JCO Global Oncology最新文献

Purpose: Treatment completion (TC), defined by completing the recommended treatment regimen, and treatment adherence (TA), defined by completing the prescribed treatment in the expected time frame, are critical for improving breast cancer (BC) mortality. Therefore, we conducted this study to measure TC and TA in Tanzania.

Methods: BC treatment data from 2019 to 2020 at Ocean Road Cancer Institute (ORCI) were collected. Demographic, socioeconomic, and clinical profiles were identified. TC and TA were measured by comparing chemotherapy and radiotherapy prescribed regimens to received treatment.

Results: Overall, 813 patients were seen at ORCI between 2019 and 2020. Mean age of patients was 51 ± 12.5 years; 97.9% identified as female; and 67.6% resided outside of Dar es Salaam. Stage III/IV disease was identified in 43.8% patients, with 24.1% showing clinical evidence of metastasis on arrival. TC across treatments ranged between 46.8% and 47.4%, while overall TA was 21.2%. TC was associated with not having metastasis on arrival (P = .01) and residing in proximity to ORCI (P = .04). TA was associated with having insurance (P < .0001) and attending a follow-up appointment after treatment (P < .0001).

Conclusion: Poor TC and TA rates in Tanzania pose a significant risk to treatment efficacy. Interventions are needed to specifically target patients with advanced-stage disease and greater geographic distance to treatment to increase treatment compliance.

Purpose: This multicenter observational study conducted in Poland aims to analyze referral patterns and clinical practice in patients with unresectable stage III non-small cell lung cancer (NSCLC), during the early stage of the national implementation of consolidation immunotherapy, focusing on the use of concurrent chemoradiotherapy (cCRT), sequential chemoradiotherapy (sCRT), and definitive radiotherapy (dRT).

Materials and methods: Adult patients with unresectable stage III NSCLC treated with curative-intent radiotherapy between April 1, 2021, and March 31, 2022, were included. Descriptive analyses were performed per the registered protocol. Group comparisons used Fisher's exact test, the chi-squared test, the Kruskal-Wallis test, and Pearson's chi-squared test.

Results: Among 273 patients, cCRT and sCRT were administered with equal frequency (37.7% each), followed by dRT (16.5%) and overlapping chemoradiotherapy (8.1%). Groups differed in performance status (PS) and age but not in Union for International Cancer Control-Tumor, Node, Metastasis (UICC-TNM) classification. PS and disease extent influenced the treatment choice. The cCRT was primarily chosen because of the tumor location, whereas sCRT was chosen mainly because of large tumor mass. Complication rates were similar, except for grade 3-4 hematologic toxicity, more frequent with cCRT.

Conclusion: In Poland, cCRT and sCRT are equally used. Treatment decisions are primarily driven by PS and tumor characteristics rather than UICC-TNM staging.

Purpose: The Pediatric Oncology East and Mediterranean (POEM) Biennial Conference serves as a regional platform to advance childhood cancer care through scientific exchange, collaborative research, capacity building, and policy engagement. The 2025 Fourth Scientific Meeting aimed to showcase regional innovations, strengthen partnerships, and align strategies with the WHO Global Initiative for Childhood Cancer (GICC).

Methods: This report summarizes the scientific, clinical, and educational content of the 4th POEM Biennial Conference, held April 30-May 3, 2025, in Amman, Jordan, under the theme Harnessing Regional Strengths to Improve Equity, Access, and Quality Care. The program included plenary lectures, symposia, oral abstracts, posters, expert sessions, and focused workshops.

