Oncology最新文献

Introduction: Following resection for gastroesophageal cancer, patients may experience symptoms like reflux, anorexia, and weight loss that can significantly impact their quality of life (QoL). Patient-reported outcomes (PROs) are becoming more important for symptom monitoring. Nevertheless, there is limited knowledge on symptom management post-gastroesophageal cancer resection.

Methods: A single-center, randomized controlled trial was conducted on postoperative patients with gastroesophageal cancer. Participants were randomly assigned to the PRO group and usual care (the control group), with a 1:1 ratio. The PRO-based symptom management included symptom assessment, monitoring, and personalized interventions such as lifestyle guidance, nutritional support, and drug therapy. An electronic system was developed on the Research Electronic Data Capture (REDCap) platform to monitor and assess patients' symptoms, QoL, and provide diagnosis and treatment. The study focused on five key symptom events: anorexia, reflux, depression, nutritional risk, and underweight. In the PRO group, assessments were conducted every 3-4 weeks for a minimum of 16 weeks. Interventions for this group primarily involved counseling, patient education, and medication prescriptions based on individual symptoms. The control group's symptoms and QoL were assessed only at baseline and week 16. The primary outcome measure was the total number of symptoms at 16 weeks, with secondary outcomes including the incidence of symptoms at the same time point. QoL was also evaluated as part of the study.

Results: Between April 2021 and May 2022, a total of 124 patients were divided into two groups: 60 in the PRO group and 64 in the control group. The PRO group exhibited notably fewer overall symptoms at the 16-week mark compared to the control group (1.20 ± 1.16 vs. 2.50 ± 1.47), along with a lower prevalence of nutritional risk (63.3% vs. 81.3%), anorexia (18.3% vs. 60.9%), reflux (13.3% vs. 57.8%), and depression (5.0% vs. 20.3%). The QoL scores were markedly higher in the PRO group. Furthermore, the PRO group displayed lower nutritional status, reflux, and depression scale trends, as well as higher anorexia trends when compared to the control group.

Conclusions: PRO-based symptom management led to superior symptom control and enhanced QoL in postoperative gastroesophageal cancer patients when compared to standard care.

Introduction: Radiofrequency ablation (RFA) generally involves the insertion of a radiofrequency electrode into the hepatocellular carcinoma (HCC) nodule under ultrasonography (US) guidance. However, the procedure is often not feasible for patients whose HCC is undetectable on conventional US. Advances in imaging technology, such as fusion imaging (FI) and cone-beam computed tomography (CBCT), may enhance treatment precision and efficacy for these challenging cases. This study assessed the efficacy of RFA guided by FI and CBCT in managing HCC poorly visualized on US.

Methods: HCC nodules were classified into GOOD (clearly delineated), POOR (poorly delineated), and NONE (undetectable) based on US visualization. All nodules underwent RFA guided by FI and CBCT either in combination with transcatheter arterial chemoembolization (TACE) or without TACE. The technical success rate and local tumor progression post-RFA were evaluated using dynamic contrast-enhanced imaging. Between-group differences were analyzed retrospectively.

Results: A total of 420 patients with 595 HCC nodules were enrolled. Complete ablation rates were 91.4%, 94.9%, and 86.2% in the GOOD, POOR, and NONE groups, respectively. For nodules with over 50% lipiodol accumulation, the complete ablation rates were 91.5%, 96.5%, and 88.8%; for those with less than 50% lipiodol accumulation, they were 95.5%, 100%, and 62.5%; and for those without lipiodol accumulation, they were 89.5%, 77.8%, and 82.4% in the GOOD, POOR, and NONE groups, respectively. Significant factors associated with complete ablation included larger nodule size and lipiodol accumulation. Cumulative local tumor progression rates at 1 year were 4.5%, 0%, and 3.8%, with no significant differences among groups.

Conclusion: FI and CBCT guidance effectively achieve local control for HCC, including nodules poorly visualized on US, with outcomes comparable to US-visible nodules, especially for those with lipiodol accumulation.

Introduction: Despite recent advancements, outcomes for unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (atezo/bev) remain suboptimal, with drug resistance posing a major challenge. This study evaluated the efficacy of additional locoregional treatments (LRTs) for oligo-atezo/bev-resistant lesions.

