{"title":"Curative strategies for high-risk acute promyelocytic leukemia.","authors":"Kuo-Kai Chin, Martin S Tallman","doi":"10.1097/CCO.0000000000001171","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001171","url":null,"abstract":"<p><strong>Purpose of review: </strong>Patients with acute promyelocytic leukemia (APL) who present with leukocytosis are considered high-risk due to lower relapse-free survival when treated with all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy. The discovery and incorporation of arsenic trioxide (ATO) in therapeutic regimens for high-risk patients have led to improved survival, but there is no consensus on the optimal treatment approach. This review addresses reduction in early death and explores questions of regimen selection, including the choice of induction, consolidation, and maintenance, as well as the use of prophylactic adjunctive therapies, while examining clinical trial and real-world evidence.</p><p><strong>Recent findings: </strong>ATRA-ATO combined with idarubicin (IDA) or gemtuzumab ozogamicin are highly effective compared to ATRA-IDA-based chemotherapy in clinical trials and real-world studies. Improved survival and early death reduction can be seen in the randomized controlled APOLLO study and in data from the recently published HARMONY and HERO analyses.</p><p><strong>Summary: </strong>ATRA-ATO-based combinations, including ATRA-ATO-IDA and ATRA-ATO-GO, are current standards of care in high-risk APL. Further studies should seek to clarify the choice between these and other regimens and to more clearly show the benefit of maintenance therapy and of additional therapies such as for differentiation syndrome and CNS prophylaxis with these highly effective induction/consolidation regimens.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Measurable residual disease as an actionable biomarker in acute myeloid leukemia. Ready or not?","authors":"Francesco Buccisano, Raffaele Palmieri, Federico Moretti, Elisa Meddi, Ilaria Cerroni, Adriano Venditti","doi":"10.1097/CCO.0000000000001197","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001197","url":null,"abstract":"<p><strong>Purpose of review: </strong>Measurable residual disease (MRD) is a reliable biomarker measuring the quality of morphological complete remission in acute myeloid leukemia (AML). This review will illustrate the settings where, along with drug development, MRD monitoring is by itself an actionable therapeutic target and represents not only a prognostic marker but a predictive marker of response, prompting a further relevant progress toward personalized medicine.</p><p><strong>Recent findings: </strong>The double nature of certain biomarkers (e.g. PML/RARA, bcr/abl, FLT3, IDH1/2, NPM1), useful for MRD monitoring and key actors in AML development, has emerged. The use of targeted drugs (e.g. FLT3 inhibitors, IDH1/2 inhibitors) or drug combination that are particularly active in specific AML subsets (e.g. Azacytidine/Venetoclax in NPM1 mutated AML), has paved the way to clinical trial experimenting maintenance or preemptive treatment driven by MRD persistence or reappearance.</p><p><strong>Summary: </strong>Accurate and specific MRD monitoring, coupled with the increasing development of targeted drugs, will give to clinicians an extraordinary opportunity to anticipate the treatment of AML relapse in the early phases eventually increasing drug efficacy and long-term outcome of the patients (visual abstract).</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Open questions on vorasidenib.","authors":"Antoine Seyve, François Ducray","doi":"10.1097/CCO.0000000000001193","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001193","url":null,"abstract":"<p><strong>Purpose of review: </strong>Vorasidenib has demonstrated efficacy in isocitrate dehydrogenase (IDH)-mutant grade 2 gliomas that do not require immediate oncological treatment. Here, we summarize open questions regarding its long-term benefit, its optimal use in IDH-mutant grade 2 gliomas as well as its potential use in grade 3 and 4 IDH-mutant gliomas.</p><p><strong>Recent findings: </strong>In IDH-mutant grade 2 gliomas, vorasidenib may act as a differentiation therapy. Updated results from the INDIGO trial suggest an additional effect on seizure control. Volumetric analysis and amino acid PET imaging may improve response assessment. However, long-term follow-up and new clinical trials will be needed to determine whether first-line vorasidenib preserves cognition, quality of life and improves overall survival. Since contrast-enhancement rather than histological grade appears to be more closely associated with disease control, selected grade 3 IDH-mutant gliomas might also benefit from first-line vorasidenib. Ongoing trials are evaluating vorasidenib as maintenance therapy after radiochemotherapy, and in association with chemotherapy and different immunotherapies.</p><p><strong>Summary: </strong>While vorasidenib is becoming the first-line treatment in the majority of IDH-mutant grade 2 gliomas, we are progressively learning how it works, how it should be used and in which contexts beyond grade 2 IDH-mutant gliomas it could be beneficial.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Josien C C Scheepens, Florien W Boele, Johan A F Koekkoek
