CA: A Cancer Journal for Clinicians最新文献

{"title":"Screening for lung cancer","authors":"","doi":"10.3322/caac.21815","DOIUrl":"10.3322/caac.21815","url":null,"abstract":"<p>The American Cancer Society has updated its guideline for lung cancer screening in people who are at higher risk because of their history of smoking.</p><p>The test used to screen for lung cancer is a LDCT scan. During an LDCT scan, you lie on a table while a computed tomography scanner uses x-rays to make detailed images of your chest, including your lungs. The scan only takes a few minutes.</p><p>LDCT scans can help find abnormal areas in the lungs that may be cancer, before they start causing any symptoms. An LDCT scan is recommended once a year for lung cancer screening.</p><p>For more information about lung cancer and screening, visit the American Cancer Society (https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/detection.html).</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"82-83"},"PeriodicalIF":254.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417639","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":"Lung cancer diagnosis and mortality beyond 15 years since quit in individuals with a 20+ pack-year history: A systematic review","authors":"Karli K. Kondo PhD,&nbsp;Basmah Rahman MPH,&nbsp;Chelsea K. Ayers MPH,&nbsp;Rose Relevo MLIS, MSMI,&nbsp;Jessica C. Griffin MS,&nbsp;Michael T. Halpern MD, PhD, MPH","doi":"10.3322/caac.21808","DOIUrl":"10.3322/caac.21808","url":null,"abstract":"<p>Current US lung cancer screening recommendations limit eligibility to adults with a pack-year (PY) history of ≥20 years and the first 15 years since quit (YSQ). The authors conducted a systematic review to better understand lung cancer incidence, risk and mortality among otherwise eligible individuals in this population beyond 15 YSQ. The PubMed and Scopus databases were searched through February 14, 2023, and relevant articles were searched by hand. Included studies examined the relationship between adults with both a ≥20-PY history and ≥15 YSQ and lung cancer diagnosis, mortality, and screening ineligibility. One investigator abstracted data and a second confirmed. Two investigators independently assessed study quality and certainty of evidence (COE) and resolved discordance through consensus. From 2636 titles, 22 studies in 26 articles were included. Three studies provided low COE of elevated lung cancer incidence beyond 15 YSQ, as compared with people who never smoked, and six studies provided moderate COE that the risk of a lung cancer diagnosis after 15 YSQ declines gradually, but with no clinically significant difference just before and after 15 YSQ. Studies examining lung cancer-related disparities suggest that outcomes after 15 YSQ were similar between African American/Black and White participants; increasing YSQ would expand eligibility for African American/Black individuals, but for a significantly larger proportion of White individuals. The authors observed that the risk of lung cancer not only persists beyond 15 YSQ but that, compared with individuals who never smoked, the risk may remain significantly elevated for 2 or 3 decades. Future research of nationally representative samples with consistent reporting across studies is needed, as are better data from which to examine the effects on health disparities across different populations.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"84-114"},"PeriodicalIF":254.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21808","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417637","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":"Reviewer acknowledgement 2023","authors":"","doi":"10.3322/caac.21821","DOIUrl":"10.3322/caac.21821","url":null,"abstract":"<p>In order to maintain the high standards of <i>CA</i>’s content, the Editors of <i>CA</i> rely on the knowledge and dedication of many experts in deciding which topics to pursue, which manuscripts to publish, and what modifications to make to ensure medical and scientific accuracy and suitability for our readers. We thank our Associate Editors and our Editorial Advisory Board, who continue to provide these services for us time and time again.