Japanese journal of clinical oncology最新文献

Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by the proliferation of tumor cells within the lumina of small vessels in systemic organs. Diagnosis remains challenging due to the frequent presentation of non-specific symptoms such as fever and general malaise. Since its listing as a distinct disease entity in the 4th edition of the World Health Organization classification, awareness of IVLBCL has increased, leading to improvements in diagnostic accuracy. Nevertheless, patients with delayed or difficult diagnosis continue to be reported. Recent genetic studies have identified recurrent genetic abnormalities associated with IVLBCL, and the potential utility of liquid biopsy for diagnosis and treatment monitoring has been suggested. However, despite these advances, a gap remains between translational research and clinical application, particularly regarding how liquid biopsy can be incorporated into clinical practice. Regarding treatment, although standard chemotherapy with central-nervous-system-directed therapy has demonstrated favorable outcomes in initial management, the efficacy and safety of emerging immune cell therapies in IVLBCL remain largely unknown. This article aims to review recent advances in the understanding and management of IVLBCL, with the ultimate goal of improving clinical outcomes and advancing therapeutic management of IVLBCL.

Background: Recently, a transbronchial needle biopsy (TBNB) method using a three-plane symmetric Acquire needle with Franseen geometry was developed to improve diagnostic yield. This study describes our experience with Endobronchial ultrasound (EBUS)-TBNB for pulmonary and mediastinal diseases.

Methods: A retrospective review was conducted involving 37 patients who underwent EBUS-TBNB with an Acquire 22G needle between July 2021 and September 2024. Enlarged lymph nodes were sampled, and medical records were analyzed to evaluate diagnostic outcomes, including histological core tissue acquisition, programmed death-ligand 1 (PD-L1) expression testing, and next-generation sequencing (NGS).

Results: We sampled a total of 48 lymph nodes (26 subcarinal [#7], 12 right lower paratracheal [#4R], and 10 right hilar [#11]) with a median longest diameter of 23.1 mm (range, 9.3-44.6 mm). Definitive diagnoses were achieved in 36 patients, including 25 cases of lung cancer, one large-cell neuroendocrine carcinoma, one renal cell carcinoma, five cases of sarcoidosis, and four cases of unspecified lymphadenopathy. The overall diagnostic yield was 97.3% (95% confidence interval: 85.8%-99.5%). Both PD-L1 expression testing and NGS were successfully performed in all lung adenocarcinoma cases (nine using the Oncomine Dx Target Test and four using the AmoyDx Pan Lung Cancer polymerase chain reaction (PCR) Panel). Histological samples were successfully obtained from 35 patients, whereas only two cases of lung squamous cell carcinoma were cytologically diagnosed due to necrotic and calcified samples. The nucleic acid yield from a single puncture was sufficient for analysis using the Lung Cancer Compact Panel.

Conclusions: EBUS-TBNB demonstrated high efficacy for diagnosing lung cancer, including PD-L1 testing and NGS, and for obtaining histological core tissue.

Objective: Immune checkpoint inhibitors (ICPis) are widely used clinically to improve the prognosis of various cancers. However, little is known about their hematologic immune-related adverse events (irAEs). This study aimed to comprehensively investigate the incidence and clinical characteristics of irAEs induced by ICPis through a cross-organ research approach.

Methods: Patients who received at least one ICPi dose at the Osaka International Cancer Institute between January 2014 and September 2021 were reviewed, irrespective of their tumor type. We analyzed the cumulative incidence of hematological irAEs and investigated the clinical course of patients who underwent bone marrow examination owing to suspected hematological irAEs.

Results: During the study period, 1500 patients in total received ICPis. Based on clinical data and the histopathological evaluation of bone marrow samples, we identified seven cases of hematologic irAEs (four of immune thrombocytopenia, two of hemophagocytic lymphohistiocytosis, and one of agranulocytosis). Additionally, we observed six cases of primary hematologic disease, four of bone marrow findings consistent with cytopenia and subsequent recovery secondary to infections or cytotoxic agents, two of bone marrow involvement by primary cancer, and one of an unknown cause. With the median follow-up of 297 days (0-2087 days), the cumulative incidence rates of hematologic irAEs at 90 days and 1 year were 0.1% (95% CI, 0.0-0.4) and 0.4% (95% CI, 0.2-1.0), respectively. None of the patients with hematological irAEs died.

