JCO Global Oncology最新文献

Purpose: We assessed radiotherapy (RT) utilization and completion among pediatric patients with brain tumor treated at Children's Cancer Hospital Egypt (CCHE).

Methods: A retrospective analysis was conducted among pediatric patients with brain tumor treated at CCHE between 2009 and 2020. Patients were categorized on the basis of demographics, tumor types, RT utilization status (prescribed, not prescribed, and did not complete), and geographic place of residence (urban v rural). RT utilization was stratified by tumor type and geographic region and compared using chi-square tests.

Results: Among 3,977 pediatric patients with brain tumor, 2,327 (58.5%) were prescribed RT. The highest RT utilization was observed among patients with diffuse intrinsic pontine glioma (DIPG; 98.2%) and germinoma (98.0%), while nonoptic low-grade glioma (LGG; 11.2%) and optic pathway glioma (OPG; 2.0%) had the lowest among patients prescribed RT, 2,264 (97.2%) completed treatment. The highest noncompletion was observed in patients with atypical teratoid rhabdoid tumor (ATRT; 6.7%) and nonoptic LGG (9.7%). Urban patients had a higher rate of RT completion (98.3%) compared with rural patients (95.9%; P < .001).

Conclusion: RT utilization and completion varied significantly by tumor type, reflecting evidence-based treatment protocols and tumor-specific challenges. Geographic disparities in RT completion underscore systemic health care inequities in Egypt. These findings emphasize the need for targeted interventions, including decentralized radiotherapy delivery models and public health strategies, to improve access to and adherence to radiotherapy among underserved populations.

Purpose: Breast cancer (BC) is the most frequently diagnosed cancer among women globally. In sub-Saharan Africa, its impact is compounded by high HIV prevalence. Studies show that women living with HIV and BC (WLHIVBC) often present at advanced stages despite contact with HIV Care and Treatment Clinics. Little is known about their experiences in navigating both conditions. This study explored barriers and facilitators to integrated care for WLHIVBC in Tanzania to inform development of a patient-centered care model.

Methods: This qualitative study used a grounded theory approach, conducting 21 in-depth interviews with 11 WLHIVBC and 10 health care providers (oncologists, infectious-disease specialists, nurses, and pharmacists) over 10 months. Analysis followed an iterative coding process using Dedoose, and a multidisciplinary team refined key themes shaping the proposed integrated care model.

Results: Participants described barriers including stigma, nondisclosure, logistical and financial constraints, fragmented services, psychological burden, and reliance on spiritual healing. Facilitators included trust in providers, colocated services, patient education, peer support, and psychosocial counseling. Faith played a dual role-strengthening some while delaying care for others. Participants identified faith-based organizations as partners in education and stigma reduction. Recommendations emphasized colocated clinics, empathetic communication, psychosocial support, and collaboration with the Ministry of Health, Ministry of Education, and faith-based organizations to strengthen community education and linkage to care.

Conclusion: WLHIVBC in Tanzania face intersecting burdens of stigma, late presentation, and fragmented services. Yet, trust, peer networks, and education provide clear entry points for integration. Findings call for holistic, patient-centered, multisectoral approaches bridging oncology and HIV care and prioritizing patient experience.

Purpose: To propose a comprehensive national policy blueprint to expand equitable radiation therapy (RT) access in India, addressing persistent rural-urban disparities and aligning with global cancer control priorities.

Design: This expert viewpoint was informed by consultations with oncology practitioners from government and private centers, medical physicists, policy planners, and patient advocates. Drawing on Indian and global precedents, best practices were synthesized to develop a 10-point framework addressing infrastructure, financing, workforce, quality assurance, and governance.

