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Surgical stage in the era of molecular profiling of endometrial cancer 子宫内膜癌分子图谱时代的手术分期
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-05 DOI: 10.1016/j.ejca.2025.116164
J.C. Kasius , W. Kildal , S.W. Vrede , H.A. Askautrud , M. Pradhan , A.M. van Altena , K.-A.R. Tobin , K. Knoll , C. Reijnen , S. Reimann , G. Dackus , L. Vlatkovic , J. Huvila , M. Steinlechner , V. Tubita , A. Gil-Moreno , M.P.L.M. Snijders , M.C. Vos , T.S. Hveem , J. Asberger , A. Kleppe

Introduction

Molecular classification has reshaped risk stratification in endometrial cancer (EC), yet the relevance of tumor spread within molecular subgroups has not been reported so far.

Material and methods

This multicenter retrospective study included 2056 EC patients treated between 1994 and 2018 across 11 European centers. All histopathological subtypes and FIGO stages were included. Tumors were classified into four molecular subgroups: POLE-mutated (POLEmut), mismatch repair deficient (MMRd), no specific molecular profile (NSMP), and TP53/p53 abnormal (p53abn). Clinical and pathological data were extracted from existing cohort databases.

Results

Patients were diagnosed with FIGO stage I (69 %), II (9 %), III (16 %), and IV (6 %), and classified into: POLEmut (8 %), MMRd (28 %), NSMP (44 %), and p53abn (21 %). The overall 5-year cancer-specific death (CSD) and recurrence rates were 16.5 % (95 % CI, 14.9 %-18.2 %) and 23.8 % (95 % CI, 22.0 %-25.7 %), respectively. In multivariable analysis cancer-specific survival (CSS) was independently associated with molecular subtype, FIGO stage, age, histopathological type, grade, lymphovascular space invasion, adjuvant therapy, residual tumor, and lymphadenectomy. FIGO stage was significantly associated with CSD also in within each molecular subgroup (p < 0.001). Patients with tumors confined to the uterus had the most favourable prognosis. Lymph node metastases significantly decreased CSS in POLEmut, MMRd, and p53abn groups. Within FIGO stage IV, molecular subtype was not significantly related to outcome.

Discussion

Surgical stage remains a strong prognostic factor across molecular subtypes and should be considered alongside molecular classification when tailoring adjuvant treatment in EC.
分子分类重塑了子宫内膜癌(EC)的风险分层,但到目前为止,分子亚群内肿瘤扩散的相关性尚未报道。材料和方法本多中心回顾性研究纳入了1994年至2018年间在11个欧洲中心接受治疗的2056例EC患者。包括所有组织病理亚型和FIGO分期。肿瘤分为4个分子亚组:极点突变(POLEmut)、错配修复缺陷(MMRd)、无特异性分子谱(NSMP)和TP53/p53异常(p53abn)。从现有队列数据库中提取临床和病理数据。结果FIGO分期为ⅰ期(69 %)、ⅱ期(9 %)、ⅲ期(16 %)、ⅳ期(6 %),分为POLEmut期(8 %)、MMRd期(28 %)、NSMP期(44 %)、p53abn期(21 %)。总体5年癌症特异性死亡率(CSD)和复发率分别为16.5% %(95 % CI, 14.9 %-18.2 %)和23.8 %(95 % CI, 22.0% %-25.7 %)。在多变量分析中,癌症特异性生存(CSS)与分子亚型、FIGO分期、年龄、组织病理类型、分级、淋巴血管间隙侵犯、辅助治疗、残留肿瘤和淋巴结切除术独立相关。FIGO分期与CSD也在各分子亚组中显著相关(p <; 0.001)。肿瘤局限于子宫的患者预后最好。淋巴结转移显著降低POLEmut、MMRd和p53abn组的CSS。在FIGO IV期,分子亚型与预后无显著相关。手术分期在分子亚型中仍然是一个重要的预后因素,在制定EC的辅助治疗时应与分子分类一起考虑。
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引用次数: 0
Current and emerging opportunities for deintensification of systemic therapies in melanoma: A scoping review 黑素瘤系统性去强化治疗的当前和新机会:范围综述
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-05 DOI: 10.1016/j.ejca.2025.116132
Jennifer A. Soon , Fanny Franchini , Peter Gourlay , Maarten J. IJzerman , Grant A. McArthur

Purpose

There is growing interest in optimising melanoma management to reduce over-treatment and improve patient safety and quality-of-life, yet clinical guidance on deintensification is minimal. This scoping review characterises the role of systemic therapies and biomarkers in current and emerging melanoma deintensification strategies. Study types, funding sources, and use of patient-reported outcomes (PRO) were also summarised.

