CA: A Cancer Journal for Clinicians最新文献

{"title":"Uncovering the hidden drivers of rural health care disparities","authors":"Banu E. Symington MD, MACP","doi":"10.3322/caac.70009","DOIUrl":"10.3322/caac.70009","url":null,"abstract":"<p>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.<span><sup>1</sup></span> 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.</p><p>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.<span><sup>1</sup></span> 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 (<i>a cup of chemo</i>, 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.</p><p>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.</p><p>Although a hub-and-spoke model of decentralized ca","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 4","pages":"280-281"},"PeriodicalIF":503.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70009","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":"OA","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 MD, PhD,&nbsp;Nigar Nargis PhD,&nbsp;Qinran Liu PhD,&nbsp;Priti Bandi PhD,&nbsp;Rebecca L. Siegel MPH,&nbsp;Parichoy Pal Choudhury PhD,&nbsp;Neal D. Freedman PhD,&nbsp;Kenneth E. Warner PhD,&nbsp;Ahmedin Jemal DVM, PhD","doi":"10.3322/caac.70005","DOIUrl":"10.3322/caac.70005","url":null,"abstract":"<p>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.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 3","pages":"216-225"},"PeriodicalIF":503.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70005","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":"OA","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 MD,&nbsp;Annie W. Chan MD","doi":"10.3322/caac.70004","DOIUrl":"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;&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;&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;&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. The m","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 3","pages":"177-179"},"PeriodicalIF":503.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70004","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defeating lethal cancer: Interrupting the ecologic and evolutionary basis of death from malignancy","authors":"Kenneth J. Pienta MD,&nbsp;Patrick L. Goodin PhD,&nbsp;Sarah R. Amend PhD","doi":"10.3322/caac.70000","DOIUrl":"10.3322/caac.70000","url":null,"abstract":"<p>Despite the advances in cancer prevention, early detection, and treatments, all of which have led to improved cancer survival, globally, there is an increased incidence in cancer-related deaths. Although each patient and each tumor is wholly unique, the tipping point to incurable disease is common across all patients: the dual capacity for cancers to metastasize and resist systemic treatment. The discovery of genetic mutations and epigenetic variation that emerges during cancer progression highlights that evolutionary and ecology principles can be used to understand how cancer evolves to a lethal phenotype. By applying such an eco-evolutionary framework, the authors reinterpret our understanding of the metastatic process as one of an ecologic invasion and define the eco-evolutionary paths of evolving therapy resistance. With this understanding, the authors draw from successful strategies optimized in evolutionary ecology to define strategic interventions with the goal of altering the evolutionary trajectory of lethal cancer. Ultimately, studying, understanding, and treating cancer using evolutionary ecology principles provides an opportunity to improve the lives of patients with cancer.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 3","pages":"183-202"},"PeriodicalIF":503.1,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576106","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 African American and Black people, 2025","authors":"Anatu H. Saka MPH,&nbsp;Angela N. Giaquinto MSPH,&nbsp;Lauren E. McCullough PhD,&nbsp;Katherine Y. Tossas PhD, MS,&nbsp;Jessica Star MA, MPH,&nbsp;Ahmedin Jemal DVM, MPH,&nbsp;Rebecca L. Siegel MPH","doi":"10.3322/caac.21874","DOIUrl":"10.3322/caac.21874","url":null,"abstract":"<p>African American and other Black individuals (referred to as Black people in this article) have a disproportionate cancer burden, including the lowest survival of any racial or ethnic group for most cancers. Every 3 years, the American Cancer Society estimates the number of new cancer cases and deaths for Black people in the United States and compiles the most recent data on cancer incidence (herein through 2021), mortality (through 2022), survival, screening, and risk factors using population-based data from the National Cancer Institute and the Centers for Disease Control and Prevention. In 2025, there will be approximately 248,470 new cancer cases and 73,240 cancer deaths among Black people in the United States. Black men have experienced the largest relative decline in cancer mortality from 1991 to 2022 overall (49%) and in almost every 10-year age group, by as much as 65%–67% in the group aged 40–59 years. This