Oncologist最新文献

Glioneuronal tumors are rare CNS neoplasms that can exhibit overlapping histological features with embryonal tumors, posing diagnostic and therapeutic challenges. We report a case of a 19-year-old Tunisian woman with a large right frontal tumor and contralateral extension. Initial partial resection suggested CNS neuroblastoma, and the patient underwent chemoradiotherapy with temporary disease control. Upon progression, a second partial resection was followed by DNA methylation profiling, which reclassified the tumor as a glioneuronal tumor with ATRX alteration, kinase fusion, and anaplastic features (GTAKA), harboring a KANK1::NTRK2 fusion. Entrectinib therapy was initiated, leading to a complete radiological response at 14 months, with marked clinical improvement and no serious adverse effects. This case highlights the essential role of DNA methylation profiling in resolving diagnostic ambiguity and guiding targeted treatment in CNS tumors. It further supports the potential efficacy of entrectinib in NTRK fusion-positive glioneuronal tumors.

Background: Zambia has the third highest cervical cancer incidence rate globally, and it remains the leading cause of cancer-related death among women. We explored the experiences of Zambian women who accessed cervical cancer screening and precancer treatment services to understand factors influencing care-seeking and access across urban, peri-urban, and rural settings.

Methods: In 2020, we conducted eight focus group discussions with women living with and without Human Immunodeficiency Virus (HIV) who underwent cervical cancer screening between 2016 and 2020. To explore their care journey, participants were grouped by screening outcome-those with cervical precancerous lesions and those without. We also conducted 18 in-depth interviews with healthcare workers providing antiretroviral treatment, cervical cancer screening, or precancer treatment at government health facilities. Transcripts were coded and analyzed using thematic analysis.

Results: Care-seeking unfolded across five stages: recognition of need to screen, hesitation and consultation, screening, result interpretation, and treatment. Women were generally knowledgeable about cervical cancer and sought screening promptly, though some delayed due to fear. Social networks and interactions with healthcare workers facilitated screening, while logistical and financial barriers, along with delays in histopathology services particularly in rural areas, hindered access to timely diagnosis and treatment.

Conclusion: Improving cervical cancer screening and precancer treatment in Zambia requires addressing systemic inefficiencies by strengthening laboratory capacity, decentralizing diagnostics, and training healthcare workers to provide respectful, consistent counselling. Expanding community engagement to counter misinformation, leveraging social networks, and providing financial protection are also critical to ensuring timely, equitable, and reassuring care.

Introduction: The rapid integration of immune checkpoint inhibitor (ICI) based combination therapies in first-line treatment of metastatic renal cell carcinoma (mRCC) is raising questions about next-line treatments and outcomes of IO rechallenge.

Methods: We performed a meta-analysis using the results from the phase-III RCTs, CONTACT-03 and TiNivo-2, to evaluate the effect of adding a PD-1/PD-L1 inhibitor rechallenge to a vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI) vs a VEGF TKI alone in patients with mRCC who had progressed on ICI based combination therapy or ICI monotherapy.

Results: A total of 865 patients with mRCC were included in this meta-analysis. The meta-analysis showed no difference in progression free survival between ICI plus VEFG TKI combination and TKI monotherapy groups (HR = 0.96, 95% CI : 0.76-1.21; p = 0.75) in patients previously progressing on ICI. Furthermore, adding IO to anti-VEGF TKI therapy was not associated with improve overall survival (HR = 1.06, 95% CI : 0.89-1.25; p = 0.52).

Conclution: In summary, PD-1/PD-L1 inhibitor rechallenge with a VEGF TKI in mRCC does not improve survival outcomes and should not be used in patients with prior progression to ICI. Understanding both intrinsic and acquired resistance mechanisms to ICI therapy is crucial for developing effective initial and sequential immunotherapy strategies in RCC.

Background: This study describes clinical characteristics, treatment patterns as well as safety outcomes of NSCLC patients harboring PD-L1 ≥ 50% who received adjuvant atezolizumab within the Italian real-world scenario.

Methods: Patients with surgically resected NSCLC harboring EGFR/ALK wild type disease and PD-L1 TPS ≥ 50%, who received at least one cycle of adjuvant atezolizumab were included. Clinical-pathological and molecular data, safety and efficacy outcomes were collected from the Italian ATLAS real-world registry.

Results: A total of 132 patients were included across 45 Italian centers between July 2022 and August 2024. Lobectomy was performed in 81.1% of cases, with 8.3% pathological stage IIA, 40.2% stage IIB, 43.9% stage IIIA, and 7.6% stage IIIB, according to the 8th TNM staging edition. The median number of atezolizumab cycles was 12.5 (range: 1-20). Treatment related adverse events (TRAEs) during atezolizumab were reported in 44 patients (33.3%), including 11 (8.3%) who experienced multiple TRAEs. Grade ≥3 TRAEs were reported in 21 cases (15.9%), leading to treatment discontinuation in 18 (13.6%). The median time to the first onset of TRAEs was 89 days (range: 3-390 days). 15 patients experienced a disease recurrence, including 6 locoregional-only and 9 distant relapses, with a median time since surgery of 13.3 months.

