JCO Global Oncology最新文献

Purpose: Social media informs 77% of patients with cancer, yet one third of posts contain misinformation. MedNews Week (MNW) is a volunteer virtual platform that delivers expert hematology-oncology content while intentionally pursuing gender balance.

Methods: We analyzed program metrics (January 2022-June 2023) for 36 biweekly keynotes by oncology leaders (mean H-index 50.1). Aggregated audience demographics and engagement data were exported from X (Twitter), LinkedIn, YouTube, and Clubhouse. Unique reach, geographic distribution, and growth were calculated after deduplicating cross-platform IDs. Attendance and engagement were compared by speaker gender with χ² tests and linear regression.

Results: MNW reached 743,991 unique viewers across 95 countries, including 23 low- and middle-income nations, and rose 10.5-fold in attendance over 18 months. Speakers achieved gender parity (18 women, 18 men); female-led sessions drew similar live attendance and video views (P = .41). MNW ranks in the top 0.07 percentile for health care influence on X. Participants included clinicians (40%), patients/advocates (22%), students (18%), and nonmedical stakeholders (20%).

Conclusion: A no-cost, volunteer, gender-balanced platform can rapidly scale credible oncology education worldwide, counter misinformation, and engage under-resourced audiences. Sustained partnerships and outcome assessments are warranted.

Purpose: Biomarkers estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) may undergo alteration on reassessment, with significant impact on management. There is a paucity of large-scale paired data on biomarker changes from low- and middle-income countries (LMICs).

Materials and methods: We performed a retrospective audit on 1,107 paired samples, wherein biomarkers were performed at least twice between: core needle biopsy (CNB) and upfront resection (category 1, n = 277); CNB and postchemotherapy resection (category 2, n = 104); primary (CNB/resection) and recurrence (local/metastatic; category 3, n = 702); and initial and subsequent distant metastasis (category 4, n = 24). Concordance was noted for individual receptors and surrogate molecular classification (hormone receptor+HER2-, hormonal receptor+HER2+, hormonal receptor-HER2+, triple-negative).

Results: Overall concordance for ER, PR, and HER2 was 85.4% (k value = 0.693), 77.1% (k value = 0.541), and 93.8% (k value = 0.827), respectively. For HRs, higher concordance was in category 1 > 3 > 2 > 4 (ER k value = 0.764 > 0.684 > 0.591 > 0.515, respectively; PR k value = 0.68 > 0.495 > 0.482 > 0.329, respectively), while HER2 was relatively constant across categories (k value range, 0.808-0.882). Molecular classification showed overall 79.5% concordance (k value = 0.688). Discordance was 27.1% in triple-positive (highest) and 17.7% in HER2+/hormonal receptor- (lowest). Univariate and multivariate analyses showed poorer concordance for therapy (v no therapy; odds ratio [OR], 0.437 [95% CI, 0.255 to 0.749]; P = .003) and specific/targeted therapy (v CT alone; OR, 0.126 [95% CI, 0.073 to 0.217]; P = .001). Shorter time interval (<6 months), both specimens breast, CNB, and optimum fixation showed better concordance on univariate (P = .004, .002, .01, and .009, respectively) but not multivariate analysis.

Conclusion: Biomarker re-evaluation is not mandatory between CNB and upfront resection or evaluating HER2 status alone, but one in five patients may show discordance at metastasis/recurrence. We recommend re-evaluation in recurrent/metastatic settings, post-treatment, >6 months' time interval, or poorly fixed material, which is of particular relevance in LMICs.

Purpose: Low- and middle-income countries (LMICs) account for nearly 70% of global cancer mortality, yet remain under-represented in oncology research. In the Middle East and North Africa, deficits in training, funding, infrastructure, regulation, and human capital restrict regionally led studies. This survey examined barriers through the experiences of cancer research professionals in Jordan and neighboring LMICs.