</p><p>We are also greatly indebted to the effort and expertise of the following individuals for reviewing manuscripts for the journal from July 1, 2022, to June 30, 2023. These individuals go beyond expectations by consistently and expeditiously delivering comprehensive, discerning reviews.</p><p>Larry Anderson Jr.</p><p>Mary Beth Beasley</p><p>Jacques Beauvais</p><p>Paul Bunn</p><p>George Calin</p><p>Steve Cohen</p><p>John Cramer</p><p>Sophie Dream</p><p>Marc Emerson</p><p>Cecilia Ethun</p><p>Martine Extermann</p><p>Sarah Fisher</p><p>Edward Garon</p><p>Hans Gerdes</p><p>Miriam Gotte</p><p>John Grecula</p><p>Alessandro Gronchi</p><p>Carmen Guerra</p><p>Dana Guyer</p><p>Sudath Hapuarachchige</p><p>Thatcher Heumann</p><p>Amanda M. Hopp</p><p>Anna Kaltsas</p><p>Hormuzd Katki</p><p>Pamela Kunz</p><p>Laura Lambert</p><p>Lisa X. Lee</p><p>Hyunjung Lee</p><p>Stephenie Lemon</p><p>Cynthia Ma</p><p>Allison Magnuson</p><p>Deana Manassaram-Baptiste</p><p>Charles Matthews</p><p>Jessica McDermott</p><p>Lorna McWilliams</p><p>Jane Meisel</p><p>Craig Messick</p><p>Joseph Misdraji</p><p>Kristen Ness</p><p>Brenda Nevidjon</p><p>Electra Paskett</p><p>Sameer Patel</p><p>Mauro Pittiruti</p><p>Richard Riedel</p><p>Flavio Rocha</p><p>Ari J. Rosenberg</p><p>Marilyn Roubidoux</p><p>Nicole Stout</p><p>Kevin ten Haaf</p><p>Richard Wein</p><p>Rudolf Werner</p><p>Lily Yang</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"653"},"PeriodicalIF":254.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung cancer screening guidelines: Smoking matters, not quitting","authors":"Don S. Dizon MD,&nbsp;Arif H. Kamal MD, MBA, MHS","doi":"10.3322/caac.21814","DOIUrl":"10.3322/caac.21814","url":null,"abstract":"&lt;p&gt;Lung cancer screening is a proven method to detect cancers early, resulting in reduced morbidity and mortality. Guidelines regarding lung cancer screening have been published by a few groups, including the American Cancer Society (ACS) who, since 2010, have recommended for low-dose computed tomography screening for those who meet the criteria. One such criterion is &lt;i&gt;years since quitting&lt;/i&gt; (YSQ). The 2023 update&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; incorporates significant evolutions that reflect an updated evidence base, in particular related to YSQ. In recognizing that genomic alterations from combustible tobacco exposure do not reliably reverse over time, the guideline update expands the population of those eligible for screening. Furthermore, it serves as a cautionary tale to current episodic smokers regarding the common assumption that quitting smoking removes the risk of lung cancer, particularly with the passage of time.&lt;/p&gt;&lt;p&gt;The rationale for this change is explained as follows: the individual risk of lung cancer does indeed decrease over time once someone quits smoking, but this reduction is relatively lower only if compared &lt;i&gt;with a similar person who continues to smoke&lt;/i&gt;. Compared with a person who never smoked, the risk for lung cancer appears to remain three times greater, even at 20 and 30 YSQ. This introduces an entirely new cohort of people now eligible for lung cancer screening, some of whom we may not visualize when imagining the patient who should be contacted for annual screening. For example, picture a business executive in her 50s who previously smoked two packs per day throughout high school and into young adulthood, quitting when she became a parent at age 30 years. She smoked during college and graduate school, but that is now in the distant past. Because of her previous smoking history of 20 pack-years, she is now—for the first time ever—considered a prime candidate for lung cancer screening to reduce the potential morbidity and mortality from lung cancer.&lt;/p&gt;&lt;p&gt;Embedded within this update are acknowledgments of the limitations of available data. For example, large trials used in this analysis did not routinely report on race or ethnicity; and, where race was captured, the vast majority of individuals were White study volunteers. Whether the same eligibility criteria for lung cancer screening applies across races is not clear, but some data suggest that race matters, with lung cancer onset at a younger age among Black people compared to White people, and with a higher proportion of those who did not meet the critical 30 pack-year threshold to initiate lung cancer screening (compared with White people). Finally, how to identify nonsmokers who may benefit from screening is not known. This is important because it accounts for 20% of all diagnoses of lung cancer. We agree that further work into who they are is urgent.