Current oncology最新文献

{"title":"Contemporary Patterns of Care for Low-Grade Glioma in Australia and New Zealand.","authors":"Meghana Maddula, Nicholas McNamee, Hui K Gan, Laveniya Satgunaseelan, Eng-Siew Koh, Catherine H Han, Subotheni Thavaneswaran","doi":"10.3390/curroncol32030183","DOIUrl":"10.3390/curroncol32030183","url":null,"abstract":"<p><strong>Aim: </strong>The management of low-grade gliomas (LGGs) is evolving with new insights into disease biology. Furthermore, recently, the phase III INDIGO¹ study highlighted the benefits of an IDH inhibitor, vorasidenib, in treating residual or recurrent grade 2 IDH-mutant gliomas following surgery alone. We aimed to characterise the current patterns of care for patients with LGGs in Australia and New Zealand, including the role of vorasidenib.</p><p><strong>Methods: </strong>An online survey examining respondents' practice setting, caseload, and preferred treatment approach to three clinical scenarios was distributed through the Cooperative Trials Group for Neuro-Oncology, New Zealand Aotearoa Neuro-Oncology Society, and the Australian and New Zealand Society for Neuropathology in December 2023 with three reminders in April, June, and September of 2024.</p><p><strong>Results: </strong>The survey response rate was 19.6% (57/291), 87.7% from Australia, and 12.3% from New Zealand, spanning medical oncology (45.7%), pathology (22.8%), radiation oncology (17.5%), and neurosurgery (14.0%). Case 1 examined an IDH-mutant grade 2 astrocytoma following gross total resection. Observation alone was recommended by 93%. Case 2 examined an incompletely resected IDH-mutant grade 2 astrocytoma. If feasible, 38% recommended further surgery and 83% adjuvant chemotherapy and radiotherapy. After 12 months of disease stability, 53% of the respondents preferred vorasidenib over the existing therapies. Case 3 examined an incompletely resected IDH-mutant grade 3 oligodendroglioma. No respondents recommended observation alone, with 26% recommending salvage surgery and 97% recommending further chemotherapy and radiotherapy.</p><p><strong>Conclusions: </strong>This study describes current management practices for LGGs in Australia and New Zealand, showing ongoing variation and a cautious approach to integrating IDH inhibitors. This highlights the critical role of multidisciplinary team-based decision-making in increasingly complex clinical situations.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extramedullary Multiple Myeloma: Challenges and Opportunities.","authors":"Matthew Ho, Luca Paruzzo, Janna Minehart, Neel Nabar, Julia Han Noll, Thomas Luo, Alfred Garfall, Saurabh Zanwar","doi":"10.3390/curroncol32030182","DOIUrl":"10.3390/curroncol32030182","url":null,"abstract":"<p><p>Extramedullary multiple myeloma (EMM), defined in this review as soft tissue plasmacytomas resulting from hematogenous spread, is characterized by the ability of MM cells to proliferate outside of the bone marrow microenvironment. It is aggressive, often associated with high-risk cytogenetics and early relapse, and independently portends significantly shorter progression-free and overall survival, even in the era of highly effective immunotherapies. The molecular and microenvironmental factors underlying extramedullary MM dissemination continue to be studied to inform the development of better treatments. In this review, we discuss our current understanding of the biology of EMM, focusing on its distinct molecular and microenvironmental characteristics vis-à-vis MM. We also review the current treatment strategies, acknowledging the paucity of large, randomized studies specific to this population.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11940950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric CNS Radiation Oncology: Recent Developments and Novel Techniques.","authors":"Justin Oh, Samir Patel, Mary-Pat Schlosser, Andrew J Arifin, Carol Oliveira, Anne-Marie Charpentier, Derek S Tsang","doi":"10.3390/curroncol32030180","DOIUrl":"10.3390/curroncol32030180","url":null,"abstract":"<p><p>Radiation therapy (RT) is a cornerstone in the management of pediatric central nervous system (CNS) tumors. Recent advancements in RT delivery and techniques aim to enhance therapeutic effectiveness while minimizing both acute and long-term complications associated with pediatric brain RT. This paper highlights innovative developments in the field, including the clinical indications, benefits, and challenges of proton therapy and stereotactic radiotherapy. The ongoing refinement of risk-adapted RT volumes is highlighted, with examples of newly proposed germinoma RT volumes and hippocampal-sparing RT. Additionally, emerging experimental approaches, including FLASH therapy and theranostics, are also discussed as promising future directions. Further prospective, multi-institutional collaborative studies are essential to validate and expand upon the benefits outlined in this review.