Cancer最新文献_第9页

New AI model shows promise for cancer diagnosis

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-02-01 DOI: 10.1002/cncr.35715

Mary Beth Nierengarten

<p>A new ChatGPT-like artificial intelligence (AI) model developed by researchers at Harvard Medical School outperforms other state-of-the-art AI methods by up to 36% in an array of diagnostic tasks across multiple forms of cancer. These tasks include the detection of cancer cells, the identification of a tumor’s origin, the prediction of patient outcomes, and the identification of the presence of genes and DNA patterns associated with treatment response.<span><sup>1</sup></span><sup>,</sup> <span><sup>2</sup></span></p><p>The Clinical Histopathology Imaging Evaluation Foundation (CHIEF) model achieved nearly 94% accuracy in cancer detection across 15 different databases containing 11 cancer types. Its accuracy increased to 96% when it was based on five biopsy data sets for multiple cancer types, which included esophageal, stomach, colon, and prostate cancers, and achieved more than 90% accuracy when it was based on previously unseen slides from surgically removed tumors of multiple cancers, which included colon, lung, breast, endometrial, and cervical cancers.</p><p>The model was trained on more than 60,000 whole-slide pathology images spanning 19 anatomical sites, and it works by reading digital slides of tumor tissues to detect cancer cells and predict a tumor’s molecular profile.</p><p>For predicting tumors’ molecular profiles, CHIEF successfully identified several important genes associated with cancer growth and suppression and predicted key genetic mutations related to a tumor’s potential response to targeted therapy. When tested on US Food and Drug Administration–approved targeted therapies (across 18 genes in 15 anatomic sites), the model was 96% accurate in detecting <i>EZH2</i> in diffuse large B-cell lymphoma, 89% accurate in detecting <i>BRAF</i> in thyroid cancer, and 91% accurate in detecting <i>NTRK1</i> in head and neck cancers.</p><p>Using tumor histopathology images obtained at initial diagnosis, CHIEF also was able to predict patient survival and outperformed other AI models by 8% in its ability to distinguish between patients with longer- and shorter-term survival (for all cancer types) and by 10% in its ability to distinguish survival rates in patients with advanced cancers.</p><p>“The performance that the model was able to demonstrate across a diverse set of types and tasks was very impressive,” says Fei Wang, MD, professor of population health sciences and founding director of the Institute of Artificial Intelligence for Digital Health at Weill Cornell Medicine, who thinks that AI has huge potential to augment clinical tasks and improve patient care.</p><p>However, he underscores the need for rigorous prospective evaluations through clinical trials to better understand how these types of models work in the real world.</p><p>“The current model has not been tested in real-world clinical care settings, so it is not clear how robust the model will be with respect to real-world challenges, such as imaging quality, c

{"title":"New AI model shows promise for cancer diagnosis","authors":"Mary Beth Nierengarten","doi":"10.1002/cncr.35715","DOIUrl":"10.1002/cncr.35715","url":null,"abstract":"<p>A new ChatGPT-like artificial intelligence (AI) model developed by researchers at Harvard Medical School outperforms other state-of-the-art AI methods by up to 36% in an array of diagnostic tasks across multiple forms of cancer. These tasks include the detection of cancer cells, the identification of a tumor’s origin, the prediction of patient outcomes, and the identification of the presence of genes and DNA patterns associated with treatment response.<span><sup>1</sup></span><sup>,</sup>\u0000 <span><sup>2</sup></span></p><p>The Clinical Histopathology Imaging Evaluation Foundation (CHIEF) model achieved nearly 94% accuracy in cancer detection across 15 different databases containing 11 cancer types. Its accuracy increased to 96% when it was based on five biopsy data sets for multiple cancer types, which included esophageal, stomach, colon, and prostate cancers, and achieved more than 90% accuracy when it was based on previously unseen slides from surgically removed tumors of multiple cancers, which included colon, lung, breast, endometrial, and cervical cancers.</p><p>The model was trained on more than 60,000 whole-slide pathology images spanning 19 anatomical sites, and it works by reading digital slides of tumor tissues to detect cancer cells and predict a tumor’s molecular profile.</p><p>For predicting tumors’ molecular profiles, CHIEF successfully identified several important genes associated with cancer growth and suppression and predicted key genetic mutations related to a tumor’s potential response to targeted therapy. When tested on US Food and Drug Administration–approved targeted therapies (across 18 genes in 15 anatomic sites), the model was 96% accurate in detecting <i>EZH2</i> in diffuse large B-cell lymphoma, 89% accurate in detecting <i>BRAF</i> in thyroid cancer, and 91% accurate in detecting <i>NTRK1</i> in head and neck cancers.</p><p>Using tumor histopathology images obtained at initial diagnosis, CHIEF also was able to predict patient survival and outperformed other AI models by 8% in its ability to distinguish between patients with longer- and shorter-term survival (for all cancer types) and by 10% in its ability to distinguish survival rates in patients with advanced cancers.</p><p>“The performance that the model was able to demonstrate across a diverse set of types and tasks was very impressive,” says Fei Wang, MD, professor of population health sciences and founding director of the Institute of Artificial Intelligence for Digital Health at Weill Cornell Medicine, who thinks that AI has huge potential to augment clinical tasks and improve patient care.</p><p>However, he underscores the need for rigorous prospective evaluations through clinical trials to better understand how these types of models work in the real world.</p><p>“The current model has not been tested in real-world clinical care settings, so it is not clear how robust the model will be with respect to real-world challenges, such as imaging quality, c","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.35715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Men face substantial lifelong risk of oral HPV infection

