Oncologist最新文献

Importance: Lung cancer management involves navigating a complex pathway from symptom onset to treatment initiation, where delays can compromise outcomes.

Objective: To identify the length of treatment intervals among Mexican lung cancer patients, compare treatment intervals to results from other countries, and identify determinants of delays.

Design: Retrospective study collecting patient records and exploring the treatment interval in lung cancer.

Setting: The study was conducted at Mexico's National Cancer Institute.

Participants: 2645 lung cancer patients with a confirmed diagnosis between 2004 and 2021 were included in the analysis.

Exposure: Social determinants of health.

Main outcome: Treatment interval (from diagnosis to treatment).

Results: Logistic regression models revealed significant associations between delays and various factors, including marital status, education, region, first symptom at presentation, treatment type, and political period. A comparison with international guidelines highlighted substantial delays in patients diagnosed at the Instituto Nacional de Cancerología and diagnosed externally.

Conclusions: Targeted interventions should consider patient characteristics to enhance care efficiency. Concerns should be raised about the observed increase in treatment intervals from 2014 and the associated impact on survival rates. There is an urgency for timely interventions, continuous research, and collaborative efforts to optimize care delivery and outcomes for lung cancer patients in Mexico.

Background and objective: Cytoreductive nephrectomy following immune checkpoint blockade (ICB) in metastatic renal cell carcinoma remains controversial, with limited data on its clinical and pathological outcomes. This study evaluated the outcomes of patients undergoing deferred cytoreductive nephrectomy (dCN) after ICB-based treatment, focusing on the radiologic and pathological responses, and postoperative clinical outcomes.

Methods: We retrospectively reviewed 24 patients with metastatic or locally advanced RCC who underwent dCN after ICB at a single institution between April 2018 and May 2024. We assessed the radiological response to ICB, pathological findings (presence and extent of necrosis) in resected primary tumors, and postoperative clinical outcomes, including the rate of patients without measurable disease and those who discontinued systemic therapy.

Results: Median ICB exposure prior to surgery was 11.3 months. Radiologically, 67% of patients had partial response, 29% had stable disease, and 4% had a complete response. Pathology showed 96% of specimens with necrosis, 21% of specimens showing no residual disease (pT0), and 21% exhibiting ≥95% necrosis. Postoperatively, 50% of patients had nonmeasurable disease of first follow-up scans, and 54% discontinued systemic therapy, with 9 patients remaining on surveillance at last follow-up. Limitations include the small sample size and retrospective design.

Conclusion: Deferred CN following ICB therapy is feasible. Extensive necrosis in the resected surgical specimen after ICB-based therapy requires further investigation as a prognostic marker for durable responses off systemic therapy.

Background: Identifying high-risk of late recurrence (beyond 10 years) in patients with hormone receptor-positive HER2-negative early breast cancer (EBC) is crucial. The Clinical Treatment Score post-5 years (CTS5) score assesses recurrence risk after 5 years of endocrine therapy (ET). This study validated CTS5 as a prognostic tool for late recurrence by examining its association with Distant Recurrence-Free Survival using GEICAM study data and evaluating model calibration.

Patients and methods: We retrospectively analyzed 5739 hormone receptor-positive HER2-negative EBC patients from the El Álamo IV registry (N = 3509, diagnosed between 2002 and 2005) and 4 adjuvant GEICAM studies (N = 2680, conducted between 1996 and 2006). All patients were distant recurrence-free and alive 5 years after starting adjuvant ET.

Results: The CTS5 classified 43.9% of patients as low-risk, 32.2% as intermediate-risk, and 23.9% as high-risk. Significant differences in DR were observed: hazard ratio (HR) for intermediate- vs. low-risk was 2.55 (95% CI, 1.85-3.51, P < .0001), and HR for high- vs. low-risk was 5.77 (95% CI, 4.28-7.78, P < .0001). Similar results were found across subgroups by menopausal status, duration of adjuvant ET, and prior adjuvant chemotherapy (CT). Calibration showed CTS5 overestimated DR rates in low-risk (P = .0314) and high-risk (P < .0001) patients compared to observed rates.

Conclusions: The CTS5 categorized patients based on late DR risk regardless of menopausal status, ET duration, or CT treatment. However, the model tended to overestimate events, particularly in high-risk groups, especially among those treated with ET for less than 60 months or not receiving CT.

