Oncology最新文献

Introduction: Nivolumab combined with chemotherapy has been approved as the first-line treatment for HER2-negative, unresectable, advanced, or recurrent gastric cancer. Patients aged ≥75 years have impaired organ function and comorbidities that increase the risk of adverse events, including immune-related adverse events more often than younger patients, potentially limiting the continuation of treatment. In this multicenter study, we aimed to evaluate the safety and efficacy of first-line nivolumab chemotherapy in older patients.

Methods: We retrospectively analyzed data from 103 patients treated with first-line nivolumab combination chemotherapy for unresectable, advanced, or recurrent gastric cancer at 12 institutions between November 2021 and January 2023. The participants were divided into groups A (<75 years, n = 67) and B (≥75 years, n = 36).

Results: The mean age was 63.9 years in Group A and 78.6 years in Group B. Body weight was significantly lower (p = 0.041), and performance status 0-1 and hypertension were more prevalent in Group B (both p < 0.01). Chemotherapy regimens and incidence of grade ≥3 immune-related adverse events were similar between the groups. The median overall survival was 15.2 months in Group A and was not reached in Group B; this difference was not significant (p = 0.689).

Conclusions: First-line chemotherapy with nivolumab is safe and effective in patients aged ≥75 years with a good performance status, as in younger patients, suggesting that it is a valid treatment option for the former subgroup.

Introduction: The prognosis of chronic myeloid leukemia (CML) has been revolutionized in recent decades with tyrosine kinase inhibitors (TKIs). Yet, comorbidities that require anticoagulation therapy pose a challenge in CML management because of the scarcity of evidence on the optimal drug combinations. This systematic review (SR) aimed to summarize the efficacy and safety considerations for the concomitant use of anticoagulants with different TKIs in CML and investigate their potential drug interactions.

Methods: A comprehensive search strategy was used, employing Medical Subject Headings and free-text terms across databases including PubMed (via OVID), Medline (via OVID), Embase (via OVID), and Web of Science. Members of the research team independently screened the titles and abstracts for eligibility based on predefined inclusion and exclusion criteria. Data extraction was then performed using a standardized form to record the studies' characteristics, the TKIs and anticoagulants used, and the safety outcomes. Two reviewers independently assessed study quality using the Critical Appraisal Skills Program (CASP) checklists and the Joanna Briggs Institute (JBI) tool for case reports.

Results: The search yielded 406 studies, of which 13 met the inclusion criteria for reporting real-world safety data in adults receiving TKIs with anticoagulants. Overall, the combinations of TKIs with anticoagulants like ponatinib with apixaban and imatinib with warfarin had no major bleeding complications. The pharmacokinetic findings suggested some interaction variability, particularly between nilotinib and warfarin, but overall anticoagulant use appeared safe in the studied populations across various indications.

Conclusion: This is the first SR to address a critical gap in the literature by evaluating the safety profiles of various TKIs in combination with different anticoagulants. The findings from cohort studies highlighted the feasibility of concomitant use of anticoagulants and TKIs in CML patients, with close monitoring of potential adverse events and drug interactions. PROSPERO registration number was CRD42024528737.

Introduction: Neratinib is a potent tyrosine kinase inhibitor with activity against HER2-positive breast cancer (HER2+). The ExteNET study demonstrated a significant invasive disease-free survival benefit of neratinib in hormone receptor-positive (HR+) HER2+ breast cancer following trastuzumab-based adjuvant therapy. However, ExteNET was conducted before the use of pertuzumab or adjuvant trastuzumab emtansine (T-DM1). We evaluated clinical characteristics of patients prescribed neratinib in current practice.

Methods: We retrospectively reviewed patients with HR+ HER2+ breast cancer eligible for neratinib at our institution from 2017 to 2024. Clinical and treatment information was extracted from the electronic medical record. High-risk status was defined using traditional high-risk HR+ breast cancer features and literature supporting high Ki-67 and tumor grade as predictors of recurrence. Chi-square and t tests were used for analysis.

Results: Among 107 eligible patients, 67 were offered neratinib and 40 were not. High-risk disease was significantly more prevalent in patients offered neratinib (p < 0.01). Residual disease and progression rates did not differ significantly between groups.

Conclusion: High-risk clinical features significantly influenced neratinib prescribing. Residual disease did not appear to impact prescribing decisions. These findings suggest biologic risk criteria may serve as practical guidelines for adjuvant neratinib use.

Introduction: Predicting post-treatment prognosis in hepatocellular carcinoma (HCC) patients undergoing conventional transarterial chemoembolization (cTACE) is challenging due to tumor heterogeneity. We here assessed the utility of the modified albumin-bilirubin grade and α-fetoprotein (mALF) score for predicting the prognosis of cTACE-treated HCC patients.

