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Oral mucositis (OM) caused by ionizing radiation is a significant therapeutic problem concerning almost all patients with head and neck cancers undergoing irradiation, however, an effective treatment method is still missing. Therapeutic actions concentrate mostly on prophylaxis, including the maintenance of the correct hygiene of the oral cavity. In 2014 the International Society of Oral Oncology (ISOO) together with the (Multinational Association of Supportive Care in Cancer (MASCC) worked out the guidelines for the treatment of patients with z OM induced by radiotherapy and chemotherapy. In 2019 these guidelines were updated. Research is ongoing to find medication which could be applicable for the prevention and treatment of OM. The problem is grave as it might complicate the progress of oncological treatment, deteriorate the patient’s quality of life or even affect the prognosis. This paper describes the pathogenesis of oral mucositis, the current trends in treatment and discusses the role of a dentistry doctors in the care of the patient with symptoms of this condition. The article also refers to the role of a multidisciplinary team – the OM prophylaxis – as part of the preparation of an oncological patient for irradiation. [ABSTRACT FROM AUTHOR]

In the present paper we synthesized 10 unique pyrimidine scaffolds (Lanso Aminopyrimidines) derived from 4-(2,2,2-trifluoroethoxy)-2-(chloromethyl)-3-methylpyridine as a core molecule, which can be used for the design of more potent and effective anticancer agents. The in vitro anticancer activities of the synthesized new pyrimidine derivatives were screened at the National Cancer Institute, USA, against a full NCI 60 cell lines. Most of the compounds exhibited remarkable growth inhibition at a single dose (10 µM) in Leukaemia cancer cell. 4-(4-{3-Methyl-4-[(2,2,2-trifluoroethoxy)pyridin-2-yl]methylamino}phenyl)-6-phenyl-1,6-dihydropyrimidin-2-amine which showed high activity against RPMI-8226 leukaemia cancer cells (GI50 35.50 µM) and can be considered as a candidate lead compound for developing new promising anticancer agents. [ABSTRACT FROM AUTHOR]

This paper presents the theoretical background of using auricular therapy (AT) for managing chemotherapy-induced nausea and vomiting (CINV) from the perspectives of traditional zang-fu organs and meridian theory. The zang-fu organs of stomach, spleen and liver play a crucial role in regulating the gastrointestinal functions. The chemotherapeutic agents can significantly impede the gastrointestinal functions and subsequently contribute to various gastrointestinal symptoms including nausea and vomiting. Dysfunctions of the stomach, spleen and liver can correspond to specific auricular acupoints, while by stimulating those acupoints, the chaotic Qi movement can be reversed to its normal status, and the hyperactivities of the gastrointestinal system can also be alleviated to reduce the CINV symptoms. Clinical studies based on such theory have well supported the effects of AT on CINV. However, relationships between the traditional theory and the modern medicine understanding of the CINV mechanisms remain unknown and should be further explored in future research. [ABSTRACT FROM AUTHOR]

Summary Objectives This paper aims to compare the longtime efficacy of induction chemotherapy followed by concurrent chemoradiotherapy (IC + CCRT) and concurrent chemoradiotherapy (CCRT) alone in locally advanced nasopharyngeal carcinoma (LANPC) by using time-to-event data based on randomized controlled trials (RCTs). Materials and methods We searched all RCTs comparing the efficacy between IC + CCRT and CCRT of LANPC in major medical databases including Pubmed, web of science, cochrane, China National Knowledge Internet Web (CNKI), Wanfang, and VIP. The Hazard ratios (HR) of time-to-event data on overall survival (OS), progressive free survival (PFS), distant metastasis failure-free survival (D-FFS), and loco-regional failure-free survival (L-FFS) from the enrolled studies were calculated for this meta analysis. Our primary endpoints were OS, PFS, D-FFS, and L-FFS. Results Four studies with 798 patients were enrolled for this paper. Compared with in CCRT alone, HRs (95% confidence interval) of OS, PFS, D-FFS and L-FFS were 0.52 (0.21–1.29), 0.66 (0.49–0.90), 0.60 (0.39–0.98) and 0.66 (0.16–2.65) respectively in IC + CCRT. Conclusions Induction chemotherapy could significantly reduce the hazard of progression and distant metastasis in LANPC on the basis of concurrent chemoradiotherapy, but do less with the hazard of overall death and loco-regional failure. [ABSTRACT FROM AUTHOR]

Health services provided at home are becoming more important in most European countries. A better understanding of the specificities of home care (HC) operations and their management is therefore necessary. The importance of operations management for HC is obvious; such systems are faced with a growing demand for care and higher expectations for improved service delivery with more and more constraints on available budget and resources. Based on interviews of HC practices in France and Italy as well as an international review of the literature related to HC operations, this paper aims at contributing to a better characterisation of HC operations and the associated decision-making models. The main part of the presentation is made at a generic level and the paper includes also a more specific part on the chemotherapy at home process. We also provide a discussion on the most relevant research topics in the field of HC operations management. [ABSTRACT FROM PUBLISHER]

In this paper, a principal question regarding the effect of inputs on the characteristics of dynamic systems is discussed. Whether an input implemented only for a limited duration, can change the characteristics of a dynamic system such that the behavior of the free system, after eliminating the input, differs from that before acting the input? In this paper, it is shown that a limited time acted input is not able to change the dynamical properties of a system after its elimination. Regarding the proposed approach, a novel finite duration treatment method is developed for a tumor-immune system. The vaccine therapy is used to change the parameters of the system and the chemotherapy is applied for pushing the system to the domain of attraction of the healthy state. For optimal chemotherapy, an optimal control is used based on state-dependent Riccati equation (SDRE). It is shown that, in spite of eliminating the treatment (therapeutic inputs), the system approaches to healthy state conditions. The present analysis suggests that a proper treatment method must change the dynamics of the cancer instead of only reducing the population of cancer cells. [ABSTRACT FROM AUTHOR]

The treatment of breast cancer requires intensive methods. Depending on the severity of the disease surgery, radiotherapy, chemotherapy, or endocrine therapy is applied. In most cases these methods are combined, thus increasing the chances of recovery, but also intensifying side effects. Until recently, physical activity was contraindicated in the treatment of malignant tumours. Currently, an increasing number of studies confirm the beneficial effect of physical activity on the physical and mental state of people after the treatment of malignant tumours. The paper presents selected studies showing the impact of physical activity on the physical fitness of women treated for breast cancer. The authors draw attention to the difficulty of comparing the results of physical activity due to the use of different questionnaires and different methods. Furthermore, the paper includes recommendations on forms of exercise indicated for cancer patients, as well as situations that require restrictions or constitute a contraindication for physical activity. [ABSTRACT FROM AUTHOR]

The main purpose of this paper is to propose an optimal finite duration treatment method for preventing tumor growth. The obtained results show that changing the dynamics of the cancer model is essential for a finite duration treatment. Therefore, vaccine therapy is used for changing the parameters of the system and chemotherapy is applied for pushing the system to the domain of attraction of the healthy state. The state-dependent Riccati equation (SDRE)-based optimal control method is used for optimal chemotherapy. In this method, the special conditions of the patients could be considered by choosing suitable weighting matrices in the cost function and restricting the drug dosage. Also, there are infinite ways to choose these state-dependent matrices. In this paper, these interesting features of this method are used for each patient. Since measuring the states of the system is impossible at each time for states feedback; an extended Kalman filter (EKF) is designed as an observer in the nonlinear system. So, the SDRE method is employed just by measuring the population of normal cells. Numerical simulations show the flexibility and effectiveness of this treatment method. [ABSTRACT FROM AUTHOR]

