JCO Global Oncology最新文献

Purpose: We assessed radiotherapy (RT) utilization and completion among pediatric patients with brain tumor treated at Children's Cancer Hospital Egypt (CCHE).

Methods: A retrospective analysis was conducted among pediatric patients with brain tumor treated at CCHE between 2009 and 2020. Patients were categorized on the basis of demographics, tumor types, RT utilization status (prescribed, not prescribed, and did not complete), and geographic place of residence (urban v rural). RT utilization was stratified by tumor type and geographic region and compared using chi-square tests.

Results: Among 3,977 pediatric patients with brain tumor, 2,327 (58.5%) were prescribed RT. The highest RT utilization was observed among patients with diffuse intrinsic pontine glioma (DIPG; 98.2%) and germinoma (98.0%), while nonoptic low-grade glioma (LGG; 11.2%) and optic pathway glioma (OPG; 2.0%) had the lowest among patients prescribed RT, 2,264 (97.2%) completed treatment. The highest noncompletion was observed in patients with atypical teratoid rhabdoid tumor (ATRT; 6.7%) and nonoptic LGG (9.7%). Urban patients had a higher rate of RT completion (98.3%) compared with rural patients (95.9%; P < .001).

Conclusion: RT utilization and completion varied significantly by tumor type, reflecting evidence-based treatment protocols and tumor-specific challenges. Geographic disparities in RT completion underscore systemic health care inequities in Egypt. These findings emphasize the need for targeted interventions, including decentralized radiotherapy delivery models and public health strategies, to improve access to and adherence to radiotherapy among underserved populations.

Purpose: Gallbladder carcinoma (GBC) has a disproportionately high incidence rate in India; however, genomic data remain sparse and inconsistent. We conducted a comprehensive genomic analysis of Indian GBC and compared its mutational profile with that of international cohorts to identify region-specific oncogenic drivers.

Materials and methods: This retrospective study analyzed 376 patients with GBC (339 tissue and 37 plasma cell free DNA [cfDNA] samples) from three Indian institutions (2022-2024) using clinically validated next-generation sequencing (NGS) panels. Genomic data were compared with curated cohorts from cBioPortal, including Western (White), Asian, and multiethnic data sets. Mutation frequencies were assessed, and statistical comparisons were performed.

Results: GBC was more frequent in women (female:male 1.5:1) and was diagnosed nearly a decade earlier than in international cohorts (median age, 54 years). TP53 (54%) and ERBB2 (15%; approximately equal to 8% amplification, with S310F/Y hotspot predominance) were the most common alterations, followed by CDKN2A (9%), KRAS (7%), and SMAD4 (7%). Microsatellite instability-high (0.6%, 2 of 170 tested) and tumor mutational burden-high (1.3%, 1 of 79 tested) tumors were rare. Compared with Western and Asian cohorts, Indian patients with GBC had significantly lower ARID1A, SMAD4, and CDKN2A alterations (all P < .001). In 37 cfDNA patients, 13 showed no variants, but detected alterations that qualitatively mirrored tissue findings.

Conclusion: This comprehensive genomic study of Indian GBC defines a distinct mutation map with region-specific drivers, notably ERBB2, supporting precision oncology and the real-world feasibility of liquid biopsy. The use of heterogeneous NGS panels across institutions remains a key limitation, introducing variability in frequency estimates, but the findings provide a foundation for region-tailored therapeutic strategies and prospective genomic correlations.

Purpose: Cancer screening programs are complex interventions involving multiple target groups, health professionals, civil society, and policymakers. Such complexity requires careful analysis of how stakeholders at micro, meso, and macro levels can both influence and be influenced by interventions. The Access Cancer Care India (ACCI) implementation research project aims to identify and codesign context-specific, integrated strategies for early detection of common cancers in India. This paper outlines stakeholder engagement strategies within ACCI, hypothesizing that engaging diverse actors through structured workshops will generate feasible and acceptable interventions to reduce diagnostic delays and strengthen early detection of cancer.

