Life after Cell Death—Survival and Survivorship Following Chemotherapy

Abstract

To prevent cancer cells replacing and outnumbering their functional somatic counterparts, the most effective solution is their removal. Classical treatments rely on surgical excision, chemical or physical damage to the cancer cells by conventional interventions such as chemo- and radiotherapy, to eliminate or reduce tumour burden. Cancer treatment has in the last two decades seen the advent of increasingly sophisticated therapeutic regimens aimed at selectively targeting cancer cells whilst sparing the remaining cells from severe loss of viability or function. These include small molecule inhibitors, monoclonal antibodies and a myriad of compounds that affect metabolism, angiogenesis or immunotherapy. Our increased knowledge of specific cancer types, stratified diagnoses, genetic and molecular profiling, and more refined treatment practices have improved overall survival in a significant number of patients. Increased survival, however, has also increased the incidence of associated challenges of chemotherapy-induced morbidity, with some pathologies developing several years after termination of treatment. Long-term care of cancer survivors must therefore become a focus in itself, such that along with prolonging life expectancy, treatments allow for improved quality of life.

Biological Aspects of Inflamm-Aging in Childhood Cancer Survivors

“…Radiation exposure activates an immune response, determining the activation of macrophages and the recruitment of neutrophils and lymphocytes and pro-inflammatory mediators’ production in order to support anti-tumor activity [ 14 , 15 ]. After irradiation, chemotherapy, or Hematopoietic stem cell transplantation (HSCT) long-term immune system alteration could persist [ 16 , 17 ]. Some studies have shown that compared with controls, survivors who underwent HCT for a primary hematologic malignancy at age ≤21 had a similar BMI but a higher percent fat mass [ 18 ].…”

Childhood Cancer Survivors: An Overview of the Management of Late Effects

“…In particular, exposure to oncological therapies (mainly chemo- and radiotherapy) causes low-grade systemic inflammatory state onset, senescent cell accumulation, the increased production of reactive oxygen species (ROS), immune response activation and DNA mutations [ 4 , 5 ]. This global inflammatory condition is known as “inflamm-aging” to indicate the correlation between inflammatory processes—exacerbated in CCS subjects—and the observed pathological conditions displayed by young adult CCS even though they are characteristic of an elder age [ 6 ].…”