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Current Oncology
Volume 31
Issue 7
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Curr. Oncol., Volume 31, Issue 7 (July 2024) – 27 articles

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19 pages, 310 KiB  
Review
Review of CAR T-Cell Therapy in Multiple Myeloma: A Canadian Perspective
by Steven Chun-Min Shih and Sita Bhella
Curr. Oncol. 2024, 31(7), 3949-3967; https://doi.org/10.3390/curroncol31070292 (registering DOI) - 6 Jul 2024
Viewed by 430
Abstract
Multiple myeloma (MM) is an incurable plasma cell malignancy. In the context of the current standard of care therapies in Canada, outcomes among patients with relapsed/refractory multiple myeloma (RRMM), particularly those with triple-class (or more) refractory disease remain poor. Immunotherapies have significantly changed [...] Read more.
Multiple myeloma (MM) is an incurable plasma cell malignancy. In the context of the current standard of care therapies in Canada, outcomes among patients with relapsed/refractory multiple myeloma (RRMM), particularly those with triple-class (or more) refractory disease remain poor. Immunotherapies have significantly changed the treatment landscape of MM. Since 2021, two BCMA-targeting CAR T-cell therapy products have been approved for RRMM—namely Idecabtagene vicleucel (Ide-cel) (ABECMA®) and Ciltacabtagene autoleucel (Cilta-cel) (CARVYKTI®), both of which are available in the US and Europe. Although they have shown unprecedented efficacy in RRMM, their clinical and logistical limitations must be acknowledged. MM CAR T-cell therapy is likely to be approved in Canada soon. Therefore, it is timely that we review the latest evidence for commercially available CAR T-cell therapy in multiple myeloma, with a focus on its relevance and impact in the Canadian setting. There will be challenges to access and strategies must be in place to ensure equitable care for all Canadians with MM. Alongside haematologists working in the immune effector cell therapy programs, providers in the community will also play a role in the ongoing monitoring and management of long-term side effects including opportunistic infections and late neurotoxicity. Full article
(This article belongs to the Topic Myeloma and Leukemia-Challenges and Current Treatment Options)
10 pages, 228 KiB  
Article
A Retrospective Analysis of Diagnostic Breast Imaging Outcomes in Young Women at a Tertiary Care Center
by Navdeep Dehar, Doris Jabs, Wilma Hopman and Mihaela Mates
Curr. Oncol. 2024, 31(7), 3939-3948; https://doi.org/10.3390/curroncol31070291 (registering DOI) - 6 Jul 2024
Viewed by 194
Abstract
(1) Purpose: The purpose of this study was to describe the outcomes of diagnostic breast imaging and the incidence of delayed breast cancer diagnosis in the study population. (2) Methods: We collected the outcome data from diagnostic mammograms and/or breast ultrasounds (USs) performed [...] Read more.
(1) Purpose: The purpose of this study was to describe the outcomes of diagnostic breast imaging and the incidence of delayed breast cancer diagnosis in the study population. (2) Methods: We collected the outcome data from diagnostic mammograms and/or breast ultrasounds (USs) performed on women between the ages of 30 and 50 with symptomatic breast clinical presentations between 2018 and 2019. (3) Results: Out of 171 eligible patients, 10 patients (5.8%) had BIRADS 0, 90 patients (52.6%) had benign findings (BIRADS 1 and 2), 41 (24.0%) patients had probable benign findings requiring short-term follow-up (BIRADS 3), while 30 (17.5%) patients had findings suspicious of malignancy (BIRADS 4 and 5). In the BIRADS 3 group, 92.7% had recommended follow-up, while in BIRADS 4 and 5, only 83.3% underwent recommended biopsy at a mean time of 1.7 weeks (range 0–22 wks) from their follow-up scan. Ten (6%) patients were diagnosed with breast cancer, all of whom had BIRADS 4 or 5, with a mean time of breast cancer diagnosis from initial diagnostic imaging of 2.2 weeks (range 1–22 wks). No patients had delayed breast cancer diagnosis in our cohort. (4) Conclusions: We conclude that diagnostic mammograms and breast US are appropriate investigations for clinical breast concerns in women aged 30–50 years. Full article
(This article belongs to the Special Issue From Screening to Treatment: Technology’s Impact on Breast Cancer Care)
16 pages, 4330 KiB  
Review
Endoscopic Grading and Sampling of Gastric Precancerous Lesions: A Comprehensive Literature Review
by Georgios Tziatzios, Dimitrios Ι. Ziogas, Paraskevas Gkolfakis, Vasilios Papadopoulos, Apostolis Papaefthymiou, Nikoletta Mathou, Athanasios Giannakopoulos, Gerasimos Gerasimatos, Konstantina D. Paraskeva and Konstantinos Triantafyllou
Curr. Oncol. 2024, 31(7), 3923-3938; https://doi.org/10.3390/curroncol31070290 (registering DOI) - 5 Jul 2024
Viewed by 304
Abstract
Gastric cancer remains a disease with an ominous prognosis, while early gastric cancer has a good-to-excellent prognosis, with 5-year survival rates of up to 92.6% after successful endoscopic resection. In this context, the accurate identification of patients with established gastric precancerous lesions, namely [...] Read more.
Gastric cancer remains a disease with an ominous prognosis, while early gastric cancer has a good-to-excellent prognosis, with 5-year survival rates of up to 92.6% after successful endoscopic resection. In this context, the accurate identification of patients with established gastric precancerous lesions, namely chronic atrophic gastritis and intestinal metaplasia, is the first step in a stepwise approach to minimize cancer risk. Although current guidelines advocate for the execution of random biopsies to stage the extent and severity of gastritis/intestinal metaplasia, modern biopsy protocols are still imperfect as they have limited reproducibility and are susceptible to sampling error. The advent of novel imaging-enhancing modalities, i.e., high-definition with virtual chromoendoscopy (CE), has revolutionized the inspection of gastric mucosa, leading to an endoscopy-based staging strategy for the management of these premalignant changes in the stomach. Nowadays, the incorporation of CE-targeted biopsies in everyday clinical practice offers not only the robust detection of premalignant lesions but also an improvement in quality, by reducing missed diagnoses along with mean biopsies and, thus, the procedural costs and the environmental footprint. In this review, we summarize the recent evidence regarding the endoscopic grading and sampling of gastric precancerous lesions. Full article
(This article belongs to the Section Gastrointestinal Oncology)
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15 pages, 1157 KiB  
Review
Cancer Prevention and Cultural Continuity for Métis Peoples in Canada: A Sco** Review
by Maria Diaz Vega, José Diego Marques Santos, Stephanie Witham, Marg Friesen, Tegan Brock, Sheila Laroque, Jennifer Sedgewick, Tracey Carr and Gary Groot
Curr. Oncol. 2024, 31(7), 3908-3922; https://doi.org/10.3390/curroncol31070289 (registering DOI) - 5 Jul 2024
Viewed by 211
Abstract
The purpose of this sco** review was to map the literature on the relationship between cultural continuity and health among Métis people as well as how this knowledge could be translated into cancer prevention initiatives. We included any Métis-specific literature evaluating connections between [...] Read more.
