Oncology Research and Treatment最新文献

Introduction: The COVID-19 pandemic has impacted the treatment of prostate cancer (PCa). The study examines any predictions that could point to future models.

Methods: Two interrupted time series analyses were conducted: one for the pre-COVID period (January 2017 to December 2019) and another for the post-COVID period during 2022. Information on age, total prostate-specific antigen (PSA), abnormal digital rectal exam (DRE), prostate volume, previous negative biopsy, number of positive biopsies, Gleason score, and biopsy outcome were collected for all patients. The categories for the results were no cancer, insignificant, low and intermediate, high-risk, and very high-risk PCa. Using a generalized linear model (GLM), the outcomes are modeled. The area under the curve (AUC) and accuracy were used to assess how well multi-class predictions performed.

Results: Overall, 244 patients who had biopsies following the COVID-19 pandemic and 832 patients who had biopsies before the pandemic were compared. The accuracy of the GLM was only 0.635. The AUC for categories no-cancer, low- and intermediate-risk, and very high-risk patients was 0.821, 0.716, and 0.926. With scaled relevance values, PSA was the most critical test. The two features that significantly influenced the treatment model prediction for PCa were biopsy PSA level and DRE, respectively.

Conclusion: Advanced age and a very high-risk group appear to have a detrimental impact on the results of biopsies conducted after the first wave of the COVID-19 era. At the same time, PSA levels and abnormal DRE are the most significant predictors in GLM.

Introduction: Up to 40% of long-term cancer survivors suffer from chronic cancer-related pain (CCRP) with often inadequate treatment. CCRP is influenced by biopsychosocial factors, with interdisciplinary multimodal pain therapy (IMPT) being a comprehensive treatment option. In our study, patients with CCRP were asked about their treatment satisfaction and treatment wishes.

Methods: Two anonymous online surveys on CCRP in long-term survivors were analyzed: survey 1 from cancer self-help group members and survey 2 from patients with CCRP assessed at the Interdisciplinary Pain Center (IPC), resulting in recommendations ranging from outpatient treatment to IMPT.

Results: Thirty-eight members of 8 self-help groups in survey 1 and 50 of 158 patients with CCRP in survey 2 completed the questionnaire. In both surveys, relevant pain impairment and pain therapy dissatisfaction were identified. A higher intensity of therapy, including the implementation of IMPT, did not lead to better pain control. Consistent with the biopsychosocial factors in CCRP, increased depression scores and increased treatment dissatisfaction correlated. In both surveys, participants expressed extensive therapy wishes.

Conclusion: Despite comprehensive therapeutic approaches, long-term survivors with CCRP suffer from severe pain and treatment dissatisfaction. Biopsychosocial influences are evident, with depression worsening treatment satisfaction. Classical IMPT for CCRP may not be targeted enough and a more specific therapeutic approach should be developed and must be tested using patient-reported outcome measures.

Introduction: Previous research indicates that combining antiviral and anti-tumor drugs may lead to compounded toxic side effects and risks of drug-drug interactions. Our study aimed to investigate the safety and effectiveness of pharmacotherapy combining second-generation integrase inhibitors (INSTIs) with chemotherapy drugs in patients with AIDS-related diffuse large B-cell lymphoma (AR-DLBCL).

Methods: We conducted a retrospective cohort study of newly diagnosed AR-DLBCL patients at the Public Health Clinical Center of Chengdu from February 2020 to May 2023. All patients received a second-generation INSTI-based regimen alongside chemotherapy. Primary endpoints included the frequency and severity of adverse effects (AEs), while secondary endpoints encompassed CD4 count, CD4/CD8 ratio, HIV viral load, and complete response (CR), partial response (PR), and overall response rate (ORR) at the end of treatment. Evaluations were performed at each chemotherapy cycle, with AEs assessed using Common Terminology Criteria for Adverse Events, version 4.02.

Results: We enrolled 96 AR-DLBCL patients with a median follow-up of 15.5 months (range: 5-33). Of these patients, 60 received bictegravir/tenofovir alafenamide/emtricitabine, while 36 were treated with dolutegravir/lamivudine/albuvirtide as their antiretroviral therapy regimen. Regarding chemotherapy, 75 patients underwent R±CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), while 21 received R±EPOCH (rituximab, etoposide, doxorubicin, vincristine, cyclophosphamide, and prednisone). The most common grade 3 or higher AEs during treatment were neutropenia (32.29%) and thrombocytopenia (20.83%). Seven patients experienced serious complications during treatment, including pulmonary tuberculosis (2), multiple organ dysfunction (1), intracranial infection (1), renal failure (1), and severe COVID-19 (2), resulting in 3 deaths. CD4 count and CD4/CD8 ratio showed slight decreases from baseline (251.76 ± 188.53 cells/μL and 0.71 ± 0.69, respectively) to the 6th month (233.44 ± 140.53 cells/μL and 0.66 ± 0.55, respectively), with no statistical significance observed (p = 0.375 and p = 0.608). Viral load rebound was not observed. The objective response rate was 85.41%, with a CR rate of 51.04%. As of June 2024, 15 patients had died from severe infections or progressive disease.

