Breast cancer is one of the leading causes of death among cancer patients worldwide. To date, there are several drugs that have been developed for breast cancer therapy. In the 21st century, immunotherapy is considered a pioneering method for improving the management of malignancies; however, breast cancer is an exception. According to the immunoediting model, many immunosuppressive cells contribute to immunological quiescence. Therefore, there is an urgent need to enhance the therapeutic efficacy of breast cancer treatments. In the last few years, numerous combinatorial therapies involving immune checkpoint blockade have been demonstrated that effectively improve clinical outcomes in breast cancer and combining these with methods of targeting epigenetic regulators is also an innovative strategy. Nevertheless, few studies have discussed the benefits of epi-drugs in non-cancerous cells. In this review, we give a brief overview of ongoing clinical trials involving combinatorial immunotherapy with epi-drugs in breast cancer and discuss the role of epi-drugs in the tumor microenvironment, including the results of recent research.

BackgroundBladder cancer is a disease frequently seen in the elderly. Frail and elderly patients with muscle-invasive bladder cancer (MIBC) are often unfit for surgery. While concurrent chemoradiotherapy (CCRT) is a well-established alternative treatment modality, only a small proportion of elderly patients receive CCRT. The purpose of this article is to review our experience with CCRT in elderly MIBC patients.MethodsBetween January 1, 2007 and December 31, 2013, we retrospectively reviewed patients aged >75 who were treated with CCRT at Taipei Veterans General Hospital. Patients' characteristics, therapeutic strategy, clinical outcomes, and treatment-related toxicities were assessed.ResultsNineteen patients (4 females and 15 males) were identified. The median age was 79.5 years (range, 78.5–84.0 years) and the median follow-up was 33.7 months (interquartile range, 19.1–51.8 months). The major adverse event was grade 3 or grade 4 neutropenia, which developed in 10 of the 19 patients. No treatment-related mortality occurred. We found no association between prognosis and the chemotherapy regimen. Chemotherapy with a conventional dose of gemcitabine (800–1000 mg/m2) was well tolerated. The two-year and three-year estimated overall survival rates were 74% and 60%, respectively.ConclusionCCRT after complete transurethral resection of the bladder tumor is feasible for elderly patients with MIBC. The conventional dose of gemcitabine as a chemosensitizer is adequate in the elderly population, but further investigation is needed

Secondary hyperparathyroidism (SHPT) is common in end-stage renal disease (ESRD) patients, and it can suppress erythropoiesis. We aimed to investigate the relationship between the consumption of erythropoiesis-stimulating agents (ESAs) and parathyroidectomy (PTX) in ESRD patients with SHPT and to determine the predictors for anemia improvement. The current standard of chronic kidney disease anemia therapy relies on the prescription of iron supplementation, and ESA. We retrospectively analyzed 81 ESRD patients with PTX at Ditmanson Medical Foundation Chiayi Christian Hospital from July 2004 to Dec 2018. The requirement of ESA therapy markedly declined from a dose of 41.6 (interquartile range [IQR], 0–91.2) to 10.3 (IQR, 0–59.5, p = 0.001) unit/kg/week. In addition, 63.7% of patients required iron replacement therapy preoperatively and the proportion reduced to 52.5% after PTX (p < 0.001). The hemoglobin (Hb) level showed an insignificant change from a median value of 10.7 g/dL (9.5–11.6 g/dL) before PTX to 10.5 g/dL (9.6–11.2 g/dL) at 6 months after PTX. A preoperative Hb level ≤ 10 mg/dL (odds ratio [OR], 20.1; 95% confidence interval [CI], 4.71–125, p < 0.001) and transferrin saturation (TSAT) < 25% (OR, 12.8; 95% CI, 2.51–129, p < 0.001) were predictors for anemia improvement. Our study demonstrated that PTX markedly decreased the requirement of ESA. Patients with a low preoperative Hb level or low TSAT showed an increase in the Hb level after PTX. PTX may be considered not only for SHPT with refractory anemia but also for high ESA-dependent patients.