JCO oncology practice最新文献

Subcutaneous (SC) formulations of monoclonal antibodies are rapidly transforming the delivery of cancer immunotherapy. Designed to replace or complement intravenous (IV) administration, SC delivery reduces infusion chair time, improves convenience, and may enhance patient and provider satisfaction while preserving pharmacokinetics (PKs), efficacy, and safety. Recent phase III studies of immune checkpoint inhibitors and bispecific antibodies-including atezolizumab, nivolumab, pembrolizumab, and amivantamab-have consistently demonstrated PK noninferiority and comparable clinical outcomes with IV formulations. Safety profiles are largely unchanged, with immune-related adverse events occurring at similar rates, although mild injection site reactions are more common. Importantly, SC amivantamab has shown a marked reduction in infusion-related reactions relative to IV dosing. Operational studies confirm that SC administration shortens treatment delivery from 30 to 60 minutes to <10 minutes, reduces chair occupancy, and optimizes infusion center capacity. Patient preference studies indicate strong favorability toward SC treatment, with most patients citing convenience, reduced venipunctures, and shorter visits as major advantages. Regulatory approvals now include SC atezolizumab and nivolumab across broad indications, SC amivantamab in Europe, and SC pembrolizumab following positive phase III results. The integration of SC immunotherapy into routine practice may improve patient experience, alleviate pressure on oncology services, and reduce health system costs without compromising outcomes. Future research should focus on implementation, real-world cost-effectiveness, and the potential for SC combinations in multiagent regimens.

Purpose: Patients with pancreatic adenocarcinoma frequently experience severe symptoms. Medical cannabis has shown promise for symptom management, yet high-quality data are lacking because of regulatory barriers in conducting cannabis research. Partnering with state cannabis programs may represent a novel pathway to conduct cannabis trials.

Methods: We conducted a pilot randomized waitlist-controlled trial of medical cannabis for 32 patients with newly diagnosed locally advanced/metastatic pancreatic adenocarcinoma with ≥1 symptoms in Minnesota. Patients were randomly assigned 1:1 to early (0-8 weeks) or delayed (9-16 weeks) cannabis intervention (certification, education, provision of cannabis products) through the Minnesota Medical Cannabis Program. The primary study period was 0-8 weeks when only the early arm received the intervention. The primary outcome was feasibility. Secondary outcomes included acceptability, and changes in symptom burden and quality of life examined in exploratory efficacy analyses.

Results: We enrolled 34 patients, 32 of whom began the study (median age 71 years, 53% women). Patients reported substantial moderate-to-severe baseline symptom burden: insomnia (85%), pain (77%), and appetite loss (69%). The study met prespecified feasibility benchmarks (74% enrollment (goal ≥20%), 81% compliance with arm allocation (goal ≥60%), and 75% patient-reported outcome completion rate [goal ≥50%]). All early arm participants recommended the intervention to others. The median daily tetrahydrocannabinol use was 7.3 mg at 8 weeks. At 8 weeks, early arm patients experienced numerically higher rates of improvement in pain (44% v 20%, P = .35), appetite (56% v 30%, P = .37), and insomnia (67% v 30%, P = .18), and lower rates of worsening cannabis-related harms (eg, dry mouth [11% v 20%, P = .99]).

Conclusion: We demonstrate a model collaboration between investigators and a state cannabis program to overcome regulatory barriers to conducting interventional cannabis research. The encouraging preliminary efficacy and safety of cannabis in managing symptoms supports further exploration.

Purpose: Older adults represent the majority of patients with cancer, yet structured approaches to address their complex needs remain rare in community oncology. We describe the design, implementation, and early outcomes of a scalable geriatric oncology program embedded in a community practice within an academic health system, emphasizing the role of health informatics and population health tools.

