Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Research shows that the number of metastases is not the sole predictor of how well you might do following treatment discount rogaine 5 60 ml without a prescription mens health 5 minute workout. Your neurological function (how you are affected by your brain metastases) and the status of the primary cancer site order generic rogaine 5 on-line prostate pills and supplements. Treatment decisions will take into account not only long term survival possibilities buy discount rogaine 5 60 ml line prostate cancer month, but your quality of life during and after treatment, as well as cognition concerns. That radiation may be whole-brain radiation therapy, whole-brain radiation plus stereotactic radiosurgery or stereotactic radiosurgery alone. This is generally followed by medical therapy (chemotherapy, radiation therapy or immune-based therapy) that may impact not only the primary cancer but also metastatic brain tumor. However in more recent times there is an increase in the use of radiosurgery or medical therapy (chemotherapy, targeted therapy or immune-based therapy) for these patients. If there is a question about the scan results or the diagnosis, a biopsy or surgery to remove the brain tumors may be done. This will allow your physicians to confrm that the brain tumors are related to your cancer. If you do not have a history of cancer, your physicians will order tests to try to determine the primary site. If no other cancer site is found, surgery to obtain a tissue sample may be performed. In general, the primary treatment for multiple metastatic brain tumors (or multiple tumors that are not close to each other) is whole-brain radiation. The goal of this therapy is to treat the tumors seen on scan plus those that are too small to be visible. A neuro-oncologist or a medical oncologist specializing in the treatment of brain tumors can help determine if this additional therapy would be of help to you. These metastatic tumors usually involve the bones of the spine – the vertebrae – and then spread and encroach upon the spinal cord. Radiation therapy alone, or surgery plus radiation, may be used to treat metastatic tumors to the spine. A neurosurgeon – a surgeon specially trained to operate on the brain and spine – will determine if your tumors can be surgically removed by evaluating your health and disease status. If surgery is not possible or the primary cancer has not been found, a biopsy may still be done to confrm the tumor type. Once the diagnosis is confrmed, radiation and or chemotherapy (depending on the type of cancer) may be part of the treatment plan. It may be used therapeutically (to treat a metastatic brain tumor), prophylactically (to help prevent brain metastases in people newly diagnosed with small-cell lung cancer or acute lymphoblastic leukemia), or most commonly as palliative (non-curative) treatment (to help relieve symptoms caused by the metastatic brain tumor). Small-cell lung tumor and germ-cell tumors are highly sensitive to radiation, other types of lung cancer and breast cancers are moderately sensitive, and melanoma and renal-cell carcinoma are less sensitive. An important and common concern about whole-brain radiation is its possible impact on cognition and thinking. There are novel approaches that spare hippocampus to help preserve memory and decrease the impact of whole brain radiation on cognition and thinking. Some drugs like memantine have been used as well in clinical trials to help decrease the deterioration of cognition and thinking associated with whole brain radiation. These approaches are still investigational and not routinely used in clinical practice. Radiosurgery focuses high doses of radiation beams more closely to the tumor than conventional external beam radiation in an attempt to avoid and protect normal surrounding brain tissue. This approach is most commonly used in situations where the tumor is small and in eloquent regions of the brain, for example, speech and motor localized areas. Small tumors are generally considered to be 3 cm or less in diameter and limited in number. Radiosurgery can also be used to treat tumors that are not accessible with surgery, such as those deep within the brain. It may also be used for recurrences if whole-brain radiation was previously given, or as a local “boost” following whole-brain radiation. There are many different pieces of equipment used to deliver radiosurgery; each has a brand name created by their manufacturer. Traditionally radiosurgery was used with surgery in patients with single brain metastasis and in combination with whole brain radiation in patients with 1-4 brain tumors. Yes, depending on the type, dose and scope of the radiation received the frst time. Focused forms of radiation therapy may be used after whole-brain radiation if the tumor is small, or radiosurgery may be repeated if tumor recurs. Your doctor can review your original treatment records and advise if you are a candidate for another course of radiation. Sometimes, the addition of chemotherapy prior to, or during, radiation treatment can also have this effect. The decision to use chemotherapy depends on the status of systemic disease, primary site, tumor size and number in the brain, available drugs, and previous history of chemotherapy treatment, if any. Small-cell lung cancer, breast cancer, germ-cell tumors and lymphoma are among these tumors. Some tumors that are sensitive to chemotherapy in other parts of the body may become resistant to the chemotherapy once in the brain. A different drug may be considered if you received chemotherapy for your primary cancer, or a different type of therapy may be considered.