The purpose of this sco** review was to map the literature on the relationship between cultural continuity and health among Métis people as well as how this knowledge could be translated into cancer prevention initiatives. We included any Métis-specific literature evaluating connections between culture, health, and well-being. We conducted electronic searches of Medline, PubMed, Embase, PsychInfo, I-Portal, and hand-searched journals, and reviewed the grey literature. Based on our inclusion criteria, articles were screened and assessed for eligibility, resulting in a sample of 22 publications. Qualitative, quantitative, and mixed methods designs were considered. The 22 publications included in this review were diverse, ranging from population-based studies to reports and news articles. There were no limitations to publication year, and most of the data presented in this review were published more than five years ago. Nevertheless, the results demonstrate the potential role of Métis cultural continuity in cancer prevention. The sco** review revealed the current lack of Métis-specific data regarding health and its intersectionality with culture. However, the existing literature indicates that cultural continuity for Métis appears to influence health and well-being positively. As such, there may be benefits to incorporating cultural continuity in cancer prevention efforts. Full article
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13 pages, 408 KiB  
Article
Critical Issues for Patients and Caregivers in Neuro-Oncology during the COVID-19 Pandemic: What We Have Learnt from an Observational Study
by Elena Anghileri, Irene Tramacere, Sara Morlino, Catia Leuzzi, Lorena Pareja Gutierrez, Saba Motta, Antonio Silvani, Anna Amato and Francesca Romana Berrini
Curr. Oncol. 2024, 31(7), 3895-3907; https://doi.org/10.3390/curroncol31070288 (registering DOI) - 4 Jul 2024
Viewed by 185
Abstract
Objective: The COVID-19 pandemic affected neuro-oncological patients and their caregivers regarding tumor care and emotional functioning, including Quality of Life (QoL). This study aimed to understand how COVID-19 affected their psychological state and the relations between patients and health personnel in neuro-oncology. Methods: [...] Read more.
Objective: The COVID-19 pandemic affected neuro-oncological patients and their caregivers regarding tumor care and emotional functioning, including Quality of Life (QoL). This study aimed to understand how COVID-19 affected their psychological state and the relations between patients and health personnel in neuro-oncology. Methods: A cross-sectional study was conducted on neuro-oncological patients and their caregivers. Results: A total of 162 patients and 66 caregivers completed the questionnaire. Altogether, 37.5% of patients perceived a greater risk of contracting COVID-19 compared to the general population. On a 0–10 scale, the patients’ tumor-related anxiety score was 5.8, and their COVID-19-related score was 4.6. The caregivers reported 7.7 and 5.5, respectively. QoL was described as at least good in 75% of both patients and caregivers; the caregivers’ care burden increased in 22.7% of cases during the pandemic, with no correlation with QoL. Future perception often changed, both in patients and caregivers. In 18% of cases, the cancer treatment schedule was changed, either by patient decision or by medical decision. However, 93.5% of patients were satisfied with their overall care. Conclusions: A considerable proportion of patients and caregivers still perceived the tumor disease as more burdensome than the pandemic, and their future as more uncertain. Such data suggest the need to build a productive alliance between patients and health professionals. Full article
(This article belongs to the Section Psychosocial Oncology)
10 pages, 857 KiB  
Article
Survival Outcomes for US and Canadian Patients Diagnosed with Hodgkin Lymphoma before and after Brentuximab Vedotin Approval for Relapsed/Refractory Disease: A Retrospective Cohort Study
by Gwynivere A. Davies, John E. Orav and Kristen D. Brantley
Curr. Oncol. 2024, 31(7), 3885-3894; https://doi.org/10.3390/curroncol31070287 - 4 Jul 2024
Viewed by 257
Abstract
Cost-effectiveness analyses are required for therapies within Canada’s universal healthcare system, leading to delays relative to U.S. healthcare. Patients with Hodgkin lymphoma (HL) generally have an excellent prognosis, but those who relapse after or are ineligible for transplant benefit from novel therapies, including [...] Read more.
Cost-effectiveness analyses are required for therapies within Canada’s universal healthcare system, leading to delays relative to U.S. healthcare. Patients with Hodgkin lymphoma (HL) generally have an excellent prognosis, but those who relapse after or are ineligible for transplant benefit from novel therapies, including brentuximab vedotin (BV). BV was FDA-approved in 2011 but not Canadian-funded until 2014. To assess the impact of access delays, we compared changes in survival for U.S. (by insurer) and Canadian patients in periods pre/post-U.S. approval. Patients were 16–64 years, diagnosed with HL in 2007–2010 (Period 1) and 2011–2014 (Period 2) from the U.S. SEER and Canadian Cancer Registries. Approval date (surrogate) was utilized as therapy was unavailable in registries. Kaplan-Meier survival curves and adjusted Cox regression models compared survival between periods by insurance category. Among 12,003 U.S. and 4210 Canadian patients, survival was better in U.S. patients (adjusted hazard ratio (aHR) 0.87 (95%CI 0.77–0.98)) between periods; improvement in Canadian patients (aHR 0.84 (95%CI 0.69–1.03) was similar but non-significant. Comparisons between insurers showed survival was significantly worse for U.S. uninsured and Medicaid vs. U.S. privately insured and Canadian patients. Given the increasingly complex nature of oncologic funding, this merits further investigation to ensure equity in access to therapy developments. Full article
(This article belongs to the Section Hematology)
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15 pages, 2139 KiB  
Review
Current Advances in Radioactive Iodine-Refractory Differentiated Thyroid Cancer
by Fabio Volpe, Carmela Nappi, Emilia Zampella, Erica Di Donna, Simone Maurea, Alberto Cuocolo and Michele Klain
Curr. Oncol. 2024, 31(7), 3870-3884; https://doi.org/10.3390/curroncol31070286 - 3 Jul 2024
Viewed by 256
Abstract
Background: Differentiated thyroid cancer (DTC) patients have an outstanding overall long-term survival rate, and certain subsets of DTC patients have a very high likelihood of disease recurrence. Radioactive iodine (RAI) therapy is a cornerstone in DTC management, but cancer cells can eventually develop [...] Read more.