Conclusion: This study showed that the safety profile of adjuvant atezolizumab outside of a clinical trial context was comparable to the IMPower-010 study, highlighting the value of the Italian ATLAS registry as source of real-word evidence to optimize the clinical management of NSCLC patients.

Background: Implementing structured shared decision making (SDM) requires high-quality, reliable patient information. In radiation oncology, patients often have limited knowledge and misconceptions about therapy and side effects, affecting their decision-making. Large Language Model-based AI systems (LLMs) may help by providing evidence-based information in accessible language, but successful implementation depends on the willingness of patients and health care professionals (HCPs) to adopt these technologies.

Methods: A survey was conducted among patients undergoing radiation therapy and HCPs between 03/2024-02/2025. Data was collected using structured electronic questionnaires (32 items for patients, 35 for HCPs). The survey assessed sociodemographic characteristics, the status of SDM in oncology, sources of information relevant to SDM, and current and anticipated LLM applications. Data were analyzed using descriptive statistics and logistic regression analysis.

Results: The internet was the prime information source for patients (n = 400). Regarding current use of LLMs, a large discrepancy between patients and HCPs (n = 200) was observed (18.2% vs. 69.5%). Although 77% of HCPs believed that patients will rely on LLMs in the future, only 29.1% of patients agreed. Most patients (65.8%) stated that even as LLMs improve, they will continue to trust physicians more; 46% of HCPs shared this view. Only 16.5% of patients were convinced that LLMs provide all relevant data for SDM in cancer care. Familiarity with technology was the strongest predictor of LLM use among patients.

Conclusion: Only a minority of radiation oncology patients currently use LLMs, and many remain skeptical about their future role-contrasting with the more optimistic expectations of HCPs.

Background: Young women with breast cancer (YWBC) face medical and psychosocial challenges that are inconsistently addressed by healthcare frameworks. This study evaluated whether a patient navigation (PN) program for YWBC facilitates access to specialty and supportive care through structured patient needs assessments and referrals.

Patients and methods: Within 3 months of diagnosis, ≤40-year-old patients were prospectively enrolled into a PN program in which a navigator systematically administered needs detection surveys and provided referrals to required services at baseline, 3 months (m), and 6 m. Attendance to referrals at baseline and 3 m was assessed at the next timepoint.

Results: Among 189 participants, 85% required >2 referrals at any timepoint. At baseline and 3 m, referrals were mostly to nutrition (66% and 46%), support groups (65% and 24%), and psychology (56% and 36%); and at 6 m, to nutrition (32%), sexology (31%), and psychology (19%). From baseline-to-3m, attendance was highest for support groups (99%), genetic cancer risk assessment (88%), and external breast prosthesis providers (82%); from 3 m-to-6m, for support groups (100%), sexology (91%), and external breast prosthesis (86%). Nearly none attended >2 referrals and receiving more referrals was associated with higher absence rates (p<.001).

Conclusion: This PN program enabled structured identification of patients' needs and referral to required services, highlighting the relevance of nutrition, support groups, and psychology needs during early assessments, as well as sexology counseling during later follow-ups. The high absence rates observed suggest that individualized selection of specific referrals prioritizing patients' needs and preferences at different timepoints in their cancer trajectory could improve attendance while avoiding patient and health-system oversaturation.

Background: Invasive papillary breast cancer (IPC) is a rare cancer known to have a better prognosis than other breast cancers. This study aimed to explore whether patients with early-stage IPC can benefit from chemotherapy.

Materials and methods: IPC cases diagnosed between 2003 and 2021 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method and the Cox proportional hazard model were performed to identify significant prognostic factors. To eliminate selection bias and baseline characteristics, propensity score matching (PSM) was used. The primary endpoints were overall survival (OS) and breast cancer-specific survival (BCSS).

Results: A total of 1,892 patients were enrolled, and 273 pairs were screened after PSM. Multivariable analysis showed that age under 50, married status, smaller tumor size, negative lymph node (LN) status, and receipt of surgery, chemotherapy or radiotherapy were independently associated with better OS. After PSM, patients receiving chemotherapy had significantly improved OS (p = 0.012), while BCSS showed no significant difference (p = 0.099). After stratified by tumor size and LN status, chemotherapy could significantly improve the OS of patients with LN-negative IPC with tumors ≥ 2.0 cm (p < 0.001). Among the patients with grade III or undifferentiated diseases, the OS of the chemotherapy group was significantly better than that of the non-chemotherapy group (p < 0.001).

Conclusions: For patients with LN-negative IPC with tumor ≥ 2.0 cm and patients with grade III or undifferentiated disease, chemotherapy significantly improved OS. Future randomized controlled trials are expected to validate the results.

