Objective: Clinical studies have shown that trastuzumab combined with pertuzumab (dual-targeted drug therapy) can significantly improve the treatment status and prognosis of HER-2 positive breast cancer patients through double targeting of HER-2. This study systematically evaluated the efficacy and safety of trastuzumab combined with pertuzumab in the treatment of HER-2 positive breast cancer.Method: We search relevant databases and collect RCTs on the treatment of HER-2 positive breast cancer with dual-targeted treatment. Meta-analysis was performed using Revman5.4 software.Results: A total of 10 studies for 8553 patients were included. Meta-analysis showed that, in terms of efficacy, overall survival (OS) (HR = 1.40, 95%CI = 1.29-1.53, p < 0.00001) and progression-free survival (PFS) (HR = 1.36, 95%CI = 1.28-1.46, p < 0.00001) in dual-targeted drug therapy were better than which in the single-targeted drug group. In terms of safety, the highest incidence (Relative risk, RR) of Adverse reactions was Infections and infestations (RR = 1.48, 95%CI = 1.24-1.77, p < 0.0001) follow by Nervous system disorders (RR = 1.29, 95%CI = 1.12-1.50, p = 0.0006), Gastrointestinal disorders (RR = 1.25, 95%CI = 1.18-1.32, p < 0.0001), Respiratory, thoracic, and mediastinal disorders (RR = 1.21, 95%CI = 1.01-1.46, p = 0.04), Skin and subcutaneous tissue disorders (RR = 1.14, 95%CI = 1.06-1.22, p = 0.0002) and General disorders (RR = 1.14, 95%CI = 1.04-1.25, p = 0.004) in dual-targeted drug therapy group. The incidence of Blood system disorder (RR = 0.94, 95%CI = 0.84-1.06, p = 0.32) and Liver dysfunction (RR = 0.80, 95%CI = 0.66-0.98, p = 0.03) was lower than that of the single targeted drug group.Conclusion: Dual-targeted treatment for HER-2-positive breast cancer can prolong the OS, PFS and improve the quality of patients' life. Meanwhile, it also brings a higher medication risk, which requires a rational selection of drug symptomatic interventions.
To analyze the clinical characteristics of children with cyclic vomiting syndrome (CVS), summarize the experience for twelve years, and improve awareness, diagnosis and treatment level of CVS.The clinical data and results of long-term follow-up of the children with CVS seen from 1994 to 2007 in our department were analyzed.Forty-one children were enrolled in the study, 21 were male, and 20 female, mean age was 8 years, mean age of onset was 4 years, mean interval from onset to proper diagnosis was 4 years; 13/41 and 20/41 patients had family history of migraine and motion sickness, 20/41 patients had triggers, such as upper respiratory tract infection, diet, and mental/emotional factor. Vomiting lasted for days, during the periods between the episodes of vomiting the children were completely healthy. The intervals of most patients were 2 to 8 weeks, and in 12/41 patients the episodes started at early morning. The peak number of emesis per hour exceeded six in 23/41 children. The episodes were characterized by a pattern of sudden onset and sudden ending. All patients showed depressed, social withdrawal, intractable nausea and anorexia. Associated symptoms and signs include pallor, excess salivation, hypertension, headache, photophobia, and abdominal pain. Electroencephalogram of 13/33 patients were slightly abnormal. Electrogastrogram showed dysrhythmia and gastrointestinal motility were abnormal during the period of onset and normal during complete remission. Eleven of the 41 of patients were treated as epilepsy, and 9 patients were diagnosed as esophageal hiatal hernia and 4 superior mesenteric artery compression syndrome and had surgery before the diagnosis was made. Eight patients diagnosed from 1994 to 2000 were followed up for ten years in average, 3 patients were treated with doxepin and alprazolanic, and were cured after 2.2 (1.0 - 4.0) years; and five patients who did not use any medicine recovered 7.7 (4 - 10) years later. Fourteen children diagnosed from 2001 to 2007 were followed up for longer than one year, 9 patients were treated with valproate, doxepin, cyproheptadine, and recovered 2.3 (1 - 4) years later; 5 patients without treatment recovered 1.9 (1 - 3) years later.The diagnosis must be based on the special manifestation of CVS, including intervals during which the patients are completely healthy, and the systemic diseases which can cause CV should be excluded. Most patients get better as they grow up. Therapeutic strategies may include combined use of neuroleptics, thymoleptics and anti-migraine when the episodes occur frequently and when there is growth retardation. Supportive care includes intravenous fluids and symptomatic treatment during an episode.
Background: Immune checkpoint inhibitors (ICIs) such as PD-1/PD-L1/CTLA-4 inhibitors have brought new opportunities for the cure of cancer patients and have been widely used and which are the most successful cancer immunotherapy drug in recent years. Gut microbiome and metabolites exert a critical regulatory function in cancer immunotherapy of ICIs, which can be affected by antibiotics intervention. However, inflammatory infections caused by impaired immune function in tumor patients often require antibiotic treatment.Objective: In this review, we briefly discussed the correlation between antibiotics and ICIs treatment to evaluate the impact of antibiotics on cancer progression.Methods: By searches of PubMed, we collected the data such as progression-free survival time (PFS) and overall survival time (OS) in patients with non-small cell lung cancer (NSCLC), kidney cancer, Melanoma, colorectal cancer, and other tumors.Results: Antibiotics have a negative effect on the prolongation of survival in cancer patients treated with ICIs. This may depend on the patient's cancer type and the type of ICIs and antibiotics they have used.Conclusions: Antibiotics may reduce the effectiveness of immunotherapy by depleting the body's microbiome. Therefore, paying attention to the changes in the level of microorganisms in cancer patients, while making more individualized and precise improvements in treatment regimens, may bring new opportunities to improve the efficacy of immunotherapy.
Objective Immune checkpoint inhibitors (ICIs) have changed the outcomes of a variety of cancers in an unprecedented manner. Gut microbiome plays a crucial regulatory role in the antineoplastic therapy of ICIs, which can be influenced by antibiotic (ABX) administration. In this efficacy evaluation, we aimed to clarify the correlations of ABX administration with the survival of cancer patients receiving ICIs treatment. Method The eligible literatures were searched using PubMed, Cochrane Library, Web of Science, and Clinical trials.gov databases before Nov 2021. The correlations of ABX administration with progression-free survival (PFS) and overall survival (OS) were determined using Hazard ratios (HRs) coupled with 95% confidence intervals (CIs). Results A total of 12 studies enrolling 6010 cancer patients receiving ICIs treatment were included in this efficacy evaluation. ABX administration was significantly correlated worse PFS (HR=1.60, 95%CI=1.33-1.92, P<0.00001) and OS (HR=1.46, 95%CI=1.32-1.61, P<0.00001). Similar results were found in the subgroup analysis of non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC) and melanoma. Conclusions ABX use during ICIs treatment of cancer may significantly shorten PFS and OS. ABX should be used cautiously in cancer patients receiving ICIs. However, further validations are still essential due to existing publication bias.
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