Pub Date : 2025-02-28DOI: 10.1016/j.ejca.2025.115331
Damian T. Rieke , Michael Bitzer , Annalen Bleckmann , Alexander Desuki , Thomas Ernst , Irene Esposito , Armin Gerger , Hanno Glimm , Peter Horak , Daniel Hübschmann , Anna Lena Illert , Volker Kunzmann , Sonja Loges , Ina Pretzell , Katja Schmitz , Andreas Seeber , Bärbel Söhlke , Andreas Wicki , Jürgen Wolf , Georg Maschmeyer
Precision oncology is a multi-step process including patient selection, tumor profiling, molecular tumor board discussion and personalized cancer management. So far, it remains largely unstandardized. The implementation of precision oncology can be beneficial for patients but implementation differs widely between tumor types and local practices. A working group was established by the Austrian, German and Swiss societies for Hematology and Medical Oncology to establish an expert consensus on evidence-based standards and implementation of precision oncology. Herein, we present a summary of this guideline. The full documents are available at www.onkopedia-guidelines.info
{"title":"Precision oncology – Guideline of the Austrian, German and Swiss Societies for hematology and medical oncology","authors":"Damian T. Rieke , Michael Bitzer , Annalen Bleckmann , Alexander Desuki , Thomas Ernst , Irene Esposito , Armin Gerger , Hanno Glimm , Peter Horak , Daniel Hübschmann , Anna Lena Illert , Volker Kunzmann , Sonja Loges , Ina Pretzell , Katja Schmitz , Andreas Seeber , Bärbel Söhlke , Andreas Wicki , Jürgen Wolf , Georg Maschmeyer","doi":"10.1016/j.ejca.2025.115331","DOIUrl":"10.1016/j.ejca.2025.115331","url":null,"abstract":"<div><div>Precision oncology is a multi-step process including patient selection, tumor profiling, molecular tumor board discussion and personalized cancer management. So far, it remains largely unstandardized. The implementation of precision oncology can be beneficial for patients but implementation differs widely between tumor types and local practices. A working group was established by the Austrian, German and Swiss societies for Hematology and Medical Oncology to establish an expert consensus on evidence-based standards and implementation of precision oncology. Herein, we present a summary of this guideline. The full documents are available at www.onkopedia-guidelines.info</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"220 ","pages":"Article 115331"},"PeriodicalIF":7.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-26DOI: 10.1016/j.ejca.2025.115329
Guillermo Villacampa , Gemma Eminowicz , Victor Navarro , Lorenzo Carità , David García-Illescas , Ana Oaknin , J. Alejandro Pérez-Fidalgo
Background
Several first-line therapeutic strategies have been evaluated alongside platinum-based chemotherapy in advanced or recurrent endometrial cancer (a/rEC). However, the optimal approach remains unclear.
Methods
A systematic review was conducted to identify randomized control trials (RCTs) that evaluate first-line therapeutic strategies in a/rEC involving immune checkpoint inhibitors (ICI) and PARP inhibitors (PARPi). A network meta-analysis with a frequentist framework using random-effects and an extracted individual patient data meta-analysis were performed. The primary endpoint was progression-free survival (PFS) by MMR status, p53 status within the MMRp population and PD-L1 status.
Results
A total of 3210 patients with EC were included. In the MMRp population, the combination (ICI and PARPi) showed a not statistically significant PFS benefit compared with each agent alone. In MMRp p53-abnormal patients (n = 590), combining PARPi and ICI statistically improved PFS compared to ICI alone (HR=0.47, 95 %CI 0.40–0.94) with a numerically better outcome compared to PARPi alone (HR=0.63, 95 %CI 0.26–1.57). No benefit from PARPi was observed in the p53 wild-type MMRp population. PD-L1-positivity (n = 1121) appears to predict more benefit from the addition of ICI and PARPi, with a larger benefit of combination therapy. In the MMRd population (n = 769), the best outcomes were observed with ICI alone, with no additional benefit of PARPi. Grade 3 or greater treatment-related adverse events were seen in 75.1 % patients treated with the combination.
Conclusions
The addition of the combination of ICI and PARPi to platinum-based chemotherapy provides greatest benefit to p53-abnormal MMRp patients. PD-L1 is a potentially useful biomarker with PD-L1-positive tumors more likely to respond to ICI. Implementation of biomarkers is crucial to redefine the treatment paradigm in a/rEC.