Methods: We retrospectively analyzed patients with intermediate-stage and advanced-stage HCC who developed drug-resistant lesions during first-line atezo/bev therapy. Patients were divided into two groups: the combination therapy group (n = 10) receiving additional LRT and the atezo/bev alone group (n = 26). Progression-free survival (PFS) 1 was measured from atezo/bev therapy initiation to progressive disease (PD) or death, whereas PFS2 was calculated from atezo/bev therapy initiation to PD of second-line therapy or death. The PFS1 in the combination therapy group was compared to the PFS1 and PFS2 in the atezo/bev alone group. Two analyses were performed for the PFS and overall survival (OS): one including the total cohort and the other restricted to those eligible for LRT upon the appearance of atezo/bev-resistant lesions. Changes in the hepatic reserve before and after LRT were also assessed.

Results: LRT, followed by continued atezo/bev therapy, safely eradicated drug-resistant lesions in the combination therapy group, without compromising the hepatic reserve. All patients in the combination therapy group transitioned to second-line treatment due to preserved hepatic reserve after PD. The PFS1 in the combination therapy group was longer than the PFS1 and PFS2 in the atezo/bev alone group in both the total cohort and LRT-eligible subgroup. Similarly, the OS in the combination therapy group was longer than in the atezo/bev alone group in both analyses.

Conclusion: LRTs may provide a viable option for managing oligo-drug-resistant lesions during first-line atezo/bev therapy for unresectable HCC when safely administered.

Introduction: Maximum tumor diameter (MTD) is one of the key aggressiveness features of hepatocellular carcinoma (HCC). However, the clinical associations and causes of large size HCC are not well understood. The aim was to compare small and large MTD (≤/>6 cm) HCCs with respect to clinical associations.

Methods: MTD ≤/> 6 cm HCCs were compared by clinical characteristics and analyzed through logistical regression models, as well as Cox proportional hazard models for death, on clinical parameters.

Results: Patients with larger HCCs had more portal vein thrombosis (PVT) and tumor multifocality, higher AST, ALKP and GGT levels and lower albumin levels. A logistic regression model of MTD (≤/>6 cm) showed the highest risk for PVT and platelet-lymphocyte ratio (PLR) >150, while albumin and female gender were protective. The combination of male gender, PLR >150, plus PVT had an odds ratio of 12.124. In Cox proportional hazard models, the highest hazard ratio for death was for PVT, and only albumin was significantly protective. PVT plus low albumin had a hazard ratio of 4.254.

Conclusion: PVT, albumin, PLR, and gender were significant for ≤/>6 cm MTD. PVT and albumin were significant for survival.

Introduction: The incidence of multiple myeloma (MM) in the USA has been increasing over the past decades with persistent demographic disparities. Social determinants of health (SDOH) were found to affect health outcomes among certain diseases. However, there were limited data on the impact of SDOH on the MM mortality rates. Our study aimed to investigate the association between the SDOH and MM mortality rates from 2016 to 2020.

Methods: County-level data from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (CDC/ATSDR SVI) were correlated with MM mortality rates from the CDC WONDER database. Counties were categorized into four quartiles based on SVI scores: SVI-Q1 (lowest vulnerability) to SVI-Q4 (highest vulnerability). Age-adjusted mortality rates (AAMRs) per 100,000 individuals for patients aged 25 years and above were analyzed. The rate ratio (RR) was measured by calculating the ratio of the AAMRs in SVI-Q4 to SVI-Q1.

Results: Between 2016 and 2020, 61,307 MM-related deaths occurred, with 20,390 in SVI-Q4 versus 8,498 in SVI-Q1. Overall, AAMR was higher in SVI-Q4 (4.90; 95% CI, 4.83-4.97) than in SVI-Q1 (4.66; 95% CI, 4.56-4.76), though the RR was not significant (1.05; 95% CI, 0.81-1.36). Higher SVI was not significantly associated with higher AAMR among males (RR: 1.03; 95% CI, 0.73-1.45) or females (RR: 1.10; 95% CI, 0.75-1.62). Among the younger patients (25-64 years old) and the older patients (65 years old and above), increasing SVI was not associated with higher AAMR (RR: 1.27 [95% CI, 0.69-2.34] and 1.01 [95% CI, 0.76-1.34], respectively). SVI was also not significantly associated with higher AAMR in the rural populations (1.07 [95% CI, 0.60-1.92]). Across racial groups - American Indians, Asians, African Americans, Hispanics, and Whites - SVI was not significantly associated with AAMR differences. Similarly, no significant differences were observed when stratified by census regions (Northeast, Midwest, South, and West).