Conclusion: Severe hematological irAEs are rare but can be life-threatening. When hematological abnormalities are detected during ICPi therapy, it is important to explore the possibility of irAEs, including bone marrow abnormalities.

Background: Lymphedema has a significant impact on patient quality of life. However, it remains unclear whether the provision of lymphedema treatment in Japan is uniform across regions. This study aimed to clarify the current situation regarding lymphedema treatment with emphasis on complex decongestive therapies (CDT) availability and implementation in Japan.

Methods: A nationwide web-based survey was conducted. Respondents included healthcare professionals from designated cancer care hospitals and other medical institutions treating lymphedema in Japan. The distribution of variables, including the implementation of lymphedema treatment, was compared between designated cancer care hospitals and other facilities using the chi-square test. Japan was divided into nine regions to compare and analyze access to medical institutions providing CDT for lymphedema on both inpatient and outpatient bases.

Results: Of the 372 facility responses analyzed, ˃95% reported treating secondary lymphedema of the extremities, whereas ˂30% treated head and neck lymphedema. The number of CDT inpatients per 100 000 people in the region with the lowest patient volume was approximately 2% of that in the region with the highest volume. Similarly, the number of CDT outpatients per 100 000 people in the lowest-volume region was one-third of that in the highest-volume region. There was no significant correlation between facilities with high outpatient numbers and those with low outpatient numbers (ρ =0.57, P-value = 0.11).

Conclusion: Eliminating regional disparities in access to lymphedema treatment facilities, particularly for inpatient CDT, would improve quality of life and enable patients to manage the condition regardless of where they live.

Treatment strategies for breast cancer have become increasingly complex over the years, requiring a deep understanding of disease pathology and the individualization of treatments on the basis of biomarkers. Circulating tumor DNA (ctDNA) enables non-invasive evaluation of the entire tumor, and its potential is being explored for treatment development. Numerous studies have evaluated ctDNA in various breast cancer subtypes during postoperative follow-up or after neoadjuvant chemotherapy, consistently showing that ctDNA positivity is associated with a higher risk of recurrence. Clinical trials evaluating therapeutic interventions on the basis of ctDNA status are also underway. Moving forward, the development of more sensitive assays and appropriate treatment strategies will be required. As the clinical application of ctDNA advances, the individualization of breast cancer treatment is expected to be further refined.

Locally recurrent rectal cancer (LRRC) remains one of the most challenging problems in the rectal cancer management, despite advances in multimodal treatments. R0 resection remains the cornerstone of curative therapy and the most critical prognostic factor. However, achieving R0 resection is technically demanding, with outcomes heavily influenced by tumor location, institutional expertise, and careful patient selection. This narrative review summarizes current surgical strategies for LRRC, emphasizing the importance of accurate anatomical classification, multidisciplinary collaboration, and individualized planning. Extended resections-including bony pelvis, pelvic sidewall, and vascular dissections-have expanded surgical indications but require specialized expertise and carry risks of functional impairment. Minimally invasive approaches, such as laparoscopic or robotic pelvic exenteration, may offer potential advantages in selected cases but remain technically challenging. Carbon ion radiotherapy, which demonstrates superior local control compared to conventional radiotherapy, is expected to be a promising treatment for unresectable LRRCs. Its future role as an alternative or perioperative treatment for resectable or borderline cases is under investigation. Preoperative chemoradiotherapy may play an important role in radiation-naïve patients, while re-irradiation strategies remain controversial for previously irradiated cases. In patients with resectable distant metastases, aggressive combined surgical approaches may be pursued if curative resection is feasible. Ultimately, shared decision-making with patients is essential for optimal management of LRRC, based on a highly individualized, evidence-based approach that balances oncological prognosis and postoperative quality of life.

Background: This Phase 2 study (NCT04238715) evaluated the efficacy/safety of tasurgratinib 140 mg daily in patients with cholangiocarcinoma (CCA) and fibroblast growth factor receptor (FGFR) 2 fusions/rearrangements.

