JCO Global Oncology最新文献

Purpose: We assessed the availability, price, and affordability of commonly used chemotherapy medications in Cameroon, Ethiopia, Kenya, and Malawi. We also examined the characteristics that could predict chemotherapy medication quality.

Methods: Samples of seven commonly used chemotherapy medications were collected: cisplatin, cyclophosphamide, doxorubicin, ifosfamide, leucovorin, methotrexate, and oxaliplatin. Stockouts and medicine prices were recorded at public national hospitals and community pharmacies. Using the National Comprehensive Cancer Network's harmonized guidelines for sub-Saharan Africa, we estimated the costs of medications to treat early-stage breast cancer, colorectal cancer (CRC), and head and neck cancer. Every sample was tested for quality using high-performance liquid chromatography against USP standards. We ran logistic regressions to assess medicine characteristics that could predict substandard and falsified chemotherapy medications.

Results: Stockouts of chemotherapy medications in public hospitals were observed in three of four countries. Other than in Malawi where medications are free when available in the public sector, chemotherapy medications were unaffordable, costing government worker salary equivalents of 47-242 days, 233-869 days, and 22-196 days to treat early-stage breast cancer, CRC, and head and neck cancer, respectively. On average across the population, $36 US dollars (USD) (95% CI, $50 USD to $134 USD, 9%-25% of medication cost) was spent on poor-quality medicines for treatment of breast cancer, $32 USD (95% CI, $6 USD to $214 USD, 0.5%-17%) for CRC, and $15 USD (95% CI, $4 USD to $49 USD, 2%-21%) for head and neck cancer. Price of the medication, public/private source, and medicine registration status were poor predictors of medicine quality.

Conclusion: We found that medicines for cancer treatment are unaffordable without government subsidies. Moreover, poor-quality chemotherapy medicines are hard to detect without chemical testing. Government policies and supply chain practice changes are needed to improve the availability, affordability, and quality of chemotherapy medications in sub-Saharan Africa.

Purpose: The 2022 European LeukemiaNet (ELN22) genetic risk stratification for AML makes critical changes, including removal of FLT3-internal tandem duplications (ITD) allelic ratio and inclusion of mutations in myelodysplasia-related (MR) genes and in-frame bZIP CEBPA mutations. We evaluated the applicability of ELN22 in a uniformly treated younger AML cohort and explored refinements to improve risk prediction.

Methods: We retrospectively analyzed 473 adult patients with AML treated with intensive therapy. A combination of cytogenetics and next-generation sequencing was used to stratify patients into the ELN17 and ELN22 risk. In addition, we also evaluated leukemic stem cell (LSC) burden at diagnosis and postinduction measurable residual disease by multiparametric flow cytometry.

Results: A total of 77 cases (16.3%) were reclassified from ELN17, primarily because of changes associated with FLT3-ITD, CEBPA, and MR gene mutations. As per ELN22, 56.7% of patients were classified as favorable, 28.3% intermediate, and 15.0% adverse risk. ELN22 adverse-risk patients had significantly inferior overall survival and relapse-free survival compared with intermediate- and favorable-risk patients. High LSC burden at diagnosis, presence of WT1 mutations, and DNMT3A-FLT3-ITD comutated NPM1 dichotomized the ELN22 intermediate-risk group.

Conclusion: We conclude that ELN22 is prognostically valid in intensively treated younger patients with AML. Incorporation of WT1 mutation status, triple-mutated NPM1, and LSC burden may improve risk stratification, particularly within the heterogeneous intermediate-risk category.

Purpose: Displaced individuals face significant health care access challenges, particularly for noncommunicable diseases. For these individuals, cancer control remains a severely neglected aspect of health care. This scoping review aims to synthesize and evaluate the current state of knowledge on equity within the cancer care continuum for refugee and asylum seeker populations worldwide.

Methods: A systematic search of PubMed and Embase was conducted for peer-reviewed articles published between 2000 and 2024, focusing on refugee and asylum seeker populations and cancer. Eligible studies addressed at least one stage of the cancer care continuum (prevention, detection, diagnosis, treatment, end-of-life care or survivorship) and included perspectives or outcomes of patients, caregivers, or providers. Data were extracted and mapped by study setting, population, cancer continuum stage, and type of barriers or interventions identified.