&lt;/p&gt;&lt;p&gt;For now, this important update is one that requires swift action at the individual, community, state, an","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"10-11"},"PeriodicalIF":254.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417662","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":"Rare Manifestation of the Cutaneous and Cervical Lymph Node Metastases of Urothelial Carcinoma of Urinary Bladder: A Case Report.","authors":"Woo Yeol Sim, Noh Hyuck Park, Yoon Yang Jung","doi":"10.3348/jksr.2022.0064","DOIUrl":"10.3348/jksr.2022.0064","url":null,"abstract":"<p><p>Lymph node metastasis from bladder cancer mainly involves the external/internal iliac and obturator nodes as the primary lymphatic drainage sites of the bladder, and common iliac sites as the secondary drainage. Lymph node involvement above the diaphragm is rare. Metastasis to the head and neck region is associated with poor prognosis and low survival rate. Herein, we report a case of cervical cutaneous and lymph node metastases in a patient with bladder cancer. This is a rare case of advanced urothelial carcinoma presenting as an aggressive inflammatory process with extensive lymph node involvement, without bony or visceral metastasis.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"19 1","pages":"1403-1407"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72394712","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":"Screening for lung cancer: 2023 guideline update from the American Cancer Society","authors":"Andrew M. D. Wolf MD,&nbsp;Kevin C. Oeffinger MD,&nbsp;Tina Ya-Chen Shih PhD,&nbsp;Louise C. Walter MD,&nbsp;Timothy R. Church PhD,&nbsp;Elizabeth T. H. Fontham MPH, DrPH,&nbsp;Elena B. Elkin PhD, MPA,&nbsp;Ruth D. Etzioni PhD,&nbsp;Carmen E. Guerra MD, MSCE,&nbsp;Rebecca B. Perkins MD, MSc,&nbsp;Karli K. Kondo PhD,&nbsp;Tyler B. Kratzer MPH,&nbsp;Deana Manassaram-Baptiste PhD, MPH,&nbsp;William L. Dahut MD,&nbsp;Robert A. Smith PhD","doi":"10.3322/caac.21811","DOIUrl":"10.3322/caac.21811","url":null,"abstract":"<p>Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50–80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50–80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (<i>strong recommendation</i>, <i>moderate quality of evidence</i>). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"50-81"},"PeriodicalIF":254.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417638","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":"Immunosurveillance in clinical cancer management","authors":"Guido Kroemer MD, PhD,&nbsp;Timothy A. Chan MD, PhD,&nbsp;Alexander M. M. Eggermont MD, PhD,&nbsp;Lorenzo Galluzzi PhD","doi":"10.3322/caac.21818","DOIUrl":"10.3322/caac.21818","url":null,"abstract":"<p>The progression of cancer involves a critical step in which malignant cells escape from control by the immune system. Antineoplastic agents are particularly efficient when they succeed in restoring such control (immunosurveillance) or at least establish an equilibrium state that slows down disease progression. This is true not only for immunotherapies, such as immune checkpoint inhibitors (ICIs), but also for conventional chemotherapy, targeted anticancer agents, and radiation therapy. Thus, therapeutics that stress and kill cancer cells while provoking a tumor-targeting immune response, referred to as <i>immunogenic cell death</i>, are particularly useful in combination with ICIs. Modern oncology regimens are increasingly using such combinations, which are referred to as <i>chemoimmunotherapy</i>, as well as combinations of multiple ICIs. However, the latter are generally associated with severe side effects compared with single-agent ICIs. Of note, the success of these combinatorial strategies against locally advanced or metastatic cancers is now spurring successful attempts to move them past the postoperative (adjuvant) setting to the preoperative (neoadjuvant) setting, even for patients with operable cancers. Here, the authors critically discuss the importance of immunosurveillance in modern clinical cancer management.