Journal of the Egyptian National Cancer Institute最新文献

{"title":"Dual-modality treatment using gamma radiation and ZnO nanoparticles: effects on normal and malignant lung cells.","authors":"Naglaa M Ismail, Soheir Korraa, Amira Abdel Rehim Qotb","doi":"10.1186/s43046-025-00312-z","DOIUrl":"https://doi.org/10.1186/s43046-025-00312-z","url":null,"abstract":"<p><p>This study primarily aims to investigate the effects of gamma (γ) radiation, both independently and in combination with zinc oxide nanoparticles (ZnO NPs), on normal and lung cancer cell lines. Lung cancer continues to be a major cause of cancer-related mortality globally. Radiotherapy is a common way of treating lung cancer. The treatment efficacy of cell death requires a high dosage of focused radiation. Due to their physicochemical properties and potential biological activity, ZnO NPs have emerged as promising candidates in nanomedicine and oncology. In this research, ZnO NPs were synthesized and characterized through various analytical techniques, including X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS), differential scanning calorimetry (DSC), and dynamic light scattering (DLS). The resulting nanoparticles were semi-spherical in shape (22-29 nm), stable, and had a zeta potential of - 21 ± 2.40 mV. The cytotoxic effects were assessed using human lung cancer cells (A549) and normal lung fibroblast cells (WI-38). Treatments involved ZnO NPs alone or combined with 15 Gy of γ-radiation over 48 h. A significant increase in cytotoxicity was observed in A549 cancer cells compared to normal cells. ZnO NPs alone showed moderate anticancer efficacy with an IC50 of 26.78 ± 0.44 µg/mL, whereas ZnO NPs + 15 Gy gamma radiation led to a pronounced reduction in cell viability with an IC50 of 15.97 ± 0.45 µg/mL. These results indicate that the combination of ZnO NPs with γ-radiation enhances apoptosis and significantly suppresses the growth of lung cancer cells (p < 0.001), offering potential for improved therapeutic outcomes in lung cancer radiotherapy.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"72"},"PeriodicalIF":1.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive evaluation of high dose methotrexate therapy: a retrospective observational trial.","authors":"Hadeer Ehab Barakat, Kholood Ashraf El Bahy, Sandy Victor Labib, Yasser Zakaria Aldesouky, Abdelrahman Ayman Ismail, Mohamed El Sayed Mohamed, Febrona Louis Sedky, Asmaa Mohamed Abdelhady, Dalia Hamdy Gaballah, Doha Ashraf Ali, Passant Mohamed Refaat, Hasnaa Al Sayed Mohamed, Ahmed Zayed Mohamed, Salwa Selim Ibrahim, Ayman M Noreddin, Abdel-Moneim M Osman, Esraa M Abdelkeriem, Mohamed M Sayed-Ahmed, Riham M Karkeet","doi":"10.1186/s43046-025-00324-9","DOIUrl":"https://doi.org/10.1186/s43046-025-00324-9","url":null,"abstract":"<p><strong>Background: </strong>Methotrexate (MTX) is a commonly prescribed drug with both chemotherapeutic and immunosuppressive applications. However, when administered in high doses (HDMTX ≥ 500 mg/m²), it can lead to serious side effects, particularly nephrotoxicity and hepatotoxicity. Although 48-h MTX levels monitoring is fundamental for the evaluation of the risk of these toxicities, the relationship between MTX level and the actual clinical outcomes is not yet fully addressed. This study aims to evaluate the predictors of 48-h serum MTX levels and the toxicity profile associated with patients receiving HDMTX for management of cancer, with a particular focus on nephrotoxicity, hepatotoxicity, length of hospital stay (LOS), antimicrobial use, and 30-day mortality.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at the National Cancer Institute, Cairo University. Patients receiving HDMTX as part of their cancer treatment in the period from January 2022 to December 2024 were included. Data collection included patient demographics, administered MTX doses, 48-h serum MTX levels, medical and medication history, antimicrobials used, and recorded adverse effects. The outcome of the study encompassed the identification of predictors for 48-h MTX levels and their association with acute kidney injury (AKI), ICU admission, and LOS. In addition to the associations with hepatotoxicity, antimicrobial usage, and mortality. Statistical analysis was performed using SPSS version 26.0.</p><p><strong>Results: </strong>Among 143 patients, elevated 48-h MTX levels (≥ 1.28 μmol/L) were associated with pleural effusion (P-value 0.038), patients diagnosed with lymphoma (P-value 0.05), and increased antimicrobial use (P-value < 0.05). A significant association was found between HDMTX and the use of carbapenems, vancomycin and fluoroquinolones (P-value < 0.05). Non-significant relation was found between HDMTX and AKI as well as LOS. Hepatotoxicity was significantly more common in patients with osteosarcoma rather than hematological malignancies, while LOS was shorter in osteosarcoma cases compared to hematological malignancies.