Despite the ongoing progress in cancer research, the global cancer burden has increased to 18.1 million new cases and 9.6 million deaths in 2018. Gynecological cancers, such as ovarian, endometrial, and cervical cancers, considerably contribute to global cancer burden, leading to $5,862.6, $2,945.7, and $1,543.9 million of annual costs of cancer care, respectively. Thus, the development of effective therapies against gynecological cancers is still a largely unmet medical need. One of the novel therapeutic approaches is to induce anti-cancer immunity by the inhibition of the immune checkpoint pathways using monoclonal antibodies. The molecular targets for monoclonal antibodies are cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and programmed death-ligand 1 (PD-L1). The rationale for the use of immune checkpoint inhibitors in patients with gynecological cancers was based on the immunohistological studies showing high expression levels of PD-1 and PD-L1 in those cancers. Currently available immune checkpoint inhibitors include nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and ipilimumab. The efficacy and safety of these inhibitors, used as monotherapy and with combination with chemotherapy, is being currently evaluated in several clinical studies. As the results are promising, more clinical trials are being planned, which may lead to the development of efficient therapies for gynecological cancer patients.
The female reproductive tract hosts a specific microbiome, which plays a crucial role in sustaining equilibrium and good health. In the majority of reproductive women, the microbiota (all bacteria, viruses, fungi, and other single-celled organisms within the human body) of the vaginal and cervical microenvironment are dominated by Lactobacillus species, which benefit the host through symbiotic relationships, in comparison to the uterus, fallopian tubes, and ovaries, which may contain a low-biomass microbiome with a diverse mixture of microorganisms. Although disruption to the balance of the microbiota develops, the altered immune and metabolic signaling may cause an impact on diseases such as cancer. These pathophysiological modifications in the gut–uterus axis may spark gynecological cancers. New information displays that gynecological and gastrointestinal tract dysbiosis (disruption of the microbiota homeostasis) can play an active role in the advancement and metastasis of gynecological neoplasms, such as cervical, endometrial, and ovarian cancers. Understanding the relationship between microbiota and endometrial cancer is critical for prognosis, diagnosis, prevention, and the development of innovative treatments. Identifying a specific microbiome may become an effective method for characterization of the specific microbiota involved in endometrial carcinogenesis. The aim of this study was to summarize the current state of knowledge that describes the correlation of microbiota with endometrial cancer with regard to the formation of immunological pathologies.
Ovarian cancer is a global problem that affects women of all ages. Due to the lack of effective screening tests and the usually asymptomatic course of the disease in the early stages, the diagnosis is too late, with the result that less than half of the patients diagnosed with ovarian cancer (OC) survive more than five years after their diagnosis. In this study, we examined the expression of TLR2 in the peripheral blood of 50 previously untreated patients with newly diagnosed OC at various stages of the disease using flow cytometry. The studies aimed at demonstrating the usefulness of TLR2 as a biomarker in the advanced stage of ovarian cancer. In this study, we showed that TLR2 expression levels were significantly higher in women with more advanced OC than in women in the control group. Our research sheds light on the prognostic potential of TLR2 in developing new diagnostic approaches and thus in increasing survival in patients with confirmed ovarian cancer.
StreszczenieKobiety chętnie sięgają po alternatywne terapie w łagodzeniu objawów menopauzalnych. Wynika to często z obawy o skutki uboczne terapii hormonalnej lub z przeciwwskazań do jej stosowania. Lekami o udowodnionej skuteczności są preparaty z grupy selektywnych inhibitorów wychwytu zwrotnego serotoniny (selective serotonin reuptake inhibitor -SSRI) i noradrenaliny oraz gabapentyna. Zmiana stylu życia i wysiłek fizyczny wspomagają leczenie farmakologiczne. Metody niekonwencjonalne, tj. joga, relaksacja, akupunktura, wymagają dużych badań z randomizacją w celu oceny ich wpływu na objawy menopauzalne.Słowa kluczowe: menopauza, gabapentyna, fitoestrogeny, soja, preparaty ziołowe, aktywność fizyczna. SummaryWomen often use non-hormonal therapy in management of menopause symptoms because safety of hormonal therapies is controversial. Antidepressant agents such as venlafaxine reduce hot flashes. Also gabapentin is effective in reducing hot flashes. Lifestyle changes and exercise can be useful as auxiliary management of vasomotor symptoms. Non-pharmacological therapy such as yoga, relaxation, acupuncture need to be evaluated in large randomized placebo-controlled trials.Key words: menopause, gabapentin, phytoestrogens, soy, herbal remedies, exercise.Czy istnieje skuteczna alternatywa dla terapii hormonalnej w leczeniu objawów menopauzalnych? WstępObjawy menopauzalne i związane z nimi pogorszenie jakości życia są jedną z najczęstszych przyczyn zgłaszania się pacjentek do lekarza. Szacuje się, że w okresie okołomenopauzalnym u 80% kobiet wystę-pują uderzenia gorąca i poty nocne [1]. Wśród badanych kobiet 7-9% podaje obecność bardzo uciążliwych objawów wazomotorycznych w postaci silnych uderzeń gorąca (7 i więcej epizodów w ciągu doby) [2]. Najskuteczniejszą formą leczenia objawów menopauzalnych jest niewątpliwie terapia hormonalna (hormonal therapy -HT) [3][4][5]. W świetle obecnej wiedzy głównymi wskazaniami do jej zastosowania są umiarkowane i silne objawy naczynioruchowe, atrofia urogenitalna, pogorszenie jakości życia oraz profilaktyka osteoporozy u pacjentek z przedwczesną menopauzą. Znajomość aktualnych wskazań i zagrożeń, jakie niesie ze sobą HT, jest niezbędne do bezpiecznego stosowania terapii w codziennej praktyce lekarskiej. Przed jej rozpoczęciem należy poinformować pacjentkę o korzyściach i ryzyku zastosowania leczenia hormonalnego i przedstawić alternatywne możliwości terapeutyczne. Kobiety cenią sobie możliwość wyboru między HT a niekonwencjonalnymi metodami terapii. Wyniki badań Women's Health Initiative (WHI) opublikowane w 2002 i 2004 r. oraz badania Milion Women Study (MWS) donosiły o zwiększonym ryzyku działań niepożądanych takich jak choroba niedokrwienna serca, udary mózgu, powikłania zakrzepowo-zatorowe, rak sutka [6][7][8]. Pomimo szerokiej krytyki dotyczącej sposobu przeprowadzonych badań, dawek, wieku i statusu menopauzalnego kobiet rozpoczynają-cych HT, szum medialny częściowo zniechęcił pacjentki do tej formy leczenia. Wiele kobiet sięga po niekonwencjonalne metody, w tym terapie ziołowe...
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