Methods

MEDLINE, EMBASE and PubMed searches identified studies on deintensification in adult patients with cutaneous melanoma (January 2013 to June 2023). Additional texts were sourced via Google Scholar and backward citation searches. Three extraction tools were tailored to accommodate the breadth of articles included: A) deintensification approaches including biomarkers in late-phase development; B) non-systematic reviews; and C) early-phase biomarkers. Screening and data extraction were performed by two reviewers using Covidence. Data were analysed using descriptive statistics with results reported as per PRISMA-ScR guidelines.

Results

Of 3721 articles screened, 301 articles were included: 31 non-systematic reviews, 198 early-phase biomarker studies, and 72 studies on deintensification approaches. Five key approaches emerged: shortened duration of therapy, dose attenuation, biomarker-informed, neoadjuvant and/or response-adapted, and miscellaneous. Most data were retrospective; only five randomised controlled trials were included in Category A (two were trial protocols). Early-phase biomarker studies comprised 66 % (n = 198/301) of articles – few progressed to trials of clinical validation/utility. PRO were reported in 11 % (n = 5/45) of Category A studies.

Conclusions

Shortened duration of anti-PD-1 therapy and neoadjuvant approaches hold substantial promise in deintensification. Future trials should prioritise consistent incorporation of PRO and focus on determining clinical utility of biomarkers.
为了减少过度治疗,提高患者安全和生活质量,人们对优化黑色素瘤管理越来越感兴趣,但关于去强化的临床指导很少。本文综述了系统性治疗和生物标志物在当前和新出现的黑色素瘤去强化策略中的作用。还总结了研究类型、资金来源和患者报告结果(PRO)的使用情况。方法:medline、EMBASE和PubMed检索了2013年1月至2023年6月成人皮肤黑色素瘤患者去强化的研究。其他文本通过b谷歌Scholar和反向引文搜索获得。三种提取工具被定制以适应所包括文章的广度:A)去强化方法,包括后期开发的生物标志物;B)非系统评价;C)早期生物标志物。筛选和数据提取由两名审稿人使用covid - ence进行。使用描述性统计分析数据,并根据PRISMA-ScR指南报告结果。结果在筛选的3721篇文章中,纳入了301篇:31篇非系统综述,198篇早期生物标志物研究,72篇去强化方法研究。出现了五种关键方法:缩短治疗时间,剂量衰减,生物标志物信息,新辅助和/或反应适应,以及其他方法。大多数数据是回顾性的;只有5个随机对照试验被纳入A类(其中2个为试验方案)。早期阶段的生物标志物研究包括66 % (n = 198/301)的文章-很少进展到临床验证/实用性试验。11 % (n = 5/45)的A类研究报告了PRO。结论缩短抗pd -1治疗时间和新辅助方法在去强化方面具有很大的前景。未来的试验应优先考虑PRO的一致性合并,并专注于确定生物标志物的临床效用。
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引用次数: 0
Recent treatment and survival trends in older versus younger women with HR-positive HER2-negative metastatic breast cancer in the real-life multicenter French ESME cohort 在现实生活中的多中心法国ESME队列中,老年女性与年轻女性hr阳性her2阴性转移性乳腺癌的近期治疗和生存趋势
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-05 DOI: 10.1016/j.ejca.2025.116166
Fanny Bouteiller , Sophie Gourgou , Michaël Bringuier , Angéline Galvin , Audrey Mailliez , Nicolas Bertrand , Mony Hung , Jean-Sébastien Frenel , Vincent Massard , Thomas Bachelot , Carole Pflumio , Anthony Gonçalves , Christelle Levy , Lise Bosquet , William Jacot , Suzette Delaloge , Thomas Grinda , Carine Bellera

Aim

To describe first-line treatments, overall (OS) and real-world progression-free (rwPFS) survival in women with hormone receptor-positive, HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) following introduction of CDK4/6 inhibitors (CDK4/6i), according to age (<70; 70 +) and diagnostic period (before/after CDK4/6i).

