CA: A Cancer Journal for Clinicians最新文献

{"title":"Transforming treatment paradigms: Focus on personalized medicine for high-grade serous ovarian cancer","authors":"Pawel Kordowitzki, Britta Lange, Kevin M. Elias, Marcia C. Haigis, Sylvia Mechsner, Ioana Elena Braicu, Jalid Sehouli","doi":"10.3322/caac.70008","DOIUrl":"https://doi.org/10.3322/caac.70008","url":null,"abstract":"High-grade serous ovarian cancer (HGSOC) is the most common and aggressive subtype of ovarian cancer, accounting for approximately 70% of all ovarian cancer cases and contributing significantly to the high mortality rates associated with this disease. Because of the asymptomatic nature of early stage disease, most patients are diagnosed at advanced stages when the cancer has already spread into the abdominal cavity, requiring complex and intensive surgical and chemotherapeutic interventions followed by maintenance therapies. Although a minority of cases are associated with well defined genetic syndromes, specific risk factors and a clear etiology in many cases remain elusive. HGSOC tumors are characterized by a high frequency of somatic gene copy number alterations, often associated with defects in homologous recombination repair of DNA. All attempts to introduce an effective screening for HGSOC to date have been unsuccessful. This review elucidates the complexities surrounding HGSOC and encompasses its etiology, epidemiology, classification, pathogenesis, and the current array of treatment strategies. Understanding molecular underpinnings is crucial for the development of targeted therapies and personalized multimodal treatment approaches in centralized therapeutic structures. This review also examines the importance of the tumor microenvironment. In addition, the authors' objective is to underscore the critical importance of placing the patient's perspective and diversity at the forefront of therapeutic strategies, thereby fostering a genuinely participatory decision-making process and ultimately improving patient quality of life.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"10 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of T-cell malignancies: Bench-to-bedside targeting of epigenetic biology","authors":"Ariana Sabzevari, Johnson Ung, Jeffrey W. Craig, Kallesh D. Jayappa, Ipsita Pal, David J. Feith, Thomas P. Loughran, Owen A. O’Connor","doi":"10.3322/caac.70001","DOIUrl":"https://doi.org/10.3322/caac.70001","url":null,"abstract":"The peripheral T-cell lymphomas (PTCL) are the only disease for which four histone deacetylase (HDAC) inhibitors have been approved globally as single agents. Although it is not clear why the PTCL exhibit such a vulnerability to these drugs, understanding the biological basis for this activity is essential. Many lines of data have established that the PTCL exhibit marked sensitivity to other epigenetically targeted drugs, including EZH2 and DNMT3 (DNA-methyltransferase 3) inhibitors. Even more compelling is the finding that combinations of drugs targeting the epigenetic biology of PTCL are beginning to produce provocative data, leading some to wonder if these agents can replace historical chemotherapy regimens routinely used for patients with the disease. Simultaneously, the field has identified a spectrum of mutations in genes governing epigenetic biology in many subtypes of PTCL, although the T follicular helper lymphomas, including angioimmunoblastic T-cell lymphoma, appear to be particularly enriched for these genetic features. While the direct relationship between the presence of any one of these mutations and responsiveness to a particular epigenetic drug has yet to be established, it is increasingly accepted that the PTCL may be the prototypical epigenetic disease as no other form of cancer has exhibited such a vulnerability to this diversity of epigenetically targeted agents. Herein, we comprehensively review this esoteric and rapidly evolving field to identify themes and lessons from these experiences that may guide efforts to improve outcomes of patients with T-cell neoplasms. Furthermore, we will discuss how these concepts might be applied to the broader field of cancer medicine.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"7 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From success to sustained action: Tobacco control must remain a priority","authors":"Vani N. Simmons, Jhanelle E. Gray","doi":"10.3322/caac.70010","DOIUrl":"https://doi.org/10.3322/caac.70010","url":null,"abstract":"<p>In this issue, Islami and colleagues present remarkable data estimating that 3.9 million lung cancer deaths have been averted over the past 5 decades, along with a compelling analysis revealing 75 person-years of life gained from avoided premature lung cancer deaths—both of which can be attributed to a major public health victory in tobacco control.<span><sup>1</sup></span> The consequence of the estimated number of averted lung cancer deaths on overall cancer mortality reductions was also analyzed. Findings revealed that these prevented deaths accounted for more than one half (51%) of the estimated declines in overall cancer deaths. With the inclusion of person-years of life gained, these results extend prior research and further highlight the striking contributions of tobacco control in reducing the overall cancer burden.