</p><p><strong>Conclusion: </strong>The serum levels of 48-h MTX are vital metrics of toxicity, as they determine the duration of hospitalization, the number of antimicrobials used, and the mortality rate. Thus, it is crucial to monitor these levels to reduce the complications associated with HDMTX usage.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"69"},"PeriodicalIF":1.8,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive radiomics based ensemble machine learning approach in CT lung nodule diagnosis.","authors":"Arooj Nissar, A H Mir","doi":"10.1186/s43046-025-00326-7","DOIUrl":"https://doi.org/10.1186/s43046-025-00326-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Computed tomography imaging, a non-invasive tool, is used around the globe by medical professionals to identify and diagnose lung cancer; a lethal disease with high rates of occurrence and mortality globally. Radiomics extracted from medical images, including computed tomography, in tandem with machine learning frameworks has received considerable focus and research for lung nodule identification.This investigation can help out clinicians to reach radiomics-based better and quicker decision support system for treatments and early diagnosis. However, it is still foggy and unclear which radiomics feature(s) to use for the prediction of pulmonary nodule. Consequently, this work is offered with an endeavor to efficiently apply machine learning techniques and radiomics to classify CT pulmonary nodules.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Lung Image Data Consortium (LIDC), containing 1018 CT cancer cases, is put to use. The Wavelet Packet Transform is used in conjunction with geometrical features, gray level run length matrix, gray level co-occurrence method and gray level difference method techniques to extract radiomics. Two techniques, boosted and bagged ensemble classification trees, are employed to choose an apposite set of features. The categorization of nodules as malignant or benign is assessed by the utilization of cutting-edge machine learning models: Support Vector Machines, Boosted Classification Ensemble Tree, Decision Trees, Bagged Classification Ensemble Tree, RUSBoosted Ensemble Trees, Subspace Discriminant Ensemble and Subspace KNN Ensemble.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The findings reveal that the Ensemble Subspace KNN gives best AUROC (93.4%), accuracy (88.3%) and F1-score (85.2%) using BACET feature selection method. The best sensitivity is produced by FGSVM (97.1%). RUSBOCET gives best precision and specificity of 93.4% and 83.1% respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Lung Cancer remains the most common and deadly type of cancer. Early detection of lung lesions and nodules is crucial in the fight against lung cancer. The purpose of this study was to investigate radiomics based on geometrical, texture, and Daubechies WPT texture features for quantitative CT image analysis. The LIDC database was used in this study. Geometrical features, texture features based on three statistical methodologies (GLCM, GLDM GLRLM) and Daubechies WPT texture features are retrieved from the nodules. Using the ensemble EFS, BOCET and BACET, pertinent features were identified. Lastly, various cutting-edge ML classifiers were used to classify LC as malignant or benign. The out-turn shows that, using BACET EFS, Ensemble Subspace KNN gives best AUROC (93.4%), accuracy (88.3%) and F1-score (85.2%). FGSVM yields the best sensitivity of 97.1%. RUSBOCET gives best precision and best specificity of 93.4% and 83.1% respectively. Therefore, the methodology can be applied with efficacy to the CT based PN classification. Thus, ","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"68"},"PeriodicalIF":1.8,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic cancer in the era of precision medicine: challenges, advances, and the future of therapeutic strategies.","authors":"Heslley Machado Silva, Reginaldo Cruz Alves Rosa","doi":"10.1186/s43046-025-00323-w","DOIUrl":"https://doi.org/10.1186/s43046-025-00323-w","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer stands among the most aggressive and fatal malignancies, with a steadily increasing incidence worldwide. Its clinical significance lies not only in its high mortality rate but also in the challenges associated with its early detection, limited therapeutic efficacy, and substantial impact on healthcare systems. The asymptomatic nature of the disease in its initial stages, combined with the absence of reliable early biomarkers, contributes to frequent late-stage diagnoses, significantly compromising treatment success and patient survival. Furthermore, the biological complexity of pancreatic tumors - often marked by specific genetic mutations and a highly immunosuppressive tumor microenvironment - drives resistance to conventional therapies, exacerbating clinical management difficulties.