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Second Line Treatment of Non-Small Cell Lung Cancer: Clinical; Pathological and Molecular Aspects of Novel Promising Drugs
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Year: 2017 Publisher: Frontiers Media SA

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Abstract

Lung cancer still remains a challenging disease with a higher mortality rate in comparison to other cancers. The discovery of oncogene addicted tumours and targeted therapies responsive to these targets lead to a meaningful change in the prognosis of these diseases. Unfortunately, these newer therapeutic options are reserved to a minor part of lung cancer patients harbouring specific mutations. In the so called wild type population, the first line options bring the median overall survival to go beyond 1 year, and in the population receiving the maintenance therapy over 16 months. Given these results, more than 60% of patients may receive a second line therapy with further opportunities to improve the length and quality of life. For patients not harbouring targetable DNA mutations newer options will be available for second line therapeutic schemes and two major assets seem to be promising: immune modulation and anti-angiogenetic agents. In particular, anti PD1/PDL1 antibodies, VEGFR antibodies and TKIs, these latter combined with standard chemotherapy docetaxel advance the median overall survival of 12 months. These drugs have a different mechanism of action, various adverse events and their activity is different depending on the types of population. However, the biomarkers’ activity and efficacy prediction are not fully or totally understood. In addition, also for patients with DNA targetable mutations new drugs seems to be promising for the use in the second line therapeutic protocols. In particular, drugs selectively directed against ALK translocation and mutational events and EGFR T790M secondary mutations seems to be very promising. In this Research Topic we critically discuss the older therapies and the historical development of second line, putting in to perspective the new agents available in clinical practice. We discuss their importance from a clinical point of view, but also consider and exploit the complex molecular mechanisms responsible of their efficacy or of the subsequently observed resistance phenomena. In this perspective, the undercovering and characterization of novel predictive biomarkers by NGS technology, the characterization of novel actors in the signal transduction pathway modulating the response of the cells, the optimization of new diagnostic tool as the evaluation of liquid biopsy and the implementation of more suitable pre-clinical models are crucial aspects dissected too. Nivolumab, nintedanib and ramucirumab probably will give the opportunity to improve the efficacy outcomes for the treatment of wild type tumours in second line therapeutic schemes, but many aspects should be debated in order that these agents are made available to patients, planning ahead a therapeutic strategy, beginning from the first line therapy, to the subsequent ones in a logical and affordable manner. As well, for treatment of mutated tumours, mutated EGFR irreversible inhibitors such as rociletinib and AZD9291, and ALK targeting drugs ceritinib and alectinib will also play an important role in the immediate future. Probably the right way is to give all the available opportunities to patients, but challenges and pitfalls should be carefully debated, and by launching this Research Topic we tried to give some practical insights in this changing landscape.


Book
Second Line Treatment of Non-Small Cell Lung Cancer: Clinical; Pathological and Molecular Aspects of Novel Promising Drugs
Authors: ---
Year: 2017 Publisher: Frontiers Media SA

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Abstract

Lung cancer still remains a challenging disease with a higher mortality rate in comparison to other cancers. The discovery of oncogene addicted tumours and targeted therapies responsive to these targets lead to a meaningful change in the prognosis of these diseases. Unfortunately, these newer therapeutic options are reserved to a minor part of lung cancer patients harbouring specific mutations. In the so called wild type population, the first line options bring the median overall survival to go beyond 1 year, and in the population receiving the maintenance therapy over 16 months. Given these results, more than 60% of patients may receive a second line therapy with further opportunities to improve the length and quality of life. For patients not harbouring targetable DNA mutations newer options will be available for second line therapeutic schemes and two major assets seem to be promising: immune modulation and anti-angiogenetic agents. In particular, anti PD1/PDL1 antibodies, VEGFR antibodies and TKIs, these latter combined with standard chemotherapy docetaxel advance the median overall survival of 12 months. These drugs have a different mechanism of action, various adverse events and their activity is different depending on the types of population. However, the biomarkers’ activity and efficacy prediction are not fully or totally understood. In addition, also for patients with DNA targetable mutations new drugs seems to be promising for the use in the second line therapeutic protocols. In particular, drugs selectively directed against ALK translocation and mutational events and EGFR T790M secondary mutations seems to be very promising. In this Research Topic we critically discuss the older therapies and the historical development of second line, putting in to perspective the new agents available in clinical practice. We discuss their importance from a clinical point of view, but also consider and exploit the complex molecular mechanisms responsible of their efficacy or of the subsequently observed resistance phenomena. In this perspective, the undercovering and characterization of novel predictive biomarkers by NGS technology, the characterization of novel actors in the signal transduction pathway modulating the response of the cells, the optimization of new diagnostic tool as the evaluation of liquid biopsy and the implementation of more suitable pre-clinical models are crucial aspects dissected too. Nivolumab, nintedanib and ramucirumab probably will give the opportunity to improve the efficacy outcomes for the treatment of wild type tumours in second line therapeutic schemes, but many aspects should be debated in order that these agents are made available to patients, planning ahead a therapeutic strategy, beginning from the first line therapy, to the subsequent ones in a logical and affordable manner. As well, for treatment of mutated tumours, mutated EGFR irreversible inhibitors such as rociletinib and AZD9291, and ALK targeting drugs ceritinib and alectinib will also play an important role in the immediate future. Probably the right way is to give all the available opportunities to patients, but challenges and pitfalls should be carefully debated, and by launching this Research Topic we tried to give some practical insights in this changing landscape.