Background: Differentiated thyroid cancer (DTC) patients have an outstanding overall long-term survival rate, and certain subsets of DTC patients have a very high likelihood of disease recurrence. Radioactive iodine (RAI) therapy is a cornerstone in DTC management, but cancer cells can eventually develop resistance to RAI. Radioactive iodine-refractory DTC (RAIR-DTC) is a condition defined by ATA 2015 guidelines when DTC cannot concentrate RAI ab initio or loses RAI uptake ability after the initial therapy. The RAIR condition implies that RAI cannot reveal new met-astatic foci, so RAIR-DTC metabolic imaging needs new tracers. 18F-FDG PET/CT has been widely used and has demonstrated prognostic value, but 18F-FDG DTC avidity may remain low. Fibroblast activation protein inhibitors (FA-Pi)s, prostatic-specific membrane antigen (PSMA), and somatostatin receptor (SSTR) tracers have been proposed as theragnostic agents in experimental settings and Arg-Gly-Asp (RGD) peptides in the diagnostic trial field. Multi-targeted tyrosine kinase inhibitors are relatively new drugs approved in RAIR-DTC therapy. Despite the promising targeted setting, they relate to frequent adverse-event onset. Sorafenib and trametinib have been included in re-differentiation protocols aimed at re-inducing RAI accumulation in DTC cells. Results appear promising, but not excellent. Conclusions: RAIR-DTC remains a challenging nosological entity. There are still controversies on RAIR-DTC definition and post-RAI therapy evaluation, with post-therapy whole-body scan (PT-WBS) the only validated criterion of response. The recent introduction of multiple diagnostic and therapeutic agents obliges physicians to pursue a multidisciplinary approach aiming to correct drug introduction and timing choice. Full article
(This article belongs to the Topic Recent Advances in Anticancer Strategies)
15 pages, 947 KiB  
Article
Right Hemicolectomy and Appendicectomy as Treatments for Goblet Cell Adenocarcinoma: A Comparative Analysis of Two Large National Databases
by Marie Line El Asmar, Mohamed Mortagy, Kandiah Chandrakumaran, Tom Cecil and John Ramage
Curr. Oncol. 2024, 31(7), 3855-3869; https://doi.org/10.3390/curroncol31070285 - 2 Jul 2024
Viewed by 417
Abstract
Introduction: Right hemicolectomy (RHC) remains the treatment standard for goblet cell adenocarcinoma (GCA), despite limited evidence supporting survival benefit. This study aims to explore factors influencing surgical management and survival outcomes among patients treated with RHC or appendicectomy using NCRAS (UK) and SEER [...] Read more.
Introduction: Right hemicolectomy (RHC) remains the treatment standard for goblet cell adenocarcinoma (GCA), despite limited evidence supporting survival benefit. This study aims to explore factors influencing surgical management and survival outcomes among patients treated with RHC or appendicectomy using NCRAS (UK) and SEER (USA) data. Methods: A retrospective analysis was conducted using 998 (NCRAS) and 1703 (SEER) cases. Factors influencing procedure type were explored using logistic regression analyses. Overall survival (OS) probabilities and Kaplan–Meier (KM) plots were generated using KM analysis and the log-rank test compared survival between groups. Cox regression analyses were performed to assess hazard ratios. Results: The NCRAS analysis revealed that age and regional stage disease were determinants of undergoing RHC, with all age groups showing similar odds of receiving RHC, excluding the 75+ age group. The SEER analysis revealed tumour size > 2 cm, and receipt of chemotherapy were determinants of undergoing RHC, unlike the distant stage, which was associated with appendicectomy. Surgery type was not a significant predictor of OS in both analyses. In NCRAS, age and stage were significant predictors of OS. In SEER, age, stage, and Black race were significant predictors of worse OS. Conclusions: The study shows variations in the surgical management of GCA, with limited evidence to support a widespread recommendation for RHC. Full article
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10 pages, 971 KiB  
Article
Quality of ChatGPT-Generated Therapy Recommendations for Breast Cancer Treatment in Gynecology
by Jan Lennart Stalp, Agnieszka Denecke, Matthias Jentschke, Peter Hillemanns and Rüdiger Klapdor
Curr. Oncol. 2024, 31(7), 3845-3854; https://doi.org/10.3390/curroncol31070284 - 1 Jul 2024
Viewed by 330
Abstract
Introduction: Artificial intelligence (AI) is revolutionizing medical workflows, with self-learning systems like ChatGPT showing promise in therapy recommendations. Our study evaluated ChatGPT’s performance in suggesting treatments for 30 breast cancer cases. AI’s role in healthcare is expanding, particularly with tools like ChatGPT becoming [...] Read more.
Introduction: Artificial intelligence (AI) is revolutionizing medical workflows, with self-learning systems like ChatGPT showing promise in therapy recommendations. Our study evaluated ChatGPT’s performance in suggesting treatments for 30 breast cancer cases. AI’s role in healthcare is expanding, particularly with tools like ChatGPT becoming accessible. However, understanding its limitations is vital for safe implementation. Material and Methods: We used 30 breast cancer cases from our medical board, assessing ChatGPT’s suggestions. The input was standardized, incorporating relevant patient details and treatment options. ChatGPT’s output was evaluated by oncologists based on a given questionnaire. Results: Treatment recommendations by ChatGPT were overall rated sufficient with minor limitations by the oncologists. The HER2 treatment category was the best-rated therapy option, with the most accurate recommendations. Primary cases received more accurate recommendations, especially regarding chemotherapy. Conclusions: While ChatGPT demonstrated potential, difficulties were shown in intricate cases and postoperative scenarios. Challenges arose in offering chronological treatment sequences and partially lacked precision. Refining inputs, addressing ethical intricacies, and ensuring chronological treatment suggestions are essential. Ongoing research is vital to improving AI’s accuracy, balancing AI-driven suggestions with expert insights and ensuring safe and reliable AI integration into patient care. Full article
(This article belongs to the Section Gynecologic Oncology)
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19 pages, 1720 KiB  
Review
The Complex Tumor Microenvironment in Ovarian Cancer: Therapeutic Challenges and Opportunities
by Bianca Garlisi, Sylvia Lauks, Caroline Aitken, Leslie M. Ogilvie, Cielle Lockington, Duncan Petrik, Jan Soeren Eichhorn and Jim Petrik
Curr. Oncol. 2024, 31(7), 3826-3844; https://doi.org/10.3390/curroncol31070283 - 1 Jul 2024
Viewed by 488
Abstract
The tumor microenvironment (TME) in ovarian cancer (OC) has much greater complexity than previously understood. In response to aggressive pro-angiogenic stimulus, blood vessels form rapidly and are dysfunctional, resulting in poor perfusion, tissue hypoxia, and leakiness, which leads to increased interstitial fluid pressure [...] Read more.
The tumor microenvironment (TME) in ovarian cancer (OC) has much greater complexity than previously understood. In response to aggressive pro-angiogenic stimulus, blood vessels form rapidly and are dysfunctional, resulting in poor perfusion, tissue hypoxia, and leakiness, which leads to increased interstitial fluid pressure (IFP). Decreased perfusion and high IFP significantly inhibit the uptake of therapies into the tumor. Within the TME, there are numerous inhibitor cells, such as myeloid-derived suppressor cells (MDSCs), tumor association macrophages (TAMs), regulatory T cells (Tregs), and cancer-associated fibroblasts (CAFs) that secrete high numbers of immunosuppressive cytokines. This immunosuppressive environment is thought to contribute to the lack of success of immunotherapies such as immune checkpoint inhibitor (ICI) treatment. This review discusses the components of the TME in OC, how these characteristics impede therapeutic efficacy, and some strategies to alleviate this inhibition. Full article
(This article belongs to the Special Issue Ovarian Cancer in the Age of Precision Medicine)
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11 pages, 228 KiB  
Article
BRCATesting for Patients Treated in Italy: A National Survey of Breast Centers Associated with Senonetwork
by Corrado Tinterri, Damiano Gentile, Francesco Caruso, Laura Cortesi, Michelino De Laurentiis, Lucio Fortunato, Donatella Santini, Daniela Turchetti, Alberta Ferrari, Alberto Zambelli and Senonetwork Italia Breast Centre Responders
Curr. Oncol. 2024, 31(7), 3815-3825; https://doi.org/10.3390/curroncol31070282 - 30 Jun 2024
Viewed by 289
Abstract
Background: Breast units (BUs) provide breast cancer (BC) care, including prevention, treatment, and genetic assessment. Genetic research has highlighted BRCA1/2 mutations as key hereditary BC risk factors. BRCA testing is crucial for personalized treatment and prevention strategies. However, the integration of BRCA testing [...] Read more.