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"187-202"},"PeriodicalIF":254.7,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159986","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":"Locally advanced mismatch repair-deficient gastroesophageal junction cancer: Diagnosis, treatment modifications, and monitoring","authors":"Rutika Mehta MD, MPH,&nbsp;Andrew Sinnamon MD,&nbsp;Aamir Dam MD,&nbsp;Christine Walko PharmD, BCOP,&nbsp;Russell Palm MD,&nbsp;Laura Barton MS,&nbsp;Gregory Lauwers MD,&nbsp;Jose M. Pimiento MD","doi":"10.3322/caac.21813","DOIUrl":"10.3322/caac.21813","url":null,"abstract":"<p>Rutika Mehta has served on advisory boards for Bristol-Myers Squibb Company, Eli Lilly &amp; Company, Merck, Astellas Pharma US Inc., Novartis, BostonGene, Guardant Health, SeaGen Inc., and Natera; and on a Data and Safety Monitoring Board for Arcus Biosciences outside the submitted work. Christine Walko is employed by Mission Healthcare, has stock and ownership interests in Nabriva Therapeutics, and has served on advisory boards or as a consultant for Jackson Laboratory for Genomic Medicine, Intermountain Precision Genomics, and Clarified Precision Medicine outside the submitted work. Laura Barton reports consulting fees from AstraZeneca outside the submitted work. Gregory Lauwers reports consulting fees from ALIMENTIV outside the submitted work. The remaining authors disclosed no conflicts of interest.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"123-131"},"PeriodicalIF":254.7,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41230823","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 identifies signs and symptoms of colorectal cancer risk at younger ages","authors":"Mike Fillon","doi":"10.3322/caac.21810","DOIUrl":"https://doi.org/10.3322/caac.21810","url":null,"abstract":"&lt;p&gt;Eight years ago, Paula Chambers-Raney from Houston, Texas, suffered from stomach pain, blood in her stool, and anemia. Her primary care physician told her that she had hemorrhoids. Then, over the next 18 months, other clinicians told her that she might have irritable bowel syndrome, she had probably eaten something red, and she should eat more green leafy vegetables for her anemia. After losing her job because of the number of sick days she had taken, with her health still not improving, she went to her county hospital’s emergency room for a colonoscopy. “They found a baseball-sized tumor,” says Chambers-Raney. “I was 44 years old and up until then was told I was too young to have something serious like colon cancer.”&lt;/p&gt;&lt;p&gt;Recognizing the alarming trend of younger people being diagnosed with colorectal cancer (CRC), in 2018, the American Cancer Society, followed by other health organizations, began recommending lowering the age for screening from the age of 50 years to the age of 45 years. A new study appearing in the Journal of the National Cancer Institute (doi:10.1093/jnci/djad068) is the latest to validate this change.&lt;/p&gt;&lt;p&gt;In the study, the researchers looked for abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia, with each indicating an increased risk for early-onset CRC. They sought to determine if these four symptoms—identified as red flags—might be key to the detection of early-onset CRC. To perform this work, the researchers conducted a nested case-control study from the IBM MarketScan Commercial Database, which includes individual claims data from approximately 113 million insured adults aged 18–64 years from across the United States. The primary analyses were restricted to adults aged 18–49 years with at least 2 years of continuous enrollment before the index date. For the secondary analyses, they included adults aged 50–64 years.&lt;/p&gt;&lt;p&gt;The primary analyses focused on identifying red-flag indications that appeared 3 months to 2 years before the index date of diagnosis. “Ultimately, the overarching objective is to improve the early detection of CRC at younger ages, which holds significant potential for improving patient outcomes,” says senior study author Yin Cao, ScD, MPH, an associate professor of surgery in the Division of Public Health Sciences of the Department of Surgery at Washington University School of Medicine in St. Louis, Missouri.