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Recent advancements in cancer vaccines: A systematic review
Avances recientes en vacunas contra el cáncer: una revisión sistemática
Stuti Srivastavaa,1, Devendra Singhb,
,1
, Sunil Kumar Vermab,1, Minakshi Pandeya,1, Avinash Sharmac,1, Himanshu Pandeyd,1, Anshu Mishrae,1
a Faculty of Biosciences, Institute of Biosciences & Technology, Shri Ramswaroop Memorial University, Lucknow, Uttar Pradesh, India
b Faculty of Biotechnology, Institute of Biosciences & Technology, Shri Ramswaroop Memorial University, Lucknow, Uttar Pradesh, India
c Faculty of Agricultural Sciences, Arunachal University of Studies, Namsai, Arunachal Pradesh 792103, India
d PG Department of Agriculture, Khalsa College, Amritsar, Punjab 143002, India
e Department of Pharmacy, Maharishi University of Information Technology, Lucknow, Uttar Pradesh, India
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This concept laid the foundation for subsequent investigations into carcinogenesis&#46;<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> In the early 20th century&#44; James Ewing&#39;s meticulous studies on tumor classification further expanded our understanding by categorizing different types of cancers based on their tissue origins&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Cancer has a vast and complex history dating back thousands of years&#46; The first known cases of cancer date back to ancient Egypt&#44; specifically around 1600&#8239;BC&#44; where papyri recorded cases of tumors and their surgical removal&#46;<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Famous Greek physicians such as Hippocrates and Galen contributed significantly to the early understanding of cancer&#44; attributing it to an imbalance of body fluids&#46; Throughout history&#44; many different theories regarding cancer have emerged&#44; including the concept of &#8220;fluid&#8221; and the belief that the disease can be caused by injury or inflammation&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> However&#44; it was not until the 19th century that more systematic scientific research on cancer began&#46; In 1838&#44; German pathologist Johannes M&#252;ller introduced the term &#8220;cancer&#8221; to describe malignant tumors&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">The 20th century saw significant advances in cancer research&#46; In 1911&#44; Peyton Rous made a groundbreaking discovery when he discovered that a virus could cause cancer in chickens&#44; laying the foundation for understanding the role of viruses in the development of cancer&#46; Then&#44; the development of chemotherapy and radiation therapy in the 1940s and 1950s revolutionized cancer treatment&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">The elucidation of DNA structure in 1953 by Watson and Crick led to a better understanding of the genetic basis of cancer&#46; Ultimately&#44; this knowledge led to the identification of specific cancer-causing genes&#44; commonly known as oncogenes&#46; The late 20th and early 21st centuries saw tremendous advances in cancer diagnosis and treatment&#44; including the development of targeted therapies and immunotherapy&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> While it remains a major health challenge&#44; ongoing research efforts continue to advance our understanding of this multifaceted disease and create more effective treatments from that bring hope to countless people affected by cancer around the world&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Classification of neoplasm &#40;tumor&#41;</span><p id="p0030" class="elsevierStylePara elsevierViewall">The uncontrolled development and spread of aberrant cells characterize the complicated group of disorders known as cancer&#46; There are many types of cancer&#44; each named after the part of the body or organ where it arises&#46; Common types include breast cancer&#44; which affects breast tissue&#59; lung cancer&#44; which originates in the lungs&#59; and prostate cancer in the prostate&#46; Colorectal cancer affects the colon or rectum&#44; while skin cancer includes both malignant and non-melanoma forms&#46; Ovarian cancer targets the ovaries&#44; and pancreatic cancer develops in the pancreas&#46;<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a></p><p id="p0035" class="elsevierStylePara elsevierViewall">While lymphoma affects the lymphatic system&#44; leukemia affects the blood as well as bone marrow&#46; Brain cancer forms in brain tissue&#44; and bladder cancer starts in the bladder lining&#46; Kidney cancer arises from the kidneys&#44; liver cancer arises from the liver&#44; and thyroid cancer arises from the thyroid gland&#46; Esophageal cancer occurs in the esophagus&#44; stomach cancer occurs in the stomach lining&#44; and cervical cancer occurs&#46;<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a> Testicular cancer affects the testicles&#44; bone cancer&#44; and sarcoma of soft tissue or bone&#46; These are just a few examples of the diversity of cancer types&#44; each requiring specific diagnostic and treatment approaches&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">These are just a few examples&#44; and there are many cancer subtypes and variations within each of these types&#46; Cancer can affect almost any part of the body and can have many different causes&#44; risk factors&#44; and treatments depending on the type plus stage of the cancer&#46;<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Medical aspects of cancer</span><p id="p0045" class="elsevierStylePara elsevierViewall">Within the vast field of medicine&#44; the field of cancer research and treatment is a ray of hope in the shadow cast by this terrible disease&#46; The medical community is working tirelessly to unravel the mysteries surrounding cancer and find effective ways to combat its insidious nature&#46; The field of oncology&#44; which focuses on cancer research and treatment&#44; has made remarkable advances in recent years&#46;<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> Physicians who specialize in oncology have a deep understanding of the complexities of diagnosing and treating different types of cancer&#46;</p><p id="p0050" class="elsevierStylePara elsevierViewall">Through extensive research&#44; they have developed advanced techniques to detect early cancer&#44; enabling rapid intervention and improving patient outcomes&#46; These methods include advanced imaging techniques&#44; for instance&#44; CT&#44; MRI&#44; and PET&#44; as well as minimally invasive diagnostic techniques such as biopsies&#44; liquid biopsies&#44; and genetic testing&#46;<a class="elsevierStyleCrossRefs" href="#bb0055"><span class="elsevierStyleSup">11&#8211;13</span></a></p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Accessible