Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide. Tumor angiogenesis plays a crucial role in breast cancer progression, making angiogenesis-associated pathways attractive therapeutic targets. Computational drug discovery approaches, including virtual high-throughput screening (VHTS), molecular docking, molecular dynamics simulations, and binding free energy calculations, have emerged as valuable tools for identifying and optimizing anticancer compounds. This review evaluates the application of these computational techniques in the discovery of antiangiogenic therapeutic candidates for breast cancer.

The epidermal growth factor receptor (EGFR) is a transmembrane receptor tyrosine kinase that plays a central role in regulating cell growth, differentiation, and survival. In non-small cell lung cancer (NSCLC) and several other malignancies, activating mutations within the EGFR kinase domain lead to persistent receptor activation and uncontrolled downstream signalling. Over the past two decades, X-ray crystallographic studies and structural data deposited in the Protein Data Bank have significantly enhanced our understanding of EGFR activation mechanisms, mutation-driven conformational changes, and inhibitor binding interactions. This review provides a critical evaluation of structural insights obtained from crystal structures of wild-type and mutant EGFR, with particular focus on clinically important mutations such as L858R, T790M, and C797S. These mutations induce specific alterations in activation loop positioning, αC-helix orientation, and ATP-binding pocket architecture, thereby influencing drug binding affinity and therapeutic response. The structural basis for the evolution of EGFR tyrosine kinase inhibitors-from first-generation reversible inhibitors to mutant-selective covalent agents-is discussed in relation to emerging resistance mechanisms. Although structural characterisation has substantially contributed to rational drug design, the ongoing development of resistance mutations highlights the need to integrate crystallographic data with tumour biology and resistance pathways to achieve more durable therapeutic strategies.

The ubiquitin-proteasome system (UPS) plays a central role in regulating protein homeostasis and degradation. Its dysregulation is closely associated with various diseases, including cancer. S-phase kinase-associated protein 2 (SKP2) is a key E3 ubiquitin ligase component of the UPS. It induces proteasome-mediated protein degradation or modulates substrate function by conjugating K48-linked or K63-linked ubiquitin chains to diverse target proteins. Recent studies have shown that the overexpression of SKP2 in several cancer types is correlated with poor clinical outcomes, underscoring its potential as a therapeutic target. Notably, emerging evidence has expanded the functional repertoire of SKP2 beyond cell cycle control to encompass metabolism, DNA repair, stemness, tumor microenvironment (TME) and immunotherapy response, positioning it as an increasingly attractive target for intervention. In this review, the oncogenic properties of SKP2 and its underlying mechanisms were elucidated in multiple cancer types. Moreover, we systematically summarized future directions for SKP2-targeted therapy.

The decision to rechallenge a patient with immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI) remains one of the most challenging dilemmas in onco-nephrology. Although major guidelines affirm that rechallenge may be considered in selected patients, they uniformly acknowledge a critical gap: no validated tool currently exists to estimate an individual's risk of recurrence. Reported recurrence rates range from 16.5% to 44%, and the survival benefit of rechallenge is inconsistent across studies. In this review, we synthesize recent evidence on risk factors for ICI-AKI recurrence, including clinical parameters (acute kidney injury (AKI) severity, renal recovery status, extra-renal immune-related adverse events (irAEs), concomitant medications, and immune checkpoint inhibitor (ICI) regimen), pathological findings (acute tubulointerstitial nephritis (ATIN) with Banff scoring, and glomerular diseases), emerging biomarkers (urinary C-X-C motif chemokine ligand 9 (CXCL9)-to-creatinine ratio with an optimal cutoff of 269.5 ng/g, and serum soluble interleukin-2 receptor alpha (sIL-2Rα) with a cutoff of ≥1.75× the upper limit of normal (ULN)), genetic markers (the propionyl-CoA carboxylase subunit alpha (PCCA) variant rs16957301), and acute kidney disease (AKD). We translate this evidence into a practical, stepwise risk stratification framework that classifies patients into low-, intermediate-, and high-risk tiers through the sequential integration of clinical, pathological, and biomarker information. The biomarker cutoffs included in this framework-derived from diagnostic studies-are hypothesis-generating in the context of recurrence prediction and require prospective validation before clinical application. For each tier, we provide corresponding recommendations regarding rechallenge decisions, monitoring intensity, and prophylactic immunosuppression, while acknowledging the limited evidence supporting prophylactic corticosteroids in this setting. Finally, we discuss current controversies-including the optimal timing of rechallenge, racial differences that challenge model generalizability, and the unresolved role of prophylactic glucocorticoids-and outline future research priorities organized around clinical validation, biomarker development, mechanistic exploration, and integration of emerging technologies. This framework is designed for immediate clinical application across diverse settings, ranging from resource-limited primary hospitals to tertiary centers. By transforming empirical decision-making into evidence-based, individualized risk assessment, this review aims to guide precision rechallenge management for patients recovering from ICI-AKI.

