CA: A Cancer Journal for Clinicians最新文献

{"title":"Metastasis-directed radiation therapy may improve progression-free survival in patients with oligometastatic solid tumors","authors":"Carrie Printz","doi":"10.3322/caac.70098","DOIUrl":"https://doi.org/10.3322/caac.70098","url":null,"abstract":"<p>In recent years, scientists have learned that patients with a limited number of metastases (i.e., oligometastatic cancers) experience improved progression-free survival (PFS) outcomes with the addition of stereotactic ablative radiosurgery directed to those metastases. These findings were demonstrated by the phase 2, randomized SABR-COMET trial (doi:10.1200/JCO.20.00818).</p><p>Although SABR-COMET assessed patients with many different cancers, a new phase 2 study, EXTEND, sought to determine which patients with specific cancers would benefit from a similar type of metastasis-directed therapy (MDT) approach in combination with standard-of-care (SOC) systemic therapy.</p><p>Findings indicated that adding MDT radiation therapy to SOC for oligometastatic disease improved PFS for patients with pancreatic, prostate, and other cancers. However, results for breast and kidney cancers were inconclusive.</p><p>The study was published in the <i>Journal of Clinical Oncology</i> (doi:10.1200/JCO-25-02856).</p><p>The multicenter, phase 2 EXTEND trial randomized patients to MDT plus SOC or SOC alone in one of six histology-specific baskets: breast, pancreas, kidney, two prostate baskets, and one “other” basket. PFS was the primary endpoint. Exploratory endpoints were ctDNA and immune profiling.</p><p>Eligible patients had one to five metastases, had received no more than four prior lines of systemic therapy for metastatic disease, and had a diagnosis within one of 12 specified histologies.</p><p>Between 2018 and 2023, 350 patients were randomized, and 334 were analyzed: MDT plus SOC (<i>n</i> = 166) and SOC (<i>n</i> = 168). MDT could include radiotherapy, resection, or ablation. Radiotherapy was used as MDT for 98% of metastases (370 of 379). At a median follow-up of 53 months, PFS was significantly longer with MDT plus SOC (hazard ratio [HR], 0.54; 95% CI, 0.41–0.72; <i>p</i> < .001). PFS also improved when the prostate baskets were excluded (HR, 0.60; 95% CI, 0.40–0.89).</p><p>The pancreas, prostate, and “other” baskets had superior PFS with MDT plus SOC, but the breast and kidney baskets were inconclusive.</p><p>Patients with detectable ctDNA at enrollment had shorter PFS and overall survival. Conversely, if ctDNA clearance occurred 3 months after enrollment, survival rates were improved. Findings also showed that patients treated with MDT plus SOC had improved clearance of ctDNA. The authors noted that these findings point to the important role that the addition of MDT may play in treating oligometastatic cancer.</p><p>In addition, immune activation induced by MDT plus SOC was most pronounced among baskets with superior PFS, and this indicates another area that warrants investigation.</p><p>Because pancreatic and prostate cancers showed the greatest promise with MDT plus SOC, researchers have initiated the phase 3 EXPAND trial in pancreatic cancer. Other independent research efforts are underway in prostate cancer. Findings in the “other” basket also ","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 4","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784614","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":"Correction to “Serious mental illness and cancer: A call to action for equitable care”","authors":"","doi":"10.3322/caac.70101","DOIUrl":"https://doi.org/10.3322/caac.70101","url":null,"abstract":"<p>McFarland D, Bergerot C, Bidstrup P, et al. Serious mental illness and cancer: a call to action for equitable care. <i>CA Cancer J Clin</i>. 2026;e70095. doi:10.3322/caac.70095</p><p>An author’s first name was misspelled in the original publication. The sixth author’s name should read Shahrzad Zamani.</p><p>The authors apologize for this error.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 4","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616821","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":"Accurate data as the foundation of equitable cancer control: Lessons from global cancer statistics 2024 and the complexity of ovarian cancer","authors":"Christina R. Washington MD,&nbsp;Kathleen N. Moore MD, MS,&nbsp;Isabelle L. Ray-Coquard MD, PhD","doi":"10.3322/caac.70096","DOIUrl":"https://doi.org/10.3322/caac.70096","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;CA: A Cancer Journal for Clinicians&lt;/i&gt;, Sung and colleagues present global cancer statistics 2024, the latest in the GLOBOCAN series produced by the International Agency for Research on Cancer.