Targeted neurotrophic tropomyosin receptor kinase (TRK) inhibitors offer a highly specific therapeutic option for patients with infantile fibrosarcoma (IFS) carrying the NTRK gene translocation. International recommendations are needed to define the role of TRK inhibitors (TRKI) for infants with IFS. We analysed retrospective data for all published patients with IFS in the European Paediatric Soft tissue sarcoma Study Group and Cooperative Weichteilsarkomstudiengruppe (CWS) experience and developed a consensus strategy with the Children's Oncology Group. Therapies consisted of tumour resection and/or perioperative chemotherapy for extensive tumours. Among the 172 European patients treated, 162 were alive at the end of the follow-up. Sixty-five patients (40% of all survivors) were treated with surgery alone and 64 patients (39%) with surgery combined with chemotherapy. Radiotherapy was delivered to 3% of survivors (five patients). In addition, 28 survivors (17%) exclusively received chemotherapy. Among the 129 patients treated with surgery, 91% had conservative surgery (118 cases). Overall, nine patients died of disease, one from toxicity (6%) and 20 patients (12%) survived with major functional deficits or had mutilating surgery. Overall, conventional conservative strategies before the era of targeted therapy, even in the case of extensive tumours, demonstrate efficacy in IFS, but are associated with acute and some chronic side effects. TRKI have demonstrated very rapid responses in the vast majority of children with IFS with limited acute toxicity. With the current state of our knowledge, both conventional chemotherapy and TRKI should be regarded as options for patients with localised disease at the physician's and parent's discretion. TRKI should be considered in patients with metastatic disease, and before mutilating surgery when conventional chemotherapy fails. Outside a clinical trial, additional data are needed to resolve the lack of consensus about front-line use of conventional chemotherapy versus TRKI in patients with localised disease. • Neurotrophic tropomyosin receptor kinase inhibitors (NTRKI) are new target drugs. • NTRKI are really efficient against infantile fibrosarcoma (IFS). • Pros and cons of NTRKI for patients with IFS are discussed. • An international consensus is proposed for advanced or refractory IFS. • This paper will help clinicians to better treat children with IFS. [ABSTRACT FROM AUTHOR]

Introduction: Metastasis to the gastrointestinal tract from lung cancer is very uncommon and is often asymptomatic. Although small bowel metastasis may commonly occur, metastases to the stomach and colon are uncommon. Case report: In this paper, we present a previously healthy 57-year-old male patient, a 60-packet per year smoker, who was taken to the emergency room with complaints of increasing abdominal pain, rectal bleeding, weight loss, and dyspnea for the last three months. Endoscopic examination revealed polypoid lesions in the duodenum and the descending colon. We diagnosed neuroendocrine small-cell lung cancer based on histopathological and immunohistochemical staining. Management and outcome: A cisplatin (d1, 60 mg/m2/day)–etoposide (d1 to d3, 120 mg/m2/day) regimen was given every three weeks as palliative chemotherapy. After the three course of chemotherapy, the lung radiograph showed a decline in hilar expansion and there was no pleural effusion. Then, he died of acute respiratory failure two weeks after radiotherapy of brain. Discussion: Gastrointestinal tract metastasis of lung cancer is recognized synchronously with or rarely before diagnosis. It is generally recognized after the diagnosis of lung cancer. These patients often have other concurrent body metastases. Prognosis is poor, and survival expectation is short. The most common metastases to the gastrointestinal tract are squamous and large cell lung cancer metastases. Our aim is to emphasize the importance of immunohistochemical examination for masses in the gastrointestinal tract and to present this rare case of synchronous duodenal and colonic metastases of small-cell lung cancer. [ABSTRACT FROM AUTHOR]

Treatment of cancer is a major challenge even though the pathophysiology is becoming clearer with time. A number of new chemical entities are developed to target cancer growth inhibition, but the targeted delivery of these products still needs novel research. This is of utmost importance not only for higher efficacy but also for a reduction in systemic toxicity and cost of treatment. Although multiple novel targets and molecules are being researched, most of them could not pass the regulatory approval process, due to low benefit–risk ratio and lack of target specificity. Failure of a majority of these drugs was in part due to their superiority claimed via surrogate markers. Despite these, currently, more than 100 chemotherapeutic agents are in practice. This review paper discusses in detail the molecular basis, drug discovery, and pros and cons over conventional treatment approaches of three novel approaches in cancer therapy, i.e., (i) antibody–drug conjugates, (ii) cancer immunotherapy, and (iii) metronomic chemotherapy. All the drugs developed using these three novel approaches were compared against the established treatment regimens in clinical trials with clinical end points, such as overall survival, progression-free survival, and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To estimate total direct health care costs associated to diagnosis and treatment of women with breast cancer in Italy, and to investigate their distribution by service type according to the disease pathway and patient characteristics. Methods: Data on patients provided by population-based Cancer Registries are linked at individual level with data on health-care services and corresponding claims from administrative databases. A combination of cross-sectional approach and a threephase of care decomposition model with initial, continuing and final phases-of-care defined according to time occurred since diagnosis and disease outcome is adopted. Direct estimation of cancer-related costs is obtained. Results: Study cohort included 49,272 patients, 15.2% were in the initial phase absorbing 42% of resources, 79.7% in the continuing phase absorbing 44% of resources and 5.1% in the final phase absorbing 14% of resources. Hospitalization was the most important cost driver, accounting for over 55% of the total costs. Conclusions: This paper represents the first attempt in Italy to estimate the economic burden of cancer at population level taking into account the entire disease pathway and using multiple current health care databases. The evidence produced by the study can be used to better plan resources allocation. The model proposed is replicable to countries with individual health care information on services and claims. [ABSTRACT FROM AUTHOR]

Cancer medicine is a challenging field with an increasing range of promising therapies and combinations. Increasingly, personalised medicine shows promise to improve cancer outcomes – response, symptom control, survival and cure. However, optimal dosing is an under‐appreciated aspect of personalised anticancer therapy, with few clinical trials addressing this specific issue. This position paper aims to inform various health professionals about the principles that guide anticancer drug dose selection and modifications. We discuss the available evidence base for personalised dosing, as well as the professional judgement required by experienced oncology physicians to determine the most appropriate dose for each patient. We provide nine steps to guide clinicians and trainees in this process, based on: pharmacology of each agent (absorption, distribution, metabolism, elimination and mechanism of action); scientific evidence for recommended doses; professional knowledge of patients' unique phenotype (adiposity, comorbidities, etc.); previous drug tolerance; individual dose adjustment in combination therapy; communication and documentation, with the added need for ongoing monitoring and adjustment. We strongly propose professional education and future research towards optimal dosing. [ABSTRACT FROM AUTHOR]

