Oncology Research and Treatment最新文献

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.

Introduction: Communication training (CT) enhances the communication skills of oncology healthcare professionals. Kommunikative Kompetenz und Performanz in der Arzt-Patient Beziehung fördern (KPAP; fostering communicative competence and performance of physician-patient relation) is an intervention study that evaluates the long-term effects 3 years after the CTs in the context of a CT programme. It is supported by the German Cancer Aid and conducted at the University Hospital of Cologne.

Methods: The aim of the study will be to assess the long-term communicative competence of physicians using a multimodal approach through self-assessment and external evaluation by trained experts and trained patient raters. Prior to the study, physicians working with cancer patients underwent a structured CT. Self-reported questionnaires were completed at the beginning (T0), at the end (T1) of the 2.5-day CT, and during a 6-h refresher session (T2) several months later. Participants were recorded on video while breaking bad news (BBN) to standardised patients. As part of this study, participants will complete self-reported questionnaires at least 3 years after the 2.5-day CT (T3). At T3, a subsample of participants (at least n = 60) will be video-recorded again. These simulated BBN encounters at T0 and T3 will be rated by trained patient raters and trained experts using the Bad News Consultation Assessment Scale (AGBS) and the Consultation and Relational Empathy instrument. The primary outcome will be the difference between AGBS scores at T3 and T0. Furthermore, expert raters will analyse these videos using Discourse Coding Analysis Software and the ComOn Rating Scale. Additionally, the health literacy of patient raters will be assessed using the European Health Literacy Survey (HLS-EU).

Conclusion: A more precise understanding of communicative competences, particularly by incorporating the patient's perspective, will enable the development of recommendations for future training and enhance the sustainability of CT.

Background: Allogeneic hematopoietic cell transplantation (alloHCT) is an established curative treatment for hematological malignancies and other severe blood disorders. However, alloHCT is also known for its significant side effects.

Summary: Here we review recent advances in targeted molecular therapy, immunotherapy, infectiology, and diagnostics that have enhanced the tolerability and efficacy of alloHCT, expanding its use to less fit and elderly patients. We analyze developments in conditioning regimens, donor selection, and the management of graft versus host disease (GVHD) and infections and discuss posttransplantation strategies to prevent relapse.

Key message: In a fresh perspective, alloHCT can serve as a platform to enhance the potential of emerging targeted and immune therapies.

Introduction: Immune checkpoint inhibitors (ICIs) are now standard of care in systemic treatment for many types of metastatic cancer, often together with cytotoxic chemotherapy. Monitoring of treatment efficacy against clinical trial benchmarks in real-world populations and subgroups such as elderly patients is necessary. Based on the results of a previous study, we evaluated age-related survival differences in a larger cohort.

Methods: Retrospective analysis of 272 patients managed in a rural real-world setting, after exclusion of those who had received neoadjuvant, adjuvant, or maintenance ICI treatment. We defined four different survival categories: death within 3 months of the first ICI dose, 3-6 months survival, 6-12 months survival, and >12 months survival. All surviving patients were followed for >12 months. Actuarial overall survival was assessed too. Age was stratified in 10-year increments.

Results: Non-small cell lung cancer (NSCLC) and malignant melanoma represented the most common tumor types. Median age was 70 years. Median actuarial overall survival was 13.6 months (5-year estimate 16%). The best survival was recorded in patients 61-70 years of age. The highest rate of early death within 3 months (29%) was seen in those aged >80 years. Long-term survival was not observed in this age group, in contrast to all others.

Conclusion: Satisfactory survival was observed in this elderly patient cohort, but survival varied with tumor type and performance status. Age was not a major determinant of survival. However, the oldest patients were at higher risk of short survival.

Background: Cancer survivorship brings numerous challenges extending beyond physical health to include psychological, social, and functional aspects that define the quality of life (QoL) of survivors. Although recognizing that diverse gender experiences lead to different ways of coping with these challenges, many clinical trials fail to account for the distinct constructs of "sex" and "gender," often conflating the two. This review highlights how gender-related aspects can manifest in core QoL domains for cancer survivors, emphasizing the importance of inclusive and effective support systems and interventions.

Summary: While interest in the impact of gender is increasing in cancer survivor research, the terms "sex" and "gender" are still often conflated in research. Gender is a social concept consisting of multiple dimensions, such as gender identity, gender roles and norms, and gender relations. Each of these dimensions can have a distinct impact on the QoL domain of cancer survivors. Research indicates that not gender identity, but gender roles, norms, and relations can significantly influence coping behaviors that, subsequently, impact QoL domains such as physical, emotional, social, and role functioning. Understanding the interplay of gender roles, norms, and their relations with other contextual social factors is crucial for developing inclusive and effective support systems and interventions for cancer survivors.

Key messages: Gender roles and norms impact important QoL domains of cancer survivors. It is important to recognize that gendered behaviors, as a result of internalized or socially desired gender roles and norms, can both help and hinder effective coping with cancer, affecting QoL.