Asia-Pacific journal of clinical oncology最新文献

Aim: The coronavirus disease 2019 (COVID-19) pandemic has significantly strained global healthcare systems. Cancer patients are particularly vulnerable to adverse outcomes from COVID-19 infection. The aim of this study is to determine adverse prognostic factors in Taiwanese cancer patients who contract COVID-19.

Methods: This retrospective cohort study reviewed the medical records of patients with cancer who were admitted for a COVID-19 infection to a tertiary medical center in Taipei from 2020 to 2022 were retrospectively reviewed. The study endpoint was all-cause mortality during hospitalization. Cox regression analyses using the stepwise selection method were used to determine factors associated with survival, which included patient demographic characteristics, medical history, length of intensive care unit (ICU) stay, presence of fever at admission, microbial culture results, vaccination status, cancer types, and laboratory metrics.

Results: Forty-two patients were included in the analyses, of which 20 died. The mean age of the patients was 71 years. Stepwise regression analyses identified the following factors were risk factors for worse survival: presence of fever at admission (hazard ratio [HR] = 9.31, 95% confidence interval [CI]: 2.38-36.42, p = 0.001), higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (HR = 1.13, 95% CI: 1.05-1.23, p = 0.002), higher total bilirubin (HR = 1.15, 95% CI: 1.05-1.26, p = 0.004), and higher creatinine level (HR = 1.38, 95% CI: 1.16-1.64, p < 0.001). Higher neutrophil segment percentage and blood urea nitrogen levels showed marginally significant associations with survival.

Conclusions: Factors associated with worse survival in cancer patients who contract COVID-19 are fever at admission, high APACHE II score, and elevated levels of total bilirubin and creatinine.

Background: Patients with brain metastases can be treated with whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS). There are no randomized study comparing WBRT with SRS in patients with brain metastases from breast cancer. This study aimed to compare WBRT with SRS in patients with breast cancer with brain metastases.

Material and methods: Breast cancer patients with 1-5 brain metastases, ≤ 3.5 cm and KPS ≥ 60 were randomized to WBRT or SRS. WBRT dose was 30 Gy/10 fractions /2 weeks. SRS dose varied from 18 to 24 Gy per fraction to 27-36 Gy in 3-6 fractions. Primary endpoint was overall survival (OS) and the secondary end points were progression free survival (PFS), performance and neurologic status, and cognitive impairment. The trial was approved by the institute ethics committee and registered in clinicaltrials.gov NCT05144867.

Results: Between July 2021 and January 2023, 103 patients were randomized; 51 in the WBRT arm and 52 in the SRS arm. Mean tumor diameter was 3.40 ± 1.22 and 2.81 ± 1.24 cm in WBRT and SRS, respectively. The median follow-up duration was 17.5 months (IQR- 7-21.9 months). Local recurrences were observed in five (9%) and nine (17%) patients in the WBRT and SRS (p = 0.32) group, respectively. Distant intracranial relapse occurred in 11 (21%) and 20 (39%) patients treated with WBRT and SRS (p = 0.36), respectively. Median OS was 17.4 months (95% CI: 6.63-17.8 months) in the WBRT arm and 14.6 months (95% CI: 14-15.2 months) in the SRS arm (p = 0.817). Median PFS was 13.9 and 11.0 months, respectively, for WBRT and SRS (p = 0.73). The 1-year OS and PFS were 55% and 47% (p = 0.51) and 41% and 43% (p = 0.75) with WBRT and SRS, respectively. At 3 months, patients treated with WBRT showed significantly better improvement in KPS (p = 0.004). In both the arms the MMSE improved at 3 months from the baseline, but it was greater with SRS.

Conclusion: There was no significant difference in the outcomes between the SRS and WBRT in breast cancer patients with brain metastasis. WBRT led to a significant improvement in the KPS. Cognitive decline was lower in the SRS arm.

Aim: To determine the feasibility of using population-based linked data to measure an Australian multidisciplinary set of 26 colorectal cancer (CRC) quality indicators.

Methods: Data were obtained on adult patients diagnosed with CRC (ICD-10-AM codes C18-C20) between July 1, 2005 and December 31, 2019 from the New South Wales (NSW) Cancer Registry. The NSW Cancer Registry data were linked to the Clinical Cancer Registry, Admitted Patient Data Collection, and death records. The feasibility assessment included (1) mapping required variables to available data, (2) review of publicly available reports to identify routine reporting of the indicators, (3) assessment of data completeness and coverage using proportional analyses, and (4) pilot test calculation of feasible indicators where data exist.

