CA: A Cancer Journal for Clinicians最新文献

{"title":"Continuous-duration maintenance therapy offers no overall survival gain in patients with newly diagnosed multiple myeloma","authors":"Carrie Printz","doi":"10.3322/caac.70109","DOIUrl":"https://doi.org/10.3322/caac.70109","url":null,"abstract":"<p>Continuous-duration maintenance therapy until disease progression is the current standard-of-care treatment after the completion of induction therapy for patients newly diagnosed with multiple myeloma, but results from a new phase 3 clinical trial are likely to change that approach.</p><p>In the National Cancer Institute (NCI)–sponsored ENDURANCE study, researchers compared continuous-duration maintenance therapy to fixed-duration maintenance therapy after induction therapy in patients with newly diagnosed standard-risk myeloma who did not undergo up-front autologous stem cell transplantation. Findings show that continuous-duration therapy did not lead to significantly longer overall survival than fixed-duration maintenance therapy stopped after 2 years.</p><p>“This is really a practice-changing study because, although it’s not the first study to look at fixed-duration therapy, it’s the first trial to show the impact on overall survival,” says Amrita Krishnan, MD, director of the Judy and Bernard Briskin Center for Multiple Myeloma Research at City of Hope in Irvine, California, and Nason–Hollingsworth Endowed Chair for Multiple Myeloma at City of Hope in Duarte, California. “It’s pushed us in the field to rethink how we treat patients with maintenance therapy. However, the results must be interpreted with caution as overall survival also depends on access to therapies at the time of relapse.”</p><p>The randomized, open-label, phase 3 clinical trial began recruitment in 2013 and was completed in 2019; the median follow-up was 7 years. After induction, 516 adult patients with newly diagnosed multiple myeloma were randomized to a continuous (indefinite)-duration group (<i>n</i> = 260) or a fixed-duration group (<i>n</i> = 256). Participants either were considered ineligible for or were not planning on receiving an up-front autologous stem cell transplant.</p><p>Patients with newly diagnosed multiple myeloma who had completed induction therapy and were considered to be at standard risk based on cytogenic testing were randomized 1:1 either to receive continuous therapy with the immunomodulatory drug lenalidomide until progression or to stop treatment after 2 years. The trial did not include patients with high-risk disease.</p><p>At a median follow-up of 86 months, overall survival was not significantly different between the two groups.</p><p>Eighty patients died in each arm; the overall survival rate at 7 years was 68.6% in the continuous-duration group and 69.0% in the fixed-duration group (difference, −0.4 percentage points; 95% confidence interval [CI], –9.0 to 8.3 percentage points; <i>p</i> = .93). The progression free-survival rate at 7 years was 36.1% in the continuous-duration group and 29.7% in the fixed-duration group (difference, 6.4 percentage points; 95% CI, –2.6 to 15.4 percentage points).</p><p>The 5-year cumulative incidence of second primary cancers (excluding nonmelanoma skin cancer) was higher with continuous-duration therapy th","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149259054","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":"Virtual sustained counseling, tobacco treatment improve quit rates in community oncology settings","authors":"Carrie Printz","doi":"10.3322/caac.70110","DOIUrl":"https://doi.org/10.3322/caac.70110","url":null,"abstract":"<p>Patients with cancer who continue to smoke after they are diagnosed face numerous health risks, including recurrences and second primary cancers. At the same time, tobacco treatment has not been integrated into the community oncology settings where most patients with cancer are treated.</p><p>In a randomized controlled clinical trial, researchers sought to assess the effectiveness of a virtual sustained treatment (VST) for tobacco cessation that included telehealth counseling plus free medication in assisting patients recently diagnosed with cancer in quitting smoking. The study compared VST to referrals to the National Cancer Institute (NCI) quitline (enhanced usual care, EUC) in community care centers nationwide.