SOUTHERN JOURNAL OF SCIENCES

Background: Acute lymphoblastic leukemia (ALL) is a heterogeneous hematological malignancy predominantly affecting individuals under 20 years of age. Traditional chemotherapy, such as clofarabine, has shown efficacy; however, novel immunotherapeutic strategies like tisagenlecleucel (Kymriah®) have significantly altered the treatment paradigm. Aim: This study aimed to perform a comparative analysis of tisagenlecleucel, a CAR-T cell therapy, and clofarabine, a second-generation purine nucleoside analog, evaluating their mechanisms of action, therapeutic benefits, limitations, and clinical applicability across diverse patient populations. Methods: A systematic comparative evaluation was conducted, encompassing pharmacological characteristics, mechanisms of action, treatment protocols, efficacy, safety profiles, and clinical indications of both agents. The analysis considered pharmacokinetic and pharmacodynamic data and included patient demographic variables. Results: Tisagenlecleucel demonstrated high efficacy in refractory B-cell ALL, with durable responses and a blood half-life of 128 days, but with notable immune-related adverse effects such as cytokine release syndrome. Clofarabine, effective across a broader patient population, acts via multiple antitumor mechanisms but carries significant toxicity risks, including infection and sepsis. Discussion: The therapies present distinct clinical profiles: tisagenlecleucel offers targeted immunotherapy with high specificity but requires specialized infrastructure and management of immune toxicities. Clofarabine is more widely accessible and applicable, but is associated with conventional chemotherapy-related side effects. Treatment accessibility and cost differ markedly between the two. Conclusions: Therapy selection should be personalized based on patient-specific factors and institutional resources. Tisagenlecleucel is ideal for pediatric and young adult patients with relapsed/refractory B-cell ALL in CAR-T-capable centers, while clofarabine remains a viable option for broader ALL populations, particularly when genetic therapies are not feasible. Further research is needed to optimize therapeutic strategies and improve access to advanced treatments.

Background: Drug repurposing offers potential advantages for cancer therapy development, particularly when utilizing medications with established safety profiles and expired patents. While individual repurposed medications have been investigated for oncological applications, comprehensive comparative analyses of research distribution patterns across multiple therapeutic candidates appear limited in the literature. Understanding these patterns may provide insights into research priorities and potential knowledge gaps. Aim: This exploratory study was designed to quantify and compare the volume of scientific literature examining the anticancer potential of eleven selected off-patent medications across different pharmacological classes. Methods: Bibliometric searches were conducted across five databases (Google Scholar, BVS, PubMed, NIH, and Science.gov) using standardized search terms combining each medication name with "cancer" and "cancer treatment." The selected medications included ivermectin, fenbendazole, mebendazole, albendazole, metformin, propranolol, disulfiram, valproic acid, thalidomide, dexamethasone, and hydroxychloroquine. Basic statistical analyses were performed to examine the distribution patterns and correlations within the database. Results: The search yielded 3,226,066 total publications with considerable variation in distribution patterns. Dexamethasone accounted for the largest proportion (1,538,058 publications, 47.68%), followed by metformin (697,172 publications, 21.61%). Some medications with smaller overall publication volumes demonstrated higher proportions of treatment-specific research, such as fenbendazole (87.82%), disulfiram with copper (86.54%), and hydroxychloroquine with zinc (75.21%). The Herfindahl Index indicated a high concentration of research attention (0.2870). Discussion: The findings suggest substantial variation in research attention across the selected medications. While some medications dominate the literature, others with focused treatment-specific research may warrant further investigation. The inverse relationship observed between total publication volume and treatment specificity suggests that research patterns in this field may be more complex than absolute publication counts indicate. Conclusions: This preliminary bibliometric assessment reveals an uneven distribution of research attention among repurposed medications being investigated for cancer applications. These patterns may inform future research prioritization, though further qualitative analysis would be valuable to assess the clinical significance of these quantitative observations.

Background: The Epstein-Barr virus (EBV) has recently been identified in human breast cancer globally, potentially contributing to the initiation and progression of this malignancy, as well as gastric cancer, nasopharyngeal carcinoma, and bladder cancer. It has been newly associated with breast cancer. Globally, breast cancer affects more women than any other type of cancer. In Iraq, the prevalence of breast cancer is comparable. Aims: The study examined Iraqi women diagnosed with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) to detect Epstein-Barr Virus Nuclear Antigen-1 (EBNA-1) and encoded RNA (EBER). Methods: A total of 50 formalin-fixed paraffin-embedded tissues from invasive ductal carcinoma (IDC) (92%) and invasive lobular carcinoma (ILC) (8%) biopsy samples constituted the case group, while 30 formalin-fixed paraffin-embedded tissues from non-cancerous breast tissue served as the control group. The presence of Epstein-Barr virus protein (EBER) in breast tissue was assessed using immunohistochemistry (IHC) and chromogenic in situ hybridization (CISH) methods. Results: EBER RNA signals were found in 31 (62%). EBER RNA signals were seen in 3 (10%) control group participants. Significant differences (P<0.04) were seen in EBV EBER RNA positive signals among study groups. Immunohistochemistry showed nuclear brown staining in 34 (68%) breast cancer patients. Control group: 3 (10%). Discussion: The research identified a statistically significant correlation between EBV positivity and breast cancer among Iraqi women, especially concerning invasive ductal carcinoma. The results corroborate previous reports of elevated EBV levels in malignant breast tissues relative to controls. Although detection approaches such as CISH and IHC provide complementary insights, additional studies are needed. Conclusions: The study concludes that EBNA-1 and EBV EBER RNA were overexpressed in our population group.