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Perioperative Immunotherapy for Patients with Non-Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis.","authors":"Zhijuan Du, Siyuan Chen, Yuhui Qin, Yahui Lv, Xiangyu Du, Heying Yu, Zhefeng Liu","doi":"10.3390/curroncol32030184","DOIUrl":"10.3390/curroncol32030184","url":null,"abstract":"<p><p><b>Background:</b> The objective of this study is to indirectly compare the efficacy and safety of all currently available neoadjuvant chemoimmunotherapy and perioperative chemoimmunotherapy in randomized controlled trials (RCTs) involving patients with resectable non-small cell lung cancer (NSCLC) to identify optimal treatment regimens. <b>Methods:</b> Eligible studies evaluating neoadjuvant chemoimmunotherapy and perioperative chemoimmunotherapy-based regimens in resectable NSCLC patients were included. Clinical outcomes were extracted for event-free survival (EFS) and overall survival (OS), as well as the incidence of pathological complete response (pCR), major pathological response (MPR), any-grade adverse events (AEs), and treatment-related adverse events (TRAEs) in the Bayesian framework. A subgroup analysis of EFS was conducted according to PD-L1 expression, histological type and reaching pCR or not. <b>Results:</b> We selected eight RCTs involving 3113 patients. Our analysis found no significant differences between perioperative immunotherapy and neoadjuvant immunotherapy in terms of MPR (RR 0.72, 95% CI 0.39 -1.3), pCR (RR 0.73, 95% CI 0.24-2.3), EFS (HR 0.95, 95% CI 0.56-1.7), and OS (HR 95% CI 3.9-4.2). Subgroup analyses revealed that neoadjuvant immunotherapy demonstrated superiority in the programmed death-ligand 1 (PD-L1) high-expression cohort, the non-squamous cell carcinoma cohort, and the non-smoking cohort. Conversely, perioperative immunotherapy ranked first in the PD-L1 low-expression cohort, squamous cell carcinoma cohort, and non-pCR cohort. <b>Conclusions:</b> Our findings indicate that neoadjuvant immunotherapy and perioperative immunotherapy exhibit comparable efficacy in patients with NSCLC. These results provide valuable evidence for guiding the treatment of patients with resectable NSCLC.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11940944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Healthcare Provider Experiences with the EXCEL Exercise Referral Pathway for Individuals Living with and Beyond Cancer.","authors":"Alexandra Finless, Mannat Bansal, Thomas Christensen, S Nicole Culos-Reed, Colleen A Cuthbert, Julianna Dreger, Jodi E Langley, Melanie R Keats","doi":"10.3390/curroncol32030181","DOIUrl":"10.3390/curroncol32030181","url":null,"abstract":"<p><p>Exercise is an evidence-based strategy shown to reduce the negative side effects associated with cancer treatment for individuals living with and beyond cancer (LWBC). Healthcare providers (HCPs) play a critical role in promoting exercise for these individuals. Notwithstanding, several barriers hinder HCPs' ability to discuss and support exercise in clinical practice. EXCEL is an exercise intervention designed to address health disparities in access to exercise oncology resources for rural/remote individuals LWBC, including a referral pathway for HCPs to use. The purpose of this study was to evaluate HCP experiences using the EXCEL exercise referral pathway. We employed an interpretive description methodology, using semi-structured interviews to assess HCP experiences with EXCEL. Overall, HCPs felt empowered to refer to exercise when they were supported in doing so. The findings highlighted (1) a need for a better understanding of the role of exercise professionals and their integration into cancer care; (2) the need for efficient referral systems including embedding referrals into existing health care electronic record systems; and (3) sharing patient feedback with exercise oncology programs back to the HCPs to drive continued referrals.