</p>\u0000<p>The decline in lung cancer mortality rates parallels the reduction in smoking that began after the landmark US Surgeon General's report in 1964 that confirmed the health risks of smoking and, most importantly, the causal relationship between smoking and lung cancer.<span><sup>2</sup></span> Since then, the adult smoking prevalence has dropped from an all-time high of 52.0% among men and 34.1% among women to 13.1% and 10.1%, respectively.<span><sup>3, 4</sup></span> Although the authors' analyses focused solely on reductions in smoking prevalence among adults, it is critical to acknowledge the profound implications of recent data on youth smoking trends and their potential to vastly reduce the future burden of lung cancer. One of most recent, greatest public health triumphs—which has received notably little attention—is the unprecedented shift in youth smoking to the lowest levels ever reported. In 1997, over one third of high school students were smoking, whereas, today, only 1.7% report smoking, making combustible cigarette use virtually nonexistent among youth.<span><sup>5</sup></span> The long-term effect of this decline should result in further dramatic reductions in lung cancer mortality and increasing person-years of life saved.</p>\u0000<p>Just as the decline in lung cancer deaths is attributed by the authors to a reduction in combustible cigarette smoking, the decrease in smoking prevalence can be attributed primarily to changes in tobacco-control policies and regulations.<span><sup>3</sup></span> As noted by the authors, the most significant decline in smoking occurred because of cigarette price increases, taxation, and the implementation of clear indoor air laws. Other key factors that contribute to a comprehensive approach to tobacco control include mass media campaigns, restrictions on marketing and advertising, access to quitting resources (e.g., tobacco quitlines available in all states at no cost), and evidence-based interventions for quitting smoking, including counseling and US Food and Drug Administration (FDA)-approved medications.<span><sup>3</sup></span></p>\u0000<p>Beyond established tobacco-control polic","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"183 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143798494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond fluorodeoxyglucose: Molecular imaging of cancer in precision medicine.","authors":"Malik E Juweid, Soud F Al-Qasem, Fadlo R Khuri, Andrea Gallamini, Philipp Lohmann, Hans-Joachim Ziellenbach, Felix M Mottaghy","doi":"10.3322/caac.70007","DOIUrl":"https://doi.org/10.3322/caac.70007","url":null,"abstract":"<p><p>Cancer molecular imaging is the noninvasive visualization of a process unique to or altered in neoplasia, such as proliferation, glucose metabolism, and receptor expression, which is relevant to patient management. Several molecular imaging modalities are now available, including magnetic resonance, optical, and nuclear imaging. Nuclear imaging, particularly using fluorine-18-fluorodeoxyglucose positron emission tomography, is widely used in the staging and response assessment of multiple cancer types. However, at this writing, new nuclear medicine probes, especially positron emission tomography tracers, are increasingly used or are being investigated for cancer evaluation. This review focuses on these probes, their biologic targets, and the applications or potential applications for their use in the assessment of various neoplasms, including both probes available for commercial use-such as somatostatin receptor ligands in neuroendocrine tumors, prostate-specific membrane antigen ligands in prostate cancer, norepinephrine analogs in neural crest tumors like neuroblastoma, and estrogen analogs in breast cancer-and others in clinical development, such as fibroblast-activating protein inhibitors, C-X-C chemokine receptor type 4 ligands, and monoclonal antibodies targeting receptor tyrosine kinases, CD4-positive or CD8-positive tumor-infiltrating lymphocytes, tumor-associated macrophages, and cancer stem cell biomarkers. These developments represent a major step toward the integration of molecular imaging as a powerful tool in precision medicine, with an expectedly significant impact on patient management and outcome.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":" ","pages":""},"PeriodicalIF":503.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer in rural America: Improving access to clinical trials and quality of oncologic care","authors":"Joseph M. Unger, Barbara L. McAneny, Raymond U. Osarogiagbon","doi":"10.3322/caac.70006","DOIUrl":"https://doi.org/10.3322/caac.70006","url":null,"abstract":"Individuals from rural areas in the United States suffer higher rates of morbidity and mortality from cancer than their urban counterparts. This review is based on the idea that equity—the elimination of unnecessary and preventable differences between groups of individuals—should underlie access to cancer care resources for patients from rural areas. Access to cancer clinical trials serves as the framework for identifying and understanding barriers in access to quality oncologic care. The authors discuss the interplay between rural living, socioeconomic status, culture, and health; and they highlight how economic considerations in rural areas often limit access to clinical trials and oncologic care because economies of scale do not apply in these regions given the requirement for high-quality oncology care even with lower patient volumes. The authors propose solutions to enhance access to clinical trials and improve the quality of oncologic care in rural areas, viewing these aims as ethical and moral imperatives.