Is L-theanine an Effective Treatment for Reducing Anxiety in Patients Ages 18-25?

Objective: The objective of this selective EBM review is to determine whether or not L-theanine, an amino acid analogue found in green tea leaves, is an effective treatment for reducing anxiety in patients ages 18-25. Study design: Review of two double-blind, randomized controlled studies and one single-blind, randomized controlled study published in 2007, 2012 and 2013 respectively. Data sources: PubMed Outcome(s) measured: Each study measured L-theanine’s ability to reduce acute anxiety with a series of self-report measures assessing acute anxiety and stress, including the Profile of Mood States (POMS), the visual analogue scales (VAS), State-Trait Anxiety Inventory (STAI) and achievement emotion measurement. Results: Kimura and colleagues found that state-trait anxiety inventory scores were significantly lower in the L-theanine group compared to placebo, Yoto and colleagues found that L-theanine significantly decreased tension-anxiety scores compared to placebo and Unno and colleagues found that scores of subjective stress were significantly lower in the L-theanine group compared to placebo. Conclusion: Each reviewed study provides convincing and statistically significant evidence that that L-theanine has the potential to reduce symptoms of anxiety. However, there were inconsistencies. All three studies used VAS as a self-report measure, but only Unno and colleagues found VAS scores to be significantly reduced. Similarly, STAI scores were only significantly lowered in the study by Kimura and colleagues. Despite these discrepancies, the studies demonstrate a likely benefit of L-theanine reducing anxiety-related symptoms

Clinical Utilization Pattern of Liquid Biopsies (LB) to Detect Actionable Driver Mutations, Guide Treatment Decisions and Monitor Disease Burden During Treatment of 33 Metastatic Colorectal Cancer (mCRC) Patients (pts) at a Fox Chase Cancer Center GI Oncology Subspecialty Clinic

Background: Liquid biopsy (LB) captures dynamic genomic alterations (alts) across metastatic colorectal cancer (mCRC) therapy and may complement tissue biopsy (TB). We sought to describe the utility of LB and better understand mCRC biology during therapy.Methods: Thirty-three patients (pts) with mCRC underwent LB. We used permutation-based t-tests to assess associations between alts, and clinical variables and used Kendall's tau to measure correlations.Results: Of 33 pts, 15 were women; 22 had colon, and the rest rectal cancer. Pts received a median of two lines of therapy before LB. Nineteen pts had limited testing on TB (RAS/RAF/TP53/APC), 11 extended NGS, and 3 no TB. Maxpct and alts correlated with CEA (p < 0.001, respectively). In 3/5 pts with serial LB, CEA correlated with maxpct trend, and CT tumor burden. In 6 pts, mutant RAS was seen in LB and not TB; 5/6 had received anti-EGFR therapy prior to LB, suggesting RAS alts developed post-therapy. In two pts RAS-mutated by TB, no RAS alts were detected on LB; these pts had low disease burden on CT at time of LB that also did not reveal APC or TP53 alts. In six patients who were KRAS wt based on TB, post anti-EGFR LB revealed subclonal KRAS mutations, likely a treatment effect. The median number of alts was higher post anti-EGFR LB (n = 12) vs. anti-EGFR naïve LB (n = 22) (9.5 vs. 5.5, p = 0.059) but not statistically significant. More alts were also noted in post anti-EGFR therapy LB vs. KRAS wt anti-EGFR-naïve LB (n = 6) (9.5 vs. 5) among patients with KRAS wild-type tumors, although the difference was not significant (p = 0.182).Conclusions: LB across mCRC therapy detects driver mutations, monitors disease burden, and identifies sub-clonal alts that reflect drug resistance, tumor evolution, and heterogeneity. Interpretation of LB results is impacted by clinical context