</p><p>Findings showed that patients receiving VST had a 6-month quit rate nearly double that of patients receiving NCI quitline referrals. Moreover, the patients using VST were nearly 4 times more likely to report smoking cessation medication use.</p><p>Dr David points out the benefits of stopping smoking at any age in terms of both mortality and morbidity.</p><p>“The last thing patients need is to get bronchitis or pneumonia or have their COPD exacerbated when they’re going through cancer,” he says.</p><p>The study was published in the <i>Journal of Clinical Oncology</i> (doi:10.1200/JCO-25-02267).</p><p>The analysis was conducted from August 2019 to December 2022. Researchers randomly assigned 306 English- and Spanish-speaking patients from 37 Community Oncology Research Program community sites.</p><p>The participants were 70.9% female and 86.3% White. The median age was 57 years, and 45.5% had non–smoking-related tumors. Within the group, 221 of 302 (73.2%) smoked within 30 min of waking.</p><p>Findings showed that 80.8% of VST participants (116 of 156) engaged in counseling, and 85.7% of participants (108 of 126) were given NRT. Those who underwent more than eight sessions versus fewer than five sessions were more likely to quit (<i>p</i> = .005). The VST group was almost 4 times more likely to report guideline-supported smoking cessation NRT than the EUC group.</p><p>Seven-day point abstinence rates at 6 months were significantly higher with VST than with EUC (28.4% [42 of 148] vs. 14.7% [21 of 143]), and no significant treatment moderators were observed. Patients in the VST arm reported higher rates of continuous abstinence and greater smoking reduction rates at 6 months. The incremental cost per quit was $7724.</p><p>Based on these data, the authors recommended that VST be implemented in community oncology care settings nationwide.</p><p>With 10%–30% of patients with cancer continuing to smoke after diagnosis, the researchers have spent years exploring ways to improve smoking cessation, notes Banu Arun, MD, professor of breast medical oncology and co-medical director of the Clinical Cancer Genetics Program at The University of Texas MD Anderson Cancer Center in Houston, Texas.</p><p>In 2020, the researchers published a study ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149259501","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":"Cancer in Hispanic communities: Lower rates, larger gaps, and the work ahead","authors":"Narjust Florez MD, Bárbara Segarra-Vázquez DHSc","doi":"10.3322/caac.70115","DOIUrl":"10.3322/caac.70115","url":null,"abstract":"<p>Cancer is once again the leading cause of death among Hispanic people in the United States.<span><sup>1</sup></span> In this issue of <i>CA: A Cancer Journal for Clinicians</i>, Saka and colleagues estimate that 229,900 Hispanic people in the continental United States and Hawaii will be diagnosed with cancer this year, and 54,200 will die from it.<span><sup>1</sup></span> Their report is the most complete look yet at cancer in our community, and it should change how we practice and conduct research in this often-forgotten population. Hispanics have lower cancer incidence than non-Hispanic Whites and Asians. That is the finding most readers will remember, and, as the authors themselves warn, it marks large disparities in cancers for which risk reduction is possible. The Hispanic population advantage rests largely on lower tobacco use rates and traditional diets largely based on vegetables and legumes; however, Hispanics face double rates of liver and gastric cancer, cholangiocarcinoma, 36% higher cervical cancer rates, and greater than 60% higher incidence of acute lymphocytic leukemia.<span><sup>1</sup></span> Much of this excess is preventable, linked to hepatitis C and <i>Helicobacter pylori</i> infection, obesity, and poor access to cancer screening. Only 56% of Hispanic adults aged 45 years and older are up to date with colorectal screening, versus 67% of White adults.<span><sup>1</sup></span></p><p>Saka et al. acknowledge that registry data cannot be separated by country of origin and is the report’s most important limitation.<span><sup>1</sup></span> The term Hispanic includes people from more than 20 countries with different migration stories, and where each community settles in the United States affects its cancer risk and access to care.