Methods: At Penn Medicine Princeton Health, we launched a dedicated pathway for patients 65 years and older receiving systemic therapy. The ASCO-endorsed Practical Geriatric Assessment was assigned by default and integrated into workflows via smart forms with automated scoring of impairments and nudges for suggested supportive care referrals based on individual patient care needs. A weekly multidisciplinary care meeting supported coordinated care. We evaluated the first 186 patients completing geriatric assessment (GA) with a follow-up of ≥3 months for impairments, supportive care delivery, and end-of-life outcomes.

Results: Among 186 patients (median age 79 years), 71% had incurable disease and 87% received systemic therapy. Despite Eastern Cooperative Oncology Group 0-2 in 90%, GA identified functional impairment in 76%, nutritional risk in 55%, and psychosocial concerns in over one third. The program generated 546 referrals (median three per patient); 51% completed advance directives. Among 53 deaths, 81% enrolled in hospice (median 17 days); only 4% received chemotherapy in the last 14 days of life. Geriatric navigation was associated with a 3.4-fold longer hospice stay (P = .002), and prioritization of quality of life with a 2.6-fold longer stay (P = .007).

Conclusion: Embedding GA into electronic health record workflows using default logic and team-based care enabled high-fidelity implementation in a resource-constrained setting. This approach identified unrecognized vulnerabilities, facilitated timely supportive care, and aligned treatment with patient values, demonstrating a replicable model to bridge the geriatric oncology implementation gap.

Purpose: Patient navigation programs are widely used to improve cancer care delivery, particularly among underserved populations. However, gaps remain in understanding which support needs are most frequently reported and whether high-risk populations are adequately represented. This scoping review examined how patient support needs are documented in cancer navigation studies and which populations are evaluated.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we reviewed articles published between January 2014 and December 2024. PubMed, Web of Science, and CINAHL Ultimate were searched for US and Canadian studies evaluating navigation or support interventions for breast, colorectal, prostate, lung, or general cancers. Eligible studies reported empirical data and addressed patient or provider perspectives on support needs. Extracted data included demographic representation, geographic location, cancer type, and unmet support needs.

Results: Of the 1,254 records identified, 25 studies met inclusion criteria. Lung cancer was the most frequently studied (60%), and most studies were conducted on the US West Coast. Although 84% of studies included patient perspectives, only 36% reported geographic setting and 12% included income data. Asian and Pacific Islander (48%), White (44%), and Hispanic/Latino (36%) populations were most represented. African American and American Indian or Alaska Native populations were underrepresented at 20% and 12%, respectively. Common support needs included communication challenges (72%), emotional support (64%), limited access to care (60%), and educational gaps (60%). Cultural competence and trust were each reported in only 24% of studies.

Conclusion: This review reveals a mismatch between populations most affected by cancer disparities and those represented in navigation research. Future studies should prioritize inclusive data collection, improved demographic reporting, and patient-centered design of support services to address persistent inequities.

Purpose: To explore pediatric oncology and palliative care health care providers' perspectives on the barriers and facilitators to pediatric palliative care (PPC) referral for children with cancer in Canada using a qualitative approach to inquiry.

Methods: Sixty-six health care providers from four tertiary pediatric hospitals across Canada participated in semistructured interviews. Data analysis used the grounded theory method. Data collection and analysis occurred concurrently using an inductive, constant comparative approach. Line-by-line coding guided the development of themes. NVivo software supported data management and coding. Through iterative analysis of the data, a systems theory-informed model of PPC referral was developed.

Results: The PPC referral process was best understood as a dynamic system involving four primary agents: oncologists, interprofessional oncology teams, PPC teams, and the patient and family. Each agent's readiness to initiate or accept referral was shaped by emotional, informational, cultural, skill-based, and environmental factors. We identified four distinct referral pathways, ranging from automatic referral at diagnosis to family-initiated referrals. Readiness for a referral emerged as a fluid, systemic state influenced by bidirectional interactions among all agents, rather than a static or solely clinical indicator.

