JCO Global Oncology最新文献

Purpose: The WHO Global Breast Cancer Initiative (GBCI) aims to improve breast cancer (BC) survival through early stage at diagnosis, prompt diagnostic evaluation, and appropriate multimodality treatment. Care pathway analysis helps to evaluate delay and dropouts through this process. Little is known about the BC care pathway of women first presenting at lower level of health systems in Africa.

Methods: Between March 2023 and February 2024, we prospectively recruited 243 women age ≥18 years in eight (six district, one regional and teaching) hospitals who, owing to breast symptoms, were referred for breast biopsy in the Oti and Volta regions of Ghana. We determined the percentages of biopsy uptake (study paid if needed), histology results receipt, survival, and treatment initiation and explored how patient-, family-, and health system-related factors influenced care pathways.

Results: Of the 243 women referred, 53 (21.1%) did not have biopsy taken for health system-related (n = 22, 41%) and participant-related (n = 26, 59%) reasons. Among 190 women who had a biopsy, 102 (54%) were malignant. The median time from first visit (recruitment) to obtaining biopsy results was 14 days (IQR, 9-27). Among malignant cases, 61% (62/102) were stage III/IV (GBCI pillar 1) and 65 (64%) of 102 initiated treatment (GBCI pillar 3) with a median time from first visit to treatment initiation of 76 days (IQR, 36-131). Thirty-seven (36%) women whose biopsies were malignant did not initiate treatment because of participant-related (19 [51%]) and health system-related (12 [32%]) factors. The 1-year survival was 76% (95% CI, 66 to 84).

Conclusion: In a unique study of women from lower levels of the health system in Ghana, we observed large gaps in biopsy uptake and treatment access, but excellent pathology turnaround times.

Purpose: Cervical cancer remains a significant public health concern globally and particularly in sub-Saharan Africa, where high rates of HIV infection exacerbate cervical cancer incidence. Understanding the cervical microbiome and its role in cancer progression is essential, especially in regions where both cervical cancer incidence and HIV prevalence are high. This study aimed to characterize the cervical microbiome in women living with HIV (WLWH) and HIV-negative women with squamous cell carcinoma of the cervix in Botswana, compare the microbiome between before and after chemoradiation therapy (CRT) in WLWH, and assess the prognostic value of specific microbial taxa for overall survival (OS) in WLWH.

Patients and methods: Cervical samples were collected from women with cervical cancer presenting to one hospital in 2018-2019. Patients' clinical data, including HIV status, were recorded. Microbial composition was analyzed using 16S rRNA gene sequencing. Microbiome diversity and composition were evaluated using alpha and beta diversity metrics. Differential microbial abundance was analyzed using linear discriminant analysis effect size. The association between microbial taxa and OS was explored using Cox proportional hazards regression.

Results: WLWH (n = 42) had a significantly lower Pielou evenness index than HIV-negative women (n = 11; 0.6 v 0.7, P = .02), suggesting a more imbalanced microbiome in WLWH. WLWH had higher levels of Parvimonas and members of the Corynebacteriaceae and Micrococcaceae families, suggesting a shift toward a more pathogenic microbiome. In WLWH, CRT did not significantly alter overall microbial diversity. However, Lactobacillus and Sutterella were enriched before treatment, reflecting a less pathogenic microbiome, whereas Ruminococcus and Phascolarctobacterium and the families Caulobacterales and Flavobacteriia were enriched after treatment, reflecting microbial adaptations to the altered immune and treatment environment. Notably, higher levels of Flavobacteriia after CRT were independently associated with worse OS in WLWH.

Conclusion: Microbiome profiles differ between WLWH and HIV-negative women with cervical cancer in Botswana. The microbiome might have prognostic significance. Future research is needed to better understand the significance of the microbiota in cervical cancer progression and treatment outcomes and the potential role of microbiome-targeted interventions.

Purpose: Next-generation sequencing is optimal for testing advanced/metastatic non-small cell lung cancer (NSCLC) biomarkers; however, implementation and access are often hindered across Asia by turnaround time (TAT), logistics, and reimbursement. This study aimed to implement a multigene biomarker testing algorithm for the comprehensive detection of actionable NSCLC biomarkers.

Methods: The AmoyDx PLC Panel, a multigene polymerase chain reaction (PCR), was used in testing, with an optimal workflow developed in Chi Mei Medical Center, Taiwan. Tests were conducted on 897 NSCLC samples between June 2022 and November 2023.

