中华肿瘤杂志最新文献

Meningeal metastasis is one of the serious complications of advanced malignant tumors, characterized by high malignancy and poor prognosis. Beijing Association of Oncology Clinical Research Committee and China Hospital Association Cancer Hospital Branch organized multidisciplinary experts to summarize the latest diagnostic criteria and therapeutic advances for meningeal metastasis, covering traditional therapies such as surgical intervention, radiotherapy, systemic chemotherapy, and intrathecal chemotherapy. It also emphasizes the potential of emerging strategies, including targeted therapy and immunotherapy, in the treatment of meningeal metastasis. Furthermore, this consensus focuses on the key elements of clinical research design for meningeal metastasis, highlighting the necessity of standardizing treatment response assessment and clinical trial endpoints. To optimize the design of clinical studies for meningeal metastasis, this consensus recommends the adoption of randomized and blinded designs, combined with biomarker analysis and the use of appropriate statistical tools. These measures are aimed at enhancing the quality and efficiency of clinical trials, thereby providing more evidence-based medical support for the treatment of meningeal metastasis.

Small cell carcinoma of the esophagus (SCEC) is a rare and highly aggressive neuroendocrine tumor with poor prognosis. The clinical manifestations are lack of specificity, and the diagnosis depends on gastroscopic biopsy pathology and immunohistochemistry. Ultrasonic gastroscope+-, enhanced CT or PET-CT, and brain MRI are recommended for accurate staging. The combination of American Joint Committee on Cancer - Tumor, Node, Metastasis (AJCC-TNM) staging system and Veterans Administration Lung Study Group (VALSG) staging systems is recommended to guide the treatment. The treatment emphasizes the multidisciplinary comprehensive mode of chemotherapy, radiotherapy and surgery. For the patients with limited disease, chemotherapy combined with local treatment (surgery or radiotherapy) is recommended. For operable patients, radical chemoradiotherapy or perioperative treatment combined with surgery is recommended. The unresectable patients were treated with radical chemoradiotherapy. Patients with extensive stage were treated with systemic chemotherapy. Etoposide combined with platinum is the first choice for chemotherapy. If systemic treatment was effective, additional local treatment could be performed for residual lesions, and symptomatic metastatic lesions are recommended for palliative care. There is still a lack of high-level evidence-based medical evidence for immunotherapy, and relevant clinical trials are recommended. This consensus aims to promote the standardization of diagnosis and treatment of SCEC and improve the quality of life and long-term survival of patients through multidisciplinary collaboration.

Chemotherapy-induced neutropenia (CIN) is a common hematological adverse event and dose-limiting toxicity of chemotherapy. CIN may lead to dose reduction or delay of chemotherapeutic agents, febrile neutropenia (FN), and severe infections, which results in increased treatment costs, reduced chemotherapy efficacy, and even life-threatening complications. Therefore, standardized assessment of the risk of CIN in cancer patients, timely identification and intervention of FN, and appropriate prevention and treatment are essential to reduce CIN-related complications, improve patients' quality of life, and enhance chemotherapy outcomes. Based on the "Consensus on clinical diagnosis, treatment, and prevention of chemotherapy-induced neutropenia in China (2023 edition)", the Committee of Medical Oncology and the Committee of Neoplastic Supportive-care of China Anti-Cancer Association have thoroughly reviewed and summarized the latest evidence and clinical practices worldwide. This update puts forward 11 recommendations regarding the definition, grading, risk assessment, prevention, and treatment strategies for CIN, aiming to provide more timely and standardized guidance for Chinese oncologists in the diagnosis, treatment, and prevention of CIN.

The phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway (PAM pathway) is a crucial signaling network regulating cell proliferation, survival, and metabolism, which plays a central role in the pathogenesis and progression of breast cancer. Targeting the PAM pathway with inhibitors provides a novel precision therapeutic option for cancer patients. However, the broad suppression of physiological PAM pathway functions in normal tissues, combined with the distinct characteristics of their molecular targets, leads to both the uniqueness of adverse reactions associated with these agents and heterogeneity within their safety profiles. Given the complexity of the adverse reaction spectrum and the specialized management requirements for PAM pathway inhibitors, Cancer Drug Clinical Research Committee of China Anti-Cancer Association and Standard Construction Committee of China Anti-Cancer Association jointly convened a multidisciplinary expert panel to develop this consensus. This document systematically synthesizes epidemiological features, pathological mechanisms, and risk factors of PAM pathway inhibitor-associated adverse reactions. It provides clinicians with evidence-based guidance on standardized prevention strategies, early warning systems, assessment frameworks, intervention protocols, and long-term monitoring pathways. The ultimate goals are to maximize medication safety, optimize treatment adherence, and ultimately enhance antitumor efficacy and patient quality of life.

The treatment of breast cancer with low expression of human epidermal growth factor receptor 2 (HER-2) has become a focused area in recent years. With the proved therapeutic effect of antibody-drug conjugates on breast cancer patients with HER-2-low expression, who has become a new targeting population in breast cancer. Recent studies have shown that patients with HER-2-ultralow breast cancer can also benefit from novel antibody-drug conjugates. To better standardize the rational clinical diagnosis and treatment of HER-2-low and HER-2-ultralow breast cancer, the Breast Cancer Working Group of the International Medical and Exchange Branch of the Chinese Anti-Cancer Association and the Chinese Medical Doctor Association Oncology Branch reviewed the latest domestic and international clinical studies and important publications in recent years. Integrating the clinical experience of Chinese pathologists and oncologists, and following expert panel discussions, a consensus on the clinical diagnosis and treatment of HER-2-low and HER-2-ultralow breast cancer was developed. This consensus aims to deepen clinicians' understanding of HER-2-low and HER-2-ultralow breast cancer, promote more precise clinical decision-making, and ultimately improve patient survival and quality of life.

