JCO Global Oncology最新文献

Purpose: Trimodal therapy (TMT) is the standard treatment for patients with nonmetastatic inflammatory breast cancer (IBC). TMT consists of neoadjuvant systemic therapy, modified radical mastectomy (MRM), and postmastectomy radiation therapy. Although broadly considered the best approach for IBC, in the United States, only a third of patients receive TMT. The rate is unknown in low- and middle-income countries (LMICs).

Methods: A questionnaire in English and Spanish was constructed to assess the awareness, knowledge, and treatment patterns of IBC among providers in LMICs. It was emailed to the ONCOLLEGE global oncology collaborative group (a network of cancer care providers practicing in LMICs) and through other oncology network providers in LMICs, enhancing the sample size through a snowball sampling approach.

Results: Between June and December of 2023, 145 participants completed the questionnaire, of whom 112 respondents were from 36 LMICs. All the providers reported that standard chemotherapy and MRM were available in their practice; 99.5% responded that radiation therapy was available. A total of 74.1% appropriately reported that IBC is a clinical diagnosis, although 51.8% stated that pathologic evidence of lymphatic emboli was required for IBC diagnosis. A third of the providers responded that >90% of their patients undergo all three parts of TMT.

Conclusion: Many patients with IBC in LMICs are not receiving TMT. Barriers to diagnosis and treatment were at least partially related to limited providers' comfort level and knowledge, suggesting that educational approaches can be impact-oriented interventions. On the basis of our findings, we created educational material, which will be translated into various languages and disseminated broadly to improve providers' awareness and knowledge of IBC.

Spain's cancer care is at a crossroads! The CCI4EU initiative promises progress, but could it widen the gap for rural and vulnerable communities? Balancing innovation with access is crucial! #CancerCare #HealthcareAccess #Spain #CCI4EU #HealthEquality.

Purpose: Biliary tract cancers (BTCs) are usually diagnosed in advanced stages, where treatment options are either palliative chemotherapy and/or best supportive care. The breakthrough results of the TOPAZ-1 trial demonstrated a 24% decrease in risk of death at 2 years with the addition of durvalumab to chemotherapy.

Materials and methods: This was a multicenter retrospective cohort study conducted across 14 institutions in India. All the patients were diagnosed with advanced BTCs. The primary objective was to assess median overall survival (mOS) with the use of durvalumab in combination with chemotherapy backbone. The patient details, treatment details, laboratory results, and outcome parameters were recorded from the prospectively collected databases.

Results: A total of 148 patients were included with a median age of 57.5 years; 36 (24.3%) patients had borderline Eastern Cooperative Oncology Group performance status ≥2. The most common subtype was gall bladder cancer (GBC), seen in 94 patients (63.5%); 126 (85.1%) patients presented with de novo metastases. At a median follow-up of 6.8 months (95% CI, 5.9 to 7.8), the estimated mOS for the entire cohort was 12 months (95% CI, 7.8 to 16.3) and median progression-free survival was 8.2 months (95% CI, 7.1 to 9.4) with objective response achieved in 44 (29.7%) patients, and the estimated 2-year OS being 25%. Immune-related grade 3/4 adverse events were reported in 11 (7.4%) patients. In multivariate analysis, age <60 years (P = .001) and standard dose of durvalumab (P < .001) were found to have improved OS compared with age >60 years and low dose of durvalumab.

Conclusion: To our knowledge, these real-world data provide the first evidence in Indian context of the efficacy and safety of durvalumab plus chemotherapy in patients with advanced/metastatic BTCs especially in GBC.

Purpose: Beliefs on causes of cancer, although sometimes aligned with known risk factors, may be influenced by personal experiences, cultural narratives, and misinformation. We investigated the prevalence of beliefs on causes of cancer and their association with cancer risk perception and lifestyle in a multiethnic Asian population.

Methods: In total, 2,008 Malaysian adults with no previous cancer were surveyed using a 42-item questionnaire adapted from the Awareness Measure and the Cancer Awareness Measure-Mythical Causes Scale. Partial least squares structural equation modeling was used to evaluate measurement models.

Results: Despite high educational attainment, only about half of the respondents believed that 7 of the 21 listed established risk factors caused cancer. Factors associated with accurate beliefs included higher socioeconomic status (SES) and having family or friends with cancer. However, 14 of the 21 listed mythical/unproven factors were correctly believed as not cancer-causing by the majority. Women and those with lower SES were more likely to hold misconceptions. Beliefs on established risk factors were significantly associated with perceived risk of cancer. Individuals with stronger beliefs in established risk factors were less likely to be associated with healthy behaviors. Conversely, stronger beliefs in mythical or unproven factors were more likely to be associated with healthy lifestyles.

