Clinical oncology最新文献

{"title":"Correspondence to the Editor: Performance of Multimodal Artificial Intelligence Chatbots Evaluated on Clinical Oncology Cases","authors":"R.K. Gopal, P. Sankar Ganesh, N.N. Pathoor","doi":"10.1016/j.clon.2024.103684","DOIUrl":"10.1016/j.clon.2024.103684","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103684"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid Chimeric Antigen Receptor (CAR) γδ T Cells for Oral Cancer Therapy: Enhanced Safety and Targeted Efficacy","authors":"K. Kamala, P. Sivaperumal","doi":"10.1016/j.clon.2024.103683","DOIUrl":"10.1016/j.clon.2024.103683","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103683"},"PeriodicalIF":3.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant Radiotherapy and Endocrine Therapy for Oestrogen Receptor Positive Breast Cancers: The Neo-RT Feasibility Study","authors":"S.V. Lightowlers ,&nbsp;A. Machin ,&nbsp;R. Woitek ,&nbsp;E. Provenzano ,&nbsp;I. Allajbeu ,&nbsp;W. Al Sarakbi ,&nbsp;N. Demiris ,&nbsp;P. Forouhi ,&nbsp;F.J. Gilbert ,&nbsp;A.M. Kirby ,&nbsp;C. Towns ,&nbsp;N. Somaiah ,&nbsp;C.E. Coles","doi":"10.1016/j.clon.2024.103669","DOIUrl":"10.1016/j.clon.2024.103669","url":null,"abstract":"<div><h3>Aims</h3><div>To establish the safety and feasibility of delivering neoadjuvant radiotherapy and endocrine therapy for oestrogen receptor-positive breast cancers with palpable size 20mm or greater, for which radiotherapy might facilitate more conservative surgery.</div></div><div><h3>Materials and methods</h3><div>A single-arm feasibility study was conducted. Patients received whole breast radiotherapy with or without radiotherapy to nodal areas. Dose/fractionation was 40Gy in 15 fractions over 3 weeks, with or without either a simultaneous integrated boost to 48Gy or sequential boost to the tumour bed. This was followed by endocrine treatment for 20 weeks, then surgery. The primary endpoint of the study was the proportion of patients successfully completing neoadjuvant radiotherapy and endocrine treatment followed by breast surgery. Response and toxicity endpoints including mastectomy rate, peri/postoperative complications, and pathological response were also evaluated.</div><div>The primary analysis is descriptive. The study regimen would be considered feasible if more than 70% of patients completed treatment, while it might not be considered feasible if less than 50% did so. With a one-sided 5% significance level and 80% power, a maximum of 43 patients would be required to detect a rate of ≤50% vs ≥70%.</div></div><div><h3>Results</h3><div>14 patients were recruited out of the planned 43. Due to slow recruitment, particularly during the COVID-19 pandemic, the decision was made to stop the trial in October 2021. One registered patient was found to be ineligible before starting treatment. 13/13 patients (100%, 90% CI: 75.3%, 100%) who received any trial treatment successfully completed all trial treatments. The lower bound of the Clopper-Pearson (exact) 90% confidence interval was 79%, indicating that the primary endpoint would have been met if the planned recruitment had been achieved. 3/13 patients underwent mastectomy. 7/13 had more conservative surgery than had been planned at baseline. 4/13 patients experienced any peri/postoperative complication. The only acute radiotherapy toxicities reported were grade 1/2 dermatitis and grade 1 fatigue. Long-term breast outcomes were clinician assessed as none/mild at all timepoints in 12/13 patients. All tumours showed evidence of some pathological response to treatment, but none had a pathological complete response.</div></div><div><h3>Conclusion</h3><div>This treatment schedule is likely feasible. It is difficult to draw strong conclusions on safety/toxicity given the small numbers, but these seem in keeping with other recent reports of neoadjuvant breast radiotherapy.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103669"},"PeriodicalIF":3.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Ablative Radiotherapy for Bone-Only Oligometastatic Breast Cancer: On a Quest to Find the Optimum Cohort","authors":"M.T. Yilmaz,&nbsp;M. Gultekin,&nbsp;S. Yuce Sari,&nbsp;T. Kumru,&nbsp;H. Kivanc,&nbsp;G. Ozyigit,&nbsp;F. Yildiz","doi":"10.1016/j.clon.2024.103670","DOIUrl":"10.1016/j.clon.2024.103670","url":null,"abstract":"<div><h3>Aims</h3><div>We aimed to evaluate the treatment outcomes and associated prognostic factors in breast cancer (BC) patients who had bone-only oligometastatic disease (OMD) and we tried to determine the subgroup that would benefit most from stereotactic ablative radiotherapy (SABR).