Methods: Stakeholder mapping and influence assessment were conducted across macro (policymakers, program coordinators, Superintendents of district hospitals and oncology centers), meso (service providers, civil society, special interest groups, community health workers), and micro (community, patients) levels in Tamil Nadu, Kerala, and Rajasthan. Formative findings and potential interventions were shared in collaborative workshops where solutions were codesigned.

Results: Diverse stakeholders actively participated across all sites. Key individual-level barriers included fear, stigma, and in Rajasthan, patriarchal norms limiting women's care-seeking. System-level barriers spanned limited diagnostic capacity, weak health care coordination, and financial constraints. Facilitators included community campaigns using lived experiences, empowerment through self-help groups, and capacity building of providers (Auxiliary Nurse Midwives and Mid-Level Service Providers, especially in Kerala). Tamil Nadu highlighted the potential of cervical cancer self-sampling. A recurring theme across states was the urgent need for clear referral and patient navigation systems.

Conclusion: Early, multilevel stakeholder engagement can surface critical barriers and codesign feasible, context-specific strategies to improve cancer detection. The ACCI model offers a replicable approach to reducing diagnostic delays and advancing equitable cancer care in low-resource settings.

Purpose: To develop a Latin American expert consensus to support, guide, and accelerate the approval and equitable access to anti-GD2 immunotherapy for patients with high-risk neuroblastoma (HR-NB) in the region. Survival rates for HR-NB have improved with the incorporation of anti-GD2 immunotherapy; however, despite the approval of two commercial anti-GD2 therapies in two countries, access remains limited in Latin America.

Methods and results: A systematic review was conducted of studies published from January 2004 through February 2025. Of 401 studies identified, 29 met inclusion criteria and served as the basis for four expert consensus statements on the use of anti-GD2 immunotherapy: (1) Newly diagnosed HR-NB maintenance therapy: Anti-GD2 immunotherapy as maintenance treatment for all newly diagnosed HR-NB patients is strongly recommended to maximize event-free survival and reduce the need for morbid and costly salvage therapies. (2) Relapsed/refractory NB: Early integration (at first relapse) of anti-GD2 immunotherapy in salvage treatment is recommended. (3) Role of high-dose chemotherapy with autologous stem-cell transplant (ASCT): Some argue that anti-GD2 immunotherapy obviates the need for ASCT. However, until results of randomized trials omitting ASCT are available, the panel recommends continued use of ASCT where it is available. (4) Newly diagnosed HR-NB: incorporation of anti-GD2 during induction/consolidation: Pilot studies using early anti-GD2 immunotherapy plus chemotherapy showed promising results but is not recommended until confirmed by larger studies with well-defined control arms.

Conclusion: This consensus highlights the urgent need to expand access to anti-GD2 therapy in Latin America as maintenance therapy for newly diagnosed patients with HR-NB and patients with relapsed or refractory neuroblastoma. Collaboration between health policymakers, the pharmaceutical industry, the Global Platform for Access to Childhood Cancer Medicines, and the pediatric oncology community is essential to address this challenge.

Purpose: Breast cancer (BC) is the most frequently diagnosed cancer among women globally. In sub-Saharan Africa, its impact is compounded by high HIV prevalence. Studies show that women living with HIV and BC (WLHIVBC) often present at advanced stages despite contact with HIV Care and Treatment Clinics. Little is known about their experiences in navigating both conditions. This study explored barriers and facilitators to integrated care for WLHIVBC in Tanzania to inform development of a patient-centered care model.

Methods: This qualitative study used a grounded theory approach, conducting 21 in-depth interviews with 11 WLHIVBC and 10 health care providers (oncologists, infectious-disease specialists, nurses, and pharmacists) over 10 months. Analysis followed an iterative coding process using Dedoose, and a multidisciplinary team refined key themes shaping the proposed integrated care model.

