Clinical & Translational Oncology最新文献

Background: Liver metastases from colorectal cancer are a common and serious complication that significantly impacts patient survival. The aim of this study is to investigate the clinical efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in the treatment of liver metastases from colorectal cancer.

Methods: A retrospective analysis was conducted on 120 patients with liver metastases from colorectal cancer who were treated in our hospital from January 2018 to January 2023. The patients were divided into two groups based on the treatment they received: the TACE group (n = 60) and the TACE combined with RFA group (n = 60). The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) were compared between the two groups, and treatment-related adverse effects were recorded.

Results: The TACE combined with RFA group showed significantly better OS (22 months vs. 18 months) and PFS (13 months vs. 10 months) compared to the TACE alone group (P < 0.05). The ORR in the TACE combined with RFA group was 61.7%, significantly higher than 40% in the TACE alone group (P < 0.05). The DCR showed no significant difference between the two groups, with 86.7% (52/60) in the TACE combined with RFA group and 78.3% (47/60) in the TACE alone group (P > 0.05). There were no significant differences in treatment-related adverse effects between the two groups (P > 0.05).

Conclusion: These findings suggest that TACE combined with RFA may offer a potential option for improving OS, PFS, and ORR in patients with liver metastases from colorectal cancer, without increasing significant adverse effects, setting a new potential standard of care in the treatment of this disease.

Purpose: Effective and sustainable treatments to improve patient outcomes are urgently needed for non-small cell lung carcinoma (NSCLC). Neoadjuvant therapies, particularly nivolumab, have shown superior outcomes in event-free survival and pathological response, yet financial coverage is scarce. We aim to provide an exploratory economic analysis to assess the implications of its incorporation into routine clinical practice.

Methods: We conducted a six-step BIA (budget impact analysis) based on a decision tree model for pathways, probabilities, and resource utilization from the national payer perspective at an event-free survival (EFS) horizon. We estimated the direct cost of drugs and all healthcare-related services for two scenarios: a baseline scenario [neoadjuvant chemotherapy (CT)] and an alternative scenario [neoadjuvant nivolumab combined with chemotherapy (N + CT)].

Results: The funnel-down technique determined 359 eligible patients nationwide per year. The total cost of treatment in the baseline scenario amounts to CLP $ 7315 million Chilean pesos (€ 8,063,219) per cohort, with three top cost drivers: 1L drugs after recurrence (51.98%), resection (29.33%) and 2L nivolumab (5.85%). The alternative scenario amounted to CLP $ 6853 million (€ 7,553,572), with the highest relative expenditure attributed to the N + CT scheme (61.76%), resection (31.31%), and follow-up (2.73%). Adjuvant costs decrease to 1.03%, as does the expenditure on 1L (51.98% versus 0.34%) and 2L treatments (5.85% versus 0.18%). Early intervention in NSCLC reduces the budgetary impact by 6.3% (savings of - $ 462 million (€ 509,647) per treated cohort).

Conclusions: Early incorporation of N + CT optimizes healthcare expenditure by providing access to therapies that improve survival rates while reducing the need for costly treatments in advanced stages. This approach represents a dominant strategy.

Background and purpose: Stereotactic body radiotherapy (SBRT) has proven useful for non-spine bone metastases (NSBM). We analyzed local relapse rates and patterns of failure after NSBM-SBRT, contrasting our results with existing contouring guidelines.

Materials and methods: We conducted a retrospective analysis of NSBM-SBRT treatments performed between 2013 and 2024 in a single institution. Clinical, pathologic, and treatment-related data were collected. Failure patterns were assessed based on imaging tests and categorized as in-field, marginal/out-of-field.

Results: Among 119 NSBM-SBRT treatments in 85 patients, the most common primary tumors were prostate (36.1%) and breast cancer (24.4%). The coxal bone was the predominant metastatic site (52.9%). The median follow-up was 32.8 months. OS rates at 1, 2, and 3 years were 90.1%, 83.5%, and 75.8%, respectively. Twenty seven relapses were observed in the treated bone with a median recurrent tumor volume of 9.9 cm³ and a median time to recurrence of 15.1 months. Relapse-free survival in the treated bone was 89.4%, 78.5%, and 74.2% at 1, 2, and 3 years, respectively. Median recurrent tumor volume within the CTV was 50.6% and the median distance from the relapse center to the initial tumor was 11.4 mm.

Conclusion: NSBM-SBRT provides effective local control with relapses often occurring near the initial tumor lesion. While adherence to existing contouring guidelines captures most scenarios, consideration of larger CTV expansions may be warranted in cases with poorer prognosis. Further studies are needed to identify risk factors for relapses outside the margins and optimize volume delineation in these scenarios.

Purpose: Outcome for children with refractory and relapse/progressive high-risk neuroblastoma (HR-NB) remains poor, without an internationally agreed standard second-line approach. Heterogeneity in patients' disease and treatment strategies challenges clinical management. The survival rate for patients with resistant disease does not exceed 20% at 5 years. The study's aim was to analyze refractory and progressive HR-NB patients in a real-world setting to evaluate current clinical practices and optimize future approaches.

Methods: Data from patients diagnosed with refractory and relapse/progressive (R/R-P) HR-NB between January 2019 and December 2021 at six of the major Spanish neuroblastoma treating hospitals were collected and analyzed.

Results: A total of 67 episodes of R/R-P HR-NB were included. Treatments applied included chemotherapy (97%), immunotherapy (48%), consolidation (21%), local treatment (surgery and/or radiotherapy) (45%) and maintenance (16%), and were administered within a clinical trial (CT) in 34% of the episodes. Biopsy was performed in 37% of the tumors and 30% were profiled. Event-free survival (EFS) in our cohort was 20.9% and overall survival (OS) 32%. Significant survival advantage (in both OS and EFS) was observed in refractory episodes compared to relapse/progressive, in first events compared to successive, and when response or disease stabilization was achieved. MYCN status, presence of lymph node metastases, use of irinotecan or topotecan, and radiotherapy were also univariate predictors of OS.