Objective: Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a new type of intraperitoneal chemotherapy for peritoneal carcinosis via minimally invasive surgery. This technique's specificity is the remote application of the therapy because of the potential risk of exposure to toxic products. The present paper summarises the important aspects of PIPAC and analyses the anaesthetic outcomes. Methods: This retrospective study included all patients undergoing PIPAC treatment between January 2015 and February 2018. Data on protocol adherence and perioperative anaesthetic complications and postoperative nausea and vomiting (PONV) and pain levels (visual analogue scale 0-10) from recovery room to 72 h were analysed. Results: The overall analysis included 193 PIPAC procedures on 87 patients. Protocol adherence was high as regards the use of propofol (100%), rocuronium (98%), antiemetic prophylaxis (99%) and lidocaine intravenous (i.v.) (87%). No accidental exposure to chemotherapy occurred during the study period. Of the 87 patients, 6.3% suffered delayed recovery, 58% due to hypothermia and 42% due to excessive sedation or curarisation. In the recovery room, 16% of patients suffered moderate to severe pain, requiring >8 mg of morphine i.v., with average doses of 13.7 mg. Median postoperative pain scores were 1 and 3 at 12 h and 0 and 0 at 72 h at rest and mobilisation, respectively. PONV was observed in <10% of patients during the first 12 h, but in 40% at 72 h. Conclusion: A dedicated anaesthetic protocol and intraoperative safety checklist facilitates safe, well-tolerated anaesthesia for PIPAC treatments. [ABSTRACT FROM AUTHOR]

The United States spends nearly 1/5th of its GDP on healthcare. Yet, to achieve value‐based care, the Economist describes the US healthcare system as handicapped by multiple, disparate silos that prevent the organization and sharing of data. This paper explores the current state of clinical oncology drug research and its relationship to value‐based cancer care. Clinical Chemotherapy Pathways are proposed as a unifying structure to bring together disparate sources of data to increase value. [ABSTRACT FROM AUTHOR]

Purpose: The complex physiological barriers impose extremely conflicting demands on systemic drug delivery, so both particle size and surface charge of the nanoplatforms become vital factors. As a carbon-based nanomaterial with excellent optical properties, carbon dots are not suitable for direct systemic transport in vivo, which limits their application in the field of biomedical imaging, especially in the areas of diagnosis and cancer treatment. Liposomes have been developed as universal nanocarriers for various drugs. In this study, we aimed to build a highly precise and penetrative drug delivery system (DDS) using carbon dots encapsulated by liposomes. Methods: Carbon dots (CDs) were synthesized by the hydrothermal method using citric acid and ethylenediamine. Furthermore, simian virus 40 large T-antigen derived the nuclear targeting sequence (NLS) was bonded on the surface of CDs to obtain CDs-NLS. The antitumor drug doxorubicin was loaded onto the CDs-NLS through an acid-labile hydrazine bond to obtain DOX@CDs. Finally, DOX@CDs were encapsulated in aqueous centers of folate-coated and pH-sensitive liposomes, named pHSL-FA. Results: In this paper, a nucleus-targeted nanocomposite (DOX@CDs), which bonds with the nuclear targeting sequence (NLS) and the anticancer drug doxorubicin (DOX), has physicochemical properties of particle size of about 3.8 nm, zeta potential of +31.8 mV and high quantum yield of 64.53%. The negatively charged folate-coated and pH-sensitive liposomes (pHSL-FA) are used as a carrier to reverse the surface charge of DOX@CDs. Compared to free DOX@CDs, pHSL-FA show higher tumor accumulation in 4 T1 tumor-bearing mice and further improve cytotoxicity to tumor cells. Conclusions: This work proposes a unique nanomedical approach that enables the precise delivery of chemotherapy drugs and significantly reduces side effects, which is promising for clinical translation. [ABSTRACT FROM AUTHOR]

Background: Diagnosis and treatment for individuals with brain tumors during childhood involves sequelae, including abnormal weight gain. This symptom is commonly clustered with fatigue and increased risk for cardiovascular disease. Children's Oncology Group recommendations include annual surveillance of body mass index (BMI) and cardiometabolic comorbidities; however, there has been little emphasis on individualized screening early in survivorship. Purpose: The primary purpose of this paper is to describe the findings of abnormal weight gain and its correlates in a sample of young childhood brain tumor survivors during early survivorship. Design and Methods: This cross‐sectional multi‐site study included brain tumor survivors of ages 8–12 years who were less than 6 years posttreatment. Convenience sampling from two pediatric cancer centers in the southern United States was utilized. Data collected included BMI, parent report of sleep, and child report of fatigue and stress. Results: The sample (N = 21) consisted of children who had received chemotherapy, radiation treatment, and surgery for childhood brain tumor. BMI in overweight and obese categories exceeded normative samples with 38% at or above the 85th percentile. There were clinically significant relationships with fatigue, stress about weight, tumor location, cranial radiation, chemotherapy, and recurrence Practice Implications: Screening for abnormal weight gain and related factors, such as fatigue should begin early in survivorship after childhood brain tumor treatment completion with the aim of health promotion and disease prevention. Adiposity measurement techniques should be utilized in future clinical and research settings to improve assessment of cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Background: Nicotinamide N-methyltransferase (NNMT) is highly expressed in several cancers and can regulate cell epigenetic status and various cell metabolism pathways, such as ATP synthesis and cellular stress response. We reported in our previous papers that NNMT overexpression inhibits the apoptosis and enhances the chemotherapy resistance of breast cancer cells. This study aims to investigate the effect of NNMT on autophagy induced by oxidative stress in breast cancer cells, which might provide a novel therapeutic strategy for breast cancer treatment. Methods: NNMT and LC3B II protein levels in the two cell models (SK-BR-3 and MDA-MB-231) with NNMT overexpression or knockdown were detected by Western blotting and correlated with each other. Changes in cellular viability, intracellular reactive oxygen species (ROS) and ATP levels were assessed after H2O2 treatment. Then, autophagosomes were imaged by transmission electron microscopy, and LC3 puncta were examined by confocal microscopy and flow cytometry. The LC3B II level and AMPK-ULK1 pathway activity were both detected by Western blotting to determine the role of NNMT in the H2O2-induced autophagy. Results: NNMT expression was negatively correlated with LC3B II expression in both cell models (SK-BR-3 and MDA-MB-231). Then, NNMT overexpression attenuated the autophagy induced by H2O2 in SK-BR-3 cells, whereas knockdown promoted autophagy induced by H2O2 in MDA-MB-231 cells. Furthermore, mechanistic studies showed that NNMT suppressed the ROS increase, ATP decrease and AMPK-ULK1 pathway activation, resulting in the inhibition of H2O2-induced autophagy in breast cancer cells. Conclusions: We conclude that NNMT inhibits the autophagy induced by oxidative stress through the ROS-mediated AMPK-ULK1 pathway in breast cancer cells and may protect breast cancer cells against oxidative stress through autophagy suppression. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to study the impact of combination Lactobacillus Rhamnosus Heriz I and Beta glucan on quality of life (QOL) in breast cancer (BC) patients receiving chemotherapy. Design/methodology/approach: In all, 30 women with BC were enrolled in this randomized double-blind placebo-controlled clinical trial. Intervention group received either daily one capsule of L. rhamnosus strain Heriz I (2 × 107 CFU) and two 10-mg capsules of soluble1–3,1–6,D-beta glucan and the placebo group receiving placebo, interval between two courses of chemotherapy. Health-related QOL was evaluated at baseline and end of the trial using the EORTC QOL Questionnaire version.3.0 (EORTC QLQ-C30). Findings: The results showed that combination of L. rhamnosus Heriz I and Beta glucan supplementation in BC patients during chemotherapy improved functional scales score from 37.3 ± 12.1 to 39.8 ± 6.8 and this increase in comparison with placebo was significant after adjusting baseline value (p = 0.015). Changes in symptoms scores were not significant after intervention (p = 0.05) but the decreased score (66.1 ± 12.9 to 60.6 ± 9.4) was considerable clinically. As well as, changes in global health status/QOL score in intervention group in comparison with the placebo group was not significant (p = 0.93). Originality/value: The findings suggest that combination of L. rhamnosus Heriz I and Beta glucan may be associated for improving functional scales and symptoms in patients with BC who underwent chemotherapy. To prove positive effect of supplements on other aspects of QOL, further studies are needed. [ABSTRACT FROM AUTHOR]

