Oncology Research and Treatment最新文献

Introduction: Approximately 50% of cancer patients use practices of complementary and alternative medicine (CAM). However, some of these methods may interact with oncological medication. Despite the generally increasing use of CAM in recent years, its prevalence has been studied insufficiently among cancer patients in Germany. Thus, this study aimed to assess the recent use of CAM among cancer patients, evaluate communication on CAM between patients and healthcare providers, and present an overview of the most frequently used practices.

Methods: A cross-sectional study was conducted using a standardized questionnaire including 19 CAM methods as well as sociodemographic and clinical parameters. Also, aspects of communication and quality of life were assessed. Patients were surveyed between September 2022 and June 2023, involving various entities such as breast cancer, lymphoma, and gastrointestinal malignancies. Data analysis was conducted using the Kruskal-Wallis test and one-factor ANOVA.

Results: In total, 154 patients (65.5% female) were included. 88.3% of patients reported use of CAM practices either before receiving their oncological diagnosis or after or both. Out of all patients, 62.3% of patients stated to have begun using at least one CAM practice post-diagnosis. 36.6% of all patients reported to have received information on potential drug interactions by their attending physician, while 60.8% informed their physician about their use of CAM. The most frequently used CAM methods were dietary supplements, massage therapy, and yoga. Overall, female patients reported use of CAM significantly more often than males.

Conclusion: Use of CAM methods appears to be common in this sample of cancer patients. To mitigate risks associated with potential drug interactions, enhanced communication and education between patients and healthcare providers is essential. Integrating a standardized questionnaire on CAM methods into routine oncological care may improve patient safety and treatment outcomes.

Introduction: Screening for anal cancer can help in its secondary prevention. We examined follow-up time for anal cancer screening among high-risk women living with HIV (WLHIV) and whether it varies with the number of risk factors for developing anal cancer.

Methods: A retrospective cohort study involving high-risk WLHIV under 65 enrolled in Medicaid for at least 2 years across 16 US states plus D.C. from 2009 to 2012. High risk was defined by a history of abnormal cervical test results or genital warts. Initial anal cancer screening was the first screening after a high-risk diagnosis, with results classified as normal or abnormal. Follow-up was until the next screening. Follow-up time was analyzed using the Kaplan-Meier estimator and the Cox Proportional Hazards model.

Results: Our cohort included 4,340 high-risk WLHIV, mean (±SD) age 41.8 (±10.2) years. About 18% (763/4,340) had both risk factors, while 9% (374/4,340) had abnormal results on their initial anal cancer screening. The median time, or the time at which 50% of the cohort received follow-up screening, was 17.53 (95% CI = 16.13, 18.30) months overall. Follow-up screening was more common in women with both risk factors for developing anal cancer compared to those with one risk factor (median time: 10.13 [95% CI = 8.90, 11.47] vs. 19.56 [95% CI = 18.36, 21.40] months; adjusted hazard ratio [aHR] = 1.53 [95% CI = 1.38, 1.68]). The follow-up was also more common in women with abnormal results on the initial screening compared to those with a normal result (median time: 7.00 [95% CI = 5.40, 9.23] vs. 18.91 [95% CI = 17.92, 20.12] months; aHR = 2.00 [95% CI = 1.76, 2.28]).

Conclusion: Follow-up time for anal cancer screening in high-risk WLHIV was about 1.5 years but varied according to the risk of developing anal cancer. Future research should examine the guideline-concordance of follow-up screening time given the recently issued guidelines for anal cancer screening.

Background: Current breast cancer (BC) surveillance is limited to the detection of local, locoregional, or contralateral recurrence. This is based on two outdated studies from the 1990s and ignores current evidence on liquid biopsies, particularly circulating tumor DNA (ctDNA).

