Combining the past and present to advance immuno-radiotherapy of cancer

Nano-chameleons: A review on cluster of differentiation-driven immune cell-engineered nanoarchitectonics for non-small cell lung cancer

Cancer, being one of the most outrageous diseases, contributed to 48 % of the mortality in 2022, with lung cancer leading the race with a 12.4 % incidence rate. Conventional treatment modalities like radio-, chemo-, photo-, and immunotherapy employing nanocarriers often face several setbacks, such as non-specific delivery, off-site toxicity, rapid opsonization via the host immune system, and greater tumor recurrence rates. Moreover, the heterogeneous variability in the tumor microenvironment is responsible for existing therapy failure. With the advent of biomimetic nanoparticles as a novel and intriguing platform, researchers have exploited the inherent functionalities of the Cluster of Differentiation proteins (CD) as cell surface biomarkers and imparted the nanocarriers with enhanced homologous tumor targetability, immune evasion capability, and stealth properties, paving the way for improved therapy and diagnosis. This article explores pathogenesis and the multifaceted role of immune cells in non-small cell lung cancer. Moreover, the agenda of this article is to shed light on biomimetic nanoarchitectonics with respect to their fabrication, evaluation, and applications unraveling their synergistic effect with conventional therapies. Further discussion mentions the hurdles in clinical translation with viable solutions. The regulatory bottlenecks underscore the need for a regulatory roadmap with respect to commercialization. We believe that biomimetic nanoarchitectonics will be a beacon of hope in warfare against lung cancer.

A bibliometric and visualization analysis of the role of traditional Chinese medicine in cancer immunotherapy

Objective

Traditional Chinese medicine (TCM) is used as a complementary treatment for patients with cancer, especially in immunotherapy. Although extensive clinical and basic research has been conducted on TCM in cancer immunotherapy, a comprehensive bibliometric analysis of this field has not yet been performed. This study aimed to investigate the progress and status of TCM, and the research focused on cancer immunotherapy.

Methods

We collected 1,657 articles on TCM in cancer immunotherapy from 1994 to 2024 from the Web of Science Core Collection database. VOSviewer, CiteSpace, and the Bibliometrix R package were used to analyze countries, institutions, journals, authors, references, and keywords to predict future trends in cancer immunotherapy with TCM.

Results

The publication rate of TCM in cancer immunotherapy research steadily increased from 1994 to 2018, with a swift growth from 2018 to 2023. China and TCM universities have achieved the most research advancements in this field. The most studied types of cancer are liver, lung, and colorectal cancers. However, few studies exist on upper respiratory tract tumors, cervical cancer, and melanoma, which deserve more attention. The study trend has gradually shifted from in vivo and in vitro models to clinical efficacy. Simultaneously, the focus of research transitioned from compound TCM preparations or classes of ingredients to specific pharmacodynamic ingredients, and the corresponding targets transitioned from cytokines to immune checkpoints. In general, molecular docking combined with multi-omics analysis is a popular and trending research method in TCM for cancer immunotherapy, helping researchers understand the mechanisms of TCM in cancer immunotherapy more comprehensively and accurately. By analyzing the literature, it is evident that TCM-based immunotherapy should contribute to effective maintenance or adjuvant therapy throughout the entire course of cancer rather than only in the late stages.

Conclusion

This study comprehensively summarized and identified research frontiers providing a reference for promoting the development of TCM immunotherapy preparations and guiding clinical practice. Consequently, more patients with cancer can benefit from immunotherapy.

IFN-Type-I Response and Systemic Immunity in Rectal Adenocarcinoma Patients Treated with Conventional or Hypofractionated Neoadjuvant Radiotherapy

