Polyester-based excipients to formulate lipophilic drugs into nanoparticles directly at the bed of the patient

In recent decades there has been an increased interest in polymeric nanoparticles as drug delivery systems thanks to their several advantages, such as continuous maintenance of drug levels in a therapeutically desirable range, and reduction of harmful side effects. These nano-colloids are generally made up of polyesters as long as they are able to easily degrade into the body. However, NP production is often a process that requires complex microfluidic devices. In addition, expensive purification steps are necessary to eliminate the unloaded drug and the high amount of organic solvent used in the NP production step. In the end, a lyophilization step is general adopted to assure a good shelf-life of the final product. All the above-mentioned steps hamper the cost-effective use of a re-formulation of the same therapeutic agent and, in turn, reduce the availability of these treatments among the patient population. For this reason, in this work, a novel NP production protocol that consists only in the use of a syringe and a needle without the need of subsequent purification and freeze-drying steps has been developed. This has been possible by the optimization of the hydrophilic/lipophilic balance of block-copolymers that are able to directly self-assemble in water. The additional degree of freedom necessary for this optimization was introduced via the synthesis of these materials thorough the combination of the reversible addition-fragmentation chain transfer (RAFT) polymerization and the ring opening polymerization (ROP). The NPs has been used to formulate Trabectedin (ET-743), a widely adopted anticancer therapeutic known for its local adverse effect. The pharmacokinetic behavior, antitumor activity and toxicity of this novel NP-based formulation has been compared to the commercially available formulation Yondelis®. NPs have shown the ability to retain the drug into circulation for a longer time in the blood stream compared to the free ET-743 allowing to considerably reduce the local toxic effects. In addition, the shift of the NP preparation step from a specialist to the final user allows to avoid all the purifications and post-processing steps necessary to assure a good shelf-life of the product. In this way, a ET-743 formulation less toxic than the commercially available Yondelis® can be produced at a competitive price taking also into account that this expensive drug is not lost in any of the NP production steps here adopted. In order to prove the versatility of this novel technology, Paclitaxel (PTX), an anticancer therapeutic that it usually formulated with a toxic surfactant (Chremophor EL), have been also formulated into this NPs. In this way, a novel PTX formulation can be produced at a lower cost compared to the ones already approved and present into the market. In particular, it has shown the same advantage in reduction of the toxicity given by the elimination of the Chremophor EL (e.g in Abraxane® and Genexol®)

Knowledge and attitudes towards clinical trials among women with ovarian cancer: results of the ACTO study

Background Despite several initiatives by research groups, regulatory authorities, and scientific associations to engage citizens/patients in clinical research, there are still obstacles to participation. Among the main discouraging aspects are incomplete understanding of the concepts related to a clinical trial, and the scant, sometimes confused, explanations given. This observational, cross-sectional multicenter study investigated knowledge, attitudes and trust in clinical research. We conducted a survey among women with ovarian cancer at their first follow-up visit or first therapy session, treated in centers belonging to the Mario Negri Gynecologic Oncology (MaNGO) and Multicenter Italian Trials in Ovarian Cancer (MITO) groups. A questionnaire on knowledge, attitudes and experience was assembled ad hoc after a literature review and a validation process involving patients of the Alliance against Ovarian Cancer (ACTO). Results From 25 centers 348 questionnaire were collected; 73.5% of responders were 56 years or older, 54.8% had a high level of education, more than 80% had no experience of trial participation. Among participants 59% knew what clinical trials were and 71% what informed consent was. However, more than half did not know the meaning of the term randomization. More than half (56%) were in favor of participating in a clinical trial, but 35% were not certain. Almost all responders acknowledged the doctor's importance in decision-making. Patients' associations were recognized as having a powerful role in the design and planning of clinical trials. Conclusions This study helps depict the knowledge and attitudes of women with ovarian cancer in relation to clinical trials, suggesting measures aimed at improving trial "culture", literacy and compliance, and fresh ways of communication between doctors and patients

Tumor Immune Microenvironment and Genetic Alterations in Mesothelioma

Malignant pleural mesothelioma (MPM) is a rare and fatal disease of the pleural lining. Up to 80% of the MPM cases are linked to asbestos exposure. Even though its use has been banned in the industrialized countries, the cases continue to increase. MPM is a lethal cancer, with very little survival improvements in the last years, mirroring very limited therapeutic advances. Platinum-based chemotherapy in combination with pemetrexed and surgery are the standard of care, but prognosis is still unacceptably poor with median overall survival of approximately 12 months. The genomic landscape of MPM has been widely characterized showing a low mutational burden and the impairment of tumor suppressor genes. Among them, BAP1 and BLM are present as a germline inactivation in a small subset of patients and increases predisposition to tumorigenesis. Other studies have demonstrated a high frequency of mutations in DNA repair genes. Many therapy approaches targeting these alterations have emerged and are under evaluation in the clinic. High-throughput technologies have allowed the detection of more complex molecular events, like chromotripsis and revealed different transcriptional programs for each histological subtype. Transcriptional analysis has also paved the way to the study of tumor-infiltrating cells, thus shedding lights on the crosstalk between tumor cells and the microenvironment. The tumor microenvironment of MPM is indeed crucial for the pathogenesis and outcome of this disease; it is characterized by an inflammatory response to asbestos exposure, involving a variety of chemokines and suppressive immune cells such as M2-like macrophages and regulatory T cells. Another important feature of MPM is the dysregulation of microRNA expression, being frequently linked to cancer development and drug resistance. This review will give a detailed overview of all the above mentioned features of MPM in order to improve the understanding of this disease and the development of new therapeutic strategies

Liquid Biopsy in the Clinical Management of High-Grade Serous Epithelial Ovarian Cancer—Current Use and Future Opportunities

The lack of a sensitive and specific biomarker and the limits relating to the single primary tumor sampling make it difficult to monitor high-grade serous epithelial ovarian cancer (HGS-EOC) over time and to capture those alterations that are potentially useful in guiding clinical decisions. To overcome these issues, liquid biopsy has emerged as a very promising tool for HGS-EOC. The analysis of circulating tumor DNA appears to be feasible and studies assessing specific pathogenic mutations (i.e., TP53) or copy number alterations have shown a sufficient degree of sensitivity and specificity to be realistically used to monitor the effectiveness of antitumor therapy. Liquid biopsy can also provide potential important information on the mechanisms of sensitivity and resistance, e.g., by the determination of the reversion of BRCA mutations. Perspective studies are needed to test whether the application of liquid biopsy will significantly improve HGS-EOC management and patients’ survival