Current Opinion in Oncology最新文献

Purpose of review: this review aims to underscore the significance of the growing number of advances related to Richter transformation (RT), an aggressive form of lymphoma arising in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma.

Recent findings: The development of sequencing analytic tools and single-cell approaches has overcome the major challenge of cellular admixture in RT, enabling a deeper understanding of the genetic alterations driving transformation from CLL to RT. These techniques have also made it possible to detect RT clones long before clinical onset. In parallel, novel targeted therapies for CLL and immunotherapeutic strategies for lymphomas are offering renewed hope. Recent phase 2 studies notably support the potential role of immune checkpoint inhibitors and bispecific T-cell engagers in RT, while experience with chimeric antigen receptor T-cell therapies continues to grow, raising hopes for improved outcomes in this historically difficult-to-treat condition.

Summary: recent research is focusing on better understanding the transformation process, improving the early detection of RT, and developing novel targeted and immunotherapy treatments and combinations for patients with RT.

Purpose of review: Follicular lymphoma (FL) and marginal zone lymphoma (MZL) are indolent subtypes of non-Hodgkin lymphoma (iNHL) characterized by a relapsing-remitting disease course. A promising novel therapeutic class emerges with T-cell engaging therapies, which include CD19 directed chimeric antigen receptor T-cell (CAR-T) therapy and CD3xCD20 directed bispecific antibodies (BsABs). This review provides a comprehensive evaluation of their efficacy and safety along with logistical considerations in relapsed/refractory (r/r) iNHL.

Recent findings: Several pivotal CAR-T trials have presented impressive response rates and durable remissions in r/r FL, while data in MZL is scarce. CAR-T is given as a single infusion, but requires a complex logistical infrastructure. Different BsAbs have shown favorable efficacy with a lower rate of acute toxicities. Off-the-shelve availability favors its usability, although prolonged administration of BsAbs might impose a substantial burden for patients. Long-term infection risk is a concern for both treatments. Clinical studies that directly compare CAR-T and BsAbs are still lacking.

Summary: Both CAR-T and BsAbs have demonstrated promising efficacy as treatment modalities in iNHL. Decision making for T-cell engaging therapies should be tailored to patient specific factors and availability. Maturation of follow-up data will further guide evidence-based treatment choices in FL and MZL.

Purpose of review: Endometrial cancer is the most common gynecological cancer among women in high-income countries and the prevalence is projected to increase worldwide because of the obesity epidemic. Surgery is a key step in the management of endometrial cancer. Performing surgery and delivering care to obese patients (BMI ≥ 30 kg/m 2 ) and especially to morbidly obese patients (BMI ≥ 40 kg/m 2 ) is challenging.This review focuses on the advantages of robotic surgery in obese patients with endometrial cancer.

Recent findings: The emergence of robotic surgery is associated with increasing rates of minimally invasive surgery for endometrial cancer. Robotic surgery offers several advantages over conventional laparoscopy, especially in obese patients with endometrial cancer which has led to decreasing rates of conversion to laparotomy. The approach allows surgical staging on obese and morbidly obese patients without increasing complication rates or the length of hospital stay, while improving ergonomics for the surgeon.

Summary: Robotic surgery should be the preferred approach for obese patients with endometrial cancer. Current data confirm its safety and benefits for this group of women, particularly for obese patients with a BMI ≥ 40 kg/m 2 .

Purpose of review: The field of chimeric antigen receptor (CAR) T-cell therapies is rapidly evolving. The number of approved indications for the existing CAR-T products is increasing, and, in parallel, so too is the number of novel products and disease targets being evaluated. Being able to navigate the available evidence is a priority for every hemato-oncologist.

Recent findings: Long-term follow up from pivotal trials, as well as real-world studies of commercial products in a range of B-cell non-Hodgkin lymphoma (B-NHL) have confirmed their ability to produce durable disease control with a manageable toxicity profile in a significant proportion of patients, including populations generally excluded from clinical trials. Nonrelapse morbidity and mortality risk profiles have been better established with long-term follow up, and risk reduction via antimicrobial prophylaxis and monitoring of hematologic recovery are being integrated as part of standard of care for these patients beyond the first-year posttreatment.

Summary: A significant proportion of B-NHL patients can achieve long-lasting remission after CAR-T. Ongoing efforts have identified demographic and disease characteristics associated with optimal response and toxicity. Novel products targeting alternative B-cell antigens or utilizing an allogeneic platform might be an option for those whose disease recurs after anti-CD19 CAR-T, with multiple studies ongoing to define their role in the treatment algorithm.

Purpose of review: The aim of this review is to summarize the available evidence on the use and benefits of minimally invasive surgery (MIS) in the management of ovarian masses and early-stage ovarian cancer.

Recent findings: MIS did not negatively impact survival outcomes or increase perioperative complication rates in patients with early-stage ovarian cancer compared to open surgery, while providing the inherent benefits associated with this surgical approach. Regarding the type of MIS, both laparoscopic and robotic approaches can be used in well selected patients at specialized centers.