Methods

We extracted data from the ESME database (NCT03275311) which includes consecutive patients starting first-line mBC in one of the 18 French Comprehensive cancer centres.

Results

We identified 17,830 eligible women (median age: 62 years). Women aged ≥ 70 years were less likely to present with aggressive disease characteristics. Use of endocrine therapy combined with CDK4/6i increased substantially over time in both age groups, from 0.9 % to 48.9 % in 70 + women, and from 0.8 % to 50.1 % in women < 70 (p < 0.001 for both). In contrast, first-line chemotherapy (alone or in combination) declined from 52.7 % to 30.0 % (p < 0.001), with consistently lower use among women 70 + compared to those < 70: 32.2 % vs. 61.1 % prior to 2016, and 16.4 % vs. 36.5 % after 2017 (p < 0.001 for both). Among 70 + women, OS improved over time (34.0–37.3 months, p = 0.03) but remained shorter than in younger women. rwPFS improved in both age groups: from 12.6 to 14.8 months in 70 + women, and from 12.3 to 14.4 months in women < 70 (p < 0.001 for both).

Conclusion

ET+CDK4/6i use rose up to ∼50 % after 2017, reaching ∼70 % in recent years among women with good PS, but remained ∼50 % in older patients with poor PS. Broader adoption is needed, with less chemotherapy use. Survival outcomes have improved but, causality cannot be confirmed due to the observational design.
目的:根据年龄描述激素受体阳性,HER2阴性(HR+/HER2-)转移性乳腺癌(mBC)患者在引入CDK4/6抑制剂(CDK4/6i)后的一线治疗,总体(OS)和真实无进展(rwPFS)生存率。方法:我们从ESME数据库(NCT03275311)中提取数据,其中包括在18个法国综合癌症中心之一开始一线mBC的连续患者。结果:我们确定了17830名符合条件的女性(中位年龄:62岁)。年龄≥ 70岁的女性出现侵袭性疾病特征的可能性较小。使用内分泌疗法结合CDK4/6i大幅增加随着时间在两个年龄组,从70年的0.9 % 48.9 % + 女性,从女性0.8 % 50.1 %结论:ET + CDK4/6i使用起来∼50 % 2017年之后,达到∼70 %近年来女性有很好的PS,但仍∼50 %与可怜的PS。老年患者需要更广泛的采用,减少化疗使用。生存结果有所改善,但由于观察性设计,不能确认因果关系。
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引用次数: 0
Liposomal irinotecan in patients with HER2-negative breast cancer and brain metastases: The PHENOMENAL phase 2 study 伊立替康脂质体在her2阴性乳腺癌和脑转移患者中的应用:一项惊人的2期研究。
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-04 DOI: 10.1016/j.ejca.2025.116161
Manuel Ruiz Borrego , David Páez López-Bravo , Mireia Margelí Vila , José Manuel Pérez-García , María Fernández , Salvador Blanch Tormo , José Ángel García-Saenz , Laura Lema , Isabel Garau , Patricia Cortez , Antonio Antón Torres , Emilio Alba Conejo , Isabel Calvo , Neus Ferrer , Isabel Blancas , Kepa Amillano , Sandra Santasusagna , Marc Antoine Benderra , Daniel Alcalá-López , Gabriele Antonarelli , Javier Cortés

Introduction

Patients with breast cancer (BC) and brain metastases (BMs) have a poor prognosis, particularly those with human epidermal growth factor 2-negative (HER2[-]) BC, including hormone receptor-positive (HR[+]) and triple-negative breast cancer (TNBC). Liposomal irinotecan (nal-IRI) crosses the blood-brain barrier and enhances antitumor activity.

