For more than three decades, postoperative chemotherapy-initially fluoropyrimidines and more recently combinations with oxaliplatin-has reduced the risk of tumor recurrence and improved survival for ...patients with resected colon cancer. Although universally recommended for patients with stage III disease, there is no consensus about the survival benefit of postoperative chemotherapy in stage II colon cancer. The most recent adjuvant clinical trials have not shown any value for adding targeted agents, namely bevacizumab and cetuximab, to standard chemotherapies in stage III disease, despite improved outcomes in the metastatic setting. However, biomarker analyses of multiple studies strongly support the feasibility of refining risk stratification in colon cancer by factoring in molecular characteristics with pathologic tumor staging. In stage II disease, for example, microsatellite instability supports observation after surgery. Furthermore, the value of BRAF or KRAS mutations as additional risk factors in stage III disease is greater when microsatellite status and tumor location are taken into account. Validated predictive markers of adjuvant chemotherapy benefit for stage II or III colon cancer are lacking, but intensive research is ongoing. Recent advances in understanding the biologic hallmarks and drivers of early-stage disease as well as the micrometastatic environment are expected to translate into therapeutic strategies tailored to select patients. This review focuses on the pathologic, molecular, and gene expression characterizations of early-stage colon cancer; new insights into prognostication; and emerging predictive biomarkers that could ultimately help define the optimal adjuvant treatments for patients in routine clinical practice.
Owing to the difficulties associated with substitutional doping of low-dimensional nanomaterials, most field-effect transistors built from carbon nanotubes, two-dimensional crystals and other ...low-dimensional channels are Schottky barrier MOSFETs (metal-oxide-semiconductor field-effect transistors). The transmission through a Schottky barrier-MOSFET is dominated by the gate-dependent transmission through the Schottky barriers at the metal-to-channel interfaces. This makes the use of conventional transistor models highly inappropriate and has lead researchers in the past frequently to extract incorrect intrinsic properties, for example, mobility, for many novel nanomaterials. Here we propose a simple modelling approach to quantitatively describe the transfer characteristics of Schottky barrier-MOSFETs from ultra-thin body materials accurately in the device off-state. In particular, after validating the model through the analysis of a set of ultra-thin silicon field-effect transistor data, we have successfully applied our approach to extract Schottky barrier heights for electrons and holes in black phosphorus devices for a large range of body thicknesses.
In this article, we explore, experimentally, the impact of band-to-band tunneling on the electronic transport of double-gated WSe2 field-effect transistors (FETs) and Schottky barrier tunneling of ...holes in back-gated MoS2 FETs. We show that by scaling the flake thickness and the thickness of the gate oxide, the tunneling current can be increased by several orders of magnitude. We also perform numerical calculations based on Landauer formalism and WKB approximation to explain our experimental findings. Based on our simple model, we discuss the impact of band gap and effective mass on the band-to-band tunneling current and evaluate the performance limits for a set of dichalcogenides in the context of tunneling transistors for low-power applications. Our findings suggest that WTe2 is an excellent choice for tunneling field-effect transistors.
Inhibition of the BRAF(V600E) oncoprotein by the small-molecule drug PLX4032 (vemurafenib) is highly effective in the treatment of melanoma. However, colon cancer patients harbouring the same ...BRAF(V600E) oncogenic lesion have poor prognosis and show only a very limited response to this drug. To investigate the cause of the limited therapeutic effect of PLX4032 in BRAF(V600E) mutant colon tumours, here we performed an RNA-interference-based genetic screen in human cells to search for kinases whose knockdown synergizes with BRAF(V600E) inhibition. We report that blockade of the epidermal growth factor receptor (EGFR) shows strong synergy with BRAF(V600E) inhibition. We find in multiple BRAF(V600E) mutant colon cancers that inhibition of EGFR by the antibody drug cetuximab or the small-molecule drugs gefitinib or erlotinib is strongly synergistic with BRAF(V600E) inhibition, both in vitro and in vivo. Mechanistically, we find that BRAF(V600E) inhibition causes a rapid feedback activation of EGFR, which supports continued proliferation in the presence of BRAF(V600E) inhibition. Melanoma cells express low levels of EGFR and are therefore not subject to this feedback activation. Consistent with this, we find that ectopic expression of EGFR in melanoma cells is sufficient to cause resistance to PLX4032. Our data suggest that BRAF(V600E) mutant colon cancers (approximately 8-10% of all colon cancers), for which there are currently no targeted treatment options available, might benefit from combination therapy consisting of BRAF and EGFR inhibitors.