Methods: This retrospective observational study included 206 early- and intermediate-stage HCC patients who had undergone cTACE. We calculated baseline and post-treatment mALF scores by assigning one point for a modified albumin-bilirubin grade of 2b or 3 and one point for an alpha-fetoprotein level of ≥100 ng/mL.

Results: The baseline mALF scores were 0, 1, and 2 points for 66 patients (32%), 95 patients (47%), and 45 patients (21%), respectively, and their median survival times were 42.3 months, 21.1 months, and 14.0 months, respectively. The baseline mALF score was also associated with overall survival, independent of the Barcelona Clinic Liver Cancer stage and the tumor burden score (hazard ratio, 1.97; 95% confidence interval, 1.56-2.49; p < 0.001). One month after cTACE, the mALF score had decreased in 26 patients and increased in 31 patients. In those with a baseline mALF score of 0 or 1, the increased mALF score was significantly associated with shorter survival periods after cTACE.

Conclusion: The baseline mALF score was useful in stratifying HCC patients undergoing cTACE, according to post-treatment prognosis. Increased mALF scores after cTACE were associated with poor prognosis in patients with a baseline mALF score of 0 or 1. Assessment of baseline and post-treatment mALF scores may help in predicting prognosis in HCC patients following cTACE.

Background: Noncoding RNAs (ncRNAs), including microRNAs, lncRNAs, and circRNAs, play essential roles in physiological and pathological processes, including cancer, where they act as drivers or suppressors. Aberrant ncRNA expression in tumors has been linked to tumor promotion or suppression, making them potential cancer biomarkers. Pyroptosis, a newly discovered form of programmed cell death, is characterized by cell swelling, membrane rupture, and inflammation, offering a novel strategy for tumor elimination.

Summary: Pyroptosis can activate anti-tumor immunity, while ncRNAs regulate pyroptosis pathways, influencing tumorigenesis through diverse mechanisms. However, the role of ncRNAs in pyroptosis, including potential initiators and their impact on tumor resistance, immunity, and cancer progression, remains unclear. The specific role of circRNAs in pyroptosis also requires further exploration.

Key messages: This article explores the role of ncRNAs in pyroptosis, with a particular focus on ncRNA-mediated mechanisms, and highlights their potential as diagnostic and prognostic markers in cancer.

Introduction: Age has been reported as a risk factor for chemotherapy-induced nausea and vomiting. However, few reports have described risk factors for nausea and vomiting with carboplatin (CBDCA). This study investigated whether the incidence of CBDCA-induced nausea and vomiting differs with age, using 70 years as the cutoff.

Methods: Patients who underwent CBDCA for lung cancer at the Cancer Institute Hospital of Japanese Foundation for Cancer Research between November 2020 and October 2023 were included in this retrospective study. The age cutoff was set at 70 years, with the complete response (CR; no vomiting/retching and no rescue medication) rate during the observation period as the endpoint.

Results: Of the 198 patients included in the analysis, 114 (57.6%) were ≥70 years old. The CR rate was 36.9% for patients <70 years old and 61.4% for patients ≥70 years old (p = 0.001). In univariate analyses, age <70 years, female sex, no drinking history, no smoking history, and higher CBDCA dose were associated with non-CR. In multivariate analysis, age <70 years, no drinking history, and higher CBDCA dose were associated with non-CR.

Conclusion: Age <70 years, no drinking history, and higher CBDCA dose were identified as risk factors for CBDCA-induced nausea and vomiting.

Introduction: This study aimed to compare the effectiveness outcomes of Child-Pugh class A patients with unresectable hepatocellular carcinoma (HCC) treated with first-line atezolizumab-bevacizumab and lenvatinib.

Methods: This retrospective study included patients with Child-Pugh A unresectable HCC who were administered first-line treatment with either atezolizumab-bevacizumab (n = 368) or lenvatinib (n = 229) at Asan Medical Center (Seoul, Korea). Effectiveness outcomes were analyzed along with the inverse probability treatment weighting (IPTW) analysis to adjust for potential confounders.

Results: Hepatitis B virus infection was the most common cause of HCC. With median follow-up duration of 11.9 for atezolizumab-bevacizumab and 20.9 months for the lenvatinib groups, patients treated with atezolizumab-bevacizumab exhibited superior progression-free survival (PFS) and overall survival (OS) than those treated with lenvatinib (median PFS 6.3 vs. 4.9 months, p = 0.031; and median OS 18.5 vs. 11.3 months, p < 0.001). After IPTW adjustment, atezolizumab-bevacizumab remained associated with favorable OS (median OS of 17.9 vs. 12.3 months, p = 0.010). Treatment with atezolizumab-bevacizumab was an independent factor of OS in both the entire and IPTW-adjusted cohorts. For patients with a viral etiology, the atezolizumab-bevacizumab group exhibited significantly longer OS than the lenvatinib group in both entire and IPTW-adjusted cohorts (p < 0.001 and p = 0.006, respectively). Conversely, both groups showed comparable OS among those with a nonviral etiology (p = 0.656 and p = 0.616, respectively).