The IFN-type-I pathway is involved in radiotherapy (RT)-mediated immune responses. Large RT fractions have been suggested to potently induce this pathway. Neoadjuvant hypofractionated short-course (scRT) and conventional long-course (lcRT) RT applied for the treatment of locally advanced rectal adenocarcinoma patients provides a unique model to address the immuno-stimulatory properties of RT on a systemic level. We prospectively analyzed the IFNβ plasma levels and lymphocyte counts (LCs) of rectal adenocarcinoma patients before and after treatment with scRT (n = 22) and lcRT (n = 40). Flow cytometry was conducted to assess the effects on lymphocytic subpopulations in a subset of 20 patients. A statistically significant increase in the post-RT IFNβ plasma levels was noted in patients undergoing scRT (p = 0.004). Improved pathological tumor regression was associated with elevated post-RT IFNβ levels (p = 0.003). Although all patients experienced substantial lymphopenia after treatment, the post-RT LC of patients treated with scRT were significantly higher compared to lcRT (p = 0.001). Patients undergoing scRT displayed significantly lower percentages of regulatory CD4+/CD25+ T-cells after therapy (p = 0.02). scRT enables effective stimulation of the IFN-type-I pathway on a systemic level and confers decreased lymphocytic cytotoxicity and limited regulatory T-cell activation compared to lcRT, supporting its increasing role in immuno-RT trials.

Locoregional drug delivery for cancer therapy: Preclinical progress and clinical translation

Systemic drug delivery is the current clinically preferred route for cancer therapy. However, challenges associated with tumor localization and off-tumor toxic effects limit the clinical effectiveness of this route. Locoregional drug delivery is an emerging viable alternative to systemic therapies. With the improvement in real-time imaging technologies and tools for direct access to tumor lesions, the clinical applicability of locoregional drug delivery is becoming more prominent. Theoretically, locoregional treatments can bypass challenges faced by systemic drug delivery. Preclinically, locoregional delivery of drugs has demonstrated enhanced therapeutic efficacy with limited off-target effects while still yielding an abscopal effect. Clinically, an array of locoregional strategies is under investigation for the delivery of drugs ranging in target and size. Locoregional tumor treatment strategies can be classified into two main categories: 1) direct drug infusion via injection or implanted port and 2) extended drug elution via injected or implanted depot. The number of studies investigating locoregional drug delivery strategies for cancer treatment is rising exponentially, in both preclinical and clinical settings, with some approaches approved for clinical use. Here, we highlight key preclinical advances and the clinical relevance of such locoregional delivery strategies in the treatment of cancer. Furthermore, we critically analyze 949 clinical trials involving locoregional drug delivery and discuss emerging trends.

Bibliometric and visual analysis in the field of tea in cancer from 2013 to 2023

Objective

Tea has been utilized in cancer research and is progressively gaining wider recognition, with its roles in cancer prevention and treatment being increasingly affirmed. The objective of this study is to investigate the current state and research hotspots in the field of tea's involvement in cancer research from 2013 to 2023, aiming to offer reference and direction for future studies.

Methods

We analyzed 4,789 articles published between 2013 and 2022 from the Web of Science database using VOSviewer, R software, and CiteSpace software.

Result

Tea-related cancer research showed an overall upward trend, with China leading in publications, followed by the United States, India, Japan, and Italy. China also had significant international collaborations, notably with Harvard University and the Egyptian Knowledge Bank. The 'Journal of Agricultural and Food Chemistry' was the most cited journal. Key topics included 'green tea,' 'cancer,' 'in vitro,' 'oxidative stress,' and 'apoptosis.' Research focused on tea's pharmacological effects, anticancer properties, mechanisms of natural compounds (e.g., polyphenols and EGCG), antioxidant and antimicrobial properties, and molecular mechanisms in cancer treatment.

Conclusion

Tea's potential as an anti-cancer medication is gaining global recognition. Our study provides a comprehensive analysis of tea-related cancer research from 2013 to 2023, guiding future investigations in this field.

Tumor-infiltrating lymphocytes, PD-L1, and MMR-deficiency combined characterization may identify subgroups of rectal cancer patients who would benefit from immunotherapy

INTRODUCTION

Mismatch repair deficiency, immunological fertility, and PD-L1 expression status are key histopathological and molecular features defining tumor responsiveness to immunotherapy and, eventually, prognosis. These were investigated in a series of locally advanced rectal cancer patients treated with postoperative chemotherapy and radiotherapy.

