Vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1 alpha (HIF-1ɑ) in lacrimal gland Adenoid cystic carcinoma: Correlation with clinical outcome

Retrospective Study Evaluating the Outcome and Efficacy of Stereotactic Body Radiation Therapy for the Treatment of Metastatic Abdominal Lymph Nodes in Dogs With Apocrine Gland Anal Sac Adenocarcinoma

Local treatment for dogs with regional lymph node metastasis secondary to apocrine gland anal sac adenocarcinoma (AGASACA) includes nodal extirpation or radiotherapy. Stereotactic body radiation therapy (SBRT) may provide a definitive intent treatment option for macroscopic nodal disease when surgery is declined or the disease is deemed inoperable. Twenty-five dogs receiving SBRT to the metastatic sacroiliac lymph nodes were retrospectively evaluated. Dogs were staged according to the previously published TNM staging system with 3 stage IIIa, 14 stage 3b, and 8 stage IV. The overall median survival time (MST) was 451 days and the stage did not significantly impact survival (p = 0.31). The overall median event-free survival time was 246 days. Significant positive prognostic factors included male sex, higher dose per fraction, and higher total dose (p = 0.034, 0.0035, 0.0047). Dogs receiving 6-7.5 Gy per fraction with a total dose of 30-37.5 Gy outperformed dogs receiving other protocols. Twelve dogs experienced gait changes in the hind limbs during the late radiation effects period. Resolution of hypercalcemia in 5 dogs was inconsistent and transient. The best response was complete in 21%, partial in 58%, and stable disease in 17% at a median of 100 days. Three dogs (12%) developed progression of treated lymph nodes at 157, 498, and 644 day. Eight dogs (32%) had recurrence of their primary (untreated by radiation) anal sac masses. SBRT was determined to be an effective alternative to surgical excision; however, more investigation is needed to determine the cause of gait changes in the late toxicity period.

Treatment strategies and prognostic insights for lacrimal gland adenoid cystic carcinoma: a review

Adenoid cystic carcinoma (ACC) is the most common type of malignant tumor in lacrimal gland cancer. The primary treatment approach involves eye-preserving surgery combined with adjuvant radiotherapy, which has proven effective in maintaining visual function and achieving favorable local control with minimal toxicity. However, the 5-year survival rate for ACC of the lacrimal gland remains below 60%. Recently, novel adjuvant therapies, including neoadjuvant intra-arterial chemotherapy, proton radiotherapy, and neutron radiotherapy, have significantly improved survival outcomes. Despite these advances, the rarity of lacrimal gland adenoid cystic carcinoma (LGACC) limits comprehensive studies on long-term survival and the potential for late toxicity, underscoring the need for further research. Additionally, recent findings on pathogenic mechanisms and proteomic abnormalities in LGACC offer a foundation for developing targeted therapies, paving the way for more personalized treatments. This article reviews contemporary treatment strategies and prognostic insights for LGACC, focusing on recent advancements and their implications for patient survival.

Integrating proteomics and network pharmacology to explore the relevant mechanism of Huangkui capsule in the treatment of chronic glomerulonephritis

Introduction

Chronic glomerulonephritis (CGN) is a common glomerular disease with multifactorial pathogenesis. Huangkui capsule (HKC), a traditional Chinese herbal formulation, demonstrates therapeutic potential in CGN; however, its molecular mechanisms remain insufficiently characterized. This study aimed to clarify the therapeutic mechanisms of HKC in CGN by integrating proteomic analysis with network pharmacology.

Methods

We employed liquid chromatography-mass spectrometry (LC-MS) to identify the active components of HKC. A CGN rat model was established and treated with HKC. Renal function parameters and serum inflammatory cytokines were assessed. Histopathological alterations and IgG deposition in kidney tissues were examined using hematoxylin-eosin (HE) staining and immunofluorescence, respectively. Proteomic profiling of renal tissue was conducted, and network pharmacology analysis was applied to identify potential therapeutic targets of HKC.

Results

A total of 39 active compounds were identified in HKC. HKC administration significantly improved renal function and mitigated glomerular injury in CGN rats. Proteomic analysis revealed 2,079 differentially expressed proteins, predominantly associated with oxidoreductase activity. Network pharmacology identified 462 targets related to HKC and 1,835 targets associated with CGN, with 13 overlapping targets, including STAT3, PIK3R1, AKT1, HIF-1α, and VEGF, which were downregulated following HKC treatment.

Conclusion

HKC exerts renoprotective effects in CGN by regulating multiple signaling pathways, notably HIF-1, VEGF, PI3K-Akt, MAPK, and PPAR. Through attenuation of inflammatory and oxidative responses, HKC alleviates renal pathological damage and supports kidney function, offering mechanistic insight into its multi-target therapeutic potential.

Vascular Endothelial Growth Factor Receptor Inhibitors for Recurrent or Metastatic Adenoid Cystic Carcinoma: A Systematic Review and Meta-Analysis

Importance

There is no systemic therapy for recurrent or metastatic adenoid cystic carcinoma (ACC) approved by the US Food and Drug Administration.

Objective

To examine the efficacy, safety, and tolerability of vascular endothelial growth factor receptor (VEGFR) inhibitors in recurrent or metastatic ACC.