Conclusion: Findings highlight the importance of prioritizing cancer literacy as a key action area in national cancer control plans. The counterintuitive associations between cancer beliefs and lifestyle emphasize the complexity of this relationship, necessitating nuanced approaches to promote cancer literacy and preventive behaviors.

Purpose: Tissue inadequacy and operational challenges may limit lung cancer comprehensive biomarker testing. Here, we describe the initial implementation of a tailored tissue molecular journey at Oncoclínicas Precision Medicine Laboratory in Brazil, which includes fast-track (FT) non-next-generation sequencing (NGS) assays combined with a broad NGS panel.

Methods: From 2021 to 2023, all nonsquamous lung cancer samples eligible for the patient support program "Lung Mapping Consortium" at Oncoclínicas & Co were evaluated using the FT panel (immunohistochemistry for PD-L1 and anaplastic lymphoma kinase [ALK], polymerase chain reaction for EGFR and BRAF, and fluorescence in situ hybridization for ROS1) plus a broad DNA and RNA sequencing panel of 180 genes (custom ARCHER panel).

Results: From 1,272 samples received by the laboratory, 3% had no tissue for any molecular testing, 20% was not eligible for broad NGS panel as per pathologist assessment (tumor purity and quantity), additional 12% did not reach presequencing analytical thresholds (nucleic acid quantity and/or quality), and 3% had postsequencing failure. Most frequent alterations were KRAS mutations (28.4%, KRAS^G12C 9.7%), EGFR mutations (23.6%, exon20 insertions 2.9%), ALK fusions (6.4%), MET exon 14 skipping (4.4%), ERBB2 mutations (3.4%), ROS1 fusions (3.1%), and BRAF^V600E (1.9%). In 35% of the samples, FT non-NGS tests were the only molecular diagnostics: EGFR mutations (14%), ALK fusions (4.4%), ROS1 fusions (1.8%), and BRAF^V600E (0.7%). Overall, high PD-L1 expression (≥50%) was found in 12.3%.

Conclusion: This study provides data on the molecular epidemiology of lung adenocarcinoma in Brazil, confirming high prevalence of EGFR mutations, ALK fusions, and MET exon 14 skipping alteration. Biomarker detection is largely affected by biospecimen collection and processing, with one third of the patients eligible for non-NGS testing only, which presents reduced coverage and sensitivity for actionable drivers.

Purpose: Breast cancer remains a major public health challenge worldwide, and understanding the trends and changes in breast cancer diagnosis and treatment over time is crucial for improving patient outcomes and guiding public health strategies. The Argentine Society of Mastology has maintained a comprehensive Breast Cancer Registry that provides valuable data for analyzing these trends.

Materials and methods: This retrospective analysis of the Breast Cancer Registry database evaluated changes in stages at the time of surgery, patterns of surgical care, and factors associated with higher stage diagnoses in patients with breast cancer in Argentina from January 2000 to December 2019.

Results: Overall, 13,239 patients met the inclusion criteria. Significant differences were observed in the axillary procedure performed, with sentinel lymph node biopsy increasing from 14.9% (2000-2004) to 69.5% (2015-2019; P < .001). A higher proportion of in situ carcinoma was detected in the last 5-year period compared with the first (11.3% v 9.4%; P = .01) and fewer patients were stage III (17.1% v 14.2%). In multivariate analysis, postmenopausal status (odds ratio [OR], 0.72 [95% CI, 0.64 to 0.80]; P < .001), health coverage (social health insurance OR, 0.53 [95% CI, 0.46 to 0.61]; P < .001 and private insurance OR, 0.36 [95% CI, 0.31 to 0.42]; P < .001), tumor grade (grade 3 OR, 2.97 [95% CI, 2.54 to 3.47]; P < .001), and phenotype (hormone receptor-positive [HR+]/human epidermal growth factor receptor 2 [HER2]+ OR, 1.36 [95% CI, 1.10 to 1.70]; P = .005; HR-/HER2+ OR, 2.14 [95% CI, 1.62 to 2.83]; P < .001; HR-/HER2- OR, 1.40 [95% CI, 1.19 to 1.66]; P < .001) were associated with the risk of diagnosis at stages II-III.

Conclusion: Significant advances in the patterns of surgical care were identified. Numerous clinical and pathologic factors correlated with higher stage at diagnosis. However, multivariate analysis failed to show a noteworthy reduction in stage at diagnosis. This observation underscores the imperative to persistently strive to improve breast cancer care in Argentina.

