Current oncology最新文献

Recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) carries a poor prognosis; however, immune checkpoint inhibitors have emerged as critical therapeutic options. Although the KEYNOTE-048 trial established the efficacy of pembrolizumab, the population was restricted to major sites (e.g., oral cavity, oropharynx, hypopharynx, and larynx), excluding subsites such as the paranasal sinuses and nasopharynx. To evaluate outcomes in these populations, we conducted a multicenter retrospective study of 167 patients with R/M SCCHN treated with pembrolizumab between December 2019 and February 2022. The cohort comprised 127 patients with tumors in included sites and 27 in excluded subsites. Primary endpoints included overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and immune-related adverse events (irAEs). In the excluded subsite group, median OS was 15.2 months (1-year rate: 70.6%), and median PFS was 4.9 months (1-year rate: 21.2%). The ORR was 22.2% and the DCR was 59.3%. The incidence of irAEs was 25.9%, with Grade ≥ 3 events in 3.7%. Survival outcomes did not differ significantly from those in included sites. These findings suggest the potential efficacy and safety of pembrolizumab in subsites excluded from KEYNOTE-048, warranting validation in prospective trials.

In the last year, great advances in the treatment outcomes of advanced EGFR-mutant NSCLC have been achieved. Two combination regimens, amivantamab plus lazertinib and platin-based chemotherapy plus osimertinib, have yielded, in the phase III randomized trials named MARIPOSA and FLAURA 2, statistically and clinically significant improvements in overall survival compared with monotherapy with osimertinib. However, translation to clinical practice of these relevant results is challenging for two main reasons. The first is that we have no evidence-based tools to choose among the two combinations, except their different safety profiles. The second is that combinations are significantly more toxic than osimertinib alone. Thus, osimertinib remains an effective treatment with an excellent safety profile, perhaps to be considered as still the best option in the majority of elderly patients and in all patients that do not intend to trade-off an excess of toxicity with survival prolongment. The safety and efficacy characteristics of the three treatment options are the basis for a patient-tailored treatment choice, but in a significant proportion of patients, a personal and intimate approach to quality of life and survival prolongment is to be considered the main driver within a well-structured shared decision-making process.

This study aimed to develop machine learning models based on conventional MRI features to classify HER2 expression levels in invasive breast cancer and explore their association with disease-free survival (DFS). A total of 678 patients from two centers were included, with Center 1 divided into training and internal test sets and Center 2 serving as an external test set. Random Forest models were trained to distinguish HER2-positive vs. HER2-negative (Task 1) and HER2-low vs. HER2-zero tumors (Task 2) using BI-RADS-based MRI features. SHapley Additive exPlanations were applied to rank feature importance, assist feature selection, and enhance model interpretability. DFS was analyzed using Kaplan-Meier curves and log-rank tests. In Task 1, key features included tumor size, axillary lymph nodes, fibroglandular tissue, peritumoral edema, and multifocal, achieving AUCs of 0.75 and 0.73 in the internal and external test sets, respectively. In Task 2, tumor size, peritumoral edema, and multifocal yielded AUCs of 0.73 and 0.72, respectively. Higher task-specific model scores were associated with shorter DFS in Task 1 (p = 0.037) and longer DFS in Task 2 (p = 0.046). MRI-based machine learning models can noninvasively stratify HER2 expression levels, with potential for prognostic stratification and clinical application.

Cervical cancer is a largely preventable disease, with over 90% of cases caused by persistent infection with human papillomavirus (HPV). Despite the availability of HPV vaccination and cervical screening, incidence rates in Canada have been rising since 2015, particularly among underserved populations. This study investigates contributing factors behind cervical cancer diagnoses in Eastern Ontario over a two-year period to identify gaps leading to failures in prevention and screening. A retrospective chart review was conducted for cervical cancer cases diagnosed between January 2022 and December 2023 at two regional cancer centres in Eastern Ontario. Cases were categorized as screen-detected, inadequately screened, or system failure, based on prior screening history and care processes. Data was collected on patient, screening, and cancer characteristics. Of 132 cases, 22 (16.7%) were screen-detected, 73 (55.3%) were inadequately screened, and 37 (28.0%) were attributed to healthcare system failure. Later-stage disease was significantly more common in the latter two groups. Thirty-one (23.5%) cases presented with palliative diagnoses, and 18 (13.6%) individuals died within 2.5 years. Inadequate screening was associated with rurality, deprivation, and lack of a primary care provider. System failures included false-negative Pap tests, loss to follow-up, and misapplication of screening guidelines. This study evaluated failures in cervical cancer prevention, which led to cervical cancer diagnoses in Eastern Ontario. Gaps included suboptimal screening participation, lack of access to care, health care system breakdowns, and limitations of the Pap test. Findings provide concrete suggestions for eliminating cervical cancer in Canada.

