Oncology Research and Treatment最新文献

This article presents new relevant aspects of the recently updated German, Swiss, Austrian Onkopedia guideline for the treatment of esophageal cancer. The full guideline can be accessed at https://www.onkopedia-guidelines.info/en/onkopedia/guidelines/esophageal-cancer/@@guideline/html/index.html. All rights for the use of text sections and figures have been obtained. The most important aspects in the perioperative treatment of resectable esophageal adenocarcinoma include the recommendation for the use of perioperative chemotherapy with FLOT as it was shown superior to preoperative chemoradiotherapy analogous CROSS in the ESOPEC trial. Furthermore, there is increasing evidence for the effectivity of targeting therapy and immune checkpoint inhibition in certain molecular defined subgroups. Immune checkpoint inhibition is recommended in combination with perioperative chemotherapy (FLOT) for MSI-H tumors, whereby the treatment should preferably take place in studies. In the metastatic setting, the approval for the PD-1 inhibitor tislelizumab was extended to the first-line treatment of both squamous cell carcinoma and adenocarcinoma of the esophagus (TAP score (≥5%) and for second line for squamous-cell cancer only (independent of PD-L1 expression). Moreover, for gastroesophageal junction (GEJ) tumors, pembrolizumab is available upon PD-L1 expression (CPS ≥1) according to the data of the KEYNOTE-859 trial. In addition to the established biomarkers HER2 und PD-L1, Claudin 18.2 represents now a new targetable option. First-line chemotherapy is to be combined with zolbetuximab in Claudin 18.2 positive GEJ tumors. For biomarker-negative adenocarcinomas of the esophagus and GEJ, a modified triplet regimen (TFOX) is a newly presented treatment option. Because of high toxicity rates and yet unclear survival benefit this option is only recommended for docetaxel-naïve patients with high remission pressure.

Introduction: In urological oncology, the physical and psychological effects of cancer and its treatment post-discharge highlight the importance of follow-up psycho-oncology consultations. This study examines their utilisation and identifies predictors in urological cancer patients after inpatient care.

Methods: A prospective, single-centre clinical observational study was conducted. Inpatients with urological cancer and ≥5 points on the Distress Thermometer and/or request for psycho-oncological support were recruited, offered an initial psycho-oncology consultation, and can attend up to five online or on-site appointments within 3 months of discharge. The following variables were collected: socio-demographics, psycho-oncological baseline documentation (PO-BADO), psychosocial distress (Distress Thermometer with problem list), anxiety and depressive symptoms (GAD-2 and PHQ-2), and performance status (ECOG).

Results: A total of 501 patients were screened, 139 were included, and 108 were analysed. Twenty five patients used psycho-oncological follow-up care (n = 16 online). The final hierarchical model predicting the use of follow-up psycho-oncological support included the two predictors: age (OR 0.93, 95% CI 0.90-0.96) and anxiety (OR 1.60, 95% CI 1.11-2.44).

Conclusion: Nearly 1 in 4 urological cancer patients use follow-up psycho-oncology consultations, mostly online. Predictors for this usage are younger age and higher levels of anxiety. To improve care, (1) online services reduce barriers; (2) older patients require support with these services; and (3) screening specifically for depression is crucial to ensure that follow-up appointments are scheduled as a mandatory part of hospitalisation.

Introduction: In urological oncology, the physical and psychological effects of cancer and its treatment post-discharge highlight the importance of follow-up psycho-oncology consultations. This study examines their utilisation and identifies predictors in urological cancer patients after inpatient care.

Methods: A prospective, single-centre clinical observational study was conducted. Inpatients with urological cancer and ≥5 points on the Distress Thermometer and/or request for psycho-oncological support were recruited, offered an initial psycho-oncology consultation, and can attend up to five online or on-site appointments within 3 months of discharge. The following variables were collected: socio-demographics, psycho-oncological baseline documentation (PO-BADO), psychosocial distress (Distress Thermometer with problem list), anxiety and depressive symptoms (GAD-2 and PHQ-2), and performance status (ECOG).

Results: A total of 501 patients were screened, 139 were included, and 108 were analysed. Twenty five patients used psycho-oncological follow-up care (n = 16 online). The final hierarchical model predi

Introduction: The introduction of immune checkpoint inhibitors (CPIs) in oncology has improved the long-term perspectives of many patients and is bringing the quality of life (QoL) into focus as a treatment-relevant variable. In clinical routine, standardized and reliable tools for collecting, understanding, and utilizing QoL information are needed. In the current work, an interdisciplinary consensus on aspects of QoL in standard clinical practice has been put forth.

Methods: After independent, structured individual interviews with members of an interdisciplinary expert panel (n = 12), ten theses on QoL with particular consideration regarding CPI therapy were drafted. These formed the basis of a multistage, independent, anonymous, externally commented, qualitative Delphi process. During the period May - December 2022, the panel developed interdisciplinary consensus recommendations for recording QoL and its role in decision-making in everyday care.

Results: Out of ten theses, five recommendations arranged into three subject areas were agreed upon. QoL is considered a multifactorial and dynamic parameter that goes far beyond treatment-associated side effects. Mindful communication with the patient is considered the basis for QoL assessment and QoL modification. In everyday clinical practice, QoL should be documented and assessed in a structured, regular, and individualized way, thereby providing a basis for decisions on treatment options.

