American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting最新文献

Organ preservation for gastroesophageal junction (GEJ) and gastric cancers is emerging as an attainable-but still selective-therapeutic goal. The convergence of effective systemic therapy, enhanced imaging, and endoscopic sophistication has reframed the role of surgery from default to discretionary. Building on watch-and-wait experience from the rectal cancer paradigm (Organ Preservation for Rectal Adenocarcinoma trial and International Watch-and-Wait Database), readiness requires more than feasibility; it depends on biologic predictability, clinical reproducibility, and system capacity. This review synthesizes current evidence on when and for whom nonoperative management may achieve oncologic parity with resection. We examine biologic readiness, defined by tumor subsets such as microsatellite instability-high (MSI-H) and Epstein-Barr virus (EBV)-positive cancers that display immune-mediated clearance after therapy; clinical readiness, reflected in trial data and surveillance protocols that safeguard against undertreatment; and system readiness, encompassing diagnostic infrastructure, workforce expertise, and equitable access to high-quality response evaluation. In esophageal/GEJ disease, Surgery As Needed for Oesophageal cancer trial demonstrates that patients achieving a clinical complete response after chemoradiation can be managed with active surveillance and achieve survival noninferior to immediate surgery, with better early quality of life, provided programs use validated clinical response evaluation, protocolized surveillance, and rapid salvage capacity. For gastric cancer, organ preservation remains investigational outside biomarker-selected contexts (eg, MSI-H, EBV-positive). Implementation demands multidisciplinary infrastructure including validated response assessment, intensive surveillance protocols, and equitable access to biomarker testing and salvage surgery. Without these elements, organ preservation risks widening existing disparities. Across these domains, the evidence suggests a threshold of cautious readiness for GEJ primaries and emerging readiness for gastric cancer. The key challenge is not technical innovation but translation-ensuring that the ability to preserve the organ does not outpace the ability to preserve outcomes. Progress toward that equilibrium will determine whether organ preservation becomes a universal standard or remains an institutional privilege.

Approximately 25% of patients with colorectal cancer present with metastatic disease to the liver at diagnosis, and about 50% develop liver metastases at some point during the course of the disease. Surgical resection of hepatic metastases remains the gold standard treatment for liver metastases. However, many patients with colorectal liver metastases (CRLMs) are not eligible for up-front resection. Despite advances in systemic chemotherapy, long-term survival continues to be strongly influenced by liver-directed treatments. A multidisciplinary approach is recommended for all patients, with a combination of systemic therapy and one or more liver-directed local treatments determined based on the goals of therapy. For unresectable CRLM (uCRLM), hepatic artery infusion pump therapy, stereotactic body radiation therapy (SBRT), image-guided ablation, and transarterial chemo- or radioembolization are local-regional options to consider. More recently, emerging evidence supports the use of liver transplantation in selected patients with uCRLM. This chapter reviews the spectrum of liver-directed therapies, their outcomes, and ongoing developments regarding local regional therapies for uCRLM.

Pancreatic ductal adenocarcinoma remains a highly lethal malignancy, with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) representing biologically and anatomically complex subsets requiring coordinated multidisciplinary care. Contemporary management integrates effective systemic therapy, selective use of radiation, dynamic assessment of treatment response, and carefully tailored surgical strategies to optimize margin-negative resection and long-term outcomes. Modern induction regimens serve as the foundation for disease control and biologic selection in both BRPC and LAPC, with emerging evidence supporting treatment adaptation on the basis of radiographic and biomarker response. Radiation therapy has evolved from conventional chemoradiation to ablative-dose techniques, which may offer durable local control in highly selected responders, although survival benefits remain to be defined in ongoing randomized trials. Surgical resection after induction chemotherapy remains the only potentially curative option. Venous resection is well established and safe in experienced centers, whereas arterial resection is reserved for exceptional responders with reconstructable disease because of increased perioperative risk and conflicting evidence of oncologic benefit. Complementary biomarkers and emerging molecular signatures are increasingly informing treatment sequencing and selection. The integration of advanced systemic therapy, tailored integration of radiation therapy, careful surgical selection, molecular profiling, and adaptive clinical trial designs reflects an accelerating shift toward personalized multimodality management aimed at improving survival in BRPC and LAPC.