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; They estimate 20.6 million new cancer cases and 9.8 million cancer deaths worldwide in 2024, equivalent to one in five people developing cancer in their lifetime, and project that the annual burden will reach 31.5 million cases by 2050, a 53% increase driven largely by population growth and aging.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The largest proportional increases will fall on low Human Development Index (HDI) and medium-HDI countries, &lt;i&gt;where the number of new cases is projected to roughly double&lt;/i&gt;. The value of these figures for setting screening, prevention, and treatment policy depends on the accuracy of the data used to generate them. This accuracy is weakest in parts of the world where the cancer burden is projected to grow fastest.&lt;/p&gt;&lt;p&gt;Sung and colleagues are explicit about this limitation. They note that only about one in three countries reports high-quality incidence data to the International Agency for Research on Cancer's Cancer Incidence in Five Continents, whereas only one in four countries reports high-quality national mortality data to the World Health Organization.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Population-based cancer registries (PBCRs) capture a small fraction of the population across much of sub-Saharan Africa and Asia, and national vital statistics systems frequently suffer from incomplete coverage and from reliance on nonspecific causes of death that must be statistically redistributed.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Therefore, the 2024 estimates are best understood as a synthesis of observed data, short-term prediction, and modeled mortality-to-incidence ratios, largely extrapolated from data collected before 2020.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The robustness of that synthesis varies widely by region, and this variability can affect the global estimates on which policymakers, funders, and clinicians base their decisions.&lt;/p&gt;&lt;p&gt;These limitations have practical consequences. When the two principal global frameworks, GLOBOCAN and the Global Burden of Disease Study, disagree on basic questions such as which cancer is most commonly diagnosed worldwide, the discrepancy arises from differences in data processing, modeling strategy, and the redistribution of ill-defined mortality codes rather than from differences in underlying biology.&lt;span&gt;&lt;sup&gt;1, 4&lt;/sup&gt;&lt;/span&gt; Most registries also lack individual-level data on socioeconomic status, a key surrogate for the social determinants that drive much of the variation in incidence and outcome, and this limits how meaningfully registry data can be translated into targeted intervention.&lt;/p&gt;&lt;p&gt;Global cancer statistics 2024 illustrates why data annotation beyond only incidence and mortality matters. The report documents a marked decoupling of incidence and mortality by HD","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 4","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467528","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":"Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide for 34 cancers in 186 countries","authors":"Hyuna Sung PhD,&nbsp;Adalberto M. Filho PhD,&nbsp;Mathieu Laversanne Msc,&nbsp;Jacques Ferlay ME,&nbsp;Rebecca L. Siegel MPH,&nbsp;Isabelle Soerjomataram MD, MSc, PhD,&nbsp;Ahmedin Jemal DVM, PhD,&nbsp;Freddie Bray BSc, MSc, PhD","doi":"10.3322/caac.70090","DOIUrl":"10.3322/caac.70090","url":null,"abstract":"<p>This article provides updated global cancer statistics for the year 2024 based on the GLOBOCAN estimates of the International Agency for Research on Cancer. The authors describe national cancer incidence and mortality by world region and the Human Development Index and predict the burden in 2050 based on demographic trends. In 2024, an estimated 20.6 million new cancer cases (19.5 million excluding nonmelanoma skin cancer) and 9.8 million deaths (9.7 million excluding nonmelanoma skin cancer) occurred worldwide, equivalent to one in five people developing cancer during their lifetime and one in nine men and one in 13 women dying from the disease. Lung cancer is the most frequently diagnosed cancer, responsible for almost 2.6 million new cases (12.8%), followed by female breast (11.8%), colorectal (9.9%), prostate (7.5%), and stomach (4.7%) cancer. Lung cancer is also the leading cause of cancer death, with an estimated 