Book
Second Line Treatment of Non-Small Cell Lung Cancer: Clinical; Pathological and Molecular Aspects of Novel Promising Drugs
Authors: ---
Year: 2017 Publisher: Frontiers Media SA

Loading...
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Abstract

Lung cancer still remains a challenging disease with a higher mortality rate in comparison to other cancers. The discovery of oncogene addicted tumours and targeted therapies responsive to these targets lead to a meaningful change in the prognosis of these diseases. Unfortunately, these newer therapeutic options are reserved to a minor part of lung cancer patients harbouring specific mutations. In the so called wild type population, the first line options bring the median overall survival to go beyond 1 year, and in the population receiving the maintenance therapy over 16 months. Given these results, more than 60% of patients may receive a second line therapy with further opportunities to improve the length and quality of life. For patients not harbouring targetable DNA mutations newer options will be available for second line therapeutic schemes and two major assets seem to be promising: immune modulation and anti-angiogenetic agents. In particular, anti PD1/PDL1 antibodies, VEGFR antibodies and TKIs, these latter combined with standard chemotherapy docetaxel advance the median overall survival of 12 months. These drugs have a different mechanism of action, various adverse events and their activity is different depending on the types of population. However, the biomarkers’ activity and efficacy prediction are not fully or totally understood. In addition, also for patients with DNA targetable mutations new drugs seems to be promising for the use in the second line therapeutic protocols. In particular, drugs selectively directed against ALK translocation and mutational events and EGFR T790M secondary mutations seems to be very promising. In this Research Topic we critically discuss the older therapies and the historical development of second line, putting in to perspective the new agents available in clinical practice. We discuss their importance from a clinical point of view, but also consider and exploit the complex molecular mechanisms responsible of their efficacy or of the subsequently observed resistance phenomena. In this perspective, the undercovering and characterization of novel predictive biomarkers by NGS technology, the characterization of novel actors in the signal transduction pathway modulating the response of the cells, the optimization of new diagnostic tool as the evaluation of liquid biopsy and the implementation of more suitable pre-clinical models are crucial aspects dissected too. Nivolumab, nintedanib and ramucirumab probably will give the opportunity to improve the efficacy outcomes for the treatment of wild type tumours in second line therapeutic schemes, but many aspects should be debated in order that these agents are made available to patients, planning ahead a therapeutic strategy, beginning from the first line therapy, to the subsequent ones in a logical and affordable manner. As well, for treatment of mutated tumours, mutated EGFR irreversible inhibitors such as rociletinib and AZD9291, and ALK targeting drugs ceritinib and alectinib will also play an important role in the immediate future. Probably the right way is to give all the available opportunities to patients, but challenges and pitfalls should be carefully debated, and by launching this Research Topic we tried to give some practical insights in this changing landscape.