Purpose: The Brazilian Public Health System (BPHS) serves approximately 71,730 patients with prostate cancer (PC) every year for which androgen deprivation therapy (ADT) is the primary treatment for patients with advanced hormone-sensitive prostate cancer (aHSPC). Androgen receptor pathway inhibitors (ARPIs) are not accessible through the BPHS. Using the BPHS as a model, this study assesses the long-term economic effect of surgical versus medical castration in aHSPC treatment to strategize cost reduction and the incorporation of ARPI in developing countries.

Patients and methods: Data of patients with aHSPC (ie, TxN1M0 ineligible for local treatment or TxNxM1) from the BPHS database were analyzed from January 1, 2011, to December 31, 2021, using the TECHTRIALS artificial intelligence platform. The main outcomes were quantitative and descriptive analyses as well as a cost analysis of surgical versus chemical castration.

Results: Of the 274,519 patients with aHSPC who received active treatment during the 11-year study period, 90% (n = 246,683) underwent chemical castration and 10% (n = 27,836) underwent bilateral subcapsular orchiectomy (BSO). The median duration of chemical castration was 28 months. The BPHS spent an estimated total of $665,552,091.40 US dollars (USD) on chemical castration and $5,939,348.47 USD on BSO, respectively. The cost per patient was $2,698 USD and $213.37 USD for chemical castration and BSO, respectively. Hypothetically, if all patients with aHSPC had undergone BSO, the total direct cost for the BPHS would have been $42,774,832.20 USD, saving $622,777,259.20 USD over 11 years, making it possible to offer low-dose abiraterone to 65% of aHSPC patients.

Conclusion: On the basis of this extensive financial analysis from the world's largest public health system database, BSO appears to be a valuable alternative to chemical castration for treating aHSPC. In resource-limited environments, the cost savings from using BSO may allow access to drugs that will improve survival such as ARPIs.

Purpose: Stronger Together is a peer mentoring model that seeks to address the severe lack of mental health and psychosocial support for patients with cancer in many low- and middle-income countries (LMICs). This article presents the results of the Stronger Together pilot study among patients with breast and gynecologic cancer in Viet Nam (VN).

Methods: Eligible participants comprised women age 25 years or older with a diagnosis of breast or gynecologic cancers and receiving treatment at four participating hospitals. Participants were asked whether they wanted to proceed with usual care or be matched with a trained and supervised peer mentor (a cancer survivor). Surveys were administered at baseline (0) and 2, 4, and 6 months and assessed depression, anxiety, stress, mental health and physical health components of quality of life (QOL), self-efficacy, and social support. We computed and compared 2-, 4-, and 6-month changes in scores from baseline and conducted difference-in-difference analyses to estimate the intervention effect at 6 months.

Results: The sample size included N = 186 participants. Mentees (n = 91) exhibited improvements in depression, anxiety, stress, and mental health QOL across all time points, whereas usual care participants (n = 95) experienced these improvements at later periods (4 and 6 months). Compared with usual care participants, mentees reported greater improvements in depression at 2 and 4 months, mental health QOL at all time points, and self-efficacy and social support at 4 and 6 months. Greater improvements in stress were also seen in the breast cancer subsample.

Conclusion: Stronger Together is a promising model to improve mental health and psychosocial outcomes among patients with breast and gynecologic cancer in VN and can help fill gaps in cancer peer support interventions in many LMICs.

Purpose: To better understand immigration disparities among a Spanish Early-Onset Colorectal Cancer (SECOC) subset, according to the country of origin.

Patients and methods: We selected 250 consecutive participants from the SECOC consortium. Data on baseline patient and tumor characteristics, family history of colorectal cancer (CRC), and follow-up were collected. The presence of mismatch repair deficiency was also assessed. Special data regarding country of origin, time of stay in Spain in case of other different country, and a 10-year cutoff that specifies the obtaining of Spanish nationality defined the variables of interest for comparison.

Results: Seventy-five percent of patients with early-onset CRC (EOCRC) (188) were born in Spain, whereas the other 25% were born outside of Spain. The mean time of living in Spain until the EOCRC diagnosis was 16.5 years. Comparatively, most of the analyzed features showed equivalent proportions between cohorts. Only Spanish patients appeared to have more familial cancer component in first degree in general (32.3%; P = .01), compared with non-Spaniards, which showed a predominant sporadic component (56.4%; P < .001). Among immigrants, those patients living in Spain before CRC diagnosis ≤10 years were younger at diagnosis (39.1 v 42.5), more frequently male (77.8 v 47.7), were in more advanced stages (88.8% diagnosed at stage III and IV [P = .01]), and had a worse prognosis regarding recurrence rates (29.4% v 6.3%).

Conclusion: Although there were few differences between Spanish and non-Spanish EOCRC, the most remarkable difference was that linked with the situation of those immigrants who have recently arrived in Spain, in relation to their lower health coverage, which could be associated with the delay in the diagnosis and their subsequent worse prognosis.