Current oncology最新文献

Focal therapy has emerged as a balanced middle ground aiming to reduce overtreatment and the risk of progression, as well as patients' distress and anxiety. Focal therapy and partial gland ablation prioritize the precise elimination of the index lesion and a surrounding safety margin to optimize treatment outcomes and lower the risk of residual disease. The paradigm of whole-gland ablation has shifted towards more targeted approaches. Several treatment templates ranging from subtotal and hemiablation to "hockey-stick", quadrant, and even focal lesion ablation have emerged. Many types of energy may be utilized during focal treatment. First, focal therapy can be grossly classified into thermal vs. non-thermal energy. The aim of this non-systematic review is to offer a comprehensive analysis of recently available evidence on focal therapy for PCa.

The treatment landscape for patients with advanced ALK-positive NSCLC has rapidly evolved following the approval of several ALK TKIs in Canada. However, public funding of ALK TKIs is mostly limited to the first line treatment setting. Using linked provincial health administrative databases, we examined real-world outcomes of patients with advanced ALK-positive NSCLC receiving ALK TKIs in Ontario between 1 January 2012 and 31 December 2021. Demographic, clinical characteristics and treatment patterns were summarized using descriptive statistics. Kaplan-Meier analysis was performed to evaluate progression-free survival (PFS) and overall survival (OS) among the treatment groups. A total of 413 patients were identified. Patients were administered alectinib (n = 154), crizotinib (n = 80), or palliative-intent chemotherapy (n = 55) in the first-line treatment. There was a significant difference in first-line PFS between the treatment groups. The median PFS (mPFS) was not reached for alectinib (95% CI, 568 days-not reached), compared to 8.2 months (95% CI, 171-294 days) for crizotinib (HR = 0.34, p < 0.0001) and 2.4 months (95% CI, 65-100 days) for chemotherapy (HR = 0.14, p < 0.0001). There was no significant difference in first-line OS between the treatment groups. In patients who received more than one line of treatment, there was a significant difference in mOS between patients who received two or more lines of ALK TKIs compared to those who received one line of ALK TKI (mOS = 55 months (95% CI, 400-987 days) and 26 months (95% CI, 1448-2644 days), respectively, HR = 4.64, p < 0.0001). This study confirms the effectiveness of ALK TKIs in real-world practice and supports the potential benefit of multiple lines of ALK TKI on overall survival in patients with ALK-positive NSCLC.

Background: Genomics is a foundational element of precision health and can be used to identify inherited cancers, cancer related risks, therapeutic decisions, and to address health disparities. However, there are structural barriers across the cancer care continuum, including an underprepared nursing workforce, long wait times for service, and inadequate policy infrastructure that limit equitable access to the benefits of genomic discoveries. These barriers have persisted for decades, yet they are modifiable. Two distinct waves of efforts to integrate genomics into nursing practice are analyzed. Drawing on research and observations during these waves, this discussion paper explores additional approaches to accelerate workforce development and health system transformation.

Results: Three recommendations for a third wave of efforts to integrate genomics are explored. (1) Collaborate across the domains of nursing practice, professions, and sectors to reset priorities in response to emerging evidence, (2) Education in leadership, policy and practice for rapid scale-up of workforce and health system transformation, and (3) Create a research framework that generates evidence to guide nursing practice.

Conclusions: Preparing nurses to lead and practice at the forefront of innovation requires concerted efforts by nurses in all five domains of practice and can optimize health outcomes. Leveraging nursing as a global profession with new strategies can advance genomics-informed nursing.

