Chinese clinical oncology最新文献

Background and objective: Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer-related mortality worldwide. Non-small cell lung cancer (NSCLC) represents 80-85% of cases, with 20-35% diagnosed at stage III. Stage III NSCLC is highly heterogeneous, encompassing both resectable and unresectable disease. The aim of this article is to review current evidence on the treatment of stage III NSCLC, with a focus on neoadjuvant chemoimmunotherapy (CT-IO) vs. the standard of chemoradiotherapy (CT/RT) followed by consolidation immunotherapy.

Methods: The narrative review was conducted and carried out using clinical trials and studies included were found through searching several databases: PubMed, Cochrane, Science Direct, EMBASE, and the clinical trial registry (www.clinicaltrials.gov).

Key content and findings: Historically, concurrent CT/RT followed by 1 year of durvalumab has been the standard for unresectable stage III disease, as demonstrated in the PACIFIC trial. The introduction of CT-IO neoadjuvant regimens has shown improved outcomes in stage IIIA and IIIB disease, particularly in terms of pathological complete response (pCR), event-free survival (EFS), and overall survival (OS). Clinical trial heterogeneity regarding tumor-node-metastasis (TNM) staging, patient selection, and adjuvant therapy duration limits direct comparisons. However, emerging data suggest that CT-IO could become a new standard for stage IIIA and selected IIIB/IIIC patients. Neoadjuvant CT-IO represents a significant shift in the treatment paradigm of stage III NSCLC, offering personalized and potentially more effective therapeutic options.

Conclusions: While CT/RT remains essential for certain subsets, particularly T4 or unresectable tumors, CT-IO should be strongly considered for most patients with stage IIIA and IIIB NSCLC.

Background: Chemotherapy has played an essential role in nasopharyngeal carcinoma (NPC) management since the 1980s, when its radiosensitizing effects were first recognized. The landmark Intergroup 0099 trial established concurrent cisplatin-based chemoradiotherapy as the standard for locoregionally advanced NPC, demonstrating significant survival benefits over radiotherapy alone. As an Epstein-Barr virus (EBV)-associated malignancy with distinct geographical distribution (endemic in southern China and Southeast Asia), NPC presents unique therapeutic challenges. Subsequent studies refined chemotherapy sequencing, introducing induction approaches to address distant failure risks and adjuvant strategies for high-risk cases. The evolution of chemotherapy regimens has been particularly crucial given NPC's anatomical complexity and surgical limitations. Recent years have seen growing emphasis on balancing efficacy with toxicity reduction, especially for endemic populations where treatment-related morbidity significantly impacts quality of life. The published documents of the last 10 years were analyzed by bibliometrics and visualization in order to assess the focus and trend of chemotherapy research in NPC.

Methods: Based on Web of Science Core Collection (WoSCC) database, the relevant literatures during the period 2014-2024 were searched and visualized the countries, authors, institutions, and keywords through CiteSpace and VOSviewer to understand the hotspots and trends of chemotherapy in NPC treatment.

Results: In the past decade, chemotherapy has gained more and more attention in NPC, and the leading countries are China and the United States, and the author with the most publications is Jun Ma. Sun Yat-sen University is the institution with the most publications.

Conclusions: Our study has learned that combination chemotherapy and survival prognosis are the focus of attention in this field, and bibliometrics can help us to have a better understanding and management of it.

Background and objective: Immune checkpoint inhibitors (ICIs) have transformed the treatment of advanced urothelial carcinoma (UC) and renal cell carcinoma (RCC). Their expanding use in the adjuvant setting, aimed at eliminating micrometastatic disease post-surgery, holds significant promise. However, balancing potential survival benefits with the risk of immune-related adverse events (irAEs) in patients who are otherwise disease-free requires careful consideration. This review evaluates current evidence on adjuvant ICIs in UC and RCC, with emphasis on clinical efficacy, irAE profiles, and strategies for mitigating toxicity.

Methods: A targeted literature search was performed across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, supplemented by manual review of American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) conference abstracts, to identify relevant studies on adjuvant ICI therapy in urological malignancies between 24 September 2024 and 25 January 2025. Relevant data on efficacy, safety, and irAE management were synthesized to highlight critical findings and research gaps.

Key content and findings: Adjuvant ICIs have shown meaningful improvements in disease-free survival for patients with high-risk UC and RCC. Grade ≥3 irAEs, particularly endocrine toxicities such as hypothyroidism, adrenal insufficiency, and hypophysitis, are relatively frequent and often irreversible, necessitating lifelong hormone replacement and long-term follow-up. Although some trials have not demonstrated overall survival advantages, emerging evidence suggests biomarkers such as circulating tumour DNA (ctDNA) could guide more precise patient selection. Optimising irAE management is pivotal, as these events can significantly affect quality of life in a population that may remain disease-free.

Conclusions: Adjuvant immunotherapy represents a potentially significant advance in UC and RCC, offering improved outcomes for select patients. Yet, the persistent nature of irAEs calls for vigilant surveillance, robust biomarker development, and integration of patient-reported outcomes to ensure informed clinical decision-making. The next frontier will rely on better risk stratification and toxicity mitigation to translate disease-free gains into durable, life-extending benefits. Future research that refines patient selection criteria and irAE management will be crucial for translating these survival gains into long-term benefits and shaping evidence-based guidelines in urological oncology.

Background and objective: Most of newly diagnosed prostate carcinomas (PCas) present as non-metastatic disease, with approximately 15% of them presenting with characteristics predicting for a high-risk of relapse. Hence, specific focus has to be placed on patients affected by localised or locally advanced disease, whose chances of cure are notably higher than those of patients in advanced settings. With androgen receptor pathway inhibitors (ARPIs) and docetaxel chemotherapy improving treatment efficacy outcomes when compared to traditional androgen deprivation therapy (ADT) in the metastatic disease, clinical trials are currently investigating the activity of ARPI for clinical management of localised or locally advanced prostate patients, with the aim of preventing the cancer from spreading systemically. To provide further insight into the biological and clinical rationale of an early treatment intensification, here we review and enlist promising studies on the treatment of localised, locally advanced, and biochemically relapsed disease. Finally, we briefly review the latest experimental treatments for these early stages-including novel agents and combinations which are believed to shape the future practice.

Methods: PubMed and MEDLINE databases were searched for trials focusing on the treatment of localised/locally advanced PCa, and which included the use of second-generation ARPIs. Also, proceedings from major oncology and uro-oncology meetings were screened.

Key content and findings: Our analysis has not yielded significant results supporting the implementation of second-generation ARPIs in the perioperative or neoadjuvant treatment of localised PCa. However, the data suggest these drugs may offer benefits in the adjuvant setting, following both radical prostatectomy (RP) and primary radiotherapy (RT).

Conclusions: The design of clinical trials that explore surrogate endpoints like metastasis-free survival (MFS) or employing multi-arm trials with genomic testing could facilitate further advancements in this field, as well as research on combining ARPI treatment with inhibition of other pathways or exploiting the immune response beyond PD-1/CD276.