Conclusion: The individual QoL of cancer patients should be assessed before and throughout therapy. Especially for long-term responders of CPI therapy and in the adjuvant setting, QoL appears to be treatment relevant. The recommendations based on the Delphi method provide practical assistance.

Introduction: Cancer-associated venous thromboembolism (CAT) is a frequent and medical relevant problem. Guidelines recommend treatment with low molecular weight heparins (LMWH) or direct oral factor-Xa inhibitors as rivaroxaban for ≥3 months. Patient's preference and convenience is an important factor to guide treatment decision and to support treatment adherence. No data are available so far about patient-reported outcome in CAT.

Methods: CONKO-011/AIO-SUP-0115/ass. was an open-label, prospective, multicenter German phase III trial for cancer patients with newly diagnosed venous thromboembolism (VTE) randomized to rivaroxaban (Riva) or site-specific LMWH. Primary endpoint was patient-reported treatment satisfaction, measured by the Anti-Clot Treatment Scale (ACTS). The 12-item ACTS Burdens scale (primary endpoint after 4 weeks) and the 3-item ACTS Benefits scale were analyzed at 4, 8 and 12 weeks. Secondary endpoints included recurrent VTE, major/clinically relevant bleeding, safety, compliance, overall mortality at 3 and 6 months, quality of life measured by the Treatment Satisfaction Questionnaire for Medication II (TSQM II) and Spitzer Index.

Results: Between 03/2016 and 06/2019, 247 (123 Riva/124 LMWH) patients were randomized. Mean ACTS Burdens scores after 4 weeks were 52.8 versus 51.2 in favor of rivaroxaban (p = 0.019) with mean score differences ranging from 3.3 (week 8; p = 0.001) to 2.4 (week 12; p = 0.006). The treatment effect of ACTS burden was consistent over treatment time (p < 0.001). More patients on LMWH requested to stop study treatment preterm (19.4% versus 11.1%).

Conclusion: Oral treatment with rivaroxaban led to an improvement in patient-reported treatment satisfaction, particularly in reducing anticoagulation-related burden, resulting in less patient-requested treatment stops.

Introduction: In clinical practice, clinicians often perform repeat colonoscopy before colorectal cancer (CRC) surgery to accurately assess tumor location, size, and the presence of other underlying lesions. No previous study has reported the safety of the interval from colonoscopy to laparoscopic CRC surgery on surgical outcomes. The purpose of this study was to evaluate the safety of the interval from colonoscopy to laparoscopic CRC surgery on surgical outcomes using propensity score matching (PSM).

Methods: The patients who underwent CRC surgery were retrospectively collected from a single clinical teaching hospital from January 2008 to January 2021. The interval from colonoscopy to laparoscopic CRC surgery was divided into the colonoscopy within 24-h group and the colonoscopy over 24-h group. The short-term outcomes were compared between the two groups.

Results: A total of 5,439 patients were included in this study. There were 529 CRC patients in the colonoscopy within 24-h group, and 4,910 patients in the colonoscopy over 24-h group before PSM. After 1:1 ratio PSM, there were 529 patients in each group and no significant difference was found in the two groups (p > 0.05) in terms of baseline information. As for short-term outcomes, the colonoscopy within 24-h group had 11.2 ± 7.1 days' postoperative hospital stay, which was longer than that of 10.4 ± 6.1 days' postoperative hospital stay in the colonoscopy over 24-h group (p < 0.05); however, no significant difference was found in operation time (p = 0.098), intraoperative blood loss (p = 0.445), retrieved lymph nodes (p = 0.409), overall complications (p = 0.135), or Clavien-Dindo ≥ grade 3 complications (p = 0.652) between the two groups.

Conclusion: Colonoscopy within 24-h prior to laparoscopic CRC surgery is safe.

Introduction: Pancreatic cancer remains a lethal disease with limited therapeutic options. Treatment with PARP inhibitors has been successfully described mainly in patients with germline mutation in BRCA1/2. The efficacy of PARP inhibitors in patients with alterations in other genes in the homologous repair pathway is under discussion.

Case presentation: A 77-year-old male patient with metastatic pancreatic ductal adenocarcinoma (PDAC) was initially treated with 5-fluoruracil, oxaliplatin, and irinotecan, followed by 5-floururacil and irinotecan over the course of 1 year, leading to sustained partial remission. Molecular genetic analysis of the tumor revealed an inactivating R2034Ter mutation in the ataxia telangiectasia serine/threonine kinase gene (ATM), being part of a homologous DNA damage repair pathway eventually involving BRCA1 and BRCA2. After discussion in the molecular tumor board, the patient received off-label olaparib maintenance therapy, under which disease was stable over a period of 18 months. After developing one new liver metastasis at 21 months on olaparib, he received conventional therapy with gemcitabine/cisplatin to which he responded.

Conclusion: This is the first case of an R2034Ter ATM mutant PDAC with sustained clinical response under olaparib maintenance therapy reported. In select cases, ATM, a member of the BRCA pathway, might be a druggable target in pancreatic cancer.