Current Treatment Options in Oncology最新文献

Opinion statement: Systemic therapy for recurrent and metastatic salivary gland malignancies (SGMs) remains a major therapeutic challenge. Traditional chemotherapy offers modest response rates with limited durability, and its role is largely palliative. The most meaningful advances have occurred in biomarker-selected subgroups: androgen receptor blockade for AR-positive salivary duct carcinoma and HER2-directed therapy for HER2-positive tumors have demonstrated superior response rates and survival (often exceeding 50%), compared with the single digit response rates seen with unselected chemotherapy or tyrosine kinase inhibitors. Small-molecule tyrosine kinase inhibitors such as lenvatinib and axitinib may provide disease stabilization in adenoid cystic carcinoma, although tumor shrinkage is uncommon and toxicity limits their long-term use. Immunotherapy as a single agent has been disappointing, but durable responses in select patients and modest activity with combination regimens suggest it may have a future role when rationally paired with other agents. In our practice, comprehensive molecular profiling is essential at the time of recurrence to identify actionable alterations, prioritize targeted therapy where available, and guide clinical trial enrollment. For most patients without a targetable alteration, platinum-based combinations remain the pragmatic choice, though expectations for benefit should be tempered. Future strategies will likely hinge on optimizing biomarker-driven therapies, expanding access to antibody-drug conjugates, and pursuing collaborative trial designs to overcome the rarity and heterogeneity of these tumors.

Opinion statement: Symptom management remains a critical priority in oncology, particularly as many survivors continue to experience fatigue, pain, sleep disturbance, neuropathy, and psychological distress despite advances in treatment. Conventional pharmacologic options often provide only partial relief and may be limited by side effects. Acupuncture and acupressure have emerged as promising non-pharmacologic approaches, but the supporting evidence is drawn from a broad and heterogeneous literature. In this opinion paper, we provide a preliminary overview of the current review-level evidence to highlight general trends and evolving areas of promise, while emphasizing the need for further sham-controlled studies to clarify effectiveness and guide integration of acupuncture and acupressure into supportive oncology.

Opinion statement: The subspecialty of cardio-oncology has undergone significant growth in recent years, alongside major advances in the management of both cardiovascular disease and cancer, the leading causes of morbidity and mortality in the United States and many countries around the world. Contemporary clinical guidelines and scientific statements have outlined evidence-based strategies for reducing the risk of cancer therapy-related cardiovascular toxicity among cancer survivors across the treatment continuum. These approaches broadly include tailoring assessment and treatment of shared risk factors before therapy; minimizing cardiac radiation exposure, integrating baseline and repeat echocardiography for those receiving anthracyclines and targeted therapies, and assessing troponins and electrocardiography for patients starting immune checkpoint inhibitors during therapy; and considering long-term cardiac surveillance and promoting healthy lifestyle behaviors after therapy. This review outlines key evidence gaps and future directions in cardio-oncology with an emphasis on contemporary trends in cardiovascular disease and cancer risk factors, current and novel approaches for risk estimation and stratification, innovative clinical trials and largescale observational registries, quality-of-care metrics and cardio-oncology rehabilitation, social determinants of health and health equity, and artificial intelligence and machine learning for precision medicine. As the number of cancer survivors continues to grow and is projected to exceed 26 million by 2040, multidisciplinary collaboration between cardiology, oncology, and other health disciplines is critical to not only improve individuals' health outcomes and quality of life associated with cardiovascular disease and cancer, but also to further elucidate the bi-directional relationship and underlying pathophysiologic mechanisms underpinning both chronic diseases.

Opinion statement: Participation in cancer clinical trials is essential for advancing medical knowledge, improving patient outcomes, and ensuring equitable access to emerging therapies. However, oncology clinical trial participants do not reflect the population affected by cancer. In particular, racial and ethnic minorities, rural residents, and individuals from lower socioeconomic backgrounds continue to be significantly underrepresented in oncology clinical trials overall, and among trials evaluating patients with head and neck cancer (HNC), relative to their frequency in the general population. This review applies the social ecological model to identify and categorize barriers to equitable clinical trial accrual across individual, interpersonal, institutional, community, and policy levels. Addressing these multilevel barriers requires the concerted efforts of researchers, clinicians, community leaders, and policymakers. Commitment to inclusive trial design and implementation is essential to ensuring that the benefits of cancer research are equitably distributed. Clinical research must reflect the populations it seeks to serve, so that all patients, not just a select few, benefit from the future of oncology innovation.

