Prostate cancer (PCa) is the most common cancer in men, and the second leading cause of cancer related death in men in Western countries. The standard therapy for metastatic PCa is androgen suppression therapy (AST). Men undergoing AST eventually develop metastatic castration-resistant prostate cancer (mCRPC), of which there are limited treatment options available. Immunotherapy has presented substantial benefits for many types of cancer, but only a marginal benefit for mCRPC, at least in part, due to the immunosuppressive tumor microenvironment (TME). Current clinical trials are investigating monotherapies or combination therapies involving adoptive cellular therapy, viral, DNA vaccines, oncolytic viruses, and immune checkpoint inhibitors (ICI). Immunotherapies are also being combined with chemotherapy, radiation, and AST. Additionally, preclinical investigations show promise with the recent description of alternative ways to circumvent the immunosuppressive nature of the prostate tumor microenvironment, including harnessing the immune stimulatory NKG2D pathway, inhibiting myeloid derived suppressor cells, and utilizing immunomodulatory oncolytic viruses. Herein we provide an overview of recent preclinical and clinical developments in cancer immunotherapies and discuss the perspectives for future immunotherapies in PCa.

BackgroundThe increasing rate of caesarean deliveries has become a serious concern for public health experts globally. Various medical and non-medical factors, such as maternal socio-demographics, are found to be responsible for this upsurge. Like in other countries, the rate of caesarean sections has increased in Pakistan as well. Therefore, there is a need to investigate the factors behind this increase. This study aims to assess the determinants associated with caesarean deliveries among child-bearing women aged 15–49 years in Pakistan.MethodsSecondary data analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2012–2013. The analysis was limited to mothers aged 15–49 years, who had given birth to at least one child during the 5 years immediately preceding the survey (n = 7461). Maternal socio-demographic characteristics and pregnancy-related variables, including antenatal care utilisation, place of delivery and pregnancy complications were considered as independent variables. The association between caesarean section deliveries (outcome variable) and its determinants was assessed by calculating unadjusted and adjusted odds ratios with 95% confidence intervals using a multivariable binary logistic regression.ResultsOf the women who had given birth to at least one child during the previous 5 years, the percentage of mothers who delivered their babies through caesarean section was found to be 13.6%. The likelihood of caesarean deliveries was associated with mothers aged more than 24 years, women residing in Punjab province, women belonging to the richest class, women with higher education, women employed at professional/managerial/technical level, and women residing in an urban setting. Additionally, the women who had pregnancy complications, a high utilisation of antenatal care and delivered their babies in private hospitals were found to have higher chances of caesarean deliveries.ConclusionsThe study revealed that there are a high percentage of women delivering babies through caesarean section in Pakistan. Therefore, strict measures need to be taken to deal with this concern. For example, detailed medical justifications by doctors for performing caesarean sections and awareness among women regarding the reduction of pregnancy complications can help to reduce the chances of malpractice related to caesarean deliveries.

Smoking is the most important cause of lung cancer as well as an important determinant of other neoplasms and nonneoplastic diseases. 2 In Pakistan, a nation-wide survey found that 21.6% of the subjects aged 15 or above were smokers, with a higher proportion among men (36%) than women (9%). In addition to cigarettes and bidis, tobacco is also smoked in local ways such as a hookah (a clay pot containing burning coal over a layer of tobacco fixed to a second pot containing water with two pipes, one for smoking and the other to filter smoke through water). 3 It is worth noting that Pakistani cigarettes contain high levels of tar and nicotine. 4 Furthermore, other possible risk factors of lung cancer, such as exposure to indoor air pollution from cooking fumes have been poorly investigated in countries from Southern Asia.To our knowledge, no studies had conducted to investigate the causes of lung cancer in Pakistan, the seventh most populated country in the world.All newly diagnosed patients of lung cancer treated at the Liaquat National Post Graduate Medical Centre, the Jinnah Post Graduate Medical Center (JPMC) and the Civil Hospital were enrolled without any restriction according to age, sex, residence or diagnostic procedure. A small number of patients diagnosed and treated at other hospitals were identified from the records of the population-based cancer registry of South Karachi. 1 Two groups of controls were selected in the same hospitals as the cases, to whom they were individually matched by sex and age. The first group comprised hospital patients undergoing minor surgical operations (e.g., hernia, appendicitis, bone fracture), the second one visitors to patients other than cases.Trained interviewers administered the questionnaire, which was designed to gather information on smoking habits, chewing, use of snuff (naswar) and residential history (including sources of indoor air pollution).Smokers were defined as having smoked at least once a day for at least 6 months. In order to combine the consumption of different tobacco products, we calculated cigarette-equivalents by using the following weights: 0.75 for bidi, 3 for pipe, 4 for cigar and 20 for hookah. Cigarette-equivalents approximate grams of tobacco. 2 Cumulative consumption of tobacco products was then calculated by multiplying the average daily consumption of cigarette-equivalents by the duration of smoking.Never smokers were chosen as the reference category for the main analyses on smoking. In some analyses, we excluded never smokers and used the least exposed group as baseline in order to assess simultaneously the effect of different aspects of smoking (e.g., duration and consumption).Most chewers used betel quid (pan), which contains betel leaf, lime, areca nut and, in most cases, tobacco. Snuff (naswar) consists of a blend of sun-cured tobacco, lime ashes of plants and variable flavoring agents. It is usually placed behind the lower lip or below the tongue.The subjects were asked about their places of residence, including fuels commonly used fo...

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