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-02-01 DOI: 10.1002/cncr.35714

Mary Beth Nierengarten

<p>Men remain at risk of acquiring an oral human papillomavirus (HPV) infection throughout their lifetime, suggesting a benefit of HPV vaccination in men regardless of age according to a study published in <i>Nature Microbiology</i>.<span><sup>1</sup></span></p><p>It is well known that oral HPV infections, particularly those with high-risk genotypes, cause oropharyngeal cancer, with HPV-16 found in approximately 90% of all oropharyngeal cancer cases in men in the United States.</p><p>Less known is the natural history of oral HPV infection. The current study fills that gap by providing information on rates of newly acquired oral HPV infections and associated risk factors for acquiring HPV infections in a multinational cohort of more than 3000 men from the United States, Brazil, and Mexico who were followed for a median of 57 months.</p><p>The study found that the incident rate of any new oral oncogenic HPV infection was 2.4 per 1000 person-months, with men in the United States having a higher incidence (3.5 per 1000 person-months) than men in Brazil and Mexico (2.1 per 1000 person-months for both).</p><p>The highest incidence rate of any new oncogenic HPV infection by age was in the youngest cohort (18–24 years) at 2.9 per 1000 person-months, which was followed by 2.2 per 1000 person-months for those 25–32 or 33–41 years old and 2.5 per 1000 person-months for those 42 years old or older.</p><p>These incidence rates stayed constant over time, whether for any oncogenic HPV infection or by HPV genotype.</p><p>By country, men in the United States had a higher risk of acquiring any oncogenic HPV infection or an HPV-16 infection compared to those in Mexico. No difference was found between men in Brazil and men in Mexico.</p><p>Risk factors associated with a higher risk of HPV infection included higher education (13–15 years), alcohol consumption (>60 alcoholic beverages in the past month), having only male sexual partners, a history of three or more female sexual partners, and more frequent performance of oral sex (at least seven times in the past 6 months). Men with one or more lost teeth due to oral disease also had a marginally elevated risk.</p><p>In all countries, no association was found between the risk of acquiring a new oral HPV infection and age, indicating that men may remain susceptible throughout their lifetime.</p><p>Zachary S. Zumsteg, MD, associate professor of the Department of Radiation Oncology at the Cedars–Sinai Samuel Oschin Comprehensive Cancer Institute, who specializes in head and neck cancers, says that the study provides strong evidence that men continue to be at risk of acquiring an oral HPV infection throughout life.</p><p>“One of the most surprising findings of this study is that the likelihood of acquiring an oral HPV infection was similar across age groups among the men enrolled in the study,” he says.</p><p>He notes that a prior cross-sectional study using data from the 2009–2010 National Health and Nutrition Examinat

{"title":"Men face substantial lifelong risk of oral HPV infection","authors":"Mary Beth Nierengarten","doi":"10.1002/cncr.35714","DOIUrl":"10.1002/cncr.35714","url":null,"abstract":"<p>Men remain at risk of acquiring an oral human papillomavirus (HPV) infection throughout their lifetime, suggesting a benefit of HPV vaccination in men regardless of age according to a study published in <i>Nature Microbiology</i>.<span><sup>1</sup></span></p><p>It is well known that oral HPV infections, particularly those with high-risk genotypes, cause oropharyngeal cancer, with HPV-16 found in approximately 90% of all oropharyngeal cancer cases in men in the United States.</p><p>Less known is the natural history of oral HPV infection. The current study fills that gap by providing information on rates of newly acquired oral HPV infections and associated risk factors for acquiring HPV infections in a multinational cohort of more than 3000 men from the United States, Brazil, and Mexico who were followed for a median of 57 months.</p><p>The study found that the incident rate of any new oral oncogenic HPV infection was 2.4 per 1000 person-months, with men in the United States having a higher incidence (3.5 per 1000 person-months) than men in Brazil and Mexico (2.1 per 1000 person-months for both).</p><p>The highest incidence rate of any new oncogenic HPV infection by age was in the youngest cohort (18–24 years) at 2.9 per 1000 person-months, which was followed by 2.2 per 1000 person-months for those 25–32 or 33–41 years old and 2.5 per 1000 person-months for those 42 years old or older.</p><p>These incidence rates stayed constant over time, whether for any oncogenic HPV infection or by HPV genotype.</p><p>By country, men in the United States had a higher risk of acquiring any oncogenic HPV infection or an HPV-16 infection compared to those in Mexico. No difference was found between men in Brazil and men in Mexico.</p><p>Risk factors associated with a higher risk of HPV infection included higher education (13–15 years), alcohol consumption (>60 alcoholic beverages in the past month), having only male sexual partners, a history of three or more female sexual partners, and more frequent performance of oral sex (at least seven times in the past 6 months). Men with one or more lost teeth due to oral disease also had a marginally elevated risk.</p><p>In all countries, no association was found between the risk of acquiring a new oral HPV infection and age, indicating that men may remain susceptible throughout their lifetime.</p><p>Zachary S. Zumsteg, MD, associate professor of the Department of Radiation Oncology at the Cedars–Sinai Samuel Oschin Comprehensive Cancer Institute, who specializes in head and neck cancers, says that the study provides strong evidence that men continue to be at risk of acquiring an oral HPV infection throughout life.</p><p>“One of the most surprising findings of this study is that the likelihood of acquiring an oral HPV infection was similar across age groups among the men enrolled in the study,” he says.</p><p>He notes that a prior cross-sectional study using data from the 2009–2010 National Health and Nutrition Examinat","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.35714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gaps in care highlight the need to expand access to clinical cancer trials 护理方面的差距凸显了扩大临床癌症试验机会的必要性。