Because headache disorders are most troublesome in the productive years (late teens to buy rogaine 5 60 ml otc prostate cancer 40s 60 years of age) cheap 60 ml rogaine 5 free shipping prostate cancer hormone injections, estimates of their ﬁnancial cost to purchase on line rogaine 5 prostate cancer zigns society are massive — principally from lost working hours and reduced productivity because of impaired working effectiveness (22). In the United Kingdom, for example, some 25 million working or school days are lost every year because of migraine alone (6). Tension-type headache, less disabling but more common, and chronic daily headache, less common but more disabling, together cause losses that are almost certainly of similar magnitude. Therefore, while headache rarely signals serious underlying illness, its public health importance lies in its causal association with these personal and societal burdens of pain, disability, damaged quality of life and ﬁnancial cost. Not surprisingly, headache is high among causes of consulting both general practitioners and neurologists (23, 24). One in six patients aged 16–65 years in a large general practice in the United Kingdom consulted at least once because of headache over an observed period of ﬁve years, and almost 10% of them were referred to secondary care (25). A survey of neurologists found that up to a third of all their patients consulted because of headache — more than for any other single complaint (26). Far less is known about the public health aspects of headache disorders in developing and resource-poor countries. Indirect ﬁnancial costs to society may not be so dominant where labour costs are lower but the consequences to individuals of being unable to work or to care for children may be severe. There is no reason to believe that the burden of headache in its personal elements weighs any less heavily where resources are limited, or where other diseases are also prevalent. For ex ample, in representative samples of the general populations of the United States and the United Kingdom, only half the people identiﬁed with migraine had seen a doctor for headache-related reasons in the last 12 months and only two thirds had been correctly diagnosed (27). Most were solely reliant on over-the-counter medications, without access to prescription drugs. In a separate general-population questionnaire survey in the United Kingdom, two thirds of respondents with migraine were searching for better treatment than their current medication (28). In Japan, aware ness of migraine and rates of consultation by those with migraine are noticeably lower (29). Over 76 Neurological disorders: public health challenges 80% of Danish tension-type headache sufferers had never consulted a doctor for headache (30). It is highly unlikely that people with headache fare any better in developing countries. The barriers responsible for this lack of care doubtless vary throughout the world, but they may be classiﬁed as clinical, social, or political and economic. Clinical barriers Lack of knowledge among health-care providers is the principal clinical barrier to effective head ache management. This problem begins in medical schools where there is limited teaching on the subject, a consequence of the low priority accorded to it. It is likely to be even more pronounced in countries with fewer resources and, as a result, more limited access generally to doctors and effective treatments. Social barriers Poor awareness of headache extends similarly to the general public. Headache disorders are not perceived by the public as serious since they are mostly episodic, do not cause death and are not contagious. In fact, headaches are often trivialized as “normal”, a minor annoyance or an excuse to avoid responsibility. These important social barriers inhibit people who might otherwise seek help from doctors, despite what may be high levels of pain and disability. Surprisingly, poor awareness of headache disorders exists among people who are directly affected by them. A Japanese study found, for example, that many patients were unaware that their headaches were migraine, or that this was a speciﬁc illness requiring medical care (31). The low consultation rates in developed countries may indicate that many headache sufferers are unaware that effective treatments exist. Political and economic barriers Many governments, seeking to constrain health-care costs, do not acknowledge the substantial burden of headache on society. They fail to recognize that the direct costs of treating headache are small in comparison with the huge indirect cost savings that might be made (for example by reduc ing lost working days) if resources were allocated to treat headache disorders appropriately. Therefore the key to successful health care for headache is education (31), which ﬁrst should create awareness that headache disorders are a medical problem requiring treatment. Education of health-care providers should encompass both the elements of good management (see Box 3. Diagnosis Committing sufﬁcient time to taking a systematic history of a patient presenting with headache is the key to getting the diagnosis right. The history-taking must highlight or elicit description of the characteristic features of the important headache disorders described above. The correct