Introduction: Oropharyngeal carcinoma (OPC) represents one of the most rapidly increasing head and neck cancers worldwide, with prognosis strongly influenced by human papillomavirus (HPV) infection. Given the clinical significance, there is a strong demand to evaluate novel biomarkers to monitor treatment outcomes. Therefore, we conducted a study to assess the prognostic value of citrulline, a well-established marker of enterocyte injury, in patients undergoing OPC treatment. Material and methods: We reanalysed a cohort of patients with OPC recruited across three tertiary oncology centres in Poland. All patients were treated with intensity-modulated radiotherapy, with concurrent chemotherapy. Serum citrulline levels were measured prior to treatment using a dedicated ELISA kit. The associations between pre-treatment citrulline levels, clinical characteristics, and patient survival outcomes were evaluated. Results: A total of 64 patients treated with chemoradiotherapy (CRT) were included. The baseline citrulline level showed no significant association with clinical characteristics. In univariable Cox regression, tumour size, along with induction chemotherapy, were significantly associated with poorer overall survival (OS) and progression-free survival (PFS). In contrast, the baseline citrulline level was not predictive in univariate analysis. In the subgroup analysis of patients with positive HPV status, both the larger tumour size and higher citrulline level were significantly associated with poorer OS and PFS. Conclusions: Baseline citrulline demonstrated prognostic value for OS and PFS in HPV-positive patients treated with CRT. These findings suggest a potential role for citrulline as a biomarker of treatment-related vulnerability in OPC and warrant further validation in larger, independent cohorts.
Introduction: The aim of this study was to assess the inflammatory status of patients with pancreatic cancer (PC) prior to the initiation of the first course of chemotherapy and to ascertain the most precise systemic inflammation index for predicting overall survival (OS). Material and methods: A single-centre retrospective analysis involving 310 patients with PC was conducted. Blood samples were collected from patients during chemotherapy qualification, either on the first day of chemotherapy or the day before the first chemotherapy dose. The following inflammatory indices were calculated: systemic immune-inflammation index, systemic inflammation response index, and inflammatory benchmark index (IBI). Statistical analyses were performed utilizing appropriate tests (e.g., the log-rank test). Results: All parameters were significant predictors of mortality; however, their area under the curve indicated only a moderate ability to differentiate mortality risk. Among the indices analysed, IBI was the sole metric that predicted OS in adjuvant (p < 0.05) and palliative (p < 0.001) cohorts, alongside disease-free survival (p < 0.04) and progression-free survival (p < 0.009). In the multivariate analysis, only IBI was proven to be statistically associated with OS (p < 0.043). Furthermore, IBI well stratified the tumour stage. Conclusions: All analysed indices related to inflammation and immune response may function as prognostic markers; however, additional studies are required to determine their precise cut-off value. In our investigation, IBI exhibited a distinctive protective effect, culminating in a 65% reduction in mortality, thereby underscoring the importance of C-reactive protein in patient stratification.
Metronomic cyclophosphamide is occasionally used as maintenance therapy for patients with metastatic triple-negative breast cancer (TNBC), although there is limited long-term safety data. In this case study, we present the patient with metastatic TNBC who achieved a durable complete response and subsequently received metronomic cyclophosphamide for seven years. Progressive cytopenias prompted an investigation, which revealed myelodysplastic syndrome with monosomy 7 once reversible causes had been addressed, including vitamin deficiencies, Helicobacter pylori infection and previous hepatitis C exposure. Following discontinuation of cyclophosphamide, gradual haematological recovery was observed, and the patient remains without radiological evidence of progression. This case highlights the potential for late haematological toxicity associated with prolonged exposure to low doses of alkylating agents, emphasises the need for periodic reassessment of maintenance therapy in long-term responders, and shows that persistent cytopenias require evaluation of alternative causes rather than being solely attributed to chemotherapy.
Introduction:Fangchinoline, a bisbenzylisoquinoline alkaloid derived from Stephaniae tetrandrine, is known for its antioxidant and anticancer potential. This study aimed to explore fangchinoline's anticancer targets in silico and evaluate its effects on human epidermal growth receptor-2 (HER-2) overexpressing MCF-7 breast cancer cells. Material and methods:Potential molecular targets were identified using GeneCards and DisGeNET, with intersecting genes analysed via DAVID and Cytoscape. Molecular docking and 50-nanosecond molecular dynamics simulations were conducted against ERBB2, IGF1R, and ADRB2 proteins. Cytotoxicity was evaluated through 3-(4,5-dimethylthiazole-2-yl)-2,5- diphenyl tetrazolium bromide assay, while flow cytometry assessed cell cycle distribution, apoptosis, expression of PI3K, Akt, mTOR, p53, HER-2, and reactive oxygen species (ROS) levels. Results:A total of 256 overlapping genes were identified, and ERBB2 emerged as the most promising target with a binding affinity of -8.57 kcal/mol. Fangchinoline exhibited cytotoxicity against MCF-7/HER-2 cells with an IC50 of 9.67 ±0.14 µM. Fangchinoline induced G2-M arrest and significantly increased apoptosis. Flow cytometry revealed downregulation of PI3K (-42.1%), Akt (-38.6%), and mTOR (-45.3%), with a corresponding upregulation of p53 (+59.8%) compared to controls. Reactive oxygen species production was elevated by +48.5% after treatment. Conclusions:Fangchinoline exhibits promising anticancer activity by targeting ERBB2 and modulating critical oncogenic and apoptotic pathways. Its ability to upregulate p53 and ROS while suppressing PI3K/Akt/mTOR signalling suggests its strong potential as a HER-2-targeted therapeutic agent.
Extranodal marginal zone lymphoma (EMZL), which has an indolent course, rarely occurs in arytenoid cartilage. Diagnosis of the condition in such an infrequent location is challenging and demands the use of various methods, such as magnetic resonance imaging and histopathological examination of the tissue sections acquired during microlaryngoscopy. We present an infrequent case of a 61-year-old patient who was diagnosed with EMZL of arytenoid cartilage after a four-year period of surveillance and examinations. Chemoimmunotherapy was implemented in this case as a successful method of treatment, as it included bendamustine and rituximab. The disease was in remission after the treatment.