{"title":"Patient-proxy agreement on health-related quality of life assessment in cancer patients.","authors":"Josien C C Scheepens, Florien W Boele, Johan A F Koekkoek","doi":"10.1097/CCO.0000000000001189","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001189","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study was to examine the role of proxy-reported outcomes in oncology, particularly in neuro-oncology, where cognitive impairment and disease progression often limit patient' ability to self-report. With increasing emphasis on patient-centered care and regulatory requirements for clinical outcome assessments (COAs), it is essential to understand when and how proxy reports can substitute or complement patient-reported outcomes (PROs), particularly in the assessment of health-related quality of life (HRQoL).</p><p><strong>Recent findings: </strong>Use of proxy-reported outcomes in cancer clinical trials is common. Proxy reports can help reduce missing data and selection bias by replacing PROs in patients with a poor health condition. However, studies consistently show poor to moderate agreement between patient and proxy reports of HRQoL outcomes, with the lowest congruence in less observable areas such as emotional functioning. Most proxy reports rely on PRO instruments not validated for proxy use, and heterogeneity in statistical methods, proxy selection, and proxy instruction further complicates interpretation.</p><p><strong>Summary: </strong>While proxy-reported outcomes should not replace PROs when patients can self-report, they offer valuable insights when self-report is not feasible. When standardized methods are followed, such as using validated instruments and clearly defining the reporting perspective, proxy reports can serve as a useful alternative in clinical trials and clinical practice.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Targeting androgen receptors in patients with metastatic breast cancer.","authors":"Lorenzo Guidi, Dario Trapani, Giuseppe Curigliano","doi":"10.1097/CCO.0000000000001187","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001187","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to summarize the current clinical evidence and future perspectives on the use of antiandrogen therapies in metastatic breast cancer, focusing on hormone receptor-positive and triple-negative subtypes, expressing androgen receptor (AR). We discuss recent clinical trials evaluating AR-targeted agents and explore mechanisms of resistance and novel therapeutic strategies.</p><p><strong>Recent findings: </strong>Clinical trials of androgen-targeting have shown modest activity in AR-positive metastatic breast cancer, with variable disease control rates and progression-free survival depending on AR expression levels, intrinsic AR-dependency and tumor subtype. Combination therapies targeting AR alongside pathways like CDK4/6 and PI3K/AKT/mTOR appear promising in overcoming therapeutic resistance. New-generation agents, including PROTACs, nonligand-binding domain AR inhibitors and epigenetic modulators offer innovative approaches to target AR signalling.</p><p><strong>Summary: </strong>Despite encouraging preclinical data, antiandrogen therapies have not demonstrated robust strong clinical efficacy in metastatic, AR-positive breast cancer, and their use in the clinical practice is still very limited. Improved patient selection using validated predictive biomarkers is crucial. Combination regimens and next-generation AR-targeting agents represent the future direction to overcome resistance and optimize therapeutic outcomes in AR-driven breast cancers.