AUCTORES
Globalize your Research
Case Report
*Corresponding Author: Erlinda M. Gordon, Cancer Center of Southern California/Sarcoma Oncology Research Center 2811 Wilshire Boulevard, Suite 414 Santa Monica, CA 90403, USA.
Citation: Erlinda M. Gordon, Sant P. Chawla, Victoria S Chua-Alcala, Don A Brigham, Amir Ahari, et al. (2022). Durable Responses Using SNK01 Autologous Enhanced Natural Killer Cells and Pembrolizumab for Chemotherapy-Resistant Advanced Sarcoma: Case Reports, Literature Review and Future Perspectives. J. Cancer Research and Cellular Therapeutics. 6(5); DOI:10.31579/2640-1053/126
Copyright: © 2022 Erlinda M. Gordon, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 07 July 2022 | Accepted: 13 July 2022 | Published: 05 September 2022
Keywords: SNK01; autologous natural killer cells; immune checkpoint inhibitor; program death ligand-1; PD-1; PD-L1; pembrolizumab; sarcoma; immunotherapy; cell therapy
Advanced or metastatic sarcoma is associated with an invariably fatal outcome. Two noteworthy cases of chemotherapy-resistant metastatic sarcoma with durable responses to SNK01 autologous enhanced natural killer cell therapy and pembrolizumab, an immune checkpoint inhibitor, are reported here. Single patient use of SNK01 and pembrolizumab was authorized by the United States Food and Drug Administration and a Central Institutional Review Board. After informed consent was obtained, Patient #1 with desmoplastic small round cell tumor and Patient #2 with radiation-induced chondrosarcoma received SNK01 2x109 cells i.v. and 200 mg pembrolizumab i.v. every 3 weeks. Patient #1’s tumors gradually decreased in size, achieving a 47% partial response after which the patient underwent two surgical resections and achieved a sustained remission. Patient #2’s tumors gradually decreased in size, achieving a 38% partial response. Albeit a very small case study, the data suggest that SNK01 plus pembrolizumab may be a viable therapeutic option for patients with chemotherapy-resistant advanced sarcoma with manageable toxicity, and supports existing evidence that natural killer cells mediate a favorable response to immune checkpoint inhibitor therapy while reducing immune-related adverse events.
Immunotherapy for sarcoma has not, hitherto, shown impressive clinical benefit as in other solid tumors. However, in principle, natural killer cell function within the tumor may be revived with the use of immune checkpoint inhibitors [1]. Recent evidence has implicated a profound role of natural killer cells in the immune checkpoint inhibitor pathway and suggests that natural killer cells can improve program death ligand 1 (PD-L1) - negative tumor response to immune checkpoint inhibitor therapy [2]. Given that natural killer cells have also been found to target and eliminate autoreactive T-cells, natural killer cells could possibly reduce autoimmune-like side effects associated with immune checkpoint inhibitor therapy as well [3].
SNK01 is a first-in-kind, autologous non-genetically modified natural killer cell therapy with highly enhanced cytotoxicity and over 90
Two single patient investigational new drug applications using SNK01 and pembrolizumab for advanced sarcoma were authorized by the United States Food and Drug Administration/Center of Biologic Evaluation and Research (USFDA/CBER), Bethesda, MD, USA, and approved by Western Institutional Review Board, Olympia, WA, USA. The treatment protocol consisted of autologous enhanced natural killer (SNK01) cells at a dose of 2 x 109 cells i.v. and pembrolizumab 200 mg i.v. every 3 weeks, followed by surgical debulking of residual disease if possible. Treatment outcome parameters included best overall response and progression-free survival using RECIST v1.1 [6], overall survival and incidence of treatment related adverse events using NCI NIH Common
toxicity Criteria for Adverse Events version 5.0 [7]. Stopping rules included serious treatment-related adverse events that did not improve to Grade 1 or less severity after 3 weeks.