Summary: ctDNA has been shown to be a reliable prognostic biomarker in early BC surveillance. It can be detected using a tumor-informed or tumor-agnostic approach. However, conclusive evidence for a survival benefit from ctDNA-guided follow-up, as needed for a paradigm shift in BC surveillance, is still lacking. According to current studies, the lead time, i.e., the time from biomarker detection to clinically overt relapse, can be up to several months. This stage of MRD (minimal or molecular residual disease) offers a new therapeutic window, and currently, several studies are evaluating the efficacy of treatments initiated within this therapeutic window, based on a positive biomarker finding. Liquid biopsy might also open up the possibility of de-escalating therapy in patients with a negative biomarker result.

Key messages: ctDNA detection predicts clinical breast cancer recurrence with high sensitivity and specificity. The interval between ctDNA detection and clinical recurrence is defined as lead time and represents a stage of molecular residual disease (MRD). ctDNA-based surveillance and adjuvant therapies have the potential to improve patient outcomes and are currently being evaluated in clinical trials.

Introduction: Artificial intelligence (AI) models offer potential benefits in supporting clinical decision-making, diagnosis, and treatment. The study aimed to compare the performance of ChatGPT-4o (Omni) and Gemini Pro in answering clinical questions and case scenarios related to gynecological oncology and to assess the consistency of their long-term responses.

Methods: A two-phase comparative analysis was conducted. 700 clinical questions (350 per model) were developed and categorized into open-ended and case-scenario questions. Three months later, the same set of questions was presented again to evaluate any changes in performance for accuracy, completeness, and guideline adherence.

Results: Omni outperformed Gemini Pro across all question types (p = 0.001). Omni achieved a mean score of 5.9 for the basic open-ended questions, higher than Gemini, which had 5.1 (p = 0.001). It also maintained a clear advantage in complex, open-ended questions, scoring a mean of 5.6 than Gemini AI's 4.2 (p = 0.001). Omni scored a mean of 5.7 for basic case scenarios, while Gemini AI lagged with a mean score of 5 (p = 0.001). Omni showed a modest improvement in complex, open-ended queries, with an increase of 0.2 points (+3.57%) (p = 0.001). Omni provided more accurate and comprehensive responses in guideline adherence than Gemini, particularly in complex cases requiring nuanced judgment and adherence to oncology protocols. Its responses aligned with the latest guidelines, including the American Society of Clinical Oncology and the National Comprehensive Cancer Network.

Conclusion: Omni is a more reliable and consistent model for answering questions related to gynecological cancers than Gemini. The stability of Omni's performance over time highlights its potential as an effective tool for clinical applications requiring high accuracy and consistency.

Introduction: Systematic therapies, including tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), have now been approved as the mainstay treatment for patients with unresectable hepatocellular carcinoma (uHCC). However, only a minority of the patients are expected to respond to TKIs and ICIs. Because early tumor shrinkage (ETS) and depth of response (DoR) might have the potential to predict survival outcomes, this study aimed to identify the optimal cutoffs for ETS and DoR to predict patients' clinical outcomes in their early treatment stage.

Methods: This retrospective study enrolled patients with uHCC treated with triple combination therapy of transcatheter arterial chemoembolization (TACE) and lenvatinib plus toripalimab between November 2017 and March 2022. The clinical characteristics, ETS, DoR, and overall efficacy were collected to analyze the optimal cutoffs for ETS and DoR and predict patient survival outcomes.

Results: A total of 157 patients were included. The objective response rate (ORR) and disease control rate (DCR) were observed in 94 (59.87%) and 130 (82.8%) patients, respectively, with a median progression-free survival (mPFS) of 8 months and a median overall survival (mOS) of 23 months. Patients with ETS ≥10% had significantly longer mPFS (11 months) and mOS (24 months), and patients with DoR ≥27% had significantly prolonged mPFS (10 months) and mOS (23 months).

Conclusion: ETS of 10% and DoR of 27% were identified as the optimal cutoffs for predicting the clinical outcomes of patients with uHCC treated with TACE and lenvatinib plus a programmed death-1 inhibitor.