Results: Of 372 screened articles, 111 met inclusion criteria. The majority of research focused on cancer prevention, detection, and diagnosis. Common themes included low cancer awareness, reduced screening uptake, delayed diagnoses, treatment interruptions, and poor survival outcomes. Financial, social, and systemic barriers such as cost, stigma, language barriers, and inconsistent policies were frequently reported. Effective interventions included culturally tailored education, refugee-specific health clinics, use of interpreters, sex-concordant providers, and community engagement.

Conclusion: Refugees and asylum seekers face persistent and multifaceted inequities in cancer care, shaped by both individual and systemic factors. Although some high-performing models and interventions exist, large gaps remain in research and service delivery. The findings emphasize the urgent need for an integrated strategy that incorporates the comprehensive cancer care needs of refugees and asylum seekers into national and international health policies.

Purpose: The American Association of Physicists in Medicine (AAPM) International Council (IC), in collaboration with Help Ukraine Group (HUG) and the Ukrainian Association of Medical Physicists (UAMP), developed a novel hybrid year-long training course to assist Ukrainian medical physicists in transitioning from Co-60 to intensity-modulated radiation therapy during the war.

Methods: To create a comprehensive curriculum for the course, AAPM IC committees, HUG, and UAMP conducted a needs assessment survey. Based on the survey results, the course was divided into three parts: foundational knowledge and linear accelerator commissioning (Part 1), treatment planning and quality assurance (QA) program (Part 2), and practical sessions on linear accelerator commissioning, QA, and treatment planning (Part 3). Part 1 and 2 featured 50 1.5-2 hour virtual lectures, with prelecture and postlecture assignments, delivered online with interactive questions, and artificial intelligence-driven synchronous subtitling in Ukrainian, while Part 3 included four 3-day practical sessions in Ukrainian at two clinical sites using equipment from two different vendors.

Results: A total of 131 medical physicists and students enrolled in Part 1 and 2, including almost all practicing medical physicists in Ukraine. Part 1 and Part 2 lectures were endorsed by AAPM and accredited by Commission on Accreditation of Medical Physics Education Programs. Average examination scores increased from 51.2% to 82.5% (Part 1) and 53.3% to 89.4% (Part 2). Satisfaction scores averaged 9.3 ± 0.9 of 10, with 96.3% recommending the course and 70% claiming changing practices. Practical sessions (Part 3) involved 62 participants, with examination scores improving from 57.8% to 80.5%. The average satisfaction for Part 3 was 9.8 ± 0.7 of 10.

Conclusion: This collaborative training initiative demonstrates a concerted effort to support, educate, and expand the medical physics community in Ukraine during wartime. It can serve as a model for similar initiatives in other low- and middle-income countries/upper middle-income countries.

Purpose: To evaluate whether baseline peripheral blood biomarkers-particularly the neutrophil-to-lymphocyte ratio (NLR)-predict immune-related adverse events (irAEs) in patients with solid tumors receiving immune checkpoint inhibitors (ICIs) and to identify optimal cutoff values for clinical risk stratification.

Methods: We conducted a retrospective cohort study of adults with solid tumors treated with ICIs (anti-programmed death 1, anti-PD-L1, or anticytotoxic T-lymphocyte-associated antigen 4-based combinations) at Srinagarind Hospital, Khon Kaen University (2018-2024). irAEs were identified according to ASCO and National Comprehensive Cancer Network criteria. Clinically significant irAEs were defined as grade ≥3 events or those requiring hospitalization or permanent ICI discontinuation. Logistic regression assessed associations between baseline NLR and irAE risk, expressed as odds ratios (ORs) with 95% CIs. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUROC), and Cox regression assessed time to irAE onset.

Results: Among 240 patients (mean age, 62.5 ± 10.8 years; 67.5% male), 70 (29.2%) developed irAEs and 21 (8.8%) experienced clinically significant events during a median follow-up of 13 weeks. Baseline NLR ≥2.75 independently predicted any irAEs (adjusted OR, 2.44 [95% CI, 1.34 to 4.42]; P = .003; AUROC 0.695 [95% CI, 0.625 to 0.766]) and clinically significant irAEs (adjusted OR, 3.05 [95% CI, 1.09 to 8.49]; P = .033; 0.770 [95% CI, 0.637 to 0.871]) in models incorporating age and ICI regimen. Baseline NLR ≥2.75 was also associated with earlier irAE onset.