Methods: We conducted a cross-sectional, web-based survey of clinicians, scientists, and allied professionals with ≥1 year of cancer research experience. Recruitment used institutional e-mails, social media, and snowball sampling. The 10- to 12-minute REDCap questionnaire covered demographics, training, funding, infrastructure, ethics/regulation, data access, collaboration, workforce, and government support. Quantitative data were summarized descriptively; open-text responses underwent thematic coding.

Results: Among 206 respondents (70.7% Jordan; 61% < 40 years; 66.3% female), 53.2% received research training at university but only 28.8% during residency; 77.9% judged programs inadequate. One third consistently struggled to obtain grants, and just 7.8% reported no difficulty. Infrastructure was limited: 38.3% had full laboratory access and 56.0% had full journal access. Only 48.7% rated national cancer data as good/excellent. International collaboration was reported by 57.0% but often impeded by bureaucracy. Human capital shortages were noted by 84.5%; 69.6% observed brain drain, and 68.2% lacked protected time. Government support was rated poor/very poor by 35.6% and excellent by 9.6%. Thematic analysis highlighted resource scarcity, bureaucratic inertia, and the absence of a national strategy.

Conclusion: Cancer research in Jordan and LMICs is constrained by linked weaknesses in training, funding, infrastructure, regulation, data, and workforce. Reforms should embed experiential training and mentorship, diversify funding, expand shared facilities and data systems, streamline ethics processes, and strengthen career pathways with protected time and incentives, underpinned by coordinated policy commitment.

Purpose: Adjuvant chemotherapy decisions for early-stage hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer remain challenging, requiring a balance between treatment efficacy and avoiding overtreatment. Gene expression signatures, such as the Oncotype DX assay, are valuable tools to predict recurrence risk and guide chemotherapy use. This study estimates the budget impact of incorporating the Oncotype DX test into clinical practice for patients with HR+/HER2- early-stage breast cancer in Brazil's private health care system.

Methods: A budget impact analysis was performed using a hybrid decision tree-Markov model with transitions between recurrence-free survival, distant recurrence, acute myeloid leukemia, and death. The eligible population was derived from epidemiologic data. Subgroup analyses included node-negative (N0) patients stratified by age and clinical risk and node-positive (N1) patients stratified by menopausal status. The model assessed direct medical costs over 5 years without applying a discount rate. Two scenarios were analyzed: scenario 1, with progressive market uptake (40%-80% over 5 years), and scenario 2, with universal testing.

Results: The introduction of the Oncotype DX test was associated with 5-year cost savings of approximately $19.3 million US dollars (USD; scenario 1) to $26.7 million USD (scenario 2). Incremental costs were observed only in N0 low-risk patients 50 years and younger ($9.5-$16.9 million USD) and premenopausal N1 patients ($2.2-$4.4 million USD).

Conclusion: Incorporating the Oncotype DX test is expected to optimize chemotherapy recommendations, reduce overtreatment, and generate cost savings in most subgroups. In Brazil's private health care system, the reduction in chemotherapy-related costs is anticipated to fully or partially offset the cost of testing.

Purpose: Africa faces a growing burden of cancer yet remains under-represented in global cancer clinical trials. This disparity limits the generation of population-specific evidence needed to improve cancer outcomes. Recruitment and retention in cancer clinical trials are particularly challenging because of various systemic and individual barriers in Nigeria. This study explores patients' perspectives on barriers and facilitators to recruitment and retention in cancer clinical trials.

Methods: A convergent parallel mixed-methods design was used, which comprised a cross-sectional survey and a descriptive qualitative approach. Participants were recruited from multiple oncology centers and secondary facilities within Nigeria's ICON-3 Practice-Based Research Network. Quantitative data were collected through interviewer-administered questionnaires, whereas qualitative data were gathered via semistructured interviews and analyzed thematically.

Results: A total of 317 patients participated in the quantitative survey, 18 of whom participated in interviews. Barriers included limited understanding of clinical trials, logistical challenges such as transportation and visit frequency, distrust in researchers and the health care system, and lack of family support. Facilitators included effective communication, incentives, flexible research visits, and culturally tailored interventions.