Background: Breast units (BUs) provide breast cancer (BC) care, including prevention, treatment, and genetic assessment. Genetic research has highlighted BRCA1/2 mutations as key hereditary BC risk factors. BRCA testing is crucial for personalized treatment and prevention strategies. However, the integration of BRCA testing in Italian BUs faces multiple challenges. This study, by Senonetwork Italia, aimed to evaluate genetic testing practices and identify obstacles within Italian BUs. Methods: Senonetwork Italia conducted a 16-question web-based survey involving 153 BUs. The survey assessed aspects of BRCA testing, including timing, urgency, counseling, patient selection, and multi-gene panels. Results: Of the 153 BUs, 109 (71.2%) responded. Testing before surgery was performed by 70.6% of centers, with urgent cases acknowledged by 87.2%. Most centers (56.0%) arranged urgent pre-test counseling within a week. BRCA mutation status influenced treatment decisions in 99.1% of cases. Multi-gene panels were used by 33.0% of centers for all genetic counseling cases, while 56.0% followed standard referral criteria. The main challenges included cost, reimbursement, and reporting timelines. Conclusions: This survey highlights significant variations in BRCA testing practices across Italian BUs and identifies key logistical and financial challenges. There is a need for standardized practices of genetic testing to ensure personalized and effective BC management in Italy. Full article
(This article belongs to the Section Breast Cancer)
7 pages, 2613 KiB  
Case Report
A Locally Advanced NSCLC Patient Harboring a Rare KIF13A-RET Fusion Benefited from Pralsetinib: A Case Report
by Zenghao Chang, Tengfei Zhu, Hao Jiang, Wei Ou and Siyu Wang
Curr. Oncol. 2024, 31(7), 3808-3814; https://doi.org/10.3390/curroncol31070281 - 30 Jun 2024
Viewed by 277
Abstract
The application of adjuvant treatment has significantly enhanced the survival of patients with resectable non-small cell lung cancer (NSCLC) carrying driver gene mutations. However, adjuvant-targeted therapy remains controversial for some NSCLC patients carrying rare gene mutations such as RET, as there is currently [...] Read more.
The application of adjuvant treatment has significantly enhanced the survival of patients with resectable non-small cell lung cancer (NSCLC) carrying driver gene mutations. However, adjuvant-targeted therapy remains controversial for some NSCLC patients carrying rare gene mutations such as RET, as there is currently a lack of confirmed randomized controlled trials demonstrating efficacy. In this report, we describe the case of a 58-year-old man with stage IIIA NSCLC who underwent complete lobectomy with selective lymph node dissection. Postoperative next-generation sequencing revealed that the patient harbored a rare KIF13A-RET fusion. The patient elected to receive adjuvant treatment with pralsetinib monotherapy and underwent serial circulating tumor DNA (ctDNA) monitoring after surgery. During follow-up, despite experiencing dose reduction and irregular medication adherence, the patient still achieved a satisfactory disease-free survival (DFS) of 27 months. Furthermore, ctDNA predicted tumor recurrence 4 months earlier than imaging techniques. The addition of bevacizumab to the original regimen upon recurrence continued to be beneficial. Pralsetinib demonstrated promising efficacy as adjuvant therapy, while ctDNA analysis offered a valuable tool for early detection of tumor recurrence. By leveraging targeted therapies and innovative monitoring techniques, we aim to improve outcomes and quality of life for NSCLC patients in the future. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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10 pages, 439 KiB  
Article
Disparities in Outcomes following Resection of Locally Advanced Rectal Cancer
by William Y. Luo, Dimitrios N. Varvoglis, Chris B. Agala, Lydia H. Comer, Pragna Shetty, Trevor Wood, Muneera R. Kapadia, Jonathan M. Stem and José G. Guillem
Curr. Oncol. 2024, 31(7), 3798-3807; https://doi.org/10.3390/curroncol31070280 - 30 Jun 2024
Viewed by 248
Abstract
Surgical margins following rectal cancer resection impact oncologic outcomes. We examined the relationship between margin status and race, ethnicity, region of care, and facility type. Patients undergoing resection of a stage II–III locally advanced rectal cancer (LARC) between 2004 and 2018 were identified [...] Read more.
Surgical margins following rectal cancer resection impact oncologic outcomes. We examined the relationship between margin status and race, ethnicity, region of care, and facility type. Patients undergoing resection of a stage II–III locally advanced rectal cancer (LARC) between 2004 and 2018 were identified through the National Cancer Database. Inverse probability of treatment weighting (IPTW) was performed, with margin positivity rate as the outcome of interest, and race/ethnicity and region of care as the predictors of interest. In total, 58,389 patients were included. After IPTW adjustment, non-Hispanic Black (NHB) patients were 12% (p = 0.029) more likely to have margin positivity than non-Hispanic White (NHW) patients. Patients in the northeast were 9% less likely to have margin positivity compared to those in the south. In the west, NHB patients were more likely to have positive margins than NHW patients. Care in academic/research centers was associated with lower likelihood of positive margins compared to community centers. Within academic/research centers, NHB patients were more likely to have positive margins than non-Hispanic Other patients. Our results suggest that disparity in surgical management of LARC in NHB patients exists across regions of the country and facility types. Further research aimed at identifying drivers of this disparity is warranted. Full article
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15 pages, 567 KiB  
Review
Improving Care for Older Adults with Cancer in Canada: A Call to Action
by Sarah Cook, Shabbir Alibhai, Ra** Mehta, Marie-France Savard, Caroline Mariano, Dominique LeBlanc, Danielle Desautels, Rossanna Pezo, **aofu Zhu, Karen A. Gelmon and Tina Hsu
Curr. Oncol. 2024, 31(7), 3783-3797; https://doi.org/10.3390/curroncol31070279 - 30 Jun 2024
Viewed by 330
Abstract
Most patients diagnosed with and dying from cancer in Canada are older adults, with aging contributing to the large projected growth in cancer incidence. Older adults with cancer have unique needs, and on a global scale increasing efforts have been made to address [...] Read more.
