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Table of Content

    Volume 28 Issue 8
    26 August 2023
    Research progress on immunotherapy for triple-negative breast cancer
    HE Lihua, ZHU Xiuzhi, JIANG Yizhou
    2023, 28(8):  842-853.  doi:10.12092/j.issn.1009-2501.2023.08.001
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    Triple-negative breast cancer (TNBC) is a subtype of breast cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). It is highly aggressive, easy to relapse, and chemotherapy remains its mainstay treatment due to the lack of therapeutic targets. In recent years, many advances have been made in the development of immunotherapy for TNBC. This review summarizes the primary modalities of immunotherapy for TNBC, including immune checkpoint inhibitors, adoptive immune cell therapy, tumor vaccines and oncolytic virus. We present the latest research progress on each treatment from the perspective of clinical study and fundamental research, while introducing the potential predictive biomarkers and resistance mechanisms of immunotherapy for TNBC.
    Mechanisms of endocrine-resistance and therapeutic breakthroughs in hormone receptor-positive, HER2-negative breast cancer
    ZHANG Huyunlong, ZHU Xiuzhi, JIN Xi, SHAO Zhimin
    2023, 28(8):  854-865.  doi:10.12092/j.issn.1009-2501.2023.08.002
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    Breast cancers that are positive for hormone receptor but negative for human epidermal growth factor receptor 2 (abbreviated as HR+/HER2-) account for approximately 60% of total cases. Targeting estrogen signaling is one of the most important therapeutic strategies for HR+/HER2- breast cancer. However, the management of endocrine-resistant HR+/HER2- breast cancer remains a difficult issue in clinical practice. Previous multi-omic analysis and translational research have identified the mechanisms underlying endocrine-resistance including genomic alteration and abnormal epigenetic modification. To overcome endocrine-resistance, we have established a comprehensive and coherent therapeutic strategy.  In addition, several novel therapies have shown promising efficacy in previous clinical trials and will emerge as alternative options for targeting endocrine-resistant HR+/HER2- breast cancer. In this review, we will introduce the mechanisms of endocrine-resistance, explain the current therapeutic strategy for endocrine-resistant HR+/HER2- breast cancer and discuss the possible targeted therapies in the future.
    Treatment progress of triple positive breast cancer
    FU Xiaoyu, KONG Deguang, LI Juanjuan
    2023, 28(8):  866-875.  doi:10.12092/j.issn.1009-2501.2023.08.003
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    Triple positive breast cancer overexpress ER (estrogen receptor), PR and HER2 (human epidermal growth factor receptor 2, HER2), accounting for about 50%-60% of the HER2 positive breast cancer patients. Based on the data from clinical trials, the crosstalk between the ER signaling pathway and the HER2 signaling pathway in triple-positive breast cancer may weaken the efficacy of anti-HER2 therapy and endocrine therapy, and this feature has attracted widespread attention. Emerging evidence shows that while blocking HER2 signaling pathway, together with enhancing blocking of ER signaling pathway, such as anti-HER2 dual-targeting + endocrine therapy ± CDK4/6 inhibitors, could effectively overcome drug resistance, and improve the efficacy. Predictive biomarkers including Ki67, intrinsic subtypes, and multi-gene assay, which have the potential benefit for personalized treatment.
    Advances in targeted therapy for HER2-positive breast cancer
    LUO Shiping, ZHANG Jie, YU Yushuai, SONG Chuangui
    2023, 28(8):  876-886.  doi:10.12092/j.issn.1009-2501.2023.08.004
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    Since the beginning of the 21st century, with the continuous development of anti-HER2-targeted drugs, more treatment options have been provided for patients with HER2-positive breast cancer and the survival prognosis has been significantly improved. At present, anti-HER2 targeted drugs mainly include monoclonal antibody drugs such as trastuzumab and pertuzumab, small molecule tyrosine kinase inhibitors such as lapatinib and neratinib, and antibody-drug conjugates such as T-DM1 and T-DXd, which play an extremely important role in different disease processes. The treatment of HER2-positive breast cancer is based on targeted therapy with trastuzumab. Early-stage patients with high risk factors can be treated with intensive targeted therapy to further improve the prognosis, while advanced patients need a reasonable arrangement of targeted therapy to overcome drug resistance and prolong survival. This article will review the current status, the latest research progress and the future prospects of anti-HER2 targeted therapy in different stages of the disease.
    Research progress of biomarkers related to the efficacy of HER2 positive breast cancer
    XIANG Yimei, ZHANG Ningning, HUANG Yuxin, ZENG Xiaohua
    2023, 28(8):  887-897.  doi:10.12092/j.issn.1009-2501.2023.08.005
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    Breast cancer is the most commonly diagnosed cancer and the main cause of cancer deaths among women worldwide. HER2 positive breast cancer accounts for 15% of all breast cancer. This subtype of breast cancer is highly invasive and has a very poor prognosis. With the development of anti-HER2 targeted therapy, the prognosis of these patients has been improved. However, some patients have poor response to the anti-HER2 therapy. Therefore, it is necessary to select biomarkers that can predict the therapeutic effect for improving the efficacy of these patients. This article describes the research progress of HER2 positive biomarkers for breast cancer, focusing on biomarkers related to the efficacy of targeted therapy, in order to provide some reference for future clinical optimization of targeted therapy.