Bacillus Calmette-Guérin (BCG) is the standard adjuvant therapy for high-risk non-muscle-invasive bladder cancer (NMIBC); however, a substantial proportion of patients develop BCG-unresponsive disease with limited bladder-preserving options. The objective of this study was to determine whether combination immunotherapy provides superior clinical efficacy and safety compared with single-agent immunotherapy for patients with BCG-unresponsive NMIBC.

Innovations in therapeutic modalities and targeted drug delivery are two key approaches to improving the effectiveness of cancer treatment. With the development of therapeutic concepts and nanotechnology, recent research has shifted from tissue- or cell-level drug delivery to organelle-specific delivery to amplify therapeutic effects. Among these organelles, the endoplasmic reticulum (ER) has emerged as a particularly promising target because of its extensive membrane network, which serves as a major site for protein synthesis, lipid metabolism, calcium homeostasis, and intracellular signaling. The disruption of ER function can trigger severe cellular stress and apoptosis, providing a rationale for ER-targeted cancer therapy. However, traditional small-molecule drugs often exhibit poor ER specificity, rapid degradation, and limited intracellular accumulation, significantly restricting their therapeutic potential. In contrast, ER-targeting multifunctional nanoplatforms have demonstrated superior advantages, including enhanced stability, precise localization, controlled drug release, and multimodal therapeutic capabilities. In this Review, we systematically summarize the recent advances in ER-targeting nanotherapeutics and their applications in chemotherapy, phototherapy, immunotherapy, biotherapy, and combination therapy. Furthermore, we discuss the advantages, challenges, and mechanistic insights of these strategies, aiming to provide perspectives on accelerating the clinical translation of ER-targeting precision drugs.

Extensive-stage small cell lung cancer (SCLC) carries a poor prognosis and has limited therapeutic options. The addition of immune-checkpoint inhibitors (ICIs) to platinum-etoposide (PE) chemotherapy has become an important first-line treatment strategy. However, the comparative benefits and harms of different first-line chemotherapy-based regimens, including ICI-containing combinations, remain unclear.

Cytotoxic chemotherapy remains integral to contemporary uro-oncology despite the rapid expansion of targeted therapy, antibody-drug conjugates, and immunotherapy. Its role is especially critical where therapeutic success depends on maintaining adequate dose intensity, most notably in metastatic testicular germ cell tumours and in cisplatin-based perioperative treatment for muscle-invasive bladder cancer. In metastatic prostate cancer and selected penile squamous cell carcinoma, taxane- and platinum-based regimens also retain clinical value but are constrained by hematologic, neurologic, renal, pulmonary, and gastrointestinal toxicities. This narrative review summarises current evidence and guideline recommendations for Common Terminology Criteria for Adverse Events (CTCAE)-guided management of chemotherapy toxicity across major uro-oncologic disease settings. A practical emphasis is placed on pretreatment risk stratification, cycle-by-cycle surveillance, supportive care, and intent-adapted treatment modification. Across tumour types, early recognition of grade 2 toxicity, urgent management of febrile neutropenia and organ toxicity, and thoughtful preservation of dose intensity when cure is realistic are the central management principles. In older, frail, immunosuppressed, heavily pretreated, or organ-limited patients, CTCAE grades must be interpreted against baseline reserve and cumulative toxicity.

Autoimmune thyroid diseases (AITDs), including Hashimoto's thyroiditis (HT) and Graves' disease (GD), affect approximately 2-5% of the global population. They are the most common organ-specific autoimmune disorders worldwide. Growing epidemiological and immunological evidence indicates that AITDs frequently coexist with immune-mediated dermatological diseases. These include atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo, and chronic spontaneous urticaria (CSU). Targeted immunotherapies have become central to the treatment of many immune-mediated skin diseases. Although these therapies are designed to act on specific immune pathways, they may also exert broader systemic immunomodulatory effects. However, thyroid function and thyroid autoantibodies are not routinely assessed in patients with immune-mediated dermatological conditions. This is also true for some patients with known or suspected AITDs. In this narrative review, we summarize the immunological overlap between cutaneous inflammation and autoimmune thyroid disease. We also discuss thyroid-related evidence for IL-4Rα inhibitors, IL-17 inhibitors, JAK inhibitors, IL-12/23 inhibitors, and immune checkpoint inhibitors (ICIs). Current evidence suggests that ICIs have the strongest established association with thyroid dysfunction. In contrast, the thyroid-related effects of dupilumab and ustekinumab are supported mainly by rare case reports. IL-17 inhibitors and selective IL-23p19 inhibitors may theoretically attenuate thyroid inflammatory pathways. However, this possibility has not yet been confirmed in clinical studies. Based on the available evidence, we propose a risk-stratified approach to thyroid surveillance across targeted immunotherapies. Routine thyroid monitoring is most strongly supported for ICIs. For patients at increased thyroid risk, selective assessment of thyroid function and thyroid autoantibodies may also be considered during treatment with dupilumab or ustekinumab. For oral JAK inhibitors, monitoring may be particularly relevant before treatment, during therapy, and after discontinuation because of the potential for immune rebound. Prospective studies are needed to define which patient subgroups would benefit most from thyroid surveillance during targeted immunotherapy.

