Metastatic melanoma (MM) still remains as one of the most worrisome cancer known to mankind. In last two decades, treatment of melanoma took a dramatic turn with the discovery of targeted therapy which targets the mutations in mitogen-activated protein kinase (MAPK) pathway and immune checkpoint inhibitors. These new findings have led to emergence of many novel drugs that have been approved by FDA. Targeted therapy drugs such as vemurafenib, trametinib and dabrafenib target the MAPK pathway whereas immunotherapies such as ipilimumab, nivolumab and pembrolizumab block immune checkpoint receptors on T lymphocytes. All these drugs have shown to improve the overall survival in MM. Despite these recent discoveries, treatment of MM remains challenging because of rapid development of resistance to targeted therapy. This review will discuss recently approved drugs and their adverse effects and also shed light on combination therapy in treatment of melanoma.

Ramucirumab is a recombinant human monoclonal antibody and is used in the treatment of advanced malignancies. Its mechanism of action is by inhibiting angiogenesis in tumor cells by targeting the vascular endothelial growth factor receptor 2. United States Food and Drug Administration (FDA) approved it initially in 2014 for the treatment of advanced gastric or gastro-esophageal junction adenocarcinoma and metastatic non-small cell lung carcinoma. It was approved by FDA in 2015 for the treatment of advanced colorectal cancer. This manuscript consolidates pre-clinical trials to phase I, II, and III trial data indicating the effects of ramucirumab on different cancer types, which led to its approval. By comparing these clinical trials alongside each other, we can more easily examine the studies that have already been completed, along with currently ongoing studies and potential further areas of interest for this newly approved treatment. This approach makes it convenient to compare dosages, overall survival, adverse events, as well as possible routes for combination therapy with ramucirumab. By compiling results for various oncological malignancies, we can differentiate between treatments that are effective and have the highest incidence of stable disease, and those that do not seem promising. Ramucirumab has been effective in the treatment of various carcinomas and this article outlines other tumors in which this treatment option may be successful.

Topotecan (TPT), a chemotherapeutic agent, is a topoisomerase-I inhibitor. Topoisomerase-I is a nuclear enzyme that relieves torsion strain in DNA by opening single strand breaks which helps in DNA replication. TPT inhibits this enzyme, thus preventing DNA replication and causes cell death. TPT has demonstrated to have broad spectrum of antitumor activity in tumors like cervical, ovarian, endometrial and small cell lung cancers (SCLCs). The intravenous (IV) formulation of the drug is currently approved by the US Food and Drug Administration for the treatment of patients with SCLC and ovarian cancer at a dose of 1.5 mg/m2 administered daily for five consecutive days, with treatment cycles repeated every 3 weeks. TPT has shown some promising activity in the treatment of non-small cell lung cancer (NSCLC) with favorable side effect profile. Several clinical trials have been conducted with TPT in either IV or oral formulation for the treatment of NSCLC as a first or second-line treatment. Here we reviewed all the clinical trials done with TPT to date in the treatment of NSCLC both as a single-agent and combination therapy.

Hypertension has a major impact on cardiovascular and renal mortality and morbidity, with a 90% lifetime risk of developing hypertension. 1 Optimal blood pressure control reduces the risk of stroke by 38% and of myocardial infarction by 16%. 2 Compared to peripheral arterial pressure measurements, aortic pressures were shown to better predict coronary artery disease (CAD) 3,4 and cardiovascular risk. 5 Brachial arterial pressure does not correctly reflect aortic pressure, especially its systolic component, due to pulse pressure amplification. 6,7 It is also important to mention that central (aortic) pressures are the pressures directly affecting coronary and cerebral circulations, as well as the left ventricle, much more than pressures measured in the arm, and the latter is of paramount importance in end-organ damage related to hypertension. 8 Several ascending aortic blood pressure indices were studied, among which aortic pulse pressure (APP) correlated with increased cardiovascular complications. 9 Moreover, a higher APP was associated with more extensive CAD at time of coronary angiography. 10 A recent large prospective study has shown the superiority of central (aortic) over peripheral (brachial) pressures, as well as the superiority of APP and pulsatility over mean pressure in predicting adverse cardiovascular events. 11 Higher APP is related to arterial stiffness, a feature of aging and multiple cardiovascular conditions. 7 Although arterial stiffening is thought to represent by itself a form of cardiovascular end-organ damage, 7 and although APP is only an indirect indicator of arterial stiffness, higher APP may link arteriosclerosis (arterial stiffening) to other forms of end-organ damage such as atherosclerosis. The role of cyclical stretch due to pulsatile pressure in atherosclerosis is recognized. 12 BackgroundAortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (cAD). Besides, the left coronary artery (LcA) has a predominantly diastolic flow while the right coronary artery (RcA) receives systolic and diastolic flow. thus, we hypothesized that increased systolicdiastolic pressure difference had a greater atherogenic effect on the RcA than on the LcA.

Malignant rhabdoid tumors were originally described in children. Subsequently, the same histological pattern was described in adults. Malignant rhabdoid tumors are aggressive neoplasms that have been reported in multiple organs. To our best knowledge, only 16 previous cases of rhabdoid tumor in the colon have been described in the literature. We present the case of an 87-year-old lady who was diagnosed with a rhabdoid tumor of the colon that relapsed rapidly after surgical resection. The literature concerning this unusual neoplasm was subsequently reviewed with comparison of all known cases in the literature.