Category: Nevin Manimala

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1543-1549. doi: 10.31557/APJCP.2026.27.4.1543.

ABSTRACT

BACKGROUND: One of the most prevalent oral cancers, oral squamous cell carcinoma (OSCC), is distinguished by its rapid growth, invasiveness, and high metastatic potential. Green AgNPs are important because they can reduce systemic toxicity by inducing oxidative stress, cytotoxicity, and apoptosis in cancer cells. The goal of this study was to use saponins as natural stabilizers to create AgNPs, and the detrimental apoptotic effects on cancer cells were examined using high-content screening (HCS) assays such as TNI, CMP, and VCC.

METHODS: The size and distribution of AgNPs were determined using saponins as natural reducing and stabilizing agents, respectively. The cytotoxic effects on OSCC-25 cells were assessed using the MTT assay, alongside real-time quantitative PCR (RT-qPCR) to identify changes in gene expression associated with apoptosis. High-content screening (HCS) was used to confirm the induction of apoptosis and to measure concentration-dependent changes in several cellular parameters. All statistical analyses were performed for each experiment.

RESULTS: The results showed that the average diameter of the generated nanoparticles was 75.87 ± 15.69 nm, facilitating cellular uptake due to their narrow size distribution. Saponin-induced AgNPs significantly increased cytotoxicity and cancer cell death in OSCC-25 cells in a dose-dependent manner. Compared with the control group, treatment with 125 and 500 μg/mL resulted in a significant decrease in fluorescence intensity (p < 0.05). However, doses of 250 μg/mL and 1000 μg/mL had no significant effects. RT-qPCR analysis revealed a significant increase in the expression of IL1R, highlighting its role in apoptotic signaling.

CONCLUSION: The findings suggest that the combination of the bioactive properties of saponins with the inherent cytotoxicity of AgNPs has therapeutic potential against oral squamous cell carcinoma. These results support the need for future preclinical and clinical studies and highlight the promise of integrating natural compounds with nanotechnology to develop safer and more effective anticancer therapies.

PMID:41945972 | DOI:10.31557/APJCP.2026.27.4.1543

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1535-1542. doi: 10.31557/APJCP.2026.27.4.1535.

ABSTRACT

BACKGROUND: Women with hemoglobinopathies represent a chronically ill population with frequent healthcare contact, yet limited integration into preventive health programs. Despite the proven effectiveness of HPV vaccination and screening, cervical cancer remains a preventable cause of both morbidity and mortality.

OBJECTIVE: To assess the levels of knowledge, awareness, and adherence to cervical cancer prevention and screening practices among women with hemoglobinopathies in Greece.

METHODS: A cross-sectional study was conducted among 202 women with thalassemia or sickle cell disease, attending a tertiary hospital’s Hemoglobinopathy Unit in Athens between December 2023 and March 2024. Data were collected using the validated Cervical Cancer Knowledge and Prevention Questionnaire (CCKP-64) and analyzed with SPSS 25, using descriptive and inferential statistics.

RESULTS: Nearly all participants were aware of cervical cancer (98.5%), the Pap test (99.0%), and the HPV vaccine (96.5%). However, only 6.5% were vaccinated against HPV, while 75.2% underwent annual Pap screening. Higher adherence to screening was associated with younger age (p = 0.009), employment status (p = 0.032), and higher income (p = 0.049). Knowledge regarding risk factors was moderate, with 58.4% recognizing HPV infection as the main cause. The most frequent reason for non-compliance was negligence (14.8%).

CONCLUSIONS: Despite adequate awareness of cervical cancer and good adherence to Pap testing, HPV vaccination rates remain strikingly low among women with hemoglobinopathies. This highlights missed opportunities to integrate HPV vaccination and education into chronic disease management. Tailored preventive strategies and continuous awareness campaigns are essential to achieving the WHO’s 2030 cervical cancer elimination goals.

PMID:41945971 | DOI:10.31557/APJCP.2026.27.4.1535

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1451-1458. doi: 10.31557/APJCP.2026.27.4.1451.

ABSTRACT

BACKGROUND: Stereotactic Body Radiotherapy (SBRT) is increasingly applied in the management of liver cancers. Flattening filter-free (FFF) beams, which offer higher dose rates, enable faster delivery and improved patient comfort. This retrospective study compares the dosimetric and delivery characteristics of SBRT using FFF and conventional flattened beams for the treatment of multiple liver targets.

METHODS: Twenty-six patients with 2-11 hepatic targets were treated using a single-isocenter volumetric modulated arc therapy (VMAT) technique. Treatment plans were created for 6X, 6FFF, and 10FFF photon beams, with prescription doses ranging from 27.5 Gy to 50 Gy in 5 fractions. Plan evaluation metrics included Planning Target Volume (PTV) coverage (V95%, V98%, V100%), mean liver dose (MLD), normal liver volume receiving <15 Gy, and maximum doses to Organs at Risk (OARs). Delivery parameters were assessed by gamma passing rate, monitor units (MU), and beam-on time (BOT). Repeated-measures ANOVA, with post-hoc least significant difference (LSD) testing, was used for statistical analysis.