<span><sup>2</sup></span> The aggregate tells one story, but the details tell many. Dominicans and Puerto Ricans are concentrated in New York, New Jersey, Florida, and Massachusetts; Salvadorans and Guatemalans in California and the Washington, District of Columbia, area; and Cubans and Venezuelans in South Florida.<span><sup>3-5</sup></span> Furthermore, growth has spread to new destinations in the South and Midwest, where health systems have little to no experience treating Hispanic patients.<span><sup>2, 5</sup></span> An Hispanic patient in Boston and one in Los Angeles may have very little in common, so outreach, interventions, and research must fit each community. Cancer incidence among people of Puerto Rican origin was nearly twice that of people of Mexican or Central American origin in one cohort,<span><sup>1</sup></span> and mortality is 15% higher in US-born Hispanic men than in those born abroad.<span><sup>6</sup></span> Survival is also likely overestimated because of loss to follow-up due to many Hispanics returning home for end-of-life care, which helps create the so-called Salmon bias, causing their deaths to be unrecorded in the United States.<span><sup>1, 7</sup></span></p><p>Cancer in","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149230185","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":"Cancer statistics for Hispanic/Latino people, 2026","authors":"Anatu H. Saka MPH,&nbsp;Tyler B. Kratzer MPH,&nbsp;Angela N. Giaquinto MSPH,&nbsp;Natalia Mazzitelli MPH,&nbsp;Paulo S. Pinheiro PhD,&nbsp;Ana P. Ortiz PhD, MPH,&nbsp;Dinorah Martinez Tyson PhD, MPH, MA,&nbsp;Ahmedin Jemal DVM, PhD,&nbsp;Rebecca L. Siegel MPH","doi":"10.3322/caac.70107","DOIUrl":"10.3322/caac.70107","url":null,"abstract":"<p>The Hispanic/Latino population is the second largest racial and ethnic group in the United States, accounting for 20% of the total population (68 million), plus approximately 3 million Hispanic Americans residing in Puerto Rico. Herein, the American Cancer Society reports cancer occurrence, risk factors, and screening for US Hispanic people using federally funded, high-quality, population-based cancer registry data and national vital statistics and survey data. In 2026, an estimated 229,900 Hispanic people will be diagnosed with cancer, and 54,200 will die from the disease in the continental United States and Hawaii. Cancer incidence during 1998–2022 rose in Hispanic women (from 345 to 385 per 100,000) and fell in Hispanic men (from 471 to 389 per 100,000), narrowing the male-to-female incidence rate ratio from a peak of 1.40 (95% CI, 1.38–1.42) in 2002 to 1.01 (95% CI, 1.00–1.02; <i>p</i> = .02) in 2022. This pattern is partly driven by declining incidence of lung and prostate cancers among men and increasing incidence of breast and uterine corpus cancers among women. Although temporal trends mirror the general population, the Hispanic cancer distribution is distinct, consistent with relatively lower prevalence of smoking, alcohol drinking, and screening and higher prevalence of obesity and cancer-causing infections. Compared with White people, Hispanic people have one half the incidence of lung and urinary bladder cancers and 24% lower breast cancer but double the rate of liver, stomach, and gallbladder cancers, 61%–65% higher acute lymphocytic leukemia, and 36% higher cervical cancer. The cancer burden in Puerto Rico is distinct, with lower rates of lung cancer but higher rates of cervical, prostate, and colorectal cancers compared with other US Hispanic populations. Residents in Puerto Rico also experience lasting health care system challenges from extreme weather events. Thus, prevention efforts should target the unique cancer profile of the Hispanic population, including infection prevention and control, healthy eating, physical activity, and routine screening, especially for cervical and colorectal cancer that are 11 percentage points lower than White people.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149101524","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":"A changing landscape in gastric cancer","authors":"Lindsay M. Hannan MD, MSPH,&nbsp;Vaia Florou MD, MS","doi":"10.3322/caac.70113","DOIUrl":"10.3322/caac.70113","url":null,"abstract":"&lt;p&gt;Gastric cancer (GC) remains one of the most lethal cancers globally. In this issue of &lt;i&gt;CA: A Cancer Journal for Clinicians&lt;/i&gt;, Wang et al. provide a comprehensive review of recent advances across the spectrum of GC.