Results: Participants described barriers including stigma, nondisclosure, logistical and financial constraints, fragmented services, psychological burden, and reliance on spiritual healing. Facilitators included trust in providers, colocated services, patient education, peer support, and psychosocial counseling. Faith played a dual role-strengthening some while delaying care for others. Participants identified faith-based organizations as partners in education and stigma reduction. Recommendations emphasized colocated clinics, empathetic communication, psychosocial support, and collaboration with the Ministry of Health, Ministry of Education, and faith-based organizations to strengthen community education and linkage to care.

Conclusion: WLHIVBC in Tanzania face intersecting burdens of stigma, late presentation, and fragmented services. Yet, trust, peer networks, and education provide clear entry points for integration. Findings call for holistic, patient-centered, multisectoral approaches bridging oncology and HIV care and prioritizing patient experience.

Purpose: To propose a comprehensive national policy blueprint to expand equitable radiation therapy (RT) access in India, addressing persistent rural-urban disparities and aligning with global cancer control priorities.

Design: This expert viewpoint was informed by consultations with oncology practitioners from government and private centers, medical physicists, policy planners, and patient advocates. Drawing on Indian and global precedents, best practices were synthesized to develop a 10-point framework addressing infrastructure, financing, workforce, quality assurance, and governance.

Results: RT services in India remain highly centralized, with only 120 of 740 districts offering access, disproportionately affecting the 934 million rural population. Key strategies in the proposed blueprint include import duty reform to incentivize rural investment, quality-linked reimbursements under public insurance schemes, bundled workforce incentives, and regionally focused public-private partnerships. Additional measures include phased deployment of indigenous linear accelerators (LINACs), pooled brachytherapy services, mandatory cancer notification, and digital integration through the Ayushman Bharat Digital Mission. Use of artificial intelligence (AI) and remote planning is highlighted as a means to address workforce shortages. The framework is modular and designed for adaptation by other low- and middle-income countries (LMICs).

Conclusion: This 10-point National RT Policy Blueprint provides a scalable pathway to strengthen oncology infrastructure and improve treatment equity in India, with direct relevance for LMICs pursuing universal health coverage and Sustainable Development Goal 3.4. Although promising, some elements such as indigenous LINAC deployment and AI-enabled remote planning are aspirational and contingent on phased implementation, infrastructure readiness, and sustained political commitment.

Purpose: Southeast Asia (SEA), home to over 690 million people across 11 countries-Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Singapore, Thailand, Timor-Leste, and Vietnam-features diverse socioeconomic contexts and cancer care landscapes. We report and interpret incidence and mortality statistics for hematologic malignancies (HMs) in SEA.

Methods: We analyzed 2022 Global Cancer Observatory data from the International Agency for Research on Cancer to report age-standardized incidence rate (ASIR) and age-standardized mortality rates (ASMR) per 100,000 individuals age 20 years and older. We focused on non-Hodgkin lymphoma (NHL), leukemia, multiple myeloma (MM), and Hodgkin lymphoma (HL), standardized using Segi-Doll world population estimates.

Results: Across 11 Southeast Asian countries, age-standardized incidence and mortality rates (ASIRs and ASMRs) for HMs vary widely, highlighting significant regional disparities. Singapore consistently reports the highest ASIRs for NHL, leukemia, MM, and HL, yet its ASMRs are much lower, reflecting strong health care infrastructure. Thailand, Brunei, and Malaysia mirror these associations, which are particularly pronounced in NHL and HL. In contrast, for leukemia and MM, Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Timor-Leste, and Vietnam demonstrated lower ASIR and ASMR that approaches ASIR, suggesting barriers to diagnosis and survivorship. Time trends suggest increasing mortality from MM and NHL, particularly in Thailand and the Philippines. Overall, survival outcomes correlate strongly with national health care capacity.