</p><p><strong>Main body: </strong>This narrative review offers a comprehensive synthesis of the major therapeutic challenges and recent advances in pancreatic cancer management over the past fifteen years. The main challenges include delayed diagnosis, the presence of treatment-resistant tumor subtypes, and the considerable financial burden of care. Particular attention is given to the tumor microenvironment, which impedes drug delivery and immune system activation due to its dense fibrotic stroma and immunosuppressive cellular composition. The review also explores emerging therapeutic strategies, including combination chemotherapy regimens such as folinic acid, fluorouracil, irinotecan, and oxaliplatin, and advanced radiotherapy techniques that aim to enhance precision while minimizing tissue damage. Furthermore, novel immunotherapeutic approaches - including messenger RNA-based vaccines and engineered cellular therapies - show promising results in stimulating targeted immune responses, although they face substantial barriers due to the tumor's immune evasion mechanisms. Targeted therapies focused on specific genetic alterations, especially those involving KRAS mutations, are also highlighted as potential breakthroughs. The review concludes by emphasizing the relevance of personalized medicine, with biomarker-driven strategies and three-dimensional tumor models offering more tailored and potentially effective interventions.</p><p><strong>Conclusion: </strong>Despite meaningful progress in the development of innovative therapeutic modalities, pancreatic cancer continues to present profound medical and scientific challenges. Integrating personalized, interdisciplinary approaches and advancing early diagnostic tools remain essential steps toward improving clinical outcomes and extending survival in affected patients. This review underscores the urgent need for continued research to transform current insights into effective and accessible treatment strategies.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"64"},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-based cancer therapies: mechanistic insights, clinical progress, and future directions.","authors":"Mahalakshmi Devaraji, Binoy Varghese Cheriyan","doi":"10.1186/s43046-025-00319-6","DOIUrl":"https://doi.org/10.1186/s43046-025-00319-6","url":null,"abstract":"<p><p>The field of cancer immunotherapy has evolved rapidly, offering new treatment paradigms by harnessing the body's own immune system to target and destroy malignancies. Various immunotherapeutic approaches, including immune checkpoint inhibitors, CAR-T cell therapy, cancer vaccines, cytokine therapies, and oncolytic viruses, have shown significant promise in treating different cancer types. This review provides a comprehensive examination of the historical development and recent advances in cancer immunotherapy. We discuss the mechanisms of action of key immunotherapeutic modalities, along with their clinical applications and innovative delivery techniques. In particular, we focus on immune checkpoint inhibitors, which have revolutionized the treatment of several cancers; CAR-T cell therapy, which has provided transformative results in hematological malignancies; and the potential of cancer vaccines, cytokine therapies, and oncolytic viruses. Additionally, the review addresses the current status of clinical trials and patents in the field, offering insight into the ongoing efforts to optimize these therapies for broader clinical use. Despite the promising results achieved, this review highlights significant challenges, such as immune-mediated toxicity, resistance to treatment, and the need for more effective delivery systems. While cancer immunotherapy has shown great potential in improving patient outcomes, overcoming existing obstacles such as toxicity and resistance remains a major challenge. This review offers a comprehensive overview of the state of cancer immunotherapy while also providing perspectives on its future directions and the ways in which these innovations may impact cancer treatment.