progress largely reflects historical reductions in smoking initiation among Black teens, advances in treatment, and earlier detections for some cancers. Nevertheless, during the most recent 5 years, Black men had 16% higher mortality than White men despite just 4% higher incidence, and Black women had 10% higher mortality than White women despite 9% lower incidence. Larger inequalities for mortality than for incidence reflect two-fold higher death rates for prostate, uterine corpus, and stomach cancers and for myeloma, and 40%–50% higher rates for colorectal, breast, cervical, and liver cancers. The causes of ongoing disparities are multifactorial, but largely stem from inequalities in the social determinants of health that trace back to structural racism. Increasing diversity in clinical trials, enhancing provider education, and implementing financial incentives to ensure equitable care across the cancer care continuum would help close these gaps.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 2","pages":"111-140"},"PeriodicalIF":503.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21874","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456442","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":"Reduced-volume radiotherapy versus conventional-volume radiotherapy after induction chemotherapy in nasopharyngeal carcinoma: An open-label, noninferiority, multicenter, randomized phase 3 trial","authors":"Ling-Long Tang MD,&nbsp;Lin Chen MD,&nbsp;Gui-Qiong Xu MD,&nbsp;Ning Zhang MD,&nbsp;Cheng-Long Huang MD,&nbsp;Wen-Fei Li MD,&nbsp;Yan-Ping Mao MD,&nbsp;Guan-Qun Zhou MD,&nbsp;Feng Lei MD,&nbsp;Lu-Si Chen MD,&nbsp;Shao Hui Huang MD,&nbsp;Lei Chen MD,&nbsp;Yu-Pei Chen MD,&nbsp;Yuan Zhang MD,&nbsp;Xu Liu MD,&nbsp;Cheng Xu MD,&nbsp;Yin Zhao PhD,&nbsp;Ji-Bin Li MD,&nbsp;Na Liu PhD,&nbsp;Fang-Yun Xie MD,&nbsp;Rui Guo MD,&nbsp;Ying Sun MD,&nbsp;Jun Ma MD","doi":"10.3322/caac.21881","DOIUrl":"10.3322/caac.21881","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nearly 90% locoregionally advanced nasopharyngeal carcinoma (LANPC) responds to induction chemotherapy (IC) with significant tumor volume shrinkage. Radiotherapy always follows IC, and reduced volume has been proposed. However, the efficacy and safety of reduced-volume radiotherapy is uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this multi-center, noninferiority, randomized, controlled trial, patients with LANPC who completed IC were randomly assigned (1:1) to receive reduced-volume radiotherapy based on post-IC tumor volume (Post-IC group) or conventional volume radiotherapy based on pre-IC tumor volume (Pre-IC group). The primary endpoint was locoregional relapse-free survival, with a noninferiority margin of 8%. Secondary endpoints comprised adverse events, and quality of life (QoL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between August 7, 2020, and May 27, 2022, 445 patients were randomly assigned to Post-IC (<i>n</i> = 225) or Pre-IC (<i>n</i> = 220) groups. The average volume receiving radical dose was 66.6 cm³ in Post-IC group versus 80.9 cm³. After a median follow-up of 40.4 months, the 3-year locoregional relapse-free survival was 91.5% in the Post-IC group versus 91.2%, with a difference of 0.3% (95% confidence interval −4.9% to 5.5%). The incidence of grade 3-4 radiation-related toxicity was lower in the Post-IC group including: acute mucositis (19.8% vs 34.1%), late otitis media (9.5% vs 20.9%) and late dry month (3.6% vs 9.5%). The Post-IC group had better QoL for global health status, physical functioning, emotional functioning, dry mouth and sticky saliva.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this trial, reduced-volume radiotherapy was noninferior to conventional volume radiotherapy in locoregional relapse-free survival, and was associated with lower toxicities and improved QoL. (ClinicalTrials.gov identifier NCT04384627).</p>\u0000 </section>\u0000 </div>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 3","pages":"203-215"},"PeriodicalIF":503.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21881","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456444","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":"Novel clinical trial designs emerging from the molecular reclassification of cancer","authors":"Mina Nikanjam MD, PhD,&nbsp;Shumei Kato MD,&nbsp;Teresa Allen BA,&nbsp;Jason K. Sicklick MD,&nbsp;Razelle Kurzrock MD","doi":"10.3322/caac.21880","DOIUrl":"10.3322/caac.21880","url":null,"abstract":"<p>Next-generation sequencing has revealed the disruptive reality that advanced/metastatic cancers have complex and individually distinct genomic landscapes, necessitating a rethinking of treatment strategies and clinical trial designs. Indeed, the molecular reclassification of cancer suggests that it is the molecular underpinnings of the disease, rather than the tissue of origin, that mostly drives outcomes. Consequently, oncology clinical trials have evolved from standard phase 1, 2, and 3 tissue-specific studies; to