Methods

PHENOMENAL (NCT03328884) was a single-arm, open-label, multicenter phase 2a study in Spain. Eligible patients had HER2[-] BC with active or stable BMs and prior chemotherapy regimen for metastatic disease (≥1 taxane line required). Nal-IRI was administered intravenously at 60 mg/m2 (salt-base) or 50 mg/m2 (free-base) every 14 days until progression and/or unacceptable toxicity. The primary endpoint was intracranial objective response rate (IC-ORR) in patients with progressive BMs. Key secondary endpoints included ORR, clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), and safety.

Results

Fifty-six women (median age 52 years; range, 32–83) were enrolled across 16 sites. Of these, 51.8 % had TNBC, and 91.1 % had progressive BMs at baseline. Median follow-up was 5.7 months (range, 0.4–56.5). The trial achieved its primary endpoint, with IC-ORR of 22.0 % (95 % CI, 11.5–36.0; p < 0.001) among patients with progressive BMs. Median PFS was 1.5 months (95 % CI, 1.4–2.9), while median OS reached 6.4 months (95 % CI, 4.9–10.8).
Treatment-emergent adverse events (TEAEs) occurred in 96.4 % of patients; 57.1 % were considered treatment-related and 14.3 % experienced grade ≥ 3 treatment-related events. Only one patient had a serious treatment-related event, and no treatment-related deaths occurred.