Metastasis is the primary cause of mortality across gastrointestinal (GI) cancers, including colorectal, gastric, pancreatic, biliary and esophageal cancers. Cancer-associated fibroblasts (CAFs) constitute the dominant stromal component of the desmoplastic GI tumor microenvironment (TME) and regulate every stage of metastatic progression. This review systematically summarizes CAF-mediated pro-metastatic mechanisms in GI tumors, including extracellular matrix (ECM) remodeling, paracrine oncogenic signaling, immune exclusion, angiogenesis, lymphangiogenesis, pre-metastatic niches (PMNs) construction and therapeutic resistance. Notably, CAFs are heterogeneous populations with context-dependent dual functions: certain myofibroblastic CAF (myCAF) subsets restrain tumor progression in pancreatic ductal adenocarcinoma (PDAC), while inflammatory CAFs (iCAFs) drive metastasis and immune suppression. Antigen-presenting CAFs (apCAFs) exert divergent immunomodulatory effects depending on tumor context. Rather than acting as uniformly tumor-promoting stromal cells, CAFs represent heterogeneous and plastic populations whose functions vary by tumor type, spatial niche, and metastatic stage. We further discuss why broad CAF depletion has shown limited clinical success and emphasize the need for subtype-specific, context- aware CAF-targeted strategies.

Given that gastric cancer is a highly heterogeneous malignant tumor, approximately 70%-80% of patients exhibit an immune "cold tumor" phenotype, resulting in a limited response rate to immune checkpoint inhibitor monotherapy. Paclitaxel is a commonly used chemotherapeutic drug for gastric cancer. Recent studies have found that paclitaxel can promote mitochondrial DNA (mtDNA) release by inducing BAK-dependent apoptosis and mitochondrial reactive oxygen species production. However, whether this process activates the cGAS-STING innate immune pathway to transform the "cold tumor" into a "hot tumor" has not been systematically analyzed. This article reviews the proposed dual pathways through which paclitaxel regulates mitochondrial DNA release: the BAK/BAX-mediated apoptotic pathway and the mitochondrial permeability transition pore (mPTP)-opening non-apoptotic pathway. Also, it elucidates the potential the molecular mechanism by which paclitaxel activates the cGAS-STING signaling axis to drive type I interferon response and promote CD8 + T cell infiltration. The translational potential of leveraging this mechanism for combining chemotherapy with immunotherapy in gastric cancer is also discussed. By integrating existing experimental evidence and theoretical frameworks, we hypothesize that core components of the mPTP could serve as biomarkers to predict the efficacy of combination therapy, which may provide new ideas for the establishment of precise combination therapy for gastric cancer with clear mechanisms, though prospective validation is urgently needed.

Combining immune checkpoint inhibitors (ICIs) with chemotherapy has become a major clinical research focus. Patients with extensive-stage small-cell lung cancer (ES-SCLC) have been treated with different first-line ICI combinations in randomized controlled trials (RCTs), but the optimal combination strategy has not yet been determined. Our aim was to evaluate this strategy through a systematic review and meta-analysis.

