Pub Date : 2025-03-03DOI: 10.1016/s1470-2045(24)00524-2
Maria Kyrgiou, Sarah J Bowden, Laura Burney Ellis, Anne Hammer, Deirdre Lyons, Theresa Freeman-Wang, Konstantinos S Kechagias, Ilkka Kalliala, Mario Preti, Vesna Kesic, Ignacio Zapardiel, Margaret Cruickshank, Murat Gultekin, Pierre Martin-Hirsch
Histological diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) has traditionally been the cutoff for local surgical treatment, due to a substantial risk of cancer development. However, evidence from the past decade suggests 50–60% of CIN2 lesions spontaneously regress, and active surveillance (or conservative management—ie, leaving the lesion untreated) might be justified in some cases. Active surveillance of CIN2 lesions is now practised widely, although clear recommendations on eligibility, frequency of surveillance, threshold for treatment, and criteria for return to routine recall are insufficient in most countries. In 2023, the cumulative risk of invasive cancer over 20 years was found to be substantially higher in patients under active surveillance when compared with patients who received immediate local treatment, with the greatest difference observed in women older than 30 years. This Policy Review and practice algorithm from the British Society of Colposcopy and Cervical Pathology and the European Society of Gynaecologic Oncology prevention committees aims to review existing evidence and present clear recommendations to assist clinical decision making. Active surveillance, rather than immediate treatment, might be reasonable in a carefully selected cohort of patients. The risk of progression, need for repeat visits, and cumulative risk of future invasion associated with active surveillance should be carefully balanced against the benefits of awaiting regression, including consideration of the woman's age, fertility wishes, additional risk factors, and likelihood of compliance to follow-up. Clinical audit and, ideally, prospective databases are required to monitor long-term outcomes and safety.
{"title":"Active surveillance of cervical intraepithelial neoplasia grade 2: 2025 British Society of Colposcopy and Cervical Pathology and European Society of Gynaecologic Oncology consensus statement","authors":"Maria Kyrgiou, Sarah J Bowden, Laura Burney Ellis, Anne Hammer, Deirdre Lyons, Theresa Freeman-Wang, Konstantinos S Kechagias, Ilkka Kalliala, Mario Preti, Vesna Kesic, Ignacio Zapardiel, Margaret Cruickshank, Murat Gultekin, Pierre Martin-Hirsch","doi":"10.1016/s1470-2045(24)00524-2","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00524-2","url":null,"abstract":"Histological diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) has traditionally been the cutoff for local surgical treatment, due to a substantial risk of cancer development. However, evidence from the past decade suggests 50–60% of CIN2 lesions spontaneously regress, and active surveillance (or conservative management—ie, leaving the lesion untreated) might be justified in some cases. Active surveillance of CIN2 lesions is now practised widely, although clear recommendations on eligibility, frequency of surveillance, threshold for treatment, and criteria for return to routine recall are insufficient in most countries. In 2023, the cumulative risk of invasive cancer over 20 years was found to be substantially higher in patients under active surveillance when compared with patients who received immediate local treatment, with the greatest difference observed in women older than 30 years. This Policy Review and practice algorithm from the British Society of Colposcopy and Cervical Pathology and the European Society of Gynaecologic Oncology prevention committees aims to review existing evidence and present clear recommendations to assist clinical decision making. Active surveillance, rather than immediate treatment, might be reasonable in a carefully selected cohort of patients. The risk of progression, need for repeat visits, and cumulative risk of future invasion associated with active surveillance should be carefully balanced against the benefits of awaiting regression, including consideration of the woman's age, fertility wishes, additional risk factors, and likelihood of compliance to follow-up. Clinical audit and, ideally, prospective databases are required to monitor long-term outcomes and safety.","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-03DOI: 10.1016/s1470-2045(25)00073-7
Chao Wei, Wei Wei
Section snippets
Contributors
CW conceived the project and drafted the manuscript. WW revised the draft. Both authors approved the final manuscript. Written informed consent to publication was obtained from the patient.
Declaration of interests
We declare no competing interests.
{"title":"Dural metastasis of prostate cancer resembling meningioma","authors":"Chao Wei, Wei Wei","doi":"10.1016/s1470-2045(25)00073-7","DOIUrl":"https://doi.org/10.1016/s1470-2045(25)00073-7","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Contributors</h2>CW conceived the project and drafted the manuscript. WW revised the draft. Both authors approved the final manuscript. Written informed consent to publication was obtained from the patient.</section></section><section><section><h2>Declaration of interests</h2>We declare no competing interests.</section></section>","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Eastern Mediterranean region covers a population of more than 700 million individuals and 22 countries and territories, sharing histories, culture, and languages. The countries and territories of this region also have large differences in demographics and human development. Population ageing and growth is predicted to more than double the number of new cancer cases in the region over the next few decades, from 782 000 in 2022 to close to 1·8 million by the year 2050. At the same time, cancer control capacity is low, with large inequalities between and within countries, further aggravated by political instability and conflicts. From 2013, the International Agency for Research on Cancer and the WHO Regional Office for the Eastern Mediterranean have been working together to strengthen cancer surveillance to inform regional and national cancer control. Based on an exposition of the cancer patterns, this Policy Review summarises remaining opportunities and barriers in ensuring high-quality cancer surveillance in all WHO Eastern Mediterranean countries and territories.