Conclusion: To optimize cancer clinical trial participation in low-resource settings, interventions must be tailored to local contexts, addressing structural and cultural barriers. Enhanced communication, community involvement, and supportive policies can significantly improve trial participation and outcomes.

Purpose: In Argentina, anaplastic lymphoma kinase (ALK) gene rearrangements occur in approximately 6.1% of non-small cell lung cancer (NSCLC) cases. Given the availability of second- and third-generation ALK inhibitors, real-world data are needed to inform optimal treatment strategies. However, access to these therapies remains limited for many patients.

Methods: We conducted a multicenter retrospective study of patients with metastatic ALK-positive NSCLC (ALKp) treated with first-line tyrosine kinase inhibitors (TKIs) from January 2014 to February 2024. Demographics, treatment patterns, clinical outcomes, and factors affecting treatment accessibility were analyzed.

Results: We identified 104 patients with ALKp. The median age was 55 years (IQR, 45-67); 86% had Eastern Cooperative Oncology Group ≤1, 58% were women, and 57% were nonsmokers. Brain metastases were present at diagnosis in 29%, with 50% receiving local treatment. First-line TKIs included alectinib (42%), crizotinib (30%), lorlatinib (16%), and brigatinib (12%). Crizotinib use was frequently due to limited access to new-generation TKIs. Adverse events occurred in 54%, with 21% grade 3 to 4. The objective response rate was 73%. At a median follow-up of 42 months, 48% experienced progression. Crizotinib was associated with higher risk of progression or death compared with newer TKIs (hazard ratio, 3.09 [95% CI, 1.75 to 5.5]; P = .01). CNS progression occurred in 18%, more often with crizotinib (42% v 8%, P = .04). Among those progressing, 82% received second-line therapy, most commonly lorlatinib or alectinib. The overall survival at 24 months was 81%, with 27% of patients deceased at data cutoff.

Conclusion: This real-world study describes outcomes and treatment patterns among patients with ALKp in Argentina. It highlights disparities in access to optimal therapies and reinforces the need for equitable access to new-generation ALK inhibitors to improve clinical outcomes.

Purpose: Colonoscopy is a proven screening method for reducing mortality from colorectal cancer (CRC), the most frequently diagnosed cancer in Ukraine. To enhance colonoscopy quality, international societies have defined key performance measures (PMs). We aimed to evaluate adherence to these PMs among Ukrainian endoscopists and explore factors affecting screening colonoscopy quality.

Methods: We conducted a cross-sectional study using a web-based survey among members of Ukraine's endoscopy society EndoAcademy (Kyiv, Ukraine) (October-November 2023). The questionnaire assessed colonoscopy practices and adherence to globally recognized PMs, categorized as six calculated (requiring ongoing numerical data tracking) and six noncalculated (performed/not performed practices).

Results: Of 540 invited endoscopists, 122 (22.6%) responded. The median number of adhered to quality PMs was 6 (IQR, 5-8), with noncalculated being reported more frequently: medians 4 (IQR, 4-5) versus 2 (IQR, 1-3), P < .01. Among noncalculated PMs, most common were postpolypectomy surveillance recommendations (98.4%, n = 120) and retrieval of removed polyps (96.7%, n = 118). For calculated PMs, cecal intubation (61.5%, n = 75) and adenoma detection (59.8%, n = 73) rates were most frequently reported. In multivariable analysis, adherence to each additional quality PM increased the odds of optimal polyp treatment (odds ratio [OR], 1.32 [95% CI, 1.03 to 1.70]), with photo/video recording (OR, 7.57 [95% CI, 1.66 to 34.49]) and adequate procedure time allocation (OR, 3.86 [95% CI, 1.18 to 12.61]) showing the strongest associations.

Conclusion: To our knowledge, this first national study of colonoscopy PMs in Ukraine highlights key documentation gaps and variation in polyp management. As the country implements a population-based CRC screening program, structured quality assurance, audit-and-feedback systems, and education grounded in international PMs will be critical to improving outcomes.