Community engagement represents a foundational strategy for advancing cancer research and improving health outcomes. This study examines advocacy as a form of community engagement across the cancer research continuum, aligning with ASCO's 2024-2025 presidential theme of "Driving Knowledge to Action: Building a Better Future." We present a comprehensive framework that promotes bidirectional learning, trust, and transparency at all stages of research, from conception to dissemination. The spectrum of engagement approaches is described, ranging from consultative models to fully collaborative partnerships, highlighting how each creates critical touchpoints throughout the research process. We identify significant challenges to meaningful community engagement-including institutional barriers, historical mistrust, and sustainability concerns-while offering practical solutions drawn from successful examples across diverse cancer research settings. This study concludes with actionable recommendations for advancing robust community engagement through diverse representation, mentorship programs, institutional support mechanisms, and dedicated funding channels. By integrating advocacy throughout the research continuum, we create pathways for patients, caregivers, community representatives, and emerging professionals to shape research agendas, inform study designs, and participate in translating findings into policy and practice, ultimately ensuring cancer research is inclusive, relevant, and accessible to all communities.

Testicular cancer is a rare but highly curable malignancy, predominantly affecting young men. Advances in multimodal therapy, including cisplatin-based chemotherapy, radiotherapy, and surgical interventions, have resulted in excellent cancer-specific survival. However, with improved survival rates, long-term health consequences and survivorship issues have emerged as critical concerns. Testicular cancer survivors (TCSs) are at risk of adverse health outcomes, including endocrine dysfunction, cardiovascular disease, secondary malignancies, chemotherapy-induced neuropathy, and psychosocial challenges. Endocrine disturbances such as hypogonadism and infertility require careful monitoring, while cardiovascular risks necessitate long-term preventive strategies. Survivors also face an elevated risk of secondary malignancies, necessitating tailored follow-up. Recent advances in the de-escalation of therapy, particularly for stage II seminoma and metastatic germ cell tumors, aim to balance oncologic efficacy with minimizing toxicity. This review discusses the evolving landscape of testicular cancer survivorship, the impact of treatment-related complications, and contemporary management strategies, emphasizing a multidisciplinary approach to optimize long-term outcomes and quality of life.

Multicancer early detection tests (MCEDs), sometimes referred to as liquid biopsies, are tests that can screen for multiple cancers by analyzing blood, urine, and other bodily fluids for biomarkers released by cancer cells. These tests have the potential to change the cancer screening paradigm if they are shown to reduce cancer mortality. However, it is not yet known whether MCEDs reduce mortality. Randomized controlled trials, the gold standard for evaluating cancer screening programs, are currently evaluating the effectiveness of MCEDs. However, because cancer-specific and all-cause mortality are end points that can take years to reach, trials are being designed with surrogate end points such as stage of disease at detection. However, the correlation between cancer stage and survival appears to vary by cancer type, and many have argued that trials must also continue to follow for the gold standard of mortality end points until these surrogate end points are appropriately validated. The widespread use of MCEDs before conclusive evidence supporting their use has the potential to cause harm to patients, could widen health inequities, and further drive health care costs. Consequently, providers should engage in shared decision making regarding MCED tests with patients who inquire about MCEDs emphasizing that MCEDs should be additive to, not replacements for, the currently recommended cancer screening tests.

Advancements in early detection and multimodal treatment strategies have significantly improved survival rates for early-stage breast cancer, now exceeding 80% at 10 years. However, breast cancer survivors (BCS) often experience persistent physical, psychological, and social challenges as direct consequences of cancer and its treatment. Effective survivorship care requires a proactive, multidisciplinary, and team-based approach to address these burdens comprehensively. Despite growing recognition of the complex needs of BCS, a persistent gap remains between symptom burden, supportive care needs, and actual care delivery. This disparity underscores the urgent need to innovate and optimize survivorship care models. This article explores the most prevalent symptoms and concerns experienced by BCS, particularly those arising from systemic and local therapies during post-treatment follow-up phase, and outlines evidence-based strategies for their management. Additionally, it examines the role of technology as a promising enabler in enhancing the quality, efficiency, accessibility, and patient-centeredness of survivorship care. By integrating multidisciplinary, proactive symptom management with digital health tools and innovative care approaches, health care systems can be equipped to better support BCS, ultimately improving their long-term health outcomes and quality of life.