{"title":"Cancer surveillance in the Eastern Mediterranean region: a 10-year International Agency for Research on Cancer–WHO Regional Office for the Eastern Mediterranean collaboration","authors":"Ariana Znaor, Heba Fouad, Mariam Zahwe, Sultan Eser, Ibtihal Fadhil, Isabelle Soerjomataram, Asmus Hammerich, Freddie Bray","doi":"10.1016/s1470-2045(24)00624-7","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00624-7","url":null,"abstract":"The Eastern Mediterranean region covers a population of more than 700 million individuals and 22 countries and territories, sharing histories, culture, and languages. The countries and territories of this region also have large differences in demographics and human development. Population ageing and growth is predicted to more than double the number of new cancer cases in the region over the next few decades, from 782 000 in 2022 to close to 1·8 million by the year 2050. At the same time, cancer control capacity is low, with large inequalities between and within countries, further aggravated by political instability and conflicts. From 2013, the International Agency for Research on Cancer and the WHO Regional Office for the Eastern Mediterranean have been working together to strengthen cancer surveillance to inform regional and national cancer control. Based on an exposition of the cancer patterns, this Policy Review summarises remaining opportunities and barriers in ensuring high-quality cancer surveillance in all WHO Eastern Mediterranean countries and territories.","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-03DOI: 10.1016/s1470-2045(24)00656-9
Zachary S Morris, Sandra Demaria, Arta M Monjazeb, Silvia C Formenti, Ralph R Weichselbaum, James Welsh, Heiko Enderling, Jonathan D Schoenfeld, Joshua D Brody, Heather M McGee, Michele Mondini, Michael S Kent, Kristina H Young, Lorenzo Galluzzi, Sana D Karam, Willemijn S M E Theelen, Joe Y Chang, Mai Anh Huynh, Adi Daib, Sean Pitroda, Lawrence Fong
Radiotherapy both promotes and antagonises tumour immune recognition. Some clinical studies show improved patient outcomes when immunotherapies are integrated with radiotherapy. Safe, greater than additive, clinical response to the combination is limited to a subset of patients, however, and how radiotherapy can best be combined with immunotherapies remains unclear. The National Cancer Institute–Immuno-Oncology Translational Network–Society for Immunotherapy of Cancer–American Association of Immunology Workshop on Combining Immunotherapy with Radiotherapy was convened to identify and prioritise opportunities and challenges for radiotherapy and immunotherapy combinations. Sessions examined the immune effects of radiation, barriers to anti-tumour immune response, previous clinical trial data, immunological and computational assessment of response, and next-generation radiotherapy–immunotherapy combinations. Panel recommendations included: developing and implementing patient selection and biomarker-guided approaches; applying mechanistic understanding to optimise delivery of radiotherapy and selection of immunotherapies; using rigorous preclinical models including companion animal studies; embracing data sharing and standardisation, advanced modelling, and multidisciplinary cross-institution collaboration; interrogating clinical data, including negative trials; and incorporating novel clinical endpoints and trial designs.
