Oncology-New York最新文献

DOGE hopes to solve rampant inefficiencies in US healthcare that contribute to unsustainable costs and a broken system by cutting spending and administrative waste.

Marginal zone lymphoma (MZL) is a rare, indolent form of non-Hodgkin lymphoma that arises from B cells in the marginal zone of lymphoid tissues. MZL comprises 3 key subtypes: extranodal, nodal, and splenic MZL. Despite being generally slow growing, MZL presents significant challenges due to its heterogeneous nature, inconsistently defined disease, and the limited efficacy and availability of current treatments. Advancements in targeted therapies and a deeper understanding of the molecular underpinnings of MZL are critical to improving patient outcomes and achieving more durable remissions. At the Lymphoma Research Foundation's 2024 Marginal Zone Lymphoma Virtual Scientific Workshop, researchers gathered to discuss recent developments in both basic scientific and clinical research so that together we can continue to develop our understanding of MZL and improve outcomes for patients. This report, which includes a summary of each presentation, aims to review the findings presented at the workshop. Additionally, it highlights opportunities, reviews questions, and assesses areas for future study to set the stage for treatment advancements in the coming decades.

Introduction: There are limited data available regarding patient outcomes in those who would have been ineligible to receive therapy based on the original clinical trial eligibility criteria. We decided to conduct a retrospective study to evaluate outcomes based on clinical trial eligibility in patients with metastatic non-small cell lung cancer (NSCLC).

Methods: A retrospective chart review of all patients with metastatic NSCLC who received first-line systemic therapy at a single academic institution was performed. Each patient's chart was reviewed to determine if they would have qualified for the phase 3 clinical trial that led to the approval of the specific treatment regimen which they received. Data were analyzed to determine if there was a difference in survival time between those who would have been eligible compared with those who were ineligible for the clinical trial of the treatment regimen administered.

Results: There were 170 patients with a diagnosis of metastatic NSCLC who received first-line systemic therapy. Of these, 109 received combined chemotherapy, 25 received immunotherapy, and 36 received targeted therapy. There is a statistically significant difference in the restricted mean survival time between the eligible and ineligible groups in those who received combined chemotherapy (19.9 months vs 13.2 months; P  = .03), but not in either the immunotherapy group (22.4 months vs 12.9 months; P = .06) or the targeted therapy group (57.7 months vs 39.0 months; P  = .14).

Conclusion: These data support less restrictive clinical trial eligibility criteria for those with metastatic NSCLC. This is especially true regarding both targeted therapy and immunotherapy treatment regimens.

Gastric cancer remains a major global health concern with high incidence and mortality rates, particularly in East Asia. Patients often have poor outcomes due to limited treatment efficacy. Zolbetuximab, a monoclonal antibody targeting claudin 18.2 (CLDN18.2)-overexpressed in 50% to 80% of gastric cancers-demonstrates promise by initiating antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity in CLDN18.2-positive cells. In clinical trials, zolbetuximab with chemotherapy improved progression-free survival (PFS) and overall survival (OS). The FAST trial showed a median OS increase from 8.4 months to 13.2 months (HR, 0.72; P  < .01). The SPOTLIGHT trial found PFS extended to 11.0 months vs. 8.9 months (HR, 0.73; P  = .0024) with OS reaching 18.2 months in the zolbetuximab arm. The GLOW trial also confirmed efficacy, with median OS improving from 12.16 months to 14.39 months (HR, 0.771; P  = .0118). Zolbetuximab's targeted action, combined with manageable adverse effects, positions it as a promising therapy for advanced gastric cancer.

Background: Lifestyle medicine (LM) is increasingly recognized in cancer survivorship guidelines. The 6 LM pillars are physical activity, a predominantly plant diet, restorative sleep, stress management, avoiding risky substance use, and social connections. Through a multidisciplinary LM clinic in oncology, we describe 2 illustrative cases and the implications for broader implementation and dissemination of this clinic model.

Methods: In the multidisciplinary LM clinic in oncology, patients meet with an American College of Lifestyle Medicine (ACLM) board-certified physician or nurse practitioner, a registered dietitian, and, as needed, a clinical psychologist, a psychiatrist, an obesity medicine physician, a physical therapist, and/or a rehabilitation medicine physician.

Results: Patient 1 met with the physician, the registered dietitian, the psychologist, and an affiliated cancer center psychiatrist. Patient 2 met with the nurse practitioner and the registered dietitian. The 2 cases presented illustrate the diversity of LM pillars and strategies to increase health and well-being post cancer treatment.

