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      Multifaceted functions of the Wilms tumor 1 protein: From its expression in various malignancies to targeted therapy

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          Highlights

          • WT1 exhibits diverse roles and mechanisms of action across various malignancies.

          • Multiple therapeutic approaches target WT1, including synthetic drugs, natural products, and vaccines.

          • WT1-targeted immunotherapy is advancing through clinical trials, bringing it closer to potential clinical application in the near future.

          Abstract

          Wilms tumor 1 (WT1) is a multifaceted protein with dual functions, acting both as a tumor suppressor and as a transcriptional activator of oncogenes. WT1 is highly expressed in various types of solid tumors and leukemia, and its elevated expression is associated with a poor prognosis for patients. High WT1 expression also indicates a greater risk of refractory disease or relapse. Consequently, targeting WT1 is an effective strategy for disease prevention and relapse mitigation. Substantial information is available on the pathogenesis of WT1 in various diseases, and several WT1-targeted therapies, including chemical drugs, natural products, and targeted vaccines, are available. We provide a comprehensive review of the mechanisms by which WT1 influences malignancies and summarize the resulting therapeutic approaches thoroughly. This article provides information on the roles of WT1 in the pathogenesis of different cancers and provides insights into drugs and immunotherapies targeting WT1. The goal of this work is to provide a systematic understanding of the current research landscape and of future directions for WT1-related studies.

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          Most cited references179

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          Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study.

          Drug treatments for patients with high-risk myelodysplastic syndromes provide no survival advantage. In this trial, we aimed to assess the effect of azacitidine on overall survival compared with the three commonest conventional care regimens. In a phase III, international, multicentre, controlled, parallel-group, open-label trial, patients with higher-risk myelodysplastic syndromes were randomly assigned one-to-one to receive azacitidine (75 mg/m(2) per day for 7 days every 28 days) or conventional care (best supportive care, low-dose cytarabine, or intensive chemotherapy as selected by investigators before randomisation). Patients were stratified by French-American-British and international prognostic scoring system classifications; randomisation was done with a block size of four. The primary endpoint was overall survival. Efficacy analyses were by intention to treat for all patients assigned to receive treatment. This study is registered with ClinicalTrials.gov, number NCT00071799. Between Feb 13, 2004, and Aug 7, 2006, 358 patients were randomly assigned to receive azacitidine (n=179) or conventional care regimens (n=179). Four patients in the azacitidine and 14 in the conventional care groups received no study drugs but were included in the intention-to-treat efficacy analysis. After a median follow-up of 21.1 months (IQR 15.1-26.9), median overall survival was 24.5 months (9.9-not reached) for the azacitidine group versus 15.0 months (5.6-24.1) for the conventional care group (hazard ratio 0.58; 95% CI 0.43-0.77; stratified log-rank p=0.0001). At last follow-up, 82 patients in the azacitidine group had died compared with 113 in the conventional care group. At 2 years, on the basis of Kaplan-Meier estimates, 50.8% (95% CI 42.1-58.8) of patients in the azacitidine group were alive compared with 26.2% (18.7-34.3) in the conventional care group (p<0.0001). Peripheral cytopenias were the most common grade 3-4 adverse events for all treatments. Treatment with azacitidine increases overall survival in patients with higher-risk myelodysplastic syndromes relative to conventional care.
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            Epithelial ovarian cancer: Evolution of management in the era of precision medicine

            Ovarian cancer is the second most common cause of gynecologic cancer death in women around the world. The outcomes are complicated, because the disease is often diagnosed late and composed of several subtypes with distinct biological and molecular properties (even within the same histological subtype), and there is inconsistency in availability of and access to treatment. Upfront treatment largely relies on debulking surgery to no residual disease and platinum-based chemotherapy, with the addition of antiangiogenic agents in patients who have suboptimally debulked and stage IV disease. Major improvement in maintenance therapy has been seen by incorporating inhibitors against poly (ADP-ribose) polymerase (PARP) molecules involved in the DNA damage-repair process, which have been approved in a recurrent setting and recently in a first-line setting among women with BRCA1/BRCA2 mutations. In recognizing the challenges facing the treatment of ovarian cancer, current investigations are enlaced with deep molecular and cellular profiling. To improve survival in this aggressive disease, access to appropriate evidence-based care is requisite. In concert, realizing individualized precision medicine will require prioritizing clinical trials of innovative treatments and refining predictive biomarkers that will enable selection of patients who would benefit from chemotherapy, targeted agents, or immunotherapy. Together, a coordinated and structured approach will accelerate significant clinical and academic advancements in ovarian cancer and meaningfully change the paradigm of care.
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              Cancer Progress and Priorities: Lung Cancer

              In the United States, lung cancer is the second most common diagnosed cancer and the leading cause of cancer-related death. Though tobacco smoking is the major risk factor accounting for 80 to 90% of all lung cancer diagnoses, there are numerous other risk factors that have been identified as casually associated with lung cancer etiology. However, there are few causally-linked risk factors for lung cancer diagnosed among never smokers which, if considered a unique reportable category, is the 11 th most common cancer and the 7 th leading cause of cancer-related death. Lung cancer survival has only marginally improved over the last several decades, but the availability of screening and early detection by low-dose computer tomography and advances in targeted treatments and immunotherapy will likely decrease mortality rates and improve patient survival outcomes in the near future.
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                Author and article information

                Contributors
                Journal
                Transl Oncol
                Transl Oncol
                Translational Oncology
                Neoplasia Press
                1936-5233
                12 December 2024
                February 2025
                12 December 2024
                : 52
                : 102237
                Affiliations
                [a ]Department of Transfusion, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32W. Sec. 2, 1st Ring Rd., Qingyang District, Chengdu, Sichuan, China, 610072
                [b ]Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, 39 Shierqiaolu, Chengdu, Sichuan, China, 610072
                [c ]Department of Pharmacy, The Second Affiliated Hospital, Army Medical University, 183 Xinqiao Road, Chongqing, China, 400000
                Author notes
                [* ]Corresponding author at: Department of Pharmacy, The Second Affiliated Hospital, Army Medical University, 183 Xinqiao Road, Chongqing, China, Postal code: 400000. Joey@ 123456tmmu.edu.cn
                [** ]Corresponding author at: Department of Transfusion, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32W. Sec. 2, 1st Ring Rd., Qingyang District, Chengdu, Sichuan, China. young926@ 123456hotmail.com
                [1]

                These authors contributed equally.

                Article
                S1936-5233(24)00363-2 102237
                10.1016/j.tranon.2024.102237
                11700300
                39672002
                cc6e0f28-97af-4c3b-ae9a-8bc76db16517
                © 2024 The Authors. Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 9 August 2024
                : 28 November 2024
                : 7 December 2024
                Categories
                Review

                wt1,malignant disease,targeted therapies,vaccines,natural products

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