Introduction: Multidisciplinary team (MDT) oncology meetings foster collaboration among healthcare practitioners to determine the most appropriate course of action for cancer patient care. Defining what is "best" for a patient is complex, involving clinical guidelines, patient needs, evidence-based practices, and available treatment options. Patient participation offers unique insights into cultural and psychosocial preferences, shifting away from the paternalistic healthcare model. This study aimed to explore the benefits, barriers, and challenges associated with integrating patient preferences (PPs) into oncology MDT decision making.

Methods: Thirty participants from two major UK oncology centers completed questionnaires, with eight participating in the follow-up interviews.

Results: The key benefits of incorporating PPs included improved patient satisfaction, treatment adherence, and decision-making efficiency. The major barriers were lack of clinical information, insufficient knowledge of preferences, and time constraints. Challenges within MDT meetings include poor attendance of key clinicians, inadequate chairing, and physical constraints.

Conclusion: This is the first UK-based study to explore physicians' perspectives on incorporating PPs into oncology decision-making. While PPs are valued, integration is often hindered by systemic pressure within the NHS. The findings highlight the complex interplay between patient-centered care ideals and practical implementation challenges, suggesting areas for improvement that incorporate patient voices into cancer care decision-making.

Introduction: The complex, multifactorial nature of gastric cancer presents significant challenges in the development of effective immunotherapies. Targeting immune checkpoints has emerged as a promising strategy, with blockade therapies demonstrating clinical success. However, resistance in a subset of patients emphasizes the need for alternative approaches. Exploration of novel immune checkpoints, particularly on natural killer (NK) cells, could enhance the efficacy and potency of immunotherapy, offering new avenues for overcoming resistance and improving patient outcomes. NK cells are crucial in the primary defense against viral infections, tumor development, and metastasis. The cytotoxic function of NK cells is finely regulated by a complex array of activating and inhibitory receptors, including checkpoint receptors. Malignantly transformed cells can impair NK-cell activity by expressing soluble or membrane-bound checkpoint ligands, thereby modulating immune responses to support tumor progression.

Methods: To investigate this dilemma, we simulated in vitro activation by NK-cell co-incubation with K562 cells and analyzed expression of TIM-3, LAG-3, TIGIT, and Siglec-7. After that, we analyzed the checkpoint expression of circulating NK cells from 35 healthy donors and compared it to their expression in patients with gastric cancer (n = 21) using flow cytometry.

Results: In healthy donors, we observed that 25-97% of all circulating NK cells expressed TIM-3, TIGIT and Siglec-7, while only a small fraction of 0.6% expressed LAG-3. Co-incubation of peripheral blood mononuclear cells from healthy donors with K562 cells resulted in heightened expression levels of TIM-3 and TIGIT on NK cells. Conversely, NK cells in patients with gastric cancer showed an increased LAG-3 and reduced Siglec-7 expression.

Conclusion: Our findings suggest the potential of LAG-3 as a next-generation checkpoint molecule, alongside Siglec-7. Especially targeting the sialic acid-Siglec-7 axis may offer promising therapeutic strategies for various cancer types in the future.

Introduction: Paraneoplastic neurological syndromes are rare manifestations of cancer, characterized by autoantibodies targeting neuronal antigens. These syndromes often precede or accompany cancer diagnosis, complicating their interpretation. In this case report, we present the first documented patient with paraneoplastic papillitis causing visual disturbances in association with colorectal adenocarcinoma.

Case presentation: A 76-year-old female presented with acute vision loss and difficulty walking. A multidisciplinary team, including an ophthalmologist, neurologist, gastroenterologist, radiologist, and oncologist, collaborated to diagnose early-stage adenocarcinoma of the ascending colon. This diagnosis was triggered by the detection of anti-CV2 and anti-amphiphysin antibodies in cerebrospinal fluid, indicative of PNS.

Conclusion: This case underscores the necessity of considering colorectal carcinoma in the differential diagnosis of inflammatory cerebrospinal fluid syndromes and highlights the crucial role of interdisciplinary collaboration in identifying rare paraneoplastic conditions.