Conclusions: Atezolizumab-bevacizumab showed superior OS compared to lenvatinib in Asian patients with unresectable HCC.

Introduction: In the ninth edition of the TNM staging system, the new nodal involvement (N) subcategories to N2 for single-station involvement (N2a) and multiple-station involvement (N2b) have been adopted. Although there are significant differences in survival rates for each group of pN categories in the ninth edition, it can be assumed that survival rates in pN1 and pN2a are relatively similar.

Methods: We retrospectively evaluated the utility of the new category by number of stations such as none, single station, and multiple station for pN in 1,000 NSCLC patients treated by pulmonary resection.

Result: Survival rates were significantly different among none, single station, and multiple station (5-year RFS: none: 79.6%, single station: 47.3%, multiple station: 24.2%, all groups, p < 0.01; 8-year OS: none: 78.7%, single station: 65.2%, multiple station: 33.6%, all groups, p < 0.01). There were significant differences among each group categorized by number of pN station in multivariate analysis for RFS (none vs. single station: p < 0.01, none vs. multiple station: p < 0.01, single station vs. multiple station: p < 0.01). There were significant differences among each group categorized by number of pN station in multivariate analysis for OS (none vs. single station: p = 0.04, none vs. multiple station: p < 0.01, single station vs. multiple station: p < 0.01).

Conclusion: There were significant differences among none, single station, and multiple station in each survival curve and in multivariate analysis for both RFS and OS. This category by number of pN station without dependence of location for lymph nodal involvement might be the new classification of lymph node involvement.

Introduction: Research on esophageal squamous cell carcinoma (ESCC) in Asian American (AsA) populations frequently aggregates data, thereby overlooking the considerable diversity inherent within this demographic. The aim of this study was to investigate the variations in ESCC characteristics and clinical outcomes among AsA.

Methods: Patients diagnosed with ESCC were identified through the Surveillance, Epidemiology, and End Results (SEER) 17 database. The AsA cohort was categorized into specific subgroups: Chinese, Japanese, Filipino, Korean, Vietnamese, South Asian (Asian Indian or Pakistani), and other Asian. The Kaplan-Meier method was employed to estimate unadjusted overall survival (OS), while Cox proportional hazards models were utilized to assess adjusted OS.

Results: A total of 9,252 patients were included, with the cohort comprising 1,100 Asian, 2,135 Black, 951 Hispanic, and 5,066 White individuals. AsA patients demonstrated the highest unadjusted OS (p < 0.001). The Vietnamese subgroup exhibited the highest proportion of male patients at 92.1%. South Asian patients showed the highest unadjusted OS among the distinct Asian subgroups, with survival rates of 56% at 1 year (95% confidence interval [CI]: 49-64), 31% at 3 years (95% CI: 25-40), and 23% at 5 years (95% CI: 17-32). After adjusting, only Chinese and South Asian patients displayed significantly improved OS compared to the White reference group (p < 0.05).

Conclusion: Considerable disparities in ESCC characteristics and outcomes exist among AsA populations. Socioeconomic, genetic, and epigenetic factors may influence these differences. Further research is essential to clarify the mechanisms of this discrepancy.

Introduction: The objective of this study was to develop an automated method for segmenting spleen computed tomography (CT) images using a deep learning model. This approach is intended to address the limitations of manual segmentation, which is known to be susceptible to interobserver variability. Subsequently, a prediction model of gastric cancer (GC) lymph node metastasis was constructed in conjunction with radiomics and deep learning features, and a nomogram was generated to explore the clinical guiding significance.

Methods: This study enrolled 284 patients with pathologically confirmed GC from two centers. We employed a deep learning model, U-Mamba, to obtain fully automatic segmentation of the spleen CT images. Subsequently, radiomics features and deep learning features were extracted from the entire spleen CT images, and significant features were identified through dimensionality reduction. The clinical features, radiomic features, and deep learning features were organized and integrated, and five machine learning methods were employed to develop 15 predictive models. Ultimately, the model exhibiting superior performance was presented in the form of a nomogram.

Results: A total of 12 radiomics features, 17 deep learning features, and 2 clinical features were deemed valuable. The DRC model demonstrated superior discriminative capacity relative to other models. A nomogram was constructed based on the logistic clinical model to facilitate the usage and verification of the clinical model.

Conclusion: Radiomics and deep learning features derived from automated spleen segmentation to construct a nomogram demonstrate efficacy in predicting lymph node metastasis in GC. Concurrently, fully automated segmentation provides a novel and reproducible approach for radiomics research.