Results: RT services in India remain highly centralized, with only 120 of 740 districts offering access, disproportionately affecting the 934 million rural population. Key strategies in the proposed blueprint include import duty reform to incentivize rural investment, quality-linked reimbursements under public insurance schemes, bundled workforce incentives, and regionally focused public-private partnerships. Additional measures include phased deployment of indigenous linear accelerators (LINACs), pooled brachytherapy services, mandatory cancer notification, and digital integration through the Ayushman Bharat Digital Mission. Use of artificial intelligence (AI) and remote planning is highlighted as a means to address workforce shortages. The framework is modular and designed for adaptation by other low- and middle-income countries (LMICs).

Conclusion: This 10-point National RT Policy Blueprint provides a scalable pathway to strengthen oncology infrastructure and improve treatment equity in India, with direct relevance for LMICs pursuing universal health coverage and Sustainable Development Goal 3.4. Although promising, some elements such as indigenous LINAC deployment and AI-enabled remote planning are aspirational and contingent on phased implementation, infrastructure readiness, and sustained political commitment.

Purpose: Southeast Asia (SEA), home to over 690 million people across 11 countries-Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Singapore, Thailand, Timor-Leste, and Vietnam-features diverse socioeconomic contexts and cancer care landscapes. We report and interpret incidence and mortality statistics for hematologic malignancies (HMs) in SEA.

Methods: We analyzed 2022 Global Cancer Observatory data from the International Agency for Research on Cancer to report age-standardized incidence rate (ASIR) and age-standardized mortality rates (ASMR) per 100,000 individuals age 20 years and older. We focused on non-Hodgkin lymphoma (NHL), leukemia, multiple myeloma (MM), and Hodgkin lymphoma (HL), standardized using Segi-Doll world population estimates.

Results: Across 11 Southeast Asian countries, age-standardized incidence and mortality rates (ASIRs and ASMRs) for HMs vary widely, highlighting significant regional disparities. Singapore consistently reports the highest ASIRs for NHL, leukemia, MM, and HL, yet its ASMRs are much lower, reflecting strong health care infrastructure. Thailand, Brunei, and Malaysia mirror these associations, which are particularly pronounced in NHL and HL. In contrast, for leukemia and MM, Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Timor-Leste, and Vietnam demonstrated lower ASIR and ASMR that approaches ASIR, suggesting barriers to diagnosis and survivorship. Time trends suggest increasing mortality from MM and NHL, particularly in Thailand and the Philippines. Overall, survival outcomes correlate strongly with national health care capacity.

Conclusion: Higher reported incidence in wealthier SEA countries may reflect greater diagnostic capacity, whereas similar incidence and mortality in low-income countries likely indicates limited access to timely diagnosis and treatment. Mortality patterns underscore the region's broad disparities in cancer care infrastructure and outcomes, shaped by socioeconomic and systemic health inequities.

Purpose: Colorectal cancer burden is increasing in Mexico. Population-based screening programs will be needed to address this public health challenge. Our objective was to explore the feasibility of offering colorectal cancer screening (CRCS) with a fecal immunochemical test (FIT) kit in the context of an existing door-to-door vaccination program in Mexico City.

Methods: The study was conducted in Mexico City in 2019-2020, before and during the onset of the COVID-19 pandemic. Design of the intervention was informed by focus group interviews with average-risk adults age 50-75 years served by a door-to-door vaccination program and interviews with primary care clinic and hospital staff serving this community. The intervention involved offering FIT to household members age 50-75 years during routine door-to-door immunization campaigns, with follow-up colonoscopy for those with abnormal results. Feasibility and acceptability of the intervention was evaluated through analysis of patient participation, clinical outcomes, and surveys.

Results: A total of 132/178 (74.2%) eligible community participants accepted a FIT kit after receiving information from a trained health promoter. Mean age of participants was 62.0 (±6.8) years, and most were women (n = 84, 63.6%). Among participants, 94 (71.2%) returned FIT for testing. Of these, 20 (21.3%) had an abnormal FIT result (≥20 ngHg/mL) and were offered colonoscopy. Of these, 10 (50%) completed the colonoscopy. Recruitment was halted due to the COVID-19 pandemic, which also became a barrier to colonoscopy completion.

