JNCI Cancer Spectrum最新文献

Advanced melanoma was historically considered incurable; however, a 52% 10-year melanoma-specific survival rate from seminal immunotherapy trials challenges that conclusion.1 There is no literature exploring clinicians' discussion of treatment intent with patients, or whether this represents cure. We performed a multicenter retrospective cohort analysis to examine treatment intent, using electronic medical records to identify 278 patients with unresectable or stage IV melanoma consented for immunotherapy from 2019 to 2023. Thirty-two (12%) were consented for curative-intent treatment (CIT). CIT frequency was not significantly influenced by patient or disease characteristics. Patients consented for CIT received significantly higher rates of combination immunotherapy than patients consented for non-curative-intent treatment (NCIT), 76% (16/21) vs 47% (116/246), P = .022. Among 267 unresectable patients, CIT rates differed significantly between Victoria and South Australia, 14% (20/142) vs 0.8% (1/125), P < .001. Our data confirms variability of documented treatment-intent in advanced melanoma. Further research is needed to understand how this affects patients.

Background: Nine National Cancer Institute-Designated Cancer Centers received supplemental funding to expand community outreach and engagement activities through a partnership with Centers for Disease Control and Prevention-funded comprehensive cancer control coalitions. This article reports on an evaluation of these awards focused on organizational relationships and partnership outcomes.

Methods: The National Cancer Institute, community outreach and engagement, and coalition representatives co-designed the evaluation, which involved document review and 18 semistructured interviews with 16 community outreach and engagement and 19 coalition representatives. Artificial intelligence-generated interview transcripts were dual-coded in NVivo, version 20/R1, software.

Results: The funding generated a diverse collection of projects and partnerships. Community outreach and engagement-coalition synergies and lessons learned were evident in the following domains: infrastructure; community and partner engagement; data monitoring; and intervention implementation, evaluation, and dissemination. Outcomes of this funding initiative were evident in the following domains: strengthened partnerships, expanded knowledge, improved health or health-care programs and policies, and thriving communities.

Conclusions: Fostering community outreach and engagement-coalition partnerships created opportunities to use synergies and build capacity for engagement across multiple domains, contributing to enhanced trust and implementation of interventions across the cancer continuum. The findings provide examples and lessons on which cancer centers and coalitions can capitalize. Successful collaborative relationships were based on identifying shared goals and complementary expertise and roles, sharing financial and other resources, and a commitment to authentic and open dialogue. Although modest and short term, supplemental funding can strengthen organizational relationships and promote effective collaboration on community-facing activities; it can also lead to improved research engagement and translation of evidence to practice.

Background: Patients' self-report of their symptoms can provide important data for the evaluation of treatment benefit and tolerability of oncology drugs. Contemporary treatment approaches, including immunotherapy and molecular targeted therapies, have unique toxicities based on their novel mechanisms of action. This scoping review aimed to summarize evidence from existing reviews and clinical practice guidelines to examine the type and prevalence of toxicities including symptomatic adverse events (sympAEs) for adult cancer patients to inform clinical care and therapeutic trials.

Methods: A systematic search of PubMed, Web of Science, and Embase was performed using predefined eligibility criteria. Thirty-one literature reviews and 3 clinical practice guidelines met inclusion criteria and were selected for review and data abstraction.

Results: Findings from this scoping review demonstrated several leading sympAEs that were reported across immunotherapy and targeted therapy drugs, including fatigue, diarrhea, and rash. In addition to these more prevalent sympAEs, there were some less frequently reported class-specific sympAEs, which had potential for significant harm or disability to the patient if not properly identified and treated. Many studies reported toxicities as AEs or syndromes solely using data reported by clinicians without additional self-report from patients.

Conclusion: We identified several core sympAEs experienced by patients participating in oncology trials using immunotherapy and targeted therapy agents, which has implications for future trial design and drug labeling. Future cancer trials should assess patient-reported sympAEs based on the identified drug mechanism to inform the tolerability of these newer agents and enhance patient safety during trial participation and clinical care.

Nearly all cervical cancers are caused by human papillomavirus (HPV). In 2006, adolescent females were recommended to receive the HPV vaccine. Our study aimed to quantify the impact of introducing the HPV vaccine in 2006 on cervical cancer incidence in 2022. We analyzed the latest Surveillance, Epidemiology, and End Results data. Our design compared the change in cervical cancer incidence from 2019 to 2022 between females recommended for HPV vaccination in 2006 (age 25-29) and females who were not (age 35-54). Beyond simple pre/post comparisons, our linear regression model adjusted for age-specific incidence trends. We found that, unlike the stagnate trends in older females between 2019 and 2022, in 25-29-year-old females, cervical cancer incidence declined 2.1 cases/100 000 (95% CI = -2.7 to -1.6): a 48% reduction from baseline trends. Although tempered by uneven adherence, after 15 years we finally appear to be realizing quantifiable benefits from this cancer prevention vaccine.

Background: Although the relative proportion of triple-negative breast cancer decreases with age, its prevalence is rising with an aging population. This study examined real-world treatment practices, whether age in older women with triple-negative breast cancer affects therapy and outcomes, focusing on the potentially curable nature of early-stage triple-negative breast cancer.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA-compliant search using population, intervention, comparison, outcomes criteria identified literature from 2014 to 2023 across 5 databases (MEDLINE, Embase, PubMed, Web of Science, and Scopus), focusing on women aged 65 years and older with early-stage triple-negative breast cancer.

