Asia-Pacific journal of clinical oncology最新文献

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.

Aims: Castrate-resistant prostate cancer (CRPC) is a common malignancy with poor prognostic outcomes. Breast cancer (BRCA) genes 1 and 2 mutations occur in prostate cancers and confer poorer prognoses. Somatic BRCA testing can lead to inconclusive results, which can gatekeep patients from accessing targeted medications. We assessed the somatic BRCA testing results among our cohort of CRPC patients for factors contributing to quality control (QC) failures and inconclusive testing.

Methods: We performed a retrospective review of the records of all patients with CRPC attending our cancer care centers from 2020 to 2023. We identified the presence/absence of somatic BRCA testing results on their record. For those with returned results, we collected key information including biopsy characteristics, time from biopsy to BRCA result, and outcome of BRCA testing.

Results: A total of 147 patients with CRPC attended our service between January 2020 and 2023. A total of 54 patients (40%) had somatic BRCA testing performed on a tumor biopsy sample. A total of 35 somatic tests (65%) returned an actionable (positive or negative) result. The remaining 19 (35%) returned as inconclusive/QC failures. QC failures were significantly associated with a greater time from initial biopsy to somatic testing result (60 vs. 27 months, p = 0.033). The type of tissue biopsied, tumor percentage in biopsy sample, tissue sampling method, and sampling hospital did not contribute significantly to QC failure.

Conclusions: A longer tissue retention interval from biopsy to somatic BRCA testing is associated with a greater risk of inconclusive test results. We recommend a repeat biopsy for BRCA testing in CRPC patients where archival tissue is older than 5 years.

Lung cancer remains the leading cause of cancer-related mortality in Australia, with diagnoses projected to rise further following the introduction of the National Lung Cancer Screening Program in July 2025. Comprehensive molecular profiling has become central to the management of non-small cell lung cancer, enabling tailored therapies such as chemoimmunotherapy, immunotherapy, and tyrosine kinase inhibitors in perioperative, adjuvant, and palliative settings. With the emergence of perioperative systemic therapies and novel agents for the management of metastatic disease, there is a need to ensure that equitable care is delivered across Australia. Further investment in oncology workforce expansion and planning is critical to meet growing demands. In this narrative review, we explore the rapidly evolving landscape of available therapeutics for managing patients with early and advanced NSCLC in the Australian context, highlight the emerging treatment options being investigated in ongoing clinical trials, and discuss future considerations for clinical practice.

Introduction: Few exercise-based oncology rehabilitation programs were available across Australia in 2015. Clinical guidelines have since recommended that exercise be included in standard cancer care. This study aimed to (1) identify and describe exercise-based oncology rehabilitation programs in Australia, (2) determine whether there have been changes in the number or content of programs since 2015, and (3) describe factors associated with program implementation.

Methods: A cross-sectional survey collected data from program coordinators of Australian oncology rehabilitation programs. Quantitative data were analysed descriptively and using independent t-tests and chi-squared tests. Qualitative data underwent content analysis.

Results: The number of oncology rehabilitation programs in Australia increased from 31 programs in 2015 to 76 programs in 2024, equating to an 88% increase from 8 to 15 programs per 100,000 cancer survivors. Sixty-two completed surveys were returned (62/76, 82% response rate). Programs were typically for people with any cancer at any stage of treatment. The proportion of programs offering education decreased by 29% since 2015 [χ²(1) = 6.011, p = 0.014]. On average, programs ran three times per week (standard deviation [SD] 4) for 11 weeks (SD 10). There was increased use of exercise testing in 2024. Program implementation was supported by an increasing presentation of cancer survivors in general rehabilitation programs (30/62, 48%) and challenged by a lack of funding (27/62, 44%).

Conclusion: Oncology rehabilitation programs in Australia have more than doubled in the past decade, but availability remains poor. Programs were mainly exercise-only, with an increased use of objective criteria for exercise dosage and progression.

Aim: To present an overview of personalized cancer vaccines currently undergoing clinical development, aiming to enhance awareness and promote collaboration among academic, commercial researchers, and non-profit communities.

Methods: A dataset of 78 clinical trials for personalized cancer vaccines was generated using ClinicalTrials.gov database as of November 25, 2024. We conducted an analysis of the studies based on sponsors, conditions, phases, types of vaccines, and global geographic distribution.

Results: The majority of trials focused on peptide vaccines (40%) and dendritic cell vaccine (19%), targeting solid tumors, brain, pancreatic and breast cancers, among others. Phase 1 trials dominated the landscape, accounting for over 90% of studies, with significant activity in the United States (44%) and China (24%). Industry sponsors backed 22% of studies. Active trials represented 72% of the dataset, reflecting ongoing research efforts in this field. Enrollment sizes varied widely, ranging from small exploratory cohorts of fewer than 10 participants to larger-scale trials enrolling up to 700 patients. Completed clinical trials evaluating personalized neoantigen vaccines across various cancer types showed that vaccines were generally well-tolerated, elicited strong T-cell responses, and resulted in promising clinical outcomes such as tumor shrinkage or prolonged progression-free survival, particularly in melanoma, glioblastoma, and urothelial cancer, although no universal cure was demonstrated.