</div></div><div><h3>Materials and methods</h3><div>We enrolled 47 patients with a total of 63 lesions with bone-only oligometastatic BC who underwent SABR for all bone lesions between July 2013 and March 2022. Cases with bone-only metastatic disease with up to 5 metastatic lesions that can be safely treated with SABR were included in this study. All statistical analyses were performed using SPSS 23.0 software (SPSS, Chicago, IL).</div></div><div><h3>Results</h3><div>The median follow-up time was 34 months. The 2- and 5-year overall survival (OS) rates were 90% and 66%, and the progression-free survival (PFS) rates were 49% and 29%, respectively. The local control rate in the SABR-treated foci was 85%. In multivariate analysis, OMD state (genuine vs. induced), de-novo OMD state (synchronous vs. metachronous), and histology (luminal vs. HER-2 enriched) were prognostic for OS. Molecular subtype switch was observed in 21 (42%) patients, and 0% PFS was observed in 5 years in patients with phenotypic discordance. SABR was well tolerated and there were no ≥grade 4 acute or late toxicities.</div></div><div><h3>Conclusion</h3><div>Our study showed that in patients with bone-only OMD, in HER2-enriched subtypes with genuine &amp; de-novo &amp; synchronous OMD, SABR should be strongly considered for all metastatic foci, especially if there is phenotypic discordance in the primary tumor and metastasis.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103670"},"PeriodicalIF":3.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reirradiation in Paediatric Tumours of the Central Nervous System: Outcome and Side Effects After Implementing National Guidelines","authors":"A. Asklid ,&nbsp;M.P. Nilsson ,&nbsp;J. Engellau ,&nbsp;I. Kristensen ,&nbsp;M. Blomstrand ,&nbsp;C. Fröjd ,&nbsp;M. Agrup ,&nbsp;A. Flejmer ,&nbsp;U. Martinsson ,&nbsp;A.-M. Svärd ,&nbsp;E. Almhagen ,&nbsp;A. Embring","doi":"10.1016/j.clon.2024.103667","DOIUrl":"10.1016/j.clon.2024.103667","url":null,"abstract":"<div><h3>Aims</h3><div>Reirradiation is becoming more frequently used in paediatric tumours of the central nervous system (CNS). To fill the void of clinical guidelines, the Swedish Working Group of Paediatric Radiotherapy compiled consensus guidelines on reirradiation in 2019. The aim of this study was to evaluate the outcome of children reirradiated for CNS tumours since implementing the guidelines.</div></div><div><h3>Material and methods</h3><div>All children in Sweden who were reirradiated for CNS tumours between 2019 and 2023 were retrospectively analysed. Data were collected on patient and treatment characteristics, outcome, and severe side effects. Radiation treatment plans were reviewed, and cumulative doses to organs at risk at reirradiation were extracted following rigid registration.</div></div><div><h3>Results</h3><div>Thirty-one patients (male 55%, female 45%) were included, and the median age at start of reirradiation was 10.2 years. The median time between primary irradiation and reirradiation was 19 months (range 2–141). The most common treatment intent at reirradiation was palliative (68%), followed by curative (32%). With a median follow-up of 8.5 months (range 0–49), the median overall survival from the end of reirradiation was 11.4 months. In the 8 patients where the treatment goal at reirradiation was symptom relief, 6 patients (75%) had relief of symptoms. The median cumulative near maximum doses (D2%) to the brain, brainstem, and chiasm/optic nerves were 71 Gy_EQD2 (range 44–102), 72 Gy_EQD2 (range 0–94), and 40 Gy_EQD2 (range 0–76), respectively. Following reirradiation, only 2 patients had grade ≥3 side effects. One with transient neurological deficit and one with rapid onset of blindness that persisted.</div></div><div><h3>Conclusion</h3><div>The implementation of national guidelines has harmonised the way paediatric patients are reirradiated for CNS tumours in Sweden. A structured follow-up shows that severe side effects are rare despite high cumulative doses to organs at risk, and that reirradiation can offer relief of symptoms and/or local control for selected patients.