International Guidelines for Management of Metastatic Breast Cancer: Can Metastatic Breast Cancer Be Cured?

A distinctive subset of metastatic breast cancer (MBC) is oligometastatic disease, which is characterized by single or few detectable metastatic lesions. The existing treatment guidelines for patients with localized MBC include surgery, radiotherapy, and regional chemotherapy. The European School of Oncology-Metastatic Breast Cancer Task Force addressed the management of these patients in its first consensus recommendations published in 2007. The Task Force endorsed the possibility of a more aggressive and multidisciplinary approach for patients with oligometastatic disease, stressing also the need for clinical trials in this patient population. At the sixth European Breast Cancer Conference, held in Berlin in March 2008, the second public session on MBC guidelines addressed the controversial issue of whether MBC can be cured. In this commentary, we summarize the discussion and related recommendations regarding the available therapeutic options that are possibly associated with cure in these patients. In particular, data on local (surgery and radiotherapy) and chemotherapy options are discussed. Large retrospective series show an association between surgical removal of the primary tumor or of lung metastases and improved long-term outcome in patients with oligometastatic disease. In the absence of data from prospective randomized studies, removal of the primary tumor or isolated metastatic lesions may be an attractive therapeutic strategy in this subset of patients, offering rapid disease control and potential for survival benefit. Some improvement in outcome may also be achieved with optimization of systemic therapies, possibly in combination with optimal local treatmen

International Guidelines for Management of Metastatic Breast Cancer: Combination vs Sequential Single-Agent Chemotherapy

Compared with treatment options for early-stage breast cancer, few data exist regarding the optimal use of chemotherapy for metastatic breast cancer (MBC). The choice of using a combination of cytotoxic chemotherapies vs sequential single agents is controversial. At the 6th European Breast Cancer Conference, the European School of Oncology Metastatic Breast Cancer Task Force convened an open debate on the relative benefits of combination vs sequential therapy. Based on the available data, the Task Force recommends sequential monotherapy as the preferred choice in advanced disease, in the absence of rapid clinical progression, life-threatening visceral metastases, or the need for rapid symptom and/or disease control. Patient- and disease-related factors should be used to choose between combination and sequential single-agent chemotherapy for MBC. Additional research is needed to determine the impact of therapy on patient-rated quality of life and to identify predictive factors that can be used to guide therapy

Earthquake Risk Assessment. Case Study: Cyprus

Short-term prediction of earthquake events is still impossible and earthquake risk assessment is therefore necessary to develop risk management strategies and deal with their consequences. For this purpose, an earthquake risk assessment framework was developed at the University of Sheffield and was demonstrated using Cyprus as a case study. This initial attempt focused on the hazard assessment model, since the vulnerability aspect was beyond the scope of the work, and was dealt in a rather simplistic manner. The study estimated an average annual earthquake risk close to CY£1 million. A continuation of the initial attempt deemed vital to improve the accuracy of the framework primarily by improving the vulnerability aspect and secondly by producing local attenuation laws. Eventually, the refined attenuation and vulnerability models will be substituted in the existing framework thus fulfilling within acceptable accuracy levels the Earthquake Risk Assessment requirements

Vers une Europe de la santé: défis et opportunités

Un nouveau cas de cancer est diagnostiqué toutes les 9 secondes. Chaque année dans l’Union européenne, 1,3 million personnes décèdent du cancer et le nombre de morts est en hausse. Il s’agit de la première cause de mortalité après les maladies cardiovasculaires, et ses conséquences sur notre santé, sur nos systèmes de santé et sur nos économies sont dévastatrices. Or, plus de 40 % des cas de cancer pourraient être évités. C’est pourquoi le 4 février dernier, la Commission européenne a lancé une consultation publique à travers l’UE ayant pour thème le plan européen de lutte contre le cancer. Ce plan sera présenté avant la fin de l’année et a pour objectif d’aider les États membres à renforcer la prévention et à améliorer les soins dispensés à l’échelle européenne. Notre santé joue un rôle clef pour notre qualité de vie, notre bien-être et notre capacité à contribuer pleinement à la société: que peut-on faire pour la préserver? Pourquoi avons-nous besoin d’un nouveau plan et comment le citoyen européen peut-il en bénéficier au mieux, notamment dans son propre pays

