Letter to Editor

Letter to Editor

The immune system plays an important role in protection against tumor growth. The theory of immune surveillance has evolved today leading to recent advancement in field of cancer immunotherapy. Here, we have revisited the basic structure of immune system with emphasis on its interaction with tumor cells. Also discussed briefly, is the landscape of current cancer immunotherapy and the future it holds.

With the increasing use of immunotherapy for various cancers, it is essential that clinicians become aware of some of the unique consequences and sude effects associated with these new treatments. Ranging from pneumonitis and colitis to Type 1 Diabetes Mellitus, immune related adverse events have been reported. Some side effects may be confused with cancer progression and thus awareness and clinical presentation of these is critical and necessary in this fast moving field of medicine.

Editorial

Chemotherapy and allogeneic stem cell transplant suppress the body’s immunity making them more prone to neutropenic sepsis, for which the patients have to be given broad-spectrum antibiotics. These antibiotics disrupt the well-organized colony of our intestinal microbiome creating dysbiosis. Dysbiosis makes the intestine a favorable platform for certain Gram-positive bacilli to proliferate which is Clostridium difficile. Traditional treatment requires the patient to take metronidazole, vancomycin, and probiotics. Recurrent C. difficile infection makes the traditional treatment a failure. Thus, fecal microbial transplant is the answer to recurrent C. difficile.

Aim: The present study was planned to analyze plasma levels of tumor necrosis factor (TNF) in invasive ductal primary breast cancer (BC) patients in a South Indian population. TNF alpha (TNF a) and TNF beta (TNF ß) are produced during inflammation as proinflammatory cytokine markers. The plasma levels of TNF a and TNF ß (lymphotoxin a) were correlated with clinicopathological features of BC. Materials and Methods: Blood samples were collected from patients before treatment. We analyzed plasma levels of TNF a, and TNF ß in 70 female BC cases and 35 age-matched healthy controls using Millipore magnetic bead kits. Results: Plasma TNF a levels in BC cases were significantly elevated (median 10.1 pg/ml) when compared to the control groups. Plasma values of TNF a and TNF ß both were significantly elevated in BC patients with hormone receptor negative cases. Plasma TNF a level was elevated in lymph node metastasis and triple negative BC. Plasma values of TNF a inversely correlated with estrogen receptor and progesterone receptor positivity. Conclusion: The plasma levels of TNF a were more significantly overexpressed than TNF ß in BC patients. Further, the patients with aggressive cancer had higher levels of inflammation markers. The present study shows that TNF levels were elevated in hormone receptor negative and triple-negative cases.

Precision medicine is defined as treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from another patient with similar clinical presentation. Precision Oncology is an innovation at the cusp of blooming. We reviewed the status of precision oncology today, and discuss the flaws, mainly in next-generation sequencing (NGS) and the design of clinical trials thus far. Precision oncology although paints a glossy imagery, the reality is laden with inherent flaws, lack of guided research and a generalisability for the clinical market. The scenario in India is similar. It remains to be seen, if Precision Oncology is able to withstand the scrutiny likely to come its way, and if it can appeal largely to a complex socioeconomic market as India. We conclude that precision oncology is not far from an exponential boom, provided the right questions are asked, and answers derived

Background: Molecular markers are gaining increasing importance as diagnostic and prognostic tools in patients with well differentiated thyroid cancers and BRAF V600E mutation has received wide attention in this regard Aim: To evaluate the clinical value of immunohistochemistry (IHC) using anti-BRAF V600E antibody (clone RM8) for detection of the BRAF V600E mutant protein in formalin-fixed and paraffin-embedded tissues of patients with papillary thyroid carcinomas. Materials and Methods: Patients who were managed for well differentiated thyroid cancers (n = 79) during the years 2005 and 2006 were included in the study. We evaluated the fidelity of the RM8 antibody specific for the BRAF V600E and compared its detection accuracy to real time polymerase chain reaction (PCR), which was taken as the gold standard. Results: Mutant BRAF V600E antibody was studied in 79 tissue sections, out of which 21 (26.5%) had staining for BRAF V600E in >20% of the tumour cells and these were considered positive. The BRAF staining was moderate in 10 (47.6%), strong in 9 (42.5%) and very strong in 2 (9.5%) of sections stained. There was a statistically significant concordance (P = 0.000) with quantitative PCR (qPCR) for BRAF mutant taken as standard. (Kappa agreement: 0.881) Further, the receiver operating characteristics (ROC) curve showed that IHC can be used as a comparable standard to the qPCR. The highest possible sensitivity of 92% and specificity of 92.6% could be achieved by considering the cytoplasmic positivity of >20% of cells with moderate to strong intensity (AUC = 0.923) Conclusion: Our study has shown that BRAF V600E IHC can be done in a conventional manner using rabbit monoclonal antibody RM8 on formalin-fixed and paraffin-embedded tissues of patients with papillary thyroid carcinomas. With a comparable diagnostic accuracy to the gold standard qPCR testing and with an added advantage of being cost effective, this technology can be considered for use as a first-line method for detection of BRAF V600E mutations, especially in resource constrained settings.