Conclusions: There is a broad early-stage pipeline of personalized cancer vaccines currently being tested in clinical trials for various cancer types.

Background: Sarawak isthe largest state in Malaysia, with a population of 2.9 millionwith 45% living more than 100 km from urban cities. These communities face the risk of delayed breast cancer diagnosis due to limited access to healthcare services. Sarawak has only four government hospitals with diagnostic mammogram facilities.

Objective: Sarawak Breast Cancer Support Group (SBCSG) has spearheaded breast cancer education and early screening outreach since 2012, with a special focus on rural communities. This paper describes the results from our 10-year program.

Methods: These programs were organized or co-organized by SBCSG from 2013 to 2023, involving local organizers and the Ministry of Health Malaysia. Women aged 18 years and above were invited to participate in clinical breast examination, and those with abnormal findings were referred to the nearest clinic or hospital for further management.

Results: We screened 2050 women, with 7.1% exhibiting abnormal breast findings. Urban screening sites reported higher abnormal findings in (9% [85/949] vs. 5% [61/1101]; p = 0.003), Malays demonstrated the highest percentage of abnormal breast findings (9.5%, 28/296). Women with fewer than three children were more likely to exhibit abnormal findings (8.3% [85/1021] vs. 5.9% [61/1029]; p = 0.003). Subjects screened at urban sites and between the ages of 30-59 were 1.6 and 2.3 times more likely to exhibit abnormal findings, respectively.

Conclusion: Screening site was the strongest independent variable for detecting breast abnormality, which could be linked to reproductive health, as women in rural areas tend to have more children, a trend that can be attributed to socioeconomic and cultural norms.

Locally advanced mucosal head and neck squamous cell carcinoma (LA-HNSCC) is associated with several key risk factors including smoking, alcohol, and human papillomavirus (HPV) infection. Unfortunately, the current treatment modalities for LA-HNSCC, which can include combinations of surgery, radiotherapy, and systemic therapy, may result in substantial treatment-related toxicity and functional consequences for patients with a significant impact on quality of life. Due to the complex nature of the disease and acute and delayed treatment-related morbidity, treatment of LA-HNSCC requires a multidisciplinary approach that is optimally funded and accessible for patients regardless of geography. This review discusses the importance of a multidisciplinary approach throughout optimal care pathways for LA-HNSCC. Additionally, it identifies and discusses key unmet clinical needs associated with the multidisciplinary approach for LA-HNSCC in Australia. This includes further investigations into pre-habilitation and individualized follow-up protocols, and the development of biomarkers to enable selection of patients for the most appropriate treatment modality and predict response and relapse. Furthermore, there are inadequate supports to enable critical survivorship care and significant inequity in access to care across Australia. This is especially true in regional and rural areas, and urgent interventions to improve equity of access and surveillance in these populations are required.

Background: Previous literature has highlighted health inequality in lung cancer treatment, possibly related to differential healthcare delivery across public and private hospitals. In this study we assessed the association between public and private hospital receipt of guideline-concordant treatment (GCT) and survival.

Methods: A retrospective study of patients in the Victorian Lung Cancer Registry was performed between April 2011 and March 2022. Models were adjusted for propensity score (age, sex, performance status, histology, ethnicity, smoking, hospital location, socioeconomic status, comorbidities, comorbid cancer). Main outcome measures were timeliness of treatment, receipt of GCT, and survival between private and public hospital-admitted patients.

Findings: Of 11,396 patients, 9213 (81%) patients had treatment in public hospitals. Compared to private-hospital patients, public-hospital patients experienced substantial treatment delay (median referral-to-treatment interval: 48 vs. 29 days, p < 0.001). After adjusting for propensity score, private-hospital patients were more likely to receive GCT in all stages of non-small-cell lung cancer (NSCLC) except stage III (Stage I: OR 2.77, p < 0.001; Stage II: OR 3.43, p < 0.001; Stage III: 1.06, p = 0.73; Stage IV: OR 2.14, p < 0.001). The private-hospital patients had lower risk of death in NSCLC stages I, II and IV and a near-significant benefit in stage III (Stage I: OR 0.67, p < 0.001; Stage II: OR 0.54, p < 0.001; Stage III: 10.81, p = 0.06; Stage IV: OR 0.79, p < 0.001).

Interpretation: Compared to private, the public-hospital patients experienced substantial delay in lung-cancer treatment, lower standard of GCT, and poorer survival rate. This study highlights substantial health inequity and disparity, demanding a need to evaluate, assess, and improve lung cancer treatment in Australian hospitals.