Results: Data mapping found that 14 indicators were potentially feasible. Linked data were available for 38,430 patients to test eight surgical indicators and 8489 patients to test six neoadjuvant therapy indicators. The data required to measure these indicators had significant limitations in data coverage, completeness, and quality, rendering the calculations unreliable and some implausible. The data completeness for staging ranged from 74% to 85%, and almost one half of diagnosis dates were illogical. Overall, six of the 26 indicators were feasible and reliable to measure. These addressed unplanned reoperation/readmission, colonoscopy, surgical mortality, and survival.

Conclusion: This study identified six clinically relevant quality indicators feasible to measure using NSW population-based data. However, these indicators were surgical processes and outcomes. There are insufficient data to produce adequate and clinically meaningful quality measurements for a multidisciplinary CRC team, particularly in diagnostic workup, neoadjuvant therapy, and supportive care.

Purpose: We aimed to analyze our radiotherapy protocol by evaluating its effect on recurrence patterns and survival outcomes.

Methods: We assessed 69 patients diagnosed with IDH-wild-type glioblastoma who underwent chemoradiotherapy at our institution from January 2014 to January 2021. A high-risk clinical target volume (CTV_high) was created with a 1 cm margin in all directions from the GTV, while a low-risk clinical target volume (CTV_low) was established with a 2 cm margin. Planned treatment volumes with a 2-3 mm margin in all directions were created, and doses of 60 and 50 Gy were prescribed in 30 fractions. Recurrence patterns were classified as central, in-field, marginal, or distant based on the 60 and 50 Gy D95 isodose lines.

Results: With a median follow-up of 21 months, 88.4% of patients experienced recurrence. The overall survival rates at 1, 2, and 5 years were 84.1%, 51.5%, and 17%, respectively. The progression-free survival rates at the same intervals were 44.9%, 21.5%, and 9.5%, respectively. Recurrence patterns were central in 63.9%, in-field in 18%, marginal in 4.9%, and distant in 13.1%.

Conclusion: The recurrence pattern remained unchanged with our protocol. With longer survival times, distant recurrence rates increase, yet central and in-field recurrences remain dominant. Despite the decrease in the volume that received the 60 Gy dose, marginal recurrences remained at a notably low level.

Background: In patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), the correlation between hematological markers and treatment outcomes has been established. However, their predictive role in the development of immune-related adverse events (irAEs) remains unclear.

Methods: We conducted a multicenter retrospective cohort study to evaluate whether pre-treatment hematological markers-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and the CRP-albumin-lymphocyte (CALLY) index-predict the development of irAEs in 147 patients with R/M SCCHN treated with pembrolizumab.

Results: Lower NLR and PLR, as well as higher LMR and CALLY index, were significantly associated with a higher incidence of irAEs. Furthermore, NLR and LMR were significantly correlated with the occurrence of severe (Grade ≥ 3) irAEs.

Conclusion: Pre-treatment NLR, PLR, LMR, and CALLY index may serve as useful predictive markers for the development of irAEs in patients with R/M SCCHN treated with pembrolizumab.

Introduction: Trastuzumab emtansine (T-DM1), an antibody-drug conjugate, targets tumor cells overexpressing human epidermal growth factor receptor 2 (HER2). This single-arm, phase IV study assessed the safety and efficacy of T-DM1 in Indian patients with HER2-positive, locally advanced, or metastatic breast cancer previously treated with trastuzumab and a taxane.

Methods: Patients received T-DM1 (3.6 mg/kg intravenously every 3 weeks) until death, disease progression, unacceptable toxicity, consent withdrawal, or up to a maximum of 12 months after the last patient's first visit, whichever occurred first. Safety was mainly assessed by the incidence and severity of adverse events (AEs). Efficacy was evaluated by progression-free survival (PFS), overall survival (OS), and overall response rate (ORR). Patients were followed up posttreatment until 12 months or until lost to follow-up, withdrawn consent, or death.