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-02-01 DOI: 10.1002/cncr.35716

Mary Beth Nierengarten

Many of those who are the most likely to face a cancer diagnosis live in geographical parts of the United States with little or no access to cancer clinical trials according to a study published in JCO Oncology Practice.¹

In more than 1200 US counties, which are home to 43% of the population aged 55 years or older, cancer clinical trials were limited (1–99 trials) or lacking (zero trials). In addition, 26% of this population lived beyond an hour’s drive of a site with >100 trials.

Other factors associated with limited or no access to clinical trials included living in a nonmetropolitan county (85% had no trials vs. 44% of metropolitan counties) and living in a county with the highest cancer mortality (85% had no trials vs. 65% of those with lower cancer mortality). Social vulnerability (derived from US Census demographic and socioeconomic data) also was linked to limited access to clinical trials, with 26% of counties with high social vulnerability having at least one trial vs. 31% of those with lower social vulnerability.

Although the uneven spread of trials across the country with potential clusters around large cancer centers was expected, the lead author of the study, Kelsey Kirkwood, MPH, associate director and data scientist for the Center for Research and Analytics of the American Society of Clinical Oncology, says that she and her colleagues were “surprised by the few counties with broad portfolios of cancer trials where patients with uncommon cancer diagnoses might find suitable options.”

The study found that only 9% of all US counties (276 counties) had a broad portfolio of 100 clinical trials or more. Only 1 in 50 nonmetropolitan counties had broad trial portfolios, whereas 1 in 20 metropolitan counties did.

Kirkwood says that the study’s findings help to pinpoint where the gaps in care are to facilitate bringing cancer trials closer to patients and their communities.

“Care sites located in counties with limited or no trial offerings are potential places to expand reach and diversity of clinical trial participation,” she says, “especially in a time of technological advancements and building momentum for clinical trial decentralization.”

She and her colleagues also will be looking at regions with active trials in rural or minority communities as potential models for successful, diverse recruitment into clinical trials. “Our goal is to use these insights to support research sites across diverse geographic areas, aiming to improve representation so that trial participation better reflects the population of patients seeking cancer treatment,” she says.

{"title":"Gaps in care highlight the need to expand access to clinical cancer trials","authors":"Mary Beth Nierengarten","doi":"10.1002/cncr.35716","DOIUrl":"10.1002/cncr.35716","url":null,"abstract":"<p>Many of those who are the most likely to face a cancer diagnosis live in geographical parts of the United States with little or no access to cancer clinical trials according to a study published in <i>JCO Oncology Practice</i>.<span><sup>1</sup></span></p><p>In more than 1200 US counties, which are home to 43% of the population aged 55 years or older, cancer clinical trials were limited (1–99 trials) or lacking (zero trials). In addition, 26% of this population lived beyond an hour’s drive of a site with >100 trials.</p><p>Other factors associated with limited or no access to clinical trials included living in a nonmetropolitan county (85% had no trials vs. 44% of metropolitan counties) and living in a county with the highest cancer mortality (85% had no trials vs. 65% of those with lower cancer mortality). Social vulnerability (derived from US Census demographic and socioeconomic data) also was linked to limited access to clinical trials, with 26% of counties with high social vulnerability having at least one trial vs. 31% of those with lower social vulnerability.</p><p>Although the uneven spread of trials across the country with potential clusters around large cancer centers was expected, the lead author of the study, Kelsey Kirkwood, MPH, associate director and data scientist for the Center for Research and Analytics of the American Society of Clinical Oncology, says that she and her colleagues were “surprised by the few counties with broad portfolios of cancer trials where patients with uncommon cancer diagnoses might find suitable options.”</p><p>The study found that only 9% of all US counties (276 counties) had a broad portfolio of 100 clinical trials or more. Only 1 in 50 nonmetropolitan counties had broad trial portfolios, whereas 1 in 20 metropolitan counties did.</p><p>Kirkwood says that the study’s findings help to pinpoint where the gaps in care are to facilitate bringing cancer trials closer to patients and their communities.</p><p>“Care sites located in counties with limited or no trial offerings are potential places to expand reach and diversity of clinical trial participation,” she says, “especially in a time of technological advancements and building momentum for clinical trial decentralization.”</p><p>She and her colleagues also will be looking at regions with active trials in rural or minority communities as potential models for successful, diverse recruitment into clinical trials. “Our goal is to use these insights to support research sites across diverse geographic areas, aiming to improve representation so that trial participation better reflects the population of patients seeking cancer treatment,” she says.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.35716","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes and treatment patterns for stage I human epidermal growth factor receptor 2-positive breast cancer in the Surveillance, Epidemiology, and End Results database, 2010–2019