RESULTS: Comparable Planning Target Volume (PTV) coverage was achieved with all beam modalities. No statistically significant differences were noted in mean liver dose (MLD), normal liver volume receiving <15 Gy, or other Organ at Risk (OAR) doses, except for lower spinal cord doses with FFF beams (p = 0.003). The 2%/2 mm gamma passing rate for 6FFF was 1% lower than for 6X and 10FFF. Monitor unit (MU) values were higher for 6FFF (4.3%) and 10FFF (1.5%) compared with 6X (p = 0.01). Beam-on time (BOT) was significantly shorter with 6FFF (3.8 ± 0.28 min) and 10FFF (3.8 ± 0.30 min) relative to 6X (5.1 ± 0.22 min) (p = 0.001).

CONCLUSION: Flattening filter-free (FFF) beams reduce beam-on time (BOT), providing an advantage for breath-hold techniques. However, despite the higher dose rate of 10FFF, no additional reduction in overall treatment time was observed.

PMID:41945962 | DOI:10.31557/APJCP.2026.27.4.1451

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1441-1450. doi: 10.31557/APJCP.2026.27.4.1441.

ABSTRACT

BACKGROUND: Breast cancer, the most common cancer among women in India, poses a significant public health challenge. However, data on pathways to care and out-of-pocket expenditure (OOPE) among breast cancer patients are limited in India. Kerala, despite its high literacy rates and excellent healthcare access, continues to experience significant delays in cancer care, making it an important setting for this study. Therefore, we aimed to study the pathways to care, estimate OOPE, and identify factors associated with OOPE among breast cancer patients in the Indian state of Kerala.

METHODS: We conducted a hospital-based cross-sectional study among 216 breast cancer patients (mean age: 57 years) from one private and one public tertiary cancer care centre (TCCC) in Kerala. A structured interview schedule was used to collect socio-demographic, clinical, and expenditure-related data. Descriptive statistics, Mann-Whitney U tests, and median regression analysis were performed. The duration of the study was from October 2024 to May 2025.

RESULTS: Most participants were diagnosed at early stages (n=152, 70.4%), and 42.5% (n=92) had health insurance coverage. In the study, 168 (77.8%: 95% CI: 71.6-83.1%) participants followed indirect pathways, initially consulting traditional healers (25, 11.57%) or other healthcare providers (143, 66.20%) before reaching TCCCs. OOPE was significantly higher among patients treated in private TCCCs compared to those in public TCCCs (median INR 2,26,395 vs 1,93,290; p = 0.015). Residence ≥82 km from the centre (coefficient:28470; p=0.044), treatment at private TCCC (coefficient:50010; p=0.001) and indirect pathway to TCCC (coefficient:46180; p=0.015) were significantly associated with higher OOPE.

CONCLUSION: The majority of breast cancer patients in Kerala accessed tertiary care through indirect pathways, with substantially higher out-of-pocket expenditure (OOPE) among those treated in private centres. Targeted policy interventions, such as strengthening primary care linkages and improving referral coordination, are essential to reduce delays in care pathways and alleviate the financial burden on breast cancer patients.

PMID:41945961 | DOI:10.31557/APJCP.2026.27.4.1441

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1411-1420. doi: 10.31557/APJCP.2026.27.4.1411.

ABSTRACT

OBJECTIVE: This article examines the financial impact of occupational cancer resulting from pesticide exposure and other carcinogenic agents in the floriculture sector of Cundinamarca, Colombia. It begins with a literature review covering (the) industry context, key occupational health factors, labor costs, and human capital. Based on this review, the study identifies gaps in the economic analysis of work-related illnesses such as cancer, particularly regarding hidden costs. Method: Using a quantitative explanatory approach, the research applies a multiple linear regression model to a dataset of 7,300 observations, analyzing absenteeism, labor costs, and worked days in relation to productivity.

RESULTS: The findings show a (59%) drop in productivity per diagnosed worker, leading to increased costs. The model yields an R² of (0.876), statistically supporting the hypothesis.

CONCLUSION: The study confirms the existence of hidden costs such as absenteeism, employee replacement, and medical expenses that are not reflected in financial statements.

PMID:41945958 | DOI:10.31557/APJCP.2026.27.4.1411

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1377-1388. doi: 10.31557/APJCP.2026.27.4.1377.