diagnostics for cancer</span><p id="p0055" class="elsevierStylePara elsevierViewall">In a few years&#44; remarkable advances have been made in the field of cancer diagnosis&#44; changing the landscape of early detection and treatment&#46; Medical professionals are now equipped with a variety of advanced tools and techniques that allow them to detect and diagnose cancer with unprecedented accuracy&#46; One diagnostic method that has revolutionized cancer detection is liquid biopsy&#46; Liquid biopsies provide a non-invasive way to detect genetic changes associated with different types of cancer by analyzing tumor DNA fragments circulating in the bloodstream&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">This breakthrough technology not only allows for fast and early detection but also allows doctors to monitor disease progression and assess response to long-term treatment&#46; Furthermore&#44; remarkable progress has been made in molecular imaging technology for cancer diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> For example&#44; a PET-CT scan combines the features of PET as well as CT to provide detailed images that highlight a tumor&#39;s metabolic activity&#46; These scans are invaluable in determining the extent of cancer spread and determining treatment&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">The advent of digital pathology has also greatly improved cancer diagnosis&#46; By digitizing tissue samples and using artificial intelligence algorithms&#44; pathologists can remotely analyze high-resolution images&#44; enabling faster and more accurate diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> This technology has great potential to improve patient outcomes through early intervention&#46; The availability of these advanced diagnostic tools offers great hope to patients battling cancer&#46; Early detection through liquid biopsy and molecular imaging allows doctors to intervene at an earlier stage when treatment outcomes are generally better&#46; Furthermore&#44; leveraging the capabilities of digital pathology improves diagnostic accuracy&#44; reduces turnaround time&#44; and ultimately leads to better management strategies&#46;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Therapeutics for cancer</span><p id="p0070" class="elsevierStylePara elsevierViewall">Vaccines have been notably fine against illnesses like measles&#44; smallpox&#44; polio&#44; and chickenpox&#46; They are one of the safest and also most reasonably priced potential for the prevention of sickness&#46; In current years&#44; vaccinations against other illnesses such as AIDS and most cancers are also being considered&#46; Cancer vaccines can be divided into preventive vaccines and therapeutic vaccines&#46; Commercially accessible preventive vaccines for the liver as well as cervical most cancers block contamination with the pathogens hepatitis B virus as well as human papillomavirus&#44; respectively&#46; The advantage of vaccines in cancer therapy lies in their capacity to &#8220;boost&#8221; the immune system&#39;s normally vulnerable response to most cancer cells&#46;<a class="elsevierStyleCrossRefs" href="#bb0095"><span class="elsevierStyleSup">19&#8211;21</span></a> However&#44; the use of vaccines in the remedy of cancer is particularly new and mostly investigational&#46; Therapeutic vaccines for lung&#44; breast&#44; prostate&#44; colon&#44; kidney&#44; and skin&#44; as well as different cancers&#44; are presently in scientific trials&#46; Oncology nurses can play an essential position in decreasing limitations to preventive vaccination in the prevalent neighborhood as well as increasing patient acceptance of cancer vaccines&#46; The types of vaccines we can use to cure or fight cancer are mRNA vaccines&#44; personalized vaccines&#44; neo-antigen vaccines&#44; combination therapies&#44; protein&#47; peptide vaccines&#44; genetic vaccines&#44; and cell-based cancer vaccines&#46;<a class="elsevierStyleCrossRefs" href="#bb0110"><span class="elsevierStyleSup">22&#8211;24</span></a></p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Personalized vaccines</span><p id="p0075" class="elsevierStylePara elsevierViewall">Researchers worked to develop personalized cancer vaccines tailored to each individual&#39;s individual cancer mutations&#46; This approach aimed to beautify the body&#39;s capability to specifically apprehend and attack most cancer cells&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Personalized immunotherapy is created by analyzing a patient&#39;s tumor to identify mutations unique to that person&#39;s cancer and using that information to develop an immunotherapy tailored to that patient&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a></p><p id="p0080" class="elsevierStylePara elsevierViewall">Before the introduction of personalized vaccines&#44; people with the same type of cancer usually received the same treatment&#46; Over time&#44; doctors have discovered that treatments work better for some people than others&#46; Even now&#44; standard treatments are available depending on the type and stage of cancer&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> However&#44; your doctor can customize it based on information about your genes and cancer genes&#46; This is personalized cancer care&#46; Personalized cancer vaccines are also known as personalized or neoantigen vaccines&#46; These vaccines are designed to target specific mutations found in a patient&#39;s neoplasm &#40;<a class="elsevierStyleCrossRef" href="#f0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a></p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0085" class="elsevierStylePara elsevierViewall">These vaccines hold the potential to be more effective as well as have less side effects as compared to other cancer treatment methods&#46;</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">mRNA vaccines</span><p id="p0090" class="elsevierStylePara elsevierViewall">mRNA cancer vaccines are an exciting area of <span class="elsevierStyleHsp" style=""></span>research and development in oncology&#46; These vaccines use messenger RNA &#40;mRNA&#41; to stimulate an immune response against cancer cells&#46; mRNA contains instructions for the immune system to recognize and target specific cancer antigens&#46;<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0145"><span class="elsevierStyleSup">29&#8211;31</span></a> There have been promising developments in mRNA vaccine technology&#44; such as COVID-19 vaccines&#46;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a></p><p id="p0095" class="elsevierStylePara elsevierViewall">mRNA vaccines are being developed as a promising cancer treatment&#46; It should be noted that the development and manufacture of mRNA vaccines requires the