Immunotherapy,represented by immune checkpoint inhibitors (ICIs),has significantly changed the treatment strategy of non-small cell lung cancer (NSCLC) and has become an important therapy for all stages of NSCLC.However,there is an urgent need for further clarification regarding ICIs for elderly patients with advanced NSCLC.Treatment strategies for ICIs were guided by assessing survival data of elderly NSCLC patients included in clinical trials.We concluded that treatment regimens such as ICI monotherapy,dual immunotherapy,and ICIs combined with chemotherapy could be carried out in elderly NSCLC patients with a performance status (PS) score <2.Elderly NSCLC patients treated with ICIs could achieve similar benefits as younger patients and are generally well tolerated.However,as age increases (especially above 80 years),the efficacy decreased and the incidence of immune-related adverse events (irAEs) gradually increased.Therefore,ICIs should be carefully selected for advanced NSCLC patients at an advanced age.Compared to age,PS was a key factor causing patients to be excluded from ICIs and poorer survival outcomes.In conclusion,immunotherapy in elderly patients with advanced NSCLC is extremely challenging,and many issues still need further exploration in this field.
Elderly breast cancer patients have different characteristics from young breast cancer patients,and their treatment faces many challenges.The treatment for elderly patients with breast cancer is often based on retrospective studies or evidence of general population lacks Class I clinical evidence. This article summarized the relevant clinical studies of advanced breast cancer with different molecular subtypes,explored the optional treatments and development directions for advanced elderly breast cancer,and provided reference for clinicians.
Patients with severe tumors do not refer to the patients with end-stage tumors,but rather to the patients with a performance status(PS) score between 2 and 4 in certain stages due to various reasons,such as acute or chronic comorbidities,tumor itself,or treatment-related adverse events.To these patients,there is a high probability of achieving survival benefit and/or improvement in PS scores after synergistic management of available life-support technologies and anti-tumor therapies based on dynamic and precise testing.Elderly patients with tumors frequently present with one or more chronic illnesses and have poor tolerance and compliance to treatment.Moreover,their treatment regimens often lack high-quality clinical evidence,making them more susceptible to developing severe tumors.The management of severe tumors in the elderly is based on three basic diagnosis and treatment technologies:dynamic and precise detection,powerful life support technologies,and skillful application of current anti-tumor treatments.In specific clinical practice,the following 7 flexible and individualized treatment strategies should be adopted for different tumor types:1.concurrent management of cancer and comorbidities,2.upgrading and downgrading of anti-tumor drugs based on PS score,3.dynamic accurate detection,4.skillful combinations for increasing efficacy and reducing toxicity,5.complete overview,paying equal attention to systemic therapy and local therapy,6.safety first in medication for the elderly,7.multi-disciplinary participation,individualized and comprehensive treatment.This article introduced the concept of severe tumors in the elderly and the associated management strategies,to increase awareness and provide feasible guidance for clinical practice.
Senescence is the major risk factor that promotes development of different stages of chronic liver diseases and is closely related to occurrence of hepatocellular carcinoma.Significant differences consist in clinicopathological features and tumor microenvironment between elderly and young patients with hepatocellular carcinoma.With rapid development of systemic therapy,immune checkpoint inhibitors combined with targeted therapy have greatly improved the prognosis of patients with advanced hepatocellular carcinoma.The selection of treatment decisions for elderly patients with hepatocellular carcinoma requires to consider unique age-related issues.Adequate communication and necessary evaluation should be carried out before making decisions.Elderly patients with hepatocellular carcinoma are speculated to benefit from combination immunotherapy based on age subgroup analysis of large clinical studies.However,data of effects and security obtained from clinical trials has certain limitations when being applied in elderly populations of real world.The optimal therapeutic strategies for elderly patients with hepatocellular carcinoma still remain to be further explored in large-scale prospective clinical studies.
Elderly patients are often complicated with a variety of underlying diseases. Because aging can impact the pharmacokinetics and pharmacodynamics of drugs,and affect the immune effect,conventional anti-tumor treatment modes such as radiotherapy,chemotherapy,targeted therapy,or immunization,can not achieve optimal efficacy.Comprehensive geriatric assessment (CGA) is a multi-dimensional and multidisciplinary diagnostic process,which is currently regarded as the core of the assessment of elderly patients with cancer.By utilizing a variety of tools and scales,comprehensive assessment of elderly patients with cancer can facilitate early intervention,guide reasonable treatment,increase the chances of benefit, and improve the quality of life for some elderly patients.Moreover,CGA can help reasonably allocate medical resources and reduce the economic burden on the community.
Prescription indication reviews are the problematic points in reviewing prescriptions of Chinese patent medicines.However,there is no commonly recognized review standard.This article conducted a statistical analysis of the prescriptions reviewed by pharmacists from July to December 2022 in the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. Combined with work experience,we analyzed the results and reasons for unqualified indication reviews,combed out the difficulties of the indications review in Chinese patent medicines,and proposed feasible strategies to provide support for the standardization and standardized development in reviewing prescriptions of Chinese patent medicines.