MATERIALS AND METHODS

Tumor-infiltrating lymphocyte (TIL) density was assessed in hematoxylin-eosin tissue sections. PD-L1 expression and the expression of MMR proteins (MLH1, PSM2, MSH2, and MSH6) were assessed with immunohistochemistry. Their association with histopathological variables (node involvement and tumor budding) and prognosis was assessed.

RESULTS

The TIL-density was significantly higher in the invading tumor front and was inversely related to tumor budding and directly with better overall survival (OS) and distant metastasis-free survival (DMFS) (p = 0.02 and 0.02, respectively). Cancer cell PD-L1 expression was related to high TIL-density (p < 0.01) but not to prognosis, although its overexpression defined a trend for poorer OS in patients with high TIL-density. High PD-L1 expression by stroma infiltrating immune cells was linked with better OS and DMFS (p = 0.007 and 0.001, respectively. MMR deficiency was recorded in 26.2 % of cases, and this was linked with higher TIL-density, but not with prognosis.

CONCLUSIONS

Dense intratumoral lymphocytic infiltration relates to a better prognosis in rectal cancer, although it is also linked with PD-L1 expression that may adversely modulate the anti-tumor effects of TILs. This latter subgroup of patients (high TIL-density/high cancer cell PD-L1 expression) could be an additional target for anti-PD-1/PD-L1 immunotherapy, along with the established subgroup of MMR deficient patients.

Bibliometric and visual analysis in the field of traditional Chinese medicine in cancer from 2002 to 2022

Objective: Traditional Chinese medicine (TCM) has been used as a complementary treatment for cancer patients, but there has been no quantitative comprehensive analysis of TCM's efficacy. The purpose of this paper is to explore the current status and hotspots of TCM in cancer research from 2002 to 2022 and to provide a reference for future research. Methods: We retrieved articles published between 2002 and 2022 from the Web of Science database and analyzed them using R software, VOSviewer, and CiteSpace software. Results: A total of 7,129 articles were included in this study. The publication rate of TCM cancer research increased steadily from 2002 to 2022, with a rapid increase from 2010 to 2021. China was the country with the most published articles, followed by the United States, Republic of Korea, Germany, and Japan. China was also the country with the most international collaborations, and China Medical University and Shanghai University of Traditional Chinese Medicine were the most representative cooperation centers. The Journal of Ethnopharmacology was the most published and cited journal. Apoptosis, expression, in vitro, activation, and other related keywords were commonly used in these articles. Breast cancer, colorectal cancer, gastric cancer, liver cancer, and lung cancer were the most studied cancer types in TCM research. Pathway-related apoptosis, anti-inflammation, and oxidative stress were the hotspots and trends of TCM's anti-cancer mechanism. Metabolomics combined with network pharmacology was the main research method. Conclusion: Traditional Chinese medicine as an anti-cancer drug has received increasing attention from researchers worldwide, and it is expected to be a hotspot for developing new anti-cancer drugs in the future. Our study provides a comprehensive analysis of the current status and hotspots of TCM cancer research, which could serve as a valuable reference for future studies.

The molecular basis of immuno-radiotherapy

PURPOSE

Radiotherapy (RT) and immunotherapy are powerful anti-tumor treatment modalities. Experimental research has demonstrated an important interplay between the cytotoxic effects of RT and the immune system. This systematic review provides an overview of the basics of anti-tumor immunity and focuses on the mechanisms underlying the interplay between RT and immune anti-tumor response that set the molecular basis of immuno-RT.

CONCLUSIONS

An 'immunity acquired equilibrium' mimicking tumor dormancy can be achieved post-irradiation treatment, with the balance shifted toward tumor eradication or regrowth when immune cells' cytotoxic effects or cancer proliferation rate prevail, respectively. RT has both immunosuppressive and immune-enhancing properties. The latter effect is also known as radio-vaccination. Its mechanisms involve up- or down-regulation of membrane molecules, such as PD-L1, HLA-class-I, CD80/86, CD47, and Fas/CD95, that play a vital role in immune checkpoint pathways and increased cytokine expression (e.g. INFα,β,γ, IL1,2, and TNFα) by cancer or immune cells. Moreover, the interactions of radiation with the tumor microenvironment (fibroblasts, tumor-infiltrating lymphocytes, monocytes, and dendritic cells are also an important component of radio-vaccination. Thus, RT may have anti-tumor vaccine properties, whose sequels can be exploited by immunotherapy agents to treat different cancer subtypes effectively.