Patient # 1: A 32-year-old hispanic male was diagnosed to have metastatic desmoplastic small round cell tumor in December 2016 for which the patient received multiple chemotherapy regimens including vincristine sulfate, doxorubicin, cyclophosphamide + ifosfamide, and etoposide phosphate followed by aldoxorubicin, irinotecan, vincristine and temozolomide. The patient then received trabectedin and pembrolizumab until disease progression in October 2019. In November 2019, the patient was enrolled in Cohort 1 of SNK01 Phase 1 study, wherein he received five weekly doses of SNK01 at a dose of 1 x 109 cells/dose. After five treatments, a follow-up CT scan revealed stable disease, although at that time, he still had extensive liver metastases with massive abdominal and pelvic disease. Because intra-patient dose escalation was not allowed in the Phase 1 study, and to improve tumor response, a single patient investigational new drug application using SNK01 and pembrolizumab was authorized by the USFDA based on a publication demonstrating how natural killer cells could play a significant role in responses of patients with PD-L1 negative tumors [2]. The patient’s tumors decreased in size over one year of treatment to a 47% partial response by RECIST v1.1 [6]. In March 2021, he underwent a surgical debulking procedure followed by whole abdominal radiation and intraperitoneal chemotherapy, after which he resumed SNK01 and pembrolizumab regimen in May 2021. His last scan in January 2022 showed sustained remission with no evidence of disease (Figure 1).
(A) PET scan before treatment; (B) PET scan after SNK01 plus pembrolizumab treatment
followed by debulking procedure; (C) Abdominal CT scan before treatment; (D) Abdominal
CT scan after SNK01 plus pembrolizumab treatment followed by debulking procedure. FDG
PET: Fluorodeoxyglucose Positron Emission Tomography; CT: Computerized Tomography.
He has now received 32 cycles of SNK01 + pembrolizumab over 28 months and has an Eastern Cooperative Oncology Group score of 0 (fully active, able to carry on all pre-disease performance without restriction). Grade 2 treatment-related adverse events included hypothyroidism, fatigue, rash, and pruritus. There were no > Grade 3 treatment-related adverse events reported.
Patient #2: A 57-year-old white male was diagnosed to have a high-grade pleomorphic liposarcoma of the right pelvis in 2004. The patient underwent pre-operative doxorubicin, ifosfamide, mesna, and radiotherapy. He then received adjuvant interferon for 2 years. In January 2019, a biopsy of the right iliac crest revealed PD-L1 positive radiation-induced chondrosarcoma. The patient underwent a two-stage surgical procedure including right hemipelvectomy and proximal femoral replacement in March 2019. The patient then received nivolumab in August 2019 until disease progression. Other targeted therapies included palbociclib and pazopanib until disease progression in June 2020. The USFDA then authorized a single patient use investigational new drug application using SNK01 2 x 109 cells and pembrolizumab 200 mg every 3 weeks and the patient had a 38% partial response by RECIST v1.1 [6] after four months of treatment (Figure 2).
(A, B) Before treatment; (C, D) Four months after treatment.
CT: Computerized Tomography.
He then undertook a surgical debulking procedure, but unfortunately, developed post-operative sepsis and died. The patient had received 18 cycles of SNK01 + pembrolizumab and survived 12 additional months. Grade 3 treatment-related adverse events included increased AST; Grade 2 treatment-related adverse events included hypothyroidism, increased ALT, increased alkaline phosphatase and increased GGT.
In recent years, the efficacy and safety of immune checkpoint inhibitors in advanced sarcoma have been reported. The pioneering SARC028 multicenter phase 2 study investigating the safety and efficacy of pembrolizumab in advanced soft tissue sarcoma and bone sarcoma showed promising activity in certain histologic subtypes [8]. Of 80 patients evaluable for response at 12 center members of the Sarcoma Alliance for Research through Collaboration, seven (18%) of 40 patients with soft tissue sarcoma had an objective response: four (40%) of ten patients with undifferentiated pleomorphic sarcoma, two (20%) of ten patients with liposarcoma, and one (10%) of ten patients with synovial sarcoma. Only 5% of 40 patients with bone sarcoma had an objective response. Nine (11%) patients had serious treatment-related adverse events, five of which were immune-related including adrenal insufficiency, pneumonitis, and nephritis.