    Clinical application and research progress of antibody drugs conjugation in breast cancer
    CHEN Keyu, HUANG Yuan, WANG Xiaojia, ZHENG Yabing
    2023, 28(8):  898-909.  doi:10.12092/j.issn.1009-2501.2023.08.006
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    Antibody drug conjugations (ADCs) are a new class of drugs with both targeted specificity and high activity of chemotherapy drugs, which has gradually become a novel generation of therapeutic models with great clinical application prospects. In recent years, ADCs composed of monoclonal antibodies against different tumor cell surface antigens and small molecule potent cytotoxic drugs have shown superior therapeutic effects on recurrent/metastatic breast cancer. This article reviews the clinical application and research progress of ADCs with different molecular targets in the field of breast cancer.
    Research progress on diagnosis and treatment of granulomatous lobular mastitis
    WANG Chaoyi, SONG Qiang, XIONG Xin, WANG Mengyuan
    2023, 28(8):  910-917.  doi:10.12092/j.issn.1009-2501.2023.08.007
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    Granulomatous lobular mastitis (GLM) is a rare form of chronic inflammatory breast disease which may be sometimes difficult to distinguish from breast cancer. The cause of GLM is unknown, but may be associated with autoimmunity, abnormal hormone levels and infection. While GLM has no specific clinical manifestations, the diagnosis is principally established by histopathology. Therapeutic options for GLM range from observation to various medical treatments, such as steroids, immunosuppressants, and antibiotics, to surgical intervention. However, there are still many difficulties in the clinical diagnosis and treatment of GLM, and there is still no unified diagnosis and treatment consensus. So, we accomplished the present review through reviewing GLM-related domestic and foreign literature, aiming to provide the basis for rational clinical diagnosis and treatment. 
    Research progress in vaccine for breast cancer 
    LI Mengxi, ZHANG Kejing, XIA Fan
    2023, 28(8):  918-925.  doi:10.12092/j.issn.1009-2501.2023.08.008
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    Breast cancer was the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%) in 2020. Breast cancer ranks first among malignant tumors in the world, seriously threatening women's health. Due to continuously enrichment of treatment methods for breast cancer, patients' prognosis have been greatly improved. The emergence of vaccines is an important treatment method to promote the development of human health. For cancer therapy, preventive vaccines have been popularized for kinds of tumor with specific incentives, such as cervical cancer caused by HPV infection. At present, the causative factors of breast cancer are still unclear, and it is still difficult to develop preventive vaccines against breast cancer. In recent years, a variety of therapeutic vaccines have emerged in the field of breast cancer treatment. When patient completed comprehensive treatment, vaccine is used to stimulate body immune system to recognize tumor cell-specific antigens, thereby reducing the recurrence rate as much as possible. Most of these vaccines are currently aimed at more malignant triple-negative breast cancer and HER2-positive breast cancer. This article will focus on the research progress of several therappeutic vaccines.
    Angelica polysaccharides improve hepatic endoplasmic reticulum stress by inhibiting the expression of GRP78, p-PERK and p-Eif2α in diabetic KK-Ay mice
    MA Xiankang, YANG Lixia, CUI Yangyang, MI Denghai
    2023, 28(8):  926-936.  doi:10.12092/j.issn.1009-2501.2023.08.009
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    AIM: To investigate the regulatory mechanism of Angelica polysaccharide on hepatic endoplasmic reticulum stress in diabetic KK-Ay mice. MEHTODS: Forty diabetic KK-Ay mice were randomly divided into model group, metformin group, and angelica polysaccharide high, medium, and low dose groups, with 8 mice in each group. 8 C57BL/6J mice were used as blank control group. The mice were gavaged with 400 mg/kg, 200 mg/kg and 100 mg/kg of angelica polysaccharide in the high, medium and low dose groups, respectively, and 200 mg/kg of metformin hydrochloride in the metformin group, while the normal and model groups were gavaged with equal volume of saline, and fasting blood glucose and body weight were measured weekly. After 4 weeks of gavage, triglyceride (TG), cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were measured in mice serum; RT-PCR was performed to observe the expression of glucose-regulated protein 78 (GRP78), phosphorylated pancreatic endoplasmic reticulum kinase (p-PERK) and phosphorylated α-subunit eukaryotic initiation factor 2 (p-Eif2α) in liver tissues. mRNA expression; Western blot, immunohistochemistry to detect the protein expression of GRP78, p-PERK, p-Eif2α in mouse liver tissues. HE staining: to observe the histopathological changes in the liver. RESULT: Compared with the blank group, the levels of TC, TG and LDL-C were significantly increased (P<0.01) and the levels of HDL-C were significantly decreased (P<0.01) in the model group; compared with the model group, the levels of TC, TG and LDL-C were significantly decreased (P<0.05, P<0.01) and the levels of HDL-C were significantly increased in the metformin group, angelica polysaccharide high and medium dose groups. Compared with the blank group, the expression of GRP78, p-PERK and p-Eif2α in the model group was significantly upregulated (P<0.01), and the expression of GRP78, p-PERK and p-Eif2α in the angelica polysaccharide high, medium and low dose groups was significantly downregulated (P<0.05, P<0.01), and the high dose group had the best effect compared with the model group. Compared with the model group, the mice in the angelica polysaccharide group showed dense liver tissue, reduced vacuole-like degeneration, reduced liver steatosis, gradually aligned hepatocytes, and clear hepatic sinusoidal structure, and the effect was dose-dependent. CONCLUSION: Angelica polysaccharide significantly improved liver injury in diabetic KK-Ay mice, and its mechanism of action may be related to the inhibition of endoplasmic reticulum stress-related proteins and factors GRP78, p-PERK and p-Eif2α expression by Angelica polysaccharide and improvement of endoplasmic reticulum stress.