Results: Among the tested samples, 83.0% were adenocarcinoma, with 74.4% at stage IV. Most samples were successfully analyzed for additional biomarkers, with 1.3% and 2.1% of samples having insufficient tissue or DNA quality, and insufficient RNA quality, respectively. This study reflected clinical reality, with most samples tested at initial diagnosis (72.0%). Other patients had previous single-gene testing for epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)/ROS proto-oncogene 1, receptor tyrosine kinase (ROS1) with negative results (11.2%), and others were tested after progression on tyrosine kinase inhibitors (16.8%). The median testing TAT was short (4 days). Of the patients tested at diagnosis (n = 638), 50.6% had EGFR mutations and 79 (12.4%) patients had alterations in Kirsten RAat Sarcoma viral oncogene homolog (KRAS) G12C (2.4%), v-raf murine sarcoma viral oncogene homolog B1 (BRAF) (0.9%), human epidermal growth factor receptor 2 (HER2) (3.5%), mesenchymal-epithelial transition factor (MET) (2.4%), ALK (1.3%), ROS1 (1.6%), and rearranged during transfection (RET) (0.5%). Among the 99 patients who had previously tested negative for EGFR/ALK/ROS1, 47 (47.5%) patients had biomarker alterations that were potentially targetable by available drugs.

Conclusion: This study highlighted the effectiveness of multigene PCR testing in identifying actionable NSCLC biomarkers for low failure rate, short TAT, and minimal tissue requirements, enabling timely, personalized interventions. The workflow implemented at Chi Mei Medical Center provides a model that other hospitals can adopt to overcome testing barriers and improve precision oncology access.

Purpose: The management of advanced classical Hodgkin lymphoma (cHL) poses a major challenge in Asia, given disparities in health care resources and the variability in health care systems across the region. This article reviews the practice landscape for advanced cHL in East and Southeast Asia (hereafter referred to as Asia), offers detailed perspectives on the challenges faced by treating physicians, and proposes solutions to improve patient outcomes.

Methods: At the Singapore Lymphoma Scientific Symposium 2024, a panel of lymphoma experts from 10 countries/territories across Asia convened to discuss local cHL management practices. Discussions were supplemented by perspectives from an expert from the United States and a review of published literature on HL in Asia in 2014-2024. This article summarizes meeting discussions and reports relevant aspects of Asian practice preferences for advanced cHL.

Results: In Asia, cHL management is hindered by the lack of local guidelines and survivorship programs, challenges in diagnosis and staging because of a lack of resources and funding, and limited access to efficacious novel drugs. This is of particular concern in vulnerable patient populations such as the elderly. To uplift the standard of care for patients with cHL locally, greater cross-regional learning and collaboration could be explored to enhance clinical management capabilities, lower the financial barriers to accessing novel drugs and technologies, and support increased research efforts and clinical trial presence in the region.

Conclusion: Although advanced cHL management remains a challenge in Asia because of diverse needs within the region, regional partnerships and initiatives can bridge existing gaps and supplement local efforts to improve outcomes among patients with advanced cHL.

Purpose: Breast cancer is the most common female cancer in Kenya, frequently presenting at late stage, and associated with high mortality. The stigma around cancer has been identified as a barrier to early detection and treatment in many settings globally. This pilot study investigated associations between breast cancer stigma, depression, anxiety, and health-related quality of life (HRQOL) outcomes.

Methods: A cross-sectional survey of 60 participants (30 newly diagnosed breast cancer [NDBC] and 30 previously treated breast cancer [PTBC]) was conducted at Aga Khan University Hospital, Nairobi, Kenya. Validated survey measures included a chronic illness stigma scale adapted for breast cancer, depression, anxiety, and HRQOL. Penalized logistic and linear regression analyses were also performed.

Results: The participants' mean age was 49.9 years (±12.1). A quarter (25%) of the participants experienced anxiety, whereas 13.3% showed signs of depression, with a mean HRQOL score of 79 (±16.9). The mean breast cancer stigma score was 39.8 (±14.9). The adjusted predicted probability of depression increased as the stigma score increased and was higher among PTBC participants than NDBC participants. The adjusted predicted probability of anxiety also increased as the stigma scores increased and was higher among those who had NDBC than PTBC participants. The adjusted predicted change in the log of HRQOL decreased as the stigma score increased and was higher among NDBC participants than PTBC participants at diagnosis.

Conclusion: Among women diagnosed with breast cancer, this study highlights the association of increased breast cancer-related stigma with anxiety, depression, and lower QOL.

Purpose: In 2013, Brazil implemented a federal law (Law 12.732/2012) mandating cancer treatment to begin within 60 days of diagnosis. Among women with newly diagnosed estrogen receptor-positive (ER+) nonmetastatic breast cancer, we describe the diagnosis-to-treatment interval, patient and tumor characteristics, and the type of treatment received, and we assess these metrics by public versus private health care setting.

