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Current Opinion in Oncology最新文献

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Immuno-oncology in the daily practice.
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-28 DOI: 10.1097/CCO.0000000000001117
Ariane Laparra

Purpose of review: Immune checkpoint inhibitors (ICI) have become an integral part of oncology treatment. ICI currently has approval for more than thirty tumor types with proven efficacy. However, ICI can expose patients to inflammatory side effects, such as immuno-related adverse events (irAE). The spectrum of irAE and the time to onset can be very broad, sometimes leading to the patient's death.Additionally, ICI could be associated with chronic or long-term adverse events that impact quality of life. The expansion of the indications for immunotherapy in the early adjuvant and neoadjuvant stages is altering the benefit-risk balance of these therapies.Furthermore, the combination of immunotherapies with other oncology treatments makes the interpretation of adverse events difficult.To date, no predictive factors have been identified in routine practice to identify patients at risk of developing serious toxicity.

Recent findings: This has led us to develop a patient care pathway dedicated to the management of these toxicities, enabling early detection of irAE to improve outcomes.

Summary: We have presented a novel care pathway based on a clinical evaluation, encompassing a daily hospital devoted to the management of toxicities, an iTox multidisciplinary board, and a pharmacovigilance database. This pathway involves a translational research program.The toxicity day hospital allowed us to care for patients at an early stage of an adverse event and to establish whether anticancer treatment was responsible for the onset of symptoms and/or biological abnormalities.The objective of this pathway is to enhance the quality of life and compliance of oncology treatment, while minimizing the necessity for unscheduled care.

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引用次数: 0
The role of the microbiome in skin cancer development and treatment.
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-23 DOI: 10.1097/CCO.0000000000001120
Anthony Martin Fuentes

Purpose of review: Recent research underscores the significant influence of the skin and gut microbiota on melanoma and nonmelanoma skin cancer (NMSC) development and treatment outcomes. This review aims to synthesize current findings on how microbiota modulates immune responses, particularly enhancing the efficacy of immunotherapies such as immune checkpoint inhibitors (ICIs).

Recent findings: The microbiota's impact on skin cancer is multifaceted, involving immune modulation, inflammation, and metabolic interactions. Beneficial strains like Bifidobacterium and Lactobacillus have shown potential in supporting anti-PD-1 and anti-CTLA-4 therapies by promoting T-cell activation and immune surveillance. Evidence from preclinical and clinical studies, including fecal microbiota transplantation (FMT), highlights improved response rates in patients with microbiota-rich profiles. Notably, certain bacterial metabolites, such as inosine, contribute to enhanced antitumor activity by stimulating IFN-γ in CD8+ T cells.

Summary: Understanding the interplay between microbiota and skin cancer treatment opens promising avenues for adjunctive therapies. Probiotic and prebiotic interventions, FMT, and microbiota modulation are emerging as complementary strategies to improve immunotherapy outcomes and address treatment resistance in melanoma and NMSC.

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引用次数: 0
Chemotherapy-induced nausea and vomiting: can we do better?
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-23 DOI: 10.1097/CCO.0000000000001114
Florian Scotté

Purpose of review: Although the management of nausea and vomiting induced by cancer treatments has evolved, several questions remain unanswered.

Recent findings: New antiemetics have been developed these last decades with therapeutic indications to be defined according to the anticancer regimen and partly as a consequence of the assessment of individual patient risk factors. Guidelines still seem to have a low level of knowledge and compliance, with a role for scientific societies in term of dissemination and education. A number of persistent issues relating to emesis still need improvement in prevention and management. Nausea remains a subjective semantic whose evaluation should possibly benefit from educational programs. The risk classification of anticancer drugs must be regularly updated, requiring regular literature reviews and the integration of data from clinical trials relating to emerging anticancer drugs. Recent data, particularly in the context of emerging drugs, highlight the importance to consider emesis' impact beyond the 5-day period, with a potential adaptation of antiemetic prophylaxis, including the mode of administration of oral drugs.

Summary: Guidelines update is presented with literature answers to the current issues in order to improve quality of patient's management in the context of emesis related to anticancer therapies.

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引用次数: 0
Cancer-associated thrombosis: what is new?
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-17 DOI: 10.1097/CCO.0000000000001125
Isabelle Mahé, Samuel Benarroch, Sadji Djennaoui, Rabiaa Hakem, Abdallah Ghorbel, Hélène Helfer, Jean Chidiac

Purpose of review: The life expectancy of patients suffering from thrombosis associated with cancer has improved significantly, making them a chronic disease. Patients with thrombosis and cancer are fragile. Treated with anticoagulants, they remain at risk of complications.

Recent findings: Consequently, news issues emerge for clinical practice: anticoagulation therapy personalization is required to optimize the benefit ratio, involving patient characteristics and cancer characteristics. During follow-up, prediction score are designed and investigated to help identify and discriminate patients at risk of venous thromboembolism recurrences and major bleedings. Considering the improved prognosis of patients with cancer and cancer-associated thrombosis, the question of extended treatment arises, representing a major unmet need to date. Finally, new strategies, in particular anti-XI agents that appear attractive options, are currently being evaluated in the treatment of thrombosis associated with cancer.

