JCO Global Oncology最新文献

Purpose: The aim of this study was to evaluate the current availability and distribution of radiotherapy (RT) and nuclear medicine equipment in Vietnam, focusing on the shortage of linear accelerators (LINACs), positron emission tomography/computed tomography (PET/CT) scanners, and brachytherapy units. The study seeks to quantify these shortages and highlight the implications for cancer treatment access and outcomes.

Methods: Data were collected from 50 hospitals across Vietnam that provide RT services or nuclear medicine imaging. The availability of LINACs, PET/CT devices, brachytherapy units, and other essential equipment was assessed, alongside patient loads and machine utilization rates. National data were compared with the standard in developed countries, with a particular focus on the International Atomic Energy Agency's (IAEA) recommendations for RT infrastructure.

Results: Vietnam has a total of 82 LINACs, resulting in a LINAC density of 0.82 per million people, which is far below the standard in developed countries of 4-8 per million. Of the existing LINACs, 43% are outdated and unable to deliver advanced RT techniques such as volumetric modulated arc therapy. Additionally, the country has only 12 PET/CT scanners and three cyclotrons, which limits access to early cancer diagnosis and treatment planning. The central region of Vietnam is particularly underserved, with only 1 PET/CT device and limited access to brachytherapy services. Long wait times for RT-often up to 2 weeks-are common, leading to delayed treatments and reduced treatment efficacy. Patients, particularly those with conditions requiring timely RT after chemotherapy, face increased risks because of these delays.

Conclusion: The shortage of modern RT and nuclear medicine equipment in Vietnam critically limits timely access to cancer treatment, affecting patient outcomes and placing a heavy burden on health care providers. Expanding access to advanced RT technology through government investment, public-private partnerships, and international collaborations with organizations such as the IAEA could alleviate these challenges. Increasing Vietnam's RT capacity is essential for improving cancer care outcomes and managing the rising burden of cancer across the country.

The WHO Global Initiative for Childhood Cancer, prompted by the marked inequity of survival across the globe, aims to increase survival rates in low- and middle-income countries to 60% by 2030. In tandem with this effort, implementing survivorship-focused care is crucial to mitigate late effects and prevent early mortality beyond the 5-year survival end point. The observed burden of secondary malignancies, cardiovascular disease, and other chronic health conditions in adult survivors of childhood cancer in high-income countries provides guidance to generate evidence in limited-resource settings. The implementation of risk stratification tools, population health management, and development of contextually relevant health care delivery models, within the current landscape of survivorship care in Latin America, Africa, and Asia as examples, are vital to continue the momentum to ensure equitable care and quality of life for all survivors of childhood cancer. This narrative review informed by expert opinion serves as a call to action for survivors, advocacy groups, health professionals, health systems, governments, and global organizations to look beyond the 5-year survival benchmark.

Variations in somatic genetic alterations can be observed across different cancer types and diverse populations. Understanding the frequency of oncogenic variants in specific populations helps elucidate carcinogenesis and risk factors, with somatic variants often serving as treatment markers. Data regarding the somatic landscape across the main tumor subtypes in patients from Latin America and the Caribbean (LAC) have increased recently, highlighting important differences from contrasting populations in North America, Europe, and Asia. Many of these differences have pressing implications regarding screening, risk factor management, targeted therapies, and health care policy. This review aims to synthesize the existing information on somatic oncogenic variants in patients' tumors from LAC. We included the frequency of somatic oncogenic variants of the most frequent tumors in LAC: prostate cancer, female breast cancer, colon cancer, gastric cancer, and lung cancer. Furthermore, we add information from tumors that are relevant in LAC because of their high incidence, specific subtypes, or aggressive phenotypes, namely gallbladder cancer, acral melanoma, and hematologic neoplasms, respectively. The data highlight distinct differences in the reported prevalences of various somatic variants across a spectrum of neoplasms. Moreover, it demonstrates that an extensive number of genetic and molecular studies have been carried out in the region, improving the level of characterization for this complex, admixed population. Nonetheless, data from many individual countries are still scarce or altogether missing, underscoring the need to establish collaborative groups to further advance progress in LAC. The need for further comprehensive research in the area should not be substituted with data from other regions as we seek to empower the choices to improve our health care outlook.