identification of the antigenic sequence of the target antigen &#40;<a class="elsevierStyleCrossRef" href="#f0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a></p><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0100" class="elsevierStylePara elsevierViewall">mRNA vaccines have proven to be a strong substitute to conventional vaccines due to its high vigor&#44; safety&#44; effectiveness&#44; rapid clinical progress&#44; as well as the potential for quick&#44; cost-effective production&#46; These vaccines have gone from being an interest to being pioneers against the COVID-19 pandemic&#46;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> Advances in the field of nanotechnology to develop mRNA vaccine delivery vehicles have been significant&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">Clinical progress of mRNA vaccines contains a series of scientific trials to assess safety&#44; immunogenicity&#44; as well as productiveness in people&#46; It will be divided into phases 1&#44; 2&#44; 3&#44; and 4 based on the number of patients and the purpose of the study&#46; In Phase 1&#44; trials are conducted in small groups primarily to confirm the safety as well as pharmacokinetics of the designed vaccine&#44; and in Phase 2&#44; trials are proof-of-principle studies designed primarily to check the outcomes achieved in Phase 1 trials as well as assess successfulness in a slightly larger number of people&#46;<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a> In 3rd phase&#44; studies are conducted at various centers as well as on multiple subjects to ratify the effectiveness as well as safety of the candidate vaccine&#46; Interestingly&#44; this research is typically performed with a placebo or active comparator&#46; Finally&#44; in 4th phase&#44; study are conducted after a vaccine has received marketing approval and are primarily intended to confirm the safety of the vaccine&#46;<a class="elsevierStyleCrossRef" href="#bb0190"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a></p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Protein&#47;peptide vaccines</span><p id="p0110" class="elsevierStylePara elsevierViewall">Protein&#47;peptide-based cancer vaccines are a type of immunotherapy designed to stimulate the immune system to recognize as well as target cancerous cells using specific proteins associated with the cells&#46; These vaccines can be made using a variety of methods&#44; including whole tumor proteins&#44; cancer-specific proteins&#44; or tumor-associated antigens&#46;<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a></p><p id="p0115" class="elsevierStylePara elsevierViewall">Here&#39;s how they ordinarily function&#58;</p><p id="p0120" class="elsevierStylePara elsevierViewall">1&#46; <span class="elsevierStyleBold">Antigen selection</span>&#58; Researchers identify specific proteins or antigens that are present in or specific to cancer cells&#46;<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a> These proteins are selected because they are recognized as foreign or abnormal by the immune system&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">2&#46; <span class="elsevierStyleBold">Vaccine design</span>&#58; The selected proteins or antigens are purified&#44; synthesized&#44; or genetically engineered&#46; They are then formulated into a vaccine&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">3&#46; <span class="elsevierStyleBold">Vaccination</span>&#58; Patients receive the protein-based cancer vaccine&#44; usually through injections&#46; The vaccine contains the cancer-associated proteins or antigens&#46;<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a></p><p id="p0135" class="elsevierStylePara elsevierViewall">4&#46; <span class="elsevierStyleBold">Immune response</span>&#58; The immune system identifies the introduced proteins as foreign and then mounts an immune response against them&#46; Immune cells&#44; like T cells and B cells&#44; are activated&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">5&#46; <span class="elsevierStyleBold">Targeting cancer cells</span>&#58; Activated immune cells&#44; particularly cytotoxic T cells&#44; seek out and attack cancer cells that express the same proteins or antigens present in the vaccine&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a></p><p id="p0145" class="elsevierStylePara elsevierViewall">The goal of protein-based vaccines &#40;cancer&#41; is to train the immune system to specifically identify as well as attack the cancerous cells&#44; thereby eliminating healthy cells&#46; However&#44; the effectiveness of these vaccines may vary depending on the type of cancer&#44; the antigen chosen&#44; and the patient&#39;s immune response&#46;<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a></p><p id="p0150" class="elsevierStylePara elsevierViewall">It is essential to note that although some protein-based cancer vaccines have shown promise in clinical trials&#44; they may not be available for all cancer types and their uses&#46; It may be limited in certain cases or combined with other cancer treatments like A multi-epitope vaccine &#40;i&#46;e&#46;&#44; SARS-CoV-2 M&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a></p><p id="p0155" class="elsevierStylePara elsevierViewall">Protein subunits with a specific virus product do not complete the infection but are used to ensure the body&#39;s immunity&#46; SARS-CoV-2 has structural defects as well as protein components S&#44; envelope &#40;E&#41;&#44; and membrane &#40;M&#41; proteins are the key proteins of SARS-CoV-2&#46; These proteins are found in the phospholipid bilayer and nucleo-capsid &#40;N&#41; protein &#40;Ribonucleoprotein core&#41; of the virus&#46; Protein S facilitates the synthesis of bacteria and enters the cell by binding to ACE 2&#46; The S protein has 2 subunits&#44; S1 plus S2&#46; The S1 unit is the C-terminal receptor binding domain &#40;RBD&#41; and is involved in receptor recognition&#44; and the S2 subunit is utilized for membrane fusion required for entry into the host&#46; M protein plays a role in the production of the Virion envelope&#46; The antibodies neutralize the virus by binding to the S protein&#44; whose genetic line or spike protein is the key part of the SARS-Cov-2 vaccine&#46; The E protein is required for SARS-Cov-2 infection&#44; and the N protein binds to the viral RNA genome to form a helicase&#46;<a class="elsevierStyleCrossRefs" href="#bb0230"><span class="elsevierStyleSup">46&#8211;48</span></a></p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Monoclonal antibodies available for cancer treatment</span><p id="p0160" class="elsevierStylePara elsevierViewall">Monoclonal antibodies are monospecific antibodies made by the same immune cells&#44; each of which is a clone of a unique parent cell&#46; It