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Changing Role of Allogeneic Stem Cell Transplantation in Adult B-ALL in the Era of CAR T Cell Therapy.","authors":"Jana van den Berg, Claudia Meloni, Jörg Halter, Jakob R Passweg, Andreas Holbro","doi":"10.3390/curroncol32030177","DOIUrl":"10.3390/curroncol32030177","url":null,"abstract":"<p><p>The treatment of B-cell acute lymphoblastic leukemia (B-ALL) in adults remains a significant therapeutic challenge. While advances in chemotherapy and targeted and immunotherapies have improved overall survival, relapsed or refractory (r/r) adult ALL is associated with poor outcomes. CD19-directed chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative option, achieving high remission rates even in heavily pretreated patients. However, relapse is common. Allogeneic hematopoietic stem cell transplantation (allo-HCT), a traditional cornerstone of remission consolidation, may improve long-term outcomes but carries risks of transplant-related mortality (TRM) and morbidity. Most evidence for HCT after CAR T therapy comes from retrospective analyses of subgroups from CAR T cell trials, with small sample sizes and inconsistent data on transplant procedures and outcomes. Despite these limitations, consolidative allo-HCT appears to prolong relapse-free survival (RFS). While overall survival (OS) benefits are in question, extended remission duration has been observed. Nonrelapse mortality (including TRM), ranging from 2.4 to 35%, underscores the need for careful patient selection. Emerging real-world data affirm these findings but highlight the importance of individualized decisions based on disease and treatment history. This review examines current evidence on the sequential use of CD19-directed CAR T-cell therapy and allo-HCT in adults with r/r B-ALL.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Resection Margins and Adjuvant Therapy on Survival Outcomes in Lymph Node-Negative Distal Cholangiocarcinoma.","authors":"Hye Jin Kang, In Young Jo","doi":"10.3390/curroncol32030178","DOIUrl":"10.3390/curroncol32030178","url":null,"abstract":"<p><p>The prognostic value of the resection margin (RM) status and the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (CCC) are unclear. RM status appears particularly impactful in lymph node-negative distal CCC, representing early-stage disease. The prognostic value of RM status was investigated, and subpopulations of patients with lymph node-negative distal CCC who might benefit from AT were identified. Overall, 139 patients with distal CCC who underwent surgical resection between March 2006 and December 2023 were analyzed. RM status was categorized as wide (>5 mm) in 65 patients (46.8%), close (≤5 mm) in 32 patients (23.0%), or positive in 42 patients (30.2%). AT was administered to 48 patients (34.5%). Patients with close or positive RMs achieved significantly lower locoregional control (LRC) than those with wide RMs. However, overall survival (OS) did not differ across the three RM groups. The impact of RM status was more evident in patients not receiving AT. Patients with wide RMs exhibited better 3-year LRC, progression-free survival (PFS), and OS rates (79.0%, 66.5%, and 69.1%, respectively) than those with close (21.7%, 15.7%, and 34.4%) or positive RMs (44.3%, 25.3%, and 50.2%, respectively). No significant differences were found between close and positive RM groups. AT appears to have improved LRC and PFS in patients with close or positive RMs but not in those with wide RMs. Close RMs were associated with poor outcomes comparable to those with positive RMs. These results indicate that achieving adequate RM width is crucial for improving survival. Moreover, AT may improve survival when adequate RMs cannot be achieved. Nonetheless, larger studies are needed to validate these findings.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and Healthcare Professional Reflections on Consenting for Extra Bone Marrow Samples to a Biobank for Research-A Qualitative Study.","authors":"Stuart G Nicholls, Erika Camilleri, Taryn Chesser, Gary Davis, Katya Godard, Grace Fox, Madeleine Jane Gordon, Krystina B Lewis, Jocelyn Lepage, Oksana Motalo, Wendy Nuttall, Craig Peleshok, Caryn Y Ito, Pierre J A Villeneuve, Mitchell Sabloff","doi":"10.3390/curroncol32030179","DOIUrl":"10.3390/curroncol32030179","url":null,"abstract":"<p><p>Little is known about patient perspectives regarding consent for obtaining extra research-specific bone marrow (BM) samples during the diagnostic procedure for acute leukemia (AL). This study aimed to better understand patient experiences with consenting to provide these samples and identify potential areas for practice improvement. Semi-structured interviews were conducted with patients treated for AL, 4-6 years prior to the interviews, and healthcare professionals involved with obtaining patient consent and sample collection. A total of 17 patients (14 agreed to provide a sample and 3 did not have a sample in the biobank) and 5 healthcare professionals were interviewed, achieving data saturation. Patients supported increasing public knowledge about research and noted the importance of friends and family in providing emotional support and retaining information. Despite time pressure and anxiety, the decision to donate a research sample did not require much deliberation. Proximal factors informing decisions included impact on patient health and family and anticipated, procedure-associated pain; distal factors included altruism and trust in healthcare professionals. Key information included expected pain and management, the purpose of research samples, and sample security and privacy. Our findings suggest that BM research sample collection may be facilitated through optimizing the environment where information is provided and the type of information provided, including pain management options and the value of the samples for current and future research.