Early detection and characterization of circulating tumor DNA (ctDNA) can reveal mint of comprehensive biological insights from indicating the presence of tumor, identifying mutational changes of malignant cells, and allowing precision or targeted therapy together with monitoring disease progression, treatment resistance, and relapse of the disease. Apart from these, one of the greatest axiomatic implications of ctDNA detection is that it provides a new shed of light as noninvasive liquid biopsy as a replaceable procedure of surgical tumor biopsy. Despite the tremendous potential of ctDNA in cancer research, there remains a paucity of quantitative study on ctDNA detection and analysis. The majority of previously published microfluidic-based studies have focused on circulating tumor cell (CTC) detection and have failed to address the potential of ctDNA. The studies on microfluidic ctDNA detection are not consistent might be due to the complexity of ctDNA isolation as they present in low concentration in blood plasma. Researchers need to leverage the ability of microfluidic system for ctDNA analysis so that the significant enigma about cancer can be resolved effectively. This study, therefore, highlights the importance of ctDNA as cancer biomarker for liquid biopsy and provides an overview of the current laboratory as well as microfluidic techniques for ctDNA detection. This paper also attempts to show the emergence of new strands of microfluidic ctDNA detection and analysis for personalized cancer chemotherapy. [ABSTRACT FROM AUTHOR]

Fluoropyrimidine-based regimens are among the most commonly used chemotherapy combinations for the treatment of solid tumors. Several genetic polymorphisms that are implicated with fluoropyrimidine anabolism and catabolism have been associated with the development of life-threatening toxicities. Uridine triacetate is an FDA-approved antidote for 5-fluorouracil or capecitabine overdose and early-onset, life-threatening toxicity within 96 h of last chemotherapy dose. To date, it is not accessible for Greek patients as per the current summary of product characteristic's time restrictions. We report and discuss the course and outcome of capecitabine toxicity in a 66-year-old female colorectal cancer patient with heterozygous dihydropyrimidine dehydrogenase deficiency. This paper highlights the difficulty in timely access of this lifesaving medication for Greek and possibly other European patients. [ABSTRACT FROM AUTHOR]

Background Maintenance therapy induces remission and prolongs disease free interval in primary and recurrent ovarian disease. For the treatment decision making process, aspects of quality of life and patients' preferences are crucial, despite the fact that scientific data are lacking. Therefore, we conducted this European-wide study in patients with ovarian cancer. Methods A 25 item questionnaire was provided to ovarian cancer patients via the internet or as a paper version in 10 European countries (Austria, Belgium, France, Germany, Italy, Romania, Slovenia, Finland, Turkey, and Spain). Data recorded were demographics, tumor stage, therapy after firstline and recurrent disease, preferences for administration, and expectations concerning maintenance therapy. Results Overall, 1954 patients participated from September 2013 to March 2016; 42% had recurrent disease. Most patients (98%) with primary epithelial ovarian cancer underwent surgery followed by chemotherapy (91%). Almost one-third of participants (29%) were receiving maintenance therapy whereas 45% had only heard of it. For 70% of patients with primary epithelial ovarian cancer, they heard about maintenance therapy from their doctor, 10% heard about maintenance therapy from other patients, and 8% from the internet. The main source of information about maintenance therapy in patients with epithelial ovarian cancer relapse was from the treating physician (72%), from other patients (8%), and from the internet (7%). For patients undergoing maintenance therapy, the four most disturbing adverse effects were polyneuropathy (37%), nausea (36%), hair loss (34%), and vomiting (34%). The main objective of maintenance treatment, as perceived by patients, was to increase the chances of cure (73%), improvement in quality of life (47%), and delay in tumor growth (37%). Many patients were willing to undergo maintenance therapy until tumor progression (38%) and 39% would prefer oral administration. No significant differences were detected in the cross country subanalysis regarding expectations of maintenance therapy and patients with primary or relapsed ovarian cancer. Conclusion Patients with ovarian cancer were willing to accept maintenance therapy of prolonged duration and preferred oral administration. There is still a gap between the efficacy of maintenance therapy and patient expectations. Patients need more information on the adverse effects and treatment goals of maintenance therapy to avoid misunderstandings. [ABSTRACT FROM AUTHOR]

Cancers of unknown primary (CUP) are among the most common causes of death due to cancer, are associated with a poor prognosis and have few therapeutic options available. Molecularly-guided site-specific treatments were explored based on the assumption that CUP are similar in their response to treatment of predicted primary tumours. Given the discordant results between these studies, a meta-analysis using a random-effects model and the inverse variance method was performed. MEDLINE and conference abstracts of American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) meetings were searched from inception until November 2019. A trend towards improved OS was noted with site-specific versus empiric treatment for CUP (HR = 0.73; 95% confidence interval (CI) 0.52–1.02). There was significant heterogeneity across the four studies (I [2] = 79%; p = 0.002) but no significant difference was noted between the treatment effect in the two subgroups (randomised vs. non-randomised; p = 0.07). The test for overall effect for progression free survival, which had only been reported for the two randomised studies, was not statistically significant (HR = 0.93; 95% CI 0.74–1.17), with little heterogeneity between studies (I [2] = 0%; p = 0.77). The results of this meta-analysis highlight the significant heterogeneity between the prospective studies comparing molecularly tailored to empiric therapy for CUP and the need for other randomised studies including only primary tumors with available effective therapies. • This paper is a meta-analysis of the trials evaluating site-specific treatments in CUP. • No significant survival benefit with site-specific versus empiric chemotherapy. • There was significant heterogeneity across the prospective studies. • Current evidence is insufficient to recommend site-specific therapy in CUP. • However, certain patients with CUP may still benefit from tailored treatments. [ABSTRACT FROM AUTHOR]