diagnosis is not always evident initially, especially when more than one headache disorder is present, but the history should awaken suspicion of the important secondary headaches. Once it is established that there is no serious secondary headache, a diary kept for a few weeks to record neurological disorders: a public health approach 77 the pattern of attacks, symptoms and medication use will usually clarify the diagnosis. Physical examination rarely reveals unexpected signs after an adequately taken history, but should include blood pressure measurement and a brief but comprehensive neurological examination including the optic fundi; more is not required unless the history is suggestive. Examination of the head and neck may ﬁnd muscle tenderness, limited range of movement or crepitation, which suggest a need for physical forms of treatment but do not necessarily elucidate headache causation. Investigations, including neuroimaging, rarely contribute to the diagnosis of headache when the history and examination have not suggested an underlying cause. Realistic objectives There are few patients troubled by headache whose lives cannot be improved by the right medical intervention with the objective of minimizing impairment of life and lifestyle (32).
Pathogenetic mechanisms Radiation dose and cataract surgery incidence in in radiation fibrosis buy rogaine 5 australia prostate oncology specialist in nashville tn. The effects of low-dose Co-60 irradiation on the course of aseptic arthritis in a 28 purchase rogaine 5 on line prostate oncology specialists reviews. Strahlenther Onkol 1998; 174(12): of atomic-bomb cataract data buy rogaine 5 cheap online prostate oncology associates, 2000–2002, a 633–639. Low risks from orbital and periorbital radiation dose X-irradiation of adjuvant-induced arthritis in therapy: a critical review. The risk of a radiation-induced malignancy following low to intermediate dose radiotherapy Background Methods used for predicting Clinically, one of the most important side-effects of risk of radiation-induced cancer radiation exposure at low to intermediate doses is the risk of inducing cancer. Therefore, it is proposed that to a confined radiation field, is large; yet with a few repopulation of the tissue will derive from normal cells, exceptions, the numbers treated are relatively small. These studies have a dose-dependent increase in risk of developing must therefore be viewed with caution when secondary lung cancers (13 years median follow-up) and extrapolating to the risks of current treatment breast cancers (19 years median follow-up). Where appropriate, information has also been obtained from An approximately linear response is also reported in epidemiological studies and medical series that often studies of atomic bomb survivors though, as expected, relate to inferior treatment techniques which are no the excess risks for different tumour sites show longer in use. When be related to dose in a similar manner; the risk will be communicating with patients, it should be emphasised real, although small, and it will be moderated by many that these risk estimates are only approximate. There was a weak link ossification, omarthritis, gonarthrosis, heel spurs and for non-Hodgkin lymphoma among men although hidradenitis suppurativa. However, often the numbers showed linear dose–response curves even up to ≥60 involved are large, making estimates somewhat Gy; the only exception was thyroid cancer, which more reliable. They also confirmed bomb form a very large group, which has been that the risk varied according to the tissue of origin of continuously monitored within the lifespan study the second cancer. This persisted beyond 40 years of follow Tissue-specifc cancer risks following up and was modified by age at treatment. However, since some childhood cancers have an underlying germline mutation, this may also contribute to the observed increase in the previous section has discussed the variety of susceptibility to second malignancies. However, there is still considerable the number of malignant melanomas was unaffected. Overall the authors considered the excess risk of There are many limitations inherent in these malignant skin cancers to be very small. However, there was only one exposed to multiple fluoroscopies, have not shown any death in this group and it has been advised that with significant increase in skin cancer risk. A nested case treatment, although the trends were only marginally 31 control study of secondary sarcomas (105 cases, 422 significant. The secondary sarcomas therefore it was advised that it should be treated with occurred at a median of 11. Five 100 centimetres (cm) skin area treated to a mean excess cases have been documented after a mean dose of 3 Gy have indicated a lifetime risk of local 33 total-body dose of 0. In skin fields not exposed to sunlight, the risk In a key study published in 1965, the cause of death would be smaller by about one order of magnitude. There were 40 leukaemia deaths, which was they presented at a younger age, compared to 70% greater than expected. The incidence of radiation-induced commonly reported tumour type although the risk is astrocytoma was slightly lower than in a control small. The overall incidence was not 15 years’ follow-up, and 56,788 patient-years of data. For adults >40 years, there is no evidence However, in these situations it has been suggested that of an increase in risk. Most studies show that for women, exposure to breast Although the mean follow-up