In allogeneic hematopoietic cell transplantation (HCT), a minority of patients have access to a suitable human leukocyte antigen (HLA)-matched related donor (MRD). To fill this gap, matched unrelated donors (MUDs) are an increasingly selected donor source. Usage and outcomes after MUD HCT for Canada are not described. We investigated temporal trends in MUD compared to MRD HCT from 2000 to 2019 using data reported to the Cell Therapy and Transplant Canada (CTTC) Registry. Of 7571 first allogeneic HCTs between 2000 and 2019, the proportion of MUD HCTs rose from 35.1% to 56.3% in the early (2000-2009) and later (2010-2019) eras, respectively. Comparing the two donor sources, the 5-year overall survival (OS) after MUD HCT for patients with malignant diseases was inferior to MRD HCT in the early era (p < 0.001). However, in the later era, OS was comparable for the two donor sources (p = 0.969). For patients with non-malignant diseases, the 5-year OS after MUD HCT was inferior to MRD in the early era (p < 0.001), but in the later era, the 5-year OS was similar between the two donor sources (p = 0.209). Improvements in OS after MUD HCT were accompanied by corresponding reductions in the 2-year non-relapse mortality after MUD HCT. We conclude that MUDs are the most common donor source in Canada, and key clinical outcomes after MUD have improved over time.

Background: The RAVE-Renal study was conducted to evaluate the real-world efficacy and safety of avelumab plus axitinib as a first-line therapy for patients with metastatic renal cell carcinoma (mRCC).

Methods: RAVE-Renal was a multicenter, noninterventional, ambispective study with both retrospective and prospective components. The study included adult patients with histologically confirmed mRCC, measurable disease per RECIST version 1.1, and no prior systemic therapy. Patients received avelumab (800 mg intravenously every 2 weeks) plus axitinib (5 mg orally twice daily). The primary endpoints were median progression-free survival (PFS) and objective response rate (ORR). The secondary endpoints included median OS, 1-year overall survival (OS) rate, and safety.

Results: A total of 125 patients from 13 sites were enrolled, with a median follow-up of 16.1 months. The median age was 61.0 years. The study population comprised 35.3% favorable, 49% intermediate, and 15.7% poor IMDC risk patients. The median PFS was 14.9 months (95% CI, 11.72-19.08). The ORR was 44.3% (95% CI, 32.5-56.1). The clinical benefit rate was 93.4%. The 1-year OS rate was 71.2%, with the median OS not reached. Any-grade treatment-related adverse events (TRAEs) occurred in 99 (79.2%) cases, including grade ≥3 TRAEs in 24 (19.2%).

Conclusions: Avelumab in combination with axitinib showed clinical benefits in a real-world setting, consistent with findings from a pivotal trial. The regimen was effective and well tolerated across various patient subgroups.

Early-stage laryngeal cancer (T1-T2) is commonly treated with organ-preserving techniques such as transoral laser microsurgery (TOLMS) or radiation therapy (RT), both providing comparable oncological outcomes but differing in functional results. Local recurrence occurs in approximately 10% of cases, making salvage surgery a crucial therapeutic option. This multi-institutional study investigates the efficacy of open partial horizontal laryngectomy (OPHL) as a salvage treatment, following recurrent laryngeal squamous-cell carcinoma (LSCC) after failed TOLMS. This analysis includes 66 patients who underwent OPHL between 1995 and 2017, reporting favorable oncological outcomes with overall survival (OS) of 87.4%, disease-specific survival (DSS) of 93.4%, and disease-free survival (DFS) of 85.5%. A recurrence rate of 10.6% was observed post-salvage OPHL, with vascular invasion and advanced pathological staging identified as significant predictors of recurrence. OPHL emerged as an effective organ-preserving alternative to total laryngectomy (TL) in select patients, especially those with limited tumor spread and preserved laryngeal function. The study highlights the importance of careful patient selection and thorough preoperative assessment to improve outcomes, positioning OPHL as a key option in treating recurrent laryngeal cancer and offering oncological control while preserving laryngeal functions.

Lung cancer is the leading cause of cancer-related deaths worldwide, and delayed detection contributes to poor outcomes. Primary care plays a crucial role in early diagnosis, but detecting lung cancer early remains challenging for general practitioners (GPs). Therefore, the aim of this scoping review was to identify optimal strategies and pathways for lung cancer screening (LCS) in primary care settings globally. We conducted a scoping review by searching PubMed, Scopus, and the Cochrane Library for relevant studies published in the past 10 years. Our keywords included "lung cancer", "primary care", "early detection", "screening", "best practices", and "pathways". We included randomized controlled trials, cross-sectional studies, and cohort studies focused on lung cancer screening in primary care. We extracted data on study characteristics, screening pathways, and key findings. We identified 18 studies that met our inclusion criteria. Important strategies for LCS included the use of shared decision-making tools, electronic health record (HER) prompts, risk prediction models, community outreach, and integration with smoking cessation programs. Barriers to implementation included the lack of provider familiarity with guidelines, time constraints, and patient factors. Healthcare professionals and policy makers in primary care settings can leverage this information to integrate the most effective screening strategies into their care, thus enhancing early detection rates and subsequently reducing global lung cancer morbidity and mortality.

