Liposome, albumin and polymer polyethylene glycol are nanovector formulations successfully developed for anti-cancer drug delivery. There are significant differences in pharmacokinetics, efficacy and toxicity between pre- and post-nanovector modification. The alteration in clinical pharmacology is instrumental for the future development of nanovector-based anticancer therapeutics. We have reviewed the results of clinical studies and translational research in nanovector-based anti-cancer therapeutics in advanced pancreatic adenocarcinoma, including nanoparticle albumin-bound paclitaxel and nanoliposomal irinotecan. Furthermore, we have appraised the ongoing studies incorporating novel agents with nanomedicines in the treatment of pancreatic adenocarcinoma.

Sorafenib is an oral multiple kinase inhibitor that blocks Raf, vascular endothelial growth factor receptor, and platelet-derived growth factor receptor. It has been approved in the US and Europe for the treatment of advanced hepatocellular carcinoma (HCC). Sorafenib has demonstrated a 44% increase in survival for advanced HCC patients, compared with best supportive care alone. We have reviewed the pharmacology, pivotal studies, and safety data for this agent. Sorafenib is the first systemic drug demonstrating a significant survival benefit, and is the standard of care for patients with advanced HCC for whom no potential curative option is available.

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BACKGROUND Squamous cell carcinoma of head and neck (SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib. CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes (levels 2 and 3). Imaging studies including (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx, oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment. He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib. CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.

BACKGROUND During dental sedation, control of the cough reflex is crucial for a safe and smooth procedure. Accumulated saliva is one of the predisposing factors for coughing. Therefore, extensive suction is very important. Using of standard saliva ejector may not be enough. We introduce handmade Adjustable Loop Suction (ALS) as an alternative solution. The features of this device are easy assembly, single use, effective suction, excellent moldability, and customised smaller sizes for young children. The suction orifice near the posterior oral cavity effectively removes the fluid and the bent suction loop assists stability in the patient's mouth. 1,2 In dental treatments, adequate removal of fluids accumulated in the oropharyngeal space is of critical importance. Failure to do so risks triggering the cough reflex, and predisposes choking of the patient, laryngospasm or oxygen desaturation. In these situations, the operator would be forced to remove the patient's mouth gag to allow the fluids to be expelled. Thus, an oral evacuation system which can effectively and efficiently drain fluids would not only greatly facilitate the procedure by providing clear visibility and lowering the frequency of interruptions, but more importantly improves patient safety by reducing stimulation of the cough reflex. Here, we introduce a handmade Adjustable Loop Suction Apparatus (ALSA) (Fig. 1 A-C) as an alternative solution to the conventional suctioning devices. It is easily assembled from materials accessible to medical providers. A common PAHSCO FR 14 (green) cap-cone suction catheter is used. Seven pairs of holes (1.0 x 1.0 mm) are perforated along the anterior portion of the suction catheter at 1.0 cm distance apart. A pliable surgical stainless-steel wire (20 gauge) is inserted as a stylet for shaping the curve of the loop. To complete the loop, the end of the suction catheter is inserted into the hole on its plastic cap-cone connector. Finally, the anterior part of the loopedsuction is bent to create a spacer, which can anchor to the opposite row of teeth. 3 The shape and curve of this ALSA can be easily adjusted as needed during the procedure.