1.9 million deaths (19.1%), followed by colorectal (9.4%), liver (7.5%), female breast (7.1%), and stomach (6.6%) cancer. Incidence rates vary four- to five-fold across regions, with the highest rates found in Australia/New Zealand (men, 477 per 100,000; women, 396 per 100,000), whereas mortality rates differ two-fold, with elevated rates in Eastern Europe for men (158 per 100,000) and Melanesia for women (108 per 100,000). The incidence burden is predicted to reach 34.4 million by 2050, up 67% from 2024, with the largest proportional increases in lower Human Development Index countries. Although global variation in cancer profiles demands a nuanced approach to cancer control at national and regional levels, primary prevention must be at the forefront, including intensified efforts to reduce tobacco use, prevent infections, lower alcohol consumption and excess body weight, and increase physical activity.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 4","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148402980","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":"Serious mental illness and cancer: A call to action for equitable care","authors":"Daniel McFarland DO, MS,&nbsp;Cristiane Bergerot PhD,&nbsp;Pernille Bidstrup PhD,&nbsp;Miri Cohen PhD,&nbsp;Paul D’Alton PhD,&nbsp;Shahrzhad Zamani DO,&nbsp;Louise Mullen MSc,&nbsp;Michelle Riba MD, MS,&nbsp;Luigi Grassi MD,&nbsp;Kelly Irwin MD, MPH","doi":"10.3322/caac.70095","DOIUrl":"10.3322/caac.70095","url":null,"abstract":"<p>Cancer advances are not distributed equitably among many segments of the population. Specifically, individuals with serious mental illness (SMI) face compounded disparities in cancer detection, treatment, and survival. SMI, characterized by conditions such as schizophrenia, bipolar disorder, and severe major depression, is associated with significant functional impairment and a two-to-three-decade reduction in life expectancy. Patients with SMI encounter unique challenges when navigating cancer care, including fragmented care pathways, less access to cancer therapeutics, limited psychosocial support, stigma, heightened vulnerability to diagnostic overshadowing where symptoms are attributed to their psychiatric rather than a medical or oncologic condition, and underrepresentation in therapeutic clinical trials. This review explores the intersection of SMI and cancer care starting with the conceptual background and its importance related to cancer outcomes and the delivery of ethical care to highlight unmet needs and a multitude of barriers. The paper proposes practical recommendations to improve cancer care for individuals with SMI who develop cancer including adopting the collaborative care model, enhancing psychosocial and psychiatric integration in oncology settings, and addressing biases inherent in clinician training. Interventions targeting individual, interpersonal, health system, and policy levels are essential to comprehensively mitigating disparities and developing durable cancer delivery strategies. Equitable cancer care for patients with SMI is both a moral imperative and a cornerstone of advancing social justice in oncology. Thus, there is a critical need to prioritize the translation of research advances, to close the gap in cancer outcomes and mortality, and to improve patient outcomes and wellbeing.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 4","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148373657","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":"Extranodal natural killer/T-cell lymphoma: From fatal to curable","authors":"Jie Xiong MD, PhD,&nbsp;Yok-Lam Kwong MD,&nbsp;Laurence de Leval MD, PhD,&nbsp;Shu-Nan Qi MD,&nbsp;Choon Kiat Ong PhD,&nbsp;Philippe Gaulard MD,&nbsp;Arnaud Jaccard MD,&nbsp;Steven M. Horwitz MD,&nbsp;Ye-Xiong Li MD,&nbsp;Sai-Juan Chen MD, PhD,&nbsp;Ritsuro Suzuki MD,&nbsp;Won Seog Kim MD,&nbsp;Wei-Li Zhao MD, PhD","doi":"10.3322/caac.70094","DOIUrl":"https://doi.org/10.3322/caac.70094","url":null,"abstract":"<p>Extranodal natural killer (NK)/T-cell lymphoma (ENKTCL) is one of the most aggressive non-Hodgkin lymphomas characterized by NK-cell or T-cell origins, a geographic prevalence in Asian and South American populations, and Epstein–Barr virus (EBV) infection. ENKTCL used to be a fatal disease upon treatment with anthracycline-containing chemotherapies. However, the treatment paradigms for ENKTCL have evolved; consequently, patients have achieved significantly improved clinical outcomes. Today, combined-modality therapies co-targeting genomic instability and metabolic vulnerability comprise the standard of