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"86 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143713543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering the hidden drivers of rural health care disparities","authors":"Banu E. Symington","doi":"10.3322/caac.70009","DOIUrl":"https://doi.org/10.3322/caac.70009","url":null,"abstract":"&lt;p&gt;Patients living in rural communities who have chronic diseases, including cancer, have inferior survival compared to those living in urban areas. In this issue, Unger et al. provide an excellent overview of factors that challenge rural patients while highlighting how clinical trial availability can improve rural outcomes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; They discuss delayed diagnosis, underinsurance, provider shortages, the higher incidence of comorbid illness and poverty, and other factors. All of these are commonly recognized factors that contribute to inferior outcomes for patients with cancer in rural communities. However, there are less well known challenges facing both patients and providers in rural areas that may result in persistent and poorer outcomes, even when more well known factors may be overcome. These factors are important not only because they contribute to cancer care decisions and outcomes but because they also compound the reluctance of patients living in rural areas to participate in clinical trials.&lt;/p&gt;\u0000&lt;p&gt;Rural practices exist in densely populated states like New York, Washington, and Pennsylvania and in large, underpopulated states like Wyoming, Alaska, and the Dakotas. Patients from these latter locations face chronic provider shortages as well as the challenge of long drives for routine care. Both of these result in patients tending to ignore early signs and symptoms that may appear minor but contribute to delayed diagnosis.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; What is under-recognized is the lack of public transportation in these rural states to help patients get to and from chemotherapy appointments, whether in outlying communities or in rural towns. Finding rides for treatment, especially because of post-treatment malaise, fatigue, or nausea (which can make driving home unsafe), is a challenge that leads many to abandon cancer care. The long drives often required in rural areas go beyond a barrier for patient access. There exists an increased risk of road closure because of wind, snow, poor visibility, or accidents, leading to more frequently interrupted care. Closed roads affect the ability of courier and mail services to deliver necessary chemotherapy drugs to patients or even to the hospital. The lack of neighboring hospitals means one cannot tap another facility for a loan (&lt;i&gt;a cup of chemo&lt;/i&gt;, as it were) to tide a patient over. This also results in delayed and often repeated cycles of interrupted chemotherapy. The effect on clinical trials is felt in the delayed delivery of trial drugs, delayed visits for time-sensitive clinical trial toxicity assessments, and even on-study required blood draws.&lt;/p&gt;\u0000&lt;p&gt;Local free housing close to treatment areas is offered in some rural sites, but this housing may not allow relatives or pets and results in a sense of isolation of patients from their sources of emotional support. Thus, even when available, free local housing is underused.&lt;/p&gt;\u0000&lt;p&gt;Although a hub-and-spoke model of decentralized","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"33 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143713544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Averted lung cancer deaths due to reductions in cigarette smoking in the United States, 1970–2022","authors":"Farhad Islami, Nigar Nargis, Qinran Liu, Priti Bandi, Rebecca L. Siegel, Parichoy Pal Choudhury, Neal D. Freedman, Kenneth E. Warner, Ahmedin Jemal","doi":"10.3322/caac.70005","DOIUrl":"https://doi.org/10.3322/caac.70005","url":null,"abstract":"Lung cancer mortality rates in the United States have declined steeply in recent decades, largely because of substantial reductions in smoking prevalence, as approximately 85% of lung cancer deaths are attributable to cigarette smoking. In this study, the authors estimate the number of averted lung cancer deaths and corresponding person-years of life gained during 1970–2022 as a measure of progress in cancer prevention through tobacco control. By using the 1970–2022 National Center for Health Statistics mortality data (with national coverage), the authors calculated the expected number of deaths for each year, age, sex, race, and age group based on the expected lung cancer death rate multiplied by the population at risk in that group. The number of averted lung cancer deaths were calculated by subtracting the observed number of deaths from the expected number in each group. Person-years of life gained were estimated as a measure of avoided