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"62"},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of 3D culture models and advanced chromatography in exosome research for triple-negative breast cancer.","authors":"Mujibullah Sheikh, Harpritkaur Bagga, Yukta Bhojwani, Umesh Telrandhe","doi":"10.1186/s43046-025-00322-x","DOIUrl":"https://doi.org/10.1186/s43046-025-00322-x","url":null,"abstract":"<p><p>Triple-negative breast cancer (TNBC) is among the most difficult subtypes of breast cancer to treat and is characterized by the absence of estrogen receptor, progesterone receptor, and HER2 expression. Owing to its Limited molecular targets and high degree of tumor heterogeneity, TNBC is associated with poor prognosis and restricted treatment options. Exosome small extracellular vesicles secreted by virtually all cell types have gained renewed attention for their role in tumor progression, metastasis, immune modulation, and drug resistance in TNBC. These vesicles carry biologically active cargo such as proteins, RNAs, Lipids, and metabolites that reflect the molecular state of their parent cells and facilitate intercellular communication. However, conventional 2D culture systems and classical exosome isolation methods fail to replicate the complexity of the tumor microenvironment and the diversity of exosomal populations. This review summarizes recent advances in the integration of three-dimensional (3D) culture systems and advanced chromatographic techniques to enhance the isolation, profiling, and functional analysis of TNBC-derived exosomes. We highlight the benefits of using 3D models, improvements in analytical workflows, and interdisciplinary approaches that are enabling progress in biomarker discovery, understanding therapy resistance, and developing exosome-based therapeutic strategies. By bridging technological innovation with biological insight, this review aims to support future advances in exosome research relevant to TNBC.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"67"},"PeriodicalIF":1.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carnitine deficiency augments methotrexate-mediated acute renal injury in rats.","authors":"Fatema Alaa El-Din Selim, Mahmoud M Khattab, Abdel-Moneim M Osman, Riham M Karkeet, Mervat M Omran, Marwa Sharaky, Mohamed M Sayed-Ahmed","doi":"10.1186/s43046-025-00321-y","DOIUrl":"https://doi.org/10.1186/s43046-025-00321-y","url":null,"abstract":"<p><strong>Background: </strong>This research aimed to explore if carnitine (CARN) deficiency is a risk factor in methotrexate (MTX)-mediated acute kidney injury (AKI) and to mechanistically reveal the potential attenuating effect of CARN against MTX-mediated nephrotoxicity.</p><p><strong>Methods: </strong>Thirty-six adult male Wister albino rats were subgrouped into six groups. Groups 1, 2, and 3 received 0.9% normal saline (0.5 mL/200 g, i.p.), mildronate (MD, 200 mg/kg/day, i.p.), and L-carnitine (CARN, 200 mg/kg/day, i.p.) for 10 uninterrupted days, respectively. Groups 4, 5, and 6 received similar doses of normal saline, MD, and CARN for 5 days prior to as well as following a solo dose of methotrexate (MTX, 20 mg/kg, i.p.), respectively.</p><p><strong>Results: </strong>Treatment with a single dose of MTX significantly boosted serum nephrotoxicity as well as hepatotoxicity indices; additionally, it increased the percentage of collagen deposition in rat kidney tissues with obvious histopathological changes. Moreover, MTX lowered kidney levels of adenosine triphosphate (ATP) and amplified acetyl-CoA carboxylase-1 (ACC-1) in kidney tissues. In MD-treated rats, MTX progressively boosted nephrotoxicity indices and collagen disposition in kidney tissues as well as progressive additional reduction in ATP as compared with MTX-treated rats and serum carnitine levels compared with MD-treated rats. Carnitine administration totally counteracted the biochemical and histopathological alterations mediated by MTX to the normal measures.</p><p><strong>Conclusions: </strong>This research proposes that carnitine deficiency is a potential risk factor in the development of MTX-mediated AKI. MTX disrupts ACC1 signaling with the consequential inhibition of ATP production. Carnitine supplementation attenuates MTX-mediated AKI. Our results are preliminary and mandate further mechanistic study to justify the progression of AKI by MTX in CARN-deficient rats.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"66"},"PeriodicalIF":1.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing breast and cervical cancer screening among ever-married women aged 15-49 in Jordan: an analysis of the 2023 Jordan population and family health survey.","authors":"Rajat Das Gupta, Shuvajit Saha, Md Ataur Rahman, Prince Nii Ossah Addo, Rohan Kothadia, Georgios Vasilios Lahanas, Ananna Mazumder, Arpan Das Gupta, Ehsanul Hoque Apu, Nazeeba Siddika","doi":"10.1186/s43046-025-00320-z","DOIUrl":"10.1186/s43046-025-00320-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study sought to investigate the prevalence and sociodemographic determinants related to breast and cervical cancer screening among ever-married women aged 15 to 49 years in Jordan.