is the product of a single stimulated B cell&#46;<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a> It binds to a single epitope on an antigen and also has high specificity for a single epitope &#40;<a class="elsevierStyleCrossRef" href="#f0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="f0015"></elsevierMultimedia><p id="p0165" class="elsevierStylePara elsevierViewall">Monoclonal antibodies are available in the market&#46; These antibodies are designed in laboratories to mimic the immune system&#39;s ability to fight off harmful pathogens like viruses or cancer cells&#46; There are several monoclonal antibodies produced on the basis of therapeutic and diagnostic use&#44; and many pharmaceutical companies produce monoclonal antibodies for various medical purposes&#44; like Biogen&#44; Johnson &#38; Johnson&#44; Eli Lilly &#38; Company&#44; Roche&#44; Sanofi&#44; etc&#46; &#40;<a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a></p><elsevierMultimedia ident="t0005"></elsevierMultimedia></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Cancer vaccine mechanisms</span><p id="p0170" class="elsevierStylePara elsevierViewall">It is essential for a cancer vaccine to elicit a potent immune response&#44; recognize&#44; and eradicate primary and secondary tumor cells with accuracy&#44; be antigen-specific&#44; have few systemic adverse effects&#44; and not cause autoimmune reactions&#46;<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0190"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0300"><span class="elsevierStyleSup">60</span></a> Another factor to take into account is that a strong immunological recall is required by the vaccination to fight cancer cells&#44; that is essential for long-term illness resolution&#46; The elevated cancer mortality rate has actually been mostly attributed to relapses rather than the initial tumor&#46; Cancer vaccines with an immunotherapy foundation attempt to stimulate the body&#39;s natural defenses against the disease&#44; whether they be cellular or humoral&#46;<a class="elsevierStyleCrossRef" href="#bb0305"><span class="elsevierStyleSup">61</span></a> Most commonly&#44; cancer vaccinations cause the development of CD8<span class="elsevierStyleHsp" style=""></span>&#43; T lymphocytes that are specifically tuned to recognize and eliminate the cancerous cells&#46; CTLs &#40;Cytotoxic T lymphocytes&#41; that are specific for tumor antigens bind to the epitopes of cancer antigens to recognize them&#46;<a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a> Additionally&#44; CTLs cause cancer cell death through a number of TCR signaling pathways&#44; including breakdown &#40;release of perforin&#47;serine protease&#41;&#44; activation of a cluster of differentiating ligand &#40;CD95L&#41;&#44; and TNF-related apoptosis-inducing ligand &#40;TRAIL&#41;&#46; Tumor dendritic cells &#40;DCs&#41; must instruct CTLs for optimal usage&#46; Antigen-presenting cells &#40;APCs&#41; known as type 1 conventional CD103<span class="elsevierStyleHsp" style=""></span>&#43; moving DCs elucidate CTLs prior to the discovery of cancer cells through three distinct mechanisms&#58; firstly&#44; cancer antigen attached to MHC-I&#44; co-stimulatory molecules &#40;CD28&#47;152 as well as CD80&#47;86&#41;&#44; as well as pro-inflammatory cytokines &#40;IL-12 as well as TNF-&#945;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0310"><span class="elsevierStyleSup">62</span></a> Upon activation&#44; CTLs&#44; as well as CD4C Th cells&#44; acquire certain traits that have an important impact on the eventual effectiveness of CTL cytotoxic actions&#46; Additionally&#44; CD4<span class="elsevierStyleHsp" style=""></span>&#43; Th cells are activated and supported by cytokine-mediated DC licensing&#46; Similar to how CD8<span class="elsevierStyleHsp" style=""></span>&#43; T-cells are activated&#44; CD4<span class="elsevierStyleHsp" style=""></span>&#43; T-cells are also activated by APCs&#44; with the exception that MHC-II than MHC-I displays the tumor antigen epitope&#46;<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a> Following activation&#44; CTLs&#44; as well as CD4C Th cells&#44; acquire certain traits that have an important impact on the efficiency of CTL cytotoxic effects&#46; The cytokine cocktail&#44; which is released through a toxic mechanism that stimulates the death of cells&#44; is frequently used to identify the phenotypes of CTLs&#46;<a class="elsevierStyleCrossRefs" href="#bb0320"><span class="elsevierStyleSup">64&#8211;66</span></a> Numerous research studies have shown that CTL-mediated IFN-&#978; plus TNF-&#945; mediated production correlates with proper tumor reducting potential as well as enhanced the endurance of patients&#46; Other studies have demonstrated that patient endurance increases once CD4C Th cells take on a Th1 phenotype&#44; which is identified by the secretion of IL-2&#44; TNF-&#945;&#44; as well as IFN-&#978;&#46; It was observed that merging the response of Th1 cells with the Th17 predisposition&#44; as shown by the IL-17 production&#44; maybe even more beneficial&#44; but this is more controversial&#46; Immunological reactions that produce a large number of antitumor T-cell clones &#40;numerous clones of T-cell&#41; were stronger because each T-cell has a distinct TCR that only identifies one antigenic epitope&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> The best immune response to vaccination may differ between different types of cancer&#46; In order to slow the spread of cancer&#44; cancer vaccinations can potentially use antibody-mediated cytotoxic mechanisms&#46;<a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0350"><span class="elsevierStyleSup">70</span></a> When cancer cells bind to antibodies&#44; antibody-mediated toxicity&#44; as well as antibody-mediated phagocytosis&#44; will be employed to kill them&#46; These methods have primarily been employed for passive immunotherapy in cancer vaccines utilizing humoral immunotherapy&#44; which aims to induce anticancer antibodies in the individual&#39;s body&#46; Once antibodies recognize epitopes on the surfaces of cancerous cells&#44; the innate immune system&#39;s macrophages&#44; natural killer cells&#44; as well as neutrophils can recognize the associated antibody Fc receptors as well as initiate cell lysis or phagocytosis&#46;<a class="elsevierStyleCrossRef" href="#bb0355"><span class="elsevierStyleSup">71</span></a><a class="elsevierStyleCrossRef" href="#f0020">Fig&#46; 4</a> shows antigen presentation controlled by the innate immune system represents activation of CD4<span class="elsevierStyleHsp" style=""></span>&#43; and CD8<span class="elsevierStyleHsp" style=""></span>&#43; epitopes&#44; which prevents the growth of tumor tissue&#46;</p><elsevierMultimedia