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-01-30 DOI: 10.1002/cncr.35729

Adrienne G. Waks MD, Paolo Tarantino MD, PhD, Emily L. Chen MD, Rachel A. Freedman MD, MPH, Nancy U. Lin MD, Nabihah Tayob PhD, Carlos T. Vallejo MD, Julieta Leone MD, Sara M. Tolaney MD, MPH, Jose Pablo Leone MD

Background

The risk of recurrence in patients with small, lymph node-negative, human epidermal growth factor receptor 2 (HER2)-positive breast cancers untreated with adjuvant chemotherapy/HER2-directed therapy is uncertain. To investigate this, the authors conducted a retrospective, population-based study of chemotherapy use and breast cancer-specific survival (BCSS) among patients with stage IA HER2-positive breast cancer.

Methods

The authors analyzed Surveillance, Epidemiology, and End Results data from patients diagnosed with stage IA HER2-positive breast cancer from 2010 to 2019. They examined the frequency of chemotherapy use by tumor size and hormone receptor (HR) status and applied multivariate logistic regression to assess the factors associated with receipt of chemotherapy. BCSS was evaluated and performed multivariable Cox regression was performed to evaluate the association between chemotherapy receipt and BCSS.

Results

Among 12,896 patients, 74.0% had HR-positive/HER2-positive breast cancer, and 26.0% had HR-negative/HER2-positive breast cancer. Adjuvant chemotherapy was received by to 58.9% of patients, with lower utilization for those who were older, Hispanic or Asian/Pacific Islander, separated/divorced/widowed, or had a lower median household income. The median follow-up was 46 months. Among the patients who had pathologic T1 (pT1) microscopic, pT1a, or pT1b tumors, the 5-year BCSS rate was 97.6%–99.6% in those who had no evidence of chemotherapy receipt in the medical record versus 98.4%–100.0% in those who did receive chemotherapy. Among patients who had pT1c tumors and had no evidence of chemotherapy receipt, the 5-year BCSS rate was 92.1% for those with HR-negative/HER2-positive breast cancer and 96.0% for those with HR-positive/HER2-positive breast cancer. Patients who had pT1c tumors and received chemotherapy had a 5-year BCSS rate of 96.7% in those with HR-negative/HER2-positive breast cancer and 98.7% in those with HR-positive/HER2-positive breast cancer.

Conclusions

In this large, population-based study of patients with stage IA HER2-positive breast cancer, patients who had tumors ≤1 cm had excellent outcomes with or without chemotherapy. Patients with pT1c tumors had a greater increase in BCSS with the receipt chemotherapy.

{"title":"Outcomes and treatment patterns for stage I human epidermal growth factor receptor 2-positive breast cancer in the Surveillance, Epidemiology, and End Results database, 2010–2019","authors":"Adrienne G. Waks MD, Paolo Tarantino MD, PhD, Emily L. Chen MD, Rachel A. Freedman MD, MPH, Nancy U. Lin MD, Nabihah Tayob PhD, Carlos T. Vallejo MD, Julieta Leone MD, Sara M. Tolaney MD, MPH, Jose Pablo Leone MD","doi":"10.1002/cncr.35729","DOIUrl":"10.1002/cncr.35729","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The risk of recurrence in patients with small, lymph node-negative, human epidermal growth factor receptor 2 (HER2)-positive breast cancers untreated with adjuvant chemotherapy/HER2-directed therapy is uncertain. To investigate this, the authors conducted a retrospective, population-based study of chemotherapy use and breast cancer-specific survival (BCSS) among patients with stage IA HER2-positive breast cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The authors analyzed Surveillance, Epidemiology, and End Results data from patients diagnosed with stage IA HER2-positive breast cancer from 2010 to 2019. They examined the frequency of chemotherapy use by tumor size and hormone receptor (HR) status and applied multivariate logistic regression to assess the factors associated with receipt of chemotherapy. BCSS was evaluated and performed multivariable Cox regression was performed to evaluate the association between chemotherapy receipt and BCSS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 12,896 patients, 74.0% had HR-positive/HER2-positive breast cancer, and 26.0% had HR-negative/HER2-positive breast cancer. Adjuvant chemotherapy was received by to 58.9% of patients, with lower utilization for those who were older, Hispanic or Asian/Pacific Islander, separated/divorced/widowed, or had a lower median household income. The median follow-up was 46 months. Among the patients who had pathologic T1 (pT1) microscopic, pT1a, or pT1b tumors, the 5-year BCSS rate was 97.6%–99.6% in those who had no evidence of chemotherapy receipt in the medical record versus 98.4%–100.0% in those who did receive chemotherapy. Among patients who had pT1c tumors and had no evidence of chemotherapy receipt, the 5-year BCSS rate was 92.1% for those with HR-negative/HER2-positive breast cancer and 96.0% for those with HR-positive/HER2-positive breast cancer. Patients who had pT1c tumors and received chemotherapy had a 5-year BCSS rate of 96.7% in those with HR-negative/HER2-positive breast cancer and 98.7% in those with HR-positive/HER2-positive breast cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large, population-based study of patients with stage IA HER2-positive breast cancer, patients who had tumors ≤1 cm had excellent outcomes with or without chemotherapy. Patients with pT1c tumors had a greater increase in BCSS with the receipt chemotherapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Meta-analysis of randomized controlled trials of external-beam radiation versus transarterial chemoembolization for hepatocellular carcinoma