In recent years,due to the development of disciplines such as molecular biology,cell biology,and materials science,the research of targeted therapy drugs has become a hot spot.Compared with conventional drugs,targeted therapy drugs can selectively increase the concentration and effectively reduce the toxic side effects of drugs in target tissues,which is an ideal way of drug delivery.Nanomaterial is receiving more attention for its superior performance in animals.The application and development of nanocrystals in targeted drug delivery systems has effectively broken the limitation of insoluble drugs and plays an indispensable role in drug delivery systems.In this paper,we briefly reviewed the characteristics and classification of targeted therapy drugs and the application of nanocrystals in pharmaceutical research to provide a reference for the related research.
L-carnitine is a carrier that assist in transport of long-chain fatty acids into mitochondria and an effective drug for treating primary carnitine deficiency (PCD).Starting supplementation as early as possible before irreversible organ damage occured can alleviate organ damage,reduce the risk of sudden death,and improve the quality of life.However,in recent years,some studies have suggested that long-term oral L-carnitine has potential risks,the metabolism of L-carnitine through intestinal flora results in the production of trimethylamine oxide (TMAO),which can increase the risk of cardiovascular disease (CVD).Therefore,this paper summarizes the clinical research progress of L-carnitine in treating PCD to provide a theoretical basis for the clinical application of L-carnitine in PCD.
Ferroptosis is a unique iron-dependent cell death pattern,a novel death phenotype distinct from apoptosis,various forms of necrosis,and autophagy.Numerous active ingredients extracted from traditional Chinese medicine have been found to exert anti-cancer effects by inducing ferroptosis in various cancers.An increasing number of studies have found that the regulation of ferroptosis can influence the sensitivity of tumor cells to drugs and even reverse drug resistance.When combined with chemotherapy drugs such as cisplatin,5-FU and gemcitabine, some natural products enhance cancer cells’ sensitivity to chemotherapeutic drugs by inducing ferroptosis.This paper mainly summarizes traditional Chinese medicine and its natural products that can exert anti-cancer effects by inducing ferroptosis,providing new insights for cancer treatment and drug resistance reversal.Additionally, it contributes to exploring the potential advantages of traditional Chinese medicine, thereby expanding its scope of application.
Intestinal microorganisms and their metabolites are involved in the pathogenesis and progression of various cardiovascular diseases, especially in the progression of heart failure. This paper mainly discussed the gut microbial metabolites trimethylamine oxide (TMAO)participated in the pathological process of heart failure, and application value of TMAO in heart failure patients.This paper introduced the change characteristics of intestinal flora and its metabolites in heart failure patients,illuminated the TMAO-mediated inflammatory response,and the related signal pathways and mechanism of myocardial hypertrophy and heart failure.High levels of TMAO are associated with poor outcomes in patients with heart failure indicating a good predictive value for the prognosis of heart failure.Regulating TMAO levels through diet,probiotics and prebiotics,antibiotics,fecal transplantation,and other pathways is expected to be a potential treatment for heart failure.
Patients with primary membranous nephropathy (PMN)tend to develop thrombosis,especially in the early phase of the disease.The pathogenesis of thrombosis is multifactorial,with hypoalbuminemia being widely regarded as an independent risk factor.Other factors include proteinuria,M-type phospholipase A2 receptor antibody,and D-dimer.Although prophylactic anticoagulation therapy is frequently used in clinical practice to prevent thrombosis in PMN patients,there are still many unresolved issues regarding the optimal prevention of thrombosis in this condition.The timing of prophylactic anticoagulation,the threshold of serum albumin level,and the choice of treatment regimen are still lacking consensus.This article reviewed the relevant literature on these topics,aiming to establish a standard for thrombosis prevention and treatment for this population in the future and provide guidance for clinical practice.
Payment by diagnosis related groups (DRG) is an important research direction in China's current medical insurance payment reform.However, it limits the clinical development and utilization of innovative medicines to a certain extent.Additional payments for innovative medicines have been thoroughly studied in many countries.This paper conducted an analysis and summary of the global experience regarding additional payment for innovative medicines under the DRG payment system.Using the United States,France, and Germany as case studies, this paper also examined the current state of medical insurance payment for innovative medicines in China and the influence of DRG payment on the development of such medicine.In addition, it has put forward explicit policy recommendations, including the establishment of inclusion criteria, the selection of appropriate payment modes, the implementation of dynamic adjustment mechanisms, the enhancement of payment methods,etc.This paper aims to provide references to comprehensively promote DRG payment reform while further establishing and enhancing medical insurance payment mechanisms related to innovative medicines in the context of China's national conditions.