care for early stage ENKTCL, whereas therapies that include targeting of immune and metabolic dysregulation are the backbone of treatment for advanced-stage ENKTCL. New agents targeting surface antigens, oncogenic signaling pathways, and EBV are under investigation and have demonstrated promising responses. Hematopoietic stem cell transplantation is beneficial when used in therapy-responsive, high-risk patients and ENKTCL-associated hemophagocytic lymphohistiocytosis, but it is not recommended for early stage ENKTCL. Although nearly 80% of patients with newly diagnosed ENKTCL achieve long-term survival, treatment of relapsed/refractory ENKTCL is critical. Because it is now understood that EBV infection has a major role in disease progression, a deeper understanding of EBV-associated oncogenesis and alterations in the tumor microenvironment foster the development of novel therapeutic strategies, such as cellular therapies and vaccines targeting EBV. Future multicenter collaborations worldwide will be needed to further optimize mechanism-based treatment in the era of precision medicine, paving a curative pathway for this once fatal disease.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 4","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343063","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":"Study finds ovarian cancer survivors who are BRCA carriers have a relatively low risk of breast cancer","authors":"Carrie Printz","doi":"10.3322/caac.70084","DOIUrl":"10.3322/caac.70084","url":null,"abstract":"&lt;p&gt;Women with &lt;i&gt;BRCA1&lt;/i&gt; and &lt;i&gt;BRCA2&lt;/i&gt; genetic mutations (&lt;i&gt;BRCA&lt;/i&gt; carriers) face high risks of developing both breast and ovarian/fallopian tube cancers; however, scientists do not know if risk-reducing mastectomy should be recommended to this group after an ovarian cancer diagnosis.&lt;/p&gt;&lt;p&gt;Because &lt;i&gt;BRCA&lt;/i&gt; carriers have an estimated lifetime breast cancer risk of 70%, many opt for this surgery even when they have no personal cancer history.&lt;/p&gt;&lt;p&gt;A new study provides further data on this decision for &lt;i&gt;BRCA&lt;/i&gt; carriers who are diagnosed with ovarian cancer. It appears in the &lt;i&gt;Journal of Clinical Oncology&lt;/i&gt; (doi:10.1200/JCO-25-01648).&lt;/p&gt;&lt;p&gt;Current National Comprehensive Cancer Network guidelines do not provide separate recommendations for &lt;i&gt;BRCA&lt;/i&gt; carriers who have been diagnosed with ovarian cancer and those who have not, according to Dallas Reed, MD, chief of clinical genetics at Tufts Medical Center in Boston, Massachusetts.&lt;/p&gt;&lt;p&gt;Instead, guidelines suggest counseling all &lt;i&gt;BRCA1&lt;/i&gt; carriers either to undergo yearly screening mammograms, breast examinations, and magnetic resonance imaging (MRI) or to undergo risk-reducing double mastectomy. Patients must make the ultimate decision of how to proceed based on a variety of individual factors.&lt;/p&gt;&lt;p&gt;“It’s really helpful to have data like these to show what happens to &lt;i&gt;BRCA1&lt;/i&gt; or &lt;i&gt;2&lt;/i&gt; patients and whether there are differences among the cohorts that we diagnose,” she says.&lt;/p&gt;&lt;p&gt;Researchers identified 960 participants with a pathogenic/likely pathogenic variant in &lt;i&gt;BRCA1&lt;/i&gt; or &lt;i&gt;BRCA2&lt;/i&gt;, a diagnosis of ovarian cancer, and no other cancer history or risk-reducing bilateral mastectomy. The 814 &lt;i&gt;BRCA1&lt;/i&gt; carriers and 146 &lt;i&gt;BRCA2&lt;/i&gt; carriers were followed for incident breast cancer from either the date of their ovarian cancer diagnosis or the date of the baseline questionnaire, whichever was later.&lt;/p&gt;&lt;p&gt;The study compared 5-, 10-, and 15-year cumulative breast cancer risks for women with ovarian cancer and an age-matched set of control women without ovarian cancer.&lt;/p&gt;&lt;p&gt;After a mean follow-up of 4.9 years, 41 women (4.3%) developed breast cancer at a mean age at diagnosis of 57.5 years (range, 39–74 years). Actuarial cumulative breast cancer risks after ovarian cancer were 4.4%, 8.9%, and 11.5% at 5, 10, and 15 years, respectively. Three deaths related to breast cancer occurred in the study.&lt;/p&gt;&lt;p&gt;The actuarial cumulative risks of breast cancer for the 741 age-matched &lt;i&gt;BRCA&lt;/i&gt; carriers without ovarian cancer were 20.9%, 38.6%, and 47.2% at 5, 10, and 15 years, respectively. The hazard ratio for breast cancer after an ovarian cancer diagnosis versus no ovarian cancer was 0.18 (95% CI, 0.12–0.27; &lt;i&gt;p&lt;/i&gt; &lt; .0001).