Purpose: Patients receiving immune checkpoint inhibitors (ICIs) may induce immune-related adverse events (irAEs). This study aimed to evaluate the toxicity induced by ICIs and explore the correlation between efficacy and toxicity in a Moroccan population.

Methods: We conducted a prospective study of patients with solid tumors who received pembrolizumab or atezolizumab at the National Institute of Oncology, Rabat from July 2018 to December 2023. We identified irAEs according to ASCO 2021 guidelines and graded them according to the Common Terminology Criteria for Adverse Events Version 4.0. Efficacy with respect to progression-free survival (PFS) and overall survival (OS) was determined. A Cox regression model was used to determine the association between irAEs and survival.

Results: Eighty-six patients with solid tumors who received ICIs were included. The primary tumor types were lung (40.7%), skin (29.1%), and GI cancer (14%). The ICIs most commonly used included pembrolizumab (67.4%) and atezolizumab (32.6%). ICIs were used as monotherapy (77.9%) or in combination (22.1%). A total of 58 (67.4%) patients presented any kind of irAEs. The most common toxicities in both the monotherapy and combination groups were GI, with rates of 25.3% and 31.5%, respectively. Patients with irAEs showed significantly longer median PFS compared with those without irAEs (9 v 3.6 months; hazard ratio [HR], 0.5 [95% CI, 0.32 to 0.99]; P = .04). The median OS was longer in patients with irAEs than in those without irAEs but was not statistically significant (19 v 10.3 months; HR, 0.8 [95% CI, 0.39 to 1.7]; P = .5).

Conclusion: Our results indicated that ICIs have the potential to induce irAEs in patients with solid tumors. These adverse effects were commonly GI. The development of irAEs was associated with improved effectiveness of ICI treatment across different malignancies.

Purpose: Triple-negative breast cancer (TNBC) presents notable treatment difficulties, especially in the public health care systems of low- and middle-income countries where access to advanced therapies is restricted. This study investigates TNBC's clinical, epidemiologic, and economic effects on survival within Brazil's public health care system.

Methods: We conducted a retrospective cohort study of patients with TNBC treated between 2010 and 2019. Overall survival (OS) rates by stage were analyzed across various patient groups, including those receiving neoadjuvant or adjuvant treatment, patients with or without complete pathologic response, Black and non-Black patients, and those treated with or without carboplatin-based therapy. Cox proportional hazards models were applied to estimate hazard ratios (HRs) with 95% CIs, and annual treatment costs were calculated per stage.

Results: Among 1,266 patients with TNBC, 710 met eligibility criteria. Kaplan-Meier analysis indicated stage II patients had a 47% lower mortality risk than stage III (HR, 0.53 [95% CI, 0.33 to 0.85]; P = .009). Patients in the adjuvant treatment group had a reduced risk (HR, 0.48 [95% CI, 0.34 to 0.69]) compared with the neoadjuvant group. Achieving complete pathologic response (pCR) greatly improved OS (HR, 0.21 [95% CI, 0.11 to 0.43]; P < .001). Black patients had better survival rates than non-Black (HR, 0.58 [95% CI, 0.40 to 0.86]; P = .006). Carboplatin use did not significantly affect OS (HR, 0.96 [95% CI, 0.65 to 1.43]; P = .857). The average monthly cost for systemic TNBC treatment increased with disease progression, from $101.87 in US dollars (USD) for stage I to $314.77 USD for stage IV second-line therapy.

Conclusion: This study provides insight into TNBC in Brazil's public health system, showing that OS decreases with disease progression but is higher among Black patients. pCR and adjuvant therapy improve survival, although costs increase significantly at advanced stages, highlighting the economic burden of late-stage TNBC management.

Purpose: Pancreatic cancer is one of the deadliest cancers in the world. In Armenia, it is 12th by incidence. The aim of this study is to evaluate treatment and outcomes of pancreatic cancer in Armenia during the past 12 years.

Methods: This is a retrospective study with data from three oncology centers in Armenia: "Muratsan" Hospital of Yerevan State Medical University, Mikaelyan institute of surgery, and Yeolyan Hematology and Oncology Center. The information was obtained from the medical records of the patients with pancreatic cancer treated at these centers during January 1, 2010-January 1, 2022. Log-rank test and Kaplan-Meier curves were used for survival analysis. Cox regression analysis was performed for identification of main prognostic factors.

