging, and laboratory data has provided significant advancements and can offer potential solutions to some challenges related to early detection of lung cancer. Adopting AI-based multimodality strategies, such as multi-omics liquid biopsy and/or VOCs’ detection, with LDCT augmented by advanced AI, could revolutionize early lung cancer screening by improving accuracy, efficiency, and personalization, especially when combined with patient clinical data. However, challenges remain in validating, standardizing, and integrating these approaches into clinical practice. In this review, we described these innovative milestones and methods, as well as their advantages and limitations in screening and early diagnosis of lung cancer. Full article

Cancer therapy is rapidly evolving from a one-size-fits-all paradigm toward highly personalized approaches. Traditional chemotherapies and radiotherapies, while broadly applied, often yield suboptimal outcomes due to tumor heterogeneity and are limited by significant toxicities. In contrast, precision oncology tailors prevention, diagnosis, and treatment to the individual patient’s genetic and molecular profile. Key advancements underscore this shift: molecularly targeted drugs (e.g., trastuzumab for HER2-positive breast cancer, EGFR and ALK inhibitors for lung cancer) have improved efficacy and reduced toxicity compared to conventional therapy. Pharmacokinetic (PK) and pharmacodynamic (PD) considerations are central to personalizing treatment, explaining variability in drug exposure and response among patients and guiding dose optimization. Modern strategies like therapeutic drug monitoring and model-informed precision dosing seek to maintain drug levels in the therapeutic range, improving outcomes. Immunotherapies, including checkpoint inhibitors and CAR-T cells, have transformed oncology, though patient selection via biomarkers (such as PD-L1 expression or tumor mutational burden) is critical to identify likely responders. Innovative drug delivery systems, notably nanomedicine, address PK challenges by enhancing tumor-specific drug accumulation and enabling novel therapeutics. Furthermore, rational combination regimens (informed by PK/PD and tumor biology) are being designed to achieve synergistic efficacy and overcome resistance. Key barriers include the high cost of biomarker testing, insufficient laboratory infrastructure, and inconsistent reimbursement policies. Operational inefficiencies such as long turnaround times or lack of clinician awareness further limit the use of precision diagnostics. Regulatory processes also remain complex, particularly around the co-development of targeted drugs and companion diagnostics, and the evidentiary requirements for rare subgroups. Addressing these barriers will require harmonized policies, investment in infrastructure, and educational initiatives to ensure that the promise of personalized medicine becomes accessible to all patients. Ensuring that advances are implemented responsibly—guided by pharmacological insights, supported by real-world evidence, and evaluated within ethical and economic frameworks—will be critical to realizing the full potential of personalized cancer medicine. Full article

Pediatric diffuse midline gliomas in the brainstem (bDMGs) are malignant primary brain neoplasms with poor prognosis. Conventional dogma cites that biopsy procedures have risks of devastating injury to the eloquent brainstem and have no direct benefit to affected patients. In recent years, the use of augmented reality (AR) adjuncts has demonstrated potential in providing excellent intraoperative three-dimensional (3D) visualization of intracranial structures. Put together, we hypothesize that the application of AR will be useful as a training tool for brainstem biopsy procedures. Anatomical models of bDMG tumors are created and uploaded to an AR application. The processed data is transferred into designated AR head-mounted devices. Briefly, individual 3D-rendered bDMG images are overlaid with an age-matched, life-sized child mannequin in prone position. A virtual stereotactic brain biopsy needle is deployed by the user into the lesion. At the end of the exercise, each user evaluates their trajectory of choice to assess its accuracy. Overall, the participants reported that the AR platform was useful in reviewing technical nuances for brainstem biopsy in a safe environment. This focused, proof-of-concept study adds to the growing body of literature that AR platforms demonstrate feasibility for neurosurgeons in the understanding of challenging operative neuroanatomy. Full article

