Cancer treatment and research communications最新文献

Background

Oral cancer is one of the ten most common malignancies in the world and approximately 90 % of cases are OSCC. Despite the progress in available treatment modalities, the mortality of patients with OSCC has remained steadily high during the last 20 years. Survival data is strongly influenced by the timing of diagnosis: with more than 50 % of patients being diagnosed at an advanced stage, and their 5-year survival rate being less than 50 %. Therefore, early diagnosis plays a crucial role in improving a patient's prognosis, as early stage cancers show a survival rate of over 90 %, whereas it drops to 5–20 % stage III and IV disease. This prospective study has been conducted with an aim of assessing diagnostic delays and looking at the various patient and tumour factors and their association with them.

Methodology

This prospective observational study was conducted from December 2023 to February 2024. The cases for the present study included cases of oral squamous cell carcinoma diagnosed by clinical, radiological and/or histological confirmation. The patient delay was recorded in days as informed by the patients themselves, about the onset of their symptoms to time taken to seek medical attention. This was then associated with various patient and tumour related factors.

Result

A total of 120 (n) patients were interviewed and these patient's case sheets were recruited for the present study. The median primary delay for the entire population was found to be 90 days while the median secondary delay was 11 days. The median total delay was found to be 106 days. The median total delay was higher among females and younger population though this was not statistically significant. However education showed a significant impact with literate patients presenting much earlier. Smoking and alcohol abuse did not show a significant effect on delay. Various tumour factors also did not show any statistically significant effect on delay although, patients with advanced stage and nodal secondaries presented at a much later time.

Conclusion

Both patient and tumour related factors as well as the decisions made during the first contact with health care providers influence delay before specialist consultation. Raising awareness of HNC symptoms among the general population and GPs is the way to get patients to curative treatment without long delay.

Despite the advancements in the treatment of localized pancreatic cancer, several unresolved issues persist in clinical practice, especially in the neoadjuvant setting. These include determining the criteria for selecting patients for treatment, identifying the most effective chemotherapy regimens, understanding the role of radiotherapy, and accurately assessing how patients respond to treatment. Current strategies for assessing patients before surgery involve thoroughly evaluating their overall health status, analyzing tumor markers, and using advanced imaging techniques. However, existing methods for staging the disease still have limitations when it comes to accurately detecting metastatic cancer. The ongoing debate between performing surgery upfront or administering neoadjuvant therapy highlights the need for robust clinical evidence to guide treatment decisions effectively. This review analyzes the evidence regarding controversial topics in neoadjuvant pancreatic cancer treatment and discusses further research efforts to enhance patient outcomes. To improve the outcomes found with surgery alone, multimodal treatment with chemotherapy.

Introduction

The landscape of breast reconstruction has changed significantly with a shift in focus to include the restoration of a patient's quality of life after cancer. Reconstructive options can be divided into alloplastic (implant based) and autologous (tissue based). This paper aims to provide a current educational summary regarding implant-based reconstruction after breast cancer surgery and review the current literature.

Method

A review of the literature was conducted utilising standard PRISMA flowchart. Databases searched included Pubmed, EMBASE, and MEDLINE.

Results

Current practice is explored within the text, including types of implants, indications, and surgical approaches. Heterogenous cohorts, surgical technique variation, and selection bias can make comparison of the literature challenging. The major evidence reviews of implant-based reconstruction topics are discussed including, ADM use, radiotherapy, and complications. Despite the benefits of autologous reconstruction, implant-based techniques still represent a significant proportion of reconstructive breast procedures. However, implant-reconstruction is not without its risks and limitations and, with such variety in practice, there remains a lack of high-quality evidence guiding practice. Most importantly, patients need to be counselled about the pros and cons of each choice, particularly with the increasing utilisation of radiotherapy post-reconstruction. Ultimately, the patient and surgeon should reach a decision in full knowledge of the risks and potential outcomes.

Conclusions

Further research is required into implant-based reconstructive therapy, which will allow a greater consensus for management and a pathway for both surgeons and patients.

Introduction

Myelosuppression, a challenge in cancer treatment, often results in severe complications. Prophylactic granulocyte colony-stimulating factors, particularly pegfilgrastim, mitigate chemotherapy-induced neutropenia. This narrative review evaluates the role of on-body injector (OBI) devices for pegfilgrastim administration. A comprehensive search strategy of PubMed and AI-powered intuitive search tools, complemented by authors’ contributions, yielded a body of papers presenting evidence on OBI devices, their effectiveness and safety, the benefits and challenges of OBI versus pre-filled syringe administration, patient preferences for pegfilgrastim administration, and economic considerations.

Discussion

OBI devices prove effective and safe, with advantages such as reduced clinic visits and enhanced adherence. Studies highlight cost-efficiency and expanded access, emphasizing the socioeconomic context. Patient and provider preferences underscore the potential of OBI devices in cancer care, with implications for healthcare resource utilization and pharmacoeconomics.

Conclusion

The value proposition of OBI devices lies in improving patient outcomes, convenience, resource optimization, and enhancing the overall cancer care experience. As biosimilar OBIs enter the market, they may offer cost savings, further influencing their adoption and their positioning as a cost-efficient alternative in cancer care. Ongoing research and technological advancements are expected to contribute to the broader acceptance of OBI devices in cancer care delivery.

Background

The data on immune checkpoint inhibitors (ICI) use in lung cancer individuals generally underrepresented in clinical trials are limited. We aimed to examine the ICI access, safety, and outcome in these populations using real-world data.

