American Journal of Clinical Oncology-Cancer Clinical Trials最新文献

Objectives: The National Comprehensive Cancer Network guidelines recommend tumor phenotyping for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 at initial breast cancer diagnosis, with repeat biopsy considered at disease progression. This study assessed the frequency, timing, regional variation, and predictors of repeat biopsies among patients with metastatic breast cancer (mBC) treated at community oncology practices in the United States.

Methods: A weighted random sample of 911 mBC patients was selected from 15 practices within the ONCare Alliance network. The data included demographics, clinical characteristics, number and types of biopsies, and associated findings. Multivariate negative binomial regression, adjusted for disease duration, was used to identify predictors of biopsy frequency.

Results: Among the cohort, 42.2% had a history of early-stage disease, while 57.8% were diagnosed with de novo stage IV mBC. After adjusting for disease duration, patients with prior early-stage disease underwent significantly more biopsies (mean: 3.9; 95% CI: 3.7-4.0) than those with de novo mBC (mean: 2.2; 95% CI: 2.1-2.3; P<0.001). Factors associated with fewer biopsies included non-Black, non-Asian minority status (RR=0.80, P<0.001), longer time to metastatic progression (RR=0.93, P<0.001), poor performance status, and geographic region.

Conclusions: A substantial proportion of patients with mBC, particularly those with de novo disease, did not undergo repeat biopsy at progression. These findings reveal disparities in biopsy practices and underscore the need for improved adherence to guideline-based care in community oncology settings.

Objectives: Synovial sarcoma (SS) of the abdomen and pelvis is a rare and understudied condition. This study aimed to evaluate survival outcomes, assess calculated versus observed outcomes, and describe radiographic features among patients with localized abdominal/pelvic SS.

Methods: A retrospective chart review of 58 patients diagnosed with localized abdominal/pelvic SS between 1992 and 2022 was performed. Overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) were assessed. Sarculator-predicted 5-year OS and disease-free survival (DFS) were compared with observed outcomes.

Results: Twenty-four (41%) patients had tumors located in the extra-abdominal/pelvic region, and 34 (59%) had tumors located in the intra-abdominal/pelvic region. Most of the patients were female (62%). Survival outcomes revealed a median OS: 5.5 years, 5-year OS: 53%, median MFS: 1.5 years, and 5-year MFS: 32%. Patients with intra-abdominal/pelvic tumors had significantly worse MFS than those with extra-abdominal/pelvic tumors (median 1.3 vs. 2.7 y; P =0.023). Larger tumor size (≥5 cm MFS HR: 4.20, 95% CI: 1.48-11.95), poorly differentiated histology (MFS HR: 2.92, 95% CI: 1.13-7.53), and positive/unknown margins (OS HR: 2.96, 95% CI: 1.29-6.78; LRFS HR: 6.61, 95% CI: 1.65-26.50; MFS HR: 2.45, 95% CI: 1.23-4.89) were associated with worse outcomes. Sarculator-predicted and observed 5-year OS (49% vs. 52%) and DFS (30% vs. 26%) were consistent. Imaging features such as cystic changes and calcification were more frequent in larger and monophasic tumors.

Conclusions: In localized abdomen/pelvic SS patients, tumor size, location, and surgical margins are critical prognostic factors. Sarculator may aid in risk stratification.

Acute myeloid leukemia (AML) continues to pose a major hurdle in hematologic oncology, driven by its genetic complexity and tendency to resist standard therapies. Even with progress in treatment-such as high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT)-outcomes remain unsatisfactory for many patients. In recent years, immunotherapy has emerged as an appealing strategy to improve survival by strengthening the body's own anti-leukemia defenses. Natural killer (NK) cells, a critical component of innate immunity, have shown strong potential for directly eliminating AML cells without prior antigen exposure. This review outlines the role of NK cells in AML immune surveillance, mechanisms by which their function becomes impaired in the disease, and the current therapeutic approaches harnessing NK cells in AML management. We also discuss key obstacles and opportunities, including strategies to boost NK cell activity, counter immune escape, and improve treatment durability. Continued investigation is essential to refine NK cell-based therapies and bring patient-tailored immunotherapeutic options into broader clinical use.