Most patients diagnosed with and dying from cancer in Canada are older adults, with aging contributing to the large projected growth in cancer incidence. Older adults with cancer have unique needs, and on a global scale increasing efforts have been made to address recognized gaps in their cancer care. However, in Canada, geriatric oncology remains a new and develo** field. There is increasing recognition of the value of geriatric oncology and there is a growing number of healthcare providers interested in develo** the field. While there is an increasing number of dedicated programs in geriatric oncology, they remain limited overall. Develo** novel methods to delivery geriatric care in the oncology setting and improving visibility is important. Formal incorporation of a geriatric oncology curriculum into training is critical to both improve knowledge and demonstrate its value to healthcare providers. Although a robust group of dedicated researchers exist, increased collaboration is needed to capitalize on existing expertise. Dedicated funding is critical to promoting clinical programs, research, and training new clinicians and leaders in the field. By addressing challenges and capitalizing on opportunities for improvement, Canada can better meet the unique needs of its aging population with cancer and ultimately improve their outcomes. Full article
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12 pages, 560 KiB  
Review
Shifting Paradigms in TNBC Treatment: Emerging Alternatives to Capecitabine in the Post-Neoadjuvant Setting
by Halima Abahssain, Amine Souadka, Rania Alem, Matteo Santoni, Nicola Battelli, Eric Amela, Antoine Lemaire, Joseph Rodriguez and Hassan Errihani
Curr. Oncol. 2024, 31(7), 3771-3782; https://doi.org/10.3390/curroncol31070278 - 30 Jun 2024
Viewed by 370
Abstract
Background: Triple-negative breast cancer (TNBC) remains a clinically challenging subtype due to its aggressive nature and limited treatment options post-neoadjuvant failure. Historically, capecitabine has been the cornerstone of adjuvant therapy for TNBC patients not achieving a pathological complete response (pCR). However, the integration [...] Read more.
Background: Triple-negative breast cancer (TNBC) remains a clinically challenging subtype due to its aggressive nature and limited treatment options post-neoadjuvant failure. Historically, capecitabine has been the cornerstone of adjuvant therapy for TNBC patients not achieving a pathological complete response (pCR). However, the integration of new modalities such as immunotherapy and PARP inhibitors has prompted a re-evaluation of traditional post-neoadjuvant approaches. Methods: This review synthesizes data from pivotal clinical trials and meta-analyses to evaluate the efficacy of emerging therapies in the post-neoadjuvant setting. We focus on the role of immune checkpoint inhibitors (ICIs), PARP inhibitors (PARPis), and antibody-drug conjugates (ADCs) alongside or in place of capecitabine in TNBC treatment paradigms. Results: The addition of ICIs like pembrolizumab to neoadjuvant regimens has shown increased pCR rates and improved event-free survival, posing new questions about optimal post-neoadjuvant therapies. Similarly, PARPis have demonstrated efficacy in BRCA-mutated TNBC populations, with significant improvements in disease-free survival (DFS) and overall survival (OS). Emerging studies on ADCs further complicate the adjuvant landscape, offering potentially efficacious alternatives to capecitabine, especially in patients with residual disease after neoadjuvant therapy. Discussion: The challenge remains to integrate these new treatments into clinical practice effectively, considering factors such as drug resistance, patient-specific characteristics, and socio-economic barriers. This review discusses the implications of these therapies and suggests a future direction focused on personalized medicine approaches in TNBC. Conclusions: As the treatment landscape for TNBC evolves, the role of capecitabine is being critically examined. While it remains a viable option for certain patient groups, the introduction of ICIs, PARPis, and ADCs offers promising alternatives that could redefine adjuvant therapy standards. Ongoing and future trials will be pivotal in determining the optimal therapeutic strategies for TNBC patients with residual disease post-neoadjuvant therapy. Full article
(This article belongs to the Section Breast Cancer)
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13 pages, 833 KiB  
Article
Adjuvant Treatment of Stage I–II Serous Endometrial Cancer: A Single Institution 20-Year Experience
by Aquila Akingbade, François Fabi, Rodrigo Cartes, James Tsui and Joanne Alfieri
Curr. Oncol. 2024, 31(7), 3758-3770; https://doi.org/10.3390/curroncol31070277 - 29 Jun 2024
Viewed by 248
Abstract
Background: Serous endometrial carcinoma (SEC) is a high-risk subtype of endometrial cancer. The effectiveness of multiple adjuvant therapies, namely chemotherapy (CT), radiotherapy (RT), and sequential/concurrent chemotherapy with radiotherapy (CRT), have previously been investigated. However, optimal management of early-stage SEC remains unclarified. Methods: All [...] Read more.
Background: Serous endometrial carcinoma (SEC) is a high-risk subtype of endometrial cancer. The effectiveness of multiple adjuvant therapies, namely chemotherapy (CT), radiotherapy (RT), and sequential/concurrent chemotherapy with radiotherapy (CRT), have previously been investigated. However, optimal management of early-stage SEC remains unclarified. Methods: All cases of early-stage SEC (FIGO 2009 stages I–II) treated in our institution from 2002 to 2019 were identified. Patient data were documented until September 2023. Overall survival (OS) and disease-free survival (DFS) were computed using Kaplan–Meier estimates and Cox’s proportional hazard model; descriptive statistical analysis was performed. Results: A total of 50 patients underwent total hysterectomy-bilateral sal**o-oophorectomy and omentectomy, displaying stage IA (60%), IB (24%), and II (16%) disease. The median follow-up was 90.9 months. Patients underwent adjuvant CRT (n = 36, 72%), CT (n = 6, 12%), or RT (n = 6, 12%). Two patients were observed and excluded from analyses. The 42 patients who received radiotherapy had pelvic external beam radiotherapy (n = 10), vaginal brachytherapy (n = 21), or both (n = 11). CRT had better OS (HR 0.14, 95%CI 0.04–0.52, p < 0.005) and DFS (HR 0.25, 95%CI 0.07–0.97, p = 0.05) than CT alone. RT displayed no OS or DFS benefits compared to CT/CRT. Recurrences were mostly distant. Acute and late G3-4 toxicities were primarily hematologic. Conclusions: Our data underline the challenge of treating SEC. CRT appears to be superior to CT alone but not to RT. Most recurrences were distant, highlighting the need for optimized systemic treatment options. Full article
(This article belongs to the Special Issue Radiation Therapy for Gynecological Cancer)
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6 pages, 947 KiB  
Project Report
Leveraging Nursing Assessment for Early Identification of Post Operative Gastrointestinal Dysfunction (POGD) in Patients Undergoing Colorectal Surgery
by Tessy Siby, Alice Shajimon, Daniel Mullen, Shahnaz Gillani, Jeffrey R. Ong, Nikki E. Dinkins, Brittany Kruse, Carla Patel, Craig Messick, Nicole Gourmelon, Mary R. Butler and Vijaya Gottumukkala
Curr. Oncol. 2024, 31(7), 3752-3757; https://doi.org/10.3390/curroncol31070276 - 29 Jun 2024
Viewed by 282
Abstract
Background: Postoperative gastrointestinal dysfunction (POGD) remains a common morbidity after gastrointestinal surgery. POGD is associated with delayed hospital recovery, increased length of stay, poor patient satisfaction and experience, and increased economic hardship. The I-FEED scoring system was created by a group of experts [...] Read more.
