The development of immunotherapy has revolutionized the landscape of cancer treatment. Personalized neoantigen vaccines are attractive systemic immunotherapies that trigger specific T-cell responses against highly specific neoantigens, and activate and expand helper and cytotoxic T-lymphocytes to enhance anti-tumor immunity. Based on the rapid development of bioinformatics and the continuous update of sequencing technology, cancer immunotherapy with tumor neoantigens has made promising breakthroughs and progress. Researchers are exploring the value of neoantigen vaccines alone or in combination in different tumor types. We provide an overview of the complex process that is necessary to generate a personalized neoantigen vaccine, discuss the current status of clinical studies and application testing personalized neoantigen vaccines in patients with cancer and future perspectives on this novel, personalized approach to immunotherapy.
We briefly analyzed the research design and results through summarizing the latest hot spots relevant to targeted therapy in combination with immunotherapy (Abbreviated as “combination therapy” ) for hepatocellular carcinoma (HCC), aiming to provide references for clinical decision-making and future research directions. It was found that the clinical study results related to combination therapy for HCC were different by summarizing the study design and results of combination therapy for HCC in recent years, which might be closely related to the study design, drug selection, research objects selection, protocol implementation, and other factors. It is suggested that a variety of factors such as disease background should be considered when combination therapy for HCC is conducted in order to obtain a more comprehensive and objective understanding.
【摘要】 目的 探討一次性麻醉穿刺包與普通腹腔穿刺包在腹腔化療中應用效果。 方法 將2008年6月-2009年4月住院的胃癌和卵巢癌行腹腔化療的患者53例，隨機分為兩組。實驗組29例，用一次性麻醉穿刺包行腹腔穿刺化療；對照組24例，用普通腹腔穿刺包行腹腔穿刺化療；比較兩組患者應用不同穿刺包行腹腔穿刺化療的并發癥比較。 結果 實驗組并發癥發生率明顯低于對照組(Plt;0.05)。 結論 一次性麻醉穿刺包應用于腹腔化療中操作簡便、創傷小、并發癥少，患者樂于接受等優點，值得在臨床上推廣使用。【Abstract】 Objective To explore the effects of one-off anesthesia paracentesis kit and ordinary peritoneal paracentesis kit in intraperitoneal chemotherapy. Methods A total of 53 patients with gastric cancer or ovarian cancer from June 2008 to April 2009 were randomly divided into two groups: 29 patients in trial group underwent intra-peritoneal chemotherapy with one-off anesthesia paracentesis kit, and 24 patients in the control group underwent intra-peritoneal chemotherapy with ordinary peritoneal paracentesis kit. The complications in two groups were compared. Results The incidence of complications in trial group was much lower than that in the control group (Plt;0.05). Conclusion One-off anesthesia paracentesis kit in intra-peritoneal chemotherapy has several advantages including simple manipulation, small injuries, and few complications, which is well accepted by the patients.
ObjectiveTo research prognostic prediction value of serum γ-glutamyltransferase-to-prealbumin ratio (GPR) for patients with hepatocellular carcinoma (HCC) after radical resection. MethodsThe clinical data of HCC patients undergoing radical resection from January 2013 to November 2021 were analyzed retrospectively. The optimal critical value of GPR was determined by receiver operating characteristic (ROC) curve. The patients were allocated into the low GPR group (GPR was the optimal critical value or less) and the high GPR group (GPR was greater than the optimal critical value). The differences of clinicopathologic characteristics were compared between the two groups. The overall survival (OS) and relapse-free survival (RFS) were analyzed by the Kaplan-Meier survival curve and compared by the log-rank test between the two groups. The risk factors affecting the OS and RFS of patients with HCC were analyzed by univariate and multivariate Cox regression, and the predictive value of GPR on the OS was evaluated by ROC curve. ResultsA total of 216 eligible HCC patients were gathered. The optimal critical value of GPR was 0.29, 93 cases were in the low GPR group and 123 cases were in the high GPR group. Compared with the low GPR group, the proportions of the patients with preoperative alanine aminotransferase >50 U/L, albumin <40 g/L, total bilirubin ≥34.2 μmol/L, tumor size >5 cm, multiple tumor lesions, stage Ⅲ of China liver cancer staging (CNLC), and major hepatectomy (liver segment resection was 3 or more) were higher in the high GPR group (P<0.05). The Kaplan-Meier survival curve showed that the OS and RFS of the low GPR group were better than those of the high GPR group (χ2=14.356, P＜0.001; χ2=7.963, P=0.005). Cox regression multivariate analysis showed that the preoperative alpha-fetoprotein (AFP) ≥400 μg/L, GPR >0.29, stage Ⅲ of CNLC, and operation time (more than 3 h) were the risk factors for OS and RFS of HCC patients (P<0.05). The area under the ROC curve of GPR alone and it in combination with risk factors (preoperative AFP and CNLC stage, respectively) and in combination with the above three indicators to predict the OS of patients with HCC were 0.636, 0.712, 0.696, and 0.737, respectively. ConclusionFrom the results of this study, GPR is associated with the postoperative survival of patients with HCC after radical resection, and GPR in combination with preoperative AFP and CNLC stage has a certain predictive value for the OS.