Methods

Patients with lung cancer newly started on ICIs from 2018 to 2021 were included. Patient factors (age, sex, race, insurance, Charlson comorbidity index (CCI), Eastern Cooperative Oncology Group (ECOG) performance status, histories of autoimmune disease (AD), infection within 3 months before treatment, and brain metastasis) were collected and grouped. Associations of each patient factor with the time-to-treatment initiation (TTI) of ICIs and immune-related adverse events (irAEs) were examined via cumulative incidence analyses and Chi-squared tests, respectively. Log-rank tests and Cox models were used to assess association of patient factors with overall survival (OS).

Results

Of 125 patients (median age:70 years (50–88), 68 (54.4 %) males), 9 (7.2 %) had Medicaid/uninsured, 44 (35.2 %) had ECOG ≥ 2, 101 (80.8 %) had CCI ≥ 3, 16 (12.8 %) had ADs, 14 (11.2 %) had infections, and 26 (20.8 %) had brain metastases. In newly diagnosed stage IV patients (N = 62), no difference in TTI was found by patient factors. Fifty irAEs occurred within 12 months and no differences in irAEs occurrence by patient factors. In advanced-stage group (N = 123), OS did not differ by patient factors, except for race (p = 0.045). Whites showed an inferior OS than non-Whites in multivariable regression. (Hazards ratio = 2.82 [1.01–7.87], p = 0.047).

Conclusions

Previously poorly represented subgroups were shown to have no significant delays in ICI use, general tolerance, and comparable outcomes. This adds practical evidence to ICI use in clinically and/or socio-demographically marginalized populations.

Objectives

Materials and methods

Results

Conclusions

Background

Recently, some evidence emphasized the value of MSH2 and MSH6 inactivation and their hypermutation in predicting different cancers. The present consideration is to evaluate the value of MSH2 and MSH6 protein deficient studied by the immunohistochemistry (IHC) method and the tumor behaviors and aggressiveness in prostatic carcinoma.

Methods

This cross-sectional study was performed on 80 examples extricated from patients who endured prostate cancer and were planned for radical prostatectomy surgery. The expression levels of the genes were studied by IHC staining.

Results

The deficiency in MSH2 and MSH6 expression was revealed in 10.0 % and 11.3 % of patients respectively, while the reduction of simultaneous expression in two genes was found in 6.2 % of patients. In the two subgroups with and without MSH2 and/or MSH6 staining, there was no difference in patients' mean age and history of prostate cancer. There was also no difference in tumor-related behaviors including combined Gleason grade group, tumor stage, vascular invasion, perineural invasion, and prostatic capsular invasion between the groups with and without gene loss.

Conclusion

The evaluation of the deficient rate of two genes among patients with prostate cancer to predict the tumor grade and its aggressive behavior needs further study in every population.

Background

Although prostate cancer (Pca) screening plays important role in early diagnosis and reduction of mortality, Tanzanian men are relatively unscreened. We aimed to investigate Pca knowledge level and barriers to screening among at-risk men in northern Tanzania.

Methods

This community-based survey was conducted in northern Tanzania from May to September 2022, involving men age ≥40 years. Participants were invited by announcing in local churches, mosques, brochures, and social media groups. Participants attended a nearby health facility where survey questionnaires were administered. Knowledge level was measured on the Likert scale and scored as poor (<50 %) or good (≥50 %).

Results

A total of 6205 men with a mean age of 60.23 ± 10.98 years were enrolled in the study. Of these, 586 (9.5 %) had ever been screened for Pca. Overall, 1263 men (20.4 %) had good knowledge of Pca. Having health insurance, knowing at least 1 risk factor or symptoms of Pca, and hospital as the source of Pca information were significantly associated with ever being screened. The most common reasons for not being screened were a belief that they are healthy (n = 2983; 53.1 %), that Pca is not a serious disease (n = 3908; 69.6 %), and that digital rectal examination (DRE) as an embarrassing (n = 3634; 64.7 %) or harmful (n = 3047; 54.3 %) procedure.

Conclusion

Having Pca knowledge, health insurance and hospital source of information were correlated with increased screening. False beliefs about DRE and the seriousness of Pca had negative effects on screening. Increasing community knowledge and universal health coverage would improve uptake of Pca screening.

Aim

To assess the safety and tolerability of subcutaneous (SC) trastuzumab (Herceptin) administered either with a single-use injection device (SID) or manually from a vial using a hand-held syringe.

Methods

The ESCAPE trial (NCT02194166) included 90 women aged 18 years or older with HER2-positive early breast cancer who underwent surgical treatment and completed (neo) adjuvant chemotherapy and radiotherapy (if indicated). Patients enrolled in the study were first subjected to 4 cycles of trastuzumab IV (8 mg/kg loading dose followed by 6 mg/kg maintenance dose, q3w) prior to being randomized into groups: [A] SC trastuzumab (fixed dose 600 mg, q3w) administered through a hand-held syringe followed by 7 cycles of SC trastuzumab administered with an SID or [B] the reverse sequence.

Results

Patient-reported outcomes revealed that 78 (94.0 % [95 % CI: 90.4–99.0]) out of 83 patients preferred SC trastuzumab over IV trastuzumab, among whom 28 patients indicated a strong preference. Sixteen out of 17 HCPs (94.1 %) were very satisfied with the use of SC trastuzumab, while 1/17 (5.9 %) remained uncertain. The mean time spent for IV vs. SC trastuzumab administration, including pre- and postinjection procedures, was 93.8 and 22 min, respectively. A total of 49 (54.4 %) patients reported 164 AEs.

Conclusions

In this trial, SC trastuzumab was preferred over IV trastuzumab. The duration of SC trastuzumab administration was significantly shorter than that of IV trastuzumab, saving patients and HCPs time. Safety and efficacy results were consistent with other published trials and were not associated with any new safety signal.