Conclusions: Treatment of refractory and relapse/progressive HR-NB is highly heterogeneous. We confirm a poor outcome, although certain epidemiological and treatment-related factors have prognostic value. Molecular profiling and inclusion in CTs should be improved.

Purpose: This study evaluates a three-dimensional (3D) deep learning (DL) model based on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting the preoperative status of spread through air spaces (STAS) in patients with clinical stage I lung adenocarcinoma (LUAD).

Methods: A retrospective analysis of 162 patients with stage I LUAD was conducted, splitting data into training and test sets (4:1). Six 3D DL models were developed, and the top-performing PET and CT models (ResNet50) were fused for optimal prediction. The model's clinical utility was assessed through a two-stage reader study.

Results: The fused PET/CT model achieved an area under the curve (AUC) of 0.956 (95% CI 0.9230-0.9881) in the training set and 0.889 (95% CI 0.7624-1.0000) in the test set. Compared to three physicians, the model demonstrated superior sensitivity and specificity. After the artificial intelligence (AI) assistance's participation, the diagnostic accuracy of the physicians improved during their subsequent reading session.

Conclusion: Our DL model demonstrates potential as a resource to aid physicians in predicting STAS status and preoperative treatment planning for stage I LUAD, though prospective validation is required.

Purpose: Treatment for metastatic castration-resistant prostate cancer (mCRPC) includes chemotherapy and inhibition of the androgen receptor pathway. However, the optimal treatment sequence in this scenario is not yet fully understood. Therefore, we conducted a systematic review and meta-analysis comparing cabazitaxel versus abiraterone or enzalutamide for efficacy and safety outcomes as second-line therapy in mCRPC patients after docetaxel failure.

Methods: We searched PubMed, Embase, and Cochrane databases for interventional studies comparing cabazitaxel versus abiraterone or enzalutamide for patients with mCRPC who have experienced treatment failure with docetaxel as their first-line therapy. We computed hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Eight studies, comprising 1,897 patients were included, of whom 548 (28.8%) received cabazitaxel. Mean follow-up time ranged from 3 to 16.4 months. Median age ranged from 68.1 to 73.9 years in the cabazitaxel group, and 68.0 to 73.1 years in the abiraterone or enzalutamide group. In our meta-analysis, cabazitaxel significantly improved progression-free survival (PFS) rates (HR 0.60; 95% CI 0.47-0.78; p < 0.001) compared to abiraterone or enzalutamide. There were no differences between groups in overall survival (HR 0.76; 95% CI 0.46-1.24; p = 0.27), therapy-related grade ≥ 3 adverse events (AEs) (OR 3.00; 95% CI 0.72-12.40; p = 0.12), and PSA decline ≥ 50% (OR 1.20; 95% CI 0.51-2.80; p = 0.67).

Conclusions: In this systematic review and meta-analysis of men with mCRPC after docetaxel failure, second-line therapy with cabazitaxel was associated with a longer PFS compared with abiraterone or enzalutamide, though without a significant difference in OS.

Increasing knowledge of the immunosuppressive tumor microenvironment in cancer-related processes has led to the developing of novel immune-based therapies that have changed the cancer treatment paradigm. In the tumor microenvironment, the plethora of soluble factors secreted by tumor cells interacts with immune cells and non-immune components to deliver signals necessary for tumor progression. Accordingly, targeting tumor-derived factors inducing this immunosuppressive tumor microenvironment has become an appealing therapeutic potential in advancing cancer treatment. CCL20, a chemokine best known to induce leucocyte migration in response to pathological and inflammatory conditions, has been implicated in tumor proliferation, angiogenesis, metastasis, immunosuppression, and therapeutic resistance. Notably, CCL20 and its receptor CCR6 are important in tumor microenvironment interactions. This review discusses the interaction between the CCL20-CCR6 axis and the tumor microenvironment and how these interactions promote tumor progression. Also, an outline of studies utilizing CCL20 in combination with other standard cancer treatments has been shed.

Purpose: There has been increased difficulty in developing safe and effective treatment using PI3K inhibitors in heme malignancies, despite the role of PI3K/AKT being well defined in this population. This study was an attempt to conduct exploratory biomarker analysis retrospectively from the phase III CHRONOS-3 trial with the aim to identify a sub-set of patients that could benefit from treatment.

Patients and methods: Patients with CD20-positive indolent B-cell lymphoma were randomized 2:1 to receive intravenous copanlisib plus rituximab (C + R) or placebo plus rituximab (P + R). Biomarker analyses were performed to examine potential associations between treatment outcome and phosphatase and tensin homolog (PTEN) protein expression, EZH2 and BCL2 mutation status via next-generation sequencing, and plasma cytokine levels.

Results: PTEN presence was associated with significant improvements in progression-free survival (PFS) for C + R over P + R in patients with iNHL (P = 0.001) and FL (P = 0.012). Both the mutant and wild-type EZH2 FL patients had equal PFS benefits when treated with copanlisib. A significant improvement in PFS was observed for patients with mutant versus wild-type BCL2 FL in the C + R arm (P = 0.002). Overall survival (OS) was significantly improved for patients with iNHL and low or undetectable versus high baseline IL-2 levels in the C + R arm (P < 0.0001, unadjusted).

Conclusions: PTEN presence, BCL2 mutations, and low or undetectable baseline IL-2 levels were associated with improved patient survival following treatment with C + R, supporting a potential role for these biomarkers in guiding treatment selection for patients with indolent non-Hodgkin lymphoma.