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-01-30 DOI: 10.1002/cncr.35720

Ryan A. Kuehnle BS, Leila T. Tchelebi MD, Ethan B. Ludmir MD, Freddy E. Escorcia MD, PhD, Sabi Shrestha MD, Nina Sanford MD, Colin M. Court MD, PhD, Jeff M. Ryckman MD, Sukeshi P. Arora MD, Eric J. Lehrer MD, Jonathan Gelfond PhD, Krishan R. Jethwa MD, MPH, Neil B. Newman MD, MSc

Background

External-beam radiation (EBRT) is a noninvasive therapeutic alternative to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The objective of this study was to conduct a systematic review and meta-analysis of prospective randomized clinical trials to assess the clinical efficacy of EBRT versus TACE for HCC as either a definitive monotherapy or as a bridge to transplantation/surgery.

Methods

A systematic review and meta-analysis were performed to include prospective randomized trials comparing EBRT versus TACE. Data was analyzed with random and fixed-effects models. The inconsistency index (I²) was chosen to assess heterogeneity. Three publications were included with a total of 142 patients. Outcomes included local control (LC), overall survival (OS), progression-free survival (PFS), and occurrences of grade ≥3 toxicity. Comparisons are reported as hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs).

Results

There were three randomized trials that met inclusion criteria. The EBRT was delivered in three to 15 fractions with a total dose between 30 and 75 gray(Gy). EBRT was associated with significantly improved LC (HR, 0.16; 95% CI, 0.08–0.34; I² = 0%) and PFS (HR, 0.37; 95% CI, 0.23–0.60; I², 0%) compared with TACE. There was no significant difference between EBRT and TACE in OS (RR, 0.79; 95% CI, 0.51–1.22; I² = 0%) or grade ≥3 toxicity (RR, 0.86; 95% CI, 0.31–2.37; I² = 57%). None of the analyses had statistically significant heterogeneity.

Conclusions

Compared with TACE, EBRT yields superior LC and PFS without providing a survival benefit in early and intermediate stage HCC. Additional larger prospective randomized controlled trials should be conducted to further investigate differences in clinical outcomes amongst patients with more advanced disease.

{"title":"Meta-analysis of randomized controlled trials of external-beam radiation versus transarterial chemoembolization for hepatocellular carcinoma","authors":"Ryan A. Kuehnle BS, Leila T. Tchelebi MD, Ethan B. Ludmir MD, Freddy E. Escorcia MD, PhD, Sabi Shrestha MD, Nina Sanford MD, Colin M. Court MD, PhD, Jeff M. Ryckman MD, Sukeshi P. Arora MD, Eric J. Lehrer MD, Jonathan Gelfond PhD, Krishan R. Jethwa MD, MPH, Neil B. Newman MD, MSc","doi":"10.1002/cncr.35720","DOIUrl":"10.1002/cncr.35720","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>External-beam radiation (EBRT) is a noninvasive therapeutic alternative to transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The objective of this study was to conduct a systematic review and meta-analysis of prospective randomized clinical trials to assess the clinical efficacy of EBRT versus TACE for HCC as either a definitive monotherapy or as a bridge to transplantation/surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were performed to include prospective randomized trials comparing EBRT versus TACE. Data was analyzed with random and fixed-effects models. The inconsistency index (I<sup>2</sup>) was chosen to assess heterogeneity. Three publications were included with a total of 142 patients. Outcomes included local control (LC), overall survival (OS), progression-free survival (PFS), and occurrences of grade ≥3 toxicity. Comparisons are reported as hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were three randomized trials that met inclusion criteria. The EBRT was delivered in three to 15 fractions with a total dose between 30 and 75 gray(Gy). EBRT was associated with significantly improved LC (HR, 0.16; 95% CI, 0.08–0.34; I<sup>2</sup> = 0%) and PFS (HR, 0.37; 95% CI, 0.23–0.60; I<sup>2</sup>, 0%) compared with TACE. There was no significant difference between EBRT and TACE in OS (RR, 0.79; 95% CI, 0.51–1.22; I<sup>2</sup> = 0%) or grade ≥3 toxicity (RR, 0.86; 95% CI, 0.31–2.37; I<sup>2</sup> = 57%). None of the analyses had statistically significant heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared with TACE, EBRT yields superior LC and PFS without providing a survival benefit in early and intermediate stage HCC. Additional larger prospective randomized controlled trials should be conducted to further investigate differences in clinical outcomes amongst patients with more advanced disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Karkinos in ancient medicine: More than just fatal cancer