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The rapidly evolving treatment paradigm of metastatic disease is particularly striking and is the focus of this editorial. Clinicians now face questions that were uncommon a decade ago: Which treatment should take priority when several biomarkers are actionable, and how should that choice influence subsequent therapy? The emergence of claudin 18.2 (CLDN18.2)-directed antibodies, antibody–drug conjugates, and cellular therapy makes these questions increasingly relevant.&lt;/p&gt;&lt;p&gt;For many years, palliative systemic treatment relied almost entirely on cytotoxic chemotherapy along with trastuzumab as an option for human epidermal growth factor receptor 2 (HER2)-positive disease&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and the vascular endothelial growth factor 2 (VEGFR2) antagonist ramucirumab as an option after first-line therapy.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Only experimental options were available once these therapies became ineffective or intolerable. This landscape has changed considerably over the past 5 years; Biomarker-driven treatment is now part of routine clinical practice, and actionable targets continue to evolve. The addition of immune checkpoint inhibitors to chemotherapy was one of the recent significant advancements.&lt;span&gt;&lt;sup&gt;4-6&lt;/sup&gt;&lt;/span&gt; Programmed death ligand-1 (PD-L1) expression, quantified using the combined positive score (CPS), is used to identify patients most likely to benefit from immunotherapy, with the magnitude of benefit generally increasing with higher CPS. Treatment decisions remain difficult for tumors with low PD-L1 expression, in which the incremental benefit is less clear. Microsatellite instability-high status and, in selected settings, high tumor mutational burden provide additional information regarding the suitability of treatment with immune checkpoint inhibitors, but this pertains to only a relatively small proportion of patients.&lt;/p&gt;&lt;p&gt;HER2-directed therapy has also expanded. HER2 is overexpressed in a subset of GCs&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; and has been successfully targeted with trastuzumab, the antibody–drug conjugate fam-trastuzumab deruxtecan-nxki, and the dual HER2-targeted, bispecific antibody zanidatamab. The eligibility criteria for first-line combinations differ. Pembrolizumab with trastuzumab and fluoropyrimidine-containing and platinum-containing chemotherapy is approved by the US Food and Drug Administration (FDA) for first-line treatment of HER2-positive advanced gastric or gastroesophageal junction adenocarcinoma with a PD-L1 CPS ≥1.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; However, the combination of zanidatamab, tislelizumab, and chemotherapy, which was approved by the FDA on August 25, 2026, does not require PD-L1 positivity.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; These distinctions matter when ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149101591","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":"Recurrent prostate adenocarcinoma after radical prostatectomy: Principles of multidisciplinary management across a spectrum of disease","authors":"Amar U. Kishan MD,&nbsp;Yulia Zekster MD,&nbsp;Adam E. Singer MD, PhD,&nbsp;Kekoa Taparra MD, PhD, MPH,&nbsp;Luca F. Valle MD,&nbsp;Michael L. Steinberg MD,&nbsp;Nicholas G. Nickols MD, PhD,&nbsp;Robert E. Reiter MD, MBA,&nbsp;Johannes Czernin MD,&nbsp;Jeremie Calais MD, PhD,&nbsp;John K. Lee MD, PhD,&nbsp;Lawrence R. Hardesty BS,&nbsp;Matthew B. Rettig MD","doi":"10.3322/caac.70111","DOIUrl":"10.3322/caac.70111","url":null,"abstract":"&lt;p&gt;A man aged 76 years in good health presented for evaluation of a rising prostate-specific antigen (PSA) level after prior radical prostatectomy (Figure 1). Briefly, his prostate cancer had been diagnosed 5 years prior in the setting of a rising PSA. A standard biopsy had revealed International Society of Urological Pathology (ISUP) grade group 3 disease, and he underwent radical prostatectomy without pelvic nodal sampling. Pathologic examination demonstrated extracapsular extension and the presence of intraductal carcinoma; otherwise, at final pathology, the tumor was ISUP grade group 3, with negative surgical margins but evidence of perineural invasion. Postoperative PSA was undetectable for 3 years and then began to slowly rise, reaching 0.06 ng/dL 42 months after surgery. PSA then began to rise more