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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 7 | Issue 3
Page Nos. 99-137

Online since Tuesday, September 1, 2020

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REVIEW ARTICLES  

Immuno-potentiating effects of Astragalus polysaccharides: A mini-literature review p. 99
Hung- Chih Lai, Jo- Pai Chen
DOI:10.4103/JCRP.JCRP_3_20  
Objective: Astragalus polysaccharides (APS) is a promising therapeutic agent because of its long history in ethnopharmacology, extensive research, wide application, and few side effects. Among its diversified properties, APS has been widely investigated for its immuno-potentiating effects such as stimulating T- and B-cell proliferation, regulating the expression of cytokines, activating macrophages, inducing the expression of surface antigens on lymphocytes, and promoting the production of antibodies. Data Sources: In this article, we review the research progress of APS focusing on its immuno-potentiating effects. Results: Based on the existing studies, APS appears to be a promising adjuvant to anticancer therapy, vaccines, antibiotics, and antiviral therapy. The information provided in this mini-review will provide a useful quick reference for its rational clinical utilization and in planning further research. Further studies are needed to evaluate its dose optimization, mechanism of action, and therapeutic combination strategies. Conclusion: APS may be another successful example of the standardization and modernization of Traditional Chinese herbal medicine.
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Vascular onco-therapies targeting continuous and intermittent intra-tumor hypoxia p. 105
Tanmoy Paul, Sharmita Basu
DOI:10.4103/JCRP.JCRP_9_20  
Objective: Solid tumors experience intra-tumor hypoxia once they achieve an increase in size. This is due to an imbalance between tumor oxygenation and the metabolic demand of the tumor as well as the development of chaotic microvasculature of the tumor. The hypoxic condition creates several barriers to the delivery of antitumor drugs to the tumor. Intra-tumor hypoxia alters the tumor microenvironment, accelerating the process of tumor angiogenesis, and culminating in the formation of chaotic tumor vasculature. The abnormal and faulty tumor microvasculature alters the interstitial pressure gradients of the tumor which severely impairs delivering drugs to solid tumors. Rectifying this microenvironment is an important avenue of anticancer research. The normalization of tumor vasculature may lead to an excellent anticancer management. Study Selection and Data Source: The present review involves recent studies on anticancer research targeting the hypoxia-signaling cascade in solid tumors. Results and Conclusion: The present review covers the cause of intra-tumor hypoxia, the resulting problems of anticancer drug delivery to the tumor, and contemporary research to overcome the problem of drug delivery to hypoxic solid tumors in humans.
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ORIGINAL ARTICLES Top