ident="f0020"></elsevierMultimedia></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Other cancer treatment methods</span><p id="p0175" class="elsevierStylePara elsevierViewall">When it comes to fighting cancer&#44; there are many treatment options that healthcare professionals can use&#44; tailored to each patient&#39;s specific needs&#46; These treatments include a multidisciplinary approach that aims to kill the cancerous cells&#44; whereas minimizing damage to healthy tissue&#46;<a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a></p><p id="p0180" class="elsevierStylePara elsevierViewall">One of the main treatment modalities is surgery&#44; in which skilled surgeons remove malignant tumors and surrounding tissue&#46; This method has evolved significantly over the years as minimally invasive techniques have become more popular&#44; providing less post-operative pain and faster recovery times for patients&#46;<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a> Additionally&#44; advances in imaging technology have allowed surgeons to precisely target tumors and perform complex procedures with greater precision&#46;</p><p id="p0185" class="elsevierStylePara elsevierViewall">Cancer treatment includes a variety of methods to combat abnormal cell growth and reduce its impact on the body&#46; The choice of cancer treatment basically depends on the stage as well as the type of cancer&#44; along with the individual patient factors&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a> Some of the main cancer treatments are shown in <a class="elsevierStyleCrossRef" href="#t0010">Table 2</a>&#46; &#40;See <a class="elsevierStyleCrossRef" href="#t0015">Table 3</a>&#46;&#41;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0190" class="elsevierStylePara elsevierViewall">Effective cancer treatment often involves a combination of these methods&#44; called a multimodal approach&#44; to target the disease from multiple angles&#46;<a class="elsevierStyleCrossRefs" href="#bb0515"><span class="elsevierStyleSup">103&#8211;105</span></a> The choice of treatment should be carefully discussed with the healthcare team to determine the most appropriate plan for each patient&#39;s unique circumstances&#46;</p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Vaccines and clinical trials</span><p id="p0195" class="elsevierStylePara elsevierViewall">The development of vaccines for cancer therapy and prevention depends heavily on clinical trials&#46; Many different forms of cancer are being tested by researchers as vaccinations&#44; including&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="li0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Bladder cancer&#58;</span> Researchers are evaluating the efficacy of a designed vaccine developed from a virus modified with the antigen &#40;HER2&#41;&#46; Some bladder cancer tumor surfaces are home to these chemicals or antigens&#46; The virus could aid in instructing the immune system to recognize as well as eliminate these tumor cells&#46;<a class="elsevierStyleCrossRef" href="#bb0570"><span class="elsevierStyleSup">114</span></a> Additionally&#44; investigators want to discover which performs well&#58; conventional medical care for bladder cancer or standard care combined with vaccination&#46;</p></li><li class="elsevierStyleListItem" id="li0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Brain tumors&#58;</span> Numerous studies were being conducted to evaluate vaccinations intended to target specific chemicals found on the brain tumor cells&#39; surface&#46;<a class="elsevierStyleCrossRef" href="#bb0575"><span class="elsevierStyleSup">115</span></a> Some emphasis on recently discovered brain cancer&#44; emphasizing cancer that has returned or recurred&#46; Teenagers and children are included in several research&#46;<a class="elsevierStyleCrossRef" href="#bb0580"><span class="elsevierStyleSup">116</span></a></p></li><li class="elsevierStyleListItem" id="li0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Breast cancer&#58;</span> A lot of research is being done on therapeutic vaccines for breast cancer&#44; whether they are used alone or in conjunction with other treatments&#46; In order to begin clinical trials for vaccines that prevent breast cancer&#44; other researchers are currently trying&#46;<a class="elsevierStyleCrossRef" href="#bb0585"><span class="elsevierStyleSup">117</span></a></p></li><li class="elsevierStyleListItem" id="li0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Cervical cancer&#58;</span> The HPV vaccinations that prevent the cancer &#40;cervical&#41; have FDA approval&#46; Vaccines that aid in treating cervical cancer at every stage are still being researched&#46;<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a></p></li><li class="elsevierStyleListItem" id="li0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Colorectal cancer&#58;</span> In order to cure colorectal cancer&#44; scientists are developing vaccinations that instruct the body to target cells with antigens suspected to be responsible&#46; NY-ESO-1&#44; guanylyl cyclase C&#44; CEA&#44; and MUC1 are some of these antigens&#46;<a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a></p></li><li class="elsevierStyleListItem" id="li0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Kidney cancer&#58;</span> To treat kidney cancer&#44; many cancer vaccines are being tested by researchers&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> Additionally&#44; vaccinations to stop the cancer &#40;kidney&#41; in its later stages from returning are being tested&#46;</p></li><li class="elsevierStyleListItem" id="li0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Leukemia&#58;</span> Studies are exploring into vaccinations that might be used to treat leukemia of several forms&#44; including AML as well as CLL&#46; Some are intended to improve the effectiveness of other therapies&#44; including a bone marrow&#47;stem cell transplant&#46;<a class="elsevierStyleCrossRef" href="#bb0520"><span class="elsevierStyleSup">104</span></a> The immune system may be assisted in eliminating the cancer by additional vaccinations created from an individual&#39;s cancer cells as well as other cells&#46;</p></li><li class="elsevierStyleListItem" id="li0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Lung cancer&#58;</span> Clinical studies for lung cancer vaccinations focus on antigens&#46;</p></li><li class="elsevierStyleListItem" id="li0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Melanoma&#58;</span> Numerous melanoma vaccines&#44; administered alone or in combination with other therapies&#44; are being studied by researchers&#46;<a class="elsevierStyleCrossRef" href="#bb0525"><span class="elsevierStyleSup">105</span></a> The immune system is instructed to eliminate more melanoma cells in the