Results: Of 70 patients involved in the final analysis, 45.7% was female. The median age at diagnosis was 63 years. The median follow-up time was 11 months (range, 2-146). A total of 11.4% of patients had stage I-II, 27.1% had stage III, and 60% had stage IV disease. The main independent prognostic factor for overall survival (OS) was the TNM stage, whereas grade of the tumor was not significant. The median OS was 11 months (range, 2-169 months): In stages I-III, patients who had surgery (44.4%) lived significantly longer than those who did not (20 v 11 months; P = .008). Main chemotherapy regimens were 5-fluorouracil, oxaliplatin, folinic acid and irinotecan (41.4%) and gemcitabine plus capecitabine (38.6%). No significant survival difference was found between these groups (13 v 11 months; P = .162).

Conclusion: Survival of patients with pancreatic cancer in Armenia is dismal, not exceeding 1 year. Hopefully, further research in the field and new treatment modalities will improve the situation.

Purpose: Metastatic urothelial carcinoma (mUC) poses a challenge to health care systems, given its treatment complexity and mortality. We aimed to describe the characteristics, treatment patterns, and survival outcomes of Mexican patients with mUC.

Methods: A retrospective study was conducted across eight centers for adults with mUC from January /2001 to December 2021. We recorded medical history, eligibility for first-line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used and survival analysis, including Kaplan-Meier curves and Cox proportional hazards model, was performed.

Results: We identified 379 patients with mUC; 37 were excluded, and 76% was male, with a median age of 67 years. The median follow-up was 8.4 months. Among those who received a first-line treatment (65%), cisplatin-based chemotherapy (45%) was the most common followed by carboplatin (39%). Causes of cisplatin ineligibility were Eastern Cooperative Oncology Group ≥2 (41%) and glomerular filtration rate <60 mL/min (33%). The overall response rate to up-front platinum therapy was 33%, with a median progression-free survival of 6.1 months (95% CI, 4.9 to 6.9). Second-, third-, and fourth-line treatment was given to 24.6%, 8.8%, and 3.5%, respectively. Chemotherapy was the most common regimen prescribed. Access to novel drugs was limited, 14 patients received avelumab, and 25% received immunotherapy as second-line treatment. The median overall survival was 11.8 months (95% CI, 10.2 to 15.2). Multivariate analysis showed that first-line treatment was independently associated with better survival, whereas poor performance status and visceral disease were associated with worse survival.

Conclusion: To our knowledge, these data represent the first effort to delineate treatment trends of mUC in Mexico. First-line treatment prescription and rates of progression to platinum therapy were higher than those described worldwide. Factors affecting survival included performance status, first-line treatment, and visceral disease. Our study highlights unequal access to novel treatments, underscoring the need for equitable care.

Purpose: Cancer constitutes a significant global health challenge, with projections indicating a continued increase in its prevalence in the foreseeable future. This trend is particularly pronounced in Latin America (LATAM), where the cancer burden has increased substantially over the coming decades. Concurrently, nursing, which represents the largest segment of the health care workforce globally, is important for addressing the multifaceted challenges posed by cancer care, particularly in low- and middle-income countries (LMICs). Despite the essential role of nursing in cancer care, several barriers hinder its optimal contribution, particularly in LMICs. These challenges include professional hierarchy, insufficient educational standards, underfunding for research, and limited representation in decision-making processes.

Methods: To address these challenges, collaborative initiatives, such as the INCREASE Proposal, have emerged, aimed at fostering interdisciplinary dialogue and action in oncology nursing within LATAM. Through focused workshops and agile methodologies, the INCREASE Proposal seeks to identify barriers and formulate solutions across key areas including education, research, clinical practice, and policy implementation.

Results: The outcomes of the INCREASE Proposal underscore the urgent need for comprehensive strategies to strengthen oncology nursing in the LATAM. These strategies include enhancing education and recognition within health care systems, fostering interdisciplinary collaboration, leveraging advanced technologies, conducting cost-benefit analyses, and promoting research-academic partnerships.

Conclusion: By addressing these challenges and implementing the proposed solutions, LATAM can advance toward optimized oncology nursing practice, improving cancer care delivery and outcomes across the region.