Conclusion: African Americans had higher AAMRs from MM compared to other racial groups. However, SVI scores were not significantly associated with MM mortality disparities. These findings suggest that SVI alone is insufficient to determine mortality disparities in MM. Future research should explore more specific indicators to identify at-risk populations and address mortality inequities in MM.

Introduction: Multidisciplinary treatments for advanced rectal cancer are diverse. Neoadjuvant chemoradiation therapy (nCRT) is a total neoadjuvant therapy treatment option. Some studies have reported that tumor-infiltrating lymphocytes (TILs) and inflammatory blood factors (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], and systemic immune inflammatory index [SII]) are predictors of nCRT efficacy. However, the relationship between changes in TILs and inflammatory blood factors during nCRT and the resulting tumor regression grade (TRG) remains unclear. In this study, we investigated whether changes in TILs and inflammatory blood factors during nCRT were related to TRG.

Methods: We retrospectively studied 196 patients with rectal cancer who underwent curative resection after nCRT for advanced rectal cancer. Immunohistochemical staining of lymphocyte surface markers, including CD3, CD4, and CD8, was performed on biopsy specimens before and during nCRT. Inflammatory blood factors were assessed using blood samples collected before treatment and 7 days after the initiation of nCRT.

Results: Changes in CD4 levels were related to TRG. NLR, and SII during nCRT were associated with TRG. TRG tended to be better in patients with values below the cutoff. The NLR during nCRT and changes in NLR, PLR, and SII were associated with the tumor shrinkage rate. Changes in PLR were related to TRG. There was no relationship between TIL, peripheral blood changes, and recurrence rate.

Conclusion: It was suggested that changes in CD4+ TILs immediately after treatment initiation and changes in inflammatory blood factors during treatment may be useful for predicting the reduction rate and TRG. These changes begin early during treatment and may be useful in predicting efficacy.

Introduction: Antihistamines (AHs) have beneficial effects as adjuvant anticancer agent in several preclinical and observational studies. We aimed to evaluate the effect of AHs on stage IV lung cancer patients.

Methods: We used data from the Cancer Registry Database provided by the Cancer Center of Kaohsiung Veterans General Hospital to investigate whether AH use is associated with improved survival among patients with stage IV lung cancer. We analyzed AHs use across various patient subgroups, including sex, age, comorbidities, co-medications, smoking status, histologic type, treatment modality, and survival time. The primary endpoint was overall survival (OS).

Results: A total of 1,886 lung cancer patients were enrolled. Of them, 41 (2.1%) patients were AH users, 1,845 (97.8%) were AH nonusers before lung cancer diagnosis, and 594 (31.6%) patients were AH users, 1,292 (68.4%) were AH nonusers after lung cancer diagnosis. AH users were more to have comorbidities with hypertension (p < 0.001), diabetes mellitus (p < 0.001), allergic disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), co-medications with targeted therapy (p < 0.001), and nonaspirin NSAID (p < 0.001). Pre-diagnostic AH users did not show improved survival outcomes. Post-diagnostic AH users tend to have a better OS among patients with a survival period of more than 90 days (median, 28.4 months and 15.1 months, respectively; HR: 0.49; 95% confidence interval: 0.43-0.55).

Conclusion: AHs use was associated with improved OS in patients with stage IV lung cancer. Further prospective studies are needed to better elucidate the role of AHs in the treatment of lung cancer.

Introduction: Immune checkpoint inhibitors (ICIs) have improved lung cancer treatment but are associated with an increased risk of cardiotoxicity. We investigated whether statins could mitigate ICI-associated cardiovascular risks in lung cancer patients.

Methods: We performed a retrospective, propensity score-matched cohort study utilizing the TriNetX database. We identified lung cancer patients receiving ICIs between April 2013 and June 2023. We created two cohorts: statin users and non-users. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, ischemic stroke, and heart failure. The secondary efficacy outcomes were myocarditis and cardiac arrest. Safety outcomes were all-cause mortality and serious immune-related adverse events (irAEs).

