Asia-Pacific journal of clinical oncology最新文献

Aim: There is substantial, protracted clinical variation in the use of neoadjuvant radiotherapy (with/without chemotherapy) prior to surgical resection for high-risk rectal cancer. In New South Wales (NSW), Australia, in 2018, this ranged from 25% to 59% across health districts. This study aimed to describe specialist clinicians' views about: the amount of clinical variation explained by patient factors and preference (warranted clinical variation) reasons for observed clinical variation solutions to address unwarranted clinical variation METHODS: A study-specific questionnaire was mailed to all rectal cancer specialists in NSW. Quantitative responses were summarized using descriptive statistics. Open-ended responses were analyzed thematically. Follow-up semi-structured interviews were conducted with a subset of participants. Proposed reasons were categorized against the Sutherland and Levesque analytic framework to assess if the observed clinical variation is warranted or unwarranted.

Results: A total of 75 of 210 eligible specialists (36%) completed questionnaires. The majority strongly supported the use of neoadjuvant radiotherapy, with no evidence of equipoise. The maximum difference in the proportion of patients receiving neoadjuvant radiotherapy explained by patient factors or preference was estimated at 10%-20%, substantially less than reported. Proposed reasons for observed clinical variation were largely unwarranted and centered on five main themes: Multidisciplinary team (MDT)-related issues (capacity) Imaging-related issues (capacity) Workforce and practice patterns (capacity) Surgeon treatment preferences (agency) Data quality (evidence) CONCLUSIONS: Improving the consistency of MDT processes, uniform access to high-quality imaging, and improving data quality for performance reporting are focus areas with the potential to reduce unwarranted clinical variation in rectal cancer care.

Aim: To evaluate the current status of circulating tumor DNA (ctDNA) utilization for non-small cell lung cancer (NSCLC) among members of the Thoracic Oncology Group Australasia (TOGA), and to identify barriers to its implementation in clinical practice across Australia and New Zealand (ANZ).

Methods: A 31-item electronic survey was distributed to TOGA members between December 2023 and August 2024. Responses were analysed descriptively to assess access, usage patterns, perceived barriers, and clinician attitudes toward ctDNA testing.

Results: Thirty complete responses were analysed. Most respondents were medical oncologists working in metropolitan academic or public hospitals. While respondents estimated 83% of patients have access to molecular testing, only 12% were believed to have access to ctDNA testing. Only 33% reported routine ctDNA use, primarily in advanced disease settings. If more accessible, 83% indicated they would adopt ctDNA in advanced NSCLC. Key barriers to ctDNA utilization included cost (93%), logistical challenges (63%), limited knowledge (50%), and assay confidence (40%). Although over half of clinicians had patients inquire about ctDNA, fewer than 40% routinely discussed it. Most preferred are in-person or virtual workshops for education. Notably, 30% lacked access to a Molecular Tumor Board, and 70% did not provide pre-test counselling regarding incidental germline findings.

Conclusion: Despite limited current use, there is strong interest in ctDNA testing for NSCLC in ANZ. Addressing funding, logistical barriers, and clinician education is essential to enabling equitable, widespread adoption of ctDNA into standard lung cancer care.

Purpose: To develop and evaluate an evidence-based mainstream germline genetic testing model to support cancer treatment including the BRCA1/BRCA2 and mismatch repair (MMR) genes across South Australia.

Methods: Participatory action research (PAR) and implementation science principles were used to guide the development of the statewide mainstream pathway. To support the implementation of the mainstream pathway, genetic testing packages for clinicians and consumer support materials have been developed, and an education program has been delivered to clinicians. This quality improvement study used an independent sample t-test to compare the average number of monthly tests completed via mainstream and traditional pathways during two nonconsecutive 6-month periods. Acceptability among patients and clinicians and clinician knowledge, confidence, and experience measures were assessed.

Results: The total number of BRCA1/2 tests did not increase from pre- to post-pathway implementation. However, there was a significant increase in both the number of tests ordered through the mainstream pathway (pre: mean 3.5, SD 2.07; post: mean 7, SD 2.53) and the proportion of total tests ordered via mainstreaming (pre: mean 14%, SD 9.25%; post: mean 25.0%, SD 5.48%). There were no changes in MMR gene testing patterns, with no mainstream tests ordered. Among clinicians (n = 20) who responded to the post-implementation survey, positive levels of acceptability were reported.

Conclusion: This study showed that the implementation of a statewide mainstream genetic testing pathway in a public health system improved the uptake of mainstream testing for BRCA1/2. Further understanding of the barriers to uptake across settings is needed to support effective utilization.