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103667"},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Switching to a Fixed-dose Combined Pertuzumab and Trastuzumab With Recombinant Human Hyaluronidase Subcutaneous Injection to Treat Human Epidermal Growth Factor Receptor 2-positive Breast Cancer in Real-world UK Clinical Practice","authors":"S. Harding,&nbsp;A. Borley","doi":"10.1016/j.clon.2024.103671","DOIUrl":"10.1016/j.clon.2024.103671","url":null,"abstract":"<div><div>Current standard of care for human epidermal growth factor receptor 2 (HER2)–positive breast cancer is first-line treatment with chemotherapy in combination with the HER2-targeting monoclonal antibodies, trastuzumab and pertuzumab. While this treatment approach is associated with improved clinical outcomes, there is a treatment burden associated with the invasive and time-consuming nature of separate intravenous (IV) administration of pertuzumab and trastuzumab. In 2020, a novel subcutaneous (SC) formulation of pertuzumab plus trastuzumab with recombinant human hyaluronidase, available as a fixed-dose combination vial that can be administered in 5–8 minutes, was approved for use by the US Food and Drug Administration and the European Medicines Agency.</div></div><div><h3>Aim</h3><div>A UK cancer centre set out to switch all patients currently receiving IV infusion of pertuzumab and trastuzumab over to the combined SC injection in a safe and timely manner and to initiate all future patients on the combined SC injection.</div></div><div><h3>Materials and methods</h3><div>Organisational governance approval was obtained before a novel project model approach was used to implement the treatment switch which incorporated aspects such as education and multidisciplinary team collaboration.</div></div><div><h3>Results</h3><div>Of the 97 eligible patients, 99% were switched to the combined SC injection safely and effectively over a 4-week period. Between 1st April 2021 and 30th September 2022, 3062 hours of pharmacy aseptic preparation time and 6764 hours of day unit chair time were saved. The number of aseptic unit operation days above the maximum capacity was reduced post-switch.</div></div><div><h3>Conclusion</h3><div>This initiative demonstrated the ability to rapidly and effectively transition &gt;95% of eligible breast cancer patients from separate IV trastuzumab and pertuzumab to a fixed combined SC formulation. Patient benefits included shorter administration appointments and a less invasive form of treatment, whereas healthcare system benefits included substantial savings in aseptic preparation time and chair time, and a meaningful increase in clinic capacity. The reported treatment-switch process provides a model that can be adopted by other centres wishing to implement similar treatment switches.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103671"},"PeriodicalIF":3.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence to the Editor: Assessing a Suitable Radiotherapy Utilisation Benchmark for Older Patients With Head and Neck Cancer","authors":"R. Dineshkumar","doi":"10.1016/j.clon.2024.103666","DOIUrl":"10.1016/j.clon.2024.103666","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103666"},"PeriodicalIF":3.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolving Role of Genomics in Colorectal Cancer","authors":"A.M. Berner ,&nbsp;N. Murugaesu","doi":"10.1016/j.clon.2024.10.033","DOIUrl":"10.1016/j.clon.2024.10.033","url":null,"abstract":"<div><div>Approximately 75% of colorectal cancers (CRCs) harbour an identifiable driver mutation, 5% of which are heritable. These drivers have recognised implications for prognosis and therapy selection. In addition, potential germline mutations require investigations to inform testing of relatives, as well as surveillance for other malignancies. With increasing numbers of targeted drugs being approved, judicious testing is required to ensure sufficient tumour sample is available for testing and at the right point in the cancer pathway. Liquid biopsy with circulating tumour DNA (ctDNA) in the blood presents an exciting adjunct to tumour tissue testing for molecular drivers, as well as escalation and de-escalation of therapy. Here, we review the most frequent molecular alterations in CRC, how genomic testing should be integrated into the treatment pathway for CRC, and sources of further education.