Current Oncology Reports最新文献

Purpose of review: This review explores the clinical applications of PSMA-PET/CT in patients with intermediate to high-risk prostate cancer, focusing on its role in diagnostic reassessment, therapeutic redirection, and potential survival benefits. By evaluating its translational pathway, we aim to provide a structured analysis of its impact on patient management and treatment outcomes.

Recent findings: Prostate cancer remains a significant health challenge, and advancements in imaging techniques such as PSMA-PET/CT have shown promise in improving diagnostic accuracy and guiding treatment decisions. Emerging evidence highlights its superior sensitivity and specificity compared to conventional imaging, facilitating better staging, detection of metastases, and therapy selection. However, challenges persist in standardizing clinical applications, integrating findings into treatment guidelines, and addressing economic considerations. This review synthesizes the latest research findings and cost-effectiveness analyses to establish a comprehensive translational framework for PSMA-PET/CT in prostate cancer management. By consolidating diverse evidence, we aim to provide the medical community with clearer insights into its clinical utility, address ongoing controversies, and propose strategies to minimize treatment risks. The conclusions drawn from this study aspire to refine treatment protocols and enhance clinical outcomes for patients with this prevalent malignancy.

Purpose of review: This review explores the evolving role of antibody-drug conjugates (ADCs) in lung cancer treatment, with a focus on their application in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). It highlights advancements in ADC design, mechanisms of action, and key outcomes from recent clinical trials.

Recent findings: ADCs have introduced a new level of precision in oncology by targeting tumor-specific antigens such as HER2, HER3, and TROP-2. Recent clinical trials of agents like trastuzumab deruxtecan, datopotamab deruxtecan, and sacituzumab govitecan have demonstrated meaningful objective response rates and manageable toxicity, offering hope for patients with advanced NSCLC and SCLC. ADCs are transforming the treatment landscape for lung cancer, offering a blend of targeted delivery and potent therapeutic effects. With ongoing efforts to improve safety, efficacy, and antigen targeting, ADCs have the potential to become a cornerstone of lung cancer therapy and pave the way for innovative multimodal approaches in the future.

Purpose of review: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with rising incidence and mortality. Early-stage HCC is often asymptomatic, and the lack of reliable early diagnostic markers leads to late-stage diagnosis with limited treatment options. Current treatment relies on tumour staging and patient status, but accurate staging requires invasive procedures that fail to capture tumour heterogeneity and progression. There is an urgent need for less invasive diagnostic strategies, such as liquid biopsy technologies, which allow for repeated sampling and real-time analysis of tumour dynamics. Liquid biopsies, including circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA), offer the potential to monitor recurrence, metastasis, and treatment responses, potentially transforming HCC clinical management by enabling earlier intervention and personalised treatment strategies.

Recent findings: Recent studies emphasise the potential of ctDNA as a non-invasive biomarker by targeting DNA methylation for early HCC detection, enabling timely intervention and personalised treatment to improve patient outcomes. Comparative analyses have shown that ctDNA mutation testing outperforms alpha-fetoprotein (AFP), with a sensitivity of 85% and a specificity of 92%, compared to 60% sensitivity and 80% specificity for AFP. Additionally, profiling the ctDNA mutation landscape of 100 HCC patients has identified recurrent mutations in genes such as TP53, CTNNB1, and AXIN1. ctDNA appears to be a promising non-invasive biomarker in the clinical management of HCC patients, with the sensitivity and specificity improving by 41.67% and 15% respectively. The ctDNA mutations, particularly those targeting DNA methylation, highlight great potential for precision medicine, critical for early diagnosis and prognosis of HCC.

Purpose of review: In recent years, new, effective bladder sparing techniques have emerged as favorable options for patients with BCG-unresponsive high-grade non-muscle-invasive bladder cancer (NMIBC) and localized muscle-invasive bladder cancer (MIBC), leading to a paradigm shift from the traditional radical cystectomy in clinical practice. Our aim is to examine the evolution of these techniques, summarize the current evidence, and shed light on the future of these treatment options.

Recent findings: Bladder preservation techniques offer a patient-centered approach while also demonstrating non-inferiority to radical cystectomy in terms of survival outcomes for both NMIBC and MIBC patients. Approved novel therapies, including systemic pembrolizumab and intravesical agents such as nadofaragene, nogapendekin alfa inbakicept, and cretostimogene grenadenorepvec, have shown promising results for BCG-unresponsive NMIBC patients. For carefully selected MIBC patients, Trimodal Therapy (TMT) remains an effective alternative. However, the consensus on the addition of neoadjuvant chemotherapy to TMT and the choice of radio-sensitizing chemotherapy / fractionation schedule of radiation therapy is still under investigation. Additionally, immunotherapy in BCG-naïve patients and as part of concurrent chemoradiotherapy regimens in MIBC patients offers favorable early results. Bladder preservation is a feasible and increasingly preferred alternative in certain NMIBC and MIBC patients who are either unfit or unwilling for radical cystectomy. Promising novel therapies, such as immunotherapy, recombinant intravesical therapies, and antibody-drug conjugates are emerging as potential alternatives. These therapies aim to achieve good oncological outcomes while maintaining quality of life, providing an alternative to the decades long standard of care.

Purpose of review: Despite differences in the various classification systems of acute myeloid leukemia (AML), rare entities can be identified according to clinical, biological or morphological characteristics. Uncommon AML defined on specific morphological criteria and/or genetic abnormalities were considered if occurring with a frequency of ≤ 5% in adult patients with AML.

Recent findings: Most of uncommon AML are characterized by a poor outcome with the standard treatment approaches. During the last decade, several therapeutic drugs with promising investigational approaches have been used in therapeutic regimens in both frontline and relapsed/refractory AML and represent a positive potential benefit for some rare entities displaying specific molecular lesions. Several rare subtypes can be identified in adult patients with AML. In this descriptive review, we assess the available information for these rare entities and summarized treatments that could be proposed especially according to their genetic characterization.