Results: A total of 16,650 lung cancer patients undergoing ICIs were identified, consisting of 6,812 statin users and 9,838 non-users. After propensity score matching, 4,379 patients were well-matched in baseline characteristics. Over a follow-up period of 12 months, statin use was associated with a lower risk of MACE (HR: 0.87, 95% CI: 0.78-0.98), primarily driven by reductions in myocardial infarction (HR: 0.75, 95% CI: 0.58-0.97) and heart failure (HR: 0.85, 95% CI: 0.74-0.98). For safety outcomes, statin use was associated with a reduction in all-cause mortality (HR: 0.83, 95% CI: 0.77-0.90) and did not result in an increased risk of serious irAEs.

Conclusion: The use of statins in lung cancer patients with cardiovascular risk factors and without previous cardiovascular events undergoing immunotherapy was associated with a reduction in MACE and all-cause mortality without an increased risk of serious adverse events.

The article "Post-Progression Treatments after Palbociclib plus Endocrine Therapy in HR+/HER2- Metastatic Breast Cancer Patients: What Is the Better Choice?" [Oncology 2021; https://doi.org/10.1159/000521252] by Alessandra Fabi, Mariangela Ciccarese, Sinome Scagnoli, Michelangelo Russillo, Francesco Schettini, Giuseppe Buono, Vito Lorusso, Katia Cannita, Grazia Arpino, Simonetta Stani, Michela Palleschi, Rosalba Rossello, Giuseppina Sarobba, Agnese Fabbri, Marianna Giampaglia, Patrizia Pellegrini, Vincenzo Adamo, Francesca Morelli, Vittoria Barberi, Gianluigi Ferretti, Giovanna Catania, Simona Pisegna, Francesco Cognetti and Diana Giannarelli has been retracted by the Publisher and the Editor.After peer review, the accepted, unedited manuscript was published online as Early View. The authors did not respond to our requests and communication regarding the production process of their article despite extensive attempts at contact. As the article has not been approved by the authors for publication, we cannot publish the final version. To avoid confusion for readers we are retracting the Early View accepted, unedited manuscript.The authors did not respond to correspondence about the retraction.

Introduction: In recent years, the therapeutic scenario of metastatic biliary tract cancers (BTCs) beyond first-line has profoundly changed owing to target therapies. human epidermal growth factor receptor-2 (HER2) represents a promising molecular target that is frequently altered in BTC. The present meta-analyses aimed to describe the response rates and survival outcomes in patients with HER2-positive locally advanced/metastatic BTC treated with anti-HER2 therapies. Moreover, the study is intended to provide an update on the evolving therapeutic scenario of HER2-overexpressed BTC.

Methods: We performed a systematic review of the literature to identify clinical trials investigating any regimen comprising a HER2-targeted therapy for metastatic BTC, and we conducted three subsequent meta-analyses on second-line phase II trials. The first one was performed to compare the group of HER2 3+ versus the group of HER2 2+ BTC patients for objective response rate (ORR). The second one compared patients according to the tumor location (gallbladder carcinoma [GBC] or extrahepatic cholangiocarcinoma [eCCA] versus intrahepatic cholangiocarcinoma [iCCA]) for ORR. The third one evaluated the overall outcomes in terms of overall survival (OS) and progression-free survival (PFS).

Results: Patients with advanced BTC and HER2 3+ had better ORR compared to HER2 2+, with a 3.7-fold higher probability of experiencing objective responses (HR 3.70, 95% CI, 1.34-10.25, p = 0.0119). Likewise, patients with GBC or eCCA had a 2.74-fold higher probability of experiencing an objective response compared to patients with iCCA (HR 2.74, 95% CI, 1.12-6.73, p = 0.0275). The weighted pooled analysis of trials with anti-HER2 agents in second line or beyond revealed an mPFS of 4.9 months (95% CI, 4.2-5.6), while mOS was 10.8 months (95% CI, 9.0-12.8).

Conclusions: Our meta-analyses have revealed improved efficacy in patients with HER2 3+ metastatic BTC and in patients with GBC or eCCA treated with anti-HER2 therapies, with a considerable mPFS and mOS in the overall population of the phase II trials analyzed. Further studies are paramount to confirm our preliminary results.