ABSTRACT
Triple-negative breast cancer (TNBC) accounts for almost 15% of all diagnosed breast cancers and often presents high rates of relapses and metastases, with generally poor prognosis despite multiple lines of treatment. Immunotherapy has radically changed the approach of clinicians towards TNBC in the last two to three years, even if targeted and specific therapeutic options are still missing; this unmet need is further justified by the extreme molecular and clinical heterogeneity of this subtype of breast cancer and by the weak response to both single-agent and combined therapies. In March 2023, the National Comprehensive Cancer Network (NCCN), the main association of cancer centers in the United States, released the last clinical practice guidelines, with an update on classic and novel approaches in the field of breast cancer. The purpose of this comprehensive review is to summarize the latest findings in the setting of metastatic TNBC treatment, focusing on each category of drugs approved by the Food and Drug Administration (FDA) and included in the NCCN guidelines. We also introduce part of the latest published studies, which have reported new and promising molecules able to specifically target some of the biomarkers involved in TNBC pathogenesis. We searched the PubMed and Scopus databases for free full texts reported in the literature of the last 5 years, using the words "triple-negative breast cancer" or "TNBC" or "basal-like". The articles were analyzed by the authors independently and double-blindly, and a total of 114 articles were included in the review.
ABSTRACT
Even if the relationships between nutrition and inflammatory bowel disease (IBD) remain underexplored, the current literature is providing, day by day, much more evidence on the effects of various diets in both prevention and treatment of such illnesses. Wrong dietary habits, together with other environmental factors such as pollution, breastfeeding, smoke, and/or antibiotics, are among the theoretical pathogenetic causes of IBD, whose multifactorial aetiology has been already confirmed. While some of these risk factors are potentially reversible, some others cannot be avoided, and efficient treatments become necessary to prevent IBD spread or recurrence. Furthermore, the drugs currently available for treatment of such disease provide low-to-no effect against the symptoms, making the illnesses still strongly disabling. Whether nutrition and specific diets will prove to effectively interrupt the course of IBD has still to be clarified and, in this sense, further research concerning the applications of such dietary interventions is still needed.
ABSTRACT
A small non-quantified number of patients is reported to be affected by forms of angina pectoris already treated by traditional therapy but no longer able to achieve better results by drugs or surgery: this is called "refractory angina". Treatments like external counterpulsation, transmyocardial laser revascularization, stem cell transplantation or spinal cord stimulation may be suitable for these patients. The analysis of major studies on spinal cord stimulation based on exercise ECG, Holter monitoring and positron emission tomography, has shown a reduction in anginal attacks and in nitroglycerin pills. Though in small figures, an improved perfusion of the ischemic areas, an increase in the time of ischemia and cardiac mortality comparable to bypass surgery as well as a better quality of life and lower costs with respect to traditional treatment are also evident. Patients who are at high risk of mortality for bypass surgery, and who cannot receive significant benefits from revascularization or improved pharmacological therapy are candidate to spinal cord stimulation. Spinal cord stimulation is safe and effective in about 70% of patients. Some issues have not been investigated yet: the clinical characteristics of "non-responders" and the possibility of avoiding sudden cardiac death in stimulated patients.