Summary: The improved prognosis of patients with cancer-associated thrombosis is accompanied by new therapeutic strategies to improve the benefit-risk ratio of anticoagulant treatment in these fragile patients, at risk of both venous thromboembolic recurrence and haemorrhagic complication.

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引用次数: 0
Can febrile neutropenia re-invent its self?
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-16 DOI: 10.1097/CCO.0000000000001116
Aspasia Georgala, Jean Klastersky

Purpose of review: Febrile neutropenia as a complication of cytotoxic chemotherapies, remains a major event in the medical journey of hematology and oncology patients. In this review, we are trying to review the new elements and highlights that are shaping febrile neutropenia in nowadays.

Recent findings: Introduction of risk-stratification, expanded use of granulocyte-colony stimulating factor and oral treatment for selected patients and rapid administration of antibiotics revolutionized the treatment of febrile neutropenia. Oral treatment with moxifloxacine or amoxicillin-clavulanate + ciprofloxacin has already been widely tested and is actually a standard of care for a meticulously selected group of patients managed as ambulatory patients. Intravenous treatment of febrile neutropenia is a major challenge for clinicians and microbiologists since the blast of the "silent pandemic" of antimicrobial resistance.

Summary: In this setting, strategies that reduce the chances of febrile neutropenia, misuse of antibiotics and enhance the rigorous control of infections may offer a chance to improve the management of febrile neutropenia and offer to our patients the chance to continue their antineoplastic treatment without perturbations.

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引用次数: 0
Is there still a place for lymph node dissection for stage III melanoma since the approval of adjuvant therapy.
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-16 DOI: 10.1097/CCO.0000000000001118
Oumnia Mouna, Charlotte Hanssens, Michel Meyers, Mireille Langouo

Purpose of review: This review aims to explore the evolving management strategies for stage III melanoma, focusing on the comparative effectiveness of traditional surgical approaches like complete lymph node dissection (CLND) versus modern adjuvant therapies. It also examines the latest evidence on the efficacy, risks, and complications of these strategies, emphasizing the role of shared decision-making between patients and clinicians.

Recent findings: Recent clinical trials and meta-analyses, including the MSLT-II and DeCOG-SLT studies, have demonstrated that CLND may not significantly improve survival outcomes in melanoma patients with sentinel lymph node biopsy (SLNB)-positive status. Instead, a shift towards observation combined with adjuvant therapies such as immune checkpoint inhibitors and targeted therapies (for BRAF-mutant melanoma) has been observed. These approaches have been associated with similar or improved recurrence-free survival rates and reduced treatment-related complications. However, challenges remain in establishing standardized protocols for adjuvant therapy use.

Summary: The management of stage III melanoma is rapidly transitioning from routine CLND towards a more individualized approach that incorporates active surveillance and adjuvant therapies based on tumor biology and patient-specific factors. Multidisciplinary discussions are essential to guide treatment decisions, and further research is required to develop clear, evidence-based protocols.

综述目的:本综述旨在探讨III期黑色素瘤不断发展的治疗策略,重点关注传统手术方法(如完全淋巴结清扫术(CLND))与现代辅助疗法的疗效比较。它还研究了这些策略在疗效、风险和并发症方面的最新证据,强调了患者和临床医生共同决策的作用:最近的临床试验和荟萃分析(包括 MSLT-II 和 DeCOG-SLT 研究)表明,对于前哨淋巴结活检 (SLNB) 阳性的黑色素瘤患者来说,CLND 可能不会显著改善生存预后。相反,人们已经开始转向观察与辅助疗法相结合,如免疫检查点抑制剂和靶向疗法(针对 BRAF 突变的黑色素瘤)。这些方法与类似的无复发生存率或更高的无复发生存率以及治疗相关并发症的减少有关。总结:III 期黑色素瘤的治疗正迅速从常规 CLND 过渡到更加个体化的方法,其中包括基于肿瘤生物学和患者特异性因素的主动监测和辅助治疗。多学科讨论对于指导治疗决策至关重要,需要进一步研究以制定明确的循证方案。
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引用次数: 0
Peripheral neuropathy: from guidelines to clinical practise.
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-16 DOI: 10.1097/CCO.0000000000001112
Berit Jordan, Franziska Jahn, Karin Jordan

Purpose of review: Chemotherapy-induced peripheral neuropathy (CIPN) is a substantial adverse effect of anticancer therapy. No effective preventive strategies are established in clinical routine, although some forms of cryotherapy or compression therapy seem to be promising. CIPN is difficult to grade objectively and has mostly relied on a clinician- or patient-based rating that is subjective and not easily reproducible.

Recent findings: Recent preclinical and clinical studies showed an indicative hint of serum neurofilaments for axonal damage as a biomarker and might be introduced in clinical practice in the future. Axonal degeneration in toxic neuropathy is triggered by molecular pathways including SARM1. Presence of certain genotypes predispose for developing severe vincristine neuropathy. Still, treatment of CIPN is focused on treating neuropathic pain primarily based on physicians experience. A positive effect of membrane stabilizers such as gabapentinoids could not be shown in a systematic review mostly due to inconsistent study populations. In the treatment and prevention of functional disability, physical exercise including sensorimotor-training and whole-body vibration seems promising.