&lt;/p&gt;&lt;p&gt;The annual risk of breast cancer after an ovarian cancer diagnosis was 0.9%, which was significantly lower than the 4.1% risk observed in age-matched &lt;i&gt;BRCA&lt;/i&gt; carriers without an ovarian cancer diagnosis.&lt;/p&gt;&lt;p&gt;The age of breast cance","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 3","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148292615","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":"Data support longer recurrence-free survival with nivolumab than with ipilimumab for stage III or IV melanoma","authors":"Carrie Printz","doi":"10.3322/caac.70085","DOIUrl":"10.3322/caac.70085","url":null,"abstract":"&lt;p&gt;Adjuvant treatment of patients with a high recurrence risk of resectable stage III or IV melanoma is the recommended standard of care. Therapies include nivolumab, pembrolizumab, and ipilimumab for all patients with melanoma and dabrafenib plus trametinib for patients with melanomas that harbor the BRAF V600 mutation.&lt;/p&gt;&lt;p&gt;In 2017, the CheckMate 238 trial showed that adjuvant nivolumab was superior to ipilimumab in terms of recurrence-free survival (RFS) and distant metastasis–free survival in patients with resected stage IIIB–C or stage IV melanoma. Nivolumab also was shown to have a more favorable safety profile.&lt;/p&gt;&lt;p&gt;The final analysis of CheckMate 238 with a minimum follow-up of 9 years supports a sustained finding of longer RFS with nivolumab compared to ipilimumab.&lt;/p&gt;&lt;p&gt;“After the initial results of CheckMate 238 became available, we knew that nivolumab was the superior therapy in these patients, but this longer-term follow up gives us additional information on how to manage them as well as confirms persistence of the therapy’s benefits,” says Bartosz Chmielowski, MD, PhD, a health sciences clinical professor of medicine in the Division of Hematology–Oncology at the University of California Los Angeles.&lt;/p&gt;&lt;p&gt;CheckMate 238 was a phase 3, randomized trial with results previously published in &lt;i&gt;The New England Journal of Medicine&lt;/i&gt; (doi:10.1056/NEJMoa1709030). Between March 30 and November 30, 2015, 906 patients, aged 15 years or older, were randomly assigned to receive either nivolumab or ipilimumab. All participants had completely resected stage IIIB–C or IV melanoma.&lt;/p&gt;&lt;p&gt;The primary endpoint was RFS. Scans were not required after 60 months, and RFS was determined by investigator reports of recurrence or a new primary lesion. Secondary endpoints included overall survival (OS) and safety. In patients with stage 3 melanoma, distant metastasis–free survival was an exploratory endpoint.&lt;/p&gt;&lt;p&gt;Since the original trial results, researchers also have gathered new data for guiding treatment, including information on the first sites of distant recurrence, subsequent systemic therapy, and the time from randomization to progression during next-line systemic therapy. Moreover, they have conducted post hoc analyses of the probability of death from melanoma.&lt;/p&gt;&lt;p&gt;At a minimum follow-up of 9 years, the median duration of RFS was 61.1 months with nivolumab and 24.2 months with ipilimumab (hazard ratio for recurrence or death, 0.76; 95% CI, 0.63–0.90). The 9-year RFS rates were 44% and 37%, respectively.&lt;/p&gt;&lt;p&gt;The median distant metastasis–free survival for patients with stage III melanoma was more than 9 years with nivolumab and 83.8 months with ipilimumab, with 9-year survival rates of 54% and 48%, respectively (hazard ratio for distant metastasis or death, 0.81; 95% CI, 0.65–1.00). The median OS was more than 9 years in both trial groups, with 9-year survival rates of 69% in the nivolumab group and 65% in the ipilimumab group (hazard ratio fo","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 3","pages":""},"PeriodicalIF":685.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148292659","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":"Radiation therapy, cytogenetic prognostication, novel systemic chemotherapy, and patient perspective in an adult with choroidal melanoma","authors":"Kevin Card MD,&nbsp;Rizwan Haq MD, PhD,&nbsp;John Mignano MD, PhD,&nbsp;Shilpa J. Desai MD","doi":"10.3322/caac.70091","DOIUrl":"10.3322/caac.70091","url":null,"abstract":"&lt;p&gt;LF was followed with stable ocular tumor measurements and resolution of her serous retinal detachment until July 27, 2023. Her fundus photography then showed tumor growth at the superior aspect of the lesion (Figure 3A) without obvious increase in thickness of the original mass (Figure 3B). The patient was offered enucleation, repeat GKSRS, or plaque brachytherapy (PBT). She elected to repeat GKSRS, which was completed on August 13, 2023. At that time, the area of recurrent choroidal melanoma had a volume of approximately 0.34 mL (Figure 4). GKSRS treatment delivered a dose of 20 Gy to the 50% isodose line using a plan consisting of seven isocenters, which encompassed the entire lesion volume.