Background: With treatment options for human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (mBC) expanding, updated assessments of contemporary treatment patterns and clinical outcomes are needed. This study aimed to conduct such an assessment using data from real-world oncology practices.

Materials and methods: Adult HER2+ mBC patients initiating first-line (1L) treatment from January 2013 to January 2021 (index date) were selected from the US Flatiron Health database and followed through January 2022. Patient characteristics and treatment patterns were summarized. Clinical outcomes were examined using Kaplan-Meier analyses.

Results: Among 2074 HER2+ mBC patients with at least 1 line of therapy (LoT), median age was 61 years and 62.8% had known hormone receptor-positive disease. During a median follow-up of 26.0 months, 1159 (55.8%) had at least 2 LoTs, and 584 (28.2%) had 3 or more. The most common 1L regimens included docetaxel, trastuzumab, and pertuzumab (THP; 38.9%) followed by THP+ platinum agent (7.5%) and ado-trastuzumab emtansine (T-DM1) monotherapy (6.1%). By the end of follow up, 18.1% of patients remained on treatment, 20.2% died, and 5.8% discontinued without starting a new treatment. Median overall survival from 1L start was 40.3 months.

Conclusions: Approximately one-quarter of the patients died or discontinued 1L therapy without receiving further treatment. Overall survival from the start of 1L was just over 3 years. This highlights a need for more effective therapies in earlier LoTs that prolong the time to progression and provide longer clinical benefits.

We assessed the recruitment and retention of a short 8-week telemedicine-based group peri-habilitation program for gynecologic cancer survivors. Multidisciplinary team included: a gynecologic oncologist with additional board certification by the American College of Lifestyle Medicine, cancer-specific nutritionist, culinary medicine chef, physical therapist, exercise physiologists, mental health counselor, body image aesthetician, pelvic floor therapist, and sex therapist. Pre- and post-self-administered questionnaires assessed conformity to lifestyle medicine pillars and a general medical symptom questionnaire (MSQ). Recruitment was suboptimal (11.7%). Neither provider referrals nor flyers sufficiently directed patients to the program, but those that completed the program expressed meaningful impact on lifestyle behavioral change and improved quality-of-life across multiple parameters including MSQ (40.0 vs 20.75) and 85% participants reported compliance with recommendations. This pilot program suggests that a multidisciplinary tele-lifestyle-based survivorship program beyond just diet and exercise to improve quality-of-life in gynecologic cancer survivors, though novel and well received, needs physician buy-in and enhanced marketing strategies.

Precision oncology has transformed non-small cell lung cancer (NSCLC) treatment by tailoring therapies to the genomic profile of the disease, significantly improving clinical outcomes. However, acquired resistance to molecularly targeted therapies remains a major challenge. This report details a 69-year-old woman with KRAS G12C-mutant metastatic NSCLC who developed resistance to sotorasib, a KRAS G12C inhibitor. Initially responding to the standard dose of 960 mg, the patient required a dose reduction to 480 mg due to liver toxicity. After 20 months, oligoprogression occurred, managed through surgical resection. Molecular analysis of the resected tissue identified KRAS amplification as a resistance mechanism. Following disease progression, re-escalation of sotorasib to 960 mg led to renewed tumor response without additional toxicity. This case highlights dose re-escalation as a potential strategy to address resistance in selected patients and underscores the critical role of molecular profiling and personalized approaches in optimizing targeted NSCLC treatments.

Background: Accurate prediction of early recurrence (ER) is essential to improve the prognosis of patients with hepatocellular carcinoma (HCC) underwent thermal ablation (TA). Therefore, a deep learning model system using longitudinal magnetic resonance imaging (MRI) was developed to predict ER of patients with HCC.

Methods: From 2014, April to 2017, May, a total of 289 eligible patients with HCC underwent TA were retrospectively enrolled from 3 hospitals and assigned into one training cohort (n = 254) and one external testing cohort (n = 35). Two deep learning models (Pre and PrePost) were developed using the pre-operative MRI and longitudinal MRI (pre- and post-operative) to predict ER for the patients with HCC after TA, respectively. Then, an integrated model (DL_Clinical) incorporating PrePost model signature and clinical variables was built for post-ablation ER risk stratification for the patients with HCC.