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Role of Patient-Reported Outcomes for Decision-Making in Early-Phase Dose-Finding Clinical Trials.","authors":"Richard Brown, Nolan A Wages, Li Liu, Arnethea L Sutton, Andrew S Poklepovic","doi":"10.3390/curroncol32030176","DOIUrl":"10.3390/curroncol32030176","url":null,"abstract":"<p><p>In early-phase dose-finding clinical trials, integrating patient-reported outcomes (PROs) is essential for enhancing patient-centered decision-making. This short communication advocates for several key practices to achieve such integration. Firstly, foster patient-centered communication that ensures patient understanding of the potential benefits of early-phase trials, thereby mitigating therapeutic misconceptions. Secondly, (a) facilitate partnerships to understand and address the underlying reasons for discrepancies between clinician and patient reports of adverse events and (b) facilitate partnerships among clinical trialists, statisticians, clinicians, patients, and advocates to gain diverse perspectives of adverse events and in so doing ensure that patients comprehend how their data will be used. Thirdly, optimize trial design and data collection by (a) determining optimal and feasible frequencies for PRO collection to minimize patient burden while maintaining data integrity and (b) effectively incorporating concordant PROs to guide dose recommendation decisions and adapt trial designs and statistical methods accordingly. Future research will involve investigating the application of these practices in patients within the Virginia Commonwealth University (VCU) Massey Comprehensive Cancer Center Catchment Area. By integrating these recommendations, early-phase dose-finding clinical trials have the potential to achieve more informed and patient-centered objectives.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11940868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling Survival Determinants in Patients with Advanced Non-Small-Cell Lung Cancer with <i>EGFR</i> Exon 20 Insertions.","authors":"Kung-Yang Wang, Shih-Chieh Chang, Yu-Feng Wei, Jui-Chi Hung, Chung-Yu Chen, Cheng-Yu Chang","doi":"10.3390/curroncol32030174","DOIUrl":"10.3390/curroncol32030174","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is the leading cause of cancer-related death in Taiwan. It is often associated with mutations in the epidermal growth factor receptor (<i>EGFR</i>) gene, with common mutations accounting for approximately 85% of all <i>EGFR</i>-related cases. However, the remaining 15% are caused by uncommon mutations in <i>EGFR</i>, mainly insertions in exon 20 (about 4%). The response to EGFR tyrosine kinase inhibitors (TKIs) can vary markedly with exon 20 insertions. However, few prior large-scale studies have examined patients with these <i>EGFR</i> mutations.</p><p><strong>Methods: </strong>This study combines the databases of several large hospitals in Taiwan to analyze the effects and clinical significance of rare EGFR mutations on responses to EGFR-TKIs, considering the changes in medication.</p><p><strong>Results: </strong>This study enrolled 38 patients with non-small-cell lung cancer and <i>EGFR</i> exon 20 insertions. It assessed the correlations of various predictors with progression-free survival (PFS) and overall survival (OS). It showed that among those with <i>EGFR</i> exon 20 insertions, the median PFS was 5.15 months, and OS reached 13 months. The median PFS was 5.4 months for afatinib, 5.7 months for chemotherapy, and 4.3 months for first-generation EGFR-TKIs.</p><p><strong>Conclusions: </strong>EGFR-TKIs may be considered as an alternative treatment option for patients with <i>EGFR</i> exon 20 insertions in cases where the currently recommended therapies, such as chemotherapy with or without amivantamab, are either unavailable or intolerable. The potential use of afatinib for specific patients in this context depends on the precise characteristics of their mutation and remains to be determined.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 3","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11941682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}