Background: Postoperative gastrointestinal dysfunction (POGD) remains a common morbidity after gastrointestinal surgery. POGD is associated with delayed hospital recovery, increased length of stay, poor patient satisfaction and experience, and increased economic hardship. The I-FEED scoring system was created by a group of experts to address the lack of a consistent objective definition of POGD. However, the I-FEED tool needs clinical validation before it can be adopted into clinical practice. The scope of this phase 1 Quality Improvement initiative involves the feasibility of implementing percussion into the nursing workflow without additional burden. Methods: All gastrointestinal/colorectal surgical unit registered nurses underwent comprehensive training in abdominal percussion. This involved understanding the technique, its application in postoperative gastrointestinal dysfunction assessment, and its integration into the existing nursing documentation in the Electronic Health Record (EHR). After six months of education and practice, a six-question survey was sent to all inpatient GI surgical unit nurses about incorporating the percussion assessment into their routine workflow and documentation. Results: Responses were received from 91% of day-shift nurses and 76% of night-shift registered nurses. Overall, 95% of the nurses were confident in completing the abdominal percussion during their daily assessment. Conclusion: Nurses’ effective use of the I-FEED tool may help improve patient outcomes after surgery. The tool could also be an effective instrument for the early identification of postoperative gastrointestinal dysfunction (POGD) in surgical patients. Full article
(This article belongs to the Special Issue Feature Reviews in Section "Oncology Nursing")
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14 pages, 440 KiB  
Review
What Is Ailing Oncology Clinical Trials? Can We Fix Them?
by Abhenil Mittal, Sara Moore, Vishal Navani, Di Maria Jiang, David J. Stewart, Geoffrey Liu and Paul Wheatley-Price
Curr. Oncol. 2024, 31(7), 3738-3751; https://doi.org/10.3390/curroncol31070275 - 28 Jun 2024
Viewed by 243
Abstract
Evidence from phase three clinical trials helps shape clinical practice. However, a very small minority of patients with cancer participate in clinical trials and many trials are not completed on time due to slow accrual. Issues with restrictive eligibility criteria can severely limit [...] Read more.
Evidence from phase three clinical trials helps shape clinical practice. However, a very small minority of patients with cancer participate in clinical trials and many trials are not completed on time due to slow accrual. Issues with restrictive eligibility criteria can severely limit the patients who can access trials, without any convincing evidence that these restrictions impact patient safety. Similarly, regulatory, organizational, and institutional hurdles can delay trial activation, ultimately making some studies irrelevant. Additional issues during trial conduct (e.g., mandatory in-person visits, central confirmation of standard biomarkers, and inflexible drug dosage modification) contribute to making trials non-patient-centric. These real-life observations from experienced clinical trialists can seem nonsensical to investigators and patients alike, who are trying to bring effective drugs to patients with cancer. In this review, we delve into these issues in detail, and discuss potential solutions to make clinical trials more accessible to patients Full article
(This article belongs to the Special Issue Advancements in Clinical Trials in Oncology: Design, Enrichment, Safety, Operations, Patient Centricity, and Endpoints)
25 pages, 338 KiB  
Article
To Reconstruct or Not to Reconstruct: Piloting a Vietnamese and Arabic Breast Reconstruction Decision Aid in Australia
by Patsy S. Soon, Khouloud Kamalmaz, Verena S. Wu, Neda Karimi, Martha Gerges, Kerry A. Sherman and Afaf Girgis
Curr. Oncol. 2024, 31(7), 3713-3737; https://doi.org/10.3390/curroncol31070274 - 28 Jun 2024
Viewed by 298
Abstract
Currently, there are no resources to support culturally and linguistically diverse (CALD) women with breast cancer to make decisions about undergoing breast reconstruction (BR). This study evaluated the usability and acceptability of decision aids (DAs) for Vietnamese- and Arabic-speaking women. This two-phase qualitative [...] Read more.
Currently, there are no resources to support culturally and linguistically diverse (CALD) women with breast cancer to make decisions about undergoing breast reconstruction (BR). This study evaluated the usability and acceptability of decision aids (DAs) for Vietnamese- and Arabic-speaking women. This two-phase qualitative recruited Vietnamese- (Phase 1) and Arabic-speaking (Phase 2) adult (age ≥ 18 years) women who were diagnosed with breast cancer and could read Vietnamese/Arabic. Women participated in either think-aloud telephone interviews (Phase 1) or semi-structured telephone interviews (Phase 2) and provided feedback on the DA. Interviews were audio-recorded, translated, and transcribed from Vietnamese/Arabic to English, and inductive thematic analysis was undertaken. Additionally, Arabic-speaking women completed the Preparation for Decision Making (PrepDM) scale in Round 2. Twenty-five women were recruited in two phases (Phase 1: Vietnamese-speaking women, n = 14; Phase 2: Arabic-speaking, n = 11). Three themes were developed in Phase 1: (1) DA content and reception; (2) linguistic attributes and cultural appropriateness; and (3) factors that improve the DAs’ impact. Three themes were developed in Phase 2: (1) varying perceptions of DA content; (2) linguistic and cultural suitability of information; and (3) impact of DA on decision making. Women from both phases identified areas for improvement: minimising the use of medical terminology, considering the cultural taboos associated with the word ‘breast’, and addressing remaining information gaps. Both language DAs were generally perceived as acceptable and useful in providing information about BR options and prompting women’s reflections about the suitability of BR as part of their treatment. The mean PrepDM score for Arabic-speaking women in Round 2 was 4.8/5 (SD = 0.3). Further work is needed to ensure that culturally adapted DAs take into account the myriad of information needs and health literacy levels. The key role of healthcare professionals in shared decision making among CALD populations should also be considered. Full article
(This article belongs to the Section Psychosocial Oncology)
15 pages, 1458 KiB  
Article
Navigation-Based Telehealth Informed Decision-Making for Prostate Cancer Screening in Black Men
by Djibril M. Ba, Chrispin Kayembe, Joe Littlejohn, Lauren J. Van Scoy, Erika VanDyke, James Williams, Avnish Katoch, Neil C. Shook, Yue Zhang, Craig Livelsberger, Alicia C. McDonald and Joshua E. Muscat
Curr. Oncol. 2024, 31(7), 3698-3712; https://doi.org/10.3390/curroncol31070273 - 28 Jun 2024
Viewed by 335
Abstract
The rapid increase in telehealth has the potential to bring informed decision-making for prostate cancer screening (PCS) at the population level to high-risk individuals. We utilized a global technology platform of electronic health records data repositories (TriNetX) to determine its utility for Navigator-guided [...] Read more.
The rapid increase in telehealth has the potential to bring informed decision-making for prostate cancer screening (PCS) at the population level to high-risk individuals. We utilized a global technology platform of electronic health records data repositories (TriNetX) to determine its utility for Navigator-guided decision-making aid for PCS in Black men ages 45–79 years with no history of prostate cancer and PSA testing. Patients from Pennsylvania were invited to participate in a telehealth-delivered informed decision-making session for PCS. Focus groups, social learning theory, visual diagrams, and quantitative data on PCS risks and benefits were used to develop the content of the sessions, which included numerical discussions of risks vs. benefits in Black men. Participants completed several surveys, including baseline demographic and numeracy questionnaires, a one-on-one telehealth session with a trained Navigator, post-Navigation surveys, and an optional follow-up session with a urologist. Eighty-seven participants were consented and recruited. Although the mean numeracy score was only 1.9 out of 6, more than 90% rated as good or excellent that the sessions aided their PCS decision-making skills. This study indicates that Navigation by telehealth offers the ability to assist in informed decision-making for PCS at the population level. Full article
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8 pages, 734 KiB  
Article
Quantifying the Dosimetric Impact of Proton Range Uncertainties on RBE-Weighted Dose Distributions in Intensity-Modulated Proton Therapy for Bilateral Head and Neck Cancer
by Suresh Rana, Noufal Manthala Padannayil, Linh Tran, Anatoly B. Rosenfeld, Hina Saeed and Michael Kasper
Curr. Oncol. 2024, 31(7), 3690-3697; https://doi.org/10.3390/curroncol31070272 - 27 Jun 2024
Viewed by 285
Abstract
Background: In current clinical practice, intensity-modulated proton therapy (IMPT) head and neck cancer (HNC) plans are generated using a constant relative biological effectiveness (cRBE) of 1.1. The primary goal of this study was to explore the dosimetric impact of proton range uncertainties on [...] Read more.