rapidly, reaching 0.37 ng/dL 51 months after surgery. He underwent a prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scan at that time, which showed an enhancing nodular soft tissue along the right prostate bed (1.1 × 0.5 cm) with intense PSMA uptake, as well as uptake in a 3-mm right internal iliac node, a 3-mm right common iliac node, and a 3-mm aortocaval node (Figure 2). Focal uptake in a left presacral area was thought to represent a ganglion, whereas uptake in the T11 vertebral body was equivocal; follow-up magnetic resonance imaging (MRI) of the thoracic spine confirmed that the T11 lesion was a hemangioma. MRI of the prostate bed showed a small focus of T2-hypointense soft tissue in the right pelvis lateral to the prostatectomy bed measuring 15 × 5 mm.&lt;/p&gt;&lt;p&gt;The patient was evaluated by a radiation oncologist, urologist, and medical oncologist, and decided to pursue a clinical trial of stereotactic body radiotherapy (SBRT; ClinicalTrials.gov identifier NCT03541850).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; He received 40 grays (Gy) in five fractions to the prostate bed gross nodule and PSMA-positive nodes, 30 Gy in five fractions to the prostate bed, and 25 Gy in five fractions to the elective lymph node regions. In addition to SBRT, he started a planned short course of androgen-deprivation therapy (ADT; this was allowed on the protocol) but stopped after 1 month because of intolerance. PSA dropped to 0.18 ng/dL 6 months after SBRT, but then rose to 0.27 ng/dL 3months later and 0.99 ng/dL 6 months after that (now nearly 6 years after his prostatectomy). PSMA PET/CT imaging revealed a decrease in size and positivity of the right internal iliac node, with stable low uptake in the right CI node and prostate bed, and resolution of the aortocaval node. However, there was new uptake in two 4–6 mm left para-aortic nodes and a 5-mm node anterior to the aorta (Figure 3).&lt;/p&gt;&lt;p&gt;The patient enrolled on a trial of PSMA PET/CT–guided, metastasis-directed therapy (MDT) with 6 months of androgen-annihilation therapy (AAT; leuprolide, apalutamide, and abiraterone; ClinicalTrials.gov identifier NCT03902951).&lt;span&gt;&lt;sup&gt;","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149072953","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":"Advances in therapeutic approaches to gastric cancer","authors":"Feng Wang MD, PhD,&nbsp;王峰,&nbsp;Zi-Xian Wang MD, PhD,&nbsp;王梓贤,&nbsp;Yu-Jing Zhang MD, PhD,&nbsp;张玉晶,&nbsp;Ye He MD, PhD,&nbsp;何叶,&nbsp;Jia-Fu Ji MD, PhD,&nbsp;季加孚,&nbsp;Yuan-Fang Li MD, PhD,&nbsp;李元方,&nbsp;Xiu-Juan Qu MD, PhD,&nbsp;曲秀娟,&nbsp;Yi Ba MD, PhD,&nbsp;巴一,&nbsp;Shu-Qiang Yuan MD, PhD,&nbsp;袁庶强,&nbsp;Rui-Hua Xu MD, PhD,&nbsp;徐瑞华","doi":"10.3322/caac.70103","DOIUrl":"10.3322/caac.70103","url":null,"abstract":"<p>Gastric cancer remains a leading cause of cancer-related mortality worldwide, with nearly 1 million new cases diagnosed annually. Despite innovations in diagnosis, most patients still present at advanced stages, contributing to a poor prognosis. For early gastric cancer, endoscopic resection or minimally invasive surgery has become standard, offering comparable oncologic outcomes with faster recovery compared with open surgery. In locally advanced disease, resection of the primary lesion and D2 lymphadenectomy, defined as dissection of lymph nodes along two levels of blood vessels supplying the stomach, remains the cornerstone of curative surgery, whereas perioperative chemotherapy, particularly oxaliplatin-based regimens, has demonstrated improved survival benefits compared with surgery alone. The integration of immunotherapy into perioperative therapy for locally advanced disease and first-line palliative therapy for metastatic disease represents a paradigm shift, with programmed death 1/programmed death-ligand 1 inhibitors combined with chemotherapy significantly improving pathologic complete response rates and overall survival, especially in programmed death ligand 1–positive and microsatellite instability-high tumors. Targeted agents include claudin 18.2 antibody, with zolbetuximab establishing a new first-line standard for claudin 18.2–positive disease, and antibody–drug conjugates, such as trastuzumab deruxtecan for human epidermal growth factor receptor 2–positive disease, both of which have revolutionized treatment paradigms. Emerging strategies include dual immune checkpoint inhibition, bispecific antibodies, chimeric antigen receptor T-cell therapy, and fibroblast growth factor receptor 2b–targeting agents. Ultimately, the field is moving toward personalized, biomarker-driven approaches within multidisciplinary frameworks, although overcoming acquired resistance and addressing global disparities in therapeutic access remain important challenges.