Efficacy and safety of uracil-tegafur in patients with recurrent or metastatic thymic carcinoma p. 111
Shih- Yu Huang, Cheng- Hua Huang, Harvey Yu-Li Su, Yen- Hao Chen, Tai- Jan Chiu, Yen- Yang Chen
DOI:10.4103/JCRP.JCRP_11_20  
Background: Thymic carcinoma (TC) is a rare but aggressive thymic epithelial neoplasm, with lymphoepithelioma-like histological features resembling nasopharyngeal carcinoma. Epstein–Barr virus is a known etiology of various tumors, including nasopharyngeal carcinoma, in Asian patients. These patients have a significant response to cisplatin plus 5-fluorouracil (5-FU) combination chemotherapy. Interestingly, this regimen seems to be effective for TC s resembling nasopharyngeal carcinoma. Currently, the standard second-line therapy for advanced TC is uncertain. The use of uracil-tegafur (UFT), a combination of uracil and 5-FU prodrug, has not been reported in literature. We analyzed the effectiveness and toxicity of UFT as an optional regimen for recurrent or metastatic TC. Materials and Methods: This retrospective study enrolled patients verified to have recurrent or metastatic TC and who were treated with UFT between 2017 and 2019 in our hospital. All patients were treated with UFT until disease progression, the patients could no longer tolerate the treatment, or patient refusal. We assessed the safety and efficacy of UFT for TC. Results: Four patients were female and seven were male. The age ranged from 41 to 77 years. The histological features of TC were squamous cell carcinoma and poorly differentiated carcinomas. Grade 3 toxicity occurred in one patient. No treatment-related deaths were observed. Among the 11 patients, 6, 2, and 3 had a partial response, stable disease, and progressive disease, respectively. The objective response rate was 54.5%. The median progression-free survival and overall survival of patients who received UFT chemotherapy were 8.16 months (95% confidence interval [CI]: 0.76–15.56 months) and 19.43 months (95% CI: 17.07–21.78 months), respectively. Conclusion: Single-agent UFT seems to have potential effectiveness and good tolerability in patients with recurrent or advanced TC.
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Oncological and renal function outcome in children with unilateral wilms' tumors treated with nephron sparing surgery or ablative nephrectomy p. 116
RB Nerli, Manas Sharma, Shridhar C Ghagane, Sreeharsha Nutalapati, Murigendra B Hiremath, Neeraj S Dixit
DOI:10.4103/JCRP.JCRP_12_20  
Background: We prospectively evaluated the oncological and renal functional outcomes of children with unilateral Wilms' tumor (WT) undergoing nephron-sparing surgery (NSS) versus ablative nephrectomy. Materials and Methods: Children presenting with unilateral WT from January 2006 to December 2015 were prospectively randomized to undergo either ablative (simple/radical) nephrectomy or NSS. Treatment was administered according to the Societe Internationale d'Oncologie Pediatrique-2001 protocol. Results: During the 10-year study period, 13 children underwent ablative nephrectomy, and 15 underwent NSS (partial nephrectomy/wedge excision). The contralateral kidneys were found to be normal on ultrasonography and computed tomography imaging. The mean age at intervention was 44.8 ± 16.7 months. Eight children presented with Stage I disease and the remaining 20 had Stage II disease. The mean follow-up period was 53. 68 ± 23.82 months and all children were alive at the last follow-up without any clinical evidence of disease. The event-free survival rates were 100% and 92.3% in the children undergoing NSS and ablative nephrectomy, respectively. The children who underwent ablative nephrectomy presented with considerably higher mean systolic and diastolic blood pressures, as well as significantly elevated mean values of serum creatinine compared to their ablative nephrectomy counterparts. Conclusion: The oncological outcome of NSS was as good as ablative nephrectomy in children with unilateral WTs. NSS also minimized the loss of renal function.
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SHORT COMMUNICATION Top

Management options for gynecological cancers in low- to middle-income countries amidst COVID-19 pandemic p. 121
Ashutosh Mishra, MD Ray, Sandeep Bhoriwal, Jyoti Sharma, Chitresh Kumar, Kunal Dhall, Manoj S Gowda, Akash Kumar
DOI:10.4103/JCRP.JCRP_14_20  
Objective: Due to Covid-19 pandemic, the oncologists and cancer patients are in a dilemma, whether they should continue with the planned treatment or wait till the pandemic is over. This review is intended to explore the management options for gynaecological cancers during the pandemic. Data sources: We searched for literature from Pubmed database and oncological socities pertaining to the management of gynaecological cancers and Covid-19 pandemic. Study Selection: For such once in a century pandemic, there is a paucity of evidence based literature. Therefore, to address this issue all the available relevant studies were reviewed. Results: Definitely, a deviation from a standard care for a longer period i.e. beyond 4-6 weeks may lead to a significant impact on over all outcomes. As this current scenario is one of the first after the advent of modern medicine, there are no clear-cut evidence based suggestions to adopt for clinicians. Various organizations like NCCN, ACS, SGO, ESMO have suggested few recommendations for present situation. Here again, a role of multidisciplinary team is of pivotal importance and every case merits discussion by multi-disciplinary team (MDT) before finalizing a strategy. We share our perspective on the issue, which is based on currently available evidences as well as the practices we intend to follow at our centre. We agree that the quality of evidence remains of low grade and are mostly based on expert recommendations with an aim to tide over this period of around 4-12 weeks. Conclusion: Precise triage of patients will play a pivotal role in preserving resources and protecting health care workers and patients. The expertise at the respective oncology centres, prevalence/incidence of COVID-19 cases in that area, the support system of the hospital and the patient profile should direct the changes in practices. We also recommend that the standard therapy should be resumed as soon as the situation improves.
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CASE REPORTS Top

