JCO oncology practice最新文献

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.

Purpose: The use of artificial intelligence (AI) or automation in financial hardship (FH) interventions has the potential to increase reach and address implementation challenges. However, cancer survivor perceptions of how AI or automation could be used in FH interventions are understudied.

Methods: Eligibility for an online crowdsourcing study included being ≥18 years of age, a cancer survivor, and living in the United States. The survey asked open-ended crowdsourcing questions about how survivors thought AI/automation could have improved their experience with financial assistance and health insurance. A qualitative content analysis was conducted that consisted of two cycles of coding including the use of ChatGPT-5 to generate the preliminary codebook.

Results: A total of N = 198 cancer survivors participated and were on average age 50.3 years (standard deviation [SD], 14.3) and age 40.1 years at diagnosis (SD, 16.2), most commonly non-Hispanic/Latine (89.9%), White (86.9%), cisgender women (69.2%), and heterosexual (70.2%). Qualitative analysis revealed seven subcategories within the financial assistance category: (1) efficient search and personalized resource matching, (2) application support and process navigation, (3) insurance and billing support, (4) conversational and interactive tools, (5) connecting to human support, (6) emotional support, and (7) concerns and lack of applicability. Furthermore, five subcategories were identified within the health insurance support category: (1) health insurance education tools and decision support, (2) health insurance navigation, (3) system simplification or automation, (4) connecting to resources and human support, and (5) concerns and lack of applicability.

Conclusion: Overall, cancer survivors generated a variety of ideas focused on reducing the administrative burden of seeking out financial assistance and dealing with health insurance. Findings demonstrate that cancer survivors could imagine AI or automation being used in FH interventions.

Purpose: We hypothesized that transgender and gender-nonconforming (TGNC) patients diagnosed with genitourinary (GU) and gynecologic (GYN) cancers may experience unique challenges and barriers to care because of association of these organs with sex assigned at birth but not gender identity. We aimed to explore their experiences in this qualitative study.

Materials and methods: TGNC adults diagnosed with a GU/GYN cancer completed an anonymous survey probing experiences with cancer diagnosis, treatment, and clinicians, with the option to complete an additional interview. Participants were accrued to thematic saturation. Analysis included descriptive statistics, open coding, and development of themes.

Results: Twenty-one patients completed a survey, and 16 completed an interview. Qualitative analysis yielded six key themes: (1) clinician dismissal and assumptions about gender identity and preferences, (2) inadequate clinician knowledge about TGNC health, (3) avoidance of oncologic care due to dysphoria and fear of discrimination, (4) increased dysphoria associated with GU/GYN cancer, (5) importance of gender identity in patients' decision making, and desire to discuss gender-affirming goals, and (6) wide spectrum of reactions to GU/GYN cancer diagnosis, associated with charged feelings toward affected organ.

Conclusion: For TGNC patients with GU/GYN cancers, gender identity matters, both for clinical decision making and patients' emotional experience. Clinicians can partner with patients through this challenging journey to ensure that patients feel safe and supported and can make treatment decisions that align with their gender-affirming goals.