Oncolytic viruses represent a unique type of agents that combine self-amplification, lytic, and immunostimulatory properties against tumors. A local and locoregional clinical benefit has been ...demonstrated upon intratumoral injections of an oncolytic herpes virus in melanoma patients, leading to its approval in the United States and Europe for patients without visceral disease (up to stage IVM1a). However, in order to debulk and change the local immunosuppressive environment of tumors that cannot be injected directly, oncolyitc viruses need to be administered systemically. Among different viruses, adenovirus has been extensively used in clinical trials but with few evidences of activity upon systemic administration. Preclinical efficacy of a single intravenous administration of our oncolytic adenovirus ICOVIR5, an adenovirus type 5 responsive to the retinoblastoma pathway commonly deregulated in tumors, led us to use this virus in a dose-escalation phase 1 trial in metastatic melanoma patients. The results in 12 patients treated with a single infusion of a dose up to 1 × 10
viral particles show that ICOVIR5 can reach melanoma metastases upon a single intravenous administration but fails to induce tumor regressions. These results support the systemic administration of armed oncolytic viruses to treat disseminated cancer.
In this paper, an analytic model is proposed, which provides, in a continuous manner, the current-voltage (<inline-formula> <tex-math notation="LaTeX">I </tex-math></inline-formula>-<inline-formula> ...<tex-math notation="LaTeX">V </tex-math></inline-formula>) characteristic of high-performance tunneling FETs (TFETs) based on direct bandgap semiconductors. The model provides the closed-form expressions for <inline-formula> <tex-math notation="LaTeX">I </tex-math></inline-formula>-<inline-formula> <tex-math notation="LaTeX">V </tex-math></inline-formula> based on: 1) a modified version of the well-known Fowler-Nordheim (FN) formula (in the ON-state) and 2) an equation that describes the OFF-state performance while providing continuity at the ON/OFF threshold by means of a term introduced as the continuity factor. It is shown that the traditional approaches, such as FN, are accurate in TFETs only through correct evaluation of the total band bending distance and the tunneling effective mass. General expressions for these two key parameters are provided. Moreover, it is demonstrated that the tunneling effective mass captures both the ellipticity of evanescent states and the dual (electron/hole) behavior of the tunneling carriers, and it is further shown that such a concept is even applicable to semiconductors with nontrivial energy dispersion. Ultimately, it is found that the <inline-formula> <tex-math notation="LaTeX">I </tex-math></inline-formula>-<inline-formula> <tex-math notation="LaTeX">V </tex-math></inline-formula> characteristics obtained by using this model are in close agreement with the state-of-the-art quantum transport simulations both in the ON- and OFF-state, thus providing the validation of the analytic approach.
In most colorectal cancer (CRC) patients, outcome cannot be predicted because tumors with similar clinicopathological features can have differences in disease progression and treatment response. ...Therefore, a better understanding of the CRC biology is required to identify those patients who will benefit from chemotherapy and to find a more tailored therapy plan for other patients. Based on unsupervised classification of whole genome data from 188 stages I–IV CRC patients, a molecular classification was developed that consist of at least three major intrinsic subtypes (A‐, B‐ and C‐type). The subtypes were validated in 543 stages II and III patients and were associated with prognosis and benefit from chemotherapy. The heterogeneity of the intrinsic subtypes is largely based on three biological hallmarks of the tumor: epithelial‐to‐mesenchymal transition, deficiency in mismatch repair genes that result in high mutation frequency associated with microsatellite instability and cellular proliferation. A‐type tumors, observed in 22% of the patients, have the best prognosis, have frequent BRAF mutations and a deficient DNA mismatch repair system. C‐type patients (16%) have the worst outcome, a mesenchymal gene expression phenotype and show no benefit from adjuvant chemotherapy treatment. Both A‐type and B‐type tumors have a more proliferative and epithelial phenotype and B‐types benefit from adjuvant chemotherapy. B‐type tumors (62%) show a low overall mutation frequency consistent with the absence of DNA mismatch repair deficiency. Classification based on molecular subtypes made it possible to expand and improve CRC classification beyond standard molecular and immunohistochemical assessment and might help in the future to guide treatment in CRC patients.
What's new?
Even when tumors look the same, they may behave differently. But patients can be treated more effectively if clinicians know how aggressively a cancer will progress or how well it will respond to treatment. That's why this study investigated molecular and genetic differences in colorectal cancer to find out how to distinguish different subtypes. They classified tumors into three categories based on three biological hallmarks: epithelial to mesenchymal transition, high mutation frequency, and proliferation. Each of the tumor types has a different prognosis and response to chemotherapy, and a patient's tumor type can help determine what treatment should be attempted.