Background: Lung carcinoids-typical and atypical-are rare neuroendocrine tumors (NETs) representing 1-2% of lung cancers. Despite clinicopathological differences, their clinical management often mirrors lung cancer protocols rather than NET-specific recommendations. Objectives: Portray a 12-year real-world experience with lung carcinoids at a Comprehensive Cancer Center, identifying gaps in diagnostic work-up, treatment decision-making, and follow-up. Methods: Retrospective observational cohort study of adult patients with histologically confirmed lung carcinoids diagnosed at IPO Porto between January 2013 and December 2024. Demographic, clinical, imaging, and treatment data were collected from electronic patient records. Analyses were descriptive. Results: Among 179 identified cases, 129 met eligibility criteria. Median age was 62 years (range 18-84); 53.6% were women and 53.5% were non-smokers; 84.5% had ECOG-PS 0-1. The most frequent presentation was respiratory symptoms (34.1%), followed by incidental findings (43.4%, of which ~20% were during staging or surveillance of other cancers). Typical carcinoids accounted for 49.6% and atypical for 43.4%. FDG-PET/CT was requested in 70.9% of cases, including many with typical carcinoid, and SSTR-PET/CT in 64.6% (dual PET in 38.8%). Most patients (65.1%) presented with stage I disease; 17.1% were stage IV. Mean time-to-first treatment was 83 days (range 1-259). Surgery was the first treatment option for 78.3% of patients. Conclusions: This real-world series highlights heterogeneity in diagnostic pathways, excessive FDG-PET use in typical carcinoids, and non-standardized follow-up. Dedicated multidisciplinary lung-NET boards and national reference centers are needed to homogenize and streamline patient management.

The incidence of peripheral lung squamous cell carcinoma (p-LUSC) has increased in recent years, but the clinical features of early-stage p-LUSC remain unclear. In the present study, we aim to elucidate the general clinical features of p-LUSC by comparing it with peripheral lung adenocarcinoma (p-LUAD). Patients with p-LUSC or p-LUAD who were at an early imaging stage and underwent complete lobectomy with systematic lymph node dissection were included. The clinical characteristics of p-LUSC were elucidated through comparative analysis with p-LUAD, and independent prognostic factors for recurrence-free survival were identified. A total of 103 patients with p-LUSC and 600 patients with p-LUAD were included. Compared with p-LUAD, all p-LUSC cases appeared as solid nodules (SDNs) on imaging, and p-LUSC was associated with the male sex, older age, smoking history, lobulation sign, interstitial pneumonia, and a shorter volume doubling time. In terms of malignant aggressiveness, p-LUSC demonstrated a significantly lower lymph node metastasis rate than SDNs of p-LUAD in the >2.0 to ≤3.0 cm group, while no statistically significant difference was observed between the two groups in the 0-2.0 cm group. As for prognosis, tumor size and lymph node metastasis were found as independent risk factors for tumor recurrence.

Major hepatectomy (MH) has traditionally been associated with higher R0 rates in colorectal liver metastases (CRLM), but at the cost of increased morbidity. Parenchymal-sparing hepatectomy (PSH) has emerged as an alternative approach aimed at reducing perioperative complications while preserving functional liver parenchyma without compromising oncological outcomes. We retrospectively analyzed 248 consecutive patients undergoing liver resection for CRLM between 2016 and 2025, classified as PSH (n = 215, 86.7%) or MH (n = 33, 13.3%). MH was performed more frequently in patients with greater tumor burden, including larger lesions, more numerous metastases, and bilobar disease (all p < 0.001). PSH was associated with shorter hospital stay, fewer postoperative complications, and lower 30-day readmission rate. In multivariable Cox analyses, surgical strategy was not associated with recurrence-free survival or overall survival, which were primarily driven by tumor burden. Among patients who developed liver recurrence, repeat hepatectomy was more often feasible after PSH than MH (p = 0.026), emphasizing the long-term value of preserving functional parenchyma. Overall, PSH was associated with lower postoperative morbidity, enabling earlier recovery, while facilitating future liver resections when needed in this chronically evolving disease.

