South Asian Journal of Cancer最新文献

Background: Global phase III trials demonstrated efficacy of abemaciclib in patients with HR +/HER2- metastatic breast cancer (BC) as a first-line therapy in combination with a nonsteroidal aromatase inhibitor (MONARCH-3) or with fulvestrant following progression after endocrine therapy (ET) (MONARCH-2). However, there is limited data on safety and tolerability of abemaciclib plus ET in the metastatic BC setting among Indian patients, which the present study aims to address.

Materials and methods: An open-label, single-arm, phase IV study was conducted across 16 centers in India to assess the safety and tolerability of abemaciclib in patients with HR +/HER2- locally advanced or metastatic BC. Patients were assigned to either cohort A, ET-naive patients (abemaciclib + anastrozole/letrozole) or cohort B, patients progressing after previous ET (abemaciclib + fulvestrant), targeting the same patient population as the global phase III MONARCH-3 and MONARCH-2 trials, respectively. Primary endpoints were all-cause adverse events (AEs) including serious AEs (SAEs).

Statistical analysis: The statistical analysis was conducted using SAS Version 9.4.

Results: Two hundred patients were enrolled, with a mean age of 54 years, most (77.0%) were aged ≤ 65 years. The median duration of exposure was similar in both cohorts (cohort A vs. B: 24.3 vs. 24.4 weeks). Overall, 75.5 % of patients reported all-cause AEs, of which 38.5% of the patients reported AEs Common Terminology Criteria for Adverse Events grade 3 and above. The most common grade 3 and above all-cause AEs for abemaciclib were neutropenia (19.0%), followed by anemia (14.0%) and diarrhea (5.5%). Fourteen (7.0%) patients encountered SAEs, including infections (2.0%) and gastrointestinal disorders (1.5%). Most of the patients continued their treatments with appropriate dose reductions (25.5%) and dose omissions (40.5%), and only 2.5% of patients discontinued study treatment due to treatment-related AEs.

Conclusion: Abemaciclib in combination with ET was found to have an acceptable tolerability in Indian patients with HR +/HER2- advanced and metastatic BC, consistent with the established safety data as reported in the pivotal global studies. No new clinical safety concerns were identified, with most of the reported AEs and SAEs managed by dose adjustments.

Familial adenomatous polyposis is an important hereditary risk factor for colon cancer. Such patients and families need special attention for prevention, early detection, and optimal treatment. Molecular testing is key to identify the specific mutation in the proband and can then make it easier to identify other family members at risk. Aggressive surveillance and colonoscopy will be indicated in most patients. Both colonic and extra-colonic manifestations are important. Chemoprevention is worth considering. Almost all patients will ultimately need colectomy. These details will be discussed in this review.

A major advance in rectal cancer was the evidence supporting short-course radiotherapy and long-course chemoradiotherapy. Both have been shown to improve local outcomes. Total neoadjuvant therapy (TNT) is the new kid on the block that provides further benefit of improving local responses as well as reducing systemic relapses, thus increasing overall survival. Details of the four key TNT trials are discussed. They pave the way for nonoperative management for patients who achieve clinical complete responses.

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, significantly increases the risk of colitis-associated cancer (CAC). Chronic inflammation, a key contributor to carcinogenesis, disrupts immune surveillance, induces deoxyribonucleic acid (DNA) damage, and alters genetic and epigenetic pathways. Molecular pathways such as STAT3, mTOR, and NF-κB drive CAC progression, while unique microbiome alterations-loss of Faecalibacterium prausnitzii and increases in Escherichia coli and Fusobacterium species-exacerbate the inflammatory milieu. CAC accounts for 2% of all colon cancers and up to 15% of IBD-related deaths. Risk correlates with IBD duration, increasing approximately 1% annually after the first decade. Surveillance via colonoscopy is crucial, with chromoendoscopy recommended for high-risk cases. Preventive drugs, including aminosalicylates, thiopurines, and biologics, offer modest benefits but lack conclusive evidence. Post-CAC diagnosis, immunosuppressants are discontinued in favor of corticosteroids, with 5-aminosalicylates continued as needed. The use of immune checkpoint inhibitors remains controversial due to exacerbation of colitis. Emerging insights into the gut microbiota's role in IBD and CAC may revolutionize prevention and management strategies. Advances in screening, surveillance, and therapeutic approaches have reduced CAC mortality, underscoring the importance of personalized medicine and ongoing research to address these complex conditions.

The present review highlights the role of computed tomography (CT), CT colonography (CTC), and magnetic resonance imaging (MRI) in the diagnosis, staging, response evaluation, and follow-up of colorectal cancer. For a CT scan, prior bowel preparation is required. This is done to enhance imaging of the colon with the use of oral or rectal contrast agents. Negative contrast like air or carbon dioxide are helpful in detecting polyps and masses by distending the colon. Virtual colonoscopy offers a lower-radiation alternative for polyp and cancer detection. Intravenous contrast administration with arterial and venous phase CT images is also important in complete staging of a known case of colon cancer and for evaluation of residual/recurrent disease. With respect to MRI, high-resolution T2-weighted images in multiple planes are important, with diffusion-weighted imaging (DWI) sequences being important for restaging. Intravenous contrast is not generally recommended. Contrast-enhanced CT and MRI are used for nodal and distant metastasis staging, with special attention to the pelvic side wall nodes. Positron emission tomography (PET) CT is to be considered for further evaluation if the findings are unclear and recurrence is suspected.