Conclusion: Baseline NLR ≥2.75, integrated with age and ICI regimen, may facilitate early identification of patients at the highest risk of clinically significant irAEs. Prospective multicenter validation is warranted to confirm its clinical utility in real-world oncology practice.

Purpose: Low survival rates among children with Burkitt lymphoma (BL) in low- and middle-income countries (LMICs) are caused by multiple factors, including delays in diagnosis and treatment abandonment. These issues are often linked to the cost of diagnostic tests, treatment, and transportation. This study describes the implementation and effectiveness of a program targeting these issues among children with BL in Kenya.

Methods: Children with symptoms suggestive of BL between 2017 and 2018 were prospectively enrolled in an intervention program including (1) Diagnosis Delay Intervention by performing flow cytometry and covering its cost and (2) Treatment Abandonment Intervention by reimbursing transportation costs, compensating for some lost family income because of the child's hospital stay, and sending reminder phone calls. A medical record review was conducted to perform a historical comparison of diagnosis delay and treatment outcomes between two cohorts (2010-2016 v 2017-2018) to measure the effectiveness of the program.

Results: Forty-three patients who had a pathologically confirmed diagnosis of BL were enrolled in the intervention program. When comparing the historical cohort (2010-2016; N = 138) and the prospective cohort (2017-2018; N = 43), it was found that after implementing the program, the mean time to diagnosis decreased from 13.57 days to 10.58 days (P = .026). Treatment abandonment decreased from 27% to 5% (P < .001), and the event-free survival estimates also showed a significant improvement, increasing from 33% to 63% between the historical and prospective cohorts (P = .027).

Conclusion: The combination of timely diagnosis and modest financial support for families to complete treatment significantly improved the survival rate of children with BL in our study. This program has the potential to be implemented for children with other cancers and in other LMIC settings.

Purpose: Adult ALL is typically treated with intensive chemotherapy although novel agents like blinatumomab and inotuzumab remain largely inaccessible in low- and middle-income countries (LMICs). Early mortality (EM) during induction is substantially higher in LMICs (10%-25%) than in high-income countries (<5%). This study aimed to identify EM risk factors in patients with adult ALL in LMICs to guide context-specific interventions.

Methods: A retrospective cohort study analyzed patients 15 years and older with newly diagnosed ALL between 2009 and 2023, regardless of the phenotype or Philadelphia status. EM was defined as death within 30 days of diagnosis.

Results: Among 203 patients (median age 36 years), the overall EM was 9.8% and 7.9% was younger than 50 years. Univariate analysis identified positive cerebral spinal fluid, cyclophosphamide during the prephase, low albumin, and obesity as associated with higher EM. In multivariable models, predictors of EM for the full cohort included age, albumin, cyclophosphamide use, and obesity. In patients 50 years and younger, only albumin and cyclophosphamide remained significant. After induction, 51.2% achieved complete response; 17.3% was unevaluable because of complications or death. Infection was common (72.9%). Sociodemographic variables were not associated with EM.

Conclusion: EM was elevated, reflecting LMIC-specific challenges like late diagnosis and limited supportive care. Low albumin and prephase cyclophosphamide use were strongly linked to EM, likely via increased immunosuppression and infection risk. Findings stress the need for locally adapted protocols and simple risk markers to reduce EM in adult ALL.

Purpose: Breast cancer (BC) is becoming a significant public health issue in Cape Verde. Understanding the profile of BC cases is crucial for improving patient outcomes and guiding public health initiatives. This study aimed to investigate the clinical and pathologic characteristics, treatment approaches, and outcomes of BC cases diagnosed and treated at Agostinho Neto University Hospital between January 2015 and July 2021 following implementation of an international treatment partnership.

Methods: A retrospective analysis was conducted on 158 female patients with BC diagnosed during the study period. Data were collected on patient demographics, tumor characteristics, treatment protocols, and survival outcomes. Immunohistochemistry was performed on a subset of 114 patients to identify molecular subtypes. Descriptive statistics were used to summarize all variables. Overall survival was analyzed, and log-rank tests were performed to formally compare the survival curves and assess the statistical significance of any observed differences. Cox proportional hazard models were used to determine the independent effect of sociodemographic factors and clinical characteristics.