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987443","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":"Redefining early stage nonsmall cell lung cancer: The dawn of the risk-adaptive and biologically precise era","authors":"Clarissa Mathias MD, PhD,&nbsp;Fabio Ynoe Moraes MD, PhD, MBA","doi":"10.3322/caac.70102","DOIUrl":"10.3322/caac.70102","url":null,"abstract":"&lt;p&gt;For decades, the management of early stage nonsmall cell lung cancer (NSCLC) was guided primarily by anatomic staging and surgical resection. Although this approach has achieved favorable outcomes for many patients, it does not fully account for the biologic heterogeneity that influences recurrence risk and treatment response. Contemporary advances in lung cancer screening, surgical techniques, precision radiotherapy, molecular profiling, and perioperative systemic therapies have collectively transformed the therapeutic landscape, supporting a more risk-adaptive approach that integrates anatomic, biologic, and patient-specific factors into clinical decision-making.&lt;/p&gt;&lt;p&gt;In this context, the review by Zhang et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; provides a comprehensive overview of the advances that are reshaping the management of localized NSCLC. Progress in lung cancer screening, minimally invasive and parenchyma-sparing surgery, stereotactic ablative radiotherapy (SABR) and other highly conformal radiotherapy techniques, together with the integration of perioperative immunotherapy and molecularly targeted therapies, has broadened the therapeutic landscape and enabled increasingly individualized treatment approaches.&lt;/p&gt;&lt;p&gt;Importantly, the review highlights the evolving limitations of relying solely on the tumor-node-metastasis classification to guide treatment decisions. Although tumor-node-metastasis staging remains the cornerstone of prognostic assessment and therapeutic planning, it provides limited information regarding tumor biology, host immune interactions, or the likelihood of micrometastatic disease.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The increasing availability of molecular profiling, circulating tumor DNA analysis, and other emerging biomarkers offers opportunities to complement anatomic staging with biologic risk assessment, potentially enabling more individualized treatment strategies. Rather than replacing established staging systems, these advances support a more integrated framework in which anatomic extent of disease, molecular alterations, immune characteristics, and dynamic biomarkers collectively inform clinical decision-making. As the field continues to evolve, the central challenge will be determining how these emerging tools can be incorporated into evidence-based care while maintaining equitable access across diverse health care settings.&lt;/p&gt;&lt;p&gt;The widespread implementation of low-dose computed tomography screening has fundamentally altered the presentation of NSCLC. Landmark trials, specifically the National Lung Screening Trial&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and the NELSON trial,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; have demonstrated significant mortality reductions, cementing low-dose computed tomography as the gold standard for high-risk populations. However, this screening success has precipitated a &lt;i&gt;stage migration&lt;/i&gt;, characterized by a dramatic increase in the detection of early stage lesions, particularly ground-glass opacities.