Asia-Pacific journal of clinical oncology最新文献

Objective: Integrating Patient-Reported Outcome Measures (PROMs) into clinical practice is increasing, with research showing benefits in patient outcomes. However, evidence regarding patient's acceptance of PROMs is limited. Sydney Cancer Survivorship Centre (SCSC) clinic is a multidisciplinary clinic where clinicians use PROMs to guide patient consultation. This study explored SCSC patient acceptability of PROMs in clinical care by evaluating PROMs' completion rates.

Methods: This retrospective audit of PROMs completion rates evaluates two periods: 1) September 2013-November 2019 (pre-coronavirus disease 2019) and 2) October 2020-September 2023, following the implementation of electronic PROMs. Overall, 866 new patients attended SCSC during the two audit periods, with 822 (95%) giving consent for data to be included. Descriptive statistical methods were used to analyse completion rates.

Results: Between September 2013 and November 2019 (audit period 1), 656 new survivors attended the SCSC clinic; 622 (95%) consented to data use. The highest completion rate for paper-based PROMs was the food questionnaire (92%); with 91% for distress thermometer, symptoms, and exercise-related PROMs; 85% for quality of life; 77% for self-rated performance status, and 55.5% for a 3-day food diary. From October 2020 to September 2023 (period 2), the response rate for PROMs was 99% (n = 198/200) for initial clinic attendees; and 92% for electronic PROMs (n = 169/184).

Conclusions: Using comprehensive PROMs in clinical care is feasible. The completion rate was high; similar between paper-based and electronic PROMs. Comprehensive PROMs can guide clinical consultations. PROMs may improve communication between survivors and clinicians and enhance the quality of care.

Introduction: This study aimed to prospectively investigate magnetic resonance (MR)-guided radiotherapy (MRgRT) for post-prostatectomy prostate cancer and report preliminary clinical outcomes.

Methods: All included patients underwent salvage or adjuvant adaptive MRgRT on a 1.5T MR integrated linear accelerator (MR-LINAC). Gastrointestinal and genitourinary toxicities were assessed. The primary endpoint was the progression-free survival (PFS) rate estimated by Kaplan-Meier (KM) survival analysis. A progression event was defined as the first occurrence of biochemical failure, radiological progression, or death. Secondary endpoints were biochemical failure-free survival (bFFS) rate, radiological PFS (rPFS) rate, and ≥G2 adverse events.

Results: Thirty post-prostatectomy patients were enrolled and followed (median follow-up: 32.0 months; 3.0-48.1 months). Three patients had biochemical failure during follow-up. One patient developed pelvic node metastases. All patients were alive. The estimated PFS rates were 96.4% (95% confidence interval [95%CI]: 89.8%-100.0%) at 2 years and 78.8% (95%CI: 61.3%-100%) at 3 years. The estimated bFFS rates were 96.4% (95%CI: 89.8%-100%) /86.6%(95%CI: 73.4%-100%) at 2/3 years, respectively. The corresponding rPFS rates were 100% at 2 years and 92.3% (95%CI: 78.9%-100%) at 3 years, respectively. There was only one acute G2 GI adverse event (1/30, 3.33%) of abdominal pain occurred. Two late G2 events (one rectal bleeding and one urinary frequency) were scored (2/30, 6.67%). No ≥G3 events were observed.

Conclusion: Our findings suggest the feasibility, excellent patient tolerance, and encouraging efficacy of post-prostatectomy MRgRT, extending our knowledge of the clinical outcomes of MRgRT and serving as a benchmark for future investigation.

Aims: Adrenocortical carcinoma is a rare cancer known for its high recurrence rate. This study aimed to evaluate the effects of postoperative adjuvant radiotherapy on the outcomes of patients with adrenocortical carcinoma.

Methods: We examined patients with adrenocortical carcinoma who had undergone curative tumor resection. Tumor stages were classified using the European Network for the Study of Adrenal Tumors staging system. Out of 131 patients, 15 underwent adjuvant radiotherapy. Patients who underwent surgery and adjuvant radiotherapy were compared with those who underwent surgery only.

Results: Baseline characteristics were similar between the adjuvant radiotherapy (n = 15) and control groups (n = 30). Local recurrence occurred in three patients (20%) who received adjuvant radiotherapy and 18 patients (60%) in the control group (p < 0.05). The estimated 3-year locoregional-free survival was significantly higher in the adjuvant radiotherapy group (77%) compared to the control group (38.1%, p < 0.05). However, there were no significant differences in recurrence-free or overall survival between the two groups.

Conclusions: Postoperative adjuvant radiotherapy significantly enhances local control of adrenocortical carcinoma. It should be considered a crucial component of treatment, particularly for patients at high risk of recurrence.

Background and aims: The interaction of immune checkpoint inhibitors (ICI) and concomitant medications such as antibiotics, metformin, statins, beta-blockers, proton pump inhibitors (PPIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and low-dose aspirin has been studied in other malignancies. Our study aims to investigate the relationship between these medications and ICI efficacy in patients with advanced hepatocellular carcinoma (aHCC).

Methods: A retrospective review of patients who received at least one dose of ICIs between May 2015 and November 2019 was performed. The primary objectives were to compare the overall survival (OS) and progression-free survival (PFS) between patients with and without medication usage. Log rank test was used to assess for differences in survival. Hazard ratios were reported using Cox proportional hazard regression analysis. The data cutoff date was December 31, 2020.

