Oncology Research and Treatment最新文献

Introduction: The concept of oncological communication skills training (CST) has already proven to be effective and has been incorporated into the relevant guidelines. The current status of CSTs in Germany is unclear.

Methods: We approached all oncology centers in Germany certified by Deutsche Krebsgesellschaft (DKG) and investigated quantitative and qualitative aspects of CST programs in a mixed-methods approach using questionnaires and interviews.

Results: Only a quarter (23.7%, n = 18/76) of the responding centers demonstrated a regular CST. These CSTs were partially congruent with the consensus recommendations while deviating significantly in other areas, such as duration, scope, and course content. We asked centers that do not offer CST or do not offer fully satisfactory CST (respondents n = 60) for factors that hinder successful implementation, which were identified as, e.g., scarce time and personnel resources (92%), no counterpart funding (27%), lack of appreciation (25%) and knowledge about the concept (3%), organizational obstacles (22%), and low prioritization (12%). Steps that could facilitate nationwide implementation were found, such as support for implementation through concrete instructions (27%), mandatory participation (20%), an active management level in the question of responsibility (17%), inclusion in the certification criteria for oncology centers (12%), and an integration into the Weiterbildungsordnung (WBO, specialist training guideline) (10%).

Conclusion: Although previous studies have shown that CSTs have positive effects, sufficient implementation has not yet been achieved across the board in Germany. Individual starting points have been identified; further efforts are needed to advance this goal.

Introduction: The role of immunotherapy in the treatment of locally advanced head and neck squamous cell carcinoma (LA HNSCC) remains uncertain, particularly in cases of unresectable LA HNSCC. This meta-analysis aimed to evaluate the efficacy of immunotherapy in patients with unresectable LA HNSCC through a systematic review of the existing literature.

Methods: This meta-analysis followed a registered protocol on the INPLASY platform with the registration number INPLASY202510102. We systematically collected studies that compared the combination of immunotherapy and standard of care (SOC) with SOC alone for patients with unresectable LA HNSCC. Review Manager, Stata, and R software were employed to conduct single-group rate meta-analysis, pairwise meta-analysis, and Bayesian network meta-analysis.

Results: A meta-analysis of fifteen eligible studies involving 3,055 patients revealed no significant improvement in progression-free survival (PFS) or overall survival (OS) with the addition of immunotherapy. Specifically, in patients with human papilloma-positive (HPV+) LA HNSCC, the combination of pembrolizumab and concurrent chemoradiotherapy (CCRT) resulted in 2-year PFS and OS rates of 93% and 97%, respectively. In contrast, LA HNSCC patients treated with chemoradiotherapy followed by sequential pembrolizumab exhibited 2-year PFS and OS rates of 89% and 94%, respectively. Furthermore, our study demonstrated that the combination of pembrolizumab and CCRT achieved a higher 2-year PFS rate compared to the combination of avelumab and CCRT.

Conclusion: Although the addition of immunotherapy to SOC regimens did not result in a survival benefit, patients with HPV+ unresectable LA HNSCC may potentially derive benefit from immunotherapy.

Background: Chimeric antigen receptor (CAR)-T cell therapy has become a groundbreaking treatment for hematological malignancies, particularly lymphomas and multiple myeloma, with high remission rates in refractory and relapsed patients. However, most CAR-T therapies target a single antigen, such as CD19, which can result in immune evasion through antigen escape. This mechanism describes the downregulation or complete loss of the targeted antigen by the tumor cells, eventually leading to relapse. To address this issue, multi-targeting strategies like logic-gated CARs, adapter CARs, or combination therapies can increase the potency of CAR-T cells. These approaches aim to minimize immune evasion by targeting multiple antigens simultaneously, thereby increasing treatment durability. Additionally, advanced tools such as next-generation sequencing (NGS), direct stochastic optical reconstruction microscopy (dSTORM), or multiparametric flow cytometry are helping to identify novel tumor-specific targets and improve therapy designs.

Summary: This review explores the current landscape of CAR-T cell therapies in lymphoid and myeloid malignancies, highlights ongoing clinical trials, and discusses the future of these innovative multi-targeting approaches to improve patient outcome.

Key messages: Antigen escape limits CAR-T cell therapy success, but multi-targeting strategies like logic gates and adapter CARs offer solutions. Optimizing antigen selection and CAR design, along with larger clinical trials, is essential for improving patient outcomes. Personalization using advanced technologies like CRISPR screening and single-cell RNA sequencing can enhance durability and effectiveness of treatments for heavily pretreated patients.

Introduction: This study aimed to evaluate the effectiveness of GPT-4o, with and without retrieval-augmented generation (RAG), in responding to soft tissue sarcoma (STS)-related queries.

Methods: The study used a 20-question dataset derived from clinical scenarios related to adult STS. The responses were generated by GPT-4o with and without the RAG approach. The RAG system incorporated the English version of German evidence-based S3 guidelines through an embedding-based retrieval system. Two sarcoma experts evaluated the responses for accuracy, comprehensiveness, and safety using a Likert scale. Statistical analyses were conducted to compare the performances.

Results: GPT-4o with RAG outperformed the model without RAG across all evaluated areas (p < 0.05). GPT-4o without RAG had a 40% error rate, which was reduced to 10% by the RAG approach. In 90% of the questions, the pages with the relevant information that addressed the questions were correctly cited using the retrieval system.

Conclusion: The RAG approach significantly enhanced the performance of GPT-4o in answering STS-related questions. However, the model still produced incorrect responses in certain complex scenarios. GPT-4o, even with RAG, should be used cautiously in clinical settings, particularly for rare diseases like sarcoma. Human expertise remains irreplaceable in medical decision-making.