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

Global cancer incidence is projected to rise dramatically, with over 35 million new cases anticipated by 2050, disproportionately affecting low- and middle-income countries (LMICs) where up to 70% of cancer deaths are expected to occur. This manuscript provides an in-depth assessment of the structural, economic, and sociocultural barriers that drive cancer care disparities in LMICs, including limited access to prevention, diagnosis, treatment, and palliative care services. Key challenges include shortages in oncology workforce, diagnostic infrastructure, radiotherapy access, and participation in clinical trials. Socioeconomic inequities, stigma, and high out-of-pocket costs further exacerbate delayed care and poor outcomes. Some innovative interventions have improved access and quality of cancer care in resource constrained settings. These include task-shifting models, digital health tools, community-based awareness and screening programs, and South-South collaborations that foster local drug innovation and manufacturing. It also explores emerging strategies in precision medicine, AI-assisted decision making, and tele-oncology tailored to LMICs. The role of public-private partnerships, sustainable financing, and international collaborations in advancing cancer control is critically examined. The future of global oncology hinges on a shift from fragmented, reactive responses to coordinated, data-driven, and sustainable strategies. By strengthening health systems and embracing context-sensitive innovation, the global community can address the widening cancer care gap and improve outcomes for vulnerable populations worldwide.

Changes to sexual function after cancer treatment are extremely prevalent, affecting up to 90% of female patients with cancer and 40%-85% of male patients with cancer. Sexual health concerns include low libido, genitourinary syndrome of menopause, dyspareunia, erectile dysfunction (ED), hypogonadism, body image concerns, and impacts on intimate relationships. Given the significant impact of sexual dysfunction on quality of life, oncology professionals should integrate sexual health discussions into routine patient care, regardless of the patient's age, sex, or cancer type. Sexuality is best understood in a biopsychosocial framework and cancer treatments including chemotherapy, surgery, radiation, and endocrine therapy can affect all of these domains. Management of genitourinary syndrome of menopause includes nonhormonal and low-dose local hormonal options. Pelvic floor dysfunction and vaginal stenosis can be treated with pelvic floor physical therapy and use of vaginal dilator therapy. ED can be treated with phosphodiesterase type 5 inhibitors and if needed, interventions such as intracavernosal injection of vasoactive agents, urethral suppositories, vacuum erection devices, and surgical implants are available. Cancer treatments such as chemotherapy, radiation, and androgen-deprivation therapy can lead to hypogonadism in men, which can be treated with testosterone therapy, unless contraindicated. Psychosocial counseling, sex therapy, and couples counseling are options for impact to sexual response, body image, and relationship concerns. A comprehensive, patient-centered approach to sexual health can help improve outcomes and overall well-being for cancer survivors.

The integration and utilization of digital media, gamified learning strategies, and artificial intelligence (AI) are fundamentally transforming the landscape of oncology education and learning. These technologies collectively enhance knowledge dissemination, facilitate professional networking and mentoring, and enrich the overall educational experience for the learner. Digital formats, including social media, offer flexible and asynchronous learning modalities that provide access to the latest studies and research, expert commentary, and opportunities for professional development and collaboration. Gamification, through the application of game-based elements within educational frameworks, promotes critical thinking, supports the acquisition and reinforcement of key concepts, and fosters engagement. AI, increasingly recognized for its disruptive potential, introduces a new dimension of information exchange and novel methodologies for learner assessment and customization of educational pathways. These tools also can present potential challenges, such as the proliferation of misinformation, heightened academic and professional competition, and the imperative to critically appraise AI-generated outputs. This article examines the transformative role of these emerging technologies in oncology education, while also addressing the associated risks and underscoring the need for learners to cultivate evaluative and critical thinking skills to navigate these tools responsibly.

In cancer genomics, there is the realization that some very frequently mutated genes like TP53 or KRAS are extremely hard to approach from a therapeutic perspective. In the realm of cancer treatment, the development of agents capable of transforming these alterations into actionable targets would be like capturing unicorns. These unicorns of oncology-drugs targeting undruggable targets that span various cancer types-offer an exciting opportunity for the development of histology-agnostic therapies. Among these, recent developments in targeting TP53 mutations, KRAS alterations, and MTAP loss mark pivotal advancements for innovative treatment strategies. TP53 mutations, which occur in nearly every cancer type, are central to tumorigenesis and contribute to resistance against conventional therapies. KRAS mutations, especially in cancers like pancreatic and lung cancers, are notoriously difficult to target but are now yielding promising therapeutic avenues. Similarly, MTAP is frequently deleted in cancers such as lung, pancreatic, and mesothelioma and plays a critical role in cellular metabolism and epigenetics, making its loss a significant vulnerability in tumor cells. Recent developments in drug discovery provide a broad foundation for the clinical testing of drugs that target common mechanisms across diverse tumor types, offering hope for a more universal approach to cancer treatment.

Distress and isolation frequently affect individuals with cancer and oncology care providers. Both oncology care teams and patient communities play a crucial role in offering support during challenging times. These networks help individuals feel less alone, enabling shared learning and fostering meaningful human connections. Encouraging deeper connections with patients and promoting participation in support groups have proven beneficial for both patients with cancer and their physicians. Support groups serve as platforms for sharing experiences, emotional support, and practical advice, meaningfully enhancing mental health and coping strategies. This communal environment reduces feelings of isolation and provides comfort through shared experiences. In this review, we will synthesize evidence on the common challenges faced by people with cancer and oncology care providers, alongside insights into the role of support groups in promoting resilience and wellness.