Methods: The study included patients with early-stage ER+ breast cancer from 14 centers in Brazil who had completed locoregional care and received >6 months of adjuvant endocrine therapy (ET). Patient, tumor, and treatment characteristics were abstracted from clinical documentation and collected in REDCap. Qualitative variables were compared between groups using the chi-square or Fisher exact tests. For quantitative variables, the nonparametric Mann-Whitney test was used. P < .05 was considered significant.

Results: From June 2021 to March 2024, 774 women enrolled in the study. The mean age at diagnosis was 56.5 years, and 55.2% received public health care. Women who received care at public institutions were more likely to be premenopausal at diagnosis (45.3% public v 29.2% private, P < .0001), living with no partner (45.6% public v 34.7% private, P = .002), and have lower educational levels (43.6% public v 6.8% private, P < .0001). Women treated in the public sector had more advanced disease with stage III tumors (29.3% public v 13.5% private, P < .0001) and were more likely to receive mastectomies (36.8% public v 29.8% private, P = .0003), axillary dissections (43.1% public v 18.1% private, P < .0001), chemotherapy (73.8% public v 58.5% private, P < .0001), and radiotherapy (87.0% public v 78.7% private, P = .002). Regarding adjuvant ET, women treated in the public sector had lower ovarian function suppression (6.8% public v 18.8% private, P < .0001) and higher tamoxifen use (52.4% public v 29.4% private, P < .0001). The diagnosis-to-treatment interval was longer in the public versus private system (93 v 41 days, P < .0001).

Conclusion: Our study revealed significant disparities in cancer care between patients with stage I to III ER+ breast cancer treated in public versus private health care systems in Brazil. Law 12.732/2012 has proven ineffective for patients treated in the public sector and is not being adequately observed or enforced by Brazilian authorities.

Purpose: Cervical cancer remains a leading cause of cancer mortality in low- and middle-income countries (LMICs). The International Gynecologic Cancer Society (IGCS) Global Gynecologic Oncology Fellowship aims to build human capacity to address the burden of cervical cancer in LMICs. This study assesses resource constraints experienced at fellowship sites with regard to management of cervical cancer.

Methods: From September to December 2020, one fellow from each of the 12 existing IGCS fellowship programs participated in a survey that assessed capacity for cervical cancer management, including access to care, diagnostics and treatment, cancer surveillance, and palliative care. Descriptive statistics were used for analysis.

Results: Patients at IGCS sites experienced significant delays to care, especially for chemotherapy and radiation therapy. Less than half of the sites had a gynecology-trained pathologist, and only 58% of sites had access to a magnetic resonance imaging machine, though with many delays in obtaining imaging reads. For treatment, neoadjuvant chemotherapy is not commonly used. Access to radiation therapy is poor, with 58% of sites reporting wait times of 5-8 weeks or more. The radiation machine downtime ranges from 1 to 3 months per year, creating gaps where no patients can access this treatment. Palliative care is practiced by variable members of the health care team although hospice services are rare.

Conclusion: This study demonstrates significant resource constraints experienced by gynecologic oncology providers in various LMICs when managing cervical cancer. This includes delays to diagnosis, poor access to chemoradiation services, and need for palliative care. Despite these limitations, the IGCS Global Gynecologic Oncology Fellowships have built workforce capacity to manage cervical cancer, serving as local champions to address this disease.

Purpose: To assess the clinical outcomes and evaluate Freedom from Introduction or Switching of Systemic Treatment (FISST) in patients with oligometastatic (OM) and oligoprogressive (OP) disease undergoing stereotactic body radiotherapy (SBRT).

Methods: The primary end points were FISST and local control (LC) rates of lesions that received SBRT. The secondary end point was overall survival (OS) after SBRT. To calculate FISST, event was defined as the need to introduce or switch the systemic line of treatment for any reason or inability to provide systemic treatment when needed because of poor performance status (PS) (Eastern Cooperative Oncology Group PS ≥3) or other reasons. OS was a secondary outcome.

Results: A total of 200 patients were included. The median age was 60 (IQR, 49-70) years. The most common primary tumors were colorectal (61, 30.5%), breast (30, 15.0%), lung (28, 14.0%), head and neck (23, 11.5%), and prostate (16, 8.0%). A total of 257 metastatic lesions were treated. Bone was the most frequent site (115, 44.7%), followed by the liver (55, 21.4%), lung (44, 17.1%), lymph nodes (25, 9.7%), and adrenal glands (11, 4.3%). The median follow-up was 15 months. FISST at 1 and 2 years were 52% and 39%, respectively. LC at 1 and 2 years were 86.3% and 80%, respectively. OS at 1 and 2 years were 76.5% and 64.8%, respectively. Grade III toxicity was reported in 1.5% of patients overall, with no observed grade IV or V toxicity.

Conclusion: SBRT is effective and safe for treating OM and OP solid cancers, prolonging FISST and potentially delaying systemic treatments, particularly in settings with limited access to advanced therapies.