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-01-29 DOI: 10.1002/cncr.35741

Michele Augusto Riva MD, PhD

引用次数: 0

Reply to “Karkinos in ancient medicine: More than just fatal cancer”

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-01-29 DOI: 10.1002/cncr.35742

Konstantine Panegyres PhD

引用次数: 0

Practical management of adverse events in patients receiving tarlatamab, a delta-like ligand 3–targeted bispecific T-cell engager immunotherapy, for previously treated small cell lung cancer

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-01-28 DOI: 10.1002/cncr.35738

Jacob M. Sands MD, Stéphane Champiat MD, PhD, Horst-Dieter Hummel MD, Kelly G. Paulson MD, PhD, Hossein Borghaei DO, Jean Bustamante Alvarez MD, David P. Carbone MD, PhD, Jennifer W. Carlisle MD, Noura J. Choudhury MD, Jeffrey M. Clarke MD, Shirish M. Gadgeel MD, Hiroki Izumi MD, PhD, Alejandro Navarro MD, Sally C. M. Lau MD, Philip E. Lammers MD, Shuang Huang PhD, Ali Hamidi MD, Sujoy Mukherjee MD, Taofeek K. Owonikoko MD, PhD

Tarlatamab is a bispecific T-cell engager immunotherapy targeting delta-like ligand 3 (DLL3) and the cluster of differentiation 3 (CD3) molecule. In the phase 2 DeLLphi-301 trial of tarlatamab for patients with previously treated small cell lung cancer, tarlatamab 10 mg every 2 weeks achieved durable responses and encouraging survival outcomes. Analyses of updated safety data from the DeLLphi-301 trial demonstrated that the most common treatment-emergent adverse events were cytokine release syndrome (53%), pyrexia (38%), decreased appetite (36%), dysgeusia (32%), and an emia (30%). Cytokine release syndrome was mostly grade 1 or 2 in severity, occurred primarily after the first or second tarlatamab dose, and was managed with supportive care, which included the administration of antipyretics (e.g., acetaminophen), intravenous hydration, and/or glucocorticoids. Other treatment-emergent adverse effects of interest included neutropenia (16%) and immune effector cell-associated neurotoxicity syndrome and associated neurologic events (10%). Given that tarlatamab is the first T-cell engager approved for the treatment of small cell lung cancer, raising awareness with regard to the monitoring and management of tarlatamab-associated adverse events is essential. Here, the authors describe the timing, occurrence, and duration of these adverse events and review the management and risk-mitigation strategies used by clinical investigators during the DeLLphi-301 trial.

{"title":"Practical management of adverse events in patients receiving tarlatamab, a delta-like ligand 3–targeted bispecific T-cell engager immunotherapy, for previously treated small cell lung cancer","authors":"Jacob M. Sands MD, Stéphane Champiat MD, PhD, Horst-Dieter Hummel MD, Kelly G. Paulson MD, PhD, Hossein Borghaei DO, Jean Bustamante Alvarez MD, David P. Carbone MD, PhD, Jennifer W. Carlisle MD, Noura J. Choudhury MD, Jeffrey M. Clarke MD, Shirish M. Gadgeel MD, Hiroki Izumi MD, PhD, Alejandro Navarro MD, Sally C. M. Lau MD, Philip E. Lammers MD, Shuang Huang PhD, Ali Hamidi MD, Sujoy Mukherjee MD, Taofeek K. Owonikoko MD, PhD","doi":"10.1002/cncr.35738","DOIUrl":"10.1002/cncr.35738","url":null,"abstract":"<p>Tarlatamab is a bispecific T-cell engager immunotherapy targeting delta-like ligand 3 (DLL3) and the cluster of differentiation 3 (CD3) molecule. In the phase 2 DeLLphi-301 trial of tarlatamab for patients with previously treated small cell lung cancer, tarlatamab 10 mg every 2 weeks achieved durable responses and encouraging survival outcomes. Analyses of updated safety data from the DeLLphi-301 trial demonstrated that the most common treatment-emergent adverse events were cytokine release syndrome (53%), pyrexia (38%), decreased appetite (36%), dysgeusia (32%), and an emia (30%). Cytokine release syndrome was mostly grade 1 or 2 in severity, occurred primarily after the first or second tarlatamab dose, and was managed with supportive care, which included the administration of antipyretics (e.g., acetaminophen), intravenous hydration, and/or glucocorticoids. Other treatment-emergent adverse effects of interest included neutropenia (16%) and immune effector cell-associated neurotoxicity syndrome and associated neurologic events (10%). Given that tarlatamab is the first T-cell engager approved for the treatment of small cell lung cancer, raising awareness with regard to the monitoring and management of tarlatamab-associated adverse events is essential. Here, the authors describe the timing, occurrence, and duration of these adverse events and review the management and risk-mitigation strategies used by clinical investigators during the DeLLphi-301 trial.</p>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

DNA damage response and repair gene mutations predict clinical outcomes in biliary tract cancer

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-01-28 DOI: 10.1002/cncr.35726

Sirui Tan MD, Mingyang Feng MD, Nan Zhou MD, Shunyu Zhang MD, Cheng Yi MD, Hongfeng Gou MD

Background

This study aims to explore the genetic characteristics of biliary tract cancer (BTC), with a particular focus on the impact of DNA damage response and repair (DDR) genes on clinical outcomes.