Conclusion: PPC referral is not a linear decision triggered by disease prognosis or progression alone, but rather a complex and evolving system shaped by interrelated human and organizational factors. Our systems theory model of PPC referral highlights the importance of fostering readiness across the health care team and integrating PPC as a relational and team-based process. These findings offer actionable insights to improve early PPC access and guide the design of interventions.

Purpose: State legislations mandating prescriber use of Prescription Drug Monitoring Programs (PDMPs) may have the unintended consequence of restricting opioid analgesics to patients dying of cancer. This study aims to assess associations of comprehensive PDMP mandates with opioid-related outcomes for patients dying of cancer, overall and by decedent race and ethnicity.

Methods: Study population were Medicare decedents who were age 66 years or older, diagnosed with breast, colorectal, lung, or prostate cancer, and died of cancer in 2011-2019. This cross-sectional study used SEER-Medicare data and a difference-in-differences design. Study sample included decedents from 10 states with an operating PDMP on January 1, 2011. Outcomes included the dichotomous event of having one or more opioid days, total and daily morphine milligram equivalents (MMEs) if having opioids, near the end of life. Generalized linear models were estimated for dichotomous (logit link function) and continuous (log) outcomes.

Results: This study included 115,256 decedents. Comprehensive PDMP mandates were associated with modest reductions in the rate of one or more opioid days (from 45.1% to 43.9%, difference = 0.011 [95% CI, -0.019 to -0.003]), total dose (from 1,600.6 to 1,521.0 MMEs, difference = 79.6 [95% CI, -131.5 to -27.6]), and daily dose from all opioids (from 75.7 to 72.9 MMEs, difference = 2.7 [95% CI, -5.1 to -0.4]). Compared with non-Hispanic White decedents, Black decedents experienced a four-fold reduction, and Asian/Pacific Islander decedents experienced a two-fold reduction, in the rate of one or more opioid days.

Conclusion: Comprehensive PDMP mandates were associated with modest reductions in opioid analgesics dispensed to Medicare patients dying of cancer. Non-Hispanic Black and Asian/Pacific Islander decedents experienced larger reductions.

Purpose: To examine real-world treatment patterns and effectiveness among patients with metastatic triple-negative breast cancer (mTNBC) in the United States.

Design: Retrospective, observational study using Flatiron Enhanced Datamart electronic health records from patients diagnosed with mTNBC between January 1, 2018, and June 30, 2023, who received ≥1 line of therapy (LoT) for metastatic disease. Patients were followed until date of death, last recorded activity, or data cutoff (December 30, 2023). Patient characteristics, treatments received from LoT1-5, and clinical outcomes (overall and by LoT) were described.

Results: The cohort comprised 1,044 patients. Most were female (99.2%); the median age was 61 years (IQR, 52-71); 52.1% were White and 21.7% were Black. The most common drug class in all LoTs was chemotherapy, as monotherapy or in combination with other agents: LoT1 85.5%, LoT2 73.2%, LoT3 65.8%, LoT4 64.7%, and LoT5 71.7%. Among patients with known PD-L1 status (n = 367), 109 (29.7%) were PD-L1-positive and 258 (70.3%) were PD-L1-negative. For the overall cohort, the median real-world overall survival (rwOS) from diagnosis was 14.0 (95% CI, 12.9 to 16.0) months. Real-world progression-free survival was 4.5 (95% CI, 4.0 to 5.0) months in LoT1 and 4.1 (95% CI, 3.5 to 4.9) months in LoT2. The median rwOS was 18.6 (95% CI, 15.2 to 24.4) months in the PD-L1-positive cohort versus 12.7 (95% CI, 11.0 to 16.0) months in the PD-L1-negative cohort. From December 1, 2021, onward, immunotherapy was received in LoT1 by 63.6% (21/33) of patients who had PD-L1-positive tumors and by 84.6% (33/39) of patients with PD-L1-positive tumors across all LoTs.

Conclusion: Real-world clinical outcomes in patients with mTNBC in the United States remain poor, particularly for patients with PD-L1-negative disease. There is an unmet need for more effective treatments for mTNBC.