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"New therapies for brain metastases: an update.","authors":"Marie Porte, Christophe Massard","doi":"10.1097/CCO.0000000000001195","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001195","url":null,"abstract":"<p><strong>Purpose of review: </strong>Brain metastases occur in nearly 20% of all patients with cancer, with a rising incidence in recent years, partly due to improved systemic therapies that have prolonged survival. Traditionally managed with local approaches such as surgery, whole-brain radiotherapy (WBRT), or stereotactic radiosurgery (SRT), the therapeutic landscape has been significantly transformed by the advent of targeted therapies, immune checkpoint inhibitors, and antibody-drug-conjugates (ADCs).</p><p><strong>Recent findings: </strong>While symptomatic lesions often require local treatment, asymptomatic or oligosymptomatic brain metastases - especially in molecularly defined subgroups - may benefit from upfront systemic therapy. Significant intracranial efficacy has been demonstrated in nonsmall cell lung cancer (NSCLC) with oncogenic drivers treated with tyrosine kinase inhibitor (TKIs), in HER2-positive breast cancer with TKIs and ADCs, and in melanoma with dual immune checkpoint blockade or BRAF/MEK inhibitors. While these therapies have substantially improved intracranial disease control, the survival outcomes remain suboptimal and the optimal sequencing or combination of systemic therapy and local treatments such as SRT is yet to be defined. Several ongoing trials are exploring these strategies with promising early results, warranting further investigation.</p><p><strong>Summary: </strong>The therapeutic landscape of brain metastases has recently been transformed by the emergence of central nervous system (CNS)-penetrant systemic therapies. These advances underscore the need for updated clinical practice guidelines to optimize the overall management of patients with brain metastases.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carmine Valenza, Julian D Etessami, Elisabetta Munzone, Gabriella Pravettoni, Giuseppe Curigliano, Dario Trapani
{"title":"Monitoring serum estradiol in premenopausal women with hormone receptor-positive breast cancer on adjuvant LHRH agonists.","authors":"Carmine Valenza, Julian D Etessami, Elisabetta Munzone, Gabriella Pravettoni, Giuseppe Curigliano, Dario Trapani","doi":"10.1097/CCO.0000000000001191","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001191","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review the current evidence and inform clinical guidance on the implications of incomplete ovarian function suppression (OFS), the utility of serum estradiol (E2) monitoring, and appropriate management strategies in premenopausal women with early breast cancer (eBC) receiving adjuvant luteinizing hormone-releasing hormone agonist (LHRHa)-based therapy for OFS.</p><p><strong>Recent findings: </strong>A universally accepted definition of incomplete OFS is currently lacking. Although biologically it is plausible that incomplete OFS may compromise the efficacy of endocrine therapy, its actual impact on clinical outcomes remains unclear. Currently, the reliability of E2 monitoring is limited by considerable variability in assay methods and reference ranges, raising concerns about its analytical validity. Notably, in a recent international survey of 205 oncologists managing patients with eBC, 43% reported routinely and 27% occasionally assessing E2 levels in premenopausal patients treated with LHRHa, suggesting inconsistent clinical practice. Standard immunoassays were the most frequently used (65%). However, interpretation of E2 values and subsequent management decisions varied widely, highlighting the absence of standardized clinical guidelines.</p><p><strong>Summary: </strong>Although not currently supported by high-level evidence, serum E2 monitoring is widely adopted in clinical practice. Prospective studies and evidence-based recommendations are urgently needed. Emerging strategies to overcome incomplete OFS include LHRH antagonists (e.g., degarelix) and oral SERDs.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Predictors of response to CD19 chimeric antigen receptor T-cell therapy in large B-cell lymphoma: a consolidated review.","authors":"Ori Ben Valid, Roni Shouval","doi":"10.1097/CCO.0000000000001188","DOIUrl":"https://doi.org/10.1097/CCO.0000000000001188","url":null,"abstract":"<p><strong>Purpose of review: </strong>CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy has transformed outcomes for relapsed/refractory large B-cell lymphoma (LBCL), yet nearly half of treated patients relapse, and toxicities remain frequent. A deeper understanding of response predictors is urgently needed to guide patient selection, treatment optimization, and development of rational combination strategies.