&lt;/p&gt;&lt;p&gt;Given the high risk of metastasis associated with choroidal melanoma, she was followed annually with surveillance abdominal MRI. In October 2023, three lesions on the liver (1.3, 0.8, and 0.5 cm) were detected, and liver biopsy confirmed the presence of liver metastases. Several treatment options were considered, but she ultimately was enrolled in a clinical trial combining darovasertib and crizotinib because of promising results (see Medical oncology perspective, below). This option was also influenced by the restriction of this clinical trial to the front-line setting. She was not eligible for treatment with tebenafusp because human leukocyte antigen (HLA) genotype did not reveal HLA-A*02:01. She began treatment with IDE196 (darovasertib) along with crizotinib, which she generally tolerated despite some nausea and lower extremity edema, both of which resolved.&lt;/p&gt;&lt;p&gt;After the repeat GKSRS, her ocular tumor measurements were again stable until August 8, 2024, when another area of tumor extension was noted at the superotemporal edge of the original tumor (Figure 5A), with ultrasound demonstrating thickness of the extension at 2.70 mm (Figure 5B). We again discussed enucleation, repeat GKSRS, or PBT. Observation was not an option because, without local control, the ocular melanoma would continue to grow, leading to a blind and painful eye. Therefore, despite visual acuity of 20/30, the patient elected for enucleation. She underwent enucleation of the right eye on September 9, 2024. Tissue pathology showed epithelioid cell melanoma, which extended to the anterior ciliary body without involvement of the sclera or the optic nerve (Figure 6A,B).&lt;/p&gt;&lt;p&gt;LF currently uses an ocular prosthesis in place of the right eye. Repeat MRI of the abdomen in January 2026 showed progression of her liver metastasis and a rising circulating tumor DNA tumor fraction after relative stability since October 2023 on darovasertib and crizotinib. Scans show no evidence of extrahepatic disease, thus she has been referred for consideration of liver-directed therapy.&lt;/p&gt;&lt;p&gt;Rizwan Haq reports grants/contracts from Delcath; personal/consulting fees from Delcath, Immunocore, and Pfizer, and support for other professional activities from Pfizer outside the submitted work. The remaini","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 3","pages":""},"PeriodicalIF":232.4,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209364","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":"Systemic amyloid light-chain amyloidosis beyond ANDROMEDA: Diagnostic challenges and therapeutic updates","authors":"Xia Wu MD,&nbsp;Heather Landau MD,&nbsp;Jennifer E. Liu MD,&nbsp;Yihan Cao MD,&nbsp;Raymond L. Comenzo MD","doi":"10.3322/caac.70092","DOIUrl":"10.3322/caac.70092","url":null,"abstract":"<p>Systemic immunoglobulin light-chain amyloidosis is a rare but life-threatening plasma cell disorder characterized by the production of misfolded monoclonal light chains that deposit as amyloid fibrils, leading to pathologic tissue remodeling and progressive multiorgan dysfunction. Despite substantial therapeutic advances, delayed diagnosis remains common because of nonspecific presentations and the need for coordinated hematologic, pathologic, and organ-specific evaluation. The introduction of daratumumab-based regimens has transformed frontline therapy, whereas advances in cytogenetic profiling, measurable residual disease assessment, and transplantation strategies have informed risk-adapted management. Emerging treatments, including BCL-2–targeted therapy, bispecific antibodies, chimeric antigen receptor T-cell therapy, and possibly fibril-directed approaches, further expand the therapeutic landscape. This review summarizes contemporary concepts in the pathobiology, diagnosis, and management of systemic light-chain amyloidosis, with an emphasis on practical diagnostic algorithms, evolving response assessment, and remaining challenges in achieving durable organ recovery and sustained survival.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"76 3","pages":""},"PeriodicalIF":232.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148203531","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}