In this paper, we propose a mathematical model that combines chemotherapy and oncolytic virotherapy as an alternative to treatment of a glioma. The main idea is to incorporate the virotherapy after the first or second chemotherapy session using a specialist virus that attacks only tumor cells. Some simulations are presented. Based on the results, we conclude that with this combined therapy may reduce the number of chemotherapy sessions and may lead to obtain better results in the fight against gliomas. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Despite aggressive upfront treatment with a combination of surgery and chemotherapy, most women with advanced epithelial malignancy will experience disease recurrence. The goal of treatment in the recurrent setting shifts away from a curative approach towards palliation of symptoms. In an attempt to delay time to first recurrence, the concept of maintenance chemotherapy emerged. This paper reviews the available literature evaluating the use of maintenance chemotherapy in the primary treatment setting and its effect on progression-free survival and overall survival. [ABSTRACT FROM AUTHOR]

A diagnosis of recurrent epithelial ovarian cancer carries with it a very poor prognosis despite aggressive chemotherapy with or without secondary surgical cytoreduction. Recently, maintenance treatment after second-line chemotherapy has gained momentum given promising results of antiangiogenics and PARP inhibitors used in this setting. When used appropriately, these agents may provide a meaningful survival benefit with minimal effects on quality of life. This paper reveals the current literature evaluating the use of maintenance therapy in the recurrent setting for the epithelial ovarian, fallopian tube, or primary peritoneal cancers. [ABSTRACT FROM AUTHOR]

In this paper we propose a heuristic approach that computes the order in which patients will be treated in an ambulatory chemotherapy center. Each patient follows an individual treatment plan that fixes dates for series of drug injections separated by recovery periods. The daily care process has three steps: consultation with the oncologist, drug preparation in the pharmacy and drug injection in medical beds. The facility closes after the last injection. As drug injection varying considerably in duration—from 15 min to 6 h—bad schedules lead to excessive overtime. In addition, after the consultation the oncologist may decide to cancel the injection because of a weak patient's health condition. In the current setting of the chemotherapy facility we work with, First Come First Served policy controls the care process. In this study, we propose to compute a common priority list of patients for consultation and injection phases. A unique list of patients is a simple tool used by nurses to manage the flow of patients and to react to uncertain events. A GRASP algorithm is developed to compute optimized list of patients in few seconds as the operating planning context requires. Two objectives are considered; the closing time and the overworking time of the facility. Numerical experiments show that our GRASP is able to quickly reach near optimal solutions and that list of patients policy performance is comparable to more complex scheduling policies. Benchmark data sets are built based on historical data of the French chemotherapy facility, ICL in Saint-Étienne. [ABSTRACT FROM AUTHOR]

PURPOSE: Patient-reported outcome measures (PROMs) that assess how patients feel and function have potential for evaluating quality of care. Stakeholder recommendations for PRO-based performance measures (PMs) were elicited, and feasibility testing was conducted at six cancer centers. METHODS: Interviews were conducted with 124 stakeholders to determine priority symptoms and risk adjustment variables for PRO-PMs and perceived acceptability. Stakeholders included patients and advocates, caregivers, clinicians, administrators, and thought leaders. Feasibility testing was conducted in six cancer centers. Patients completed PROMs at home 5-15 days into a chemotherapy cycle. Feasibility was operationalized as ≥ 75% completed PROMs and ≥ 75% patient acceptability. RESULTS: Stakeholder priority PRO-PMs for systemic therapy were GI symptoms (diarrhea, constipation, nausea, vomiting), depression/anxiety, pain, insomnia, fatigue, dyspnea, physical function, and neuropathy. Recommended risk adjusters included demographics, insurance type, cancer type, comorbidities, emetic risk, and difficulty paying bills. In feasibility testing, 653 patients enrolled (approximately 110 per site), and 607 (93%) completed PROMs, which indicated high feasibility for home collection. The majority of patients (470 of 607; 77%) completed PROMs without a reminder call, and 137 (23%) of 607 completed them after a reminder call. Most patients (72%) completed PROMs through web, 17% paper, or 2% interactive voice response (automated call that verbally asked patient questions). For acceptability, > 95% of patients found PROM items to be easy to understand and complete. CONCLUSION: Clinicians, patients, and other stakeholders agree that PMs that are based on how patients feel and function would be an important addition to quality measurement. This study also shows that PRO-PMs can be feasibly captured at home during systemic therapy and are acceptable to patients. PRO-PMs may add value to the portfolio of PMs as oncology transitions from fee-for-service payment models to performance-based care that emphasizes outcome measures. [ABSTRACT FROM AUTHOR]

Cancer is still a disease with many unknowns. In this paper, we developed a study on the proliferation of tumor cells under chemotherapeutic treatment and the influence of integrative oncology on these results. Initially, we analyzed mathematically tumor behavior, using the Gompertz model, with and without chemotherapeutic treatment. We observed the variation of the immune system and tumor cell fighter cells directly associated with the integrative treatment through the noetic threshold. We analyzed tumor cell behavior, associated with the immune system, especially after treatment completion. The uncertainties under the parameters used led us to use the fuzzy theory and with that also define the fuzzy noetic threshold. We inserted the possibility of resistant cells to the chemotherapeutic treatment and studied the optimal control with this treatment. We also considered the values of the initial conditions, the node threshold, and the resistant cells by fuzzy numbers. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this paper is investigating the effect and mechanism of Shenfu injection (a Traditional Chinese Medicine injection form) on prevention and treatment of paclitaxel chemotherapy in peripheral nerve injury. Methods. Wistar rat dorsal root ganglion cells were cultured in vitro and divided into groups of MOCK, PT, PT + LD, and PT + HD. Each group was cultured at a total serum concentration of 10%, including 10% blank serum in the MOCK group, 0.73 (IC30) μmol/L paclitaxel + 10% blank serum in the PT group, and 10% and 5% drug-containing serum and equal amount of paclitaxel were added into the high- and low-dosage groups, respectively. After culturing for 24 hours, the following tests were performed: (1) cell proliferation detected by using CCK-8 and a microplate reader; (2) axon length detected by cellular immunostaining and detection analysis on antibody β-tubulin III; and (3) changes in mitochondrial membrane potential by analyzing immunofluorescence staining with JC-1 probe. Results. (1) Cell proliferation: OD values of the MOCK group and PT group were 0.43 ± 0.02 and 0.25 ± 0.03, respectively (P < 0.05), while OD values of groups PT + LD and PT + HD were 0.41 ± 0.05 and 0.46 ± 0.03, respectively, higher than group PT (P < 0.05). (2) Axon length: (171.19 ± 9.2) μm and (59.2 ± 6.1) μm (P < 0.05) in the MOCK group and PT group, respectively; and (124.2 ± 18.3) um and (154.5 ± 22.9) um in the PT + LD and PT + HD groups, respectively, higher than the PT group (P < 0.05). (3) Changes in mitochondrial membrane potential: the MOCK group showed red fluorescence. Compared with the MOCK group, the green fluorescence of the PT group was enhanced and the red fluorescence was weakened. The red fluorescence of the PT + LD and PT + HD groups was partially enhanced compared with the PT group. Conclusion. Shenfu injection can prevent the toxicity of DRG neurons induced by paclitaxel, and its mechanism may be related to the alleviation of mitochondrial dysfunction. [ABSTRACT FROM AUTHOR]