In 2018, Chawla et al. reported on their clinical experience with combination chemo-/immunotherapy using trabectedin and nivolumab for advanced soft tissue sarcoma [9]. Twenty-eight heavily treated patients received trabectedin (1.5 mg/m2 via continuous intravenous infusion for 24 hours) every 3 weeks, and nivolumab (3 mg/kg intravenously over 30 minutes) every 2 weeks. Tumor responses were assessed by RECIST v1.1 [6]. All patients had metastatic disease and a median of 4 lines of prior chemotherapy. Best overall response rate was 18.2%, median progression-free survival was 45.4 weeks (range: 10-95 weeks), median overall survival was 66.5 weeks (10-95 weeks), 6-month progression-free survival rate was 68.2%, and 6-month overall survival was rate 95.4%. Safety analysis in 28 patients showed > Grade 3 treatment-related adverse events including anemia (7%), fatigue (3.6%), thrombocytopenia (3.6%), neutropenia (3.6%) and increased creatine kinase (3.6%). Taken together, the data suggested that paired administration of trabectedin and nivolumab is safe, and that this chemo-/immuno-therapy approach may have synergistic activity that could lead to improved clinical outcomes.
In 2021, Chawla et al. (10) reported on the results of the TNT study, a Phase 2 study using Talimogene Laherparepvec, Nivolumab and Trabectedin for previously treated advanced soft tissue sarcoma (NCT03886311). Best overall response (complete and partial responses) was 11% and disease control rate was 80.6%. Safety analysis in 47 patients showed the following > Grade 3 treatment-related adverse events: anemia (25.5%), increased ALT (17%), fatigue (8.5%), thrombocytopenia (8.5%), and neutropenia (8.5%). There was no > Grade 3 injection site reaction with talimogene laherparepvec intratumoral injections. Further, there was one conversion of an unresectable to resectable tumor, showing 100% tumor necrosis on histopathologic examination. Taken together, the data indicated that the TNT protocol may be effective as second/third line therapy for advanced soft tissue sarcoma, with no new safety signals seen.
Recently, Gordon et al. reported on the results of a five-year study using the SAINT protocol: A Phase 2 study using Safe Amounts of Ipilimumab, Nivolumab and Trabectedin as first-line therapy for previously untreated patients with advanced soft tissue sarcoma [11]. The guiding hypothesis was that sarcoma cells are more immunogenic earlier in the course of the disease [12] and that immune checkpoint inhibitors that promote sustained T cell activation would be most effective when given as first-line therapy, together with a tumoricidal agent, trabectedin, that depletes the tumor microenvironment of growth-promoting macrophages. In this article, best overall response was 21.6% with 87.5% disease control rate in 88 patients. Median progression-free survival was 7 (range:1-44) months, median overall survival was 14 (range: 1-46) months. Grade 3 or greater treatment-related adverse events included increased ALT (29.5%), anemia (11.4%), increased AST (11.4%), fatigue (9.1%), neutropenia (6.8%), thrombocytopenia (4.5%), hyponatremia (2.3%), increased ALP (2.3%), port site infection (2.3%), increased CK (2.3%), psoriasis exacerbation (1.1%), adrenal insufficiency (1.1%), dehydration (1.1%), and rhabdomyolysis (1.1%). There was no incidence of alopecia nor cardiac toxicity reported. Taken together, by indirect comparison, these data indicate that first-line combinatorial therapy with the SAINT protocol (1) may be more effective than standard first line therapy (doxorubicin/ifosfamide/mesna), and (2) may be safer than standard first line therapy for advanced soft tissue sarcoma.