Results: In the external testing cohort, the area under the receiver operating characteristic curve (AUC) of the DL_Clinical model was better than that of the Clinical (0.740 vs 0.571), Pre (0.740 vs 0.648), and PrePost model (0.740 vs 0.689). Additionally, there was a significant difference in RFS between the high- and low-risk groups which were divided by the DL_Clinical model (P = .04).

Conclusions: The PrePost model developed using longitudinal MRI showed outstanding performance for predicting post-ablation ER of HCC. The DL_Clinical model could stratify the patients into high- and low-risk groups, which may help physicians in treatment and surveillance strategy selection in clinical practice.

Background: Neuroendocrine carcinoma (NEC) is an aggressive, poorly differentiated Grade 3 (G3) tumor with high nuclear and cellular atypia and Ki-67 indices over 20%. While most cases are lung NECs, extrapulmonary NECs are rarer and less studied. Standard treatment involves etoposide and platinum (EP) chemotherapy. Inspired by the IMpower133 study, which showed survival benefits with atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer, this study investigates whether atezolizumab combined with platinum and etoposide can offer similar benefits for extrapulmonary NEC.

Method: This retrospective cohort study, conducted at Taipei Veterans General Hospital from January 2016 to June 2023, compared the efficacy of atezolizumab combined with platinum and etoposide versus standard chemotherapy alone in extrapulmonary NEC patients. The outcomes assessed were response rate, progression-free survival (PFS), and overall survival (OS).

Result: The study evaluated 56 patients: 14 received atezolizumab with platinum and etoposide (EP), while 42 were treated with EP alone. The median PFS was 5.2 months, and median OS was 11.9 months for the whole cohort. While there were no significant differences in OS or PFS between the groups, the response rate was significantly higher in the atezolizumab group. Additionally, a neutrophil-lymphocyte ratio (NLR) above 3 was linked to poorer OS.

Conclusion: The addition of atezolizumab to EP did not improve PFS and OS in extrapulmonary NEC patients but did result in a higher response rate. Moreover, an NLR above 3 at diagnosis was identified as a poor prognostic factor for OS.

Background: Previous research demonstrates longer survival for patients with lung-only metastatic pancreatic adenocarcinoma (mPDAC) compared to liver-only mPDAC. The objective of this study is to understand the survival differences, impact of chemotherapy, and associated genomic features of mPDAC that is isolated to either the liver or lung.

Patients and methods: Longitudinal clinical outcomes and molecular sequencing data were retrospectively analyzed across 831 patients with PDAC across all stages whose tumors first metastasized to the liver or lung. Survival differences were evaluated using Cox regression. Mutational frequency differences were evaluated using Fisher's exact test.

Results: Median overall survival (mOS) was shorter in patients with liver-only metastasis (1.3y [1.2-1.4], n = 689) compared to lung-only metastasis (2.1y [1.9-2.5], n = 142) (P = .000000588, HR = 2.00 [1.53-2.63]. Survival differences were observed regardless of choice of 1st-line standard-of-care therapy. For 5-fluorouracil-based therapies, mOS for liver-only mPDAC was 1.4y [1.3-1.6] (n = 211) compared to 2.1y [1.8-3.3] for lung-only mPDAC (n = 175) (P = .008113, HR = 1.75 [1.16-2.65]). For gemcitabine/nab-paclitaxel therapy, mOS for liver-only mPDAC was 1.2y [1.1-1.5] (n = 175) compared to 2.1y [1.6-3.4] for lung-only disease (n = 32) (P = .01863, HR = 1.84 [1.11-3.06]). PDAC tumors with liver-only metastases were modestly enriched (unadjustable P < .05) for: TP53 mutations, MYC amplifications, inactivating CDK2NA alterations, inactivating SMAD alterations, and SWI/SWF pathway mutations. PDAC tumors with lung-only metastases were enriched for: STK11 mutations, CCND1 amplifications, and GNAS alterations.

Conclusion: Patients with lung-only mPDAC demonstrate an improved prognosis relative to those with liver-only mPDAC. Responses to chemotherapy do not explain these differences. Organotropic metastatic tumor diversity is mirrored at the molecular level in PDAC.