Conclusion: Second-generation INSTIs seem to be a safe and effective first-line treatment option for AR-DLBCL patients undergoing chemotherapy, regardless of the chemotherapy type.

Introduction: Epidural anesthesia is a standard procedure to mitigate pain during surgery for endometrial cancer (EC). Little data exist about the influence of epidural anesthesia on the oncological outcome in elderly patients with EC. This retrospective study aimed to investigate potential correlations between epidural anesthesia and cancer recurrence in patients with EC.

Methods: We screened the medical records of patients ≥60 years treated surgically for EC at the University Medical Center Mainz between January 2008 and December 2019. All women underwent general anesthesia (GA) alone or combined with epidural anesthesia (EGA). Cox regression, the Kaplan-Meier method and propensity score matching were used to analyze the prognostic influence of the anesthesiologic regime on survival.

Results: A total of 152 women with EC were included. Twenty-nine patients (19.1%) formed the EGA cohort. The median time of follow-up (FU) was 31 months (interquartile range [IQR]: 8-67.5). The EGA cohort showed more in-hospital complications (27.6 vs. 8.9%; p = 0.006), especially thromboembolic events (3 vs. 0 events; p = 0.006), as well as a longer hospital stay (11 [IQR: 8-13] vs. 7 [IQR: 4-9] days; p < 0.001). Twenty-six patients (17.1%) developed a recurrence in the follow-up at a median of 13 months [IQR: 7.75-29.5]. Thirty-two patients died during FU (21.1%). The EGA cohort showed higher FIGO stages and a higher histological grading than the GA cohort. In the Kaplan-Meier analysis, EGA showed a significantly reduced 5-year recurrence-free survival (RFS) (36.5% vs. 72.6%, p < 0.001) and overall survival (OS) (58.6% vs. 79.9%, p = 0.008). However, in multivariate Cox regression analysis including FIGO stages and histological grading, EGA did not influence RFS (HR: 2.02; 95%-CI: [0.99-4.12], p = 0.054), and OS (HR: 1.03; 95%-CI: [0.40-2.66], p = 0.951). This was backed up by the propensity score- matched analysis for survival (RFS: p = 0.604, OS: p = 0.86).

Conclusion: Considering risk factors, epidural anesthesia in combination with GA did not differ in recurrence-free and overall survival compared to GA. Prospective randomized trials are warranted in order to further evaluate this topic.

Introduction: Endometrium cancer is the most common gynecological malignancy in developed countries. In this study, we aimed to investigate the effect of HER2 positivity on prognosis in endometrial cancer.

Methods: In our study, patients admitted to our clinic with a diagnosis of endometrial cancer between September 2019 and December 2023 were retrospectively evaluated. Human epidermal growth factor receptor 2 (HER2) immunohistochemistry was performed in 121 patients. HER2-low group (HER2 score: 0 and 1) and HER2-high group (HER2 score: 2 and 3) were defined according to the HER2 immunohistochemistry score in the pathology, and patients were compared accordingly.

Results: We observed that 97 (80.2%) of the patients were in the HER2-low group, while 24 (19.8%) were in the HER2-high group. In the OS analysis, age (p = 0.381), menopausal status (p = 0.511), ECOG performance status (p = 0.087), histological type of tumor (p = 0.727), pathological grade (p = 0.206), serum LDH (p = 0.091), and albumin (p = 0.315) levels did not affect the prognosis. Patients with lower FIGO stage (p = 0.003) and HER2-high patients (p = 0.040) had better survival outcomes. Multivariable analysis showed that FIGO stage (p = 0.004) and HER2 status (p = 0.040) were independent risk factors affecting survival in endometrial cancer.

Conclusion: As a result of our study, it was observed that FIGO stage and HER2 status were independent risk factors affecting OS in endometrial cancer patients. HER2-high group had a better prognosis than HER2-low group.

Background: Tumor is a major public health problem worldwide and poses a serious threat to human life and health. Vitamin D deficiency increases the risk of developing tumors.

Summary: Epidemiological evidence supports the antitumor effect of vitamin D mainly comes from the binding of its active metabolites and vitamin D receptor to play relevant biological functions. The meta-analysis generally reported that high vitamin D status was a protective factor for breast cancer. In addition, the relationship of vitamin D-related gene polymorphisms with the tumor and the relationship between vitamin D levels and tumor occurrence and risk have also attracted much attention.