Conclusions

nal-IRI demonstrated IC activity in HER2[-] BC with BMs. While overall efficacy was limited and long-term outcomes remain poor, these results highlight the unmet need in this challenging population and support the importance of developing more treatment strategies.
乳腺癌(BC)和脑转移(BMs)患者预后较差,特别是人表皮生长因子2阴性(HER2[-]) BC,包括激素受体阳性(HR[+])和三阴性乳腺癌(TNBC)。伊立替康脂质体(nal-IRI)穿过血脑屏障,增强抗肿瘤活性。方法:现象(NCT03328884)是一项在西班牙进行的单臂、开放标签、多中心2a期研究。符合条件的患者HER2[-] BC伴有活动性或稳定性脑转移,既往有转移性疾病化疗方案(需要≥1紫杉醇类药物)。Nal-IRI以60mg /m2(盐基)或50mg /m2(游离基)静脉滴注,每14天一次,直到进展和/或不可接受的毒性。主要终点是进展性脑转移患者的颅内客观缓解率(IC-ORR)。关键次要终点包括ORR、临床获益率(CBR)、无进展生存期(PFS)、总生存期(OS)和安全性。结果:56名女性(中位年龄52岁,范围32-83岁)在16个站点入组。其中,51.8 %患有TNBC, 91.1 %在基线时患有进行性脑转移。中位随访时间为5.7个月(范围0.4-56.5)。该试验达到了主要终点,IC- orr为22.0 %(95% % CI, 11.5-36.0; p )结论:nal-IRI在伴有脑转移的HER2[-] BC中显示IC活性。虽然总体疗效有限,长期结果仍然很差,但这些结果突出了这一具有挑战性的人群中未满足的需求,并支持制定更多治疗策略的重要性。
{"title":"Liposomal irinotecan in patients with HER2-negative breast cancer and brain metastases: The PHENOMENAL phase 2 study","authors":"Manuel Ruiz Borrego ,&nbsp;David Páez López-Bravo ,&nbsp;Mireia Margelí Vila ,&nbsp;José Manuel Pérez-García ,&nbsp;María Fernández ,&nbsp;Salvador Blanch Tormo ,&nbsp;José Ángel García-Saenz ,&nbsp;Laura Lema ,&nbsp;Isabel Garau ,&nbsp;Patricia Cortez ,&nbsp;Antonio Antón Torres ,&nbsp;Emilio Alba Conejo ,&nbsp;Isabel Calvo ,&nbsp;Neus Ferrer ,&nbsp;Isabel Blancas ,&nbsp;Kepa Amillano ,&nbsp;Sandra Santasusagna ,&nbsp;Marc Antoine Benderra ,&nbsp;Daniel Alcalá-López ,&nbsp;Gabriele Antonarelli ,&nbsp;Javier Cortés","doi":"10.1016/j.ejca.2025.116161","DOIUrl":"10.1016/j.ejca.2025.116161","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with breast cancer (BC) and brain metastases (BMs) have a poor prognosis, particularly those with human epidermal growth factor 2-negative (HER2[-]) BC, including hormone receptor-positive (HR[+]) and triple-negative breast cancer (TNBC). Liposomal irinotecan (nal-IRI) crosses the blood-brain barrier and enhances antitumor activity.</div></div><div><h3>Methods</h3><div>PHENOMENAL (NCT03328884) was a single-arm, open-label, multicenter phase 2a study in Spain. Eligible patients had HER2[-] BC with active or stable BMs and prior chemotherapy regimen for metastatic disease (≥1 taxane line required). Nal-IRI was administered intravenously at 60 mg/m<sup>2</sup> (salt-base) or 50 mg/m<sup>2</sup> (free-base) every 14 days until progression and/or unacceptable toxicity. The primary endpoint was intracranial objective response rate (IC-ORR) in patients with progressive BMs. Key secondary endpoints included ORR, clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), and safety.</div></div><div><h3>Results</h3><div>Fifty-six women (median age 52 years; range, 32–83) were enrolled across 16 sites. Of these, 51.8 % had TNBC, and 91.1 % had progressive BMs at baseline. Median follow-up was 5.7 months (range, 0.4–56.5). The trial achieved its primary endpoint, with IC-ORR of 22.0 % (95 % CI, 11.5–36.0; <em>p</em> &lt; 0.001) among patients with progressive BMs. Median PFS was 1.5 months (95 % CI, 1.4–2.9), while median OS reached 6.4 months (95 % CI, 4.9–10.8).</div><div>Treatment-emergent adverse events (TEAEs) occurred in 96.4 % of patients; 57.1 % were considered treatment-related and 14.3 % experienced grade ≥ 3 treatment-related events. Only one patient had a serious treatment-related event, and no treatment-related deaths occurred.</div></div><div><h3>Conclusions</h3><div>nal-IRI demonstrated IC activity in HER2[-] BC with BMs. While overall efficacy was limited and long-term outcomes remain poor, these results highlight the unmet need in this challenging population and support the importance of developing more treatment strategies.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116161"},"PeriodicalIF":7.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721844","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}
引用次数: 0
Letter to the editor Re: Immunotherapy and PARP inhibitors as first-line treatment in endometrial cancer: A systematic review and network meta-analysis 回复:免疫疗法和PARP抑制剂作为子宫内膜癌的一线治疗:一项系统综述和网络荟萃分析
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-04 DOI: 10.1016/j.ejca.2025.116163
Yibin Lin , Xiao Chen , Wei Chen, Yang Sun
{"title":"Letter to the editor Re: Immunotherapy and PARP inhibitors as first-line treatment in endometrial cancer: A systematic review and network meta-analysis","authors":"Yibin Lin ,&nbsp;Xiao Chen ,&nbsp;Wei Chen,&nbsp;Yang Sun","doi":"10.1016/j.ejca.2025.116163","DOIUrl":"10.1016/j.ejca.2025.116163","url":null,"abstract":"","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116163"},"PeriodicalIF":7.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735855","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}
引用次数: 0
Response to letter Re: Tarlatamab-induced immune-related adverse events: Real-world pharmacovigilance study using the FAERS database 对字母Re的回应:tarlatamab诱导的免疫相关不良事件:使用FAERS数据库的真实世界药物警戒研究
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-04 DOI: 10.1016/j.ejca.2025.116151
Nikhil Vojjala, Prakash Neupane, Nausheen Ahmed
{"title":"Response to letter Re: Tarlatamab-induced immune-related adverse events: Real-world pharmacovigilance study using the FAERS database","authors":"Nikhil Vojjala,&nbsp;Prakash Neupane,&nbsp;Nausheen Ahmed","doi":"10.1016/j.ejca.2025.116151","DOIUrl":"10.1016/j.ejca.2025.116151","url":null,"abstract":"","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116151"},"PeriodicalIF":7.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693228","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}
引用次数: 0
The telomerase vaccine UV1 combined with ipilimumab and nivolumab versus ipilimumab and nivolumab in advanced melanoma (INITIUM): A randomized open-label phase 2 study 端粒酶疫苗UV1联合伊匹单抗和纳武单抗与伊匹单抗和纳武单抗治疗晚期黑色素瘤(INITIUM):一项随机开放标签2期研究。
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-03 DOI: 10.1016/j.ejca.2025.116162
Paul Lorigan , Theresa Michelle Medina , Marta Nyakas , Annemie Rutten , Lynn G. Feun , Charles Lance Cowey , Miranda Payne , Israr Hussain , Timothy Kuzel , Steven O’Day , Amna Sheri , Philip Adam Friedlander , Satish Kumar , Vanja Sue Bergersen , Øivind Foss , Espen Basmo Ellingsen , Jens Bjørheim , Oliver Edgar Bechter