was 12. Nevertheless, following exposure to higher therapeutic doses Further analysis of this cohort suggested that the (such as those for thyroid eye disease, pituitary mechanism underlying the risk may relate to genomic instability at an early stage of tumour development. The risk factor for breast cancer needs to be assessed for women exposed in specific circumstances Thyroid cancer where the breast is directly affected; the effective dose concept which applies to a general population the thyroid of young children is the most 10 is unhelpful in this situation. Several estimates of the radiosensitive organ with regard to radiation risk versus benefit of mammography screening are carcinogenesis; a risk that falls rapidly with increasing available, however, these are very dependent on the age. It has been also been found to show a small but measureable estimated that after a mean lung dose of 1 Gy the increase. Sadetzki S, Chetrit A, Freedman L, Stovall M, unique human population: lessons learned from Modan B, Novikov I. Long-term follow-up for the atomic bomb survivors of Hiroshima and brain tumor development after childhood Nagasaki. Disaster Med Public Health Prep 2011; exposure to ionizing radiation for tinea capitis. Sadetzki S, Chetrit A, Lubina A, Stovall M, of leukaemia, lymphoma and multiple myeloma Novikov I. Solid cancer incidence in atomic bomb A reanalysis of curvature in the dose response for survivors exposed in utero or as young children. Second malignant neoplasms following Int J Radiat Oncol Biol Phys 2013; 85(2): 451–459. Berrington de Gonzalez A, Gilbert E, Curtis R considering radiation effects in the cell and et al. Second solid cancers after radiation therapy: possible implications for cancer therapy: a a systematic review of the epidemiologic studies collection of papers presented at the of the radiation dose–response relationship. Radiother Oncol breast tumors after radiotherapy for a first cancer 2005; 76(3): 270–277. An international collaboration among Second primary neoplasms in patients with cancer registries. Incidence of malignant factors associated with secondary sarcomas in skin tumours in 14,140 patients after grenz-ray childhood cancer survivors: a report from the treatment for benign skin disorders.
Overall the differences in proportions are not great and this is reflected in the narrow range for the estimation of the optimal utilisation rate for each jurisdiction order rogaine 5 60 ml on line mens health 5k training. Even when there is clear and significant evidence in favour of a treatment rogaine 5 60 ml otc prostate cancer 65, a patient may choose to rogaine 5 60 ml fast delivery man health clinic singapore have an alternate less effective treatment or to have no treatment at all. The right to make a choice is recognised as the right of autonomy in the National Statement on Research Ethics (1) and more broadly in the community. Jansen et al conducted a review of determinants of patients’ preferences for adjuvant therapy in cancer (2). A total of 40 determinants of patients’ preferences were classified into seven categories: (i) treatment-related determinants (such as potential benefits of treatment, degree of toxicity, previous experience of treatment) (ii) socio-demographic characteristics and current quality of life (age, sex, marital status, dependents living at home etc) (iii) clinical characteristics (type of cancer, stage of disease, lymph node status, disease recurrence, tumour size) (iv) determinants related to methodology (effects of framing of questions with regards to survival, side effects, dying, treatment benefits, level of starting point of questions, order of starting point and interviewer) (v) time-related determinants (impact of the passing of time on determinants) (vi) cognitive/affective determinants (belief in treatment benefits, negative emotions, feeling a need to take action, anticipated regret) and (vii) specialist-related determinants. Newcomb and Carbone showed that physicians exert a significant influence on their patients’ treatment choices (3). Several studies of cancer patients have noted the importance of the treating specialist’s recommendation on patients’ treatment preferences (4-7). Yellen and Cella state that the most important determinant of patient willingness to undergo aggressive treatment may be the way in which the treatment is described by the oncologist as well as the strength of the recommendation (4). Patients’ preferences for taking responsibility for treatment decisions vary, with some patients wanting to make their own treatment decisions while others wish to receive information but not to be actively involved in treatment decisions (8-13). Several studies report that older patients and those with fewer qualifications are more likely to want the doctor to make treatment decisions (11-13). Degner and Sloan reported that patients close to a life-threatening event were more passive with respect to treatment decision preference than a comparison group of healthy individuals (14). An analysis of 729 cancer patients’ preferences for involvement in decision making showed that patients tended to prefer a decreasing level of involvement over time (15). There are two situations in which patient choice can have a significant effect on the overall optimal radiotherapy utilisation model since they involve commonly occurring cancers where there is no clear evidence of benefit for any one treatment option. The major concern about including patient preference