Non-small cell lung cancer (NSCLC) is a severe disease with a very poor prognosis. Some 30–80% of patients with NSCLC die within five years of cancer diagnosis. The main factors contributing to this condition are the lack of effective markers for diagnosing cancer at an early stage, as well as the complexity of the biological processes involved in tumorigenesis and progression. The development of knowledge regarding all aspects of NSCLC has provided information used in the detection, systemic anticancer therapy and monitoring of NSCLC, which has a significant impact on prognosis and quality of life. NSCLCs release various biological substances into the bloodstream. Liquid biopsies allow for the analysis of tumor components in body fluids, and the usefulness of these biopsy tests as a substitute for tumor tissue is increasing. In this article, we critically review the available literature on microRNAs, circulating cell-free DNA (cfDNA), tumor-educated platelets (TEPs), circulating tumor cells (CTCs), circulating extracellular vesicles (EVs), and metabolomic and proteomic markers in the diagnosis and monitoring of NSCLC. However, the usefulness of these new markers in clinical practice has significant limitations. Full article

Skin tumors are among the most common neoplasms in dogs and cats, sharing biological and environmental risk factors with human cancers. Owners play a critical role in early detection, yet little is known about their knowledge and attitudes. This study aimed to assess the knowledge, perceptions, attitudes, and practices of Portuguese pet owners regarding skin tumors in companion animals. An online cross-sectional survey was completed by 420 respondents. Overall, awareness of risk factors such as sun exposure and age was relatively high, but most owners were unable to identify specific tumor types or locations. Only one-quarter believed skin tumors are curable, while the majority expressed uncertainty. Women, those with multiple or long-term pet ownership, and individuals with family or personal experience of cancer showed greater knowledge and more proactive behaviors. However, a gap between knowledge and practice still remains. These findings underscore the need for targeted educational strategies to enhance owners’ health literacy, facilitate early detection, and promote timely veterinary care. Full article

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy marked by late diagnosis, rapid progression, and poor prognosis, with a 5-year survival rate of 2–9%. Traditional tissue biopsy faces limitations in accessibility and real-time monitoring. Liquid biopsy—a minimally invasive technique analyzing tumor-derived materials such as circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, tumor-educated platelets (TEPs), and cell-free RNAs (cfRNAs)—offers dynamic insights into PDAC biology. This review advances beyond the prior literature by offering a unified synthesis that bridges molecular mechanisms, biomarker dynamics, and clinical translation within the context of PDAC. It also summarizes key clinical trials evaluating liquid biopsy in PDAC, underscoring its growing impact on precision oncology. Full article

Background/Objectives: Representing the most common malignancy worldwide, skin cancer requires timely detection to improve prognosis. Both educational level of the patients and health literacy are important variables in terms of prevention and diagnosis in early stages of the disease, but data from Central and Eastern Europe are limited. Methods: We realized a prospective observational study that included 76 patients who were diagnosed with skin cancer and treated at the “Prof. Dr. I. Chiricuță” Institute of Oncology in Cluj-Napoca, Romania. Demographic, clinical, histopathological, and psychosocial data were collected in a standardized form. The primary aim was the measurement of diagnostic delay, defined as the interval since symptom onset until diagnosis. Secondary variables included education level, place of residence, participation in awareness campaigns and understanding capacity. Statistical analyses were applied. Results: The mean age in the cohort was 58.3 years; 52.6% were male and 84.2% were urban residents. The most frequent histological type was melanoma (47.4%), followed by basal cell carcinoma (36.8%), and squamous cell carcinoma (10.5%). The median delay in diagnostic was equal to 3 weeks. Education level was significantly related to earlier presentation (Kruskal–Wallis, p = 0.043), with shorter delays noticed in patients with university or postgraduate degrees (compared to those with secondary education). However, there were no significant differences between patients with rural and urban provenience (p = 0.483). Patients’ capacity of understanding showed no correlation with diagnostic delay, but their prior participation in awareness campaigns was strongly associated with higher comprehension (p < 0.001). Also, skin self-examination did not significantly impact time to diagnosis (p = 0.86). Conclusions: Higher levels of education and patients’ exposure to awareness campaigns might represent predictors of shorter diagnostic delay, highlighting the impact of public health initiatives and targeted educational strategies to improve early detection of skin cancers in Romania. However, the findings must be interpreted in light of the study’s limitations, namely the relatively small sample size and single-center design. Full article