Results: The meeting attracted 351 delegates from 24 countries, including physicians, nurses, researchers, policymakers, and advocates. Scientific highlights featured the first regional multicenter outcomes of chimeric antigen receptor T-cell (CAR-T) therapy in low- and middle-income settings, updated survival data in acute lymphoblastic leukemia, and advances in hematopoietic cell transplantation using haploidentical and αβ T-cell-depleted grafts. Special sessions addressed CNS tumors, lymphomas, survivorship, gene therapy, and qualitative research. Advocacy panels highlighted equity and access for displaced and conflict-affected populations. Regional initiatives included strengthening the POEM Palliative Care and achieving consensus on early cancer detection strategies aligned with the WHO GICC. Pre- and post-conference workshops on artificial intelligence, sarcoma management, nursing leadership, and retinoblastoma delivered hands-on training and reinforced regional capacity building. Workshop evaluations demonstrated strong learning outcomes and a high likelihood of practice change.

Conclusion: The 2025 POEM Biennial Conference reaffirmed the network's role as a catalyst for advancing childhood cancer care across the Eastern Mediterranean. By integrating scientific advances with strategies for equity, access, and policy reform, POEM continues to accelerate progress toward the global target of achieving at least 60% survival for all children with cancer by 2030.

Purpose: Combined-modality therapy (CMT) improves survival in patients with early-stage extranodal natural killer-/T-cell lymphoma (ENKTCL) compared with radiotherapy (RT) alone. However, the effect is inadequate for low-risk patients as defined by nomogram-revised risk index (NRI). As such, it remains unclear whether the survival benefits outweigh the additional costs.

Materials and methods: A Markov model was constructed to compare CMT versus RT alone for patients with early-stage ENKTCL, according to five risk groups defined by NRI model. Transition probabilities, effectiveness, and cost data were derived from the China Lymphoma Collaborative Group cohort, while health utility data were estimated from adverse effects. Life-years, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated from the perspective of Chinese payers. Evaluations for customized countries or settings can be accomplished using a web-based tool.

Results: Over the 6-year horizon, CMT increased life-years by 5.47, 5.19, 4.82, 4.62, and 4.49 years at $517,472 US dollars (USD)/QALY, $22,871 USD/QALY, $7,865 USD/QALY, $4,598 USD/QALY, and $2,278 USD/QALY for the low-risk (NRI = 0), intermediate-low-risk (NRI = 1), intermediate-high-risk (NRI = 2), high-risk (NRI = 3), and very high-risk (NRI = 4) groups, respectively. The probabilities of cost-effectiveness at a willingness-to-pay threshold of $5,208 USD/QALY were 0.00%, 0.01%, 7.40%, 72.07%, and 99.10% for each risk group. Over the lifetime horizon, all risk groups, except for low-risk group, had a probability of over 90% of being cost-effective. Estimates were varied according to country settings, integrated through a web-based customized analysis.

Conclusion: CMT is unlikely to be cost-effective for low-risk patients but highly likely to be cost-effective for high-risk and very high-risk patients. As for intermediate-low or intermediate-high-risk patients, the cost-effectiveness of CMT varies depending on the time horizon and willingness-to-pay threshold.

Purpose: Breast cancer imposes a substantial disease burden on the Brazilian population. Furthermore, the potential unnecessary use of adjuvant chemotherapy exposes patients to risks and adverse effects without significant therapeutic benefits. The purpose of this study is to determine the extent to which genomic testing for treatment selection, particularly in early stages, is a cost-effective strategy for optimizing care, while minimizing costs and unnecessary interventions.

Methods: We estimated the economic impact of the Oncotype DX test to guide the decision about prescribing adjuvant chemotherapy. The model integrates a decision tree and a Markov model with transitions between the health states of recurrence-free survival, distant recurrence, acute myeloid leukemia, and death. The probabilities of distant recurrence were derived from the TAILORx and RxPONDER clinical trials, combined with local evidence regarding utility and overall survival estimates. The analysis was conducted from the perspective of the Brazilian private health care system, which covers about one quarter of the Brazilian population. Scenario and sensitivity analyses with Monte Carlo simulations were performed.

