JCO oncology practice最新文献

Purpose: Ovarian cancer (OC) is a leading cause of gynecologic cancer mortality, with poor survival rates for advanced-stage disease. Comprehensive national data detailing contemporary patterns of care remain scarce. This study uses data from Australia's National Gynae-Oncology Registry (NGOR) to delineate current patterns of care against clinical quality indicators (CQIs) and correlate adherence to these measures with overall survival (OS).

Methods: This prospective study analyzed NGOR data for women with newly diagnosed epithelial OC across 47 sites between April 2017 and March 2024. Adherence to 15 predefined CQIs was assessed. OS, adjusted for key prognostic factors (Eastern Cooperative Oncology Group, age, stage, comorbidity), was estimated using Cox proportional hazards regression.

Results: A total of 3,133 patients were included. In an adjusted multivariate analysis, significantly improved OS was associated with receiving first-line platinum-taxane doublet chemotherapy (hazard ratio [HR], 0.57 [95% CI, 0.47 to 0.68], P < .001), undergoing germline or somatic BRCA1/2 testing (HR, 0.66 [95% CI, 0.56 to 0.78], P < .001), and achieving no macroscopic residual disease after primary (HR, 0.48 [95% CI, 0.34 to 0.68], P < .001) or interval debulking surgery (HR, 0.56 [95% CI, 0.44 to 0.71], P < .001). Adjusted 5-year OS rates for International Federation of Gynecology and Obstetrics stages I, II, III, and IV were 87%, 76%, 42%, and 28%, respectively.

Conclusion: This national registry reveals variations in CQI adherence. While survival for advanced-stage disease has improved, it remains suboptimal. Adherence to specific quality indicators-notably optimal surgical cytoreduction, standard first-line chemotherapy, and genetic testing-is significantly associated with improved survival. Continuous monitoring and targeted quality improvement initiatives are essential for enhancing survival for women with OC.

Purpose: Oncofertility, a multidisciplinary field that integrates oncology and reproductive medicine, is a vital component of comprehensive cancer care. This review compares fertility-related recommendations for adults with newly diagnosed cancer who are considering fertility preservation (FP) before treatment. Guidelines reviewed include the 2025 National Comprehensive Cancer Network (NCCN) Survivorship Guideline, 2025 ASCO Guideline on FP, 2022 Clinical Oncology Society of Australia (COSA) FP Guideline, and 2020 European Society for Medical Oncology (ESMO) Clinical Practice Guideline.

Methods: Recent guidelines from NCCN, ASCO, COSA, and ESMO were reviewed and compared for recommendations on fertility risk discussions, female and male preservation methods, multidisciplinary care, future pregnancy, and contraception.

Results: All guidelines emphasize early, patient-centered discussions about fertility risks and preservation options before initiating cancer treatment. Embryo and oocyte cryopreservation are universally recommended as standard and effective FP methods for women. Ovarian tissue cryopreservation and ovarian transposition are recommended as alternative options. Sperm cryopreservation is strongly recommended, with ASCO and NCCN additionally supporting testicular sperm extraction for post-treatment FP. The use of gonadotropin-releasing hormone agonists is supported by COSA, ESMO, and NCCN in people with breast cancer at diagnosis, while ASCO limits its recommendation to adjunct use alongside established FP techniques. All guidelines highlight the importance of multidisciplinary care, including specialized oncofertility counseling and referrals to fertility and mental health specialists. Pregnancy after cancer treatment is generally considered safe across all guidelines, and only COSA and ESMO provide specific recommendations regarding contraception.

Conclusion: There is a strong consensus on FP methods and the importance of early counseling. However, further high-quality research is necessary to strengthen the evidence base and improve guideline recommendations for fertility in people with cancer.

Purpose: Combination therapy, which adds docetaxel or androgen receptor pathway inhibitors (ARPIs) to androgen deprivation therapy, improves overall survival in patients with metastatic hormone-sensitive prostate cancer (mHSPC). Despite strong clinical evidence and guideline support, real-world use of these therapies remains suboptimal. The extent to which sociodemographic marginalization contributes to this gap in care is poorly understood.