Results: A total of 70 eligible patients (median age [range]: 50.0 [27.0-75.0] years) received at least one dose of T-DM1 (median duration [range]: 32.0 [1.0-125.0] weeks). Adverse events in 21 (30.0%) patients were treatment-related. The most common treatment-related AEs and SAEs were thrombocytopenia (seven [10.0%] and three [4.0%] patients, respectively) and epistaxis (four [6.0%] and two [3.0%] patients, respectively). During the study, 10 (18.0%) patients died (disease progression: n = 6; AE: n = 3; and unknown reason: n = 1), while 2 patients died during the follow-up period. Median PFS was 14 months (95% confidence interval [CI]: 8.0, 17.0). Among 65 evaluable patients, 16 (23.0%) achieved partial responses; ORR was 23.0%.

Conclusions: Trastuzumab emtansine was found to be safe and efficacious in the Indian patients.

Purpose: This study aimed to identify breast cancer-specific circulating tumor DNA (ctDNA) methylation markers that correspond to tissue DNA methylation.

Methods: Using The Cancer Genome Atlas (TCGA) database, we selected breast cancer-specific DNA methylation markers. The methylation and expression patterns of candidate genes were analyzed in breast cancer cell lines and tissue samples. We also assessed the methylation status in ctDNA obtained from breast cancer patients and examined associations with the clinicopathological features.

Results: Among candidate genes with breast cancer-specific methylation patterns, USP44, ZNF454, and GPRC5B were selected. The methylation status and expression of selected genes varied by molecular subtype of cancer in the cell line. In tissue samples, expression of all three genes was generally lower in breast cancer than in controls. ctDNA methylation patterns showed no significant change before and after treatment for each candidate gene. Correlations between gene expression and DNA methylation status or clinicopathological characteristics in cancer tissues differed among genes.

Conclusion: Further studies are needed for clinical application of liquid biopsy using methylation analysis for ctDNA according to individual characteristics for breast cancer.

Papillary tumors of the pineal region (PTPR) are rare central nervous system neoplasms, with a limited number of pediatric cases reported in the literature. Their optimal management remains unclear due to their unpredictable biological behavior and high recurrence rates. This study presents the clinical course, treatment, and long-term follow-up of a 3-year-old child diagnosed with PTPR. Additionally, we conducted a comprehensive review of 35 pediatric cases reported to date, analyzing clinical presentation, treatment strategies, recurrence patterns, and outcomes. The review revealed that gross total resection (GTR) was performed in 69.6% of cases, yet recurrence occurred in 38.8% of these patients. In cases of subtotal resection (STR), the rate of recurrence was significantly higher, with 60% of patients experiencing a relapse. Adjuvant radiotherapy (RT) seems to enhance disease control, especially in cases with STR. Spinal dissemination was observed in 5.7% of cases at diagnosis and 6.2% at recurrence, both of which were associated with poor prognosis. Our case highlights the effectiveness of adjuvant RT for the first time in preventing tumor progression following STR, with long-term disease stability (9 years and 2 months) observed over a 9-year and 6-month follow-up period. PTPRs have a high recurrence rate, which requires careful selection of patients for adjuvant therapies. Although GTR is the standard treatment approach, adjuvant RT may offer additional control in specific cases, particularly for patients with STR or those classified as high-risk. Further research is needed to establish standardized treatment protocols and improve long-term outcomes for pediatric patients with PTPR.

Aim: The use of plant-derived drugs in cancer therapy is widely considered in the treatment of different malignancies including breast cancer. Cucurbitacin D (CuD) is able to induce apoptosis in cancerous cells through different signaling pathways. The aim of this study was to examine the effect of different concentrations of CuD on viability and death pattern.

Methods: Antiproliferative effects of CuD on these cell lines' viability were investigated using the MTT assay. Real-time PCR was applied to evaluate the expression alterations of Bcl-2, Bax, caspase-3, p53 (that related to apoptotic cell death pathway), Atg5, Beclin-1, PTEN, and Akt genes (autophagy genes) in the MCF-7 (ER positive) and MDA-MB-468 (triple negative) breast cancer cells.

Results: Significant dose-dependent and antiproliferative effects of CuD were observed on MCF-7 and MDA-MB-468 cells after 24 h with IC50 value about 30 and 25 µM, respectively (p < 0.01). Significant changes in expression of the genes in the breast cancer lines were observed under different concentrations of CuD.

Conclusion: Our results confirmed that CuD may influence breast cancer cell lines' viability at specific doses and by altering the expression of these genes. The differences between the gene's aberrations in our breast cancer cell lines propose that these genes can have a distinct role in the pathophysiology and therapy responsiveness of various subtypes of breast cancer.