The potential of using Satellite Remote Sensing for identifying the impact of climate change on existing reinforced concrete (RC) structures

Concrete is a widely used construction material worldwide due to its high durability over time. Despite the long-term performance of concrete, there are still failures in reinforced concrete (RC) buildings due to the deterioration of concrete caused by environmental and weather conditions. Also, climate change accelerates the deterioration processes in RC structures and affects their safety and serviceability. Therefore, there is an urgent socio-economic need for optimum maintenance and repair of existing RC structures according to climate changes for achieving acceptable levels of structural safety. To achieve this, the science of satellite remote sensing is essential for quantifying and providing up-to-date information on the climate changes occurring in the atmosphere, land, and oceans on a global scale. This paper presents the influence of climate change on existing RC structures. At the same time, this paper highlights the potential of using satellite remote sensing for identifying the impact of climate change on existing RC structures in order to accurately assess the performance of existing building stock and, then to propose efficient and optimum maintenance and repairing strategies toward a resilient society

C5aR agonist enhances phagocytosis of fibrillar and non-fibrillar Aβ amyloid and preserves memory in a mouse model of familial Alzheimer's disease.

According to the amyloid hypothesis of Alzheimer's disease (AD) the deposition of prefibrillar and fibrillar Aβ peptide sets off the pathogenic cascades of neuroinflammation and neurodegeneration that lead to synaptic and neuronal loss resulting in cognitive decline. Various approaches to reduce amyloid load by reducing production of the Aβ peptide or enhancing amyloid clearance by primary or secondary immunization have not proven successful in clinical trials. Interfering with the normal function of secretases and suboptimal timing of Aβ peptide removal have been put forward as possible explanations. Complement, an innate component of the immune system, has been found to modulate disease pathology and in particular neuronal loss in the AD mouse model but its mechanism of action is complex. C1Q has been shown to facilitate phagocytosis of Aβ peptide but its Ablation attenuates neuroinflammation. Experiments in AD mouse models show that inhibition of complement component C5a reduces amyloid deposition and alleviates neuroinflammation. Phagocytes including microglia, monocytes and neutrophils carry C5a receptors. Here, a widely used mouse model of AD, 5XFAD, was intermittently treated with the oral C5a receptor agonist EP67 and several neuronal and neuroinflammatory markers as well as memory function were assessed. EP67 treatment enhanced phagocytosis, resulting in a significant reduction of both fibrillar and non-fibrillar Aβ, reduced astrocytosis and preserved synaptic and neuronal markers as well as memory function. Timely and phasic recruitment of the innate immune system offers a new therapeutic avenue of treating pre-symptomatic Alzheimer disease

International guidelines for management of metastatic breast cancer (MBC) from the European School of Oncology (ESO)-MBC Task Force: Surveillance, staging, and evaluation of patients with early-stage and metastatic breast cancer

In clinical practice, the surveillance and follow-up of patients with breast cancer (BC) is quite variable. At the 7th European Breast Cancer Conference, the ESO-MBC Task Force convened a series of lectures, followed by open debate, on the use of physical examination, imaging, and laboratory tests in patients with early-stage BC, and for restaging evaluations and follow-up among patients with MBC. Based on the available data, the Task Force recommends against intensive, routine radiologic or blood-based surveillance (with the exception of mammography) in patients with early-stage BC. As systemic therapies for MBC continue to improve, this question might be re-visited in the context of a carefully controlled clinical trial in specific BC subtypes. For patients with MBC, response to therapy should generally be assessed 2-3 months after initiation of treatment, and thereafter every 2-4 months for endocrine therapy or every 2-4 cycles for chemotherapy, depending on the dynamics of the disease, the location and extent of metastatic involvement, and type of treatment. Additional testing should be performed irrespective of the planned intervals if progression of disease is suspected (e.g. in the case of specific symptoms). Use of tumor markers is not recommended for surveillance of early-stage patients, but may be helpful in monitoring response to therapy in patients with metastatic disease. However, change in tumor markers alone should not be used for decision-making. Moving forward, enhanced efforts to document quality of life over time should be made in order to more fully evaluate the risk/benefit ratio of available options

Response

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Keeping faith with trial volunteers.

Journal Articleinfo:eu-repo/semantics/publishe