Changing the History of Prostate Cancer with New Targeted Therapies

The therapeutic landscape of metastatic castration-resistant prostate cancer (mCRPC) is changing due to the emergence of new targeted therapies for the treatment of different molecular subtypes. Some biomarkers are described as potential molecular targets different from classic androgen receptors (AR). Approximately 20–25% of mCRPCs have somatic or germline alterations in DNA repair genes involved in homologous recombination. These subtypes are usually associated with more aggressive disease. Inhibitors of the enzyme poly ADP ribose polymerase (PARPi) have demonstrated an important benefit in the treatment of these subtypes of tumors. However, tumors that resistant to PARPi and wildtype BRCA tumors do not benefit from these therapies. Recent studies are exploring drug combinations with phosphatidylinositol-3-kinase (PI3K) or protein kinase B (AKT) inhibitors, as mechanisms to overcome resistance or to induce BRCAness and synthetic lethality. This article reviews various different novel strategies to improve outcomes in patients with prostate cancer.

Seizures and Neuropsychiatric Toxicity in Patients with Non-Metastatic CRPC Treated with New Antiandrogens: Systematic Review and Meta-Analysis

INTRODUCTION

Recently, enzalutamide, apalutamide, and darolutamide have shown benefits in metastasis-free survival in non-metastatic castration-resistant prostate cancer (nmCRPC) patients compared to placebo. Previous evidence about the safety profile of these new androgens is limited. This meta-analysis studies seizure and neuropsychiatric effects of new anti-androgens compared to placebo in nmCRPC patients.

METHODS

PubMed and Cochrane databases were systematically reviewed until 1 March 2020 by 2 independent researchers using a pre-specified search strategy. Placebo-compared randomized controlled trials (RCTs) of nmCRPC patients treated with new anti-androgens providing data on neuropsychiatric events and seizures were included. Variables were seizure, headache, mental impairment, and dizziness. Pooled risk ratios (RR) were calculated using the Mantel-Hansel random effects model and Review Manager v5.3 software.

RESULTS

After systematic review, 3 eligible RCTs were selected that included 4,104 patients; 2,687 comprised the treatment group and 1,417 the control group. No significant increase in RR for seizures was registered with the new anti-androgens compared to placebo (RR 1.96; 95% confidence interval [CI] 0.40-9.61). However, 2 trials excluded patients with risk factors or a history of seizures. There was also no significant increase RR for grade ≥3 seizures (RR 2.50; 95% CI 0.12-52.02). RR for suffering dizziness (any grade) was 1.57 (95% CI 1.07-2.32) with the new anti-androgens, but no significant differences were found in the other study regarding neuropsychiatric events or grade ≥3 events.

CONCLUSIONS

New anti-androgens (i.e., enzalutamide, apalutamide, and darolutamide) are acceptably safe in terms of seizures and neuropsychiatric toxicity compared to placebo in patients with nmCRPC.

Chaos theories and therapeutic commonalities among depression, Parkinson's disease, and cardiac arrhythmias

This report reviews and compares all therapies that have shown efficacy in depression and Parkinson's disease, although some are not in current use and others are at the experimental stage. They include pharmacological modification of neurotransmitter pathways, electroconvulsive therapy (ECT), sleep deprivation, psychosurgery, electrical stimulation through cerebral electrodes, and transcranial magnetic stimulation. Stemming from a pathophysiological model that stresses the brain as an open, complex, and nonlinear system, all therapies have been attributed a common mechanism of action. This report suggests that the therapeutic isomorphism is related to their ability to help the CNS deactivate cortical-subcortical circuits that are dysfunctionally coupled. These circuits are self-organized among neurons of their informational subsystem (rapid conduction) and modulating subsystem (slow conduction). Finally, this report extends the analysis and comparison of these therapies to some cardiac arrhythmias.

Observations on peritumoral oedema in meningioma. Part II: Mechanisms of oedema production

Meningiomas occurring in 160 patients were studied in relation to oedema production using computerised tomography. Statistically significant positive correlations with oedema production were found with tumours of large surface area, anterior parasagittal position, prominent vascularity, involving dural sinuses, and with short clinical history. Significant negative correlations were found with small tumour size and the presence of calcification. It is considered that hydromechanical factors predominate in oedema production with meningioma.

Observation on peritumoural oedema in meningioma. Part I: Distribution, spread and resolution of vasogenic oedema seen on computed tomography

The distribution of oedema detected by computed tomography in 46% of 160 patients with cerebral meningiomas was studied. Oedema occurred most frequently in the centrum semiovale and deep white matter around the ventricular trigones and frontal horns, the distribution reflecting mainly the size of the interstitial spaces adjacent to the tumour. Other theoretically relevant factors such as hydrocephalus and cerebral atrophy did not influence oedema distribution. Cyst like spaces of various types were observed in 20% and their aetiology is discussed. Oedema usually resolved after surgery, but in at least 13% it persisted after 3 months. Atrophy related to tumour size and not to presence or extent of oedema. Increased oedema after surgery was never of vasogenic type and could nearly always be ascribed to a definable complication.

CT changes associated with migraine

In order to determine further the correlation between severe migraine and cerebral atrophy, a group of patients attending either the Charing Cross Hospital migraine clinic or outpatient clinics at the National Hospital, Queen Square, was investigated by computed tomography. The results confirm an association between atrophy and migraine of more than 5 years duration, probably more severe in men than women. The most striking changes were seen in those men who suffered from attacks lasting less than 6 hr.

A comparative study of the psychiatric nurses' attitudes towards mental patients

THE aim of the present study is to analyse the effect of professional training on the psychiatric nurse's tolerance of mental disorders. We have used as samples two clearly-differentiated population groups : university students (N=328) and psychiatric nurses (N=50). The testing instruments were a semantic differential test and questionnaires on the subjects of aetiological factors, prognosis of mental disorders and social distance. We have found that while in an aetiological context the attitudes of both nurses and the students towards mental disorders are practi cally the same, attitudes towards prognosis and treatment seem greatly changed in those who possess psychiatric training and experience. Psychiatric nurses are not free from prejudice in respect of mental disorders.