Summary: More research is needed on quantification of biomarkers indicative for axonal degeneration prior to CIPN symptom expression. All these recent findings should support the health-care team for a patient centred treatment approach.

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引用次数: 0
Emerging toxicities in oncology.
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-16 DOI: 10.1097/CCO.0000000000001122
Didier Mayeur

Purpose of review: New anticancer drugs often are associated with improved results, such as objective response and disease-free survival. But with these new drugs, patients, caregivers and medical oncologist have to face new toxicities, quite different from the side effects of conventional chemotherapy. The aim of this review is to share the actual knowledge about these new toxicities.

Recent findings: We review here some of these new toxicities, as ocular, cardio, lung and mucocutaneous toxicities, as well as specific side effects of CAR-T cells. We also discuss a specific problem, which is financial toxicity.

Summary: With this review, caregivers and medical oncologists will be aware of these new toxicities and able to develop their own network of specialized practitioners to provide the best possible supportive care.

综述的目的:新的抗癌药物往往能改善疗效,如客观反应和无病生存期。但在使用这些新药的同时,患者、护理人员和肿瘤内科医生也不得不面对与传统化疗副作用截然不同的新毒性。本综述旨在分享有关这些新毒副作用的实际知识:我们在此回顾了其中一些新的毒性反应,如眼部、心脏、肺部和皮肤黏膜毒性反应,以及 CAR-T 细胞的特殊副作用。小结:通过这篇综述,护理人员和肿瘤内科医生将了解到这些新的毒性,并能发展自己的专业医师网络,提供尽可能好的支持性护理。
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引用次数: 0
How to monitor the side effects of treatments in cancer patients.
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-06 DOI: 10.1097/CCO.0000000000001123
Mario Di Palma

Purpose of review: Monitoring the side effects of treatments in cancer patients is a key challenge in clinical practice, especially with the development of oral therapies.The impact on patients is multifaceted: morbidity or even life-threatening risks in the case of severe side effects; deterioration in quality of life and functional abilities; lower adherence to treatments; reduced dose intensity, which can affect the efficacy of therapies.

Recent findings: The availability of digital tools for remote patient monitoring is transforming our ability to track these patients effectively. These tools enable monitoring of a large number of patients while identifying those experiencing difficulties; early detection of side effects.

Summary: The aim of this article is to provide an overview of the use of digital tools for patient follow-up, their relevance, benefits, and the impact on both patients and healthcare organization.

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引用次数: 0
Prophylactic cranial irradiation for small cell lung cancer in the era of immunotherapy and molecular subtypes. 免疫治疗和分子亚型时代小细胞肺癌的预防性颅脑照射。
IF 2.8 4区 医学 Q2 ONCOLOGY Pub Date : 2025-01-01 Epub Date: 2024-12-02 DOI: 10.1097/CCO.0000000000001111
Veronika Pozonec, Maria Dorothea Pozonec, Clemens Aigner, Joachim Widder, Kristiina Boettiger, Zsolt Megyesfalvi, Balazs Dome

Purpose of review: Small cell lung cancer (SCLC) is an aggressive disease with a poor prognosis, whereas its metastatic capacity carries a predilection for the brain. Although prophylactic cranial irradiation (PCI) has been used to address this problem, upcoming alternatives might necessitate reflection of its application in SCLC treatment.

Recent findings: The addition of immunotherapy to treatment guidelines has provided a new strategy for the management of brain metastases. Complementation of immunotherapy with active MRI surveillance could potentially replace PCI and avoid irradiation-related cognitive side effects. SCLC's molecular profile is heterogeneous, with differential response to treatment modalities between subgroups. Investigation of these variances might be essential to improve therapeutic outcomes in SCLC patients.

Summary: The role of PCI in SCLC treatment must be examined in light of immunotherapy. We summarize recent results, bearing SCLC subtypes and therapeutic vulnerabilities in mind, to derive tailored treatment strategies for SCLC patients in future settings.

综述目的:小细胞肺癌(SCLC)是一种预后不良的侵袭性疾病,其转移能力倾向于脑部。虽然预防性颅脑照射(PCI)已被用于解决这一问题,但未来的替代方案可能需要反思其在SCLC治疗中的应用。最近的发现:在治疗指南中加入免疫疗法为脑转移的治疗提供了一种新的策略。免疫治疗与主动MRI监测的补充可能潜在地取代PCI,并避免辐射相关的认知副作用。SCLC的分子特征是异质性的,不同亚组对治疗方式的反应不同。研究这些差异可能对改善SCLC患者的治疗效果至关重要。总结:PCI在SCLC治疗中的作用必须结合免疫治疗来考察。我们总结了最近的研究结果,考虑到SCLC亚型和治疗脆弱性,以便在未来的环境中为SCLC患者提供量身定制的治疗策略。
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引用次数: 0
期刊
Current Opinion in Oncology
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