ObjectiveTo analyze the platelet (PLT) count, coagulation function, and portal vein thrombosis (PVT) in the patients underwent splenectomy due to different etiologies. MethodsThe patients who underwent splenectomy in the Affiliated Hospital of Southwest Medical University from January 2013 to December 2022 were collected. According to the etiology, the patients were assigned into the occupying group (splenic and pancreatic occupying lesions), hypersplenism group (portal hypertension and hypersplenism), and splenic rupture group (traumatic splenic rupture). The changes of PLT, white blood cells (WBC), red blood cells (RBC), neutrophils (Neut), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (DD), and PVT were observed after splenectomy. ResultsA total of 166 patients were collected, including 42 in the occupying group, 22 in the hypersplenism group, and 102 in the splenic rupture group. There were no statistically significant differences in the age and preoperative Child-Pugh score among the patients of the three groups (P>0.05). There were 12 (7.2%) patients with PVT, including 2 in the occupying group, 6 in the hypersplenismn group, and 4 in the splenic rupture group. The PVT incidence among the three groups had a statistical significant difference (Fisher exact test, P=0.003), which in the hypersplenismn group was higher than the occupying group (P=0.016) and the splenic rupture group (P=0.002), while there was no statistically significant difference between the occupying group and the splenic rupture group (P=1.000). The overall trend was that the PLT, RBC, WBC, and various coagulation function indicators such as PT, APTT, and Fib among the three groups all showed an upward trend immediately after splenectomy, but the postoperative peak time and change trends had no markedly regular among the three groups. The PLT of the patients with and without PVT changed over time during the observation period (patients without PVT: F=60.238, P<0.001; patients with PVT group: F=9.700, P=0.043), and which showed a continuous upward trend after surgery, reaching a peak on the 14th day and then beginning to decline in the patients of both 2 groups. However, there was no statistically significant intergroup effect between the 2 groups (F=0.056, P=0.816). ConclusionsThe results of this study suggest that the peak value of PLT in the hypersplenism group is lower as compared with the occupying group and the splenic rupture group, and the PVT is more likely to occur. However, no difference of the PLT level is found in the patients without and with PVT.
ObjectiveTo evaluate the efficacy and cost-effectiveness of thymalfasin (Tα1) as an adjuvant therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after surgery.MethodsPatients with HBV-related HCC who underwent hepatectomy from February 2007 to December 2015 in West China Hospital of Sichuan University, Chengdu Military General Hospital, or the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the Tα1 group and the observation group. Log-rank test and Kaplan-Meier curve were used to assess the overall survival, recurrence-free survival, and safety of patients. A Markov model was used to calculate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of the Tα1 group compared with the observation group. Cost data was from the hospital information system of the three hospitals. Utility scores mainly came from published data. Sensitivity analyses were applied to explore the impact of essential variables.ResultsA total of 208 patients with HCC after liver resection were enrolled, among them 48 received Tα1 treatment (the Tα1 group) and 160 were only followed up (the observation group). There was no significant difference between the two groups in the baseline characteristics. The median overall survival of the Tα1 group and the observation group was 102.0 months [95% confidence interval (CI) (74.8, 129.2) months] and 81.6 months [95%CI (65.7, 97.6) months], respectively, and the difference was statisitically significant (P=0.047); the median recurrence-free survival was 66.7 months [95%CI (17.3, 116.1) months] and 37.4 months [95%CI (28.7, 46.2) months], respectively, and the difference was statistically significant (P=0.044). There were no grade Ⅲ-Ⅳ adverse events and no treatment-related death occurred. The ICER of Tα1 group was ￥108 050.02/QALY, which was less than the willingness to pay (￥177 785.25/QALY).ConclusionsTα1, as an adjuvant therapy for HBV-related HCC patients, can improve the prognosis of the patients, and the cost is within the acceptable level in our country, so this strategy is likely to be a cost-effective option compared with the observation group.
【摘要】 目的 探討替吉奧膠囊聯合奧沙利鉑治療晚期胃癌的近期療效和毒性反應。 方法 2010年1-7月，16例晚期胃癌患者根據體表面積來確定初始劑量，體表面積lt;1.25 m2，替吉奧膠囊40 mg/次，2次/d；體表面積1.25~1.5 m2，替吉奧膠囊50 mg/次，2次/d；體表面積gt;1.5 m2，替吉奧膠囊60 mg/次，2次/d，早、晚飯后分別口服1次，連續服用28 d，停藥14 d。奧沙利鉑注射液130 mg/m2加入5%葡萄糖注射液500 mL避光緩慢靜gt;2 h，第1、21天重復，連用2周期。按RECIST 1.1標準評價客觀療效和不良反應。 結果 16例患者中PR 9例（56.3%），SD3例（18.8%），PD 4例（25%），總有效率為69.0%。不良反應主要是血液學毒性、胃腸道反應及外周神經毒性，且均在Ⅰ~Ⅱ。 結論 替吉奧膠囊聯合奧沙利鉑方案治療晚期胃癌的近期療效較好，不良反應可以耐受，值得進一步研究應用。【Abstract】 Objective To explore the early efficacy of Oxaliplatin combined with S1 capsule on advanced gastric cancer and observe the toxicity. Methods A total of 16 patients with advanced gastric cancer from January to July 2010 were treated with chemotherapy: oxaliplatin 130 mg/m2 mixed with 5% glucose injection 500 mL in the first day and repeated in the 21st day; Po after breakfast and dinner: S1 capsule with an initial dose according to the body surface area. Body surface lt;1.25 m2, 40 mg once, twice per day; body surface:1.25-1.5 m2,50 mg once, twice per day; body surface gt;1.5 m2, 60 mg once, twice per day. The medication lasted for 28 days, withdrew for 14 days. All of the patients underwent the treatment for two cycles. Efficacy and toxicities were evaluated according to the RECIST 1.1 standard. Results Of the 16 patients, partial remission (PR) was in nine (56.3%), stable disease was in three (18.8%) (SD), and progression disease was in four (PD). The total response rate was 69.0%. The major toxicities included leucopenia, nausea, vomiting and neurosensory abnormity. Conclusion Oxaliplatin combined with S1 capsule is effective on advanced gastric cancer, and the adverse effects are tolerable.