Conclusion: Offering CRCS with FIT during door-to-door vaccination activities was feasible and acceptable to outreach workers and patients. Further studies are needed to determine interventions and implementation strategies necessary for scale-up and the effectiveness within integrated health systems.

Purpose: Dihydropyrimidine dehydrogenase (DPD) deficiency, an autosomal recessive metabolic disorder, causes a considerable deficit in the patient's metabolism of fluoropyrimidine drugs, most notably 5-fluorouracil (5-FU) and capecitabine. There is a higher frequency of severe toxicities after a fluoropyrimidine regimen among patients with GI and hepatopancreaticobiliary (HPB) malignancies on chemotherapy because of this metabolic deficiency. This prospective study aims to assess the rate of DPD deficiency and clinical significance of DPD deficiency in patients receiving fluoropyrimidine chemotherapy at a tertiary oncology center in India.

Materials and methods: From March 2024 to February 2025, we prospectively recruited 146 patients with histologic confirmation of GI and HPB cancers who were commencing a 5-FU- or capecitabine-based regimen. We performed pretreatment DPD tests on all patients using TRUPCR DPYD reverse transcriptase polymerase chain reaction for four known variants. Severe toxicities (Common Terminology Criteria for Adverse Events v5.0) were assessed after the first cycle of chemotherapy. Dose reductions, advances in therapy, and admissions were also noted.

Results: Of the 146 study participants, 11 (7.5%) had a DPYD mutation. HapB3 (rs56038477) was the most commonly encountered variant (72.7% of patients), along with registries of DPYD*2A (18.2%) mutation and mutation c.2846A>T (9.1%). Severe toxicities (grade ≥3) were above other grade toxicities (61.6%) in mutation carriers (72.7%) as compared with mutation noncarriers (37.0%, P = .03). Neutropenia, diarrhea, and thrombocytopenia were the common toxicities at a frequency of 18.5%, 12.3%, and 15.1%, respectively. After dose reduction, 90.9% of mutation carriers required a dose reduction versus 14.8% of mutation noncarriers (P < .001). Both groups had no problems in completing treatment.

Conclusion: Individuals with DPYD mutations experience increased toxicity and dose adjustments; however, treatment efficacy was not affected. This indicates that a coordinated effort that incorporates routine DPYD testing can mitigate treatment toxicities and individualized fluoropyrimidine dosing for patients with GI and HPB cancers.

Purpose: The study evaluated the real-world outcomes of the pertuzumab/docetaxel/carboplatin/trastuzumab (PTCH) regimen in Indian patients with human epidermal growth factor receptor 2-positive (HER2+) early, locally advanced, and oligometastatic breast cancer (BC).

Methods: Data from patients treated with neoadjuvant PTCH between January 2015 and December 2024 were retrospectively reviewed. The primary end point was the pathologic complete response (pCR) rate, with secondary end points including disease-free survival (DFS) and toxicity. Kaplan-Meier analysis assessed survival; Cox regression and logistic regression were used for multivariate analyses.

Results: A total of 152 patients were included (median age: 47 years; range: 23-72 years): 45 patients (29.6%) had stage II, 89 (58.55%) had stage III, and 18 (11.84%) had oligometastatic disease. Overall, 68 (44.7%) patients had hormone receptor-positive disease, and 94 (61.8%) were premenopausal. The overall pCR rate was 83 (54.6%). The pCR rate of the hormone receptor-negative group (68%) was higher than that of the hormone receptor-positive group (45.1%). With a median follow-up of 33 months, the 3-year DFS was 47.5%, 58% in patients who achieved pCR, and 33.5% in those who did not achieve pCR (P = .001). The most common adverse events (grade 3/4) were diarrhea (17.1%) and thrombocytopenia (7.8%). In the multivariate analyses, lower odds of achieving pCR were associated with recurrence (odds ratio, 0.383, P = .018). An improved DFS was observed in the age group of 31-45 years.