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103661"},"PeriodicalIF":3.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Somatic Genomic Testing on Breast Cancer Care","authors":"T. Khalid ,&nbsp;R.I. Cutress ,&nbsp;M. Remer ,&nbsp;E.R. Copson","doi":"10.1016/j.clon.2024.10.037","DOIUrl":"10.1016/j.clon.2024.10.037","url":null,"abstract":"<div><div>Developments in our understanding of the molecular biology of breast cancer have had a direct impact on the investigations needed to provide optimal breast cancer care. Somatic genomic tests are now used routinely to inform decisions regarding adjuvant chemotherapy use in selected early breast cancer patients, and to identify patients with advanced disease who can potentially benefit from novel targeted agents.</div><div>In this overview, we describe the somatic genomic tests currently available within the National Health Service (NHS) for early and advanced breast cancer patients. We review the underlying biology and the evidence base for clinical utility of these tests in routine clinical practice. In addition, we identify the somatic genomic biomarkers currently in use in breast cancer clinical trials that are most likely to influence future breast cancer management. We also consider the challenges associated with tissue-based genomic testing in advanced breast cancer and the role of circulating tumour deoxyribonucleic acid (ctDNA) testing.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103665"},"PeriodicalIF":3.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Experiences of Using Wearable Health Monitors During Cancer Treatment: A Qualitative Study","authors":"S. Collinson ,&nbsp;S. Ingram-Walpole ,&nbsp;C. Jackson ,&nbsp;A. Soliman ,&nbsp;A.K.C. Chan ,&nbsp;E. Tholouli ,&nbsp;H. Balata ,&nbsp;M. Merchant ,&nbsp;K.J. Kirkby ,&nbsp;S. Sweeney ,&nbsp;F. Blackhall ,&nbsp;T. Bashall ,&nbsp;E. Searle ,&nbsp;S. Pan ,&nbsp;M. Braun ,&nbsp;G.B. Kitchen ,&nbsp;J.A. Moore ,&nbsp;Z. Merchant ,&nbsp;A.J. Wilson","doi":"10.1016/j.clon.2024.10.036","DOIUrl":"10.1016/j.clon.2024.10.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Wearable health monitors (WHM) offer minimally invasive, ambulatory monitoring of physiological parameters and activity. WHMs are being used increasingly in healthcare but adoption for patients undergoing cancer treatment is limited in part due to a lack of understanding of patient intentions as they receive treatment. The aim of this study explores the patient experience of using WHMs during their cancer pathway, including barriers and enablers of WHM use.</div></div><div><h3>Methods</h3><div>A phenomenological qualitative approach was used with single semi-structured interviews conducted in focus groups with individuals enrolled in the EMBRaCE-GM study, where WHMs were worn for up to six months prior to, during and after treatment of either colorectal, lung, or head and neck cancer, or leukaemia/lymphoma.</div></div><div><h3>Results</h3><div>We identified three major themes: perceived patient benefits, barriers to the adoption of WHMs and the importance of treatment partnerships between patients and healthcare professionals. WHMs promoted positive behaviour change, prioritisation of own health, and represented a form of ‘digital advocacy’. Potential barriers were aesthetic, experiential and technological. WHM introduction was time-sensitive, with patients finding their use acceptable at different stages in their cancer pathway. Patients desired reciprocal interaction with WHMs and were less concerned with data accuracy.</div></div><div><h3>Discussion</h3><div>This study identifies factors influencing patient decisions to use WHMs as part of cancer treatment. Novel findings include the optimal time to start wearing WHMs and the validity of measurements perceived as less of a concern for patients (in contrast to clinicians) who use wearable data with their own experiences as part of a sense-making exercise. Future work should focus on balancing patient and clinician expectations to provide guidance on the feasibility of WHM in routine clinical practice.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"Article 103664"},"PeriodicalIF":3.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}