Natural killer cells of the innate immune system play a key role as the main effector cells against cancer. In recent years, there has been increasing evidence of natural killer cell-mediated immunosurveillance of sarcoma cells, highlighting the potential of using natural killer cells as a therapeutic tool against sarcoma [13]. Hence, a rational approach would be to boost innate natural killer cell-mediated anti-tumor activity with ex vivo activated natural killer cells. Autologous natural killer cells have always been challenging to grow ex vivo, especially when derived from chemotherapy-treated patients. Thus, universal allogeneic donor-derived products have been mostly used [14]. SNK01 is the first-in-kind, autologous, non-genetically modified natural killer cell product with significant anti-tumor cytotoxicity and over 90% expression of cell determinants CD16, NKG2D, NKp46, and DNAM-1, that can be consistently produced even from chemotherapy-treated cancer patients [4]. While most, if not all, natural killer cell therapies have focused on hematologic malignancies, SNK01 has been shown to exhibit strong activity against both hematologic malignancies and solid tumors in preclinical studies. For patients with advanced sarcomas in the relapsed/refractory setting, there are few, if any, effective salvage treatment options. Monotherapy with PD-L1 inhibitors have shown only modest activity in most sarcomas, especially in tumors that have little to no PD-L1 expression [2,8]. In our experience, SNK01 can be safely administered without the need for lymphodepletion [4]. Interim results of Cohort 4 of a Phase 1 study using SNK01 cell therapy and avelumab, a PD-L1 immune checkpoint inhibitor for chemotherapy-resistant sarcoma have been reported [15]. These patients were treated with 4 x 109 SNK01 cells and 800 mg of avelumab intravenously every two weeks. Best overall response rate was 13.3% and disease control rate was 33.3%. Response was independent of PD-L1 status. Three of 15 patients had a grade 2/3 adverse event which was related to avelumab. There were no adverse events related to SNK01. The authors concluded that combinatorial therapy with SNK01 and avelumab may be safe with antitumor activity in advanced sarcoma that is independent of PD-L1 status.
Albeit these are very small studies that require confirmation in a larger randomized Phase 2 study, the interim results of the on-going Phase 1 study using SNK01 and avelumab for previously treated advanced sarcoma and the promising results of these two case studies suggest that combination therapy using SNK01 and an immune checkpoint inhibitor may improve treatment outcome of patients with advanced chemotherapy-resistant sarcoma.
Future perspectives: An interesting concept is that improved efficacy may be achieved by combining SNK01, an immune checkpoint inhibitor and a targeted cell cycle checkpoint inhibitor, e.g., DeltaRex-G, a tumor-targeted retroviral vector (1) that uniquely targets/hunts down tumors, and (2) that kills not only cancer cells/ cancer stem cells, but also proliferative neovasculature, tumor- associated growth-promoting macrophages and tumor associated fibroblasts [16]. Extracellular matrix deposition by tumor-associated fibroblasts down-regulate ligands of natural killer cell- activating receptors [14] and prevent immune cell trafficking in the tumor microenvironment. Reducing extracellular matrix production by DeltaRex-G therapy may enable SNK01 cell entry in the tumor microenvironment, favor natural killer cell-ligand interactions and improve tumor control and treatment outcome.
Taken together, the data (1) suggests that SNK01 plus pembrolizumab may be a viable salvage therapy regimen for chemotherapy-resistant advanced sarcoma with manageable toxicity, and (2) supports existing evidence that natural killer cells mediate a favorable response to immune checkpoint inhibitor therapy while reducing immune-related adverse events. Randomized Phase 2 studies are planned to confirm these encouraging results and biologic insights.
Ethics approval and consent to participate
The clinical protocol was approved by the USFDA/CBER and the Western Institutional Review Board. Written informed consent was obtained from each patient prior to treatment.
Consent for publication was obtained from Patient #1 and from the family of Patient #2.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
EMG, SPC, VSC, AA, CV, EY and DAB have no competing interests. PYC and PYS are employees of and have equity in NKGen Biotech, Inc.
Funded in parts by the Cancer Center of Southern California/Sarcoma Oncology Research Center and the Aveni Foundation. The SNK01 product was provided by NKGen Biotech, Inc. and pembrolizumab was prescribed.
EMG and SPC are the clinical investigators of the clinical trial, conducted the study and evaluated the patients' tumor responses, survival and safety, wrote parts of the manuscript, as well as reviewed and edited the final manuscript. VSC, AA, CV, EY and DAB analyzed the data, reviewed the literature and reviewed and edited the final manuscript. PYC and PYS reviewed the literature, wrote parts of the manuscript, reviewed and edited the final manuscript. All authors have read and approved the final manuscript.
The authors are grateful to Dr. Sandra Chaplan Memorial Fund and Dawn Royal Memorial Fund for their generous donations to the Aveni Foundation (www.avenifoundation.org), and to Heather Gordon (heathergordondrawings.com) for graphic illustrations.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