Summary Background Since the 1990s, fluorouracil-based adjuvant chemotherapy has significantly reduced the risk of tumour recurrence in patients with stage III colon cancer. We aimed to assess ...whether the addition of cetuximab to standard adjuvant oxaliplatin, fluorouracil, and leucovorin chemotherapy (FOLFOX4) in patients with stage III colon cancer improved disease-free survival (DFS). Methods For this open-label, randomised phase 3 study done in nine European countries, we enrolled patients through an interactive voice response system to the central randomisation centre, with a central stratified permuted block randomisation procedure. We randomly assigned patients with resected (R0) stage III disease (1:1) to receive 12 cycles of FOLFOX4 twice a week with or without cetuximab. Patients were stratified by N-status (N1 vs N2), T-status (T1-3 vs T4), and obstruction or perforation status (no obstruction and no perforation vs obstruction or perforation or both). A protocol amendment (applied in June, 2008, after 2096 patients had been randomly assigned to treatment-restricted enrolment to patients with tumours wild-type at codons 12 and 13 in exon 2 of the KRAS gene ( KRAS exon 2 wild-type). The primary endpoint was DFS. Analysis was intention to treat in all patients with KRAS exon 2 wild-type tumours. The study is registered at EudraCT, number 2005-003463-23. Findings Between Dec 22, 2005, and Nov 5, 2009, 2559 patients from 340 sites in Europe were randomly assigned. Of these patients, 1602 had KRAS exon 2 wild-type tumours (intention-to-treat population), 791 in the FOLFOX4 plus cetuximab group and 811 in the FOLFOX4 group. Median follow-up was 3·3 years (IQR 3·2–3·4). In the experimental and control groups, DFS was similar in the intention-to-treat population (hazard ratio HR 1·05; 95% CI 0·85–1·29; p=0·66), and in patients with KRAS exon 2/ BRAF wild-type (n=984, HR 0·99; 95% CI 0·76–1·28) or KRAS exon 2-mutated tumours (n=742, HR 1·06; 95% CI 0·82–1·37). We noted heterogeneous responses to the addition of cetuximab in preplanned subgroup analyses. Grade 3 or 4 acne-like rash (in 209 of 785 patients 27% vs four of 805 <1%), diarrhoea (113 14% vs 70 9%), mucositis (63 8% vs 10 1%), and infusion-related reactions (55 7% vs 30 4%) were more frequent in patients treated with FOLFOX4 plus cetuximab than in those patients who received FOLFOX4 alone. Interpretation The addition of cetuximab to FOLFOX4 did not improve DFS compared with FOLFOX4 alone in patients with KRAS exon 2 wild-type resected stage III colon cancer. This trial cannot conclude on the benefit of cetuximab in the studied population, but the heterogeneity of response suggests that further investigation of the role of FOLFOX4 plus cetuximab in specific patient subgroups is warranted. Funding Fédération Francophone de Cancérologie Digestive (FFCD), Merck KGaA, and Sanofi-Aventis.
Accurate detection of characteristic proteins secreted by colon cancer tumor cells in biological fluids could serve as a biomarker for the disease. The aim of the present study was to identify and ...validate new serum biomarkers and demonstrate their potential usefulness for early diagnosis of colon cancer.
The study was organized in three sequential phases: 1) biomarker discovery, 2) technical and biological validation, and 3) proof of concept to test the potential clinical use of selected biomarkers. A prioritized subset of the differentially-expressed genes between tissue types (50 colon mucosa from cancer-free individuals and 100 normal-tumor pairs from colon cancer patients) was validated and further tested in a series of serum samples from 80 colon cancer cases, 23 patients with adenoma and 77 cancer-free controls.
In the discovery phase, 505 unique candidate biomarkers were identified, with highly significant results and high capacity to discriminate between the different tissue types. After a subsequent prioritization, all tested genes (N = 23) were successfully validated in tissue, and one of them, COL10A1, showed relevant differences in serum protein levels between controls, patients with adenoma (p = 0.0083) and colon cancer cases (p = 3.2e-6).
We present a sequential process for the identification and further validation of biomarkers for early detection of colon cancer that identifies COL10A1 protein levels in serum as a potential diagnostic candidate to detect both adenoma lesions and tumor.
The use of a cheap serum test for colon cancer screening should improve its participation rates and contribute to decrease the burden of this disease.
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