premature mortality based on the average additional years a person would have lived if they had not died from lung cancer. The authors estimated that 3,856,240 lung cancer deaths (2,246,610 in men, 1,609,630 in women) were averted, and 76,275,550 person-years of life (40,277,690 in men, 35,997,860 in women) were gained during 1970–2022, with an average of 19.8 person-years of life gained (17.9 in men, 22.4 in women) per averted death. The number of averted lung cancer deaths accounted for 51.4% of the estimated declines in overall cancer deaths and was substantially greater in men (60.1%) than in women (42.7%). By race, this proportion was 53.6% in the White population (62.8% in men, 44.6% in women) and 40.0% in the Black population (44.4% in men, 34.7% in women). The substantial estimated numbers of averted lung cancer deaths and person-years of life gained highlight the remarkable effect of progress against smoking on reducing premature mortality from lung cancer.","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"7 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"People experiencing homelessness face inpatient care disparities","authors":"Carrie Printz","doi":"10.3322/caac.70002","DOIUrl":"10.3322/caac.70002","url":null,"abstract":"<p>When Patricia Santos, MD, was a medical resident in radiation oncology at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, she and her colleagues observed the numerous challenges that people experiencing homelessness (PEH) face after a cancer diagnosis.</p><p>“A number of us who were doing work in this space had our own individual stories of what we saw on a one-on-one basis, but we found very little literature on what that actually meant for cancer care delivery and services among the unhoused,” says Dr Santos, now an assistant professor of radiation oncology at Emory University School of Medicine in Atlanta, Georgia.</p><p>She practices at Atlanta’s Grady Memorial Hospital, one of the largest public safety net hospitals in the country.</p><p>Setting out to learn more while still at MSKCC, she and her colleagues launched a study that was published in <i>JAMA Oncology</i> (doi:10.1001/jamaoncol.2024.3645). This large cross-sectional study of hospitalized US adults diagnosed with cancer found that PEH had higher prevalences of lung and upper gastrointestinal cancers along with comorbid substance use disorder and HIV. Despite these diagnoses and longer hospital stays, these individuals were less likely to undergo invasive procedures or systemic therapy or have higher-than-median costs of stay than housed populations. Homelessness was associated with a lower rate of death while a patient was in the hospital. However, PEH were found to be 4 times more likely to be discharged against medical advice.</p><p>Using the 2016–2020 National Inpatient Sample, the cross-sectional study assessed hospitalized inpatient adults aged 18 years or older who were diagnosed with cancer. Researchers developed a cohort of PEH and housed individuals who were matched according to age, sex, race, ethnicity, insurance type, cancer diagnosis, number of comorbidities, substance abuse disorder, severity of illness, year of admission, hospital location, hospital ownership, region, and hospital bed size.</p><p>The study included 13,793,462 housed individuals (median age, 68 years) and 45,150 PEH (median age, 58 years).</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 2","pages":"85-86"},"PeriodicalIF":503.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunotherapy combination shows longer progression-free survival than chemotherapy alone for patients with a rare type of metastatic colorectal cancer","authors":"Carrie Printz","doi":"10.3322/caac.70003","DOIUrl":"10.3322/caac.70003","url":null,"abstract":"&lt;p&gt;Results from a new study published in the November 27, 2024, issue of The &lt;i&gt;New England Journal of Medicine&lt;/i&gt; (&lt;i&gt;NEJM&lt;/i&gt;; doi:10.1056/NEJMoa2402141) showed that a combination of two immunotherapy drugs led to longer progression-free survival (PFS) than chemotherapy alone in patients with a rare type of metastatic colorectal cancer (CRC) called mismatch repair–deficient (dMMR) adenocarcinoma. Experts consider these results practice changing.&lt;/p&gt;&lt;p&gt;“We’ve had very few innovations in colorectal cancer up until the immunotherapy era starting around 2014, so this is huge in this rare subtype,” says Benjamin L. Schlechter, MD, a Dana Farber Cancer Institute oncologist who specializes in gastrointestinal cancers and was not involved with the study. “It really hammers home the point that for the vast majority of these patients, first-line immunotherapy is superior to first-line chemotherapy.”&lt;/p&gt;&lt;p&gt;The phase 3, multinational, open-label randomized trial is known as CheckMate 8HW. It was conducted at 128 hospitals and cancer centers across 23 countries. Researchers compared the effectiveness of the immunotherapy drugs nivolumab and ipilimumab to that of chemotherapy in patients with microsatellite instability–high (MSI-H) or dMMR metastatic CRC.&lt;/p&gt;&lt;p&gt;MSI-H and dMMR refer to the same rare type of CRC. This subtype represents between 4% and 7% of CRCs. Unlike other CRCs, the MSI-H and dMMR subtypes have deficiencies in their DNA repair proteins that make them more susceptible to treatment with immunotherapy.