Background: In current clinical practice, intensity-modulated proton therapy (IMPT) head and neck cancer (HNC) plans are generated using a constant relative biological effectiveness (cRBE) of 1.1. The primary goal of this study was to explore the dosimetric impact of proton range uncertainties on RBE-weighted dose (RWD) distributions using a variable RBE (vRBE) model in the context of bilateral HNC IMPT plans. Methods: The current study included the computed tomography (CT) datasets of ten bilateral HNC patients who had undergone photon therapy. Each patient’s plan was generated using three IMPT beams to deliver doses to the CTV_High and CTV_Low for doses of 70 Gy(RBE) and 54 Gy(RBE), respectively, in 35 fractions through a simultaneous integrated boost (SIB) technique. Each nominal plan calculated with a cRBE of 1.1 was subjected to the range uncertainties of ±3%. The McNamara vRBE model was used for RWD calculations. For each patient, the differences in dosimetric metrices between the RWD and nominal dose distributions were compared. Results: The constrictor muscles, oral cavity, parotids, larynx, thyroid, and esophagus showed average differences in mean dose (Dmean) values up to 6.91 Gy(RBE), indicating the impact of proton range uncertainties on RWD distributions. Similarly, the brachial plexus, brain, brainstem, spinal cord, and mandible showed varying degrees of the average differences in maximum dose (Dmax) values (2.78–10.75 Gy(RBE)). The Dmean and Dmax to the CTV from RWD distributions were within ±2% of the dosimetric results in nominal plans. Conclusion: The consistent trend of higher mean and maximum doses to the OARs with the McNamara vRBE model compared to cRBE model highlighted the need for consideration of proton range uncertainties while evaluating OAR doses in bilateral HNC IMPT plans. Full article
(This article belongs to the Special Issue Advances in Intensity Modulated Proton Therapy for Head and Neck Cancer Treatment)
8 pages, 1220 KiB  
Case Report
Durable Response to Atezolizumab in Extensive-Stage Small-Cell Lung Cancer Leading to 60 Months Overall Survival: A Case Report
by Freeman Paczkowski, Jacques Raphael and Claire Browne
Curr. Oncol. 2024, 31(7), 3682-3689; https://doi.org/10.3390/curroncol31070271 - 27 Jun 2024
Viewed by 457
Abstract
Small-cell lung cancer (SCLC) remains a disease with poor prognosis, particularly in extensive-stage SCLC (ES-SCLC). Current standard-of-care treatment includes chemotherapy with platinum agents and etoposide plus immunotherapy with atezolizumab or durvalumab, which has achieved a mean overall survival of 12–13 months in clinical [...] Read more.
Small-cell lung cancer (SCLC) remains a disease with poor prognosis, particularly in extensive-stage SCLC (ES-SCLC). Current standard-of-care treatment includes chemotherapy with platinum agents and etoposide plus immunotherapy with atezolizumab or durvalumab, which has achieved a mean overall survival of 12–13 months in clinical trials. However, long-term survival in ES-SCLC, even with the addition of immunotherapy, continues to be rare. We present the case of a middle-aged male patient diagnosed with ES-SCLC who was treated with four cycles of induction chemotherapy (carboplatin and etoposide) and atezolizumab, starting maintenance atezolizumab every 21 days thereafter, and thoracic radiotherapy. After 9 months, he experienced mild disease progression and was rechallenged with six cycles of carboplatin and etoposide with continued atezolizumab. Subsequent imaging showed near-complete disease resolution which has been sustained since. He has continued on maintenance atezolizumab since diagnosis and has achieved 60 months overall survival and 44 months progression-free survival. Throughout treatment, he has maintained a high functional capacity and only experienced one immune-related adverse event. Our patient is representative of a small subset who are capable of achieving durable responses to immunotherapy and his case highlights the need for further research to elucidate the clinical and biological factors driving this response. Full article
(This article belongs to the Section Thoracic Oncology)
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13 pages, 255 KiB  
Review
Salvage High-Intensity Focused Ultrasound for Prostate Cancer after Radiation Failure: A Narrative Review
by Sina Sobhani, Anosh Dadabhoy, Alireza Ghoreifi and Amir H. Lebastchi
Curr. Oncol. 2024, 31(7), 3669-3681; https://doi.org/10.3390/curroncol31070270 - 26 Jun 2024
Viewed by 746
Abstract
For patients diagnosed with localized prostate cancer, there are multiple treatment options available. The traditional treatment modalities include radical prostatectomy and radiotherapy. Nevertheless, focal therapy, including high-intensity focused ultrasound (HIFU) and cryotherapy, has emerged as a less-invasive method in this setting. Some patients [...] Read more.
For patients diagnosed with localized prostate cancer, there are multiple treatment options available. The traditional treatment modalities include radical prostatectomy and radiotherapy. Nevertheless, focal therapy, including high-intensity focused ultrasound (HIFU) and cryotherapy, has emerged as a less-invasive method in this setting. Some patients undergoing primary radiation therapy experience recurrence, but there is currently no consensus on the optimal approach for salvage treatment in such cases. The lack of robust data and randomized controlled trials comparing different whole-gland and focal salvage therapies presents a challenge in determining the ideal treatment strategy. This narrative review examines the prospective and retrospective data available on salvage HIFU following radiation therapy. Based on the literature, salvage HIFU for radio-recurrent prostate cancer has promising oncological outcomes, with an overall 5-year survival rate of around 85%, as well as incontinence rates of about 30% based on the patient’s risk group, follow-up times, definitions used, and other aspects of the study. Salvage HIFU for prostate cancer proves to be an effective treatment modality for select patients with biochemical recurrence following radiotherapy. Full article
(This article belongs to the Section Genitourinary Oncology)
12 pages, 493 KiB  
Article
Long-Term Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Origin
by Kadhim Taqi, Jay Lee, Scott Hurton, Cecily Stockley, Lloyd Mack, Justin Rivard, Walley Temple and Antoine Bouchard-Fortier
Curr. Oncol. 2024, 31(7), 3657-3668; https://doi.org/10.3390/curroncol31070269 - 25 Jun 2024
Viewed by 623
Abstract
Background: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a major treatment of colorectal peritoneal carcinomatosis (CPC). The aim was to determine the disease-free survival (DFS) and overall survival (OS) of patients undergoing CRS–HIPEC for CPC and factors associated with long-term [...] Read more.