Background: The symptom burden associated with advanced pancreatic cancer, such as metastatic pancreatic adenocarcinoma (mPC), reduces patients' health-related quality of life (HRQoL). Recognizing the impact of disease- and treatment-related symptoms is essential in refining patient-reported outcomes (PROs) in clinical research, ensuring that PRO measures in clinical trials support US Food and Drug Administration label statements, and improving patient HRQoL.

Patients and methods: Patients with mPC and caregivers of patients with mPC were interviewed for this qualitative study. Insights from interviews were used to update a preliminary conceptual model derived from a targeted literature review. The primary objective was to obtain an in-depth understanding of patients' experience of living with mPC and the impact of mPC on patients' lives.

Results: Across 19 interviews (n = 16 patients, n = 3 caregivers), the most frequently reported symptoms were tiredness (n = 19); fatigue, nausea, and weight loss (n = 18 each); and diarrhea and hair loss/thinning (n = 16 each); 17 participants reported mPC- and/or treatment-related pain. The most frequently reported impacts were anxiety (n = 17), reduced physical functioning (n = 16), and worry/fear of disease (n = 16). After identification of the most salient symptoms and impacts, 2 symptoms and 4 impacts were added to the preliminary conceptual model and 31 symptoms and 11 impacts were removed to generate the final conceptual model (40 symptoms and 26 impacts).

Conclusion: This qualitative interview study uncovered previously unreported symptoms and impacts of mPC and supports the careful selection of appropriate PRO measures that more comprehensively reflect the experience of patients with mPC in future clinical trials.

Introduction: Metastatic uveal melanoma (MUM) has a poor prognosis, but hepatic arterial infusion chemotherapy (HAIC) may improve outcomes in patients with hepatic metastases. To identify reliable prognostic factors for patient stratification and treatment allocation, we analyzed the clinical and imaging data from a large single-center cohort using machine learning (ML) models.

Methods: Pre- and post first treatment clinical data of 235 patients with MUM treated with HAIC between 2009 and 2019 were retrospectively analyzed using Cox regression to identify prognostic factors for overall survival (OS) and time to change treatment strategy (TTCS). Furthermore, ML models were trained on clinical and computed tomography (CT) data for endpoint prediction.

Results: Pre-treatment multivariate analysis identified elevated lactate dehydrogenase (LDH) (OS: 6.5 vs. 16.4 months, hazard ratio (HR)=1.87, p = 0.006) and gamma-glutamyl transpeptidase (GGT) (OS: 7.6 vs. 16.4 months, HR = 1.67, p = 0.012) as prognostic factors for inferior OS. Decreased albumin (TTCS: 1.3 vs. 6.1 months, HR = 6.26, p < 0.001) and elevated LDH (TTCS: 2.9 vs. 7.6 months, HR = 1.72, p = 0.011) and alanine aminotransferase (ALT) (TTCS: 3.7 vs. 6.4 months, HR = 1.65, p = 0.004) predicted shorter TTCS. Scoring enhanced the power of the prognosticators for OS and TTCS. Post first treatment multivariate analysis emphasized the importance of inflammation management and liver protection. ML models incorporating radiomics features from base line CT imaging were not superior to models based on pre-treatment clinical data alone.

Conclusion: We identified independent but synergistic prognostic factors for outcome stratification to guide treatment decisions and optimize patient management. ML-based radiomics features did not significantly enhance prognostic performance.

Background: Both hyperthermic intraperitoneal chemotherapy (HIPEC) and conventional intraperitoneal chemotherapy (IP) have shown survival benefits in ovarian cancer (OC), but direct comparisons between the two perfusion modalities are lacking. This study aimed to compare effectiveness and safety between HIPEC and conventional IP in OC.

Methods: This retrospective real-world study analyzed 606 patients with stage Ⅱ-IV OC who received HIPEC or IP following cytoreductive surgery between 2013 and 2024. The primary endpoint was progression-free survival. Overall survival and adverse events were secondary endpoints. The study used inverse probability of treatment propensity-score weighting. We also conducted sensitivity analyses to evaluate result robustness and subgroup analyses to explore potential effect modification.

Results: After a median follow-up of 26 months, disease progression occurred in 40.6% of patients in the HIPEC group and 55.0% in the IP group (hazard ratio [HR] 0.79; p = 0.103). Mortality rates were 13.2% and 22.5%, respectively (HR 0.83; p = 0.434), showing no significant differences in progression and survival between the two groups. Exploratory subgroup analyses suggested a trend toward improved progression-free outcomes with HIPEC, particularly among patients with BRCA wild-type or BRCA1-mutated tumors and early postoperative perfusion. Hypoalbuminemia was the most common event in both groups (HIPEC 27.2%; IP 15.6%). HIPEC group had more abdominal distension and wound dehiscence, whereas IP patients experienced nausea and rash more frequently.

Conclusions: HIPEC did not significantly improve survival over conventional IP in the overall population, but showed greater benefit in specific subgroups, underscoring the importance of individualized intraperitoneal chemotherapy strategies in OC.