Results: The median age at diagnosis was 52.5 years, with patients ranging from 28 to 91 years. Most patients resided on Santiago Island. Invasive ductal carcinoma was the most common type, found in 93% of cases. Over half of the tumors were poorly differentiated, and 57% were diagnosed at advanced stages (III and IV). Subtype distribution mirrored sub-Saharan patterns, with 24% triple negative and 11% human epidermal growth factor receptor 2 positive. Among patients with potentially curable BC, 61.4% received adequate therapy that followed the National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA), including radiotherapy treatment, although this was performed abroad. The median follow-up calculated by reverse Kaplan-Meier was 33.7 months (IQR, 20.5-52.8 months). Patients treated according to stage-appropriate and phenotype-specific recommendations achieved better outcomes (79.9% 3-year survival).

Conclusion: This study emphasizes the importance of early diagnosis and adoption of the NCCN Harmonized Guidelines for SSA. Access to radiotherapy abroad, necessitated by the absence of local radiotherapy facilities, was correlated with improved survival. These findings underscore the feasibility of improving outcomes in low-resource settings through standardized treatment frameworks.

Purpose: Latin America (LATAM), home to over 650 million people, remains under-represented in global oncology trials despite a growing cancer burden. This study aimed to evaluate the evolution of LATAM participation in phase III oncology trials over the past decade, with a focus on site distribution, cancer types studied, therapeutic classes investigated, and demographic reporting.

Methods: We conducted a cross-sectional analysis of global phase III oncology trials registered on ClinicalTrials.gov between January 1, 2013, and December 31, 2022. Trials were included if they studied anticancer therapies and listed at least one LATAM site. We extracted data on trial geography, cancer type, treatment modality, control group, and Hispanic ethnicity reporting. Trends in proportional regional site representation and therapy class were assessed using the Mann-Kendall trend test.

Results: A total of 172 phase III trials with LATAM sites were identified, representing 2,609 of 29,718 global sites (8.8%). Brazil (45.8%), Argentina (18.6%), and Mexico (13.0%) accounted for over 75% of LATAM trial sites. LATAM's proportional site representation increased modestly from 7.1% in 2013 to 9.3% in 2021 (Bonferroni-adjusted P = .040), but no individual country showed a statistically significant increase. The most frequently studied cancers were lung (26.7%), breast (22.1%), and genitourinary (16.3%). Targeted therapies (42.4%) and immunotherapies (33.1%) dominated, whereas hormone therapy declined over time. Hispanic ethnicity was reported in only 61.6% of trials, with no improvement over time.

Conclusion: Although LATAM's participation in global oncology trials has increased, it remains geographically concentrated and demographically under-reported. Structural and policy efforts are needed to improve trial equity and align research with regional cancer burdens.

Purpose: This study aims to evaluate the safety, feasibility, effectiveness, and cost-saving potential of a shortened, vial-sharing outpatient blinatumomab regimen for treating relapsed or refractory (R/R) ALL in children.

Materials and methods: We conducted a retrospective study of pediatric patients with R/R B-cell ALL (B-ALL) treated with a shortened outpatient blinatumomab regimen (<21 days), aiming to achieve a negative measurable residual disease (MRD) remission before hematopoietic stem-cell transplantation (HSCT).

Results: Twelve patients were included: three (25%) with primary refractory disease and nine (75%) with relapse. The median follow-up time was 33 months (range, 10-76 months). Blinatumomab was administered for a median of 19 days (range, 11-21), with 75% (9 of 12) of patients completing treatment entirely on an outpatient basis. Five patients (62%) achieved CR with undetectable MRD, and all four patients who initiated treatment because of persistent MRD achieved MRD clearance (100%). Ten patients (83%) proceeded to haploidentical HSCT. The estimated 3-year overall survival (OS) was 54%, and the relapse-free survival (RFS) was 44%. These optimization measures resulted in a 43% reduction in drug-related expenditures.

Conclusion: Reduced-duration outpatient blinatumomab shows promise as a context-adapted strategy for heavily pretreated pediatric patients with ALL. Given the small retrospective cohort, these findings should be interpreted with caution.