Current Opinion in Oncology最新文献

Purpose of review: Oncologic emergencies are a critical interface between oncology and acute-care medicine. As global cancer trends evolve and healthcare disparities persist, this review seeks to address the pressing need to understand the epidemiology, predictors of outcomes, and care strategies for oncological emergencies across diverse healthcare contexts. The limited data available in this field underscores the vast knowledge gaps and the potential for significant scientific discovery.

Recent findings: North American research networks have highlighted the variability in emergency department admissions and identified key determinants of outcomes, including functional status and disease staging. European studies have revealed that emergency presentations are frequently linked to advanced disease, whereas data from Asia and Oceania suggest that tumor burden and ethnicity significantly influence emergency care. In resource-limited regions, infection-related malignancies and inadequate healthcare infrastructure exacerbate challenges in managing oncologic emergencies. Despite these regional differences, consistent predictors of clinical outcomes, such as performance status and disease stage, have emerged as universal themes.

Summary: This review highlights the need for targeted research and innovative interventions to bridge gaps in knowledge and care delivery. Region-specific strategies based on local epidemiological insights can improve patient outcomes and promote equity in oncological emergency management worldwide.

Purpose of review: Medical treatment of angiosarcomas is based on chemotherapy and tyrosine kinase inhibitors with limited efficacy. Immune therapy represents an exciting new therapeutic opportunity in this indication.

Recent findings: Several clinicals trials, randomized or not, have been recently released to better define the scope and efficacy of immune therapy in angiosarcoma.

Summary: Angiosarcoma is a rare and malignant aggressive soft tissue sarcoma with a wide diversity of presentation in terms of location, aetiology, biology. Medical treatment may be considered as neo adjuvant treatment for locally advanced disease or as palliative treatment in case of metastatic spreading. Doxorubicin and paclitaxel are the two regimens with highest level of evidence of efficacy. Other chemotherapy like gemcitabine or antiangiogenic tyrosine kinase inhibitors may also be efficient. Immune therapy represents an exciting new opportunity under assessment, the selection of patients likely to benefit from this strategy according to clinical or biological criteria remains to be defined. The access to innovative therapy for angiosarcoma is limited by the rarity and heterogeneity of the disease.

Purpose of review: Murine double minute 2 (MDM2) is an oncogene that plays a crucial role in regulating the activity of the tumor suppressor protein p53. By binding to p53, MDM2 promotes its degradation, thus promoting the malignant proliferation. The MDM2-p53 interaction has thus generated interest as a therapeutic target, particularly in some sarcomas characterized by the amplification of the MDM2 gene. In this manuscript, we provide an overview of the current and emerging targeted therapies for MDM2-amplified sarcomas.

Recent findings: Although several agents have been developed with promising results in preclinical studies, these molecules have failed to show conclusive benefit in clinical trials. Nevertheless, the MDM2-p53 pathway inhibition remains an area of ongoing investigation, including the development of novel inhibitors and combination strategies.

Summary: In the era of precision medicine, there is an unmet need for new effective therapies in patients with inoperable/metastatic sarcomas. In some histotypes, MDM2 is overexpressed due to gene amplification, leading to a reduced p53 activity and then in oncogenic transformation. By blocking the activity of MDM2, p53 function can be restored, potentially leading to tumor cell death. However, further research is needed to optimize the translation of MDM2 inhibitors into the clinical setting.

Purpose of review: Aspirin (acetylsalicylic acid, ASA) is gaining recognition as a possible chemopreventive agent for colorectal cancer (CRC). This review explores current evidence on ASA use in both primary and secondary prevention of CRC among sporadic cases and in patients with Lynch syndrome (LS).

Recent findings: Observational cohorts consistently indicate a modest, time-dependent reduction in CRC incidence with long-term ASA use, especially in individuals with elevated baseline risk. In LS, extended follow-up from randomized trials reveals a robust protective effect, although the ideal dose remains unsettled. For secondary prevention, randomized trials in unselected patients did not detect a clear advantage, on the other hand tumors harboring Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (PIK3CA)-mutation have a substantial gains in recurrence prevention, emphasizing the role of molecular stratification.

Summary: Accumulating evidence supports a nuanced approach to ASA chemoprevention, tailoring treatment to each patient's genetic background, lifestyle factors, and risk profile. Ongoing research on dosage optimization and biomarker-driven selection is expected to further refine the integration of ASA into standard CRC prevention strategies.

Purpose of review: Despite remarkable progress in the management of gastrointestinal stromal tumors (GISTs), critical challenges persist. Key aspects such as risk stratification, the optimal duration of adjuvant therapy, and strategies to enhance the efficacy of first-line treatment remain subjects of ongoing debate. This review explores emerging concepts and innovative approaches aimed at refining patient selection and optimizing therapeutic decision-making to further improve clinical outcomes.

Recent findings: Molecular and genomic parameters have the potential to enhance traditional risk models, enabling more precise stratification of high-risk patients. Innovations in artificial intelligence and liquid biopsy are emerging as powerful tools for refining predictions of recurrence and treatment response. Meanwhile, the definition and prognostic significance of tumor rupture remain pivotal challenges that influence both risk assessment and adjuvant therapy decisions. Furthermore, transcriptomic and multiomic analyses have unveiled distinct GIST subtypes with significant prognostic and therapeutic implications, paving the way for more tailored treatment strategies.

Summary: Integrating molecular features into clinical decision making may refine risk assessment and personalize the treatment in patients with GIST. Future research should focus on validating these tools and redefine clinical trial designs to accelerate drug development for this rare disease.

