3 research outputs found

    Remote controlling of CAR-T cells and toxicity management: Molecular switches and next generation CARs

    Get PDF
    Cell-based immunotherapies have been selected for the front-line cancer treatment approaches. Among them, CAR-T cells have shown extraordinary effects in hematologic diseases including chemotherapy-resistant acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), and non-Hodgkin lymphoma (NHL). In this approach, autologous T cells isolated from the patient's body genetically engineered to express a tumor specific synthetic receptor against a tumor antigen, then these cells expanded ex vivo and re-infusion back to the patient body. Recently, significant clinical response and high rates of complete remission of CAR T cell therapy in B-cell malignancies led to the approval of Kymriah and Yescarta (CD19-directed CAR-T cells) were by FDA for treatment of acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Despite promising therapeutic outcomes, CAR T cells also can elicit the immune-pathologic effects, such as Cytokine Release Syndrome (CRS), Tumor Lysis Syndrome (TLS), and on-target off-tumor toxicity, that hampered its application. Ineffective control of these highly potent synthetic cells causes discussed potentially life-threatening toxicities, so researchers have developed several mechanisms to remote control CAR T cells. In this paper, we briefly review the introduced toxicities of CAR-T cells, then describe currently existing control approaches and review their procedure, pros, and cons. © 2021 The Author

    Recommendations for breast surgical care during COVID-19 outbreak in Iran: setting priorities of management

    Get PDF
    Objective: During the recent pandemic of COVID-19, apposite planning is necessary to maintain health system resources. Cancer patients are susceptible to COVID-19, but accurate cancer management should be carried out.  As breast cancer is the most common female cancer in Iran, and surgery is the main treatment, we carried out this study to provide the best recommendations for breast surgery and care during the outbreak of COVID-19 in Iran. Materials and Methods: As cancer and breast surgeons at Cancer Institute of Iran, based on our personal and institutional experience and recently released guidelines, we defined the main headings about breast surgery issues during the outbreak. We investigated the present literature and then discussed each issue. Results: The best agreed recommendations were delineated. Briefly, telemedicine should be prioritized over in-hospital presence of patients. Visits should be postponed except for cancer workups and treatments, or cases suspicious for cancer. Appropriate protective, preventive, and instructive measures related to COVID-19 should be observed in the outpatient and inpatient Departments for patients, companions, and health care providers. Staging procedures should be minimized. Surgery for non-malignant lesions, reconstructive and cosmetic surgery should be postponed. When breast cancer surgery can be substituted by non-operative treatments without impairing prognosis or quality of life, it should be deferred. Surgeries with lower complication rates and length of stay are favored. Conclusions: At the time of COVID-19 epidemic, surgery should be performed for breast cancer only if this modality is more advantageous than other therapies in terms of disease outcome and is worth the increased risk of transmission of COVID-19. Otherwise, it should be deferred until control of the epidemic

    Management policies of breast cancer surgery, chemotherapy and radiotherapy during COVID-19 outbreak in Iran

    Get PDF
    Objective: Introducing a modified guideline to save medical and human resources during COVID-19, and suggesting modifications to cancer treatment procedures during COVID-19 with the aim of reducing patients’ exposures to medical centers. Materials and Methods: Breast cancer management protocols were discussed among our colleagues in Cancer Institute of Tehran University of Medical Sciences through interactive applications (WhatsApp and Skype). We have provided the consensus of all opinions under relevant headings. Our recommendations will be modified as pandemic severity changes. Results: Surgery is restricted to patients whose survival is likely to be compromised if surgery is not performed. As for systemic therapy, we prefer to prescribe less toxic regimens and choose tri-weekly cycles instead of bi-weekly or weekly ones. In the case of radiotherapy, hypofractionated schedules are preferred schedules. Conclusions: COVID-19 pandemic put cancer patients, physicians, and health care systems in a challenging situation. All our colleagues agreed to choose less invasive and minimal interventions at this time because it is imperative to spare medical resources and workforce, and decrease patients’ contact with medical environments. We know that some of our suggestions may interfere with standard and routine practice, but our recommendations will be changed when COVID-19 pandemic severity changes
    corecore