Purpose

Immune checkpoint inhibitor (ICI) combinations have improved outcomes in patients with advanced melanoma; however, long term survival remains poor. The addition of therapeutic cancer vaccines to ICI combinations represents a promising strategy to enhance efficacy.

Methods

In this phase 2, randomized, open-label trial, 156 patients with unresectable or metastatic melanoma were randomized 1:1 to receive 4 cycles of ipilimumab 3mg/kg and nivolumab 1mg/kg with or without UV1, a telomerase-targeted therapeutic cancer vaccine, followed by maintenance nivolumab 480 mg every 4 weeks. The primary endpoint was progression-free survival (PFS) based on blinded independent central review. Secondary endpoints included overall survival (OS), response assessments, and safety.

Results

At a minimum follow-up of 18 months, the projected median PFS was 34.3 months (95 % confidence interval [CI], 7.95 to NR) with ipilimumab-nivolumab-UV1 and 38.4 months (95 % CI, 8.15–38.37) with ipilimumab-nivolumab (hazard ratio, 0.95 [95 % CI, 0.59–1.55]). PFS at 12 months was 57 % (95 % CI, 45.0–68.1) and 57 % (95 % CI, 44.6–67.0) in the ipilimumab-nivolumab-UV1 and ipilimumab-nivolumab arms, respectively. Objective response rates were 59.7 % (ipilimumab-nivolumab-UV1) and 59.2 % (ipilimumab-nivolumab; odds ratio, 1.12; 95 % CI, 0.58–2.16). Median overall survival was not reached in either arm (hazard ratio, 1.15 [95 % CI, 0.60–2.20]). Grade > 3 treatment-emergent adverse events were reported in 64.5 % and 65.4 % of patients respectively.