ABSTRACT

INTRODUCTION: Globally, hepatocellular carcinoma (HCC) ranks as the third most common cause of cancer-related death. The five-year overall survival (OS) rate for patients with unresectable HCC is only 12%. Currently, systemic therapies have become the primary treatment options for unresectable hepatocellular carcinoma. Studies comparing the efficacy of first-line treatments including lenvatinib, atezolizumab plus bevacizumab, and sorafenib have shown inconsistent results. There remains a need for updated comparative evidence on cross-mechanism therapy regimens for unresectable disease, as existing findings are still not completely clear. This network meta-analysis aims to provide clearer insights into which treatment offers greater efficacy for patients with unresectable HCC.

METHODS: This study was conducted following the 2022 PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Literature searches were performed using PubMed, ScienceDirect, Google Scholar, the Cochrane Library, SpringerLink, and EBSCO to gather studies comparing lenvatinib, atezolizumab plus bevacizumab, and sorafenib for the management of unresectable HCC. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Overall survival (OS) was analyzed using R statistical software (version 4.4.0).

RESULTS: Eleven studies reporting overall survival (OS) were included in the OS analysis comparing lenvatinib, atezolizumab plus bevacizumab, and sorafenib in the treatment of unresectable HCC. The network meta-analysis showed no significant OS differences between atezolizumab plus bevacizumab and lenvatinib (HR: 0.98; 95% CI: 0.24-4.10) or sorafenib (HR: 1.4; 95% CI: 0.21-9.87). Furthermore, there was no significant difference in OS between lenvatinib and sorafenib (HR: 1.41; 95% CI: 0.38-5.14). Based on the SUCRA plot in this meta-analysis, atezolizumab plus bevacizumab showed the highest probability of being ranked first among the three therapies. Lenvatinib had the highest probability of being ranked second, while sorafenib was more likely to be ranked third.

CONCLUSION: Atezolizumab plus bevacizumab, lenvatinib, and sorafenib demonstrated similar therapeutic efficacy based on overall survival. Although the hazard ratios (HRs) were not statistically significant, the SUCRA ranking suggested a clinical trend favoring atezolizumab plus bevacizumab.

PMID:41945955 | DOI:10.31557/APJCP.2026.27.4.1377

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1313-1321. doi: 10.31557/APJCP.2026.27.4.1313.

ABSTRACT

BACKGROUND: The association between green tea consumption and the risk of liver cancer has been reported inconsistently. This study aimed to investigate this association in a large, prospective cohort study of Japanese adults. Methods: The Japan Collaborative Cohort (JACC) Study included 41,999 participants (18,205 men and 23794 women) aged 40-79 years, free from liver cancer at baseline between 1988 and 1990. Validated self-administered questionnaires were used to assess individual socio-demographics, medical history, and lifestyles. Participants were then followed for liver cancer incidence until the end of 2009. Cox proportional hazard models were utilized to calculate hazard ratios (HRs) with 95% confidence intervals (95% CIs) of liver cancer based on the frequency of green tea consumption of <1 cup (reference), 2-4, 5-6, and ≥7 cups/day, after adjusting for potential confounding factors, including age, sex, study area, education, histories of diabetes, liver diseases, and gallbladder disease, body mass index, drinking status, smoking status, coffee consumption, sports participation, and walking. Major confounders, including coffee consumption, drinking status, and a history of liver disease, were further stratified in the analysis. Population-attributable fractions (PAFs) of liver cancer was also calculated based on green tea consumption.

RESULTS: Green tea consumption was associated with a trend of lower risk of liver cancer with the multivariable HR (95% CI) of 0.87 (0.61-1.23) for 2-4 cups/day, 0.87 (0.61-1.25) for 5-6 cups/day, and 0.61 (0.40-0.95) for ≥7 cups/day, compared to <1 cup/day (p for trend= 0.029). The inverse association was statistically significant for men, people without a history of liver diseases other than cancer, and current drinkers. The multivariable PAF (95%CI) for ≥7 cups/day was 7.1% (0.9-11.4).

CONCLUSION: Green tea consumption was associated with a lower risk of liver cancer in Japanese adults in a dose-response manner, ranging from <1 cup/day to ≥7 cups/day.

PMID:41945949 | DOI:10.31557/APJCP.2026.27.4.1313

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1287-1294. doi: 10.31557/APJCP.2026.27.4.1287.

ABSTRACT

OBJECTIVE: To evaluate the levels of knowledge, attitudes, and practices (KAP) regarding cancer among patients and their caregivers, and to determine how these factors influence health-seeking behavior and early detection practices. Additionally, the study aimed to identify key gaps and barriers that may hinder effective cancer prevention and timely treatment.

METHODS: A cross-sectional study was conducted with 140 participants, using a structured, pretested questionnaire. KAP scores were analyzed using descriptive statistics, t-tests, and regression analysis to determine the predictors of health behaviors. Correlation analysis was used to assess the interrelationships among KAP components.