Purpose of review: Maintenance therapy (MT), particularly antiangiogenic approaches such metronomic chemotherapy (MC), correspond to the continuous administration of low-dose anticancer agents in a context of minimal residual disease. While widely used in pediatric acute lymphoblastic leukemia for decades, MT has recently shown promise in solid tumors. Additionally, antivascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI) are increasingly explored in pediatric sarcomas.

Recent findings: This review summarize current evidence on MT efficacy in pediatric sarcomas, focusing on MC and TKIs. It examines their impact on the tumor microenvironment and cancer progression, as well as potential future applications, including standalone use or combination with targeted therapies, immunotherapies and/or drug repurposing.

Summary: MT has been demonstrated to improve outcomes in specific sarcomas, especially high-risk localized rhabdomyosarcoma, and has therefore become a standard of care. Its role in other sarcomas, such as Ewing sarcoma and osteosarcoma, is under investigation. However, critical challenges remain, including optimizing drug selection, treatment duration, and patient stratification to maximize benefits.

Purpose of review: This review aims to show the current evidence and the challenges that remain to guide future research on the prevalence, incidence, prognosis, and factors associated with burnout, and current interventions for its prevention and reduction.

Recent findings: An overview of systematic reviews with meta-analyses found that burnout is highly prevalent among oncologists and oncology nurses, mainly emotional exhaustion. However, these meta-analyses showed a lack of original research from continents such as Africa or Oceania, and no studies were meta-analyzed evaluating physical therapists or psycho-oncologists. To our knowledge, the incidence of occupational burnout has not been meta-analyzed on this topic, and the number of prospective cohort studies and randomized clinical trials is probably limited. On the other hand, some cross-sectional studies and nonrandomized clinical trials have been recently published. These studies have highlighted the association between burnout with psychological (e.g. anxiety) and occupational factors (e.g. job demands) and the reduction of burnout using different psychological interventions.

Summary: Occupational burnout is a topic of interest in oncology. However, important gaps in knowledge remain and need to be filled before establishing firm conclusions on this topic.

Purpose of review: Despite guidelines, life-sustaining treatment preferences (LSTP) documentation for advanced cancer patients remains limited and reactive to clinical events. As proactive documentation is a core component of early palliative care (EPC), addressing barriers to EPC can in parallel facilitate LSTP documentation. This narrative review examines barriers to both processes and proposes recommendations to overcome them.

Recent findings: Barriers stem from patients, oncologists, and the healthcare system. Patients and oncologists face communication challenges. For patients, knowledge gaps on illness and LSTP documentation, family dynamics prioritizing informal over formal discussions, and limited intercultural considerations, compound these challenges. For oncologists, a curative-focused medical culture reinforces them. In the healthcare system, this culture contributes to deprioritizing LSTP documentation.

Summary: Addressing these barriers requires multilevel recommendations. For patients: interventions to enhance illness understanding, foster culturally sensitive oncologist communication, and optimize care organization. For oncologists: integrating communication training and palliative care (PC) knowledge into oncology fellowships while cultivating a supportive medical culture for LSTP documentation through role modeling and intervision. For healthcare systems: LSTP documentation benchmarks, proactive EPC integration through automated reminders, telehealth, standardized medical records, and reimbursement codes. Assessing the implementation and sustainability of these recommendations is crucial to enhancing proactive LSTP documentation in advanced cancer care.

Purpose of review: While adoptive cell therapies such as chimeric antigen receptor T (CAR-T) cell have demonstrated efficacy in hematological malignancies, their success in solid tumors remains challenging due to tumor heterogeneity, antigen specificity, and the suppressive tumor microenvironment. This review aims to provide an overview of recent advancements in cellular therapies, in sarcomas and other solid malignancies.

Recent findings: In the field of sarcomas, the approval of afamitresgene autoleucel (afami-cel) for synovial sarcoma in Atoxiciugust 2024 marks a milestone in T cell therapy, demonstrating an objective response rate (ORR) of 39% and a median overall survival (OS) of 16.9 months in the SPEARHEAD-1 phase 2 trial. Other trials exploring NY-ESO-1 specific T-cell receptor-engineered T (TCR-T) therapies in myxoid round-cell liposarcoma (MRCL) have shown promising response rates. Beyond sarcomas, CAR-T therapies targeting CLDN18.2 in gastrointestinal cancers, GD2 in gliomas, and PSCA in prostate cancer have demonstrated varying degrees of efficacy, with ongoing research to date.

Summary: Clinically, these therapies highlight the need for improved patient selection criteria, and optimized antigen targeting. Toxicity management must also be taken into account, as cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) can be severe. Further studies should focus on improving safety and T cell persistence, and refining manufacturing processes to increase accessibility and scalability.

Purpose of review: Sarcomas are a rare and heterogeneous group of tumours, making large-scale data collection crucial for research and ultimately improve patient outcomes. This review highlights recent initiatives in sarcoma data collection through national and international networks, emphasizing results derived from collaborative efforts. Given the increasing availability of electronic medical data, this review is timely assessing the readiness of sarcoma collaborative datasets to exploit innovation and increase sustainability in the long-term as well as international collaboration.

Recent findings: Through a systematic review we identified 8 major sarcoma databases (6 national; 2 international). These initiatives all enhanced prognostication and personalized medicine by also integrating clinical and genomic datasets, while increasing data standardization which is the basis for data interoperability and integration across reference centres. Notable efforts, such as the IDEA4RC project, are establishing interoperable data models using sarcoma as use case to enhance global research.

Summary: Collaborative data collection is essential when studying sarcomas. Strengthening international networks will generate real world data networks, increase research and its efficiency, and ultimately ameliorate patient care. Future efforts should focus on expanding data-sharing frameworks, implement innovative solutions for ensuring data interoperability and increase value of real-world evidence in research and therapeutic advancements.