Summary: MIS appears to be a feasible and well tolerated surgical option for the evaluation of ovarian masses and for the comprehensive staging of early-stage ovarian cancer patients. Compared to open surgery, MIS offers several advantages, including significantly reduced blood loss, a lower need for transfusion, shorter hospital stays and faster postoperative recovery, without compromising surgical results. Furthermore, extensive retrospective studies have shown comparable survival outcomes between both approaches. However, high-quality evidence from randomized clinical trials is still needed to establish definitive conclusions and draw international recommendations.

Purpose of review: This review aims to provide the latest updates regarding circulating tumor DNA (ctDNA) applications in breast cancer. We discuss the current indications and recent research efforts including important ongoing trials.

Recent findings: In the metastatic setting, ctDNA has an established role for identifying druggable mutations (e.g. PIK3CA, ESR1, etc.). Various ctDNA assays used in randomized trials have been approved by regulatory authorities as companion diagnostic devices. Beyond precision medicine, emerging evidence indicates that ctDNA could be used for disease monitoring and detecting acquired resistance mechanisms. In the early setting, two types of ctDNA detection assays can be used: tumor-agnostic and tumor-informed, both having pros and cons. The clinical utility of ctDNA as a surveillance tool for patients with early breast cancer after treatment with curative intent is under investigation. Moreover, many research groups have demonstrated the potential role of ctDNA as a biomarker for assessing response to neoadjuvant systemic treatment and modification of therapeutic plan.

Summary: CtDNA is currently used in metastatic breast cancer for treatment selection, and its clinical utility in early breast cancer is prospectively evaluated.

Purpose of review: Psychological interventions are essential for adolescents and young adults with cancer (AYACs), who experience poor outcomes in their emotional health, social functioning, health behaviors, and cancer-related cognitive impairments (CRCI). This scoping review synthesizes and discusses recent interventions aiming to promote resilience in AYAs with cancer up to 39 years old. The aim is to identify effective intervention strategies and highlight gaps in current research.

Recent findings: Twelve studies were identified, covering interventions targeting physical health, cognition and behavior, social support, emotion regulation, and neurobiology. Most interventions focused on physical activity and cognitive-behavioral approaches, demonstrating positive effects on psychological distress, self-efficacy and quality of life. However, there is a lack of interventions addressing social support, neurobiological resilience, and emotion regulation, despite their well established role in fostering adaptation to adversity.

Summary: Findings underscore the importance of integrative, multimodal approaches for resilience-building in AYACs. Future research should prioritize interventions that incorporate social, emotional, and neurobiological dimensions while ensuring accessibility through digital health solutions. Additionally, early implementation of psychological interventions during the initial cancer treatment period could be critical for mitigating long-term psychological distress and cognitive impairments. Co-constructing interventions with AYACs through participatory approaches is essential to enhance their effectiveness.

Purpose of review: Integrative oncology (IO) has evolved into an evidence-informed discipline endorsed by major oncology organizations. However, integrating IO into standard oncology care remains a challenge, often dependent on institutional culture and provider attitudes. This exploratory pilot study aimed to assess healthcare professionals' (HCPs) knowledge, communication practices, perceived needs, and perspectives regarding IO in a Belgian Comprehensive Cancer Center with no preexisting IO pathway.

Recent findings: Among the 33 participants, 45% understood IO as a patient-centered approach, while 88% acknowledged complementarity to conventional medicine. However, 24% found its definition unclear. Physician-patient communication remains challenging, with 48% of HCPs believing patients hesitate to discuss IO. Key needs include training (88%), standardized communication tools (45%), and a directory of recommended therapists (94%). The interviews facilitated a shift in perception, with 55% of HCPs expressing increased willingness to engage in IO initiatives.

Summary: Successfully integrating IO requires tailored training, specialized referents, and a well structured care pathway. The observed shift in mindset among HCPs highlights the importance of awareness and collaborative solution-building for effective IO adoption.

Purpose of review: The purpose of this review is to evaluate the role of epigenetic-targeting approaches in the management of neuroendocrine neoplasms (NENs), particularly as a priming strategy for subsequent therapies. We explore the molecular basis of epigenetic modifications in NENs, and we review preclinical and clinical studies on DNA methyltransferase and histone deacetylase (HDAC) inhibitors.

Recent findings: DNA methyltransferase and HDAC inhibitors can upregulate SSTR2 expression, thereby improving radioligand uptake and treatment response in NENs. The LANTana study investigates ASTX727 as a strategy to restore SSTR2 expression in metastatic NENs, allowing previously ineligible patients to receive PRRT. Preclinical studies demonstrate that combining epigenetic agents with radiotherapy, chemotherapy, or targeted inhibitors can enhance tumour sensitivity and overcome resistance.

Summary: Epigenetic modifications play a crucial role in NENs, influencing tumour progression, therapy resistance, and SSTR2 expression. Epigenetic priming with DNA methyltransferase and HDAC inhibitors can enhance SSTR2 expression, improving the efficacy of PRRT in NENs. The LANTana study and other trials are investigating whether epigenetic-targeting approaches can be integrated into NEN treatment to optimize PRRT and overcome therapeutic limitations.