human body by destroying melanoma cells as well as antigens in vaccinations&#46;</p></li><li class="elsevierStyleListItem" id="li0050"><span class="elsevierStyleLabel">&#8226;</span><p id="p0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Myeloma&#58;</span> For those with multiple myeloma who are close to remission&#44; there are several clinical studies investigating at vaccinations&#46; This indicates that there are no symptoms and that the cancer has spread throughout the body&#46; Additionally&#44; those who have smoldering myeloma or require an autologous bone marrow or stem cell transplant are being tested for vaccinations by researchers&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a></p></li><li class="elsevierStyleListItem" id="li0055"><span class="elsevierStyleLabel">&#8226;</span><p id="p0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Pancreatic cancer&#58;</span> Many vaccines for therapy are being developed by researchers to improve the response of immune systems to pancreatic cancer cells&#46; The vaccination can be administered in conjunction with other treatments or as the only form of care&#46;<a class="elsevierStyleCrossRef" href="#bb0590"><span class="elsevierStyleSup">118</span></a></p></li><li class="elsevierStyleListItem" id="li0060"><span class="elsevierStyleLabel">&#8226;</span><p id="p0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Prostate cancer&#58;</span> Sipuleucel-T is a vaccination that medical professionals can administer to patients with this cancer who have advanced disease&#46;<a class="elsevierStyleCrossRef" href="#bb0595"><span class="elsevierStyleSup">119</span></a> Presently&#44; research is examining if the vaccination might benefit those with prostate cancer in its early stages&#46;</p></li></ul></p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Recent advancements in cancer treatment</span><p id="p0260" class="elsevierStylePara elsevierViewall">In recent years&#44; the field of cancer vaccines has seen amazing advancements&#44; paving the way for more effective and targeted treatments&#46; One significant breakthrough is the development of personalized cancer vaccines&#46;<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a> These vaccines are tailor-made to stimulate the immune system of patients to identify as well as attack the specific cancerous cells&#46;</p><p id="p0265" class="elsevierStylePara elsevierViewall">Scientists have also made tremendous progress in utilizing different vaccine platforms&#46; One such platform is mRNA-based vaccines&#44; which have gained vast attention because of their potential in addressing various types of cancer&#46; Unlike traditional vaccines that introduce weakened or inactivated viruses&#44; mRNA-based vaccines use messenger RNA molecules to instruct cells to produce specific antigens that trigger an immune response against cancer cells&#46;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a></p><p id="p0270" class="elsevierStylePara elsevierViewall">One more recent advancement is a technique known as molecular mimicry&#46; Actually&#44; the word &#8220;molecular mimicry&#8221; was first introduced in year 1964 to define the similarity amongst the human cells and antigens expressed by infectious agents&#44; which cause bacterial escape the host immune response and infection is stronger&#46;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> The opposite inference of molecular mimicry had been proposed 2 years prior despite the lack of scientific proof of molecular similarity&#46; Cross-reactive antibodies against human heart tissue as well as group A streptococcal cells were recognized in a suffering from rheumatic fever&#44; signifying a pathophysiological role in that autoimmune disease&#46;<a class="elsevierStyleCrossRef" href="#bb0600"><span class="elsevierStyleSup">120</span></a> The phenomena of immune evasion and molecular mimicry-induced autoimmunity may seem contradictory but are 2 sides of the same coin&#44; representing extremes of a continuous biological process&#46;<a class="elsevierStyleCrossRefs" href="#bb0100"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="p0275" class="elsevierStylePara elsevierViewall">In recent times&#44; nanotechnology is also going to play a vital role in cancer vaccine development&#46; In order to comprehend&#44; develop&#44; and employ material devices&#44; systems&#44; and structures with fundamentally novel characteristics and functionalities deriving from their microscopic structure&#44; nanotechnology requires the ability to operate on the atomic&#44; molecular&#44; as well as supramolecular levels&#46;<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a> The engineering and science involved in design&#44; synthesis&#44; and characterization in at least 1 dimension that is on the nanoscale scale&#44; or one-billionth of a meter&#44; is referred to as nanotechnology&#46;<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a> With the help of nanotechnology&#44; protein&#47;peptide vaccines&#44; genetic vaccines&#44; and cell-based cancer vaccines can be developed for the treatment of various types of cancers&#46;<a class="elsevierStyleCrossRef" href="#bb0605"><span class="elsevierStyleSup">121</span></a></p></span></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Conclusion</span><p id="p0280" class="elsevierStylePara elsevierViewall">In conclusion&#44; the recent advancements in cancer vaccines have brought new hope to the field of oncology&#46; With the development of personalized and targeted vaccines&#44; researchers are making significant strides in improving patient outcomes and reducing the burden of cancer&#46; The integration of innovative technologies such as genetic sequencing and immunotherapy has revolutionized the way we approach cancer treatment&#46; As scientists continue to unravel the complexities of the immune system and harness its power to fight against cancer&#44; we can remain optimistic about a future where effective vaccines offer a promising avenue for prevention and treatment&#44; bringing us closer to a world free from this devastating disease&#46;</p></span></span>"
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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Cancer is a versatile and common disease that occurs as a result of the uncontrolled growth as well as the spread of abnormal cells in the human body&#46; Its history spans thousands of years&#44; from the first descriptions of ancient civilizations to the advancement of modern science&#46; His research throughout the 20th and 21st centuries revealed the genetic and molecular mechanisms of growth and development&#46; Treatment options are diverse and include surgery&#44; radiation&#44; chemotherapy&#44; chemotherapy&#44; and immunotherapy&#46; Despite great progress&#44; cancer remains a global health problem&#46; Research is ongoing to further unravel the complexity of this disease to improve early diagnosis&#44; personalized treatment strategies&#44; and achieve better patient outcomes&#46; This study provides a general definition&#44; diagnosis&#44; treatment&#44; and course of cancer and attempts to determine whether it is beneficial or harmful to humans&#46;</p></span>"