{"title":"Immunotherapy and PARP inhibitors as first-line treatment in endometrial cancer: A systematic review and network meta-analysis","authors":"Guillermo Villacampa , Gemma Eminowicz , Victor Navarro , Lorenzo Carità , David García-Illescas , Ana Oaknin , J. Alejandro Pérez-Fidalgo","doi":"10.1016/j.ejca.2025.115329","DOIUrl":"10.1016/j.ejca.2025.115329","url":null,"abstract":"<div><h3>Background</h3><div>Several first-line therapeutic strategies have been evaluated alongside platinum-based chemotherapy in advanced or recurrent endometrial cancer (a/rEC). However, the optimal approach remains unclear.</div></div><div><h3>Methods</h3><div>A systematic review was conducted to identify randomized control trials (RCTs) that evaluate first-line therapeutic strategies in a/rEC involving immune checkpoint inhibitors (ICI) and PARP inhibitors (PARPi). A network meta-analysis with a frequentist framework using random-effects and an extracted individual patient data meta-analysis were performed. The primary endpoint was progression-free survival (PFS) by MMR status, p53 status within the MMRp population and PD-L1 status.</div></div><div><h3>Results</h3><div>A total of 3210 patients with EC were included. In the MMRp population, the combination (ICI and PARPi) showed a not statistically significant PFS benefit compared with each agent alone. In MMRp p53-abnormal patients (n = 590), combining PARPi and ICI statistically improved PFS compared to ICI alone (HR=0.47, 95 %CI 0.40–0.94) with a numerically better outcome compared to PARPi alone (HR=0.63, 95 %CI 0.26–1.57). No benefit from PARPi was observed in the p53 wild-type MMRp population. PD-L1-positivity (n = 1121) appears to predict more benefit from the addition of ICI and PARPi, with a larger benefit of combination therapy. In the MMRd population (n = 769), the best outcomes were observed with ICI alone, with no additional benefit of PARPi. Grade 3 or greater treatment-related adverse events were seen in 75.1 % patients treated with the combination.</div></div><div><h3>Conclusions</h3><div>The addition of the combination of ICI and PARPi to platinum-based chemotherapy provides greatest benefit to p53-abnormal MMRp patients. PD-L1 is a potentially useful biomarker with PD-L1-positive tumors more likely to respond to ICI. Implementation of biomarkers is crucial to redefine the treatment paradigm in a/rEC.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"220 ","pages":"Article 115329"},"PeriodicalIF":7.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-25DOI: 10.1016/j.ejca.2025.115324
Harriet L. Lancaster , Beibei Jiang , Michael P.A. Davies , Jan Willem C. Gratama , Mario Silva , Jaeyoun Yi , Marjolein A. Heuvelmans , Geertruida H. de Bock , Anand Devaraj , John K. Field , Matthijs Oudkerk
Purpose
Artificial intelligence (AI) could reduce lung cancer screening computer tomography (CT)-reading workload if used as a first-reader, ruling-out negative CT-scans at baseline. Evidence is lacking to support AI performance when compared to gold-standard lung cancer outcomes. This study validated the performance of a commercially available AI software in the UK lung cancer screening (UKLS) trial dataset, with comparison to human reads and histological lung cancer outcomes, and estimated CT-reading workload reduction.
Methods
1252 UKLS-baseline-CT-scans were evaluated independently by AI and human readers. AI performance was evaluated on two-levels. Firstly, AI classification and individual reads were compared to a EU reference standard (based on NELSON2.0-European Position Statement) determined by a European expert panel blinded from individual results. A positive misclassification was defined as a nodule positive read ≥ 100mm3 and no/<100mm3 nodules in the expert read; A negative misclassification was defined as a nodule negative read, whereas an indeterminate or positive finding in the expert read. Secondly, AI nodule classification was compared to gold-standard histological lung cancer outcomes. CT-reading workload reduction was calculated from AI negative CT-scans when AI was used as first-reader.
Results
Expert panel reference standard reported 815 (65 %) negative and 437 (35 %) indeterminate/positive CT-scans in the dataset of 1252 UKLS-participants. Compared to the reference standard, AI resulted in less misclassification than human reads, NPV 92·0 %(90·2 %-95·3 %). On comparison to gold-standard, AI detected all 31 baseline-round lung cancers, but classified one as negative due to the 100mm3 threshold, NPV 99·8 %(99·0 %-99·9 %). Estimated maximum CT-reading workload reduction was 79 %.