AGO‐OVAR 12 investigated the effect of adding the oral triple angiokinase inhibitor nintedanib to standard front‐line chemotherapy for advanced ovarian cancer. At the primary analysis, nintedanib demonstrated significantly improved progression‐free survival (PFS; primary endpoint) compared with placebo. We report final results, including overall survival (OS). Patients with primary debulked International Federation of Gynaecology and Obstetrics (FIGO) stage IIB–IV newly diagnosed ovarian cancer were randomised 2:1 to receive carboplatin (area under the curve 5 or 6) plus paclitaxel (175 mg/m2) on day 1 every 3 weeks for six cycles combined with either nintedanib 200 mg or placebo twice daily on days 2–21 every 3 weeks for up to 120 weeks. Between December 2009 and July 2011, 1,366 patients were randomised (911 to nintedanib, 455 to placebo). Disease was considered as high risk (FIGO stage III with >1 cm residuum, or any stage IV) in 39%. At the final analysis, 605 patients (44%) had died. There was no difference in OS (hazard ratio 0.99, 95% confidence interval [CI] 0.83–1.17, p = 0.86; median 62.0 months with nintedanib vs. 62.8 months with placebo). Subgroup analyses according to stratification factors, clinical characteristics and risk status showed no OS difference between treatments. The previously reported PFS improvement seen with nintedanib did not translate into an OS benefit in the nonhigh‐risk subgroup. Updated PFS results were consistent with the primary analysis (hazard ratio 0.86, 95% CI 0.75–0.98; p = 0.029) favouring nintedanib. The safety profile was consistent with previous reports. What's new? Primary results from the randomised phase III AGO‐OVAR 12 trial comparing nintedanib (a triple angiokinase inhibitor) with placebo given in combination with chemotherapy and then continued as maintenance therapy in patients with newly diagnosed advanced ovarian carcinoma demonstrated a significant improvement in progression‐free survival with nintedanib. However, as reported in this paper, final overall survival (OS) results showed that the addition of nintedanib had no impact on OS. These results do not, therefore, support use of nintedanib in ovarian cancer. [ABSTRACT FROM AUTHOR]

Background: Liver cancer is the fifth most common cancer worldwide. Currently, because of increased risk factors and life expectancy, the prevalence of this cancer has increased. Therefore, health care systems should focus more on liver cancer. Evaluation of efficacy and side effects of therapeutic methods can identify potential problems in such patients and provide a good basis for patient care plans. This is an effective step to increase patient satisfaction and subsequently increase treatment success. This review study aimed to evaluate the side effects and efficacy of treatment modalities in patients with liver cancer. Materials and Methods: This study was based on the method presented by Cronin and colleagues (2008), which has five stages. The articles in the timeframe of 2018-2012 were searched. 20 paper have been selected and studied which are more relevant to the topic, and each of them has at least two keywords. Results: The treatment modalities for liver cancer are classified into two groups: surgical (hepatic resection, liver transplantation), and nonsurgical (microwave, radiofrequency, trans arterial chemoembolization, ethanol injection, and chemotherapy). Their complications are divided into physical and psychological sections. The more invasive these methods (surgical) or the more systemic side effect they have (chemotherapy), the greater the physical and psychological complications will be. This study shows that the incidence of adverse events in chemotherapy and hepatic resection was higher than the other treatments, while microwave and radiofrequency had fewer side effects. Adverse effects are the determinants of survival, health-related quality of life, and efficacy of therapeutic modalities. This study shows that the efficacy of microwave and radiofrequency therapies were more than the other therapeutic modalities. Conclusion: Treatment modalities in liver cancer are classified into two groups, surgical and non-surgical. Their consequences are categorized as physical and psychological. By assessing the complications of treatments the survival rate and quality of life in patients with liver cancer are determined. Although in many situations because of patient's conditions and the stages of the disease, it is not possible to choose treatments with low side effects, increasing the awareness of the benefits and potential side effects of each treatment, can help in planning for prevention and appropriate action. Also, increasing the patients’ knowledge about the side effects of the therapeutic methods will lead to the patients’ informed involvement in the treatment process, which will have a significant positive effect on reducing anxiety and depression in affected patients, and promote the quality of medical and nursing care, and can reduce the financial burden of the community. [ABSTRACT FROM AUTHOR]

Current cancer therapy such as chemotherapy and radiography are known to possess many side effects that could lead to serious complications. The application of natural product as complementary and alternative treatment provides significant advantages. It could increase the sensitivity of chemotherapy and radiography while at the same time reducing their associated side effects and complications. With regards to anticancer drugs, more than 50% of the modern oncological drugs are derived from natural products. An edible mushroom, Ganoderma lucidum has long been used in traditional and conventional medicine in China, for the prevention and treatment of various human diseases. The fungus possesses a wide variety of bioactive compounds present in its fruiting bodies, mycelium and spores, including anticancer property that has been proven in in vitro and in vivo studies. The carcinostatic effects of G. lucidum have been shown in a variety of cancer cell lines, including breast, pancreas, lung, colon, skin and prostate. This paper presents in vitro and in vivo studies of the anticancer properties of G. lucidum in cancers. [ABSTRACT FROM AUTHOR]

Background/Aim: Although the trends of surgical treatment in vulvar cancer patients are towards less extended resections, a significant number of cases are still diagnosed with locally advanced diseases imposing performing extended resections. The aim of this paper is to identify the prognostic factors for the development of early postoperative complications following vulvar surgery. Patients and Methods: Between 2017 and 2019, 145 patients with vulvar cancer were submitted to surgery with a curative intent. Results: Among these cases there were 93 cases diagnosed with early stages of the disease and 52 cases diagnosed with advanced stages. The risk of postoperative complications was significantly influenced by: i) the stage of the disease, ii) the preoperative levels of serum albumin, iii) the status of the resection margins, iv) previous history of irradiation, v) length of hospital stay and vi) association of comorbidities. Conclusion: Vulvar cancer surgery for locally advanced disease is still associated with high rates of postoperative complications, and an attentive selection of cases submitted to surgery is mandatory. [ABSTRACT FROM AUTHOR]

There have been remarkable changes in gastric cancer treatments in Japan, resulting in superb improvement of prognosis in patients with this disease. In this paper, the last 50 years have been divided into three eras: before 1990; the 1990s; and the era of evidence, which means after 2000. Changes of treatments and prognosis were analyzed by several factors, such as surgery, chemotherapy, informed consent, clinical trials, and others, as improvement of prognosis is not due to one factor but several ones influencing each other. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy is one of the treatment modalities for cancer. The side effects of treatment, at times, can affect the emotional well-being of patients and their caregivers, thereby leading to distress. This paper aims at screening and identifying levels of distress among patients undergoing chemotherapy and their caregivers. Subjects and Methods: A cross-sectional study design was used. Patients (n = 102) undergoing chemotherapy in the outpatient daycare unit and their caregivers (n = 101) were screened for distress using the National Comprehensive Cancer Network distress thermometer and the problem checklist. Data were analyzed using descriptive and inferential statistics. Results: Patients (53.4%) and their caregivers (22.2%) reported experiencing moderate-to-severe levels of distress. Patients reported significant distress in the areas of physical (P = 0.000) and emotional problems, whereas caregivers reported distress in the areas of family (P = 0.000) and emotional problems. There was no significant difference in emotional problems (P ≥ 0.05) between the patients and their caregivers. There was a positive correlation between physical and emotional problems (r = 0.760, P = 0.000). Majority of patients (85.2%) and caregivers (80.1%) showed interest to avail psycho-oncology services. Conclusions: Distress is prevalent among patients with cancer undergoing chemotherapy and their caregivers. Clinical implications highlight the need to identify and address caregiver distress during routine distress screening for patients using specific psychosocial interventions. Future research warrants the use of administering specific assessments to identify severe psychological issues, such as depression and anxiety for patients reporting severe levels of distress on the screening tool. [ABSTRACT FROM AUTHOR]

The article reports on a general handout that details requirements linked with the use of investigational oral chemotherapy medication. Topics mentioned include a paper released by the Hematology/Oncology Pharmacy Association in 2014 that calls for best practice standards within an investigational drug service, oral chemotherapy education sheets with information to patients with cancer and caregivers, and the increased needs and risks associated with the use of oral investigational medications.