Conclusion

For patients with treatment naïve advanced melanoma, the addition of UV1 to ipilimumab-nivolumab did not result in improved efficacy compared with ipilimumab-nivolumab alone.
目的:免疫检查点抑制剂(ICI)联合治疗可改善晚期黑色素瘤患者的预后;然而,长期存活率仍然很低。在ICI组合中加入治疗性癌症疫苗是一种有希望提高疗效的策略。方法:在这项2期随机、开放标签试验中,156例不可切除或转移性黑色素瘤患者以1:1的比例随机接受ipilimumab 3mg/kg和nivolumab 1mg/kg的4个周期,联合或不联合UV1(一种端粒酶靶向治疗性癌症疫苗),随后每4周维持nivolumab 480 mg。主要终点是基于盲法独立中心评价的无进展生存期(PFS)。次要终点包括总生存期(OS)、反应评估和安全性。结果:在至少18个月的随访中,ipilimumab-nivolumab- uv1组的预计中位PFS为34.3个月(95% %可信区间[CI], 7.95至NR), ipilimumab-nivolumab组的中位PFS为38.4个月(95% % CI, 8.15至38.37)(风险比为0.95[95 % CI, 0.59至1.55])。ipilimumab-nivolumab- uv1组和ipilimumab-nivolumab组12个月的PFS分别为57 %(95 % CI, 45.0-68.1)和57 %(95 % CI, 44.6-67.0)。客观缓解率为59.7 % (ipilimumab-nivolumab- uv1)和59.2 % (ipilimumab-nivolumab;优势比为1.12;95% % CI, 0.58-2.16)。两组均未达到中位总生存期(风险比为1.15[95 % CI, 0.60-2.20])。> 3级治疗不良事件报告分别为64.5% %和65.4 %的患者。结论:对于naïve晚期黑色素瘤患者,ipilimumab-nivolumab联合UV1治疗与单用ipilimumab-nivolumab相比,并没有提高疗效。
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引用次数: 0
Large B-cell lymphoma: The LYSA pragmatic guidelines 大b细胞淋巴瘤:LYSA实用指南
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-03 DOI: 10.1016/j.ejca.2025.116070
Pierre Sesques , Guillaume Manson , Sydney Dubois , Francois Xavier Gros , Gabriel Brisou , Clémentine Sarkozy , Sophie Bernard , Estelle Bourbon , Luc Matthieu Fornecker , Eric Durot , Laurent Martin , Catherine Chassagne-Clément , Francisco Llamas Gutierrez , Charlotte Syrykh , Marie-Hélène Delfau-Larue , Salim Kanoun , Laetitia Vercellino , Caroline Bodet-Milin , Haifa Bahri , Jules Zhang Yin , Benoit Tessoulin
The management of large B-cell lymphomas (LBCL) has undergone major changes over the last 5 years. These changes reflect the availability of new therapies (immunotherapies, cell therapies, targeted molecules), but also a better compartmentalization of the entities and their specific clinical characteristics. Numerous first-, second- and third-line therapeutic strategies are available, and each practitioner is committed to selecting the treatment that offers the best balance between efficacy and toxicity. Advances in the understanding of LBCL biology, coupled with improvements in diagnostic and monitoring tools and therapeutic approaches, have significantly enhanced patient outcomes in recent years. In this article, we present a set of pragmatic guidelines developed by the LYSA (Lymphoma Study Association) for the management of LBCL. These guidelines address key aspects of diagnosis, staging, response evaluation, and treatment, integrating the latest evidence from clinical trials, expert consensus, and real-world practice. They aim to provide clinicians with a clear, practical framework to optimize care for patients with LBCL, ensuring that the best available evidence is translated into clinical practice.
大b细胞淋巴瘤(LBCL)的治疗在过去5年中发生了重大变化。这些变化反映了新疗法(免疫疗法、细胞疗法、靶向分子疗法)的可用性,但也反映了实体及其特定临床特征的更好划分。许多一线、二线和三线治疗策略是可用的,每个从业者都致力于选择治疗,提供疗效和毒性之间的最佳平衡。近年来,对LBCL生物学认识的进步,加上诊断和监测工具以及治疗方法的改进,显著提高了患者的预后。在这篇文章中,我们提出了一套由LYSA(淋巴瘤研究协会)制定的用于LBCL管理的实用指南。这些指南涉及诊断、分期、反应评估和治疗的关键方面,整合了来自临床试验、专家共识和现实世界实践的最新证据。他们的目标是为临床医生提供一个清晰、实用的框架,以优化LBCL患者的护理,确保将现有的最佳证据转化为临床实践。
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引用次数: 0
Subsequent anticancer therapy in patients randomized to placebo alone or best supportive care 患者的后续抗癌治疗随机分为安慰剂组或最佳支持治疗组
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-03 DOI: 10.1016/j.ejca.2025.116148
Christopher Rios , Alyson Haslam , Timothée Olivier

Aim

Oncology randomized controlled trials (RCTs) may use placebo or best supportive care (BSC) as control arms under certain conditions. The appropriateness of such comparators is uncertain when many control patients subsequently receive anticancer therapy. This study aimed to evaluate whether the use of inert control arms in recent FDA registration trials was justified, using subsequent anticancer therapy data.

Methods

We conducted a cross-sectional analysis of FDA registration trials for anticancer drugs approved between January 2009 and November 2024, identified from an internally compiled database of FDA records. Eligible trials were RCTs in advanced or metastatic disease using placebo-only or BSC as the control arm and reporting subsequent systemic therapy for at least the control group. Data on trial characteristics, crossover design, subsequent therapy, and outcomes were abstracted. Descriptive statistics and regression analyses assessed associations between subsequent therapy rates and trial outcomes.

Results

Among 550 FDA approvals, 18 trials met inclusion criteria. Overall, 49 % of patients in control arms received subsequent systemic therapy. Trials allowing crossover reported higher rates of subsequent therapy (66.0 %) than those without crossover (40.7 %). A significant inverse association was observed, with a 0.07 decrease in hazard ratio for every 10 % increase in control patients receiving subsequent therapy.