Background: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a major treatment of colorectal peritoneal carcinomatosis (CPC). The aim was to determine the disease-free survival (DFS) and overall survival (OS) of patients undergoing CRS–HIPEC for CPC and factors associated with long-term survival (LTS). Methods: consecutive CPC patients who underwent CRS–HIPEC at a HIPEC center between 2007 and 2021 were included. Actual survival was calculated, and Cox proportional hazards models were used to identify factors associated with OS, DFS and LTS. Results: there were 125 patients with CPC who underwent primary CRS–HIPEC, with mean age of 54.5 years. Median follow-up was 31 months. Average intraoperative PCI was 11, and complete cytoreduction (CC-0) was achieved in 96.8%. Median OS was 41.6 months (6–196). The 2-year and 5-year OS were 68% and 24.8%, respectively, and the 2-year DFS was 28.8%. Factors associated with worse OS included pre-HIPEC systemic therapy, synchronous extraperitoneal metastasis, and PCI ≥ 20 (p < 0.05). Progression prior to CRS–HIPEC was associated with worse DFS (p < 0.05). Lower PCI, fewer complications, lower recurrence and longer DFS were associated with LTS (p < 0.05). Conclusion: CRS and HIPEC improve OS in CPC patients but they have high disease recurrence. Outcomes depend on preoperative therapy response, extraperitoneal metastasis, and peritoneal disease burden. Full article
(This article belongs to the Section Surgical Oncology)
14 pages, 1144 KiB  
Article
Nonspecific Signs and/or Symptoms of Cancer: A Retrospective, Observational Analysis from a Secondary Care, US Community Oncology Dataset
by Christopher B. Benton, Ding He, Karen Todoroff, Marie V. Coignet, Ying Luan, Jason C. Wong, Kathryn N. Kurtzman and Ira Zackon
Curr. Oncol. 2024, 31(7), 3643-3656; https://doi.org/10.3390/curroncol31070268 - 25 Jun 2024
Viewed by 439
Abstract
To help determine the unmet need for improved diagnostic tools to evaluate patients with nonspecific signs and/or symptoms (NSSS) and suspicion of cancer, we examined patient characteristics, diagnostic journey, and cancer incidence of patients with NSSS within The US Oncology Network (The Network), [...] Read more.
To help determine the unmet need for improved diagnostic tools to evaluate patients with nonspecific signs and/or symptoms (NSSS) and suspicion of cancer, we examined patient characteristics, diagnostic journey, and cancer incidence of patients with NSSS within The US Oncology Network (The Network), a secondary care community oncology setting. This retrospective, observational cohort study included patients aged ≥40 years with ≥1 NSSS in their problem list at their first visit within The Network (the index date) between 1 January 2016 and 31 December 2020. Patients were followed longitudinally with electronic health record data for initial cancer diagnosis, new noncancer diagnosis, death, end of study observation period, or 12 months, whichever occurred first. Of 103,984 patients eligible for inclusion, 96,722 presented with only 1 NSSS at index date; 6537/103,984 (6.3%) were diagnosed with 1 primary cancer within 12 months after the index date; 3825/6537 (58.5%) with hematologic malignancy, and 2712/6537 (41.5%) with solid tumor. Among patients diagnosed with cancer (n = 6774), the median time to cancer diagnosis after their first visit within The Network was 5.13 weeks. This study provides a real-world perspective on cancer incidence in patients with NSSS referred to a secondary care setting and highlights the unmet need for improved diagnostic tools to improve cancer outcomes. Full article
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13 pages, 379 KiB  
Article
Dynamic Prediction of Overall Survival for Patients with Osteosarcoma: A Retrospective Analysis of the EURAMOS-1 Clinical Trial Data
by Marta Spreafico, Audinga-Dea Hazewinkel, Hans Gelderblom and Marta Fiocco
Curr. Oncol. 2024, 31(7), 3630-3642; https://doi.org/10.3390/curroncol31070267 - 22 Jun 2024
Viewed by 444
Abstract
Current prediction models for patients with ostosarcoma are restricted to predictions from a single, static point in time, such as diagnosis or surgery. These approaches discard information which becomes available during follow-up and may have an impact on patient’s prognosis. This study aims [...] Read more.
Current prediction models for patients with ostosarcoma are restricted to predictions from a single, static point in time, such as diagnosis or surgery. These approaches discard information which becomes available during follow-up and may have an impact on patient’s prognosis. This study aims at develo** a dynamic prediction model providing 5-year overall survival (OS) predictions from different time points during follow-up. The developed model considers relevant baseline prognostic factors, accounting for where appropriate time-varying effects and time-varying intermediate events such as local recurrence (LR) and new metastatic disease (NM). A landmarking approach is applied to 1965 patients with high-grade resectable osteosarcoma from the EURAMOS-1 trial (NCT00143030). Results show that LR and NM negatively affected 5-year OS (HRs: 2.634, 95% CI 1.845–3.761; 8.558, 95% CI 7.367–9.942, respectively). Baseline factors with strong prognostic value (HRs > 2) included poor histological response (≥10% viable tumor), axial tumor location, and the presence of lung metastases. The effect of poor versus good histological response changed over time, becoming non-significant from 3.25 years post-surgery onwards. This time-varying effect, as well as the strong impact of disease-related time-varying variables, show the importance of including updated information collected during follow-up in the model to provide more accurate survival predictions. Full article
(This article belongs to the Special Issue Treatment of Bone Tumors in Children)
15 pages, 551 KiB  
Review
Integrating Molecular Insights into Biliary Tract Cancer Management: A Review of Personalized Therapeutic Strategies
by Mar Ros-Buxó, Ezequiel Mauro, Tamara Sauri, Gemma Iserte, Carla Fuster-Anglada, Alba Díaz, Laura Sererols-Viñas, Silvia Affo and Alejandro Forner
Curr. Oncol. 2024, 31(7), 3615-3629; https://doi.org/10.3390/curroncol31070266 - 21 Jun 2024
Viewed by 645
Abstract
Biliary tract cancers (BTCs) are rare and aggressive malignancies with an increasing incidence and poor prognosis. The standard systemic treatment for BTCs has evolved to include immune checkpoint inhibitors associated with gemcitabine–cisplatin as first-line therapies. However, survival rates remain low, highlighting the critical [...] Read more.
Biliary tract cancers (BTCs) are rare and aggressive malignancies with an increasing incidence and poor prognosis. The standard systemic treatment for BTCs has evolved to include immune checkpoint inhibitors associated with gemcitabine–cisplatin as first-line therapies. However, survival rates remain low, highlighting the critical need for personalized treatment strategies based on molecular profiling. Currently, significant advancements have been made in the molecular characterization of BTCs, where genetic alterations, such as IDH1 mutations and FGFR2 fusions, provide targets for therapy. Molecular profiling is crucial early in the management process to identify potential candidates for clinical trials and guide treatment strategy. The integration of these molecular insights into clinical practice has allowed for the development of targeted therapies, although many of them are still in the phase 2 trial stage without definitive survival benefits demonstrated in phase 3 trials. This integration of comprehensive molecular profile insights with traditional treatment approaches offers a new horizon in the personalized medicine landscape for BTCs, with the aim of significantly improving patient outcomes through precision oncology. Full article
(This article belongs to the Special Issue Biomarkers and Precision Medicine in Upper Gastrointestinal Malignancies)
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