Purpose: To describe the theoretical, evidence-based and consumer-informed development of a smartphone self-management program aiming to support adherence to oral chemotherapy in adolescents and adults diagnosed with cancer. Methods: The design of the program followed two frameworks for the development and evaluation of mHealth interventions and was conducted in three steps: 1) conceptualization, which involved an extensive literature review and a scoping review that led to the identification of the behavioral change strategies in the program; 2) definition of features and structure, based on a formative study with end-users to explore their preferences about the structure and elements of the program; and 3) selection of program delivery technology, whereby available technology platforms were examined and the most suitable tool to deliver the program was selected. Results: Three main reasons for oral chemotherapy non-adherence were identified: forgetfulness, side-effects and poor knowledge about oral chemotherapy. Key behavior change strategies were also identified, namely, medication intake reminders and information about oral chemotherapy and managing side-effects. Based upon end-user feedback the method of delivery of these behavioral strategies that was deemed most appropriate was conventional text messages. The reminders were standard, short, text-only messages sent when each oral chemotherapy dose was due, one way (no need to reply) and addressed the end-users using their first name. Delivery of information about oral chemotherapy and side-effects was tailored to each individual's preferred frequency. Conclusion: The careful design process described in this paper may serve to inform the development of future mobile phone-based medication adherence-enhancing interventions for people with cancer. A trial to explore end-users acceptability of and satisfaction with the intervention is currently underway. Trial Registration: ACTRN12618001987257p. [ABSTRACT FROM AUTHOR]

The multidrug resistance (MDR) of tumor cells often leads to the failure of chemotherapy against cancer. It is urgently needed to develop a safe and effective strategy of overcoming MDR for enhancing chemotherapy efficiency. In this work, one type of new folic acid-polyethylene glycol (FA-PEG) modified polydopamine nanoparticles (FAPPs) was synthesized for gas/chemo/photothermal triple-combination therapy of multidrug resistant cancer. The nanoparticles loaded nitric oxide (NO) donor act as a NO nanoemitter to generate NO via a NIR light irradiation switch, which has a great capacity of reversing MDR via inhibiting the overexpression of P-glycoprotein (P-gp) and cell respiration with the reduction of both the adenosine triphosphate (ATP) content and mitochondrial membrane potential (ΔΨ m) in MDR tumor cells. Moreover, the amount of generated NO can be regulated by changing the action time of the nanoparticles. After that, the nanoparticles loaded chemotherapeutic agent (DOX) act as a photothermal-chemotherapy nanomedicine, which can release DOX with a high concentration in tumor cell for chemotherapy and simultaneously produce a large amount of heat for photothermal therapy under NIR irradiation. Finally, the gas/chemo/photothermal triple-combination therapy with the nanomedicines displays an excellent therapeutic efficacy in nude mice bearing MDR tumors. The multidrug resistance (MDR) of tumor cells frequently leads to the failure of chemotherapy against cancer. It is urgently needed to develop a safe and effective strategy of overcoming MDR for enhancing chemotherapy efficiency. In this paper, a NIR light switching nitric oxide nanoemitter is successfully developed for gas/chemo/photothermal triple-combination therapy of multidrug resistant cancer. The controllably generated NO under NIR irradiation can effectively reverse multidrug resistance by inhibiting the overexpression of P-gp and cell respiration, significantly enhancing the chemotherapeutic agent concentration in tumor cells, and simultaneously a large amount of heat is produced for photothermal therapy. Image, graphical abstract [ABSTRACT FROM AUTHOR]

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Background: Anti-cancer therapy is often a cause of premature ovarian insufficiency and infertility since the ovarian follicle reserve is extremely sensitive to the effects of chemotherapy and radiotherapy. While oocyte, embryo and ovarian cortex cryopreservation can help some women with cancer-induced infertility achieve pregnancy, the development of effective methods to protect ovarian function during chemotherapy would be a significant advantage.Objective and Rationale: This paper critically discusses the different damaging effects of the most common chemotherapeutic compounds on the ovary, in particular, the ovarian follicles and the molecular pathways that lead to that damage. The mechanisms through which fertility-protective agents might prevent chemotherapy drug-induced follicle loss are then reviewed.Search Methods: Articles published in English were searched on PubMed up to March 2019 using the following terms: ovary, fertility preservation, chemotherapy, follicle death, adjuvant therapy, cyclophosphamide, cisplatin, doxorubicin. Inclusion and exclusion criteria were applied to the analysis of the protective agents.Outcomes: Recent studies reveal how chemotherapeutic drugs can affect the different cellular components of the ovary, causing rapid depletion of the ovarian follicular reserve. The three most commonly used drugs, cyclophosphamide, cisplatin and doxorubicin, cause premature ovarian insufficiency by inducing death and/or accelerated activation of primordial follicles and increased atresia of growing follicles. They also cause an increase in damage to blood vessels and the stromal compartment and increment inflammation. In the past 20 years, many compounds have been investigated as potential protective agents to counteract these adverse effects. The interactions of recently described fertility-protective agents with these damage pathways are discussed.Wider Implications: Understanding the mechanisms underlying the action of chemotherapy compounds on the various components of the ovary is essential for the development of efficient and targeted pharmacological therapies that could protect and prolong female fertility. While there are increasing preclinical investigations of potential fertility preserving adjuvants, there remains a lack of approaches that are being developed and tested clinically. [ABSTRACT FROM AUTHOR]

The present study was aimed to explore the current practices related to oral chemotherapy prescription, dispensing, monitoring and patient education. The novelty of this study was based in utilizing most recent data for retrieving relevant outcomes. A cross-sectional design was employed to recruit 161 pharmacists, physicians, and nurses. A survey questionnaire was implemented to examine prescribing practices, coordinating and monitoring adherence, safety monitoring, and education of patients regarding oral chemotherapy. Descriptive statistics and Chi-square analysis were used to present data through Statistical Package of Social Sciences software. A majority of the healthcare providers (79 %) received training on the safe handling of oral chemotherapy, while 74 % were trained by their organization regarding patient education. While 68 % of hospitals used self-designed papers as resources to guide patient education, 51 % used drug pamphlets and 16 % used personalized treatment calendars. Almost 94 % of hospitals applied double checks for calculated doses as additional safety technique; while, other hospitals (34 %) used barcode scanning. The future planning and implementation of oral chemotherapy needs proper educational and training for the healthcare workers. In addition, health care workers should follow guidelines for quality assurance of their prescriptions. [ABSTRACT FROM AUTHOR]