Methods: Eligible Japanese and Chinese patients who had surgically unresectable, advanced, or metastatic CCA and had received ≥1 prior gemcitabine-based combination chemotherapy regimen were included and treated with oral tasurgratinib 140 mg daily. The primary endpoint was objective response rate (ORR); the study was considered successful if the lower limit of the ORRs 90% CI was >15%. Secondary endpoints included duration of response and safety. FGFR2 fusions/rearrangements were confirmed by fluorescence in situ hybridization performed in central laboratories. Tumor responses were measured every 8 weeks by Response Evaluation Criteria in Solid Tumors version 1.1 per independent imaging review.

Results: Sixty-three patients were treated; 23 (37%) had received 1 prior regimen, all others had received ≥2. By the data cutoff date (15 March 2023), the ORR was 30.2% (two-sided 90% CI: 20.7-41.0). The median duration of response for responders was 5.6 months (95% CI: 3.7-9.3; range: 1.0+ to 14.8+). Sixty-one patients (97%) had ≥1 treatment-related treatment-emergent adverse event; 18 patients (29%) had ≥1 grade ≥3 treatment-related treatment-emergent adverse events. Four patients (6%) had a fatal adverse event, none were considered treatment-related. Tasurgratinib had promising antitumor activity in patients with CCA harboring FGFR2 fusions or rearrangements after ≥1 prior gemcitabine-based chemotherapy regimen.

Conclusions: The primary endpoint (ORR) met the study's predefined success criteria. Tasurgratinib had a manageable safety profile consistent with previous reports and the known pharmacological profile of FGFR inhibitors.

Objective: To investigate healthcare professionals' perceptions of suicide-related behaviors among people with head and neck cancers in Japan.

Methods: A two-phase, multicenter retrospective study was conducted. First, head and neck cancer specialists completed a survey on their experience with suicide-related behaviors and institutional prevention efforts. Second, a medical record review explored associations between suicide-related behaviors and treatment factors.

Results: There were 152 respondents, of whom 82 (53.9%) had encountered suicide-related behaviors, and 69 (45.4%) had experienced patient suicides. A total of 110 cases of suicide were reported. Only 4.6% of respondents had attended lectures on preventing suicide, although 37.5% had implemented preventive measures. Overall, 27 cases were analyzed, including 18 suicides, and nine attempts. The majority of these involved men who were either smokers or drinkers. Behaviors often occurred when people were post-treatment without any recurrence. Common preceding factors were eating difficulties, speech impairment, and psychological decline.

Conclusions: Suicide risk among people with head and neck cancer extends well beyond diagnosis and remains under-addressed. Increased awareness and education among healthcare professionals, and provision of multidisciplinary support, are essential for comprehensive prevention.

Background: Soft tissue sarcomas (STSs) are a diverse group of rare malignant tumors accounting for <1% of all human tumors. Almost 50% of patients with STS develop metastatic disease, mainly within 3 years of initial diagnosis. Lung metastasis occurs in 20%-30% of STS cases, while bone metastasis is rare.

Patients and methods: We investigated tumor characteristics and clinical outcomes in 59 patients with STS who developed bone metastases.

Results: A total of 21 patients had solitary bone metastasis: two in the extremity, 11 in the vertebral body, and eight in the trunk. Around 38 patients had multiple bone metastases: 18 with extremity bone involvement and 20 with no extremity bone involvement. Fourteen patients developed complicated bone metastases with distant extrapulmonary metastases. Seven patients had no distant metastases other than bone; that is, the bone was the first distant metastasis. The 5-year disease-specific survival (DSS) rate after primary treatment was 45.1%. The median 5-year DSS after bone metastasis was 28.1 months. The 5-year DSS rate was 55.6% in nine patients who underwent radical local treatment for solitary bone metastases. The 5-year DSS rate was 14.7% in 50 patients who did not undergo local radical treatment for bone metastases, with a significant correlation.

Conclusion: Patients with bone metastases from STS had a relatively good prognosis after bone metastases. Solitary bone metastases can be aggressively treated. Although nearly half of the patients received bone-modifying agents, the effectiveness of these therapeutics warrants further investigation.