Book
Rheumatology : Expert Consult - Online
Authors: --- --- --- ---
ISBN: 9780323091381 0323091385 9789996093043 9996093042 9789996092985 9996092984 0702063037 Year: 2014 Publisher: London : Elsevier Health Sciences UK,

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Abstract

Stay current in the ever-changing discipline of rheumatology with clear, reliable guidance from Hochberg's Rheumatology, one of the most respected and trusted sources in the field. Designed to meet the needs of the practicing clinician, this medical reference book provides extensive, authoritative coverage of rheumatic diseases from basic scientific principles to practical points of clinical management in a lucid, logical, user-friendly manner. Track disease progression and treat patients more effectively with the information on genetic findings, imaging outcomes, cell and biologic therapies,

Keywords

Rheumatic Diseases. --- Antirheumatic Agents --- Enthesopathy --- Rheumatism --- Disease, Rheumatic --- Diseases, Rheumatic --- Enthesopathies --- Rheumatic Disease --- Rheumatology --- therapeutic use --- Rheumatic Diseases --- Rheumatism. --- Rheumatology. --- Electronic books. --- Therapeutic Uses --- Connective Tissue Diseases --- Musculoskeletal Diseases --- Pharmacologic Actions --- Diseases --- Skin and Connective Tissue Diseases --- Chemical Actions and Uses --- Therapeutic Effects --- Therapeutic Effect --- Therapeutic Use --- Effect, Therapeutic --- Effects, Therapeutic --- Use, Therapeutic --- Uses, Therapeutic --- Books in machine-readable form --- Digital books --- E-books --- Ebooks --- Online books --- Books --- Electronic publications --- Anti-Rheumatic Agents --- Anti-Rheumatic Agents, Non-Steroidal --- Anti-Rheumatic Drugs --- Antirheumatic Disease-Modifying Second-Line Drugs --- Antirheumatic Drugs --- Antirheumatic Drugs, Disease-Modifying --- Disease-Modifying, Antirheumatic Second-Line Drugs --- Anti-Rheumatic Agent --- Anti-Rheumatic Drug --- Antirheumatic Agent --- Antirheumatic Disease-Modifying Second-Line Drug --- Antirheumatic Drug --- DMARD --- Disease-Modifying Antirheumatic Drug --- Disease-Modifying Antirheumatic Drugs --- Agent, Anti-Rheumatic --- Agent, Antirheumatic --- Anti Rheumatic Agent --- Anti Rheumatic Agents --- Anti Rheumatic Agents, Non Steroidal --- Anti Rheumatic Drug --- Anti Rheumatic Drugs --- Antirheumatic Disease Modifying Second Line Drug --- Antirheumatic Disease Modifying Second Line Drugs --- Antirheumatic Drug, Disease-Modifying --- Antirheumatic Drugs, Disease Modifying --- Disease Modifying Antirheumatic Drug --- Disease Modifying Antirheumatic Drugs --- Disease Modifying, Antirheumatic Second Line Drugs --- Drug, Anti-Rheumatic --- Drug, Antirheumatic --- Drug, Disease-Modifying Antirheumatic --- Non-Steroidal Anti-Rheumatic Agents --- Antimalarials --- Immunosuppressive Agents --- Internal medicine --- Connective tissues --- Joints --- Rheumatic diseases --- Collagen diseases --- Musculoskeletal system --- Chemical Actions --- Actions, Chemical --- Actions, Pharmacologic --- Pharmacological and Toxicological Phenomena --- Drug Therapy --- Orthopedic Disorders --- Musculoskeletal Disease --- Orthopedic Disorder --- Connective Tissue Disease --- Disease, Connective Tissue --- Diseases, Connective Tissue --- Handbooks, manuals, etc. --- Therapeutic Uses. --- Connective Tissue Diseases. --- Musculoskeletal Diseases. --- Pharmacologic Actions. --- Disease. --- Skin and Connective Tissue Diseases. --- Chemical Actions and Uses. --- Antirheumatic Agents.


Book
Advances in the Treatment of Renal Cell Carcinoma
Authors: ---
Year: 2022 Publisher: Basel MDPI - Multidisciplinary Digital Publishing Institute

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This Special Issue of Cancers focuses on new advances in the treatment of renal cell carcinoma, both surgical and pharmacological (and combinations of these), and novel approaches to tackle treatment resistance and improve our understanding of this phenomenon.


Book
Mycobacterium tuberculosis Pathogenesis, Infection Prevention and Treatment
Authors: --- ---
Year: 2020 Publisher: Basel, Switzerland MDPI - Multidisciplinary Digital Publishing Institute

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Abstract

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB) and it represents a persistent public health threat for a number of complex biological and sociological reasons. According to the most recent Global Tuberculosis Report (2019) edited by the World Health Organization (WHO), TB is considered the ninth cause of death worldwide and the leading cause of mortality by a single infectious agent, with the highest rate of infections and death toll rate mostly concentrated in developing and low-income countries. We present here the editorial section to the Special Issue entitled “Mycobacterium tuberculosis Pathogenesis, Infection Prevention and Treatment” that includes 7 research articles and a review. The scientific contributions included in the Special Issue mainly focus on the characterization of MTB strains emerging in TB endemic countries as well as on multiple mechanisms adopted by the bacteria to resist and to adapt to antitubercular therapies.