Data Sources

PubMed, Embase, and Cochrane Library were systematically searched for studies of VEGFR inhibitors in recurrent or metastatic ACC from database inception to August 31, 2023.

Study Selection

Inclusion criteria were prospective clinical trials of recurrent or metastatic ACC treated with VEGFR inhibitors, reporting at least 1 outcome of interest specifically for ACC. Of 1963 identified studies, 17 (0.9%) met inclusion criteria.

Data Extraction and Synthesis

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline was followed to extract data. Data were pooled using a random-effects generalized linear mixed model with 95% CIs.

Main Outcomes and Measures

The primary efficacy outcome was best overall response to VEGFR inhibitors, including objective response, stable disease, or progressive disease (PD). Safety and tolerability outcomes included incidence of grade 3 or higher adverse events, rates of exit from trial due to PD or drug-related toxic effects, and dose reduction rate (DRR).

Results

A total of 17 studies comprising 560 patients with recurrent or metastatic ACC treated with 10 VEGFR inhibitors were included. The objective response rate was 6% (95% CI, 3%-12%; I2 = 71%) and stable disease was the most frequent best overall response (82%; 95% CI, 74%-87%; I2 = 67%). The 6-month disease control (defined as objective response and stable disease) rate was 54% (95% CI, 45%-62%; I2 = 52%). The rate of grade 3 or higher adverse events was 53% (95% CI, 42%-64%; I2 = 81%) and of DRR was 59% (95% CI, 40%-76%). Most patients (57%; 95% CI, 44%-70%; I2 = 83%) continued therapy until PD; 21% (95% CI, 15%-28%; I2 = 62%) of patients suspended therapy for toxic effects. In subgroup analysis by specific VEGFR inhibitor, the objective response rate was 14% (95% CI, 7%-25%; I2 = 0%), stable disease rate was 76% (95% CI, 63%-85%; I2 = 0%), proportion treated until PD was 61% (95% CI, 14%-94%; I2 = 94%), and DRR was 78% (95% CI, 66%-87%; I2 = 39%) with lenvatinib. Corresponding axitinib results were objective response rate of 8% (95% CI, 4%-15%; I2 = 0%) and stable disease rate of 85% (95% CI, 72%-92%; I2 = 69%), with 73% (95% CI, 63%-82%; I2 = 0%) of patients treated until PD, and the DRR was 22% (95% CI, 12%-38%; I2 = 77%). Rivoceranib had the highest objective response rate (24%; 95% CI, 7%-57%) but high heterogeneity among studies (I2 = 95%) and the lowest rate of patients who continued therapy until PD (35%; 95% CI, 20%-55%; I2 = 90%).

Conclusions and Relevance

This systematic review and meta-analysis found that VEGFR inhibitors were associated with high rates of disease stabilization in recurrent or metastatic ACC. Of 10 included VEGFR inhibitors, lenvatinib and axitinib were associated with the best combined and consistent efficacy, safety, and tolerability profiles, substantiating their inclusion in treatment guidelines.

Adenoid Cystic Carcinoma of the Lacrimal Gland

Purpose

To explore the various aspects of adenoid cystic carcinoma of the lacrimal gland (LACC), including its clinical features, presentations, genetic factors, as well as current and potential future treatment options.

Methods

A thorough exploration of the literature was conducted by extensively searching the PubMed database. A total of 68 articles with a primary focus on adenoid cystic carcinoma were selected.

Results

LACC is the most frequent malignant epithelial tumor of the lacrimal gland. It is characterized by the symptoms such as pain, progressive swelling of the eye, double vision, and bulging of the eye. Although LACC is a rare tumor, early detection and appropriate treatment are crucial due to its aggressive nature which includes high recurrence rate and a significant risk of mortality. The primary treatment options for LACC involve a wide range of surgical procedures, including orbitotomy, exenteration, and cranio-orbital resection. Neoadjuvant intra-arterial chemotherapy represents the paradigm shift in the treatment of LACC enhancing patient survival when compared to conventional treatments.

Conclusion

The existing literature emphasizes the importance of identifying prognostic factors that can guide treatment decisions and enhance the outcomes for patients with LACC.

Systemic and Targeted Therapies in Adenoid Cystic Carcinoma

OPINION STATEMENT

Adenoid cystic carcinoma (ACC) is an often-indolent type of salivary gland cancer (SGC). A subset of patients develops progression or aggressive disease warranting systemic therapy in the recurrent/metastatic (R/M) setting. We recommend genomic testing for all patients with R/M disease to aid with prognostication and eligibility for potential experimental therapies. Here, we review the currently available treatment options (cytotoxic chemotherapies and vascular endothelial growth factor receptor (VEGFR)-targeting tyrosine kinase inhibitors (TKIs)). Based on limited data, we nominate regimens which may have more favorable efficacy profiles. Among the cytotoxic chemotherapies, several regimens are acceptable when incorporating a platinum agent. Among the VEGFR-targeting TKIs, lenvatinib and axitinib are the preferred options. Larger, randomized studies prioritizing combinations with mechanistic synergism are needed. Predictive biomarkers are critical, as there is currently little evidence to guide sequencing of available options for individual patients. Immunotherapy is an available option, but has been associated with only modest benefit in ACC. We go on to review other therapies that have been studied and nominate those with promise based on early clinical data.