Aim: The uptake of telehealth, including for clinical trials (teletrials), accelerated during the pandemic and helps address inequity of access for underserved populations. This report discusses the work of experts in Victoria to implement teletrials in cancer clinical trials but has learnings for other jurisdictions and in other disease types.

Methods: Three funded programs in Victoria (the Regional Trials Network Victoria, Trial Hub Alfred, and the Victorian Comprehensive Cancer Centre Alliance), each tasked with improving access to clinical trials for regional patients, formed the Victorian Teletrial Collaborative. In addition, they coordinated work with the Australian Teletrial Program and Safer Care Victoria. The Collaborative, backed with a Memorandum of Understanding and using a collective impact framework, held a workshop and developed a workplan and program logic. It met monthly to make progress against the workplan, which had four main themes: governance/logistics, education/training, advocacy/awareness, and operational Processes.

Results: The Collaborative developed operational templates, toolkits for consumers and clinicians, education and training modules, and discussion papers to help overcome barriers to the implementation of teletrials. It conducted a workshop of national experts to consider barriers and enablers for the implementation of teletrials in early-phase clinical trials and developed a masterclass for clinicians. Future work plans focus on advocacy and communication about teletrials.

Conclusion: The Victorian Teletrial Collaborative has utilized an evidence-based approach to develop a series of toolkits and recommendations aimed at facilitating the sustainable uptake of teletrials in our jurisdiction and elsewhere.

Aim: To characterize the long-term adverse events (AEs) observed in patients who received lenvatinib.

Methods: We longitudinally assessed long-term AEs in patients with advanced or metastatic radioiodine-refractory differentiated thyroid cancer who had received lenvatinib for more than 1 year. AEs were graded according to the National Cancer Institute Common Terminology Criteria for AEs. Grade 2 AEs were defined as intolerable if a patient complained of distress.

Results: Seventeen patients were treated for more than 1 year. The median age was 69 years. The median duration of lenvatinib treatment was 40 months. Notable intolerable grade 2 and 3 AEs were developed in the following order: hypertension (median day 18; range, day 1-131), diarrhea (median, day 27; range, day 4-1205), hand-foot skin reaction (median, day 33; range, day 20-582), platelet decrease (median, day 57; range, day 15-427), proteinuria (median, day 72; range, day 18-1772), anorexia (median, day 319; range, day 57-1541), and chronic kidney disease (CKD) (median, day 715; range, day 274-1296). After 2 years of administration, the decrease in estimated glomerular filtration rate became remarkable. Grade 3 hypertension occurred in 94.1% (16/17) of patients, of whom 66.8% (11/16) developed intolerable grade 2 proteinuria at a median interval of 35 days. Of these patients, 54.5% (6/11) developed intolerable grade 2 CKD at a median interval of 245 days.

Conclusions: This longitudinal study revealed which AEs appeared and when. The findings provide useful information about when and which AEs we should be attentive to during daily practice.

Background: Polatuzumab vedotin + bendamustine + rituximab (Pola-BR) was recently approved in Malaysia for treating relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). A multicenter retrospective study was conducted to assess the effectiveness of this regimen among patients in a compassionate use program.

Objective: To determine treatment response and survival rates for R/R DLBCL patients treated with Pola-BR in Malaysia.

Methodology: Safety and efficacy data of 23 adults with R/R DLBCL treated with Pola-BR at nine centers in Malaysia (September 2019-February 2021) were used. Of the 23 patients, 13 received six cycles of Pola-BR. The median follow-up was 10 months (1-37 months). The primary endpoint was complete response (CR) rate; secondary endpoints were overall survival (OS), progression-free survival (PFS), and adverse events (AEs).

Results: The overall response rate was 56.5%, with 34.8% achieving CR. The 1-, 2-, and 3-year OS rates were 51.6%, 51.6%, and 44.2%, respectively, with a median OS of 27 months. The 1- and 2-year PFS rates were 48.2% and 41.3%, respectively, with a median PFS of 10 months; 60% of the nonresponders had progressive disease. Cox proportional hazard regression analysis showed that bulky disease was a significant hazard for disease progression. A total of 42 AEs were recorded, of which 66.7% were grade ≥ 3 AEs; 90.5% of the AEs were hematological and resolved with treatment; only one patient succumbed to neutropenic sepsis.

Conclusions: Pola-BR has a favorable safety profile for R/R DLBCL treatment in Malaysia, although larger sample sizes and longer follow-ups are needed to confirm these results.