Objectives: The Hispanic-American population is the nation's second-largest racial/ethnic group and the second most rapidly growing population. Radiation therapy (RT) is an indispensable, highly effective treatment for cancer; therefore, any barriers impairing RT access may yield deleterious consequences for Hispanic-Americans. The Navigator-Assisted Hypofractionation (NAVAH) program was developed to optimize RT access for all cancer patients. A key component of NAVAH is the use of culturally sensitive surveys to assess the impact of patient navigation before and after RT. We present initial findings from a Spanish-language cancer support group comprised of Hispanic-American patients as a baseline before implementation of NAVAH at our institution.

Methods: A previously validated, Spanish-language, culturally sensitive survey was implemented to identify barriers to cancer care among Hispanic Americans. Participants were recruited to complete interviewer-administered surveys between monthly group visits. Surveys assessed several domains, including acceptability, accessibility, accommodation, affordability, and availability.

Results: Eight cancer survivors completed surveys in person. Interviewees reported a positive but variable assessment of the availability, accommodation, and accessibility domains, suggesting that services may adequately meet patients' needs and preferences. However, responses in the acceptability domain reflected a strong perception of disparities and ethnic bias. In addition, feedback in the affordability domain indicates a heightened vulnerability to financial toxicity within this population.

Conclusions: These initial findings from the NAVAH program underscore the persistent challenges faced by Hispanic-American cancer patients, particularly in the realms of perceived discrimination and financial toxicity. These insights emphasize the necessity for culturally sensitive interventions, such as bilingual patient navigation programs, to address and mitigate the multifaceted barriers encountered by Hispanic-American patients. The NAVAH program's approach of incorporating culturally attuned surveys and support mechanisms represents a promising step toward optimizing equity in cancer treatment. Moreover, these early impressions pave the way for further investigation involving patients actively receiving RT.

Objectives: Esophageal cancer (EC) often presents with dysphagia due to tumor obstruction. Esophageal stenting has the potential of palliating dysphagia, improving nutrition, preventing aspiration, and improving quality of life (QoL) but may be associated with risks. The present systematic review and guidelines are intended to assist treatment decision-making when considering stent placement in patients with EC based on the available evidence.

Methods: Using the population, intervention, comparator, outcome, timing and study design framework, the evidence was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective phase II-III trials and retrospective analyses published between January 1, 2010 and December 3, 2024 in the Ovid Medline database. These references were assessed by American Radium Society (ARS) Appropriate Use Criteria (AUC) methodology. RAND-UCLA consensus methodology was used to rate the appropriateness of the use of stents.

Results: ARS AUC recommendations include (1) esophageal stenting is usually not appropriate in patients with early-stage EC in whom upfront surgery is planned; (2) esophageal stenting is usually not appropriate in patients with locally-advanced EC in whom neoadjuvant/perioperative therapy and esophagectomy or definitive chemoradiation is planned; (3) esophageal stenting may be appropriate in the setting of metastatic EC, especially in patients with short life expectancy with limited treatment options; (4) esophageal stenting is usually not appropriate for benign stricture following curative-intent therapy; (5) esophageal stenting is usually not appropriate for locally recurrent tumor in the setting of prior radiation; and (6) esophageal stenting is usually appropriate for management of tracheoesophageal fistula before curative-intent treatment.

Conclusions: This ARS AUC summary provides guidelines for the use of esophageal stents in patients with EC provides based on available evidence.

Objectives: Lung adenocarcinoma (LUAD), which is the most frequently diagnosed form of lung cancer, constitutes a major global health challenge due to its significant mortality rate. Palmitoylation, as a key post-translational modification of proteins, plays an important role in tumor progression. However, its influence on sculpting the tumor immune microenvironment (TME) and its subsequent impact on patient prognosis remains incompletely understood.