Background and aims: Hand-foot syndrome (HFS) is a distinct and relatively frequent toxic skin reaction associated with certain chemotherapy agents, particularly capecitabine. Given the complications of this syndrome and the critical importance of timely and accurate treatment, the present study aims to investigate the efficacy of topical heparin gel in alleviating HFS in cancer patients undergoing treatment with capecitabine.

Methods: A total of 40 patients with grade ⩽ 1 HFS associated with capecitabine were randomly assigned to intervention and control groups. The intervention group received heparin sulfate gel four times a day (21 days) along with capecitabine treatment, while the control group received only capecitabine and placebo gel. The changes in the severity of HFS and clinical manifestations, including erythema, swelling, blisters, hyperkeratosis, and bleeding, at baseline and 3 weeks posttreatment were evaluated. The data were subsequently validated by Fisher's or Chi-square tests.

Results: At the beginning of the study, there were no significant differences between the two groups regarding disease manifestations. However, after the intervention, a significant difference was observed between the groups in terms of erythema and swelling ( p  = 0.001). There were no significant differences between the groups in other manifestations, such as blisters, bleeding, and scaling ( p  = 0.99). Comparison of the degree of HFS in the intervention group showed that 11 patients experienced improvement after the intervention, while all patients in the control group remained at the same degree of syndrome as before the intervention.

Conclusion: The management of HFS in cancer treatment includes a combination of prevention, patient education, symptom improvement, and dose-intensity management. According to the results, it can be said that due to the positive effect of topical heparin gel in improving HFS caused by capecitabine and due to the absence of side effects, the use of topical heparin gel is recommended.

Key points: Hand-foot syndrome (HFS) is a distinct and relatively frequent toxic skin reaction associated with capecitabine.The efficacy of topical heparin gel in alleviating HFS in cancer patients was investigated.Topical heparin gel is recommended due to its positive effect in improving HFS caused by capecitabine.

Objectives: Women with colorectal cancer have an increased risk of developing ovarian malignancies, which have a poor prognosis. Shared decision making on the possibility of prophylactic salpingo-oophorectomy (PSO) during colorectal cancer surgery in postmenopausal women has, therefore, been implemented. Effects of PSO on perioperative parameters are unknown. This study therefore compares perioperative parameters between women with and without PSO.

Materials and methods: Women undergoing colorectal cancer surgery between January 2020 and March 2023 in four centers in the Netherlands offering the possibility of PSO were included. Perioperative parameters were compared between the group with and without PSO.

Statistical analysis: Continuous data were analyzed with independent t -tests or nonparametric tests when applicable. Categorical variables were analyzed with chi-square tests. Propensity score matching was performed to control for potential confounders. The variables age, American Society of Anesthesiologists classification, TNM stages, and type of surgery were used as respective covariates. Perioperative data were again analyzed between the matched groups. A sensitivity analysis including all participants was performed to evaluate the effect of PSO on duration of admission and on complications.

Results: The present study included 112 women who underwent PSO and 28 who did not. The PSO group was significantly younger (median: 74 vs. 79 years, p  = 0.002), had a shorter hospital stay (median: 4 vs. 6 days, p  = 0.006), and experienced less overall postsurgical complications (31 vs. 64%, p  = 0.002). These differences were neither observed after propensity score matching nor after sensitivity analysis. Malignant adnexal tissue was identified in three patients.

Conclusion: PSO in combination with elective colorectal cancer surgery in postmenopausal women does not lead to different or worse perioperative outcomes compared with the group without PSO. Nonetheless, the decision to undergo this combined surgery should be made on individual basis. Future research needs to focus on long-term follow-up and generalizability.

Background: International medical graduates (IMGs) play a crucial role in the United Kingdom National Health Service (NHS), yet they encounter significant challenges adapting to the NHS environment. This study aims to identify the enablers and barriers affecting the adaptation of IMGs, specifically focusing on surgical trainees in the Master of Surgery (MCh) program at Edge Hill University.

Methods: A qualitative approach was employed, utilizing an interpretivist philosophy and descriptive design. Data were collected through focus group discussions with first-year MCh surgical trainees. Thematic analysis was conducted to extract key themes related to adaptation.

Results: Three focus groups with a total of seven participants revealed several enablers and barriers. Enablers included robust administrative support, effective communication courses, comprehensive mentorship programs, and supportive hospital staff. Barriers identified were limited access to formal teaching, a fast-paced academic environment, language and cultural differences, and variations in medical practice.

Conclusion: The successful integration of IMGs into the NHS hinges on strong support systems, including administrative assistance, mentorship, and cultural and communication training. Addressing these barriers can facilitate smoother adaptation, enhance retention, and improve patient care.

Recommendations: To enhance IMG adaptation, the study recommends extensive induction programs, improved mentorship and support networks, cultural competence training, and better access to formal teaching with feedback.