Opinion statement: The treatment landscape for melanoma has been dramatically transformed by the advent of novel therapeutic approaches, particularly immune checkpoint inhibitors (ICIs) and targeted therapies (TTs). Clinical outcomes, such as overall survival, progression-free survival, objective response rate, and the incidence of immune-related adverse events, are useful metrics for evaluating these agents; however, cost considerations have become increasingly important. Globally, the medical costs associated with melanoma treatment are increasing. In recent years, the cost-effectiveness of ICIs and TTs in both unresectable and adjuvant settings has been extensively analyzed. Most studies have reported that anti-PD-1 antibody monotherapy is more cost-effective than combination regimens involving ICIs or TTs in both settings. However, most cost-effectiveness analyses were based on simulation models derived from international clinical trials data; therefore, they may not accurately reflect real-world outcomes, which can vary significantly among different patient populations. Furthermore, treatment costs vary substantially among countries due to differences in healthcare systems, reimbursement policies, and pricing. Cost-effectiveness analyses based on real-world data from individual countries are essential to accurately determine the most cost-effective treatment options for patients with melanoma.

Opinion statement: Improved survival in pediatric oncology has highlighted the growing burden of cancer treatment-related cardiotoxicity among survivors of childhood cancers. While the cardiotoxicity of anthracyclines and chest radiation are well documented as major contributors of late morbidity and mortality, the rapid adoption of immunotherapies and targeted agents in pediatrics raises new concerns regarding the unknown long-term cardiovascular risk. Recent advances include risk-adapted surveillance protocols and pediatric-based imaging guidelines are important steps towards optimizing early detection and intervention. However, significant gaps persist, particularly in the development of effective treatment options for cardiotoxicity, consistent cardiovascular event reporting, seamless transitions to adult care, and the meaningful integration of machine learning and precision medicine into real-world practice. In light of these ongoing challenges, we believe that while national and international guidelines are an essential framework, optimal cardiology care for pediatric cancer survivors must be grounded in individualized assessment and supported by multidisciplinary collaboration. Ongoing research and innovation are imperative to closing these gaps and advancing the long-term cardiovascular outcomes of this vulnerable population.

Opinion statement: As a type of skin cancer, melanoma is characterized by a high rate of recurrence and metastasis, making it one of the leading causes of mortality associated with skin cancer. With the continuous advancement in technology, current treatment options for melanoma and metastatic melanoma have significantly improved; however, the threat posed by melanoma still warrants attention from the broader population. Artemisinin, derived from the plant Artemisia annua, is recognized as a promising drug molecule that demonstrates effective activity against both malaria and cancer. In this study, artemisinin and its derivatives (such as artemisinic acid, artesunate, and dihydroartemisinin) were shown to possess inhibitory effects on melanoma and ocular melanoma Further investigations revealed that the efficacy of these compounds is primarily linked to their ability to reduce melanin content, inhibit melanogenesis and cellular proliferation, suppress tumor growth in murine models, counteract tumor metastasis and angiogenesis, as well as promote apoptosis. The core mechanisms underlying these effects may be associated with signaling pathways such as PI3K/AKT/mTOR, MALAT918/YAP, along with those related to angiogenesis. In this study, we reviewed the inhibition of melanoma angiogenesis by natural products and its potential mechanisms using literature from PubMed, EMBASE, Web of Science, Ovid, ScienceDirect, Geenmedica, Cochrane Library and China National Knowledge Infrastructure databases. The search timeframe spans from the inception of the database to September 2025. Inclusion criteria encompass original English-language research articles, clinical trials, case reports, and relevant reviews focusing on the mechanisms, efficacy, or clinical applications of artemisinin derivatives in melanoma and ocular melanoma. Exclusion criteria include non-English literature, studies not directly related to melanoma, ocular melanoma, or the antitumour effects of artemisinin, and inaccessible Chinese-language literature. We additionally identified supplementary eligible studies through manual screening of reference lists from relevant literature.This study emphasizes the critical role of artemisinin and its derivatives in combating melanoma and ocular melanoma. The aim is to facilitate further development and utilization of these compounds while providing relevant insights for clinical research endeavors.

Opinion statement: The current landscape of second-line treatment for cholangiocarcinoma (CCA) appears to be evolving, with emerging strategies offering potential improvements over traditional approaches. Although conventional chemotherapy demonstrates limited efficacy following progression after first-line therapy, the development of targeted therapies and immunotherapies is creating new possibilities for enhancing clinical outcomes. The increasing focus on molecular biomarkers-such as isocitrate dehydrogenase (IDH), B-raf kinase (BRAF), and neurotrophic receptor tyrosine kinase (NTRK) mutations, as well as fibroblast growth factor receptor (FGFR2) fusions and HER2/neu overexpression-represents a significant advancement in enabling precise, targeted treatment options. Evidence from recently completed and ongoing clinical trials evaluating these therapies, both as monotherapy and in combination with chemotherapy and/or immunotherapy, supports this shift. Continued research aimed at refining treatment selection and advancing personalized therapeutic strategies is essential, with the goal of achieving longer survival and improved quality of life for patients undergoing second-line therapy for CCA.