Methods

A total of 180 patients with BTC and next-generation sequencing data were retrospectively analyzed. Clinical outcomes were compared between DDR-positive and DDR-negative groups.

Results

DDR mutations were found in 28.3% of patients, with ATM (7.8%), BAP1 (5.6%), and BRCA2 (3.3%) being the most common. DDR-positive patients receiving first-line platinum-based chemotherapy (n = 73) had a signiﬁcantly higher objective response rate (50.0% vs. 14.9 %; p = .001), longer median progression-free survival (mPFS) (7.7 vs. 3.8 months; p = .001) and longer median overall survival (28.6 vs. 11.9 months; p < .001). Multivariate analysis confirmed that deleterious DDR gene mutations were independently associated with prolonged mPFS (hazard ratio [HR], 0.37; 95% CI, 0.20–0.67; p < .001) and median overall survival (mOS) (HR, 0.19; 95% CI, 0.08–0.46; p < .001). In 56 patients receiving immunotherapy combined with chemotherapy, DDR-positive patients had a signiﬁcantly higher overall response rate (45% vs. 8.3%; p = .001), longer mPFS (7.7 vs. 3.8 months; p = .009), and longer mOS (12.7 vs. 8.8 months; p = .011). Multivariate analysis showed that the presence of deleterious DDR gene mutations was associated with significantly longer mPFS (HR, 0.34; 95% CI, 0.16–0.73); p = .005] and mOS (HR, 0.23; 95% CI, 0.08–0.62; p = .004).

Conclusion

Deleterious DDR gene mutations are associated with improved clinical outcomes in patients with BTC treated with platinum-based chemotherapy or immunotherapy combined with chemotherapy.

{"title":"DNA damage response and repair gene mutations predict clinical outcomes in biliary tract cancer","authors":"Sirui Tan MD, Mingyang Feng MD, Nan Zhou MD, Shunyu Zhang MD, Cheng Yi MD, Hongfeng Gou MD","doi":"10.1002/cncr.35726","DOIUrl":"10.1002/cncr.35726","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aims to explore the genetic characteristics of biliary tract cancer (BTC), with a particular focus on the impact of DNA damage response and repair (DDR) genes on clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 180 patients with BTC and next-generation sequencing data were retrospectively analyzed. Clinical outcomes were compared between DDR-positive and DDR-negative groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DDR mutations were found in 28.3% of patients, with ATM (7.8%), BAP1 (5.6%), and BRCA2 (3.3%) being the most common. DDR-positive patients receiving first-line platinum-based chemotherapy (<i>n</i> = 73) had a signiﬁcantly higher objective response rate (50.0% vs. 14.9 %; <i>p</i> = .001), longer median progression-free survival (mPFS) (7.7 vs. 3.8 months; <i>p</i> = .001) and longer median overall survival (28.6 vs. 11.9 months; <i>p</i> < .001). Multivariate analysis confirmed that deleterious DDR gene mutations were independently associated with prolonged mPFS (hazard ratio [HR], 0.37; 95% CI, 0.20–0.67; <i>p</i> < .001) and median overall survival (mOS) (HR, 0.19; 95% CI, 0.08–0.46; <i>p</i> < .001). In 56 patients receiving immunotherapy combined with chemotherapy, DDR-positive patients had a signiﬁcantly higher overall response rate (45% vs. 8.3%; <i>p</i> = .001), longer mPFS (7.7 vs. 3.8 months; <i>p</i> = .009), and longer mOS (12.7 vs. 8.8 months; <i>p</i> = .011). Multivariate analysis showed that the presence of deleterious DDR gene mutations was associated with significantly longer mPFS (HR, 0.34; 95% CI, 0.16–0.73); <i>p</i> = .005] and mOS (HR, 0.23; 95% CI, 0.08–0.62; <i>p</i> = .004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deleterious DDR gene mutations are associated with improved clinical outcomes in patients with BTC treated with platinum-based chemotherapy or immunotherapy combined with chemotherapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000–2019 in Seattle and Tacoma, Washington

IF 6.1 2区医学 Q1 ONCOLOGY

Cancer

Pub Date : 2025-01-27 DOI: 10.1002/cncr.35677

Kristine A. Karvonen MD, MS, David R. Doody MS, Dwight Barry PhD, Kira Bona MD, MPH, Lena E. Winestone MD, MSHP, Abby R. Rosenberg MD, MS, MA, Jason A. Mendoza MD, MPH, Stephen M. Schwartz PhD, MPH, Eric J. Chow MD, MPH

Background

Historical redlining has been associated with inferior survival in adult-onset cancers. However, its relationship with pediatric, adolescent, and young–adult-onset cancer outcomes is unknown.