Conclusion

Nearly half of patients in control arms of trials using inert comparators received subsequent active therapy, calling into question the appropriateness of these control designs. Inappropriate use of inactive controls may inflate treatment effects. Regulators and ethics committees should ensure justified comparator selection in vulnerable populations.
aimonology随机对照试验(rct)在一定条件下可以使用安慰剂或最佳支持治疗(BSC)作为对照。当许多对照患者随后接受抗癌治疗时,这种比较物的适宜性是不确定的。本研究旨在评估在最近的FDA注册试验中使用惰性对照臂是否合理,并使用随后的抗癌治疗数据。方法:我们对2009年1月至2024年11月FDA批准的抗癌药物注册试验进行了横断面分析,这些试验来自FDA内部编制的记录数据库。符合条件的试验是晚期或转移性疾病的随机对照试验,使用安慰剂或BSC作为对照组,并报告至少对照组的后续全身治疗。对试验特征、交叉设计、后续治疗和结果的数据进行了抽象。描述性统计和回归分析评估了后续治疗率和试验结果之间的关系。结果在550个FDA批准的试验中,18个试验符合纳入标准。总体而言,对照组中49%的患者接受了随后的全身治疗。允许交叉的试验报告的后续治疗率(66.0%)高于不允许交叉的试验(40.7%)。观察到显著的负相关,接受后续治疗的对照患者每增加10%,风险比降低0.07。结论:在使用惰性比较物的对照组中,近一半的患者随后接受了积极治疗,这让人质疑这些对照设计的适宜性。不适当使用非活性对照可能会夸大治疗效果。监管机构和伦理委员会应确保在弱势群体中选择合理的比较者。
{"title":"Subsequent anticancer therapy in patients randomized to placebo alone or best supportive care","authors":"Christopher Rios ,&nbsp;Alyson Haslam ,&nbsp;Timothée Olivier","doi":"10.1016/j.ejca.2025.116148","DOIUrl":"10.1016/j.ejca.2025.116148","url":null,"abstract":"<div><h3>Aim</h3><div>Oncology randomized controlled trials (RCTs) may use placebo or best supportive care (BSC) as control arms under certain conditions. The appropriateness of such comparators is uncertain when many control patients subsequently receive anticancer therapy. This study aimed to evaluate whether the use of inert control arms in recent FDA registration trials was justified, using subsequent anticancer therapy data.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of FDA registration trials for anticancer drugs approved between January 2009 and November 2024, identified from an internally compiled database of FDA records. Eligible trials were RCTs in advanced or metastatic disease using placebo-only or BSC as the control arm and reporting subsequent systemic therapy for at least the control group. Data on trial characteristics, crossover design, subsequent therapy, and outcomes were abstracted. Descriptive statistics and regression analyses assessed associations between subsequent therapy rates and trial outcomes.</div></div><div><h3>Results</h3><div>Among 550 FDA approvals, 18 trials met inclusion criteria. Overall, 49 % of patients in control arms received subsequent systemic therapy. Trials allowing crossover reported higher rates of subsequent therapy (66.0 %) than those without crossover (40.7 %). A significant inverse association was observed, with a 0.07 decrease in hazard ratio for every 10 % increase in control patients receiving subsequent therapy.</div></div><div><h3>Conclusion</h3><div>Nearly half of patients in control arms of trials using inert comparators received subsequent active therapy, calling into question the appropriateness of these control designs. Inappropriate use of inactive controls may inflate treatment effects. Regulators and ethics committees should ensure justified comparator selection in vulnerable populations.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"233 ","pages":"Article 116148"},"PeriodicalIF":7.1,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735721","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}
引用次数: 0
Letter Re: Tarlatamab-induced immune-related adverse events: Real-world pharmacovigilance study using the FAERS database 信Re: tarlatamab诱导的免疫相关不良事件:使用FAERS数据库的真实世界药物警戒研究
IF 7.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-12-01 DOI: 10.1016/j.ejca.2025.116150
Emanuel Raschi , Charles Khouri , Elisabetta Poluzzi, Fabrizio De Ponti
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引用次数: 0
期刊
European Journal of Cancer
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