Ovarian cancer is the most lethal malignancy of the female reproductive system worldwide. Chemoresistance, particularly platinum resistance, is a major factor limiting improvement in prognosis, and its underlying mechanisms involve complex regulation of and escape from multiple programmed cell death pathways in cancer cells. Disulfidptosis is triggered by high expression of solute carrier family 7 member 11 (SLC7A11) under glucose starvation and shares upstream regulatory nodes with ferroptosis. Necrosis by sodium overload is driven by sodium ion overload mediated by transient receptor potential cation channel subfamily M member 4 (TRPM4), but its role remains to be further investigated. Other programmed cell death pathways are interwoven into a dynamic regulatory network through key regulatory molecules such as tumor protein p53, the caspase family, cysteine-aspartic proteases, and glutathione. Autophagy can inhibit pyroptosis; ferroptosis and pyroptosis can synergistically amplify cell-killing effects through the reactive oxygen species/NOD-like receptor thermal protein domain-associated protein 3 axis; ferroptosis and cuproptosis share the glutathione metabolic axis; and the interaction between ferroptosis and disulfidptosis can shift from antagonism to synergy under specific metabolic stress. Ferroptosis and necrosis by sodium overload mutually promote each other through cascades involving adenosine triphosphate depletion, reactive oxygen species accumulation, and mitochondrial damage. PANoptosis can overcome cancer-cell resistance to a single mode of cell death through the simultaneous activation of multiple cell death pathways. A comprehensive review of the roles and interactive networks of various programmed cell death modalities, including disulfidptosis, necrosis by sodium overload, apoptosis, autophagy, necroptosis, pyroptosis, ferroptosis, cuproptosis, and PANoptosis, in platinum resistance in ovarian cancer is expected to provide a solid theoretical basis and potential translational directions for reversing platinum resistance and optimizing clinical treatment strategies.

Immune checkpoint inhibitors (ICIs), particularly those targeting the programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) axis, have emerged as potential tools beyond cancer immunotherapy in people with HIV (PWH). In the setting of effective antiretroviral therapy (ART), chronic inflammation, T-cell exhaustion, and persistent viral reservoirs remain major obstacles to durable HIV remission or cure. Accumulating evidence suggests that ICIs may modulate these processes by reversing latency, enhancing HIV-specific immune responses, and contributing to reservoir regulation and immune restoration. In this review, we summarize current evidence on the role of ICIs in HIV infection, with a focus on reservoir regulation and immune restoration. We discuss the biological rationale for checkpoint blockade in chronic HIV infection and review available data from preclinical models, clinical studies in PWH with cancer, exploratory trials in non-cancer populations, and combination cure strategies. We also address recent findings on proviral landscape changes and key safety considerations. Overall, ICIs represent a promising but still limited component of HIV cure-oriented strategies. Their effects on reservoir dynamics and immune restoration remain heterogeneous, and further progress will require safer dosing approaches, biomarker-guided patient selection, standardized reservoir assessment, and well-designed clinical trials.

Ubiquitin-specific protease 28 (USP28) is a deubiquitinating enzyme initially identified as a regulator that stabilizes p53 and c-MYC in response to DNA damage stress. Beyond its role in maintaining genomic integrity and cell cycle checkpoints, USP28 is implicated in diverse pathological processes. In various solid tumors, including lung, pancreatic, ovarian, and hepatocellular carcinomas, USP28 is markedly upregulated; it promotes proliferation, metabolic reprogramming, invasion, and therapeutic resistance by stabilizing oncoproteins such as c-Myc, STAT3, and SOX9. Conversely, in specific contexts like breast cancer and certain melanomas, USP28 deficiency drives malignant progression, revealing a context-dependent functional duality. These findings underscore the complexity of USP28 signaling and highlight its potential as a therapeutic target for precision medicine. This review summarizes the molecular characteristics and physiological functions of USP28, its context-dependent roles in neoplastic diseases, and its translational implications for targeted therapy and biomarker discovery.

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of lung cancer (LC), offering durable responses in non-small cell lung cancer (NSCLC) and, to a lesser extent, small cell lung cancer (SCLC). Nevertheless, clinical outcomes remain highly heterogeneous, with many patients experiencing primary or acquired resistance and/or immune-related adverse events (irAEs) that impair their quality of life and treatment adherence. The human microbiome, particularly in the gut and oral compartments, has emerged as a critical modulator of systemic antitumor immunity and a promising noninvasive predictive biomarker for ICI efficacy and toxicity. This narrative review synthesizes the current evidence on microbiome composition, diversity, and function in patients with LC receiving ICIs as monotherapy, dual blockade, or in combination regimens, as well as clinically relevant biomarkers associated with treatment response and toxicity. Higher gut microbial alpha diversity and enrichment of beneficial taxa (e.g., Akkermansia muciniphila, Faecalibacterium prausnitzii, and certain Firmicutes) are consistently linked to improved progression-free survival (PFS) and overall survival (OS), mediated by microbial metabolites such as short-chain fatty acids and inosine, which enhance T-cell priming, tumor microenvironment remodeling, and gut-lung axis communication. Microbiome-disruptive exposures, particularly antibiotics and proton pump inhibitors (PPIs), induce dysbiosis and are strongly associated with poorer survival outcomes. Mechanistic insights from preclinical models and clinical cohorts, alongside clinical confounders, underscore the complementary role of the microbiome relative to established markers such as programmed death-ligand 1 (PD-L1) and tumor mutational burden. Prospective standardization of metagenomic profiling and microbiome-modulating interventions represents a key next step in translating these findings into personalized immunotherapy strategies for LC.