{"title":"Proceedings of the National Cancer Institute Workshop on combining immunotherapy with radiotherapy: challenges and opportunities for clinical translation","authors":"Zachary S Morris, Sandra Demaria, Arta M Monjazeb, Silvia C Formenti, Ralph R Weichselbaum, James Welsh, Heiko Enderling, Jonathan D Schoenfeld, Joshua D Brody, Heather M McGee, Michele Mondini, Michael S Kent, Kristina H Young, Lorenzo Galluzzi, Sana D Karam, Willemijn S M E Theelen, Joe Y Chang, Mai Anh Huynh, Adi Daib, Sean Pitroda, Lawrence Fong","doi":"10.1016/s1470-2045(24)00656-9","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00656-9","url":null,"abstract":"Radiotherapy both promotes and antagonises tumour immune recognition. Some clinical studies show improved patient outcomes when immunotherapies are integrated with radiotherapy. Safe, greater than additive, clinical response to the combination is limited to a subset of patients, however, and how radiotherapy can best be combined with immunotherapies remains unclear. The National Cancer Institute–Immuno-Oncology Translational Network–Society for Immunotherapy of Cancer–American Association of Immunology Workshop on Combining Immunotherapy with Radiotherapy was convened to identify and prioritise opportunities and challenges for radiotherapy and immunotherapy combinations. Sessions examined the immune effects of radiation, barriers to anti-tumour immune response, previous clinical trial data, immunological and computational assessment of response, and next-generation radiotherapy–immunotherapy combinations. Panel recommendations included: developing and implementing patient selection and biomarker-guided approaches; applying mechanistic understanding to optimise delivery of radiotherapy and selection of immunotherapies; using rigorous preclinical models including companion animal studies; embracing data sharing and standardisation, advanced modelling, and multidisciplinary cross-institution collaboration; interrogating clinical data, including negative trials; and incorporating novel clinical endpoints and trial designs.","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-03DOI: 10.1016/s1470-2045(24)00648-x
Ian F Tannock, Elisabeth G E de Vries, Antonio Fojo, Marc Buyse, Lorenzo Moja
Access to many cancer medicines on WHO's Essential Medicines List (EML) is restricted because of price, especially in low-income and middle-income countries (LMICs). Other cancer medicines that have been shown to improve survival, such as immune checkpoint inhibitors for lung cancer, are not included on the EML because approved doses and schedules exceed affordable prices in LMICs. Multiple strategies are therefore needed to reduce medicine costs or circumvent these problems, such as optimising doses and schedules. Cancer medicines are approved by regulatory agencies, such as the US Food and Drug Administration and the European Medicines Agency, following rigorous clinical trials. However, these approvals can involve dosing regimens and treatment schedules that, although effective in showing statistically significant benefits in trials, can be higher in intensity, frequency, or duration than is necessary to achieve meaningful improved survival. In clinical practice, these regimens can lead to concerns about balancing optimal therapeutic outcomes with the risk of side-effects, patient quality of life, and long-term health effects. Various types of evidence can, and should, be used to explore and show near-equivalence of beneficial outcomes from reduced-intensity treatments, including randomised clinical trials, dose-finding phase 1 and 2 studies, and pharmacokinetic and pharmacodynamic studies. The positive effects of proving that lower doses or less intensive schedules retain therapeutic activity include reduced toxicity and large price reductions, leading to better cost-effectiveness and greater access to treatments that improve survival. Beyond regulatory approvals, identification of regimens that have similar outcomes with reduced doses and less intense schedules should be a priority for clinicians and policy makers in the selection process to identify effective medicines at national and global levels.
{"title":"Dose optimisation to improve access to effective cancer medicines","authors":"Ian F Tannock, Elisabeth G E de Vries, Antonio Fojo, Marc Buyse, Lorenzo Moja","doi":"10.1016/s1470-2045(24)00648-x","DOIUrl":"https://doi.org/10.1016/s1470-2045(24)00648-x","url":null,"abstract":"Access to many cancer medicines on WHO's Essential Medicines List (EML) is restricted because of price, especially in low-income and middle-income countries (LMICs). Other cancer medicines that have been shown to improve survival, such as immune checkpoint inhibitors for lung cancer, are not included on the EML because approved doses and schedules exceed affordable prices in LMICs. Multiple strategies are therefore needed to reduce medicine costs or circumvent these problems, such as optimising doses and schedules. Cancer medicines are approved by regulatory agencies, such as the US Food and Drug Administration and the European Medicines Agency, following rigorous clinical trials. However, these approvals can involve dosing regimens and treatment schedules that, although effective in showing statistically significant benefits in trials, can be higher in intensity, frequency, or duration than is necessary to achieve meaningful improved survival. In clinical practice, these regimens can lead to concerns about balancing optimal therapeutic outcomes with the risk of side-effects, patient quality of life, and long-term health effects. Various types of evidence can, and should, be used to explore and show near-equivalence of beneficial outcomes from reduced-intensity treatments, including randomised clinical trials, dose-finding phase 1 and 2 studies, and pharmacokinetic and pharmacodynamic studies. The positive effects of proving that lower doses or less intensive schedules retain therapeutic activity include reduced toxicity and large price reductions, leading to better cost-effectiveness and greater access to treatments that improve survival. Beyond regulatory approvals, identification of regimens that have similar outcomes with reduced doses and less intense schedules should be a priority for clinicians and policy makers in the selection process to identify effective medicines at national and global levels.","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-03DOI: 10.1016/s1470-2045(25)00086-5
John H Heinzerling, Kathryn F Mileham, Myra M Robinson, Charles B Simone
No Abstract
{"title":"Refining multimodal strategies for locally advanced NSCLC – Authors' reply","authors":"John H Heinzerling, Kathryn F Mileham, Myra M Robinson, Charles B Simone","doi":"10.1016/s1470-2045(25)00086-5","DOIUrl":"https://doi.org/10.1016/s1470-2045(25)00086-5","url":null,"abstract":"No Abstract","PeriodicalId":22865,"journal":{"name":"The Lancet Oncology","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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