Results: A total of 168 patients were included. Median age was 69 years, 85.7% male, 60.7% ECOG 0, 78.0% Child-Pugh A liver cirrhosis, 57.7% hepatitis B etiology, 8.9% hepatitis C, and 33.3% nonviral. One hundred three patients (61.3%) received ICI monotherapy, while 38.7% received ICI in combination. Sixty-two patients (36.9%) had concomitant antibiotic usage, 26.8% metformin, 30.4% statin, 31.0% beta-blockers, 60.1% PPI, 6.5% NSAIDs, and 11.9% aspirin. Patients with aHCC receiving antibiotics did not have a shorter OS (adjusted HR [aHR] 1.40, 95% CI 0.94-2.09, p = 0.096) or shorter PFS (aHR 0.94, 95% CI 0.66-1.34, p = 0.73), as compared to those who did not receive antibiotics. However, patients with aHCC of viral hepatitis etiology receiving ICI treatment and concurrent antibiotics had shorter OS (5.5 vs. 14.2 months, aHR 1.93, 95% CI 1.17-3.17, p = 0.010) and PFS (1.1 vs. 2.6 months, aHR 2.69, 95% CI 1.28-5.65, p = 0.009), as compared to those who did not receive antibiotics.

Conclusions: The use of antibiotics may diminish ICI efficacy in patients with aHCC of viral hepatitis etiology, while the use of metformin, statins, beta-blockers, NSAIDs, and aspirin is not associated with significant clinical outcomes.

Shared decision-making is ethically imperative, and is a key component in cost-effective, efficient and equitable cancer care. We review the recent advances in resources, training, tool development, and health policy, supporting the implementation of shared decision-making, and how the Philippines is primed for it.

Lung cancer is the most fatal cancer worldwide. The etiology of lung cancer has yet to be fully characterized. Smoking and air pollution are several risk factors for lung cancer. Berberine, an isoquinoline alkaloid, is an antihyperglycemic, antidepressant, antioxidative, anti-inflammatory, and anticancer compound. Evidence substantiates that berberine has antitumor effects, exerting its effects by targeting a variety of cellular and molecular processes, such as apoptosis, autophagy, cell cycle arrest, migration, and metastasis. Although the beneficial effects of berberine have been reported, some limitations including low bioavailability and absorption as well as poor aqueous solubility have hindered its clinical application. Nanotechnology and nanodelivery bioformulation approaches may bypass these limitations. In addition, the combination of berberine with other therapies has been shown to result in greater treatment efficacy for lung cancer. Herein, we summarize cellular and molecular pathways that are affected by berberine, its clinical efficacy upon various combinations, and the potential for nanotechnology in lung cancer therapy.

Background: Gemcitabine and docetaxel (GD) is a common chemotherapy regimen for metastatic soft tissue sarcoma (STS). The GeDDiS trial compared GD with doxorubicin in the first-line setting, using gemcitabine 675 mg/m² over a prolonged rate of 90 min-reporting a 20% response rate and 5.4-month median progression-free survival (PFS). We aimed to examine the real-world efficacy and toxicity of GD in our center, using a standardized dose of gemcitabine 900 mg/m² over 30 min on Days 1 and 8 and intravenous docetaxel 75 mg/m² over 60 min on Day 8 every 21 days.

Methods: A retrospective analysis was conducted of patients with unresectable or metastatic STS receiving GD between July 2018 and October 2022. Data collected included patient and tumor characteristics, dose intensity, toxicity, response, PFS, and overall survival (OS).

Results: Thirty-eight patients were included. Median follow-up was 19 months (range 3-30). Line of treatment (n) was first line (10), second line (13), ≥ third line (15). The median number of cycles was 6. Response rate was 42%, including 5% with a complete response. At the time of data collection, 33 patients had disease progression and 24 patients had died. PFS (median, 6-month rate) was 4.5 months and 44%. OS (median, 12-month rate) was 15 months and 65%. Grade 3/4 toxicity included anemia (21%), neutropenia (5%), thrombocytopenia (5%), and febrile neutropenia (3%).

Conclusion: These data demonstrate the activity of gemcitabine using a standardized dose and rate with docetaxel comparable to other published data and favorable toxicity in a real-life patient population despite altered gemcitabine dosing and a heavily pretreated patient population.

Background: Health outcomes for Aboriginal and Torres Strait Islander people in Australia are significantly worse than in the non-Indigenous population.

Aim: To evaluate demographic factors and treatment (surgery and radiotherapy) rates for cervical cancer and to compare these between the Aboriginal and non-Aboriginal populations to identify any differences in outcomes or modifiable treatment differences between the populations.

Methods: Retrospective cohort analysis of all patients in the state of New South Wales, Australia, diagnosed with cervical cancer between 2009 and 2018 using linked registry, treatment, and death data.

Results: The crude incidence rate for cervical cancer in Aboriginal women in NSW (17.29/100,000) was more than double the rate among non-Aboriginal women (6.77/100,000). Aboriginal women were diagnosed with cervical cancer, including metastatic disease, at a younger age. There was no significant difference in presentation stage, surgery or radiotherapy treatment rates, or overall survival at 5 years between the two populations.

Conclusion: Although access to cancer care looks similar as an aggregate in Aboriginal versus non-Aboriginal populations, there were disparities with reduced access to care (patients who did not receive either radiotherapy or surgery) among Aboriginal patients who were socioeconomically disadvantaged or residing in remote areas. The lower age of cancer diagnosis among Aboriginal women may have effects on survivorship, including negative effects on fertility, loss of income, and other personal, social, and economic consequences. Efforts to improve access to care, including screening, diagnosis, and treatment, should be targeted toward younger Aboriginal women and those who are socioeconomically disadvantaged or those residing in remote areas.