Background: Since 2023, ChatGPT-4 has been impactful across several sectors including healthcare, where it aids in medical information analysis and education. Electronic patient-reported outcomes (ePROs) play a crucial role in monitoring cancer patients' post-treatment symptoms, enabling early interventions. However, managing the voluminous ePRO data presents significant challenges. This study assesses the feasibility of utilizing ChatGPT-4 for analyzing side effect data from ePROs.

Methods: Thirty cancer patients were consecutively collected via a web-based ePRO platform, reporting side effects over 4 weeks. ChatGPT-4, simulating oncologists, dietitians, and nurses, analyzed this data and offered improvement suggestions, which were then reviewed by professionals in those fields.

Results: Two oncologists, two dieticians, and two nurses evaluated the AI's performance across roles with 540 reviews. ChatGPT-4 excelled in data accuracy and completeness and was noted for its empathy and support, enhancing communication and reducing caregiver stress. It was potentially effective as a dietician.

Discussion: This study offers preliminary insights into the feasibility of integrating AI tools like ChatGPT-4 into ePRO cancer care, highlighting its potential to reduce healthcare provider workload. Key directions for future research include enhancing AI's capabilities in cancer care knowledge validation, emotional support, improving doctor-patient communication, increasing patient health literacy, and minimizing errors in AI-driven clinical processes. As technology advances, AI holds promise for playing a more significant role in ePRO cancer care and supporting shared decision-making between clinicians and patients.

Focal therapy offers a promising approach for treating localized prostate cancer (PC) with minimal invasiveness and potential cost benefits. High-intensity focused ultrasound (HIFU) and brachytherapy (BT) are among these options but lack long-term efficacy data. Patient follow-ups typically use biopsies and multiparametric MRI (mpMRI), which often miss recurrences. PET/CT with PSMA has emerged as a promising tool for detecting residual disease or recurrence post-treatment, offering higher sensitivity and specificity than traditional imaging. We retrospectively reviewed patients who underwent [⁶⁸Ga]Ga-PSMA-11 PET/CT for biochemical recurrence (BCR) after HIFU or brachytherapy from 2016 to 2024. Out of 22 patients, 32% had HIFU and 68% had brachytherapy. The median time from treatment to PET scan was 77 months, with a median PSA level of 3 ng/mL. [⁶⁸Ga]Ga-PSMA-11 PET/CT identified PC recurrence in 63.6% of cases. Of these, 50% showed prostate recurrence, 14% had lymph node involvement, and 28% had metastatic disease. Focal therapies like HIFU and brachytherapy are effective and minimally invasive options for localized PC. [⁶⁸Ga]Ga-PSMA-11 PET/CT is valuable for detecting recurrence or residual disease, enhancing post-treatment surveillance.

Vulvar cancer is one of the rarest gynecological malignancies. The development of this condition can be associated with either dysplasia linked to human papillomavirus (HPV), primarily affecting younger women, or vulvar dermatoses such as lichen sclerosus, which predominantly affect older women. Over the last decade, the incidence of vulvar cancer has risen by 0.6% annually, while the relative survival rate has declined. Although metastasis to the vulva is uncommon, it can occur, particularly from cancers in nearby organs such as the cervix, bladder, rectum, or anus. More rarely, metastases from breast cancer and renal cell carcinoma have been reported in the vulva. Vaginal metastases from clear cell renal carcinoma are especially rare. In this article, we present the case of a 56-year-old patient diagnosed with clear cell renal carcinoma, who came to our clinic with a lesion on the right labia, which was identified as a metastasis originating from the kidney. Given the rarity of genital metastases in renal cancer, such cases should be examined and discussed to encourage further research and studies.