RESULT: Moderate levels of knowledge (mean score: 62.2 ± 9.7) and attitudes (71.1 ± 8.0) were observed, with notable gaps in awareness of risk factors and early detection methods. Practice scores (82.6 ± 9.5) were influenced by both attitude and knowledge levels, with knowledge showing the strongest correlation with practice (r = 0.51, p < 0.001). Regression analysis identified education level (β = 0.33, p < 0.001) and economic status (β = 0.23, p = 0.03) as significant predictors of KAP scores.

CONCLUSION: Knowledge and attitudes are key determinants of cancer-related health behaviors. Enhancing awareness and fostering positive attitudes through targeted educational interventions can improve early detection, treatment adherence, and preventive practices. Strengthening public health initiatives, addressing stigma, and improving access to healthcare are critical for optimizing cancer outcomes and promoting sustainable behavioral change.

PMID:41945946 | DOI:10.31557/APJCP.2026.27.4.1287

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1277-1286. doi: 10.31557/APJCP.2026.27.4.1277.

ABSTRACT

OBJECTIVE: Chronic inflammation and oxidative stress play important roles in breast cancer progression. Cyclooxygenase-2 (COX-2) is a major proinflammatory enzyme that is often overexpressed in tumor cells. Eleutherine bulbosa (Dayak onion) is a traditional Indonesian medicinal plant with antioxidant and anti-inflammatory properties. This study aimed to evaluate the effect of a combination of ethanol extract of E. bulbosa and tamoxifen on COX-2 levels in a 7,12-dimethylbenz[a]anthracene (DMBA)-induced BALB/c mouse model.

METHODS: A total of thirty-six 8-10-week-old female BALB/c mice were randomly divided into six groups: a negative control, a positive control (DMBA alone), and four treatment groups that received E. bulbosa extract (180 mg/kg BW), tamoxifen (10 mg/kg BW), or their combination for 14 days. COX-2 levels were measured using an enzyme-linked immunosorbent assay (ELISA). Statistical analysis included the Shapiro-Wilk test (normality), Levene’s test (homogeneity), Brown-Forsythe test, and Games-Howell post hoc test.

RESULT: All treatment groups showed a decrease in COX-2 levels compared to the positive control. The combination group (tamoxifen + E. bulbosa) exhibited the lowest COX-2 levels (3.86 ng/mL), close to the value observed in the negative control group (3.07 ng/mL), indicating a synergistic effect between the two agents.

CONCLUSION: The combination of tamoxifen and E. bulbosa ethanol extract significantly reduced COX-2 levels in DMBA-induced breast cancer models. These results suggest the potential of this combination as an effective adjuvant therapy. Further studies are needed to confirm the underlying molecular mechanisms and to evaluate its toxicity profile.

PMID:41945945 | DOI:10.31557/APJCP.2026.27.4.1277

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1239-1248. doi: 10.31557/APJCP.2026.27.4.1239.

ABSTRACT

BACKGROUND: Acute myeloid leukemia (AML) is a genetically heterogeneous malignancy. However, the immune microenvironment-including immune checkpoint pathways and metabolic regulators also plays a pivotal role in disease progression.

AIMS: To investigate the immune-metabolic landscape of newly diagnosed AML patients, focusing on the PDL1-PD1 and IDO-Kynurenine-AhR pathways, and their association with vitamin D levels.

SETTING: A prospective, observational study conducted at a tertiary care academic hospital.

MATERIALS: A total of 127 newly diagnosed AML patients were enrolled. Flow cytometry was used to assess PD-L1 expression on blasts and immune T cell subsets. Serum levels of tryptophan, kynurenine, and vitamin D were measured using enzyme-linked Immunosorbent Assay (ELISA) and Chemiluminescent Immunoassay (CLIA).

STATISTICS: Correlation analysis and chi-square test/Mann-Whitney U test were applied. A p-value <0.05 was considered significant.

RESULTS: PDL1 expression on blasts inversely correlated with CD8+ T cells (p=0.044), indicating immune evasion. CD3+ positively correlated with CD8+ T cells (p=0.007), while CD4+ negatively correlated with CD8+ T cells (p<0.001), suggesting divergent immune roles. Elevated tryptophan/kynurenine correlated with increased PD1+CD4+ T cells (p=0.039), which in turn were associated with higher Treg frequencies (p=0.001). Low vitamin D levels were associated with higher odds of aTregs (OR 2.7; 95% CI 1-7).

CONCLUSIONS: An immunosuppressive microenvironment in AML is driven by PD-L1 expression, kynurenine pathway activation, and low vitamin D levels. These findings suggest potential immunotherapeutic targets and highlight vitamin D’s immunomodulatory role.

PMID:41945941 | DOI:10.31557/APJCP.2026.27.4.1239