Current Opinion in Oncology最新文献

Purpose of review: With novel therapeutics improving cancer survival rates, the need for accurate treatment response assessment has become increasingly crucial. The Response Evaluation Criteria in Solid Tumours remains the standard imaging method for evaluation of treatment response, yet it has recognized limitations. Molecular imaging with targeted tracers offers earlier and more precise assessment of treatment efficacy, by capturing biological information beyond a change in tumour size. We discuss these recent advances, including tracers in clinical practice, and novel tracers in the pipeline, and how these can improve our assessment of treatment response.

Recent findings: The development of novel tracers is enabling more precise cancer diagnosis, staging and treatment, and enables the use of targeted treatments. Upcoming tracers offer the potential to predict treatment response prior to treatment, eradicating the morbidity associated with ineffective therapy. Improved PET hardware, such as total body PET, allows accurate insights into factors such as tumour uptake kinetics, which can be paired with artificial intelligence tools to allow prediction of tumour characteristics.

Summary: This review summarizes recent advances in molecular imaging, including tracers that target tumour metabolism, tumour microenvironment and other treatable tumour targets. These aim to improve treatment response assessment, with the hope of improving outcomes by offering personalized and timely treatment adjustments.

Purpose of review: Chimeric antigen receptor T-cell therapy (CAR T) in relapsed, refractory multiple myeloma (RRMM) has rapidly expanded with two FDA-approved agents and many more in the clinical trial pipeline. As such, we aim to review the standard of care and investigational products.

Recent findings: Idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) were initially approved in the fourth-line setting and quickly moved to the second-line and third-line settings due to efficacy. Delayed neurotoxicities remain a challenging entity to consider when deciding on CAR T versus other options. Given the high efficacy of cilta-cel, many trials are evaluating its role as frontline consolidation or even in smoldering myeloma. Many novel CAR T products are being studied and will improve the impressive armamentarium of RRMM therapeutics.

Summary: This is an exciting area with countless studies investigating novel CAR T constructs and sequencing in hopes of further extending and improving our patients' lives.

Purpose of review: The use of minimally invasive surgery (MIS) in advanced ovarian cancer management following neoadjuvant chemotherapy yields potential benefits in patient recovery and quality of life compared with traditional open surgery. MIS techniques, including robot-assisted procedures, have been increasingly utilized in recent years despite ongoing debates about their oncologic safety.

Recent findings: Recent prospective and retrospective studies indicate that MIS for interval debulking after neoadjuvant chemotherapy can achieve similar cytoreductive outcomes (no visible residual disease, CC-0) to laparotomy in carefully selected patients. Key reported advantages include reduced perioperative morbidity, lower blood loss, and shorter hospital stays. Nonetheless, current data are limited by patient selection bias, power of the studies to detect differences, and concerns about accurately detecting small-volume disease laparoscopically. Ongoing randomized controlled trials, such as the LANCE trial, are expected to provide robust evidence to clarify oncologic outcomes of MIS. Additionally, early studies indicate MIS might be feasible for selected cases of recurrent ovarian cancer.

Summary: MIS is emerging as a viable and potentially advantageous alternative to open surgery for advanced ovarian cancer after neoadjuvant chemotherapy, provided careful patient selection and surgical expertise. Definitive conclusions about long-term oncologic outcomes and recurrence require results from randomized clinical trials.

Purpose of review: This review explores the evolving role of minimally invasive surgery (MIS) in early-stage cervical cancer following the landmark LACC trial, which shifted the standard of care back to open surgery. We revisit critical evidence, dissect controversial subgroups, and highlight areas where MIS may still hold clinical value.

Recent findings: Subgroup analyses and recent prospective trials suggest that MIS may remain a viable option for selected patients with low-risk tumours (<2 cm), particularly when preceded by conisation and incorporating protective surgical strategies. The SHAPE trial demonstrated noninferiority of simple hysterectomy compared to radical hysterectomy in these cases, and post hoc analyses indicate comparable outcomes between MIS and open approaches in this context. Additional real-world studies, such as SUCCOR and SUCCOR-Cone, underscore the potential protective role of preoperative conisation and specific intraoperative techniques. Nonetheless, all these findings remain hypothesis-generating and require validation.

Summary: While open surgery remains the current standard for early-stage cervical cancer, evidence is emerging that selected patients with low-risk features might safely undergo MIS, especially within the framework of clinical trials. Ongoing studies are expected to redefine surgical paradigms and guide future practice.

Purpose of review: While advances in lymphoma treatment have improved survival, they are accompanied by a variety of late effects that affect physical health, psychosocial well being, and social reintegration. This review highlights data from recent publications on lymphoma patient survival, including in adolescent and young adult (AYA) patients. Its goal is to support the development of personalized, evidence-based strategies to meet the complex needs of lymphoma survivors.

Recent findings: Recent studies confirm that lymphoma survivors face a wide spectrum of lymphoma and chemotherapy-related late effects, including fatigue, cognitive and neurological symptoms, mental distress, endocrine and sexual dysfunction, bone and oral health issues, increased risk of infections, and reduced work ability. Cardiovascular complications and second cancers remain the leading causes of late mortality. New data are drawing attention to long-term complications following cellular and immunotherapies. Some survivorship care plans and nurse-led interventions have shown promising results, however lymphoma-specific studies and long-term follow-up remain limited.