Purpose of review: The review compares the effectiveness of neoadjuvant(pre-operative, NAC) and adjuvant(post-operative, AC) in Soft Tissue Sarcomas as this topic is controvesial and multiple new studies have been over the years.

Recent findings: Sarculator and other nomograms assess patients with a predicted 10-year OS below 60% who will benefit from perioperative chemotherapy. Further research supports perioperative chemotherapy's role. European guidelines do not recommend anthracycline and ifosfamide (AI) perioperative chemotherapy as a standard treatment for STS of the extremities and trunk. However, some studies show that AI chemotherapy can improve recurrence-free survival (RFS). The EORTC 62,771 trial found that the CYVADIC regimen (doxorubicin, dacarbazine, cyclophosphamide, vincristine) reduced RFS without affecting OS. Meanwhile, the EORTC 62,931 trial showed no effect of AI chemotherapy on RFS or OS, but a pooled analysis suggested an OS benefit for patients with R1 (microscopically positive) resections. The AI regimen shows further support from Sarculator-based data, with EORTC 62,931 analysis indicating an improvement in disease-free survival and OS in patients with low expected OS. Similar outcomes were seen in the ISG-STS 1001 study. Recently, PERSARC analysis revealed that AI chemotherapy significantly improves OS in high-grade STS patients with a low 5-year OS prediction (< 33%). NAC improves the chances of complete tumour removal, especially in large, high-grade tumours. It often reduces the need for more aggressive surgeries by shrinking tumours before surgery, leading to higher rates of successful resections with clear margins (R0). Sarculator and other nomograms assess patients with a predicted 10-year OS below 60% who will benefit from perioperative chemotherapy. Further research supports perioperative chemotherapy's role.

Purpose of review: Mesenteric fibrosis (MF) is a hallmark of small intestinal neuroendocrine neoplasms (SI-NEN) and is frequently associated with significant morbidity due to related complications such as intestinal obstruction, ischemia, and cachexia.

Recent findings: Herein we performed a systematic review to discuss the development of MF in SI-NEN. The pathophysiological mechanisms acknowledged as causative for the development of MF include the major components of the tumor microenvironment, such as fibroblasts, endothelial and immune cells and the extracellular matrix, which are involved in a complex interplay activating several signaling pathways that promote profibrotic factors and induce both a desmoplastic reaction and tumor proliferation. Surgery remains the mainstay of treatment, while several medical management options of MF complicating SI-NEN available present rather limited efficacy. MF is a frequent characteristic of SI-NEN that requires particular attention and targeted management to avoid complications.

Introduction: Men from culturally and linguistically diverse (CALD) backgrounds face challenges in accessing equitable and quality healthcare. However, little is known about the patterns of care among men diagnosed with prostate cancer (PCa) from CALD backgrounds. We aimed to map the available literature on patterns of care and treatment outcomes in men from CALD backgrounds who have PCa.

Methods: We used the Johanna Briggs Institute scoping review methodology. We searched five bibliographic databases (Ovid MEDLINE, EMBASE, SCOPUS, CINAHL, and Ovid Emcare) and grey literature. We explored patterns of PCa care extending from screening and early detection to end-of-life care and treatment outcomes.

Results: A total of 7,148 records were identified; 58 studies were included. Most studies were from the United States (US) (n = 41) and used ethnic origin (n = 14), nativity (n = 10), immigration history (n = 11), or country of birth (n = 13) as indicators of CALD. Most studies focused on screening and early detection for PCa (n = 37), specifically prostate-specific antigen (PSA) testing. Twelve papers were on PCa treatment (e.g., surgery, radiation therapy, and active surveillance), five on follow-up and supportive care, and four on treatment outcomes (i.e., change in measured PSA and PCa cancer-specific survival). There were disparities in the PCa care continuum and treatment outcomes between CALD and non-CALD patients. Factors influencing screening and early detection for PCa were systematically summarised and most addressed individual-level determinants.

Conclusions: Key findings from our scoping review emphasised the existence of guideline-discordant care, disparities in PCa screening test use, and differences in PCa treatment received among men from CALD backgrounds. However, little is known about patterns of care in diagnostic modalities, treatment phases, and palliative and end-of-life care.

Purpose of review: The introduction of PSMA-PET/CT scans is expected to increase the incidence of clinically lymph node-positive metastatic hormone-sensitive prostate cancer (mHSPC). The 8th AJCC-TNM classify disease with metastasis limited to pelvic nodes (cN1M0) and nonregional lymph nodes (M1a) as stage IV. To date, there is limited prospective evidence for management of this subgroup. Additionally, no specific recommendations currently exist for managing M1a as a distinct condition but as a part of CHAARTED low volume disease (LVD). Our review examines relevant results from phase III trials examining the management of clinically positive nodal disease over the last decade.

Recent findings: STAMPEDE is the only phase III trial that gave recent data about cN1M0 and isolated M1a management. Cohort sub-analysis of the control arm showed improved failure-free survival after local radiotherapy (RT) plus Androgen Deprivation Therapy (ADT), while metastasis-free survival benefit from Abiraterone Acetate with Prednisolone (AAP) addition was noted when compared to standard of care (SOC), awaiting the overall survival (OS) benefit result. The STAMPEDE H arm showed a marginal significance of M1a stratified OS after RT. Future trials, including PEARLS, ALADDIN and STAMPEDE2, are expected to offer more insights. Interventional Phase III trials directed to clinically node positive patients are still needed to aid deciding on the best management, and nodal metastasis number and size impact on prognosis.