Conclusion
Implementing AI as first-reader to rule-out negative CT-scans, shows considerable potential to reduce CT-reading workload and does not lead to missed lung cancers.
{"title":"Histological proven AI performance in the UKLS CT lung cancer screening study: Potential for workload reduction","authors":"Harriet L. Lancaster , Beibei Jiang , Michael P.A. Davies , Jan Willem C. Gratama , Mario Silva , Jaeyoun Yi , Marjolein A. Heuvelmans , Geertruida H. de Bock , Anand Devaraj , John K. Field , Matthijs Oudkerk","doi":"10.1016/j.ejca.2025.115324","DOIUrl":"10.1016/j.ejca.2025.115324","url":null,"abstract":"<div><h3>Purpose</h3><div>Artificial intelligence (AI) could reduce lung cancer screening computer tomography (CT)-reading workload if used as a first-reader, ruling-out negative CT-scans at baseline. Evidence is lacking to support AI performance when compared to gold-standard lung cancer outcomes. This study validated the performance of a commercially available AI software in the UK lung cancer screening (UKLS) trial dataset, with comparison to human reads and histological lung cancer outcomes, and estimated CT-reading workload reduction.</div></div><div><h3>Methods</h3><div>1252 UKLS-baseline-CT-scans were evaluated independently by AI and human readers. AI performance was evaluated on two-levels. Firstly, AI classification and individual reads were compared to a EU reference standard (based on NELSON2.0-European Position Statement) determined by a European expert panel blinded from individual results. A positive misclassification was defined as a nodule positive read ≥ 100mm<sup>3</sup> and no/<100mm<sup>3</sup> nodules in the expert read; A negative misclassification was defined as a nodule negative read, whereas an indeterminate or positive finding in the expert read. Secondly, AI nodule classification was compared to gold-standard histological lung cancer outcomes. CT-reading workload reduction was calculated from AI negative CT-scans when AI was used as first-reader.</div></div><div><h3>Results</h3><div>Expert panel reference standard reported 815 (65 %) negative and 437 (35 %) indeterminate/positive CT-scans in the dataset of 1252 UKLS-participants. Compared to the reference standard, AI resulted in less misclassification than human reads, NPV 92·0 %(90·2 %-95·3 %). On comparison to gold-standard, AI detected all 31 baseline-round lung cancers, but classified one as negative due to the 100mm<sup>3</sup> threshold, NPV 99·8 %(99·0 %-99·9 %). Estimated maximum CT-reading workload reduction was 79 %.</div></div><div><h3>Conclusion</h3><div>Implementing AI as first-reader to rule-out negative CT-scans, shows considerable potential to reduce CT-reading workload and does not lead to missed lung cancers.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"220 ","pages":"Article 115324"},"PeriodicalIF":7.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.ejca.2025.115323
Harriet L. Lancaster , Anna N.H. Walstra , Kyle Myers , Ricardo S. Avila , Jan Willem C. Gratama , Marjolein A. Heuvelmans , Sean B. Fain , David A. Clunie , Ella A. Kazerooni , Maryellen L. Giger , Anthony P. Reeves , Jens Vogel-Claussen , Harry de Koning , Rowena Yip , Luis M. Seijo , John K. Field , James L. Mulshine , Mario Silva , David F. Yankelevitz , Claudia I. Henschke , Matthijs Oudkerk
Reduction in lung cancer mortality is achievable through low dose computed tomography (LDCT) screening in high-risk individuals. Many countries are progressing from local LDCT screening studies to national screening programs. Implementation of effective large-scale screening programs is complex and requires a multi-disciplinary approach. A recent overview of the technical aspects of implementing high quality LDCT for screening resulted from the inaugural international expert meeting of the Alliance for Global Implementation of Lung and Cardiac Early Disease Detection and Treatment (AGILE). This covers the most important aspects of the CT imaging process: standardisation in CT image acquisition and interpretation, CT protocol management, technology developments and minimal requirements, integration of lung cancer biomarkers, and the role of AI in CT lung nodule detection, segmentation, and classification, and related data security issues.