HPV-related head and neck cancers are increasing globally and although they constitute a major public health problem, there are currently no validated screening or early detection methods in widespread clinical use. This review discusses advances in clinical and molecular aspects of prevention, screening, and early detection of HPV-related head and neck cancers (HNCs), such as potential use of HPV blood or saliva seropositivity, RNA biomarkers, liquid biopsy, circulating tumor DNA, and proteomics. In addition to HPV vaccination, public education about vaccination, smoking, and safe sexual practices is warranted. Continued research is warranted to define optimal use and integration of approaches for prevention, screening, and early detection methods of HNCs. Full article

Background/Objectives: Skin cancer is the most common cancer worldwide, creating a significant burden on healthcare systems. According to the World Health Organization, 1.5 million new cases are reported annually, though the actual number is likely higher due to underreporting. The main risk factor is UV radiation, with additional contributors such as smoking, older age, and outdoor work. Basal cell carcinoma (70–80%) and squamous cell carcinoma are the most prevalent non-pigmented skin cancers. This study assessed the knowledge of patients undergoing surgical treatment for facial skin cancer regarding risk factors, prevention, treatment, and health-related behaviors. The goal was to guide educational strategies aimed at reducing disease incidence and improving outcomes. Methods: A cross-sectional study of 220 patients treated at the UCK Department of Plastic Surgery (April–August 2024) was conducted. Participants completed anonymous questionnaires on demographics, medical history, beliefs about lesions, and sun-protective behaviors. Clinical data included tumor location, size, histopathology, and excision completeness. Statistical significance was set at p < 0.05. Results: Patients were on average 71 years old; 61% had a secondary education. Sun protection habits varied by education and gender. SPF use was higher among those with higher education (79.55%) and among women (55.83%). SPF users had smaller lesion diameters (p < 0.001). However, 71% delayed seeking care for over a year, often due to misperceptions. Conclusions: There is a notable lack of awareness about skin cancer, especially prevention and early detection. Education and gender influence protective behaviors. Tailored educational initiatives may help reduce incidence and promote earlier diagnosis. Full article

Background: Inflammatory bowel disease (IBD) represents significant health challenges on a global scale, primarily encompassing Crohn’s disease and ulcerative colitis. These conditions are characterized by cycles of relapse and remission. Current treatment options, including conventional chemical therapies and biologics such as anti-Tumor Necrosis Factor α (anti-TNFα), anti-integrin, anti-interleukins 12 (IL-12) or 23 (IL-23) agents, Janus Kinase (JAK) inhibitors, and sphingosine-1-phosphate (S1p) receptor modulators, provide symptomatic relief but do not offer a cure. These therapies are associated with both localized and systemic adverse effects, necessitating careful patient monitoring. Probiotics and prebiotics have been investigated for their potential to enhance gut microbiota diversity, which may assist in managing IBD. However, their efficacy in preventing disease flares remains limited. Recent advances in drug delivery systems, including pressure-based and pH-sensitive formulations, aim at enhancing localized treatment efficacy while minimizing adverse effects. Additionally, a pharmacogenomic approach could improve treatment personalization, optimize therapeutic outcomes, and enhance patients’ quality of life by addressing mental health needs and ensuring comprehensive follow-up care. Despite increased awareness and education among healthcare providers regarding IBD, there is still a need for clearer guidance on available treatment options. Objective: This review aims at providing deeper understanding of IBD management strategies, ultimately striving to improve the quality of care for individuals affected by this disease. Full article