</p><p><strong>Methods: </strong>This research employed secondary data from the 2023 Jordan Population and Family Health Survey (JPFHS), which included 12,547 ever-married women aged 15 to 49. Weighted multivariable logistic regression analyses were conducted to quantify screening prevalence and identify related covariates, presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The prevalence of screening for breast and cervical cancer was 15.2% and 16.2%, respectively. Increased screening participation was substantially correlated with advanced age, larger home affluence, higher parity, previous sexually transmitted infections (STIs), and exposure to radio communications. Women aged 35-49 were more likely to receive breast (AOR: 4.0; 95% CI: 2.6-6.0) and cervical cancer screening (AOR: 5.5; 95% CI: 3.3-9.2) compared to those aged 15-24 years. Women in the highest wealth quintile had a greater likelihood of being screened for breast cancer (AOR: 2.1; 95% CI: 1.6-2.8) and cervical cancer (AOR: 2.6; 95% CI: 1.9-3.5). Moreover, breast cancer screening correlated with recent healthcare service consumption (AOR: 1.3; 95% CI: 1.1-1.6), while cervical cancer screening had a favorable association with elevated educational attainment (AOR: 1.6; 95% CI: 1.2-2.3). Living in rural areas was inversely correlated with cervical screening participation (AOR: 0.7; 95% CI: 0.6-1.0).  CONCLUSION: Screening rates for breast and cervical cancer among Jordanian women are inadequate. Interventions that facilitate equitable access-especially aimed at younger, less educated, rural, and low-income women-are crucial for enhancing participation and diminishing inequities in early cancer detection.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"65"},"PeriodicalIF":1.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De-escalating axillary surgery in node-positive early breast cancer patients undergoing primary surgery: current evidence and recommendations.","authors":"Hussain Abdulla, Eman Hamza, Maha Alsendi","doi":"10.1186/s43046-025-00318-7","DOIUrl":"https://doi.org/10.1186/s43046-025-00318-7","url":null,"abstract":"<p><p>Landmark trials have shown that axillary lymph node dissection (ALND) can be safely omitted in early breast cancer patients with 1-2 positive nodes. Despite lack of prospective data, the National Comprehensive Cancer Network (NCCN) guidelines recommend that patients with 1-2 suspicious or biopsy-proven positive lymph nodes having primary surgery can undergo sentinel lymph node biopsy (SLNB). In the era of de-escalation of axillary surgery, breast cancer management in patients with clinically node-positive (cN +) axilla is driven by tumour biology and response to neoadjuvant chemotherapy (NACT). In this review, we discuss the management of the axilla in early breast cancer patients with low-volume biopsy-proven nodal disease and summarise the evidence supporting omission of ALND in these patients undergoing primary surgery.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"60"},"PeriodicalIF":1.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of tumor microenvironment in cancer promotion, development of drug resistance and cancer treatment.","authors":"Duaa E Fathah, Samina Ejaz","doi":"10.1186/s43046-025-00317-8","DOIUrl":"10.1186/s43046-025-00317-8","url":null,"abstract":"<p><p>Cancer is a multifactorial disease and the second leading cause of death worldwide after cardiovascular disease. Initially, it was considered a genetic disease or gene expression disorder, but now it is regarded as a tumor microenvironment (TME) disease. The TME consists of cancer cells, endothelial cells, fibroblasts, and immune cells that interact with each other. These interactions support tumor growth by providing nutrients via altered metabolic mechanisms such as glutamine metabolism, aerobic glycolysis, and fatty acid metabolism. The by-products of these altered metabolic pathways interfere with the function of surrounding cells and thus lead to cancer progression. The role of metabolic crosstalk highlights the intricate relationship between the cancer cells and their TME. This review comprehensively analyzes recent studies to enhance understanding of the metabolic crosstalk in TME. It highlights how tumor-associated macrophages and fibroblasts reprogram lipid and glucose metabolism to create an immunosuppressive environment. This review also provides information about the role of hypoxia-induced HIF-1α signaling in the promotion of lactate accumulation. This factor in turn ensures tumor cells' survival and makes them resistant to anti-cancer drugs. Further, we have discussed therapeutic approaches targeting TME, including use of PD-1, PD-L1 inhibitors, CAR-T cell therapy, and oncolytic viruses to improve patient outcomes. Besides this, clinical studies involving the estimation of lactate, GLUT1, and HIF-1α levels may help to recognize high-risk patients and develop guidance for personalized metabolism-targeting therapies. In the long run, such studies can ultimately improve patient outcomes and thus reduce disease burden.</p>","PeriodicalId":17301,"journal":{"name":"Journal of the Egyptian National Cancer Institute","volume":"37 1","pages":"59"},"PeriodicalIF":1.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}