{"title":"Action plan for an international imaging framework for implementation of global low-dose CT screening for lung cancer","authors":"Harriet L. Lancaster , Anna N.H. Walstra , Kyle Myers , Ricardo S. Avila , Jan Willem C. Gratama , Marjolein A. Heuvelmans , Sean B. Fain , David A. Clunie , Ella A. Kazerooni , Maryellen L. Giger , Anthony P. Reeves , Jens Vogel-Claussen , Harry de Koning , Rowena Yip , Luis M. Seijo , John K. Field , James L. Mulshine , Mario Silva , David F. Yankelevitz , Claudia I. Henschke , Matthijs Oudkerk","doi":"10.1016/j.ejca.2025.115323","DOIUrl":"10.1016/j.ejca.2025.115323","url":null,"abstract":"<div><div>Reduction in lung cancer mortality is achievable through low dose computed tomography (LDCT) screening in high-risk individuals. Many countries are progressing from local LDCT screening studies to national screening programs. Implementation of effective large-scale screening programs is complex and requires a multi-disciplinary approach. A recent overview of the technical aspects of implementing high quality LDCT for screening resulted from the inaugural international expert meeting of the Alliance for Global Implementation of Lung and Cardiac Early Disease Detection and Treatment (AGILE). This covers the most important aspects of the CT imaging process: standardisation in CT image acquisition and interpretation, CT protocol management, technology developments and minimal requirements, integration of lung cancer biomarkers, and the role of AI in CT lung nodule detection, segmentation, and classification, and related data security issues.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"220 ","pages":"Article 115323"},"PeriodicalIF":7.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.ejca.2025.115308
Ami V. Desai , Aditi Bagchi , Amy E. Armstrong , Cornelis M. van Tilburg , Ellen M. Basu , Giles W. Robinson , Huanmin Wang , Michela Casanova , Nicolas André , Quentin Campbell-Hewson , Yeming Wu , Alison Cardenas , Bo Ci , Carolina Ryklansky , Clare E. Devlin , Georgina Meneses-Lorente , Jade Wulff , Katherine E. Hutchinson , Amar Gajjar , Elizabeth Fox
Background
Entrectinib, a central nervous system (CNS)-penetrant TRK/ROS1 inhibitor, has demonstrated clinical activity in children with NTRK1/2/3 or ROS1 fusion-positive extracranial solid and CNS tumours. We present integrated data of entrectinib in children with NTRK or ROS1 fusion-positive tumours from the STARTRK-NG, TAPISTRY, and STARTRK-2 trials.
Methods
Efficacy analyses were undertaken on TRK/ROS1 inhibitor-naïve patients aged <18 years with metastatic/locally advanced NTRK1/2/3 or ROS1 fusion-positive extracranial solid or CNS tumours who received ≥1 entrectinib dose and had ≥6 months of follow-up from enrolment. Tumour responses were confirmed by blinded independent central review (BICR) per RECIST v1.1/RANO criteria. Primary endpoint: BICR-assessed confirmed objective response rate (cORR). Key secondary endpoints: duration of response (DoR); time to response (TtR); safety.
Results
As of 16 July 2023, out of 91 safety-evaluable patients, 64 (NTRK: n=44; ROS1: n=20) were efficacy evaluable. In the NTRK and ROS1 subgroups, respectively, median age was 4.0 years and 7.5 years; median survival follow-up was 24.2 months and 27.6 months. cORR was 72.7 % (NTRK, 95 % confidence interval [CI]: 57.2–85.0) and 65.0 % (ROS1, 95 % CI: 40.8–84.6). Median DoR was not reached (NTRK, 95 % CI: 25.4–not evaluable [NE]); ROS1, 95 % CI: 16.2–NE); median TtR was 1.9 months in both subgroups. The most frequently reported treatment-related adverse events included weight gain (35.2 %) and anaemia (31.9 %).
Conclusion
Integrated data from three trials confirm entrectinib induces rapid and durable responses in children with NTRK or ROS1 fusion-positive tumours. The increased duration of safety monitoring does not demonstrate new or cumulative toxicity.