Methods: We conducted a population-based cohort study in Ontario, Canada, including patients 66 years or older diagnosed with de novo mHSPC between 2014 and 2022. The primary exposure was marginalization, measured using the Ontario Marginalization Index (ON-MARG), which captures area-level socioeconomic disadvantage across four domains: residential instability, material deprivation, age and labor force participation, and racialized and newcomer populations. We used hierarchical logistic regression models to assess the association between ON-MARG and receipt of combination therapy, adjusting for demographic, clinical, and physician-level factors. A secondary exposure examined socioeconomic status using a hybrid measure combining rurality and urban income quintile.

Results: We included data from 6,051 men. Higher overall ON-MARG scores were associated with lower odds of receiving combination therapy (odds ratio [OR], 0.91 [95% CI, 0.83 to 0.99]). The most pronounced disparity was observed in the domain capturing racialized and newcomer populations (OR, 0.89 [95% CI, 0.81 to 0.97). Patients residing in higher median household income urban areas had greater odds of combination therapy compared with rural residents (OR, 1.39 [95% CI, 1.08 to 1.79]).

Conclusion: Despite universal health care, access to combination therapy for mHSPC remains inequitable, particularly among patients living in marginalized, rural, and/or low-income communities. These disparities underscore the need for equity-driven policy interventions to ensure that all patients with mHSPC benefit from life-prolonging treatment advances.

Purpose: The prognostic significance of traditional donor selection criteria for human leukocyte antigen (HLA)-matched unrelated donor (MUD) hematopoietic cell transplantation (HCT) is uncertain in the era of post-transplant cyclophosphamide (PTCy). We re-evaluated the impact of donor age, sex, cytomegalovirus (CMV) serostatus, and ABO compatibility in a large, contemporary cohort of patients receiving PTCy-based graft-versus-host disease (GVHD) prophylaxis.

Methods: We retrospectively analyzed 699 patients who underwent an 8/8 HLA-matched MUD HCT with PTCy. We assessed the impact of donor characteristics on overall survival (OS), progression-free survival (PFS), relapse, nonrelapse mortality, GVHD, and engraftment. Least absolute shrinkage and selection operator regression confirmed variable selection.

Results: Recipient-related factors, specifically the disease risk index and HCT-comorbidity index, were the primary determinants of OS and PFS. By contrast, traditional donor characteristics had a limited impact on survival. Donor age, analyzed as a continuous variable, was not associated with OS (hazard ratio [HR], 0.99 [95% CI, 0.978 to 1.011]; P = .524). Similarly, donor CMV and ABO compatibility did not influence survival. The effect of donor-recipient sex mismatch was primarily limited to modulating GVHD risk. Female-to-male sex mismatch had higher hazard for grade 3-4 acute GVHD (aGVHD) (HR, 3.08 [95% CI, 1.15 to 8.20]; P = .025; adjusted P = .222), whereas male-to-female grafts were associated with a 42% reduction in the hazard for grade 2-4 aGVHD (95% CI, 0.39 to 0.87; P = .009; adjusted P = .045). Major ABO mismatch was associated with delayed neutrophil engraftment in bone marrow grafts but not in peripheral blood grafts.

Conclusion: Collectively, these findings suggest that for patients receiving PTCy, the hierarchy of donor selection factors might have evolved, allowing for greater flexibility in donor choice. Our findings provide a solid foundation for future larger external validation studies.

Purpose: To examine patient report of engagement with clinicians and relatives about their germline genetic test results across risk groups in women diagnosed with cancer.

Patients and methods: We surveyed women age 20-79 years diagnosed with breast, ovarian, or uterine cancer in 2018-19 in Georgia or California, in whom a germline genetic testing yielded a pathogenic variant (PV) in a breast, ovarian, or uterine cancer susceptibility gene (grouped by high v moderate risk) or a variant of unknown significance (VUS) about 4 years after diagnosis (N = 1,767, 52.4% response rate).