Study on the Correlation between Pain and Cytokine Expression in the Peripheral Blood of Patients with Bone Metastasis of Malignant Cancer Treated Using External Radiation Therapy

The incidence of cancer is increasing worldwide on a yearly basis, with the number of patients with bone metastases also increasing annually. Events associated with bone metastases can seriously affect patient quality of life, through pain, hypercalcemia, bone marrow regeneration disorders, and spinal cord compression. In this nonrandomized controlled clinical trial study, we focused on the relationship between bone metastasis, pain, and cytokines before and after radiotherapy. We hypothesized that radiotherapy alters the cytokine profile of the local bone environment. Combined with the analgesic effects of radiotherapy, certain cytokines may be very sensitive to radiation. External radiation therapy is commonly used to treat cancer patients with bone metastases and can effectively relieve metastasis-related pain, although its underlying mechanisms have not been fully elucidated. For this case-control study, we recruited 30 cancer patients with bone metastasis and 30 healthy individuals. Peripheral venous blood from healthy individuals was collected. The clinical characteristics and peripheral venous blood were collected from patients one week before and one week after radiotherapy. The preradiotherapy and postradiotherapy pain scores, quality of life (QOL), and blood cytokine profiles of the patients to that of the controls were collected to identify pain-related cytokines. Finally, the pain score and the quality of life score improved significantly after radiotherapy. Moreover, the preradiotherapy and postradiotherapy blood cytokine profiles of the patients showed significant differences, indicating that the analgesic effect of radiotherapy against bone metastases is mediated via altered cytokine production. Furthermore, some cytokines were more sensitive to radiotherapy. The levels of MIP-1δ, MCP-2, TIMP-1, RANTES, IGFBP3, and TNF-α showed significant differences in the pairwise comparative analysis and may therefore mediate pain associated with bone metastasis.

Cold atmospheric plasma-induced oxidative stress and ensuing immunological response - a Neo-Vista in immunotherapy

Plasma, the fourth state of matter could be artificially generated at room temperature under atmospheric pressure - termed as cold atmospheric plasma (CAP). The reactive oxygen and nitrogen radicals emanated during plasma discharge accord manifold applications in medicine and have proven clinical applications in cancer treatment, dentistry, and dermatology. Developments in the field termed "Plasma medicine" has inclined research toward its prospects in immunotherapy. Controlled generation of reactive oxygen and nitrogen radicals during plasma formation produces oxidative stress on tissue of concern, selectively and activates a number of cytological and molecular reactions, triggering immunological response. Plasma treatment induces immunogenic cell death (ICD) in tumor cells and elicits enhanced adaptive and systemic immune response with memory cells, conferring better defense to cancer. HIV inactivation, reduced viral replication, reversal of latency in HIV-infected cells, and augmented infected cell opsonization has been observed with CAP treatment. Plasma-treated medium has shown to deactivate Herpes simplex virus (HSV-1) in human corneal explants and epithelial cells, and lessen the severity of herpes simplex keratitis. Perception of cellular changes that triggers innate and adaptive immune response during CAP treatment is quintessential for understanding and expansion of research in this arena. This review mentions the inimitable properties of plasma that makes it a safe and sensitive immunotherapeutic tool. The methods of plasma generation relied for the purpose are elucidated. The cellular mechanism of immunological stimulation in cancer, HIV, and keratitis during CAP treatment is detailed. The future prospects and challenges are briefly addressed.HighlightsReactive oxygen and nitrogen radicals produced by cold atmospheric plasma (CAP) triggers oxidative stress in exposed cells.Cells in oxidative stress incite immunological response that could be suitably manipulated for immunotherapy.The role of reactive radicals and methods of plasma generation for immunotherapy is elucidated.The cellular and molecular cascade of reactions leading to immunological cell death in cancer cells is detailed.The mechanism of HIV inactivation and reduced infection; further, deactivation of HSV in Herpes keratitis in intact human corneal explants is also described.