Conclusion: The PTCH regimen demonstrated efficacy and a tolerable safety profile in patients with HER2+ BC in an Indian real-world setting. Achieving pCR is a significant predictor of improved DFS. The PTCH regimen obviates the need for adjuvant trastuzumab emtansine after surgery, making it a cost-effective strategy in a limited-resource setting.

Purpose: Esophageal squamous cell carcinoma (ESCC) is a prevalent cancer in eastern Africa. Optimal management strategies in eastern Africa have not been well established. This study aimed to evaluate ESCC treatment outcomes at Kamuzu Central Hospital (KCH), a national cancer center in Malawi.

Methods: This prospective, observational, cohort study was conducted as part of a multicenter collaboration within the African Esophageal Cancer Consortium (ClinicalTrials.gov identifier: NCT05177393). Patients who presented to KCH with esophageal cancer (EC) were recruited from June 2021 to December 2022. Data on patient and treatment characteristics were collected using interviews and chart review. Mobile phone outreach was used to assess patient-reported outcomes (PROs). PROs were analyzed using linear mixed modeling. Kaplan-Meier method with log-rank test and Cox proportional hazards regression were used to evaluate overall survival by treatment group.

Results: A total of 148 of 150 eligible patients enrolled. Of 114 with biopsy-proven EC, 97% (n = 111) had ESCC. Most were documented as having localized disease; however, 56% did not complete staging imaging. Forty-seven percent received supportive care, 30% self-expandable metallic stent (SEMS), 20% chemotherapy, and 3% SEMS plus chemotherapy. SEMS was associated with the highest proportion experiencing dysphagia improvement (SEMS 68% v chemotherapy 63% v supportive care 39%). Twelve-month survival rate was the highest in the chemotherapy arm (29% v supportive care 19% v SEMS 6%, log-rank P = .018).

Conclusion: ESCC remains a highly fatal malignancy in Malawi. Most patients at KCH are treated with SEMS or supportive care. Although data must be interpreted with caution given likely confounding, chemotherapy was associated with the highest 12-month survival rate as compared with SEMS and supportive care, whereas SEMS was associated with the highest likelihood of improved dysphagia.

Purpose: Access to cancer medicines is a function of both availability and affordability. In Nepal, where patients are responsible for procuring and purchasing treatments out of pocket, access is limited by both unavailability of medicines and unaffordability of available medicines. This study aimed to examine the availability, affordability, and price variation of GI cancer medicines in Nepal's public cancer hospitals.

Methods: A cross-sectional survey was conducted among four public cancer hospitals across Nepal between October 2022 and January 2023. Availability, affordability, and price variations of 26 therapeutic regimens for gastroesophageal, colorectal, hepatobiliary, and pancreatic cancers were examined. The maximum and minimum monthly retail prices of each individual available medicine and regimen were compared, and interhospital and intrahospital differences in price were calculated. Affordability was assessed by comparing monthly treatment costs with the monthly national per capita gross domestic product (GDP).

Results: Fourteen of 26 (53.8%) regimens were available in at least one hospital, whereas nine (34.6%) were available in all four public cancer hospitals. We discovered differences as high as 422% in capecitabine pricing within the same hospital, and differences in irinotecan pricing of 997% across hospitals. With the exception of capecitabine monotherapy, and fluorouracil plus cisplatin, all of the remaining available GI cancer treatments have monthly prices that exceed the monthly per capita GDP of Nepal.

Conclusion: GI cancer drug access in Nepal is limited by low availability and significant price variation. Intrahospital and interhospital price disparities may influence patients to seek out different prices across institutions to avoid financial toxicity, adding logistical burden. Price regulation, transparency, and local manufacturing are needed to improve equitable access to cancer medicines.