into a study of optimal utilisation is the concern that empirical studies of patient choice may be affected by Page | 548 patients’ socio-demographic factors, by issues of access and by other confounding factors that the study aims to overcome by providing a benchmark of optimal access. Prostate Cancer In the management of early prostate cancer, evidence-based guidelines suggest that there is no evidence of the superiority of any one of the four available treatment options, i. Patterns of practice studies have not been described here since these studies have the disadvantages that there is a wide variation in treatments administered between countries (16) (17) and even within countries (18) (19), reflecting the fact that patterns of care studies reveal what treatment is being administered and perhaps what is more accessible, and not necessarily the optimal treatment that should be administered. Patterns of care studies are biased by such issues as geographical access to treatments and to medical practitioners and by varying costs to patients of different treatments. Patient choice studies used or considered in previous optimal utilisation models for prostate cancer (20) (21-23) have disadvantages that include: not all treatment options being offered (24-27), hypothetical scenarios being offered to well men without prostate cancer (24;25), small sample size (25;26), or inadequate pre-choice counselling without consultation with both a radiation oncologist and a urologist (24-26;28;29). Patients who decided on surgery were significantly younger than those who received radiation therapy and brachytherapy. Patients indicated that physician recommendation was the most important reason influencing their treatment decision. Sommers et al surveyed 167 men with clinically localised prostate cancer who had not yet undergone treatment regarding treatment choices (30). The majority of men who opted for surgery were motivated by the need for physical removal of the cancer. External beam radiotherapy was mainly chosen by patients who feared other treatments while most men chose brachytherapy because it was more convenient for their lifestyle. Of the 768 patients, 40% chose surgery, 31% chose external beam radiotherapy, 21% Page | 549 chose brachytherapy and 8% opted for active surveillance. These data were therefore used for all branches on the decision tree where equivalent treatment options were applicable. In the optimal radiotherapy utilisation model for non-metastatic prostate cancer, since there is no evidence of superiority of any one treatment option, data on patient preferences between the four treatment options have been used at several decision nodes in the tree. This is less than ideal for the reasons highlighted above; however, in the absence of a clear patient choice study that definitively identifies what the patients choice would be under ideal conditions this was thought to be the most pragmatic approach. However Katz et al reported that more patient involvement in decision making was associated with greater use of mastectomy (36), possibly due to the increasing use of immediate breast reconstruction. Due to the lack of suitable patient preference data in early breast cancer, population-based actual practice data was instead used in the model of optimal radiotherapy utilisation. National Health and Medical Research Council and Australian Vice-Chancellors Committee. Someone to live for: social well-being, parental status and decision-making in oncology. Management preferences in stage I non-seminomatous germ cell tumors of the testis: an investigation among patients, controls and oncologists. Helping patients make informed choices: A randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer. Breast irradiation postlumpectomy: development and evaluation of a decision instrument. Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools. The patient-physician partnership: decision making, problem-solving and the desire to participate. Decision making during serious illness: what role do patients really want to play? Factors associated with initial therapy for clinically localized prostate cancer: prostate cancer outcomes study. Geographic, age and racial variation in the treatment of local/regional carcinoma of the prostate. The National Cancer Data Base Report on Race, Age, and Region Variations in Prostate Cancer Treatment. Radiotherapy in cancer care: estimating optimal utilisation from a review of evidence-based clinical guidelines.
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Patients with active autoimmune disease buy rogaine 5 60 ml with amex prostate cancer urine test, greater than one etiology of hepatitis buy rogaine 5 60 ml low cost man health summit, a medical condition that required immunosuppression discount rogaine 5 60 ml on line prostatectomy, or clinical evidence of ascites by physical exam were ineligible for the trial. Child-Pugh class and score were A5 for 72%, A6 for 22%, B7 for 5%, and B8 for 1% of patients. Sixty-four percent (64%) of patients had extrahepatic disease, 17% had vascular invasion, and 9% had both. All patients received prior sorafenib; of whom 20% were unable to tolerate sorafenib. Assessment of tumor status was performed at 13 weeks followed by every 9 weeks for the first year and every 12 weeks thereafter. Eighty-four percent of patients had prior surgery and 70% had prior radiation therapy. Patients with active autoimmune disease requiring systemic immunosuppression within the last 2 