High-altitude hypoxia is closely associated with cancer initiation and progression.Hypoxia promotes tumor development through multiple mechanisms including modifying acidic microenvironment,triggering tumor angiogenesis,influencing vasculogenic mimicry,inducing epithelial-mesenchymal transition,remodeling of extracellular matrix,promoting immune escape and adaptive landscapes,maintaining cancer stem cells and inhibiting senescence.Targeting hypoxia may become a novel efficient strategy for cancer therapy.

Tumor related-inflammation is important component of tumor microenvironment. The inflammation status in tumor microenvironment may demolish immunosystem, influence signaling transduction and change the homing of normal stem cell in tumor microenvironment, which probably promote tumor development. The better understanding of molecular pathway of tumor related inflammation would be helpful for identification of novel molecular targets.

Objective To construct a new staging scheme for patients with hepatocellular carcinoma(HCC).Methods A retrospective analysis of HCC cases from 1999 to 2003 was performed.The Cox model was used for multivariate analyses.The final model was derived from 10 randomly-chosen training samples and the prognostic validity of the new staging score was assessed on the corresponding testing samples.Results A simple scoring system was produced,assigning linear scores(0/1/2) to the covariates (TNM,?-fetoprotein,and Child-Pugh).Compared with Okuda stage and CLIP score,the new staging system,structured as a five-category tool,had a greater discriminant ability.Conclusion The new staging system,accounting for both liver function and tumor characteristics,can accurately identify patients with different prognoses,particularly in the advanced phases of HCC,thus representing a useful tool in the treatment of the disease.

The conventional treatment options for advanced gastric carcinoma patients remain unsatisfactory in terms of response rate and overall survival benefit. Targeted therapy plus systemic chemotherapy now becomes a new promising therapeutic option. In this review we profiled important trials of international multicenter phase Ⅲ clinical studies in patients with advanced gastric carcinoma, including ToCA trial, EXPAND trial, LOGIC trial, AVAGAST trial, REAL3 trial, and granite-1 trial. These trials warrant the role of molecular targeted therapy in patients with advanced gastric carcinoma.

Precision chemotherapy is the prospective direction of cancer chemotherapy,which involves the selection of the effective chemotherapy regimens based on the chemotherapy-related genes.Chemotherapyrelated genes include DNA repair genes,drug metabolism enzymes,drug transporters,apoptosis-related genes and cancer-related genes.These genes can predict the response and toxicity of chemotherapy,and determine the clinical outcome.

Metronomic chemotherapy involves antiangiogenic processes that help host to fight against cancer by using continuous low dose drugs.Metronomic chemotherapy can be an effective treatment option for patients with head and neck carcinoma,breast cancer,gastrointestinal cancer,ovarian and prostate cancer. Metronomic chemotherapy also involves multiple mechanisms that include antiangiogenesis,immune stimulation and direct tumor cell targeting effects.We need to carefully evaluate the clinical effects of combination chemo-therapies that incorporate the other treatment schedules.

Cancers evolution is a process of clonal selection,cell competition and clonal expansion. Cancers evolution includes cancer memory,heterogeneity,resistance,transformation and adaption et al.This evolution enables cancer cells to adapt to any hostile environment and to survive.An understanding of cancers evolution will provide a theoretical guidance for the implementation of the precision therapy.

With the coming era of targeted therapy,novel criteria such as the modified response evalu-ation criteria in solid tumors (RECIST),positron emission tomography response criteria in solid tumors (PETRCIST),Choi criteria and immune-related response criteria have been proposed as standardized methods to assess therapeutic response.Biomarkers and circulating tumor cells may be considered suitable for the evalu-ation of response.These criteria may be useful for the evaluation of therapeutic response to tumors.

Cancer precision therapeutics is defined as a therapy strategy based on molecular profiles and classifiers generated from high-throughput molecular assays.Precision therapeutics in oncology is becoming reality thanks to the next-generation sequencing and cancer targeted agents.Selecting optimal targets,identif-ying appropriate combinations of therapies and real-time monitoring of tumor evolution may be critical for practi-cing precision therapeutics.

Maintenance therapy is an important strategy for cancer treatment,which mainly include continuation maintenance therapy and switch maintenance therapy,with a classical model of metronomic chemo-therapy.Maintenance therapy can be an effective treatment option for patients with non-small cell lung cancer, breast cancer,colorectal cancer and ovarian cancer.