Key messages: This paper reviews the research progress of vitamin D metabolism, potential anticancer mechanisms in the tumor microenvironment, and its relationship with the risk of different tumors, and explores the relationship between vitamin D-related gene polymorphisms and tumors, providing theoretical reference for primary prevention of future tumors.

Background: The detection of circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) in breast cancer has seen significant progress over the last two decades. These blood-based biomarkers offer a minimally invasive alternative to traditional methods for assessing disease progression and monitoring treatment response, with the potential to transform breast cancer management.

Summary: CTCs and ctDNA have emerged as valuable tools for prognosis and treatment guidance in breast cancer. Studies have shown that CTC count correlates with survival and changes in CTC levels can predict clinical outcomes (STIC CTC, DETECT III). Additionally, the molecular characterization of CTCs can help guide therapy (DETECT III). ctDNA, while also predictive of survival (BioItaLEE), provides further utility in identifying treatment failure (PADA-1, PALOMA III) and functions as a real-time tumor biopsy (plasmaMATCH, MONALEESA). Despite these promising advances, challenges remain, including the rarity of CTCs and the need for standardization in ctDNA detection methods.

Key messages: CTC and ctDNA detection have improved significantly and hold the potential for less invasive breast cancer management. CTCs are associated with survival outcomes and treatment guidance, while ctDNA is helpful in predicting treatment failure and can serve as a dynamic tumor biopsy. Ongoing research is needed to address the challenges of CTC rarity and variability in ctDNA detection methods for widespread clinical use.

Introduction: Cancer-related malnutrition is a highly prevalent, yet often overlooked concern in clinical practice. Although cancer-related management guidelines recommend standardized nutritional care, its implementation is scarce. The aim of this study was to investigate the prevalence of malnutrition and the medical need for nutrition counseling in cancer patients employing a novel standardized nutritional management program (containing malnutrition risk screening, nutritional assessment, and counseling). Furthermore, differences of malnutrition parameters in different cancer patient cohorts were examined.

Methods: Cancer patients were screened for malnutrition using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) on the first day of their inpatient admission to the internal oncology or hematology wards. PG-SGA total score and classification into the three PG-SGA nutrition stages (A, B, C) were used to determine nutritional status. In case of a positive screening, nutritional assessment and individualized counseling by a nutritionist followed. For group comparisons, patients were divided into different groups (e.g., age, gender, tumor entity) and were evaluated accordingly.

Results: A total of 1,100 inpatients were included. 56.8% of the patients had suspected or already existing malnutrition. The most common nutrition impact symptom was loss of appetite (26.7%), followed by fatigue (16.5%) and pain (16.0%). Female (p < 0.001), elderly (p < 0.001), and patients with upper gastrointestinal tract tumors (p < 0.001) showed an unfavorable nutritional status and higher need for counseling. Despite suffering from malnutrition, patients had body mass indices within the upper end of the normal range.

Conclusion: This study shows a high prevalence of malnutrition in hospitalized cancer patients and highlights the need for a standardized nutritional management in the clinical setting. Therefore, it is recommended to provide a malnutrition risk screening for all cancer patients and a following adequate assessment and personalized nutritional care if needed.

Background: Ovarian cancer (OC) remains the most common cause of death among all gynecological cancer. For early-stage disease (FIGO stages I and II), staging surgery followed by chemotherapy (CT) with carboplatin ± paclitaxel often results in high rates of progression-free and overall survival. However, this is not the case for advanced-stage disease (stages III and IV), where recurrence rates are significantly higher. Consequently, additional therapeutic strategies, such as maintenance treatment, are essential to improve outcomes in these patients.

Summary: Several randomized controlled trials have proven the benefit of bevacizumab, an anti-vascular endothelial growth factor antibody (anti-VEGF) as first-line maintenance treatment. Molecular testing led to the introduction of poly (ADP-ribose) polymerase inhibitors (PARPis), with outstanding results in BRCA-mutated (BRCAmt) and homologous recombination-deficient without BRCAmt (HRd) tumors, but not as ideal in HR-proficient (HRp) tumors, which make up the majority of the OC tumors; therefore, further research in this category of tumors is urgently warranted. Immunotherapy, both with CT and as maintenance, failed to improve survival in advanced OC.

Key messages: Combining multiple drug classes (immune checkpoint inhibitors, anti-VEGF, and PARPi) was able to improve survival; results in HRp tumors are however still pending. Phase 2 and 3 trials are underway to investigate more innovative treatment of OC.