Conclusion: Higher reported incidence in wealthier SEA countries may reflect greater diagnostic capacity, whereas similar incidence and mortality in low-income countries likely indicates limited access to timely diagnosis and treatment. Mortality patterns underscore the region's broad disparities in cancer care infrastructure and outcomes, shaped by socioeconomic and systemic health inequities.

Purpose: Colorectal cancer burden is increasing in Mexico. Population-based screening programs will be needed to address this public health challenge. Our objective was to explore the feasibility of offering colorectal cancer screening (CRCS) with a fecal immunochemical test (FIT) kit in the context of an existing door-to-door vaccination program in Mexico City.

Methods: The study was conducted in Mexico City in 2019-2020, before and during the onset of the COVID-19 pandemic. Design of the intervention was informed by focus group interviews with average-risk adults age 50-75 years served by a door-to-door vaccination program and interviews with primary care clinic and hospital staff serving this community. The intervention involved offering FIT to household members age 50-75 years during routine door-to-door immunization campaigns, with follow-up colonoscopy for those with abnormal results. Feasibility and acceptability of the intervention was evaluated through analysis of patient participation, clinical outcomes, and surveys.

Results: A total of 132/178 (74.2%) eligible community participants accepted a FIT kit after receiving information from a trained health promoter. Mean age of participants was 62.0 (±6.8) years, and most were women (n = 84, 63.6%). Among participants, 94 (71.2%) returned FIT for testing. Of these, 20 (21.3%) had an abnormal FIT result (≥20 ngHg/mL) and were offered colonoscopy. Of these, 10 (50%) completed the colonoscopy. Recruitment was halted due to the COVID-19 pandemic, which also became a barrier to colonoscopy completion.

Conclusion: Offering CRCS with FIT during door-to-door vaccination activities was feasible and acceptable to outreach workers and patients. Further studies are needed to determine interventions and implementation strategies necessary for scale-up and the effectiveness within integrated health systems.

Purpose: Dihydropyrimidine dehydrogenase (DPD) deficiency, an autosomal recessive metabolic disorder, causes a considerable deficit in the patient's metabolism of fluoropyrimidine drugs, most notably 5-fluorouracil (5-FU) and capecitabine. There is a higher frequency of severe toxicities after a fluoropyrimidine regimen among patients with GI and hepatopancreaticobiliary (HPB) malignancies on chemotherapy because of this metabolic deficiency. This prospective study aims to assess the rate of DPD deficiency and clinical significance of DPD deficiency in patients receiving fluoropyrimidine chemotherapy at a tertiary oncology center in India.

Materials and methods: From March 2024 to February 2025, we prospectively recruited 146 patients with histologic confirmation of GI and HPB cancers who were commencing a 5-FU- or capecitabine-based regimen. We performed pretreatment DPD tests on all patients using TRUPCR DPYD reverse transcriptase polymerase chain reaction for four known variants. Severe toxicities (Common Terminology Criteria for Adverse Events v5.0) were assessed after the first cycle of chemotherapy. Dose reductions, advances in therapy, and admissions were also noted.

Results: Of the 146 study participants, 11 (7.5%) had a DPYD mutation. HapB3 (rs56038477) was the most commonly encountered variant (72.7% of patients), along with registries of DPYD*2A (18.2%) mutation and mutation c.2846A>T (9.1%). Severe toxicities (grade ≥3) were above other grade toxicities (61.6%) in mutation carriers (72.7%) as compared with mutation noncarriers (37.0%, P = .03). Neutropenia, diarrhea, and thrombocytopenia were the common toxicities at a frequency of 18.5%, 12.3%, and 15.1%, respectively. After dose reduction, 90.9% of mutation carriers required a dose reduction versus 14.8% of mutation noncarriers (P < .001). Both groups had no problems in completing treatment.

Conclusion: Individuals with DPYD mutations experience increased toxicity and dose adjustments; however, treatment efficacy was not affected. This indicates that a coordinated effort that incorporates routine DPYD testing can mitigate treatment toxicities and individualized fluoropyrimidine dosing for patients with GI and HPB cancers.