tissue-specific, biomarker-driven trials; to tissue-agnostic trials untethered from histology (all <i>drug-centered designs</i>); and, ultimately, to <i>patient-centered</i>, N-of-1 precision medicine studies in which each patient receives a personalized, biomarker-matched therapy/combination of drugs. Innovative technologies beyond genomics, including those that address transcriptomics, immunomics, proteomics, functional impact, epigenetic changes, and metabolomics, are enabling further refinement and customization of therapy. Decentralized studies have the potential to improve access to trials and precision medicine approaches for underserved minorities. Evaluation of real-world data, assessment of patient-reported outcomes, use of registry protocols, interrogation of exceptional responders, and exploitation of synthetic arms have all contributed to personalized therapeutic approaches. With greater than 1 × 10¹² potential patterns of genomic alterations and greater than 4.5 million possible three-drug combinations, the deployment of artificial intelligence/machine learning may be necessary for the optimization of individual therapy and, in the near future, also may permit the discovery of new treatments in real time.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 3","pages":"243-267"},"PeriodicalIF":503.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21880","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991872","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":"Erectile dysfunction common within the first year after rectal cancer surgery","authors":"Mike Fillon","doi":"10.3322/caac.21879","DOIUrl":"10.3322/caac.21879","url":null,"abstract":"&lt;p&gt;Colorectal cancer studies commonly use broad “umbrella” terms when discussing the outcomes of rectal cancer surgery and fail to ferret out the prevalence of the individual side effects. A study from Denmark has investigated the prevalence of erectile dysfunction (ED) 1 year after rectal cancer surgery, especially because survival rates for patients with rectal cancer have increased substantially on account of improvements in surgical, oncological, perioperative, and chemotherapy care.&lt;/p&gt;&lt;p&gt;However, this also has led to a growing risk of postsurgical complications, noted the study authors. For example, resection of the rectum can cause intraoperative nerve damage to the pelvic plexus nerves, which is believed to be the leading cause of postoperative sexual dysfunction.&lt;/p&gt;&lt;p&gt;The study appears in the &lt;i&gt;European Journal of Surgical Oncology&lt;/i&gt; (doi:10.1016/j.ejso.2024.108662).&lt;/p&gt;&lt;p&gt;According to the lead study author, Sebastian B. Hansen, PhD, who works at the Center for Perioperative Optimization in the Department of Surgery at the Copenhagen University Hospital in Denmark, the primary objective of this systematic review was to estimate the prevalence of ED within the first year after surgery for rectal cancer.&lt;/p&gt;&lt;p&gt;The second objective, Dr Hansen says, was to assess to what extent the surgical approach and techniques, including chemotherapy and radiotherapy, affected the occurrence of ED. “We wanted to investigate if the risk of developing sexual dysfunction following rectal cancer treatment was substantial, and if so, what contributed to it.” He adds that they were aware that the disease itself might contribute to the risk of sexual function impairment.&lt;/p&gt;&lt;p&gt;The researchers believe that their data overall are valid, even though the prevalence of moderate to severe ED varied between different studies. As a result, they are confident that “a great number of recovering rectal cancer patients are at risk.”&lt;/p&gt;&lt;p&gt;The overall confidence levels were low because even though the initial search resulted in 74 studies, only 22 studies were included in the analysis, as noted previously. The researchers wrote that this was due to “shortcomings” in the data reporting. For example, they noted that even though most of the studies used the 5- and 15-item versions of the International Index of Erectile Function, which allows for the stratification of ED degrees on a point score, the bulk of the studies reported only the mean or median results. They believe that this minimized their ability to gauge the level and intensity of ED. “The degree of ED is important since rectal cancer usually affects older men who (already) might have some deterioration in ED function at the time of diagnosis (and not an after effect from surgery),” they said.&lt;/p&gt;&lt;p&gt;Another key finding from the study was that overall, no significant difference was found with respect to the time of follow-up during the first year. However, the researchers speculate that a reason for the lower inc","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"75 1","pages":"5-6"},"PeriodicalIF":503.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21879","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142989952","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}