JCO Global Oncology最新文献

Purpose: Lung cancer remains a leading cause of cancer mortality in Brazil, with non-small cell lung cancer (NSCLC) accounting for 85% of cases, with 1.6% carrying epidermal growth factor receptor (EGFR) exon 20 mutations. In the phase I CHRYSALIS trial (ClinicalTrials.gov identifier: NCT02609776), amivantamab demonstrated a median overall survival (OS) of 22.8 months versus 8.3 months with docetaxel, the standard second-line Brazil's Unified Health System (SUS) therapy. Although the Brazilian Health Regulatory Agency approved amivantamab, the National Commission for the Incorporation of Technologies' cost-effectiveness reviews result in an average 10-year delay before SUS incorporation. We aimed to estimate premature deaths and life-years lost attributable to this access gap.

Methods: Using National Institute of Cancer (INCA) data, we estimated SUS-eligible patients, NSCLC prevalence, and EGFR exon 20 frequency. Stage distribution and 5-year recurrence rates identify candidates for amivantamab. A hazard ratio (HR) was derived from the inverse exponential method (ln(2)/OS ratio). Preventable deaths were calculated as: eligible patients × (1 - HR). Life-years gained per patient were estimated as OS difference.

Results: Of the 26,548 new patients with lung cancer, 18,973 are SUS-eligible, 16,127 have NSCLC, and 258 have EGFR exon 20 mutations. Metastatic disease accounts for 114, whereas recurrences occur in 60 (stage III), eight (II), and four (I), totaling 186 candidates annually. With an HR of 0.364, the annual preventable death in the base-case scenario is equal to 186 × (1 - 0.364) × 95% = 112 patients. Over 10 years, 1,120 premature deaths and 1,353 life-years could be avoided.

Conclusion: Delayed SUS incorporation of amivantamab may result in over a 1,000 preventable deaths and life-years lost among Brazilian EGFR exon 20-mutated NSCLC. Urgent real-world studies and cost-effectiveness analyses are needed.

Purpose: About one in three Black Africans carry the African-predominant allele variants CYP2D6*17 and/or CYP2D6*29, which confer a reduced enzymatic activity. CYP2D6 intermediate metabolizers (IM) have a reduced biotransformation rate of tamoxifen compared with its more active metabolite endoxifen.

Methods: A prospective cohort study of Black Zimbabwean patients with hormone receptor-positive breast cancer on tamoxifen therapy was conducted. Patients were genotyped for CYP2D6 and followed up for event-free survival (EFS) on tamoxifen.

Results: In total, 18 CYP2D6 IM and 33 normal metabolizers (NM) were enrolled. At 2 years, the estimated EFS was 40.1% (95% CI, 20.3 to 79.4) for the IM group and 84.0% (95% CI, 72.1 to 97.9) for the NM group (log-rank P = .0021). A Cox proportional hazards model, after adjusting for BMI, stage at diagnosis, and previous breast cancer surgery, estimated about a 5.5-fold higher hazard of recurrence, progression, or death in IM compared with NM.

Conclusion: Individuals with hormone receptor-positive breast cancer who are CYP2D6 NM had better disease recurrence and progression-free survival outcomes compared with IM.

Purpose: Majority of the patients with gastric cancer in resource-restricted country, like Jordan, are diagnosed with advanced-stage disease with poor treatment outcomes. This study explores the state of gastric cancer in Jordan and outlines strategies for disease control.

Materials and methods: Data on disease stage at presentation and treatment outcomes were obtained from the King Hussein Cancer Center registry. Patients were staged according to the US SEER staging system, which classifies gastric cancer into localized, regional and distant. Overall survival (OS) was reported for the whole group and stratified by age at diagnosis, stage, sex, and year of diagnosis, and compared with published data from the United States and Asia.

Results: During the study period, a total of 888 patients were treated and followed up at our institution. The majority (n = 503, 56.6%) were diagnosed with distant metastases); 315 (35.5%) had regional disease and only a minority (n = 70, 7.9%) had localized disease. After a median follow-up of 5.7 (1.3-18.7) years, the 5-year OS for the entire cohort was 18.1% (95% CI, 15.5% to 20.8%), varying by stage; 62.9% (95% CI, 50.7% to 74.3%) for localized disease, 34.1% (95% CI, 28.7% to 39.8%) for regional disease, and only 1.86% (95% CI, 0.80% to 3.36%) for distant metastasis, P < .0001. Patients' age at diagnosis (<40 v ≥40 years), sex, or year at diagnosis (recent years v >10 years ago) had no significant impact on 5-year OS.

Conclusion: Although gastric cancer is relatively uncommon in Jordan, fewer than 10% of patients are diagnosed at an early, localized disease, contributing to persistently poor treatment outcomes with little improvement over time. National initiatives and strategies to improve treatment outcome are urgently needed.

Purpose: Value in health care is a multifaceted concept encompassing patient outcomes, treatment effectiveness, and costs. However, the definition of value can vary between distinct health systems. We compared the perceptions of value in cancer care between providers in high-income countries (HICs) and low- and middle-income countries (LMICs).

Materials and methods: A novel survey assessed the relative importance of health care priorities, including longevity, experience, functional and emotional well-being, costs to patients, and costs to the health system between providers in HICs and LMICs. Kendall's coefficient of concordance assessed agreement between groups.

Results: We received 365 responses: 216 (59.2%) from HICs and 149 (40.8%) from LMICs. HIC providers more frequently rated treatment experience (82.9% v 65.1%) and patient functional independence (72.7% v 59.7%) as extremely important, while fewer rated emotional well-being (65.3% v 78.5%) and costs to the health system (26.4% v 51.7%) as such (all P < .050). With consensus (HIC: W = 35%; P < .001; LMIC: W = 19%; P < .001), both cohorts ranked patient emotional well-being (2.56 ± 1.30 HIC v 2.74 ± 1.58 LMIC; P = .254) as the most important priority. HICs placed higher priority on treatment experience (3.02 ± 1.55 v 3.59 ± 1.47; P < .001) and less on costs to the health system (5.56 ± 1.15 v 4.97 ± 1.44; P < .001), when compared with LMICs.

Conclusion: Although there is consensus on the importance of patient-centered outcomes, the prioritization of treatment experience and costs of care to the health system differ between HICs and LMICs. These findings underscore the importance of developing adaptable value frameworks that are relevant and effective across diverse health care settings.

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.