&lt;/p&gt;&lt;p&gt;“To our knowledge, this study is among the first large-scale studies to identify predictive red-flag signs and symptoms for early-onset CRC compared to a matched control group and in comparison with signs and symptoms in people with CRC diagnosed at older ages,” she says.&lt;/p&gt;&lt;p&gt;The researchers found that 19.3% of people with early-onset CRC had symptoms beginning within 3 months to 2 years of their diagnosis with a median diagnostic interval of 8.7 months. In addition, 49.1% first showed symptoms within 3 months of their diagnosis. Also, the median diagnostic interva","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"448-450"},"PeriodicalIF":254.7,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21810","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5975403","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":"Adding immunotherapy to chemotherapy improves survival for endometrial cancer patients","authors":"Mike Fillon","doi":"10.3322/caac.21809","DOIUrl":"https://doi.org/10.3322/caac.21809","url":null,"abstract":"&lt;p&gt;There is encouraging news for patients with endometrial cancer based on the results of two recent phase 3 clinical trials: Immunotherapy combined with chemotherapy may appreciably increase progression-free survival for patients with advanced or recurrent endometrial cancer.&lt;/p&gt;&lt;p&gt;Both trials—NRG-GY018 and RUBY— were presented at the Society of Gynecologic Oncology 2023 Annual Meeting on Women’s Cancer in Tampa, Florida. Both also appear in &lt;i&gt;The New England Journal of Medicine.&lt;/i&gt;\u0000 &lt;/p&gt;&lt;p&gt;The NRG-GY018 trial (doi:10.1056/NEJMoa2302312) was a double-blind, placebo-controlled, randomized study. Enrolled were 816 volunteers with stage III/IVA, stage IVB, or recurrent endometrial cancer who were randomized 1:1 to receive either pembrolizumab—an immune checkpoint inhibitor—plus chemotherapy with paclitaxel and carboplatin or a placebo plus chemotherapy for six cycles. They then received as many as 14 cycles of maintenance pembrolizumab or placebo.&lt;/p&gt;&lt;p&gt;All had newly diagnosed stage III or IVA disease with Response Evaluation Criteria for Solid Tumors– measurable disease or stage IVB or recurrent endometrial cancer with or without measurable disease.&lt;/p&gt;&lt;p&gt;The volunteers were divided into two cohorts: those who had mismatch repair–deficient (dMMR) disease and those who had mismatch repair–proficient (pMMR) disease. The primary outcome was progression-free survival in both cohorts. Interim analyses were scheduled after 84 events of death or progression in the cohort with dMMR disease and at least 196 events in the cohort with pMMR disease.&lt;/p&gt;&lt;p&gt;The double-blind, placebo-controlled RUBY trial (doi:10.1056/NEJMoa2216334) enrolled 494 patients with first recurrent or primary advanced stage III or IV endometrial cancer. Measurable disease was required for stages IIIA–C1, and 49 patients with carcinosarcoma—a rare and difficult-to-treat subset of endometrial cancer—were included. Volunteers were randomly assigned in a 1:1 ratio to receive 500 mg of dostarlimab or a placebo intravenously in combination with paclitaxel plus carboplatin. Doses were received every 3 weeks for the first six cycles. This was followed by 1000 mg of dostarlimab or the placebo intravenously every 6 weeks for up to 3 years.&lt;/p&gt;&lt;p&gt;Computed tomography or magnetic resonance imaging was performed every 6 weeks until Cycle 8 and then every 9 weeks until Week 52. Imaging was then performed every 12 weeks. There were 118 volunteers (23.9%) who had dMMR, microsatellite instability–high tumors.&lt;/p&gt;&lt;p&gt;For the NRG-GY018 study, the primary outcome was investigator-assessed progression-free survival according to the Response Evaluation Criteria for Solid Tumors (version 1.1). Key secondary outcomes included safety, overall survival, and health-related quality of life as assessed, the researchers reported.&lt;/p&gt;&lt;p&gt;“At 12-months, the percent of patients who were without evidence of disease progression or death in the dMMR cohort was 74% for the pembrolizumab group and 38% for the pla","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 5","pages":"445-447"},"PeriodicalIF":254.7,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21809","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"5975407","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}