Cancer Cytopathology最新文献

The prognosis for patients diagnosed with medullary thyroid carcinoma (MTC) varies significantly with the timing of detection: the earlier the diagnosis, the higher the likelihood of achieving a complete cure (or at least a better outcome). Ogmen et al. show that the routine measurement of calcitonin in serum could lead to an earlier MTC diagnosis.

Four years into the coronavirus disease 2019 (COVID-19) pandemic, multiple studies have agreed that patients with cancer are more susceptible to COVID-19 infection and have a higher risk of worse outcomes than the general population. Large cohort studies have revealed plenty of nuances, however, while raising additional questions in need of better answers.

Some cancer types, such as hematologic malignancies, have been associated with a higher risk of poor COVID-19 outcomes, as have some treatment types, such as recent cytotoxic chemotherapies, as well as a long list of other demographic factors and comorbidities. Researchers are just starting to investigate the added danger of long COVID-19.

The data, however, have also provided some reassurances, says Noha Sharafeldin, MD, PhD, MSc, an assistant professor of medicine at the University of Alabama at Birmingham and an associate scientist at the university’s O’Neal Comprehensive Cancer Center. One of the most notable findings is that vaccination against the SARS-CoV-2 virus can reduce the risk of severe infection even among those with hematologic malignancies.

“I think the thing we know for sure, if, God forbid, we’re hit with something similar again, is that this should be a group of people who should be at the forefront of protection efforts because of so many factors working against them,” Dr Sharafeldin says. “But the flip side of it is that vaccines work in those patients. We shouldn’t think that these patients might not benefit from these kinds of interventions.”

In a study that predated the first COVID-19 vaccines, Dr Sharafeldin and her colleagues found that COVID-19 positivity as significantly associated with an increased risk of all-cause mortality in adult patients with cancer.¹ Within the subset of patients who had cancer and were positive for COVID-19, multiple comorbidities, male gender, an age of 65 years or older, a hematologic malignancy, multiple tumor sites, and cytotoxic therapy received up to 30 days before the COVID-19 diagnosis were all associated with a higher risk of all-cause mortality. Recently administered immunotherapies or targeted therapies, however, did not increase the risk.

Dr Sharafeldin says that the assessment provided a kind of early natural history of COVID-19. The study drew on the medical records of nearly 4.4 million patients in the National COVID Cohort Collaborative. At the time, no one was sure of how to account for COVID-19 vulnerability or diagnosed infections in patients with cancer, particularly those in need of a bone marrow transplant. The study allowed the researchers to quantify the overall risk and identify the most vulnerable subset of patients with cancer. As expected, Dr Sharafeldin says, patients with hematologic malignancies had the highest risk of all-cause death, which was explainable by their predisposition for greater immunodeficiency.

“One thing we solidified is that this g

Recent efforts to develop a histologic grading system for medullary thyroid carcinoma is gaining broad acceptance. How well do these grading parameters translate to cytology specimens?

Generic carboplatin and cisplatin are inexpensive and indispensable. The platinum-based, injectable chemotherapeutic drugs have factored prominently in curative regimens and combination therapies that have significantly extended patients’ lives. By rights, they should be the poster children of cost-effective cancer care. Instead, they have become the focal points of a painful drug shortage in the United States that has dragged on since February 2023.

“This is the most critical chemotherapy shortage I’ve ever seen, and this is, certainly, a public health emergency,” says Angeles Alvarez Secord, MD, MHSc, director of gynecologic oncology clinical trials at Duke Cancer Institute in Durham, North Carolina. “It breaks my heart that you have cancer patients—or any patient for that matter—going through this.”

Drug shortages are a long-standing headache for hospitals, but the breadth and duration of the ongoing shortage in what another expert calls “bread-and-butter” oncology drugs have created an unusually acute crisis. The shortage has also renewed calls for government action that multiple providers and professional societies say is long overdue.

“It’s really mind blowing that we are here in 2023 dealing with pretty significant impacts on patients,” says Kirollos Hanna, PharmD, director of pharmacy at Minnesota Oncology and an assistant professor of pharmacy at the Mayo Clinic College of Medicine in Rochester, Minnesota. With cisplatin and carboplatin, he says, “We were at a point where we said, ‘No metastatic disease utilization.’ We said, ‘Find something else, even if the data are subpar.’ That’s all we had to work with, because we needed to be sure we were curing our bladder and testicular cancer patients.”

Stephen Colvill, MBA, assistant research director of the Duke–Margolis Center for Health Policy at Duke University, says that the severe impact of the cancer drug shortage has increased the visibility of what has been a “pretty consistent” problem. Among the root causes, he cites a lack of investment in modernized equipment, facilities, quality infrastructure, redundancy, and risk mitigation plans for generic drugs both within and beyond the United States.

In late 2022, a major production facility in Ahmedabad, India, owned by Intas Pharmaceuticals, failed a surprise Food and Drug Administration (FDA) inspection for a range of egregious safety and quality infractions. When the plant shut down, it knocked out an estimated half of all cisplatin and methotrexate production for the US market. Because the sterile, injectable form of cisplatin is complicated to make, other production facilities could not easily pick up the slack. Then, as demand spiked for alternatives, the ripple effect contributed to shortages of carboplatin as well.

By May 2023, 93% of academic cancer centers reported a shortage of carboplatin, while roughly 70% were short of cisplatin, according to a National Comprehensive Cancer Network (NCCN

Several standardized systems for nongynecological cytopathology have been published following the successful implementation of The Bethesda System for Reporting Cervical Cytology. Each of these systems comprises a set of reporting categories accompanied by a risk of malignancy. However, in most cases, these risk of malignancy estimates have not been based on high-quality evidence and often may not be consider proper “risks” (because they have been estimated based on cross-sectional studies). This commentary discusses the problems related to the data used to generate these risks. To make nongynecological cytopathology reporting more evidence-based, large-scale prospective cohort studies and randomized trials, in addition to high-quality systematic reviews and meta-analyses, should be performed.