• A new method is proposed to determine drug dose for mixed therapy in cancer treatment. • Optimal drug dose for treatment of reference patient is determined via SDRE method. • The SDRE based MRAC design method is introduced for nonlinear MIMO systems. • Personalized drug delivery for an unknown patient is determined using the MRAC method. • The continuous and bang-bang drug delivery protocols are achieved and compared. The paper presents Model Reference Adaptive Control (MRAC) design strategy to determine personalized drug delivery protocol for mixed therapy with chemotherapy and immunotherapy in cancer treatment. We consider a nonlinear mathematical ODE set for cancer dynamics that includes tumor, natural killers, circulating lymphocytes and cytotoxic T-cells population together with the interaction of chemotherapy and immunotherapy. For researchers and physicians, the main challenge in mathematical models is the determination of the exact model parameters. In order to have a drug administration policy for a patient with unknown parameter set, we develop State Dependent Riccati Equations (SDRE) based MRAC design approach to determine the personalized drug delivery protocol for patients with unknown model parameters. First of all, we determine the optimal drug delivery scenario for a reference patient with known dynamics parameters using SDRE approach. Then for any patient with unknown parameters, the personalized mixed therapy protocol is determined based on the treatment regimen of the reference patient. In the proposed methodology, unknown patients are considered as a black-box simulator in the design and the mathematical model parameters of the patient are not essential for the design of drug administration protocol. In addition, the Bang-Bang and continuous drug delivery regimens could be obtained using proper adaptation gains in the presented MRAC methodology. The simulation results demonstrate the effectiveness of the proposed MRAC approach for prescribing a treatment regimen of chemo-immunotherapy. [ABSTRACT FROM AUTHOR]

Chemotherapy‐induced peripheral neurotoxicity (CIPN) is a major toxicity of cancer treatment, leading to dose reduction and premature treatment cessation, potentially affecting patient function, and quality of life. The development of accurate and sensitive assessment tools for CIPN is essential to enable clinical monitoring during treatment, follow‐up of long‐term outcomes and measurement of toxicity in clinical trials. This review examines CIPN clinical assessment scales incorporating clinician‐based, composite, and patient‐reported outcomes (PROs), providing a systematic review of their properties and an updated critical analysis of recommendations on current evidence for their use. This systematic review of CIPN assessment tools identified 50 papers containing 41 assessment tools, across 4 categories (common toxicity criteria; composite neurological scale; PROs; pain scale). The majority of these tools were PROs, underscoring the importance of patient‐based assessment of symptoms. While there has been considerable work in the field over the past 10 years, this review highlights significant gaps, including a lack of evaluation of responsiveness and problematic neuropathic pain evaluation. There remains a need for consensus on the best available tool and the need to modify existing instruments to improve utility. [ABSTRACT FROM AUTHOR]

Soft tissue sarcomas (STS) comprise a heterogeneous and rare group of tumors derived from mesenchymal cells that can rise in any anatomic site and present with diverse biological behaviors. Radical surgery was a common procedure for STS and used to be the standard treatment for many years. However, despite good results regarding local control (LC), it had poor functional outcomes. Nowadays amputations are rarely needed, and the treatment is always multidisciplinary. Many papers have been published on the use of conservative surgery (CS) associated with adjuvant treatments using radiotherapy (RT) and chemotherapy (CT), reporting the possibility of avoiding radical surgeries, maintaining the same results of LC and better quality of life than amputations. Exclusive resection is indicated in lowgrade superficial tumors or in small intramuscular tumors. There are benefits of using neoadjuvant and adjuvant RT; however neoadjuvant RT is associated with a higher incidence of healing difficulties, while adjuvant RT is associated with a higher incidence of fibrosis. RT is indicated for almost all cases of STS. Advanced technology RT is associated with greater LC and lower morbidity than conventional RT and brachytherapy (BRT). CT is not routinely used adjutancy but may be employed in highgrade tumors, or tumors greater than 5 cm. Neoadjuvant CT may have benefits through early treatment of micrometastases and increased resectability rates. New drugs such as targeted therapy, monoclonal antibodies and immunotherapy are under investigation. [ABSTRACT FROM AUTHOR]

• Candida auris is a difficult to detect pathogen that is resistant to many antifungals. • Outbreak measures and screening should be instigated on detection of a first case. • It is critical to use environmental hygiene and effective decontamination methods. • Staff education on control measures for Candida auris is vital to drive best practice. • Formation of environmental biofilms means that disinfectant efficacy may be affected. Candida auris (C. auris) is an emerging fungal pathogen causing invasive infections and outbreaks that have been difficult to control in healthcare facilities worldwide. There is a lack of current evidence for pragmatic infection prevention and control recommendations. The aim of this paper was to review the epidemiology of C. auris and identify best practices with a panel of experts, in order to provide guidance and recommendations for infection prevention and control measures based on available scientific evidence, existing guidelines and expert opinion. The Infection Prevention and Control working group of the International Society of Antimicrobial Chemotherapy organised an expert meeting with infection prevention and mycology experts to review recommendations for healthcare workers on infection prevention and control measures for C. auris at inpatient healthcare facilities. The most common interventions included: screening, standard precautions, cleaning and disinfection, inpatient transfer, outbreak management, decolonisation, and treatment. [ABSTRACT FROM AUTHOR]

Myoepithelial carcinoma occurs mainly in salivary glands but rarely can also occur in soft tissues or bone. In this paper, we evaluated the role of surgical margins, radiotherapy, and chemotherapy in myoepithelial carcinoma of soft tissue and bone (MC-SB) treated at our Institute. Medical records of 33 patients presenting with MC-SB between 1998 and 2015 at our institution were retrospectively analysed, and diagnosis and treatment were studied. The median follow-up was 58.5 months. Twenty patients had tumours originating in soft tissues and 13 in bone. Eight patients (24.2%) had metastases at diagnosis, the remaining 25 had localised disease. Thirty-two underwent resection of the primary lesion. In 29 surgical margins were evaluated: wide in 28 with 10/28 who recurred (35.7%) and marginal resection in 1 who also recurred. Six patients received adjuvant radiotherapy. Metastases developed in 15/25 patients (60%) with localised disease at onset. Chemotherapy was administered in patients with metastatic advanced disease. Cisplatin+doxorubicin was administered in six patients as first-line chemotherapy with an objective response in 5/6 patients with a median 4-month duration. Five-year overall survival rate was 62.6% in patients with localised tumours and 12.5% in those metastatic at diagnosis. MC-SB showed a high incidence of local recurrences and metastases. Despite different chemotherapy regimens, the outcome remains poor in patients with metastatic disease. Due to the absence of a standard protocol, we encourage treatment by multidisciplinary teams in referral centres with renowned expertise. • Being rare, reports on soft tissue and bone myoepithelial carcinoma are scarce. • Despite wide margins, local recurrences and metastases frequently occur. • Neoadjuvant or adjuvant radiotherapy should be considered in prospective studies. • Platinum-based agents, doxorubicin, paclitaxel are used in advanced disease. • Multidisciplinary treatment should be encouraged in selected referral centres. [ABSTRACT FROM AUTHOR]