years were ineligible. Patients who tolerated axitinib 5 mg twice daily for 2 consecutive cycles (6 weeks) could increase to 7 mg and then subsequently to 10 mg twice daily. Axitinib could be interrupted or reduced to 3 mg twice daily and subsequently to 2 mg twice daily to manage toxicity. Assessment of tumor status was performed at baseline, after randomization at Week 12, then every 6 weeks thereafter until Week 54, and then every 12 weeks thereafter. Patients with active autoimmune disease or a medical condition that required immunosuppression were ineligible. Assessment of tumor status was performed at baseline and then every 6 weeks until week 24, followed by every 9 weeks thereafter. All 94 of these patients received prior systemic therapy for endometrial carcinoma: 51% had one, 38% had two, and 11% had three or more prior systemic therapies. These reactions may include: Pneumonitis: Advise patients to contact their healthcare provider immediately for new or worsening cough, chest pain, or shortness of breath [see Warnings and Precautions (5. Infusion-Related Reactions Advise patients to contact their healthcare provider immediately for signs or symptoms of infusion related reactions [see Warnings and Precautions (5. Embryo-Fetal Toxicity Advise females of reproductive potential of the potential risk to a fetus and to inform their healthcare provider of a known or suspected pregnancy [see Warnings and Precautions (5. Laboratory Tests Advise patients of the importance of keeping scheduled appointments for blood work or other laboratory tests [see Warnings and Precautions (5. Received: 15 November 2018; Accepted: 20 December 2018; Published: 28 December 2018 Abstract: Metastasis represents the leading cause of cancer-related death mainly owing to the limited efﬁcacy of current anticancer therapies on advanced malignancies. Although immunotherapy is rendering promising results in the treatment of cancer, many adverse events and factors hampering therapeutic efﬁcacy, especially in solid tumors and metastases, still need to be solved. Indeed, the engagement of activating receptors by tumor-expressed ligands, along with a lack of co-engagement of an appropriate number of inhibitory receptors, results in the exocytosis of cytotoxic granules containing perforin and granzymes that induce apoptotic cell death of the target cells. The latter is a relevant process underlying the therapeutic activity of certain monoclonal antibodies . The Metastatic Cascade the metastatic cascade involves tumor cell detachment from their neighbors, local invasion of surrounding tissues—as either a singular cells or groups of tumor cells—and the tumors entrance into the nearby pre-existing or neo-formed vasculature. Metastasis formation is an extremely selective process wherein a progressive decimation of the tumor population occurs. The metastatic cascade may be envisioned as a sequence of selective microenvironments demanding speciﬁc malignant attributes. Among these tumor-extrinsic factors, the host’s anti-tumor immune response is a major hindrance that cancer cells must avoid to successfully seed distant metastases. In fact, owing to cancer immunosurveillance, a myriad of immune components can be detected at every step of the metastatic process as a forced companion of tumor cells, an immune contexture that constitutes a strong prognostic factor of the outcome of the disease . This pairing results in a complicated bidirectional relationship whereby the immune system shapes the immunogenicity of the developing tumor by operating both tumor-promoting and tumor-obstructive mechanisms throughout the metastatic process. Accordingly, transplantation of epithelial tumors expressing neu oncogene into syngeneic mice induced an immune-mediated rejection of cancer cells . Consistent with cancer immunoediting, these mice subsequently relapsed with tumors enriched in neu-negative variant cancer cells with a mesenchymal phenotype. Metastatic cells develop speciﬁc mechanisms that allow them to survive outside of the tumor nest and to cross the blood to extravasate into distant tissues. To conclude, immune evasion is a major obstacle in the development of effective anticancer therapies. The recent advances in understanding the immune evasion mechanisms developed by disseminated cells are opening new opportunities for novel and more effective cancer immunotherapies. Immunotherapy in the Treatment of Metastasis the treatment of cancer metastasis is one of the greatest challenges in medicine. Indeed, metastasis is responsible for more than 90% of cancer-associated mortality. Conventional therapeutic strategies, including surgical resection, chemotherapy and radiotherapy are relatively efﬁcient in the elimination of primary tumors, but show limited efﬁcacy in the elimination of metastases. Although immunotherapies are a promising strategy against cancer metastasis, current immunotherapies are mainly focused on T cells, and many toxicity and efﬁcacy complications remain to be solved. These approaches (and their effectiveness) greatly vary depending on the tumor type, tumor cell phenotype, patient, and feasibility of the treatments. Preliminary antitumor evaluation showed no objective responses, but the clearance of lung metastases in two patients was observed . It may also perform pro-inﬂammatory activities in many tissues and promote colitis-associated colon cancer . However, high proportions of patients relapse and experience brain metastasis after treatment with trastuzumab.