Summary: Care for lymphoma survivors is becoming an increasingly important part of long-term management. Long-term follow-up care remains highly heterogeneous across the world, lacking systematic and structured approaches. As treatment methods evolve, survivorship models must adapt accordingly to ensure that long-term outcomes and quality of life are adequately addressed in the heterogeneous population of lymphoma survivors.

Purpose of review: The increasing adoption of minimally invasive techniques has transformed the surgical management of endometrial cancer. Among these, single-port techniques, including laparoendoscopic single-site surgery (LESS), robotic single-port laparoscopy (RSPL), and vaginal natural orifice transluminal endoscopic surgery (vNOTES), have emerged as promising alternatives to conventional multiport laparoscopy. This review aims to evaluate recent evidence regarding the feasibility, perioperative outcomes, and oncologic safety of these techniques, with a focus on their role in endometrial cancer staging and management.

Recent findings: Current literature highlights the advantages of single-port techniques, such as reduced postoperative pain, shorter hospital stays, and improved cosmetic outcomes compared to multiport laparoscopy. LESS and RSPL offer enhanced visualization and improved ergonomics, addressing some of the technical challenges associated with single-site surgery. Meanwhile, vNOTES has demonstrated feasibility for hysterectomy and sentinel lymph node mapping, with studies reporting high detection rates and promising perioperative outcomes. However, concerns remain regarding long-term oncologic safety, standardization of SLN procedures, and technical feasibility in obese patients. While preliminary data are reassuring, particularly for RSPL and vNOTES, mature evidence on recurrence and survival outcomes remains limited.

Summary: Single-port techniques and vNOTES represent viable, minimally invasive alternatives in the surgical management of endometrial cancer. Their benefits in perioperative recovery and cosmetic outcomes are well documented, but their widespread adoption is limited by technical challenges, standardization issues, and a lack of long-term oncologic data. Large, multicentric, and randomized trials are necessary to further validate these approaches and establish their role in routine clinical practice.

Purpose of review: To summarize recent treatment strategies for primary central nervous system lymphoma (PCNSL) and present the new avenues for this rare and aggressive disease.

Recent findings: The current induction regimens based on high-dose methotrexate (HD-MTX) give similar and still insufficient response rates. Intensive consolidation with autologous stem cell transplantation has become the standard of care for eligible responder patients, while conventional whole brain radiotherapy has been abandoned due to irreversible treatment-related neurotoxicity. Maintenance treatment is being assessed for elderly and frail patients. Efforts are being made to improve the outcome after induction, mainly by adding targeted therapy to standard HD-MTX-based chemotherapy. A better understanding of PCNSL biology will optimize the use of targeted therapies based on the characteristics of the lymphoma cells and the tumor microenvironment. Preliminary results of chimeric antigen receptor T cells are encouraging. Cytokines or circulating tumor DNA are emerging as strong complementary tools to neuroimaging.

Summary: Outcome of fit patients has improved with intensive consolidation. New avenues include maintenance strategies for elderly and frail patients, targeted induction treatment, modern immunotherapies, and new drug-delivery modalities. Risk stratification and dynamic response assessment are necessary to design and evaluate personalized and response-driven treatment strategies.

Purpose of review: The evaluation of lymph node status is crucial for the correct staging of patients with vulvar carcinoma and to assess whether adjuvant treatment is necessary. Classically, this procedure is performed with an open approach to the inguinal region; however, this procedure is associated with a significant complication rate.For this reason, the video-endoscopic approach to inguinal lymph node assessment has been proposed in recent years. This review aimed to provide an overview on the feasibility and outcomes of the video-endoscopic inguinal lymphadenectomy (VEIL).

Recent findings: VEIL appeared to be a viable alternative to the open approach, with similar outcomes in terms of the number of lymph nodes removed and blood loss. While the postoperative complications rate was lower in the VEIL group, operative times tended to be longer. This may be due to the lack of standardization of the technique and to the variability in video-endoscopic approaches (laparoscopic vs robotic). Sentinel lymph node biopsy with endoscopic approach has also been described.

Summary: VEIL appears to be feasible and safe, adding benefits in terms of postoperative complications. Nevertheless, few studies are available and further data is needed to confirm these findings.

Purpose of review: As the global population ages rapidly, there is an increasing need to address the particular challenges faced by elderly women with gynecological cancers. This review focuses on the role of laparoscopic surgery (LPS) and highlights its benefits, limitations, and future directions in this vulnerable population. By examining recent findings, this study provides timely insights into the application of minimally invasive surgical techniques in the elderly.

Recent findings: Current literature underscores the benefits of LPS, including reduced blood loss, shorter hospital stays, and fewer postoperative complications, making it a viable option for elderly patients. However, challenges such as frailty, comorbidities, and the physiological effects of pneumoperitoneum remain significant. Advances in frailty assessment tools, enhanced recovery after surgery (ERAS) protocols, and robotic-assisted surgery (RAS) are transforming preoperative planning and surgical outcomes.

Summary: Laparoscopic surgery offers considerable advantages for elderly women with gynecologic cancers, balancing oncologic efficacy with reduced perioperative morbidity. Future research must focus on inclusive trials and geriatric-specific guidelines to optimize outcomes and broaden the applicability of minimally invasive techniques in this population.