&lt;/p&gt;&lt;p&gt;“These cancers don’t normally repair their DNA, and that happens in a few different ways,” Dr Schlechter says. “You can be born with a mutation in DNA repair that’s called Lynch syndrome, and that’s a significant proportion of these patients. Or, the cancer, through other mechanisms, can damage those same DNA repair genes. These cancers are very genetically distinct from normal tissue, which is not the case with the average colorectal cancer.”&lt;/p&gt;&lt;p&gt;The study authors note that patients with MSI-H or dMMR metastatic CRC have poor outcomes with standard chemotherapy with or without targeted therapy. In previous nonrandomized studies, nivolumab plus ipilimumab showed a benefit in treating the disease.&lt;/p&gt;&lt;p&gt;CRC survivor and patient advocate Allison Rosen, who did not have this type of cancer, is enthusiastic about the results. “The more options that rare colorectal cancers have, the better,” she says. “The treatment options haven’t changed for a long period of time, so anytime I see new research that gives any mutation a new line of therapy, it’s exciting.”&lt;/p&gt;&lt;p&gt;In the trial, patients with unresectable or metastatic CRC with an MSI-H or dMMR status received nivolumab plus ipilimumab, nivolumab alone, or chemotherapy with or without targeted therapy (mFOLFOX-6 or FOLFIRI) in a 2:2:1 ratio with or without targeted therapies (bevacizumab or cetuximab).&lt;/p&gt;&lt;p&gt;Researchers enrolled 808 patients who either had or previously had not had systemic tr","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 2","pages":"87-89"},"PeriodicalIF":503.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment adaptation based on response to induction chemotherapy in nasopharyngeal carcinoma: An evolving landscape","authors":"Nadia A. Saeed, Annie W. Chan","doi":"10.3322/caac.70004","DOIUrl":"https://doi.org/10.3322/caac.70004","url":null,"abstract":"&lt;p&gt;Patients with nasopharyngeal carcinoma (NPC) represent a distinct group with head and neck cancer. They are often nontobacco users, nonalcohol users, and on average are 10 to 20 years younger than patients with cancers of other head and neck sites. Given good baseline health status and the effectiveness of contemporary treatment,&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; patients with NPC typically have long projected life expectancies and commonly develop late treatment effects, such as cranial nerve deficits and dysphagia. Previous efforts in reducing radiation-related toxicity included the use of reduced target doses&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; and volumes.&lt;span&gt;&lt;sup&gt;3, 5-8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;\u0000&lt;p&gt;In this issue of &lt;i&gt;CA: A Cancer Journal for Clinicians&lt;/i&gt;, Tang et al. report the results of their multicenter phase 3 trial of 445 patients with locoregionally advanced NPC, in which patients were randomized to receive either reduced-volume radiotherapy based on the postinduction chemotherapy (post-IC) gross tumor volume (GTV) or standard radiotherapy based on the preinduction (pre-IC) chemotherapy GTV.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; The primary end point was locoregional relapse-free survival at 3 years, with a noninferiority margin of 8%. Overall survival, distant metastasis-free survival, failure-free survival, adverse events, and quality of life (QoL) were also reported as secondary end points. The study is well designed, has a large patient cohort, and provides high-quality data exploring this essential question. With a median follow-up of 40.4 months, patients in the post-IC arm had noninferiority in locoregional relapse-free and overall survival as well as lower toxicities and improved QoL compared with patients in the pre-IC arm. This study has important implications for the future of tailored radiotherapy in NPC. Long-term follow-up, however, is necessary to confirm the findings.&lt;/p&gt;\u0000&lt;p&gt;The findings of Tang et al. shared similarities with those of another recently published randomized trial.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; In that multicenter trial of 212 patients with stage III–VB, locally advanced NPC, the authors demonstrated that treating the post-IC GTV resulted in noninferior locoregional relapse compared with treating the pre-IC GTV, with potentially improved QoL and less late toxicity. Different chemotherapy regimens and schedules were used in the study. Given the results of these two randomized trials demonstrating noninferiority in both locoregional relapse and survival with this de-intensification approach, should the use of the post-IC GTV for intensity-modulated radiotherapy planning be adopted universally? Before we make a conclusion, let us first examine some fundamental questions in NPC treatment.&lt;/p&gt;\u0000&lt;p&gt;First, does chemosensitivity equate with radiosensitivity? In these studies, the determination for radiosensitivity was based on chemosensitivity. It is important to recognize that chemosensitivity does not necessarily correlate with radiosensitivity. Th","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"20 1","pages":""},"PeriodicalIF":254.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}