{"title":"Efficacy and safety of entrectinib in children with extracranial solid or central nervous system (CNS) tumours harbouring NTRK or ROS1 fusions","authors":"Ami V. Desai , Aditi Bagchi , Amy E. Armstrong , Cornelis M. van Tilburg , Ellen M. Basu , Giles W. Robinson , Huanmin Wang , Michela Casanova , Nicolas André , Quentin Campbell-Hewson , Yeming Wu , Alison Cardenas , Bo Ci , Carolina Ryklansky , Clare E. Devlin , Georgina Meneses-Lorente , Jade Wulff , Katherine E. Hutchinson , Amar Gajjar , Elizabeth Fox","doi":"10.1016/j.ejca.2025.115308","DOIUrl":"10.1016/j.ejca.2025.115308","url":null,"abstract":"<div><h3>Background</h3><div>Entrectinib, a central nervous system (CNS)-penetrant TRK/ROS1 inhibitor, has demonstrated clinical activity in children with <em>NTRK1/2/3</em> or <em>ROS1</em> fusion-positive extracranial solid and CNS tumours. We present integrated data of entrectinib in children with <em>NTRK</em> or <em>ROS1</em> fusion-positive tumours from the STARTRK-NG, TAPISTRY, and STARTRK-2 trials.</div></div><div><h3>Methods</h3><div>Efficacy analyses were undertaken on TRK/ROS1 inhibitor-naïve patients aged <18 years with metastatic/locally advanced <em>NTRK1/2/3</em> or <em>ROS1</em> fusion-positive extracranial solid or CNS tumours who received ≥1 entrectinib dose and had ≥6 months of follow-up from enrolment. Tumour responses were confirmed by blinded independent central review (BICR) per RECIST v1.1/RANO criteria. Primary endpoint: BICR-assessed confirmed objective response rate (cORR). Key secondary endpoints: duration of response (DoR); time to response (TtR); safety.</div></div><div><h3>Results</h3><div>As of 16 July 2023, out of 91 safety-evaluable patients, 64 (<em>NTRK</em>: n=44; <em>ROS1</em>: n=20) were efficacy evaluable. In the <em>NTRK</em> and <em>ROS1</em> subgroups, respectively, median age was 4.0 years and 7.5 years; median survival follow-up was 24.2 months and 27.6 months. cORR was 72.7 % (<em>NTRK,</em> 95 % confidence interval [CI]: 57.2–85.0) and 65.0 % (<em>ROS1</em>, 95 % CI: 40.8–84.6). Median DoR was not reached (<em>NTRK,</em> 95 % CI: 25.4–not evaluable [NE]); <em>ROS1</em>, 95 % CI: 16.2–NE); median TtR was 1.9 months in both subgroups. The most frequently reported treatment-related adverse events included weight gain (35.2 %) and anaemia (31.9 %).</div></div><div><h3>Conclusion</h3><div>Integrated data from three trials confirm entrectinib induces rapid and durable responses in children with <em>NTRK</em> or <em>ROS1</em> fusion-positive tumours. The increased duration of safety monitoring does not demonstrate new or cumulative toxicity.</div><div><strong>Registered clinical trials:</strong> STARTRK-NG: NCT02650401; TAPISTRY: NCT04589845; STARTRK-2: NCT02568267</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"220 ","pages":"Article 115308"},"PeriodicalIF":7.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As adjuvant chemotherapy for stage III gastric cancer, the phase III (JACCRO GC-07) trial showed that docetaxel plus S-1 (DS) was superior to S-1 in terms of recurrence-free and overall survival. However, whether adding docetaxel to S-1 in the adjuvant setting affects survival after recurrence remains unclear. The optimal treatment strategy for patients who develop recurrence during or after DS has also been controversial.
Methods
We used results from JACCRO GC-07 to investigate post-recurrence survival (PRS) in patients who developed recurrence during or after completing adjuvant chemotherapy. PRS was compared between adjuvant groups and among post-recurrence chemotherapeutic regimens.
Results
During 5 years of follow-up after surgery, 161 of 441 patients in the DS group and 216 of 452 patients in the S-1 group developed recurrence, with median PRS of 12.6 and 11.4 months, respectively (hazard ratio [HR] 0.98, 95 % confidence interval [CI] 0.79–1.22; p = 0.84). Among patients with recurrence, 115 patients in the DS group and 165 patients in the S-1 group received chemotherapy, and median PRS was 14.5 and 13.7 months, respectively (HR 1.04, 95 %CI 0.81–1.34; p = 0.76). Platinum-based chemotherapy resulted in longer PRS than non-platinum chemotherapy, regardless of the adjuvant chemotherapeutic regimen or time of recurrence.
Conclusions
PRS was similar between patients who received adjuvant chemotherapy with DS or with S-1 alone. PRS was also similar between groups of patients who received chemotherapy after recurrence. Platinum-based chemotherapy might be the optimal treatment for patients who develop recurrence after completing adjuvant DS, regardless of the time of recurrence.