Conclusion: This paper details the model of implementation of a novel oncology-focused multidisciplinary LM clinic and the clinical focuses of 2 diverse patients. The LM needs of cancer survivors seeking lifestyle consultation are growing, and awareness of the benefits of LM for this population can enhance the quality of life for patients who are survivors of cancer.

The incidence of neuroendocrine tumors (NETs) in the US is rising, with 8.3 cases per 100,000 individuals diagnosed in 2018 compared with 6.98 cases per 100,000 individuals diagnosed in 2012. 1,2 Most patients with NETs are diagnosed with metastatic disease, at which point curative surgery is no longer a treatment option. 3 Prior to 2017, available treatments for advanced NETs included somatostatin analogues (lanreotide [Somatuline] and octreotide [Sandostatin]), targeted therapy (everolimus [Afinitor] and sunitinib [Sutent]), and chemotherapy. 4-7 In 2017, the World Health Organization added a classification for well-differentiated grade 3 NETs (Ki67 > 20% and ≤ 55%). 8 Previously these tumors were placed under the umbrella of poorly differentiated neuroendocrine carcinomas. Given that well-differentiated grade 3 NETs are relatively new, standard-of-care treatment options are undefined.

We present a 65-year-old man with multiple myeloma who developed a rare complication of pleural effusion. Initial laboratory results showed elevated creatinine, calcium, and protein electrophoresis with an M spike. A bone marrow biopsy confirmed 80% plasma cells. Despite the rarity of pleural effusion in patients with multiple myeloma, our patient demonstrated significant improvement with targeted therapy and palliative care. This case highlights the importance of early recognition and management of pleural effusion in patients with multiple myeloma and underscores the need for further research into optimal management strategies and underlying mechanisms.

The Case A 47-year-old woman with a history of drug-resistant epilepsy during childhood presented to the emergency department with sudden dyspnea and chest pain. Upon admission, her oxygen saturation was 88%. A chest CT scan revealed pulmonary cystic lesions consistent with lymphangioleiomyomatosis and a right spontaneous pneumothorax, which resolved with the placement of a chest tube. Physical examination revealed a hypopigmented macule on the skin of the lumbar region, facial angiofibromas, and periungual fibromas. An abdominal MRI documented multiple bilateral renal tumors that were hypointense on T2-weighted imaging and showed a black boundary artifact, suggestive of fat-poor angiomyolipomas (AMLs). Subsequent percutaneous biopsy of the largest renal tumor confirmed the diagnosis of angiomyolipoma (positive for HMB-45 on immunohistochemistry). The brain MRI revealed subependymal nodules. The pulmonary function tests showed a mild obstructive pattern. Germline genetic testing confirmed the suspected diagnosis, and the patient started oral systemic treatment with everolimus (Afinitor) 10 mg once daily, along with dexamethasone rinses for prophylaxis.

The multidisciplinary team meeting has become a fundamental component of cancer care across most of Europe, North America, and Australia. In certain institutions, it holds a mandatory role in the treatment planning of all patients with cancer. Although the multidisciplinary team meeting has demonstrated improved adherence to clinical protocols in the oncology field and serves as a valuable educational tool for clinicians, it is difficult to truly gauge its impact on clinical outcomes due to the wide heterogeneity in interinstitutional meeting practices and the varied data reporting clinical outcomes. This literature review will provide an overview of the history and contextual role of the multidisciplinary team meeting in cancer management and discuss the barriers to its implementation, offering means to navigate these barriers. This review will also explore the barriers to adherence to treatment recommendations offered by the multidisciplinary team meeting in cancer care, through the lens of the patient and health care provider.

Acute myeloid leukemia (AML) is a heterogeneous disease characterized by the accumulation of malignant myeloid progenitor hematopoietic cells in the bone marrow and peripheral blood. Recent studies have shown promising results with the use of small molecule inhibitors and targeted therapy in the treatment of patients with AML. One such molecule is venetoclax, which has been approved in AML by the FDA in combination with hypomethylating agents or low-dose cytarabine. We thoroughly searched electronic literature related to venetoclax and its role in AML, using databases such as MEDLINE, PubMed, Google Scholar, and PsychInfo, through April 2024. We applied population, intervention, comparison, and outcome criteria, specifically focusing on studies with a population using venetoclax from review articles and clinical trials. All selected studies were required to be in English, and any study that did not involve the use of venetoclax was excluded. A meticulous literature review was conducted to consolidate the current knowledge and new combination therapies on AML. In our review article, we focused on the latest advances in the treatment of patients with AML. Based on the literature, we recommend that physicians prioritize the use of venetoclax in the management of this deadly disease because it has been shown to significantly impact the course of the disease.