Methods: This study was based on the TCGA-LUAD and GSE72094 cohort data sets to explore the potential role of palmitoylation-related genes (PRGs) in LUAD. Through the integration of differential analysis, weighted gene coexpression network analysis (WGCNA), univariate Cox analysis and least absolute shrinkage and selection operator (LASSO) regression analysis, prognostic genes for LUAD were screened. Furthermore, the infiltration patterns of immune cells across different groups were assessed by applying the ssGSEA and CIBERSORT algorithms. To elucidate the potential biological processes mediated by PRGs in LUAD pathogenesis, GSEA, GO and KEGG enrichment analyses, were used. In addition, the consensus clustering method was utilized for identify molecular subtypes of LUAD.

Results: This study identified 5 PRGs as prognostic genes for LUAD and constructed a robust prognostic model. Immune infiltration analysis indicated that the level of immune cell infiltration in patients of the high-risk group was significantly lower. Further enrichment analysis showed that the upregulated differentially expressed genes (DEGs) in the high and low risk groups were related to the cytoskeleton, while the downregulated DEGs were related to lipid metabolism. In addition, this study successfully classified LUAD into 2 molecular subtypes with significant differences.

Conclusions: Our research delves into the intricate TME and molecular mechanisms of LUAD, providing new insights into the pathologic mechanism and treatment strategies of LUAD.

Objectives: Patient navigation is a key component in achieving optimal cancer care outcomes. While a vast amount of literature suggests its clear benefits in cancer care, limited objective data exists regarding navigation metrics, specifically the number of navigator-patient contacts and time spent with patients. This study attempts to attain findings from the published literature to better understand navigation metrics to achieve optimal cancer care outcomes.

Methods: A systematic PubMed search was performed in April 2025 focusing on cancer patient navigation, with the term "patient navigation or navigator in postdiagnosis cancer care-contact metrics." Important metrics analysed were the median number of navigator-patient contacts, the median time spent per patient, the most common barriers addressed, and their respective improved outcomes. These metrics were then compared with results from the ongoing Phase I Navigator-Assisted Hypofractionation (NAVAH) trial (clinicaltrials.gov, NCT05978232).

Results: A total of 7 peer-reviewed studies met the inclusion criteria. The number of patient-navigator contacts widely ranged from 1 to 119; the average being 13.4 (∼0.3 times/mo, compared with 2 times/mo in NAVAH). The median time spent per patient varied from 40 minutes to over 10 hours (compared with 20 mins/encounter in NAVAH). The most commonly discussed topic was financial assistance, which is consistent with NAVAH findings. Improved outcomes were significantly reduced treatment interruption days and securing early specialist appointments.

Conclusions: As previously published data depicted wide variability, it highlights the need for standardized data collection and reporting practices, as such quantitative data can facilitate the evolution of patient navigation in achieving improved cancer care outcomes.

Objectives: Papillary thyroid cancer (PTC) patients develop nonthyroid second primary malignancy (SPM) at a rate higher than the general population. We aimed to investigate the incidence of SPM, demographic risk factors, and relationship with RAIT among PTC patients.

Methods: A retrospective review was performed of PTC patients who underwent thyroid surgery at a single institution from 1/2007 to 1/2011.

Results: Of 528 patients, 40 (7.6%) were diagnosed with SPM (SPM+) over a median follow-up of 9.3 years. The standardized incidence ratio was 1.3 using demographic-adjusted SEER data. Median time to SPM diagnosis was 4.0 years (IQR 2.0, 6.7). Breast cancer was the most common SPM, occurring in 12 patients (30%). RAIT use and RAIT dose were not associated with SPM. There was no significant association between SPM and mortality (6.3% SPM+ vs. 3.1% SPM-, P =0.300). Older age (median 56.5 vs. 49.0 y, P =0.004), prior personal history of cancer (22.5% vs. 11.3%, P =0.036), and family history of cancer (70.0% vs. 42.8%, P <0.001) were associated with SPM+, but none were identified as independent risk factors.

Conclusions: This study did not find any association between SPM and RAIT in PTC patients. Factors other than RAIT, such as age and personal or family history of cancer were associated with SPM risk in PTC patients.