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        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">El c&#225;ncer es una enfermedad vers&#225;til y com&#250;n que se produce como resultado del crecimiento descontrolado y la propagaci&#243;n de c&#233;lulas anormales en el cuerpo humano&#46; Su historia abarca miles de a&#241;os&#44; desde las primeras descripciones de civilizaciones antiguas hasta el avance de la ciencia moderna&#46; Sus investigaciones a lo largo de los siglos XX y XXI revelaron los mecanismos gen&#233;ticos y moleculares del crecimiento y el desarrollo&#46; Las opciones de tratamiento son diversas e incluyen cirug&#237;a&#44; radiaci&#243;n&#44; quimioterapia&#44; quimioterapia e inmunoterapia&#46; A pesar de los grandes avances&#44; el c&#225;ncer sigue siendo un problema de salud mundial&#46; Se est&#225;n realizando investigaciones para desentra&#241;ar a&#250;n m&#225;s la complejidad de esta enfermedad para mejorar el diagn&#243;stico temprano&#44; las estrategias de tratamiento personalizadas y lograr mejores resultados para los pacientes&#46; Este estudio proporciona una definici&#243;n general&#44; diagn&#243;stico&#44; tratamiento y curso del c&#225;ncer e intenta determinar si es beneficioso o perjudicial para los humanos&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Name of antibody&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Target&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Their uses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">References&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Abagovomab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">Mouse&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">CA-125 &#40;imitation&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Ovarian cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0265"><span class="elsevierStyleSup">53</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abituzumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Humanized&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0270"><span class="elsevierStyleSup">54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adecatumumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Human&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EpCAM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostate and breast cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0275"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Belantamab mafodotin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Humanized&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Refractory multiple myeloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0280"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bermekimab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Human&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-1a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colorectal cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0285"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brentuximab vedotin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chimeric&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD30&#40;TNFRSF8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hodgkin&#39;s lymphoma&#44; anaplastic large-cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0290"><span class="elsevierStyleSup">58</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabiralizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Humanized&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CSF1R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metastatic pancreatic cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0295"><span class="elsevierStyleSup">59</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#46; No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Description&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery to remove the tumor is a common method when the cancer is still localized and has not spread&#46; Surgeons aim to remove the tumor and surrounding tissue to prevent its return&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0390"><span class="elsevierStyleSup">78</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiation therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">This method usages high-energy radiation beams to target as well as to destroy the cancerous cells&#46; It may be used as an initial cure or in amalgamation with other therapies&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0400"><span class="elsevierStyleSup">80</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0405"><span class="elsevierStyleSup">81</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chemotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">It involves the use of drugs that circulate all over the body and kill rapidly dividing cells&#44; including cancer cells&#46; It is effective against local and metastatic cancer&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0415"><span class="elsevierStyleSup">83</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Immunotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Immunotherapy exploits the body&#39;s immune system to identify as well as to attack the cancerous cells&#46; This therapy comprises of checkpoint inhibitors&#44; adoptive cell therapy&#44; and monoclonal antibodies&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0420"><span class="elsevierStyleSup">84&#8211;86</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Targeted therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">These drugs specifically target molecules or pathways involved in cancer development&#46; They usually have fewer side effects than chemotherapy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0435"><span class="elsevierStyleSup">87</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0440"><span class="elsevierStyleSup">88</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hormone therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Used primarily for hormone-sensitive cancers like prostate and breast cancer&#44; hormone therapy aims to block or reduce the effects of hormones that promote the growth of tumors&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0445"><span class="elsevierStyleSup">89&#8211;91</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stem cell transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">This procedure is used to replace damaged or cancerous bone marrow with the healthy stem cells&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0460"><span class="elsevierStyleSup">92</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0465"><span class="elsevierStyleSup">93</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stratified medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tailoring treatments based on a suffers genetic profile is becoming increasingly important because it can lead to more effective therapies with fewer side effects&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0470"><span class="elsevierStyleSup">94</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0475"><span class="elsevierStyleSup">95</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Palliative care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Although not a cure&#44; it aims to improve the quality of life of patients with cancer by controlling symptoms and providing emotional support&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0480"><span class="elsevierStyleSup">96&#8211;98</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complementary therapies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Some patients explore complementary methods such as acupuncture&#44; yoga&#44; or dietary changes along with conventional treatments to improve their health&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0495"><span class="elsevierStyleSup">99&#8211;102</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Product&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cancer type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Completed phase III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">References&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Provenge&#194;&#174;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Approved</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostate cancer</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III D9901&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F &#40;Efficacy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0530"><span class="elsevierStyleSup">106</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III D9902A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F &#40;Efficacy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0535"><span class="elsevierStyleSup">107</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III D9902B&#44; IMPACT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0540"><span class="elsevierStyleSup">108</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DCVax&#194;&#174;-Brain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Approved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glioblastoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incomplete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0545"><span class="elsevierStyleSup">109</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HybriCell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Approved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanoma&#44; Renal cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incomplete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0550"><span class="elsevierStyleSup">110</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M-VaxTM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Approved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III &#40;immune-pharmacology&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0555"><span class="elsevierStyleSup">111</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CIMAVax EGF&#194;&#174;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Approved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-small cell lung cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incomplete&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0560"><span class="elsevierStyleSup">112</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oncophage&#194;&#174; &#40;vitespen&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Approved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renal cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III C-100-12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F &#40;Efficacy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0565"><span class="elsevierStyleSup">113</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Table shows various clinical trial testing of the vaccines against various types of cancer&#46;</p>"
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          "identificador" => "bs0005"
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                  "contribucion" => array:1 [
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                      "titulo" => "mRNA vaccine for cancer immunotherapy"
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                        0 => array:2 [ …2]
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                    0 => array:2 [
                      "doi" => "10.1186/s12943-021-01335-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mol Cancer"
                        "fecha" => "2021"
                        "volumen" => "20"
                        "numero" => "1"
                        "paginaInicial" => "41"
                        "link" => array:1 [ …1]
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            1 => array:3 [
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comprehensive review of mRNA vaccines"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/ijms24032700"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Mol Sci"
                        "fecha" => "2023"
                        "volumen" => "24"
                        "numero" => "3"
                        "paginaInicial" => "2700"
                        "link" => array:1 [ …1]
                      ]
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              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of mRNA vaccines&#58; scientific and regulatory issues"
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                        0 => array:2 [ …2]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/vaccines9020081"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccines"
                        "fecha" => "2021"
                        "volumen" => "9"
                        "numero" => "2"
                        "paginaInicial" => "81"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
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            3 => array:3 [
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ISSN: 24451460
Original language: English
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