Results: From 7171 records, 37 studies were included. Older women with triple-negative breast cancer exhibited less aggressive features, including lower Ki67, higher androgen receptor, and higher Bcl2 expression. Breast-conserving surgery with radiation therapy (RT) was associated with improved overall survival and breast cancer-specific survival, with fewer recurrences compared with mastectomy with or without RT. Older women with triple-negative breast cancer were more likely to receive RT than systemic therapy, and the lack of RT correlated with worse outcomes. Multivariate analyses showed that systemic treatment improved 5-year overall survival and breast cancer-specific survival. Overall, outcomes did not show significant differences between women aged 70 years and older and women younger than 70 years at a median follow-up of 46 months.

Conclusions: The lack of overall outcome improvements for older women with triple-negative breast cancer following treatment may not solely be due to absent targetable receptors because the intrinsic biology in older patients may be relatively favorable. Instead, treatment selection biases against active treatment due to age-related factors may contribute substantially. Treatment decisions should be biology based and guided by a multidisciplinary, holistic, and patient-centered approach that carefully considers comorbidities, functional status, social support, and patient preferences.

Background: Early tumor shrinkage and depth of response have emerged as potential prognostic indicators in metastatic colorectal cancer (CRC). However, their associations with overall survival, progression-free survival (PFS), and postprogression survival in patients receiving anti-epidermal growth factor receptor (EGFR) antibodies or bevacizumab remain unclear.

Methods: We analyzed 3219 treatment-naive patients with RAS wild-type metastatic CRC from 8 randomized studies (CRYSTAL, OPUS, PRIME, CAIRO2, CALGB80405, WJOG4407G, ATOM, PARADIGM) in the Aid and Research in Digestive Cancerology database. Early tumor shrinkage was defined as a 20% or more reduction in tumor size at 8 ± 2 weeks, whereas depth of response was assessed by maximum tumor shrinkage at nadir. Cox regression models evaluated the associations of early tumor shrinkage and depth of response with overall survival, PFS, and postprogression survival, adjusting for confounders. A 2-sided test was conducted with a significance level of .05.

Results: Early tumor shrinkage and depth of response substantially stratified overall survival, PFS, and postprogression survival outcomes across all treatment groups. Early tumor shrinkage positivity was associated with improved overall survival, PFS, and postprogression survival in anti-EGFR and bevacizumab-based therapies, with a trend toward better outcomes in the anti-EGFR group. The depth of response analysis revealed optimal cutoff values of 0.55 for anti-EGFR-based therapy and 0.47 for bevacizumab-based therapy to achieve a median overall survival of approximately 32 months.

Conclusions: Early tumor shrinkage and depth of response serve as valuable prognostic markers in RAS wild-type metastatic CRC, particularly for patients treated with anti-EGFR antibodies. These findings highlight the potential role of early tumor shrinkage and depth of response in guiding treatment strategies and improving outcomes for patients with CRC.

We validated updated National Health Interview Survey questions on mammography indications compared with electronic health records (EHRs). We asked 244 Kaiser Permanente Washington members ages 40-74 years and eligible for breast cancer screening to self-report their most recent mammogram reason by using a series of new hierarchical yes/no questions. We first asked if they had the mammogram because of a health problem, then as a follow-up test, and last for screening. We compared self-reported reasons with 2 EHR datasets: procedure/diagnostic codes and radiologist-defined indications. Self-reported exams for a health problem had 89.2% agreement with codes and 92.2% agreement with radiologist-defined indications. Self-reported exams for follow-up had 87.5% agreement with codes and 89.3% agreement with radiologist-defined indications. Self-reported exams for screening had 91.4% agreement with codes and 95.7% agreement with radiologist-defined indications. Self-reported mammogram indications have good agreement with procedure/diagnostic codes and radiologist-reported indications, when asked using this novel hierarchical approach.

Background: Harm associated with persistent opioid use beyond the first-year intensive cancer treatment is underinvestigated in cancer survivors. We examined rates and risk factors for persistent opioid use and all-cause mortality after the first-year breast cancer survivorship.

Methods: This retrospective cohort study used electronic health record data from Kaiser Permanente Southern California for women diagnosed with a nonmetastatic breast cancer between 2009 and 2019 who filled 2 or more opioid prescriptions. Rates of persistent opioid use were estimated from first-year survivorship through December 31, 2021. Rate ratios (RRs) and 95% confidence intervals (CIs) for factors associated with persistent use were estimated using a multivariable Poisson regression model. Hazard ratios (HRs) for all-cause mortality associated with persistent opioid use were estimated using multivariable Cox regression models.

Results: Of 14 347 eligible individuals (mean [SD] age = 61.9 [12.5]), 2285 (15.9%) developed persistent opioid use, with an incident rate of 25.5 per 1000 person-years. Risk factors included older age (≥65 vs < 65 years: RR = 1.63, 95% CI = 1.24 to 2.14), smoking (current: 1.89, 1.68 to 2.13; former: 1.30, 1.20 to 1.41), baseline comorbidities (Elixhauser Comorbidity Index 5+ vs 0: 1.70, 1.29 to 2.24), and substance use disorders (1.58, 1.43 to 1.74). All-cause mortality was doubled among individuals with persistent use (51.6, 48.0 to 55.6 per 1000 person-years) than in those without (25.3, 24.2 to 26.4). Persistent use was associated with an increased all-cause mortality (adjusted HR = 1.84, 1.66 to 2.04).

Conclusions: Persistent opioid use was common in breast cancer survivors and associated with increased mortality. Further research is needed to explore factors that may be contributing to increased mortality.