Breast cancer is the most common malignancy among women worldwide, with its incidence continuing to rise, posing a serious threat to women's health. In recent years, with the widespread adoption of molecular subtyping in diagnosis and treatment, breast cancer therapy has entered an era of individualized precision medicine. Early-stage breast cancer is primarily managed with surgery, combined with chemotherapy, radiotherapy, endocrine therapy, and targeted therapies (such as trastuzumab and pertuzumab), significantly improving cure rates. However, for recurrent or metastatic breast cancer, particularly refractory subtypes such as triple-negative and HER2-positive breast cancer, the efficacy of traditional treatments remains limited, and patients still face poor prognosis. Antibody-drug conjugates (ADCs), as an innovative targeted therapy strategy, combine the precise targeting of monoclonal antibodies with the potent cytotoxicity of payload drugs, delivering cytotoxic agents directly to tumors through targeted chemotherapy, achieving "precision delivery and efficient killing". ADCs represent a relatively novel class of highly targeted anticancer biologics. In the field of breast cancer treatment, ADCs have made groundbreaking progress. Agents such as T-DM1 and T-DXd have significantly prolonged progression-free survival and overall survival in HER2-positive patients, providing critical treatment options for advanced-stage patients, markedly improving survival outcomes, and are now being explored in earlier lines of therapy, reshaping the treatment landscape of breast cancer. Although ADCs are generally well-tolerated, their unique structure-comprising antibodies, cytotoxic payloads, linkers, and conjugation processes-leads to distinct adverse effects and heterogeneous safety profiles within the class. Based on the latest research advances in ADC therapy for breast cancer and incorporating clinical experience from both domestic and international settings, the Professional Committee on Anticancer Drug Clinical Research of the China Anti-Cancer Association has jointly developed the "Guidelines for managing adverse reactions to antibody-drug conjugates in breast cancer (2025 edition)". This guideline aims to provide healthcare professionals with practical guidance on the early identification, regular assessment, timely management, and follow-up monitoring of ADC-related adverse reactions or events.

In recent years, the incidence of B-cell non-Hodgkin lymphoma (B-NHL) in China has shown a steady increase, accounting for approximately 85%-90% of all lymphomas. Although standard immunochemotherapy regimens such as R-CHOP have led to long-term remission in some patients, approximately 30%-40% still experience relapse or refractory disease, with dismal prognosis and a median survival of less than one year. For patients who fail multiple lines of therapy, conventional options such as chemotherapy, radiotherapy, or hematopoietic stem cell transplantation offer limited benefits, highlighting an urgent need for innovative treatments. Chimeric antigen receptor T-cell (CAR-T) therapy, a breakthrough form of adoptive cellular immunotherapy, modifies autologous T cells to specifically recognize and eliminate malignant B cells, thereby achieving significant survival improvement in patients with relapse or refractory B-NHL. The clinical research and clinical application of CAR-T in the treatment of hematological tumors in China are in a state of rapid development. At present, there are two targeting CD19 CAR-T cells for the treatment of B-cell lymphoma, which gradually changed the diagnosis and treatment practice of lymphoma in China. At the same time, the clinic is actively exploring and improving the whole-process management experience of CAR-T therapy in lymphoma patients. So the Lymphoma Quality Control Expert Committee of the National Cancer Quality Control Center organized experts to form the consensus through discussion and revision many times, aiming to provide better guidance for clinicians to standardize the whole-process management of CAR-T cell therapy for B-cell Lymphoma, and further improve the survival benefits of patients.

Malnutrition and metabolic disorders occur in a high proportion of oncology patients, and malnutrition has a significant impact on both treatment and prognosis, resulting in a heavy disease and economic burden. In recent years, as awareness of the nutritional status of oncology patients has improved, especially the multiple negative effects of malnutrition, it has highlighted the lack of clinical treatment and insufficient knowledge of adverse effects, leading to the lack of special medical use foods for oncology patients as well as irregularities in their use. In order to further promote the clinical and family standardised application of special medical purpose foods for oncology patients, the expert group collects and collates high-quality evidence in recent years, and discusses and summarises the opinions on clinical application, and consolidates the consensus "Expert consensus on clinical application of whole nutritional oncology foods for special medical purposes (2025 edition)", aiming to promote the standardisation of oncology nutritional treatment, meet the special nutritional needs of oncology patients, improve the clinical knowledge on the application of special medical purpose foods for oncology, and provide detailed and practical guidance on clinical operation.

Amivantamab is the first fully humanized bispecific antibody approved for the treatment of non-small cell lung cancer (NSCLC) in the world. Amivantamab can block epidermal growth factor receptor (EGFR) pathway and mesenchymal-epithelial transformation factor (MET) pathway simultaneously, trigger the internalization and degradation of EGFR and MET, and activate the antitumor immune response. Amivantamab has been approved by the National Medical Products Administration for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR exon 20 insertion mutation, EGFR exon 19 deletion or exon 21 L858R substitution mutation, and is expected to be widely used in clinical practice soon. How to reasonably manage the adverse reactions related to amivantamab and maximize its efficacy is an urgent problem to be solved. Based on the existing medical evidence, combined with clinical experience, the expert group of this consensus finally formulated this "Expert consensus on amivantamab clinical application and adverse reaction management (2025 edition)" after multiple discussions. The contents of the consensus include the clinical use and management of adverse reactions of amivantamab. The recommendations focus on the prevention of infusion-related reactions, skin adverse reactions, venous thromboembolism, peripheral edema, oral mucositis, ocular toxicity and interstitial lung disease, amivantamab dose adjustment and treatment when adverse events occur, in order to provide guidance for clinicians to correctly use amivantamab and manage related adverse reactions.