Purpose: With the addition of palbociclib to endocrine therapy, many hormone receptor-positive (HR+) metastatic breast cancer (mBC) patients experience toxicities that can lead to dose reductions and cycle delays. We examined the actual doses of palbociclib received by patients and their treatment responses. These dose adjustments, made at the physician's discretion, are not always consistent with pharmaceutical company recommendations. The aim of this study was to assess the influence of dose adjustments on dose intensity and treatment response in our patients. Methods: Records of patients with HR+ mBC treated with palbociclib between December 2016 and January 2019 at the Sainte-Catherine Institute were retrospectively reviewed. Dose intensity was defined as the total dose of palbociclib received by each patient during the first six months of treatment. Anticipated dose reductions and extended cycle delays were recorded. Treatment response at six months and survival were assessed using statistical analyses. Results: A total of 131 women were included; the median age was 67 years. Forty-six patients (35%) experienced an anticipated dose reduction or an extended cycle delay during the first six months of treatment. Logistic regression analysis showed that factors correlated with six-month treatment response included anticipated dose reduction or extended cycle delay (OR = 14.6, 95% CI 3.74-97.4, p < 0.001), cycle delay > 4 weeks (OR = 5.94, 95% CI 1.58-21, p = 0.01), initial dosage < 125 mg (OR = 4.09, 95% CI 1.13-13.7, p = 0.034), and six-month dose intensity < 14,250 mg (OR = 26.0, 95% CI 4.91-481, p < 0.001). Conclusions: In this real-world assessment of clinical outcomes in French patients with HR+ mBC treated with palbociclib, a palbociclib dose intensity lower than recommended-particularly due to cycle delays longer than four weeks-was associated with an increased risk of six-month disease progression.

Cervical cancer remains a significant global health burden, disproportionately affecting women in low- and middle-income countries despite being preventable. Since 2018, rapid advances in molecular profiling, immunotherapy, refinement of minimally invasive surgery, and targeted therapeutics have transformed diagnostic and therapeutic paradigms. This narrative review synthesizes clinical and translational progress across the continuum of care from 2018 to 2025. We summarize the evolving landscape of precision screening-including HPV genotyping, DNA methylation assays, liquid biopsy, and AI-assisted cytology-and discuss their implications for global elimination goals. Surgical management has shifted toward evidence-based de-escalation with data from SHAPE, ConCerv, and ongoing RACC informing fertility preservation and minimally invasive approaches. For locally advanced disease, KEYNOTE-A18 establishes pembrolizumab plus chemoradiation as a new curative standard, while INTERLACE underscores the benefit of induction chemotherapy. In the metastatic setting, survival outcomes have improved with the integration of checkpoint inhibitors (KEYNOTE-826, BEATcc, EMPOWER-Cervical 1), vascular-targeted therapies, and antibody-drug conjugates, including tisotumab vedotin and emerging HER2 and TROP-2-directed agents. We further highlight emerging biomarkers-PD-L1, TMB, MSI status, HPV integration patterns, APOBEC signatures, methylation classifiers, ctHPV-DNA-and their evolving role in treatment selection and surveillance. Future directions include neoadjuvant checkpoint inhibition, PARP-IO combinations, HER3-directed ADCs, DDR-targeted radiosensitizers, HPV-specific cellular therapies, and AI-integrated precision medicine. Collectively, these advances are reshaping cervical cancer care toward biologically individualized, globally implementable strategies capable of accelerating WHO elimination targets.

Prostate cancer survivors require coordinated long-term care after treatment. We examined patterns of follow-up care and identified characteristics associated with the frequency of radiation oncology (RO) visits during survivorship. We conducted a population-based cohort study of men diagnosed with prostate cancer between April 2010 and March 2019 in Ontario, Canada, who underwent first-line radiotherapy. Survivorship began three years following radiation. Using a recurrent event framework, we identified demographic and clinical characteristics associated with the rate of RO follow-up. Survivors seeking RO follow-up declined by 46.2% over five years of survivorship. Higher-risk characteristics, such as higher ISUP grade, higher stage, detectable prostate-specific antigen (PSA) score, and receipt of brachytherapy and/or hormones, were associated with more frequent RO visits. For instance, relative to International Society of Urological Pathology (ISUP) Grade 1, those with Grades 3 through 5 experienced follow-up rates that were 20%, 25%, and 34% higher, respectively. Despite concordance between patient risk and rate of RO follow-up, 23.6% of survivors continued to visit their RO providers into their fifth year of survivorship, more than half of whom were ISUP grades 1-2. Primary care follow-up remained stable. While frequency of RO follow-up appropriately reflected patient risk profile, many low-risk survivors still sought long-term RO-led care. This suggests an opportunity to encourage lower-risk prostate cancer survivors to seek follow-up care with their general practitioner.