&lt;/p&gt;&lt;p&gt;Simu","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910286","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":"Early stage nonsmall cell lung cancer: Toward a risk-adaptive paradigm in the era of biologic precision","authors":"Chaoqi Zhang MD, PhD,&nbsp;张超奇,&nbsp;Xuanyu Gu MD,&nbsp;谷炫谕,&nbsp;Pan Wang MD,&nbsp;王攀,&nbsp;Dongyu Li MD,&nbsp;李东宇,&nbsp;Guochao Zhang MD,&nbsp;张国超,&nbsp;Ting Wang MD, PhD,&nbsp;王婷,&nbsp;Peng Wu PhD,&nbsp;吴芃,&nbsp;Wei Rao MD,&nbsp;饶薇,&nbsp;Shan Muhammad PhD,&nbsp;Binghua Tan MD,&nbsp;谭炳华,&nbsp;Yun Che MD, PhD,&nbsp;车云,&nbsp;Mobai Zhu MD,&nbsp;朱墨白,&nbsp;Qilin Qiao MD,&nbsp;乔奇临,&nbsp;Fanbo Lai MD,&nbsp;来凡博,&nbsp;Bohui Zhao MD,&nbsp;赵博慧,&nbsp;Kailun Fei MD,&nbsp;费凯伦,&nbsp;Yue Wu PhD,&nbsp;吴玥,&nbsp;Zhihui Zhang PhD,&nbsp;张志慧,&nbsp;Min Dai PhD,&nbsp;代敏,&nbsp;Wanqing Chen MD, PhD,&nbsp;陈万青,&nbsp;Yawei Zhang PhD,&nbsp;张亚玮,&nbsp;Nan Bi MD,&nbsp;毕楠,&nbsp;Jie Wang MD,&nbsp;王洁,&nbsp;Jie He MD, PhD,&nbsp;赫捷","doi":"10.3322/caac.70100","DOIUrl":"10.3322/caac.70100","url":null,"abstract":"<p>The clinical landscape of early stage nonsmall cell lung cancer is at transformative crossroads. Driven by the widespread adoption of low-dose computed tomography screening, the frequent detection of ground-glass opacities, and a rising incidence among never-smokers, the diagnostic center of gravity has shifted toward earlier, potentially curable disease. This shift has been accompanied by equally important therapeutic advances, including parenchyma-sparing surgical techniques, minimally invasive platforms enhanced by digital navigation, and the transformative integration of perioperative immunotherapy and targeted agents. Concurrently, noninvasive monitoring approaches, such as liquid biopsy, have emerged as powerful tools to guide precision management. Despite this progress, substantial barriers to achieving a universal cure persist. Clinicians continue to face uncertainty in the management of ground-glass opacities, the anatomy-based TNM staging system fails to capture the biologic heterogeneity of early tumors, and global disparities in access to innovation remain unresolved. To address these challenges, the authors propose a shift toward a risk-adaptive management paradigm that harnesses artificial intelligence–driven analytics and multi-omics profiling to tailor treatment intensity according to each patient's biologic risk. Such an approach would enable appropriate escalation for high-risk individuals while permitting safe de-escalation for those at low risk. This holistic, lifespan-oriented strategy must be embraced to deliver equitable and durable cures for patients with early stage nonsmall cell lung cancer.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910240","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":"The new (version 9) American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging protocol for carcinoma of the vulva","authors":"Alexander B. Olawaiye MD,&nbsp;Elliot A. Asare MD, MS,&nbsp;Ian S. Hagemann MD, PhD,&nbsp;Priya R. Bhosale MD, MBA,&nbsp;Stephanie Gaillard MD, PhD,&nbsp;Brian Rous MBBChir, PhD,&nbsp;Bunja Rungruang MD,&nbsp;Shitanshu Uppal MD, MBA,&nbsp;Gulisa Turashvili MD, PhD,&nbsp;Kaled M. Alektiar MD,&nbsp;Jonathan A. Cosin MD,&nbsp;Uma Krishnamurti MD, PhD,&nbsp;Lee-may Chen MD,&nbsp;Keiichi Fujiwara MD, PhD,&nbsp;Matthew A. Powell MD,&nbsp;Mauricio A. Cuello MD, PhD,&nbsp;David G. Mutch MD","doi":"10.3322/caac.70104","DOIUrl":"https://doi.org/10.3322/caac.70104","url":null,"abstract":"<p>The American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging for all cancer sites has been updated periodically as a published manual for many years. The last update of the manual version, the eighth edition <i>AJCC Cancer Staging Manual</i>, went into use on January 1, 2018. The AJCC has since restructured and updated its processes for curating, analyzing, and publishing updates to the TNM staging system. All AJCC staging-related data are now housed on its new application programming interface. Consequently, the subsequent AJCC TNM staging updates are now published electronically as protocols and are released by disease sites. The protocol for carcinoma of the vulva, AJCC version 9, is now published. The new TNM vulvar cancer staging was validated using the American College of Surgeons’ National Cancer Data Base. This article highlights the changes to the new AJCC TNM staging protocol for carcinoma of the vulva; these changes align with the 2021 International Federation for Gynecology and Obstetrics staging. The most important of the changes are: (1) a new method for depth of invasion measurement, (2) the addition of a new T subcategory—T4, (3) redefined N subcategories, and (4) an increased number of M subcategories with the addition of <i>clinical</i> to all M subcategories.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 5","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849263","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}