{"title":"Post-recurrence survival in patients with stage III gastric cancer who received adjuvant chemotherapy; post-hoc analysis of the JACCRO GC-07 study","authors":"Hiroo Ishida , Yu Sunakawa , Yasuhiro Kodera , Kazuhiro Yoshida , Mitsugu Kochi , Yoshihiro Kakeji , Takeshi Sano , Masahiro Takeuchi , Wataru Ichikawa , Masashi Fujii","doi":"10.1016/j.ejca.2025.115322","DOIUrl":"10.1016/j.ejca.2025.115322","url":null,"abstract":"<div><h3>Background</h3><div>As adjuvant chemotherapy for stage III gastric cancer, the phase III (JACCRO GC-07) trial showed that docetaxel plus S-1 (DS) was superior to S-1 in terms of recurrence-free and overall survival. However, whether adding docetaxel to S-1 in the adjuvant setting affects survival after recurrence remains unclear. The optimal treatment strategy for patients who develop recurrence during or after DS has also been controversial.</div></div><div><h3>Methods</h3><div>We used results from JACCRO GC-07 to investigate post-recurrence survival (PRS) in patients who developed recurrence during or after completing adjuvant chemotherapy. PRS was compared between adjuvant groups and among post-recurrence chemotherapeutic regimens.</div></div><div><h3>Results</h3><div>During 5 years of follow-up after surgery, 161 of 441 patients in the DS group and 216 of 452 patients in the S-1 group developed recurrence, with median PRS of 12.6 and 11.4 months, respectively (hazard ratio [HR] 0.98, 95 % confidence interval [CI] 0.79–1.22; p = 0.84). Among patients with recurrence, 115 patients in the DS group and 165 patients in the S-1 group received chemotherapy, and median PRS was 14.5 and 13.7 months, respectively (HR 1.04, 95 %CI 0.81–1.34; p = 0.76). Platinum-based chemotherapy resulted in longer PRS than non-platinum chemotherapy, regardless of the adjuvant chemotherapeutic regimen or time of recurrence.</div></div><div><h3>Conclusions</h3><div>PRS was similar between patients who received adjuvant chemotherapy with DS or with S-1 alone. PRS was also similar between groups of patients who received chemotherapy after recurrence. Platinum-based chemotherapy might be the optimal treatment for patients who develop recurrence after completing adjuvant DS, regardless of the time of recurrence.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"219 ","pages":"Article 115322"},"PeriodicalIF":7.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.ejca.2025.115320
Katharina Steger , Heidelinde Fiegl , Barin Feroz , Katharina Leitner , Christian Marth , Hubert Hackl , Alain G. Zeimet
Purpose
To explore why in large phase III randomized clinical trials TP53-mutated (TP53mut) endometrial cancer (EC) was the only tumor showing survival benefit to immune checkpoint inhibitors (ICIs) added to chemotherapy when compared with other low TMB TP53mut cancers, such as high-grade serous ovarian (HGSOC) and triple-negative breast cancer (TNBC).
Experimental Design
From 606 patients with one of the three mentioned cancers, “The Cancer Genome Atlas” data on clinical outcome, TMB and detailed composition of the tumor immune-microenvironment (TIME) (immune infiltrating cells, cytokines, and other immune-modulators) were compared using the Kruskal-Wallis test, followed by Pearson correlation. Prognostic value of studied variables was assessed by Kaplan-Meier and Cox-regression analyses.
Results
TMB was very low in all three TP53mut entities, being lowest in EC (median: 1.27 Mut/Mb; p < 0.001). Interestingly, high TMB was significantly associated with improved clinical outcome in every entity, whereby best discrimination for PFS was found in EC (HR: 0.52). Compared to EC, immune-suppressing regulatory T-cells were higher in HGSOC and TNBC (p < 0.001) and M2-like macrophages higher in HGSOC (p < 0.001). In contrast, immune-activating mDCs were more prominent in EC than in HGSOC (p < 0.001). Differential modulator expression analyses revealed highest discrimination for the immune-inhibiting FOXP3, C1QA and XBP1, which all exhibited lower levels in EC compared with HGSOC and TNBC (p < 0.001).
Conclusion
Characteristics of TIME differ substantially among the assessed entities in terms that EC exhibits fewer immunosuppressive traits, expecting a higher likelihood for responding to ICIs, despite a very low TMB, whereas HGSOC and TNBC exhibit an immune hostile TIME.