Results: Most patients with PVs (84.5%) had a genetic counseling visit to discuss test results, and a majority (70.6%) were encouraged to share results with relatives with no difference across PV risk groups. Half of the patients with PV reported that a genetic counselor gave them advice about how to talk to relatives and one third reported that a counselor talked directly with a relative. Physician engagement with patients about family communication of test results was low: one third of patients with high-risk PV reported that their oncologist encouraged them to share results with relatives. Patients with PV shared test results with 80% of first-degree relatives and one third of second-degree relatives. Compared with patients with PVs, those with VUS had less engagement with clinicians about sharing test results with relatives; were less likely to believe that they had a responsibility to share results with family; and were less likely to share results with relatives.

Conclusion: Patients with PVs share results with many family members but clinician support is insufficient, especially among cancer doctors. A substantial proportion of patients with VUS-only engage relatives about results but more research is needed about the nature of the discussions regarding these indeterminate findings.

T-cell bispecific antibodies (bsAbs) bind a tumor-associated antigen and the CD3 molecule on T cells, inducing direct T-cell-mediated tumor killing. T-cell bsAb therapies have high response rates and improved survival, mostly in relapsed and refractory hematologic malignancies, but pose challenges in clinical practices because of toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Despite the proven efficacy and off-the-shelf availability, their use in community settings remains limited. At ThedaCare Cancer Center, collaboration with Froedtert Hospital enabled the community implementation of bsAb therapy. Given limited literature in this area, we sought to review our experience to highlight lessons and ongoing challenges in this area. Key strategies included appointing a project champion, forming a multidisciplinary bsAb team, designing educational modules, and integrating clinical decision support tools such as order sets and best practice advisories into the electronic medical record (EMR) system. Pharmacists played vital roles in drug handling, toxicity management, and financial logistics. Training programs focused on recognizing and managing bsAb-related side effects, while EMR tools supported early intervention. Challenges included operational logistics, specialized staffing, and financial barriers. Addressing these requires institutional commitment, caregiver education, financial navigation, and collaboration with academic centers. Structured workflows, provider and patient education on CRS and ICANS symptoms, and around-the-clock support systems are important. Our experiences set a framework for the broader implementation of innovative cancer therapies that share similar therapeutic mechanisms and potential side-effect profiles.

Management of multiple myeloma has transformed care of patients in high-income countries. Use of proteasome inhibitor-immunomodulator (IMiD) triplets and anti-CD38-based quadruplets and routine use of front-line autologous stem-cell transplantation (ASCT) as consolidation have extended survival beyond a decade for most newly diagnosed cases. However, in low- and middle-income countries (LMICs), care delivery is constrained by high out-of-pocket expenditure, limited transplant center infrastructure, erratic drug supply, and inequities in diagnostic access. This review aims to contextualize global advances within resource-limited settings in India and to provide a pragmatic, evidence-informed framework for optimizing outcomes where cost and capacity are major determinants of care. We integrate evidence from pivotal phase II/III international trials and real-world cohorts evidence from local studies and expert consensus to evaluate therapeutic choices across the disease continuum. Bortezomib, lenalidomide, and dexamethasone (VRd) remains the most cost-effective induction regimen, whereas CD38-based quadruplets offer incremental benefit but are often limited by affordability in LMIC settings. Early or frontline use of ASCT significantly deepens response and extends progression-free survival at a fraction of the cost of continuous use of monoclonal antibody therapy. At relapse, antibody-sparing triplets such as pomalidomide-bortezomib-dexamethasone or carfilzomib-dexamethasone are effective alternatives, whereas alkylator-based regimens and salvage ASCT remain valuable when novel agents are inaccessible. Emerging immunotherapies remain largely inaccessible in LMIC settings. The review emphasizes the need for the development of equitable access strategies, government procurement initiatives, and patient-assistance programs to translate global therapeutic advances into real-world benefits in resource-constrained settings. By systematically integrating clinical evidence with local economic considerations and health system realities, this review provides a roadmap for delivering high-value care in LMICs, balancing efficacy, affordability, and equity.