Results: Compared with clinicopathologic risk assessment alone, use of the Oncotype DX test for both node-negative (N0) and node-positive (N1) leads to an increase in quality-adjusted life-years (QALYs) at lower costs (0.15 QALYs and $-3,975.59 US dollars [USD]). The main impact drivers were chemotherapy costs, chemotherapy prescription probabilities, and Oncotype DX test cost. Considering the Brazilian official cost-effectiveness thresholds ($8,000.00 USD to $24,000.00 USD per QALY), the probabilistic sensitivity analysis indicated a high probability of the test being cost-effective across all analyzed scenarios and indications.

Conclusion: Oncotype DX could be a cost-saving strategy in the Brazilian private health care perspective. Alternative scenarios and testing indications did not alter these conclusions.

Purpose: Breast cancer is the leading cause of cancer-related death among Brazilian women. Understanding the regional disparities in mammographic screening coverage is essential for improving early detection strategies. The purpose of this study was to analyze mammographic screening coverage and proportion of BI-RADS 0 results across Brazilian states and regions.

Patients and methods: This cross-sectional study analyzed mammographic screening data from the Unified Health System (SUS) for 2022. The primary outcomes and measures were mammographic SUS coverage rates and proportion of Breast Imaging Reporting and Data System (BI-RADS) 0 results. Secondary outcomes included the number of mammography devices per state, proportion of municipalities with equipment, and distribution of radiologists both in absolute numbers and relative concentrations in the capital cities. Women age 50-69 years in 2022 without private health services were studied. Mammographic coverage was defined as the proportion of women in the target population (age 50-69 years without private insurance) who underwent screening mammography in 2022 and the proportion of BI-RADS 0 results, defined as examinations classified as inconclusive.

Results: This study analyzed data from over 22 million women age 50-69 years. The annual mammographic screening coverage across the country was low, ranging from 1.3% to 15.9%. A high proportion of BI-RADS 0 results were observed in 44% of the states. Although mammography devices are unequally distributed, coverage remains low even in regions with a high concentration of services. This suggests the influence of other factors, such as accessibility barriers, insufficient screening education, and a lack of active surveillance within the target population.

Conclusions: Mammographic screening coverage in Brazil is insufficient and unevenly distributed. The high rates of BI-RADS 0 suggest significant quality concerns. Addressing these disparities is crucial for the effective early detection of breast cancer.

Purpose: Anticancer therapy increases the risk of hepatitis B virus (HBV) reactivation in patients with occult hepatitis B infection (OHBI), particularly in those who receive rituximab or stem-cell transplantation. However, the exact risk of HBV reactivation in patients with ALL/lymphoblastic lymphoma (LBL) receiving prolonged, intensive myelosuppressive chemotherapy is not known and thus the role of antiviral prophylaxis is not clearly established.

Patients and methods: This prospective observational study was conducted at a single tertiary cancer center in India (October 2017 to August 2021). Patients age 15 years and older with ALL/LBL were screened for OHBI and enrolled. Liver function tests and HBV DNA levels were monitored at baseline, during treatment, and throughout follow-up phase. During episodes of hepatitis, extended serology panel was performed. The primary end point was the incidence of HBV reactivation.

Results: OHBI was identified in 30.4% (172/566) of patients treated at our center during the study period. In the prospective cohort, 65 patients with ALL/LBL and OHBI, treated on a pediatric-inspired protocol, were enrolled. HBV reactivation occurred in six patients (9.2%; 95% CI, 4.3 to 18.7), none of whom developed HBV-related hepatitis. Seventeen patients experienced at least one episode of grade ≥3 hepatitis, with a median AST of 401 U/L (range, 192-3,490) and ALT of 430 U/L (range, 255-1,950). Hepatitis led to chemotherapy delays in five patients, with a median delay of 15.5 days (range, 7-39).

Conclusion: Our findings indicate a moderate to high risk of HBV reactivation in ALL/LBL patients with OHBI treated with pediatric-inspired protocols, particularly during maintenance, supporting prophylactic antiviral therapy as standard practice in regions with high or intermediate HBV endemicity.