Gemcitabine/cisplatin/pembrolizumab-induced posterior reversible encephalopathy syndrome p. 127
Yuh- Ching Gau, Hui- Ching Wang, Hui- Hua Hsiao, Yi- Chang Liu
DOI:10.4103/JCRP.JCRP_6_20  
Posterior reversible encephalopathy syndrome (PRES) is a syndrome related to endothelial dysfunction and disorder in cerebral autoregulation. The clinical manifestations include seizures, headache, mental alteration, and visual disturbance. The causes of PRES are diverse and include renal failure, transfusion, transplantation, endocrine disorders, autoimmune diseases, and cytotoxic and immunosuppressive agents. Various anti-cancer drugs such as gemcitabine and platinum can also cause PRES, and a few case reports have discussed the effect of immunotherapy on PRES. In this article, we present a case who developed PRES after receiving gemcitabine, cisplatin, and pembrolizumab. We also review previous cases with gemcitabine/cisplatin- and immunotherapy-induced PRES. Most of these cases had a good clinical outcome, the resolution of neurologic signs varied from days to weeks.
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Primary adenocarcinoma of the urinary bladder: Report of two cases with a literature review p. 130
Tsung- Jang Yeh, Shih- Hao Tang, Yi- Chang Liu, Hui- Hua Hsiao
DOI:10.4103/JCRP.JCRP_17_20  
Urothelial carcinoma is the most discussed form of bladder cancer. However, there are also other histological subtypes, such as adenocarcinoma, which have different presentations, treatment strategies, and prognosis. Primary adenocarcinoma of the urinary bladder can be classified as urachal adenocarcinoma and nonurachal adenocarcinoma. The average age of patients with urachal adenocarcinoma is about one decade younger than those with the nonurachal subtype, and the prognosis of urachal adenocarcinoma is better. Complete surgical resection is the standard treatment, but adjuvant therapy is always needed due to the high relapse rate. Due to the rareness, research about this malignancy is limited. Herein, we report two cases with different primary adenocarcinomas of the urinary bladder and perform a literature review.
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Successfully overcoming carboplatin hypersensitivity by continuous 48-h infusion of cisplatin plus poly (ADP-ribose) polymerase inhibitor for heavily pretreated recurrent ovarian cancer p. 134
Yu- Mei Zheng, Jyh- Ming Chow, Chia- Lun Chang, Gi- Ming Lai
DOI:10.4103/JCRP.JCRP_16_20  
The success of ovarian cancer treatment is hampered by the recurrent nature and the resistance or hypersensitivity to a platinum regimen. The addition of poly (ADP-ribose) polymerase (PARP) inhibitors can increase the sensitivity to platinum-resistant tumors, although while increasing risk of hematologic toxicity. Substituting cisplatin for carboplatin could result in satisfactory outcomes in the case of carboplatin hypersensitivity. However, there are no efficacy and safety data regarding continuous low-dose cisplatin infusion combined with an oral PARP inhibitor for ovarian cancer patients with hypersensitivity to carboplatin. Herein, we report the case of a heavily pretreated ovarian cancer patient with carboplatin hypersensitivity who safely received low-dose cisplatin (30 mg/m2 every 3 weeks) over a 48-h infusion combined with a PARP inhibitor for a total of 10 days (D− 2–D7) and successfully achieved partial response after four cycles of treatment, the efficacy of which was further enhanced by the addition of deep regional hyperthermia.
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