Methods

This study identified incident cancer among individuals <40 years of age living in Seattle and Tacoma between 2000–2019 via the population-based Cancer Surveillance System. The authors determined case redlining status using Home Owners’ Loans Corporation data overlaid with 2000 and 2010 census tracts. Kaplan–Meier methods and multivariable Cox proportional hazards models were used to determine 5- and 10-year overall survival and hazard ratio (HR) of death according to redlined status. Cox models adjusted for patient and tumor characteristics and area-level poverty; interaction between redlining and area-level poverty was also assessed.

Results

Among 4355 cases (median age at diagnosis 32 years), overall survival at 5 years was lower (85.1%; 95% confidence interval [CI], 83.5%–86.5%) among individuals residing in redlined neighborhoods compared with those in unexposed neighborhoods (90.3%; 95% CI, 89.0%–91.5%). Survival differences persisted at 10 years. The unadjusted hazard of death for redlined exposed individuals with cancer was higher than redlined unexposed (hazard ratio [HR], 1.62; 95% CI, 1.39–1.89). In the fully adjusted model, mortality remained higher for redlined cases (HR, 1.32; 95% CI, 1.12–1.56). There did not appear to be effect modification from area-level poverty in the relationship between redlining and death (p = .49).

Conclusions

Among young individuals with cancer, residence at diagnosis in previously redlined neighborhoods was associated with lower survival compared with those residing in nonredlined neighborhoods, supporting the hypothesis that structural racism exerts persistent effects on contemporary health outcomes.

背景：历史红线与成人发病癌症的低生存率有关。然而，其与儿科、青少年和年轻成人发病癌症结果的关系尚不清楚：结果：4355 个病例（中位年龄）中有 1 个病例（中位年龄）患上了癌症：在 4355 个病例中（诊断时的中位年龄为 32 岁），居住在红线社区的患者 5 年的总生存率（85.1%；95% 置信区间 [CI]，83.5%-86.5%）低于未受红线影响社区的患者（90.3%；95% 置信区间，89.0%-91.5%）。生存率的差异在 10 年后依然存在。与未暴露于红线区的人相比，暴露于红线区的癌症患者未经调整的死亡风险更高（风险比 [HR]，1.62；95% CI，1.39-1.89）。在完全调整模型中，红线病例的死亡率仍然较高（HR，1.32；95% CI，1.12-1.56）。在划定红线与死亡之间的关系中，地区层面的贫困似乎并不影响两者之间的关系（P = .49）：结论：在患有癌症的年轻人中，与居住在非赤贫社区的人相比，诊断时居住在以前被赤贫化的社区的人存活率较低，这支持了结构性种族主义对当代健康结果产生持续影响的假设。

{"title":"Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000–2019 in Seattle and Tacoma, Washington","authors":"Kristine A. Karvonen MD, MS, David R. Doody MS, Dwight Barry PhD, Kira Bona MD, MPH, Lena E. Winestone MD, MSHP, Abby R. Rosenberg MD, MS, MA, Jason A. Mendoza MD, MPH, Stephen M. Schwartz PhD, MPH, Eric J. Chow MD, MPH","doi":"10.1002/cncr.35677","DOIUrl":"10.1002/cncr.35677","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Historical redlining has been associated with inferior survival in adult-onset cancers. However, its relationship with pediatric, adolescent, and young–adult-onset cancer outcomes is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study identified incident cancer among individuals <40 years of age living in Seattle and Tacoma between 2000–2019 via the population-based Cancer Surveillance System. The authors determined case redlining status using Home Owners’ Loans Corporation data overlaid with 2000 and 2010 census tracts. Kaplan–Meier methods and multivariable Cox proportional hazards models were used to determine 5- and 10-year overall survival and hazard ratio (HR) of death according to redlined status. Cox models adjusted for patient and tumor characteristics and area-level poverty; interaction between redlining and area-level poverty was also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 4355 cases (median age at diagnosis 32 years), overall survival at 5 years was lower (85.1%; 95% confidence interval [CI], 83.5%–86.5%) among individuals residing in redlined neighborhoods compared with those in unexposed neighborhoods (90.3%; 95% CI, 89.0%–91.5%). Survival differences persisted at 10 years. The unadjusted hazard of death for redlined exposed individuals with cancer was higher than redlined unexposed (hazard ratio [HR], 1.62; 95% CI, 1.39–1.89). In the fully adjusted model, mortality remained higher for redlined cases (HR, 1.32; 95% CI, 1.12–1.56). There did not appear to be effect modification from area-level poverty in the relationship between redlining and death (<i>p</i> = .49).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among young individuals with cancer, residence at diagnosis in previously redlined neighborhoods was associated with lower survival compared with those residing in nonredlined neighborhoods, supporting the hypothesis that structural racism exerts persistent effects on contemporary health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 3","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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