{"title":"Differences in immunogenicity of TP53-mutated cancers with low tumor mutational burden (TMB) A study on TP53mut endometrial-, ovarian- and triple-negative breast cancer","authors":"Katharina Steger , Heidelinde Fiegl , Barin Feroz , Katharina Leitner , Christian Marth , Hubert Hackl , Alain G. Zeimet","doi":"10.1016/j.ejca.2025.115320","DOIUrl":"10.1016/j.ejca.2025.115320","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore why in large phase III randomized clinical trials <em>TP53</em>-mutated (<em>TP53</em>mut) endometrial cancer (EC) was the only tumor showing survival benefit to immune checkpoint inhibitors (ICIs) added to chemotherapy when compared with other low TMB <em>TP53</em>mut cancers, such as high-grade serous ovarian (HGSOC) and triple-negative breast cancer (TNBC).</div></div><div><h3>Experimental Design</h3><div>From 606 patients with one of the three mentioned cancers, “The Cancer Genome Atlas” data on clinical outcome, TMB and detailed composition of the tumor immune-microenvironment (TIME) (immune infiltrating cells, cytokines, and other immune-modulators) were compared using the Kruskal-Wallis test, followed by Pearson correlation. Prognostic value of studied variables was assessed by Kaplan-Meier and Cox-regression analyses.</div></div><div><h3>Results</h3><div>TMB was very low in all three <em>TP53</em>mut entities, being lowest in EC (median: 1.27 Mut/Mb; p < 0.001). Interestingly, high TMB was significantly associated with improved clinical outcome in every entity, whereby best discrimination for PFS was found in EC (HR: 0.52). Compared to EC, immune-suppressing regulatory T-cells were higher in HGSOC and TNBC (p < 0.001) and M2-like macrophages higher in HGSOC (p < 0.001). In contrast, immune-activating mDCs were more prominent in EC than in HGSOC (p < 0.001). Differential modulator expression analyses revealed highest discrimination for the immune-inhibiting <em>FOXP3</em>, <em>C1QA</em> and <em>XBP1</em>, which all exhibited lower levels in EC compared with HGSOC and TNBC (p < 0.001).</div></div><div><h3>Conclusion</h3><div>Characteristics of TIME differ substantially among the assessed entities in terms that EC exhibits fewer immunosuppressive traits, expecting a higher likelihood for responding to ICIs, despite a very low TMB, whereas HGSOC and TNBC exhibit an immune hostile TIME.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"219 ","pages":"Article 115320"},"PeriodicalIF":7.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.ejca.2025.115321
Gaia Griguolo , Michele Bottosso , Andrea Crema , Tommaso Giarratano , Federica Miglietta , Giorgio Bonomi , Eleonora Mioranza , Davide Napetti , Davide Massa , Giovanni Faggioni , Maria Vittoria Dieci , Valentina Guarneri
Background
Interest in metastatic solid tumors patients achieving exceptionally durable responses to systemic treatment is progressively increasing; however, available evidence still remains limited. This study characterizes patients with metastatic breast cancer (mBC) achieving an exceptional response, with a focus on patients discontinuing systemic treatment.
Methods
In this retrospective monocentric study, patients with mBC achieving exceptional responses (2021–2023) were identified; clinical features, hormone receptor (HR) and HER2 status, and radiological responses were collected. Exceptional response was defined as complete (CR) or partial response (PR) lasting for more than twice the expected progression-free survival (PFS). No evidence of disease (NED) was defined as radiological absence of disease achieved integrating locoregional treatments.
Results
We identified 58 exceptional responders: 31 HER2+ (53.5 %), 16 HR+ /HER2- (27.6 %), and 11 HR-/HER2- (19.0 %). 5-year PFS was 89.1 % and 5-year OS was 94.6 % overall, and numerically better in HR-/HER2- mBC (5-year PFS/OS: 100 %) compared to HER2+ (90.2 %/93.5 %) and HR+ /HER2- (80.8 %/93.8 %) mBC.
Best radiological response was CR/NED in 69.0 % and PR in 31.0 % of patients. CR/NED status was significantly associated with better outcomes compared to PR (5-year OS: 100 % vs. 83.0 %, p = 0.004). Eleven patients (9 with CR/NED, 2 with PR) discontinued treatment in absence of disease progression; subsequent progression was observed only in one patient with PR.
Conclusion
mBC patients achieving exceptional responses exhibit favorable long-term survival outcomes, particularly if achieving CR/NED. These findings highlight the importance of further research to refine management strategies and explore the potential for systemic treatment discontinuation in these patients.