Anthracycline and cytarabine chemotherapy has been the backbone of induction chemotherapy for AML for more than 50 years. Advances in our understanding of leukemia biology and the development of targeted agents against leukemia driver mutations have revolutionized therapy for subsets of patients. In addition, the development of more effective and less toxic induction regimens with a backbone of venetoclax and hypomethylating agents is a real advance in therapy for older or less fit patients with AML. In this review, we will describe improved outcomes for alternate induction strategies, results with combinations of targeted agents and standard chemotherapy, and the important role of complete diagnostic testing and clinical trials to improve outcomes for patients with AML.

Sexual and gender minority (SGM) individuals continue to experience disparities in cancer risk, screening, treatment, and outcomes. Despite advances following the 2017 ASCO recommendations, inequities persist, driven by systemic barriers, stigma, and discrimination in health care. State-level and federal-level actions threaten health care access to for sexual minority women (SMW) and transgender and gender-diverse (TGD) people creating additional barriers to safe and evidence-based health care. This review outlines the literature and gives practical recommendations for breast and gynecologic cancer care of SMW and TGD people. SMW and transgender men and nonbinary people with a cervix share multiple barriers to cervical cancer screening with lower uptake. TGD individuals face additional barriers, including gender dysphoria during examinations. Current evidence supports offering human papilloma virus self-sampling to improve screening uptake. Evidence supports lower breast cancer risk in TGD people compared with cisgender women but advice must be tailored to surgical history and hormone use. For TGD individuals with cancer, gender-affirming hormone therapy should be managed through shared decision making, balancing oncologic risk with quality-of-life considerations. Cancer care must account for the unique needs of SGM populations, emphasizing cultural humility, structural competency, and trauma-informed care. While broader health care reforms are needed to address the systemic inequities that underlie these disparities, clinicians have an obligation to provide affirming, patient-centered care that recognizes the impact of societal discrimination on health and fosters trust with SGM patients.

New technologies and innovations are changing the future of melanoma care. Teledermatology and skin screening mobile apps aided by artificial intelligence (AI) diagnostic support could assist in closing disparity gaps in melanoma early detection and access to specialty care. Although the field of AI in dermatology has exploded over the past decade, prospective validation of available algorithms using real-world, multimodal data sets has shown performance decline, limiting their current use in clinical practice. Newer methodological approaches have focused on how AI can augment clinical decision making to speed diagnosis and care delivery-and whether the model output results in a favorable change for the patient. Selective BRAF and MEK inhibitors have an established role in the adjuvant and metastatic setting for the approximately 50% of patients whose melanomas harbor a BRAF V600 mutation. Acquired resistance to these agents remains a challenge, however. For other driver mutations, including class II and III BRAF mutations, alterations in NRAS and CDKN2A, novel agents and combinations are demonstrating promising activity. At least 50% of patients with metastatic melanoma do not derive long-term benefit from immune checkpoint inhibitors (ICIs). Adoptive cellular immunotherapy with tumor infiltrating lymphocytes offers the possibility of a durable response for a minority of these patients. Potentially more effective and better tolerated T-cell therapies are being evaluated in clinical trials.

Patient-centered physician-directed care is facing unprecedented challenges. Escalating health care spending on low-value services with a focus on managing disease rather than promoting health is leading to increasing financial toxicity to patients and payment pushback by insurers. In an effort to rein in costs, policymakers are implementing legislation and regulations aimed at curbing spending that have had the unintentional consequences of increasing market consolidations, ultimately creating monopolies and monopsonies that have driven up costs, lowered quality, and ultimately disenfranchises both doctors and patients. The ramifications of such policies have opened the floodgates to the corporatization of medicine. "Speaking to Power With Power: Advocating for Your Profession" explores how physicians can become agents of change in this ever-evolving health care paradigm. This session is geared to exploring the challenges our profession faces and how oncologists can advocate for their patients and profession in their communities, practices, and hospitals both locally and on the state and national arenas. Topics for discussion will include: Leading in your community: explore the challenges facing doctors in their practices and institutions and how they can lead on the local level. Advocating for change: introduction to advocacy tools that can be used on the state and national levels. Negotiating your path to career success: provides tools physicians can use to find common ground when negotiating with key stakeholders. Engaging in payer contracting: how to navigate the ever-changing payer contracting marketplace and leverage value propositions and networks with payers.

Early-career oncologists navigate a complex landscape of professional development, clinical responsibilities, and research endeavors. This manuscript explores key challenges and strategies for success in the early years of an oncology career, focusing on the first job after fellowship, career transitions, and practical tips for intentionality. Effective mentorship is pivotal, providing guidance in clinical decision making, research pursuits, and professional networking. Career development strategies include securing funding, building collaborative networks, and identifying opportunities for leadership. Additionally, balancing clinical duties with research and personal well-being requires time management and institutional support. This article emphasizes the importance of fostering inclusive mentorship, advocating for work-life integration, and leveraging institutional and professional resources to support career sustainability. By addressing these key aspects, early-career oncologists can build a fulfilling and impactful career while contributing meaningfully to the field of oncology.