The cancer journal
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Review
Adoptive therapy with chimeric antigen receptor-modified T cells of defined subset composition.
The ability to engineer T cells to recognize tumor cells through genetic modification with a synthetic chimeric antigen receptor has ushered in a new era in cancer immunotherapy. The most advanced clinical applications are in targeting CD19 on B-cell malignancies. The clinical trials of CD19 chimeric antigen receptor therapy have thus far not attempted to select defined subsets before transduction or imposed uniformity of the CD4 and CD8 cell composition of the cell products. This review will discuss the rationale for and challenges to using adoptive therapy with genetically modified T cells of defined subset and phenotypic composition.
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Randomized Controlled Trial
A randomized, double-blind, 2-period, placebo-controlled crossover trial of a sustained-release methylphenidate in the treatment of fatigue in cancer patients.
This study assessed the efficacy of methylphenidate versus placebo for cancer-related fatigue reduction. Other objectives were to analyze cytokine levels and to determine the effects of methylphenidate on other symptoms, cognitive function, work yield, and patients' perceptions and preferences. ⋯ Low-dose methylphenidate did not improve cancer-related fatigue. Patients taking methylphenidate had better cognition and were able to work more hours. Patients tolerated methylphenidate well, and the majority felt better and wanted to continue treatment.
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Adjuvant treatments after breast-conserving surgery (BCS) for ductal carcinoma in situ to prevent local relapse are considered standard of care. However, patient selection to prevent increased morbidity without proven survival benefit remains a challenge. To predict the risk of ipsilateral breast tumor relapse (IBTR) after BCS, the Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram. The aim of this study was to develop our own prediction model for IBTR and to provide an external validation of the MSKCC nomogram. ⋯ Despite the small number of events, the need for multiple imputation, and few patients without radiation, the MSKCC nomogram performance was somewhat better than our model. This shows that the MSKCC nomogram is externally valid. The MSKCC nomogram allows users to integrate the information from 10 different variables to provide a more precise risk stratification than the use of conventional single variables or hazard ratios.
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Low- and medium-resource countries are facing a significant increase in the incidence of noncommunicable diseases such as cancer. Unfortunately, the majority of patients with cancer present with advanced disease, and disease-directed treatment may be unlikely to be effective and/or not available. Globally, there will be a growing need for palliative care services. ⋯ This article provides an overview of the progress in providing palliative care in low- and medium-resource countries. In addition, more specific information is provided on palliative care in low-resource countries in Latin America, Asia, and Africa. Finally, a more personal perspective is presented on the development of palliative care in Ethiopia, as an example.
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Pain in cancer patients involves complex interactions between physiological, psychological, sociocultural, sensory, cognitive, and behavioral dimensions. Pain management interventions will be most effective when pharmacological and nonpharmacological treatments are individualized after exploring the various contributors to pain and suffering, and the patient and family are educated and involved in decision making. This entails a systematic multidimensional approach with frequent reassessments of pain and related outcomes.