{"title":"Exceptional responses to systemic treatment in metastatic breast cancer: clinical features and long-term outcomes","authors":"Gaia Griguolo , Michele Bottosso , Andrea Crema , Tommaso Giarratano , Federica Miglietta , Giorgio Bonomi , Eleonora Mioranza , Davide Napetti , Davide Massa , Giovanni Faggioni , Maria Vittoria Dieci , Valentina Guarneri","doi":"10.1016/j.ejca.2025.115321","DOIUrl":"10.1016/j.ejca.2025.115321","url":null,"abstract":"<div><h3>Background</h3><div>Interest in metastatic solid tumors patients achieving exceptionally durable responses to systemic treatment is progressively increasing; however, available evidence still remains limited. This study characterizes patients with metastatic breast cancer (mBC) achieving an exceptional response, with a focus on patients discontinuing systemic treatment.</div></div><div><h3>Methods</h3><div>In this retrospective monocentric study, patients with mBC achieving exceptional responses (2021–2023) were identified; clinical features, hormone receptor (HR) and HER2 status, and radiological responses were collected. Exceptional response was defined as complete (CR) or partial response (PR) lasting for more than twice the expected progression-free survival (PFS). No evidence of disease (NED) was defined as radiological absence of disease achieved integrating locoregional treatments.</div></div><div><h3>Results</h3><div>We identified 58 exceptional responders: 31 HER2+ (53.5 %), 16 HR+ /HER2- (27.6 %), and 11 HR-/HER2- (19.0 %). 5-year PFS was 89.1 % and 5-year OS was 94.6 % overall, and numerically better in HR-/HER2- mBC (5-year PFS/OS: 100 %) compared to HER2+ (90.2 %/93.5 %) and HR+ /HER2- (80.8 %/93.8 %) mBC.</div><div>Best radiological response was CR/NED in 69.0 % and PR in 31.0 % of patients. CR/NED status was significantly associated with better outcomes compared to PR (5-year OS: 100 % vs. 83.0 %, p = 0.004). Eleven patients (9 with CR/NED, 2 with PR) discontinued treatment in absence of disease progression; subsequent progression was observed only in one patient with PR.</div></div><div><h3>Conclusion</h3><div>mBC patients achieving exceptional responses exhibit favorable long-term survival outcomes, particularly if achieving CR/NED. These findings highlight the importance of further research to refine management strategies and explore the potential for systemic treatment discontinuation in these patients.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"219 ","pages":"Article 115321"},"PeriodicalIF":7.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.ejca.2025.115307
Ruoshuang Han , Haoyue Guo , Jinpeng Shi , Haowei Wang , Sha Zhao , Yijun Jia , Xiaozhen Liu , Jiayu Li , Lei Cheng , Chao Zhao , Xuefei Li , Caicun Zhou
{"title":"Corrigendum to “Tumour microenvironment changes after osimertinib treatment resistance in non-small cell lung cancer” [Eur J Cancer 189 (2023) 112919]","authors":"Ruoshuang Han , Haoyue Guo , Jinpeng Shi , Haowei Wang , Sha Zhao , Yijun Jia , Xiaozhen Liu , Jiayu Li , Lei Cheng , Chao Zhao , Xuefei Li , Caicun Zhou","doi":"10.1016/j.ejca.2025.115307","DOIUrl":"10.1016/j.ejca.2025.115307","url":null,"abstract":"","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"219 ","pages":"Article 115307"},"PeriodicalIF":7.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-17DOI: 10.1016/j.ejca.2025.115294
Anna N.H. Walstra , Harriet L. Lancaster , Marjolein A. Heuvelmans , Carlijn M. van der Aalst , Juul Hubert , Dana Moldovanu , Sytse F. Oudkerk , Daiwei Han , Jan Willem C. Gratama , Mario Silva , Harry J. de Koning , Matthijs Oudkerk
{"title":"Corrigendum to: Feasibility of AI as first reader in the 4-IN-THE-LUNG-RUN lung cancer screening trial: Impact on negative-misclassifications and clinical referral rate, European Journal of Cancer, Volume 216, 5 February 2025, 115214","authors":"Anna N.H. Walstra , Harriet L. Lancaster , Marjolein A. Heuvelmans , Carlijn M. van der Aalst , Juul Hubert , Dana Moldovanu , Sytse F. Oudkerk , Daiwei Han , Jan Willem C. Gratama , Mario Silva , Harry J. de Koning , Matthijs Oudkerk","doi":"10.1016/j.ejca.2025.115294","DOIUrl":"10.1016/j.ejca.2025.115294","url":null,"abstract":"","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"218 ","pages":"Article 115294"},"PeriodicalIF":7.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}