    Measurement tools and rationality evaluation of clinical research coordinator's work ability and workload
    ZHONG Wei, SHI Shuxia, QIN Qinyue, YU Guo
    2023, 28(8):  937-947.  doi:10.12092/j.issn.1009-2501.2023.08.010
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    AIM:To establish a project management tool to measure the working ability of research coordinators and the workload of clinical trial projects, and optimize medical institutions or clinical trial site management organization (SMO) allocation basis of clinical trial items by collecting the work stress and personal ability values of clinical coordinators. METHODS: Different words in the five major databases were searched and information on the work capacity and workload in the Subei People' s Hospital was collected. In addition, the paper analyzes the characteristics of coordinators working pressure source by SPSS26.0 statistical software and stability coefficient method. RESULTS: The study established the clinical research coordinator's personal ability - assessment tool (CRCPA-AT) and clinical trial project workload - assessment tool (CTPW-AT) to assess the coordinator's working ability and clinical trial workload. The two tools in this study were tested retrospectively in 61 coordinators and 144 clinical trials, 39 (66.1%) coordinators' projects were reasonably allocated, 18 (30.5%) coordinators were in the state of theoretical pressure and 12 (20.3%) coordinators had high actual pressure, which matched with the theoretical pressure. CONCLUSION: In this study, two scoring scales were established to quantify the working ability of the coordinators and the workload of clinical trial projects. Through the verification of the 61 coordinators and its management projects, the Likert5 point scoring method was used to analyze, more than 86.4% of the actual pressure of coordinators was consistent with the theoretical pressure quantified by the tool.
    Analysis of 197 cases of pentoxifylline injection and exploring supervision mode of rational drug use in hospitals
    CHEN Qun, ZHU Heping, YUAN Xiaolong
    2023, 28(8):  948-953.  doi:10.12092/j.issn.1009-2501.2023.08.011
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    AIM: To analyze and evaluate the use of pentoxifylline injection in a hospital, and explore effective supervision mode, so as to provide some reference for clinical rational drug use. METHODS: A total of 197 inpatients with pentoxifylline injection who were discharged from October 2021 to June 2022 were randomly selected from HIS system. Referring to drug-label and collecting evidence-based medical evidence to judge the rationality of use of pentoxifylline injection in the hospital. RESULTS: Among the 197 medical records extracted, 140 medical records were unreasonable, accounting for 71.07% of the total medical records. Among them, 111 cases (79.29%) were no indication for use, 13 cases (9.29%) were off-label, 2 cases (1.43%) were inappropriate for indications, 13 cases (9.29%) were inappropriate for usage and dosage, and 1 case (0.71%) was inappropriate for solvent. CONCLUSION: The irrational use of pentoxifylline injection in this hospital is serious. It is necessary to standardize its clinical application through the intervention of smart pharmacy management mode, improving system, strengthening medication education and other ways. 
    Research progress on the relationship between subclinical hypothyroidism and depression
    ZHANG Taotao, SU Wenxiu, TIAN Limin
    2023, 28(8):  954-960.  doi:10.12092/j.issn.1009-2501.2023.08.012
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    Subclinical hypothyroidism (SCH) is a mild impairment of thyroid function. Several existing studies suggest that SCH is associated with an increased risk of depression, but some studies have also found no correlation between SCH and depression. Therefore, whether there is an association between SCH and depression and the mechanism of interaction between the two remains controversial. Growing evidence suggested that SCH patients should not be routinely treated with levothyroxine, and the effect of the treatment of thyroid disease on various clinical psychiatric outcomes is also controversial. This article reviews the current research on the correlation between SCH and depression risk and whether drug intervention is needed.