Cervical cancer remains a leading cause of cancer-related death among women globally, despite the availability of effective prevention through human papillomavirus (HPV) vaccination and HPV-based screening. This review explores the state-of-the-art technologies for cervical cancer prevention, examining their efficacy, implementation challenges, and global disparities in access. Prophylactic HPV vaccination and HPV DNA testing have demonstrated high efficacy in reducing cervical cancer incidence, yet their uptake remains uneven-especially in low- and middle-income countries (LMICs), where the disease burden is greatest. Barriers include infrastructure limitations, workforce shortages, sociocultural obstacles, and competing health priorities. Strategies such as single-dose vaccination, early childhood immunization, self-sampling, and screen-and-treat approaches offer promising pathways to expand access. In high-income countries (HICs), where HPV vaccine uptake is higher and screening systems are more established, the reduced risk of infection and high negative predictive value of HPV testing support a shift toward screening deintensification. Precision prevention frameworks-leveraging biomarkers, genotyping, and artificial intelligence-offer further opportunities to enhance accuracy and efficiency. The review also underscores the importance of health system strengthening, international collaboration, and policy support to achieve the WHO's 90-70-90 targets for cervical cancer elimination. Moreover, innovations developed for cervical cancer prevention-such as decentralized screening, mobile health platforms, and task-shifting-offer a valuable model for improving strategies for primary and secondary prevention of other cancers.

The excellent cure rates documented in clinical trials today constitute a very high bar for attempts to de-escalate therapy for early-stage breast cancer (EBC). Moreover, any therapy de-escalation must be made in the context of an optimal multimodal treatment concept as de-escalation of one modality should not be met by escalation of another. In surgery, omission of sentinel lymph node biopsy can now be safely offered for patients with low-risk hormone receptor-positive/human epidermal growth factor receptor 2-negative (HER2-) disease. After neoadjuvant therapy, adapting surgical and/or radiation therapy (RT) treatment steps to systemic treatment response has already become a reality, yet technical quality assurance is mandatory. Increased use of novel targeted agents in eBC requires adaptation of RT timing that has been addressed by current consensus recommendations. Last but not least, omission of chemotherapy (CTx) is a key question for patients and their physicians in hormone receptor-positive/HER2- EBC. In patients with zero to three involved lymph nodes, gene expression assays safely allow CTx omission. Endocrine response assessment, that is, Ki67 determination, after a short 4-week endocrine therapy before surgery adds important information, particularly for premenopausal patients. The overall goal of therapy de-escalation is to reduce treatment burden without compromising patient outcomes. Thus, de-escalation concepts overall, as well as biomarkers used for therapy de-escalation, need to be evidence-based and validated by prospective clinical trials.

Combination immune checkpoint inhibitor therapy (ICI) with ipilimumab (anti-cytotoxic T-lymphocyte-associated protein 4) + nivolumab (anti-PD-1) in untreated, metastatic melanoma has achieved a ten-year melanoma-specific survival of 52%. However, approximately 40%-55% of patients with metastatic melanoma have primary resistance and do not initially respond to anti-PD-1, and an additional 25% of patients develop secondary resistance, exhibiting an initial response followed by disease progression. In PD-1-refractory melanoma, treatment options are limited. Addition of ipilimumab, relatlimab (anti-LAG3), or lenvatinib (VEGFR TKI) has minimal to modest efficacy. Switching to targeted BRAF/MEK inhibition improves survival for BRAF-mutant disease. MEK and KIT inhibitors have limited activity in NRAS- and KIT-mutant metastatic melanoma, respectively. Recently, personalized, autologous tumor-infiltrating lymphocyte therapy has become a US Food and Drug Administration-approved second-line option; lifileucel demonstrates durable response (approximately 30%) in heavily pretreated, metastatic melanoma. Emerging therapeutics that show promising clinical benefit in ongoing clinical trials include novel engineered oncolytic viral and human leukocyte antigen (HLA)-restricted immune-mediated T-cell therapies. As a therapy which is limited to patients who are HLA-A*02:01, T-cell receptor (TCR) engineered T cells (TCR-T) iterates on personalized adoptive cell transfer, and immune mobilizing monoclonal TCRs against cancer are CD3 bispecifics that bind glycoprotein 100 (tebentafusp, approved for metastatic uveal melanoma) or PRAME to activate T cells. Finally, in patients at high risk for immune-related adverse events (irAEs), ICI should still be considered. ICI may be given with modified immunosuppression in patients with autoimmune disease or previous organ transplantation. Cumulative data support safe administration in older patients and in ICI rechallenge for patients with previous irAE.