</p><p><strong>Recent findings: </strong>Emerging data reveal that response to CAR-T therapy is shaped by patient-specific, tumor-intrinsic, and treatment-related factors. Clinical variables such as age, performance status, inflammation, and microbiome composition influence efficacy. Tumor burden, disease distribution, histologic subtype, and genomic alterations correlate with resistance. Treatment factors, including bridging strategies, lymphodepletion regimen, and CAR-T product design, affect expansion, persistence, and clinical outcomes. Novel insights from immune profiling, radiomics, and single-cell transcriptomics offer further granularity and predictive potential.</p><p><strong>Summary: </strong>Predictors of CAR-T response span diverse biological and clinical domains and are increasingly actionable. Integrating multimodal biomarkers into routine workflows can personalize care and improve outcomes. Prospective validation, real-time monitoring, and adaptive trial designs are essential next steps toward precision CAR-T therapy.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chimeric antigen receptor T-cell therapy in aggressive lymphomas.","authors":"Gilles Crochet, Marc André, Wivine Bernard","doi":"10.1097/CCO.0000000000001172","DOIUrl":"10.1097/CCO.0000000000001172","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides the latest update on chimeric antigen receptor (CAR) T-cell therapy in diffuse large B-cell lymphoma (DLBCL), as of April 2025, with a focus on specific patient populations, long-term toxicities, and the optimal sequencing of therapies, particularly in view of emerging treatments such as bispecific antibodies.</p><p><strong>Recent findings: </strong>Currently, three autologous CAR T-cell therapies targeting CD19 (axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel) have been approved for third-line treatment of DLBCL, demonstrating durable complete remission rates of up to 40%. More recently, axicabtagene ciloleucel and lisocabtagene maraleucel have been approved for second-line therapy in refractory or early-relapsed DLBCL. Additionally, the emergence of CD20/CD3 bispecific antibodies has expanded therapeutic options for relapsed/refractory DLBCL, raising questions about the optimal sequencing of these therapies. Growing real-world evidence further supports the efficacy of CAR T-cell therapy in specific populations, including elderly patients, patients with transformed indolent B-cell non-Hodgkin lymphoma, and those with Richter's transformation. Finally, extended follow-up periods have allowed for a better characterization of the long-term toxicities associated with CAR T-cell therapy.</p><p><strong>Summary: </strong>Recent data on CAR T-cell therapy in DLBCL provides valuable insights into its benefits for specific populations, the optimization of treatment sequencing, and the management of long-term toxicities.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":"433-440"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Circulating tumor DNA in B cell lymphomas.","authors":"Marco Fangazio, Laurent Dewispelaere","doi":"10.1097/CCO.0000000000001178","DOIUrl":"10.1097/CCO.0000000000001178","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review evaluates the importance of circulating tumor DNA (ctDNA) as a minimally invasive tool in lymphoma management.</p><p><strong>Recent findings: </strong>Current literature demonstrates ctDNA's ability to alleviate the shortcomings of standard biopsy and imaging, providing real-time insights into tumor burden, clonal evolution, and treatment resistance. In Hodgkin lymphoma, ctDNA allows for comprehensive genomic profiling and treatment monitoring. In diffuse large B-cell lymphoma (DLBCL), ctDNA correlates with disease burden and is valuable for tracking resistance, especially in CAR T-cell therapy. In rare subtypes like primary central nervous system lymphoma (PCNSL) and intravascular large B-cell lymphoma (IVLBCL), ctDNA enhances diagnostic precision and enables early relapse detection. Even in indolent lymphomas, ctDNA could prove useful in relapse monitoring and risk assessment.</p><p><strong>Summary: </strong>CtDNA analysis could become a key element in personalized lymphoma management, enabling earlier interventions and tailored treatment strategies. However, future efforts should focus on harmonizing methodologies and validating findings in large-scale trials to allow these techniques to be adopted in routine practice.</p>","PeriodicalId":10893,"journal":{"name":"Current Opinion in Oncology","volume":" ","pages":"408-413"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}