Surgical oncology clinics of North America
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Surg. Oncol. Clin. N. Am. · Oct 2020
ReviewMediastinal Germ Cell Tumors: Updates in Diagnosis and Management.
Primary mediastinal nonseminomatous germ cell tumors represent a rare but important malignancy that occurs in otherwise young and healthy patients. Treatment is challenging and involves cisplatin-based chemotherapy followed by surgery to remove residual disease. Avoiding bleomycin-containing chemotherapy in the treatment of primary mediastinal nonseminomatous germ cell tumors is important. Prechemotherapy and postchemotherapy pathology as well as postoperative serum tumor markers are independent predictors of long-term survival.
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Immune checkpoint inhibitors (ICIs) are therapeutic antibodies that target regulatory molecules on T cells and represent the most widely used FDA-approved class of immunotherapy. ICIs are associated with unique immune-mediated toxicities called immune-related adverse events. ⋯ This article summarizes toxicities, potential mechanisms of action, management strategies, and other clinical considerations. Unique mechanisms of action and immune-related toxicities of other FDA-approved classes of immunotherapy are reviewed.
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Indications for robotic surgery have been rapidly expanding since the first introduction of the robotic surgical system in the US market in 2000. As the robotic systems have become more sophisticated over the past decades, there has been an expansion in indications. ⋯ Complex abdominal cancers are increasingly operated on using robot-assisted laparoscopy and with acceptable outcomes. In this article, the authors discuss robotic developments, from the past and the future, with an emphasis on cancer surgery.
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The design of modern oncology clinical trials seeks to match patients' cancer molecular biomarkers with medications that specifically target those biomarkers, a general paradigm shift in cancer care coined clinical cancer biology. This approach exploits the synthetic lethality between a specific genetic alteration in the cancer cell and a drug: rapid termination of exaggerated kinase activity exemplifies this phenomenon. Synthetic lethality-based investigations are driven by rapidly evolving technologies for cancer molecular profiling. As these technologies evolve, future clinical trials will test drugs' activity based on the molecular mechanisms rather than by the tumor's appearance under a microscope.
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Surg. Oncol. Clin. N. Am. · Apr 2017
ReviewCurrent Progress in Human Epidermal Growth Factor Receptor 2 Targeted Therapies in Esophagogastric Cancer.
Esophagogastric cancer is a worldwide health problem. The addition of the epidermal growth factor receptor 2 (HER2)-directed antibody trastuzumab to chemotherapy increased the overall survival of patients with metastatic HER2-positive esophagogastric cancer. This article discusses the available data to support HER2 as validated biomarker and recently completed and ongoing clinical trials of HER2-directed agents in metastatic and localized disease. Also reviewed is the mechanisms of resistance for HER2-directed therapy and ongoing research strategies including new imaging techniques and studies with patient-derived xenografts.