The development of immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) pathway has brought about a breakthrough in cancer treatment; nevertheless, therapeutic resistance remains a significant challenge. Recent research shows that mitochondrial metabolism plays an essential role in T-cell function and therapeutic efficacy. Activation of PD-1 inhibits glycolytic metabolism, mitochondrial biogenesis, and oxidative phosphorylation (OXPHOS), resulting in T-cell exhaustion and impaired function. Concurrently, metabolic reprogramming in tumor cells, characterized by increased glycolysis, glutaminolysis, and fatty acid oxidation (FAO), creates an immunosuppressive tumor microenvironment (TME) through nutrient deprivation and the accumulation of metabolites such as lactate and 2-hydroxyglutarate (2-HG). In this review, we analyze the bidirectional relationship between PD-1 signaling and mitochondrial dysfunction and discuss emerging therapeutic approaches that combine metabolic reprogramming with immune checkpoint blockade.

The combination therapies are significantly more effective than monotherapies in enhancing anticancer efficacy, reducing drug-related toxicity, and lowering the risk of drug resistance in cancer treatment. However, achieving precise delivery of the drugs to the tumor site remains a major challenge. With the deepening exploration of surface-engineered nanocarriers, ligand-modified liposomal drug delivery systems (LLDDS) are constructed by integrating the active-targeting properties of functional ligands (such as peptides, glycans, and aptamers) with the inherent advantages of liposomes. LLDDS show promise for exhibiting strong tumor-targeting capability, improving pharmacokinetics, biodistribution, and therapeutic efficacy of anticancer agents, such as chemotherapy drugs, and enabling the multifunctional integration of multiple therapeutic strategies. This review summarizes the development of liposomes and ligand-mediated surface modification strategies. More significantly, the development of multifunctional liposomes, targeted delivery, improved anticancer effectiveness, and possible anticancer mechanisms are highlighted in the discussion of LLDDS's recent advancements for integrated therapy approaches in a variety of malignancies. Lastly, the potential and difficulties of clinical translation in this ever-evolving area are examined.

Immune checkpoint inhibitors (ICIs) have revolutionized lymphoma treatment, yet resistance driven by complex regulatory networks remains a major hurdle. Circular RNAs (circRNAs) have emerged as central signaling hubs that integrate metabolic, inflammatory, and oncogenic cues to fine-tune immune checkpoints such as PD-L1 and CD47 in lymphoma. Here, we systematically dissect the molecular mechanisms by which circRNAs govern immune checkpoints in lymphoma, including nuclear transcriptional control, interactions with RNA-binding proteins (RBPs), competitive endogenous RNA (ceRNA) networks, and micropeptide translation. We differentiate between cell-extrinsic, exosome-mediated reprogramming of the tumor microenvironment and cell-intrinsic circRNA circuits within lymphoma cells spatially. Subtype-specific investigations demonstrate the importance of Epstein-Barr virus (EBV)-encoded circRNAs in immune evasion and the synergistic interactions between 9p24.1 amplification and circRNAs in classical Hodgkin lymphoma (cHL). While therapeutic approaches including antisense oligonucleotides, CRISPR-Cas13, and nanodelivery technologies demonstrate preclinical synergy with ICIs, circulating circRNAs show potential as dynamic indicators for predicting ICI responses. We also critically examine ongoing discussions about the flaws of current model systems, the technological constraints of current validation techniques, and the physiological significance of the ceRNA hypothesis. Positioning circRNAs as multimodal regulatory hubs, this review provides a theoretical framework for developing circRNA-based immunotherapies to overcome resistance in lymphoma.

Glioblastoma (GB) is the most aggressive primary malignant brain tumor in adults and remains associated with poor survival despite surgical resection followed by radiotherapy and temozolomide (TMZ) chemotherapy. Intrinsic and acquired resistance to TMZ, including MGMT-dependent DNA repair and activation of pro-survival pathways, could decrease treatment efficacy. Drug repurposing offers an attractive strategy to identify agents that may enhance TMZ activity because these drugs already have known pharmacokinetic and safety profiles. This narrative review summarizes the available evidence on repurposed drugs investigated as potential modulators of TMZ response in GB.