Book
Advances in the Treatment of Renal Cell Carcinoma
Authors: ---
Year: 2022 Publisher: Basel MDPI - Multidisciplinary Digital Publishing Institute

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Abstract

This Special Issue of Cancers focuses on new advances in the treatment of renal cell carcinoma, both surgical and pharmacological (and combinations of these), and novel approaches to tackle treatment resistance and improve our understanding of this phenomenon.


Book
Mycobacterium tuberculosis Pathogenesis, Infection Prevention and Treatment
Authors: --- ---
Year: 2020 Publisher: Basel, Switzerland MDPI - Multidisciplinary Digital Publishing Institute

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Abstract

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB) and it represents a persistent public health threat for a number of complex biological and sociological reasons. According to the most recent Global Tuberculosis Report (2019) edited by the World Health Organization (WHO), TB is considered the ninth cause of death worldwide and the leading cause of mortality by a single infectious agent, with the highest rate of infections and death toll rate mostly concentrated in developing and low-income countries. We present here the editorial section to the Special Issue entitled “Mycobacterium tuberculosis Pathogenesis, Infection Prevention and Treatment” that includes 7 research articles and a review. The scientific contributions included in the Special Issue mainly focus on the characterization of MTB strains emerging in TB endemic countries as well as on multiple mechanisms adopted by the bacteria to resist and to adapt to antitubercular therapies.


Book
New Therapies of Liver Diseases
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Year: 2022 Publisher: Basel MDPI - Multidisciplinary Digital Publishing Institute

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Abstract

In this Special Issue of the journal, advancements in the treatment of liver diseases are illustrated by international experts in the field. New treatment options for primary biliary cirrhosis and, hopefully, primary sclerosing cholangitis are discussed. Up-to-date pharmacological therapy for preventing liver cirrhosis decompensation and treating acute-on-chronic liver failure is highlighted. Furthermore, new treatments for cholangiocarcinoma, based on biological and tissue markers, will be available in the near future, aiming to surpass the current unsatisfactory results of traditional therapies. Immunotherapy has been applied to hepatocellular carcinoma (HCC). The new first-line treatment, combining atezolizumab plus bevacizumab for HCC in the intermediate and advanced stages, will allow for an increase in patient survival in the near future. Liver transplantation (LT) remains the preferred treatment for many patients with end-stage liver diseases and HCC. The selection criteria for LT in patients with HCC moved from morphological to dynamic criteria, such as those derived from the assessment of tumor responses to locoregional and/or systemic treatments before transplantation. This allowed many patients who would have been excluded from a transplantation with the old selection criteria to access one. Finally, a very interesting issue regarding new indications for liver transplantation is illustrated.


Book
New Therapies of Liver Diseases
Author:
Year: 2022 Publisher: Basel MDPI - Multidisciplinary Digital Publishing Institute

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Abstract

In this Special Issue of the journal, advancements in the treatment of liver diseases are illustrated by international experts in the field. New treatment options for primary biliary cirrhosis and, hopefully, primary sclerosing cholangitis are discussed. Up-to-date pharmacological therapy for preventing liver cirrhosis decompensation and treating acute-on-chronic liver failure is highlighted. Furthermore, new treatments for cholangiocarcinoma, based on biological and tissue markers, will be available in the near future, aiming to surpass the current unsatisfactory results of traditional therapies. Immunotherapy has been applied to hepatocellular carcinoma (HCC). The new first-line treatment, combining atezolizumab plus bevacizumab for HCC in the intermediate and advanced stages, will allow for an increase in patient survival in the near future. Liver transplantation (LT) remains the preferred treatment for many patients with end-stage liver diseases and HCC. The selection criteria for LT in patients with HCC moved from morphological to dynamic criteria, such as those derived from the assessment of tumor responses to locoregional and/or systemic treatments before transplantation. This allowed many patients who would have been excluded from a transplantation with the old selection criteria to access one. Finally, a very interesting issue regarding new indications for liver transplantation is illustrated.

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