Therapeutic Advances in Medical Oncology最新文献

{"title":"Genomics of cervical, vulvar and vaginal cancers and the potential of precision medicine.","authors":"Holly E Barker, Joseph Polidano, Andrew Jarratt, Clare L Scott","doi":"10.1177/17588359251363499","DOIUrl":"10.1177/17588359251363499","url":null,"abstract":"<p><p>Most cases of cervical cancer are still caused by persistent infection with high-risk human papillomavirus (HPV) variants, which also drives the development of ~30% of vulvar and ~76% of vaginal malignancies. Implementation of HPV vaccination has significantly decreased the incidence of high-grade pre-cancerous cervical, vulvar and vaginal lesions. However, cervical, vulvar and vaginal cancers can still develop (with or without HPV integration) and treatment options are limited compared to more common cancers. As with many other cancer types, molecular studies should identify targeted agents that could be added to treatment regimens to improve response rates and survival. Combination regimens involving chemoradiotherapy, anti-angiogenics and immune checkpoint inhibitors should be considered in the first instance. Then, depending on the molecular profile of a particular tumour, more targeted therapies should be considered. In particular, HER2-targeted therapies are likely to be a viable treatment option for many individuals, including those with cervical adenocarcinoma of gastric-type and vulvar Paget's disease. In cervical cancer, TGFβ, PI3K, ATR and PARP inhibitors have shown some benefit and warrant further investigation. In vulvar cancer, combination therapies involving EGFR inhibitors require ongoing evaluation. In vaginal cancer, combination therapies targeting the PI3K and MAPK pathways should be investigated for squamous cell carcinoma and melanoma, respectively. Finally, with the rapid expansion of antibody-drug conjugates in recent years, this is an especially exciting area of investigation. For cervical, vulvar and vaginal cancers specifically, trastuzumab deruxtecan and tisotumab vedotin could be important therapeutic options in the right context. In this review, we describe the molecular features of different cervical, vulvar and vaginal cancer types, current genomically-matched therapies being investigated and discuss treatment strategies with future potential.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251363499"},"PeriodicalIF":4.2,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of sequential treatment strategies involving first-line pembrolizumab with trastuzumab and chemotherapy for unresectable metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma.","authors":"Caicong You, Jiahao Zhang, Jianying Lei, Wu Fu, Bin Zheng, Hongfu Cai, Maobai Liu, Na Li","doi":"10.1177/17588359251378294","DOIUrl":"10.1177/17588359251378294","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer is a leading cause of cancer-related mortality worldwide, and HER2-positive gastric or gastroesophageal junction (G/GEJ) adenocarcinoma constitutes an aggressive molecular subtype. The KEYNOTE-811 phase III trial demonstrated improved clinical outcomes with combination therapy of pembrolizumab, trastuzumab, and chemotherapy (PTC) compared to trastuzumab and chemotherapy alone (TC), but the economic value of this regimen remains uncertain.</p><p><strong>Objective: </strong>To assess the cost-effectiveness of the PTC regimen versus TC for unresectable metastatic HER2-positive G/GEJ adenocarcinoma in the United States, stratified by PD-L1 combined positive score (CPS), and to evaluate the economic impact of real-world sequential treatment strategies.</p><p><strong>Design: </strong>A model-based pharmacoeconomic evaluation.</p><p><strong>Method: </strong>A 10-year semi-Markov model was developed using data from the KEYNOTE-811 trial to estimate disease progression, costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Additionally, a 21-day cycle micro-simulation model was constructed to evaluate sequential treatment pathways involving first-line PTC or TC, followed by trastuzumab deruxtecan or ramucirumab plus paclitaxel, and third-line paclitaxel monotherapy or best supportive care. One-way and probabilistic sensitivity analyses were conducted to test model robustness.</p><p><strong>Results: </strong>For patients with PD-L1 CPS ⩾1, the PTC regimen provided an additional 0.33 QALY at an incremental cost of $247,474.27 compared to TC, resulting in an ICER of $750,750.50 per QALY-well above the U.S. willingness-to-pay threshold of $150,000/QALY. In CPS < 1 and overall populations, ICERs were -$377,258.54 and $957,550.19 per QALY, respectively. In sequential treatment analyses, the TC-based sequences were more cost-effective than PTC-based sequences, with the ICERs of PTC-based regimens exceeding $745063.32 per QALY. Sensitivity analyses confirmed the robustness of these findings.</p><p><strong>Conclusion: </strong>From a U.S. payer perspective, PTC is not cost-effective for HER2-positive metastatic G/GEJ adenocarcinoma at current prices, regardless of PD-L1 CPS status or treatment sequence. Price reduction strategies and biomarker-driven therapy selection are warranted to improve economic value.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251378294"},"PeriodicalIF":4.2,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world analysis of HER2-ultralow in HR+/HER2- metastatic breast cancer: prevalence and first-line chemotherapy outcomes.","authors":"Laurent Mathiot, Olivier Kerdraon, Florent Le Borgne, Véronique Verriele, Anne Patsouris, Marie Robert, Jérôme Chetritt, Delphine Loussouarn, Mario Campone, François Bocquet, Jean-Sébastien Frenel","doi":"10.1177/17588359251378863","DOIUrl":"10.1177/17588359251378863","url":null,"abstract":"<p><strong>Background: </strong>HER2-ultralow is an emerging subgroup of metastatic breast cancer (mBC). However, despite an increasing interest, limited data exist on its prevalence and outcomes, especially among patients receiving standard first-line chemotherapy.</p><p><strong>Objectives: </strong>This study assessed the prevalence and outcomes of HER2-ultralow mBC in a real-world cohort of hormone receptor-positive (HR+)/HER2-negative patients receiving first-line standard-of-care (SOC) chemotherapy.</p><p><strong>Design: </strong>A retrospective, single-center cohort study.</p><p><strong>Methods: </strong>We included HR+/HER2-negative mBC patients treated with SOC between January 2016 and February 2023. Patient data were reviewed from electronic health records. HER2-zero tumors (immunohistochemistry 0) were rescored by expert pathologists using the American Society of Clinical Oncology/College of American Pathologists guidelines to distinguish HER2-ultralow from HER2-null cases. Real-world progression-free survival (rwPFS) and real-world overall survival (rwOS) were estimated using Kaplan-Meier and multivariable Cox regression models.</p><p><strong>Results: </strong>Among 320 patients (median age, 62.4 years), 72.8% had visceral metastases, and 17.5% had bone-only disease. Previous CDK4/6 inhibitor treatment was reported in 43.4%. Rescoring identified 15.6% with HER2-ultralow, 61.9% with HER2-low, and 22.5% with HER2-null tumors. The median follow-up was 39.4 months (95% confidence interval (CI), 37.1-47.6). Median rwPFS was 7.9 months (95% CI, 4.6-19.0), 7.3 months (95% CI, 6.4-9.1), and 6.2 months (95% CI, 4.6-8.9) for HER2-ultralow, HER2-low, and HER2-null groups, respectively. Median rwOS was 19.5 months (95% CI, 10.7-33.4), 21.5 months (95% CI, 19.0-25.8), and 16.6 months (95% CI, 11.9-23.6). In patients previously treated with CDK4/6 inhibitors, median rwPFS was 4.6 months (95% CI, 2.7-21.4), 6.1 months (95% CI, 5.5-7.3), and 5.6 months (95% CI, 3.8-8.7).</p><p><strong>Conclusion: </strong>HER2-ultralow accounts for 15.6% of HR+/HER2-negative mBC cases and demonstrates outcomes comparable to HER2-low with SOC chemotherapy.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251378863"},"PeriodicalIF":4.2,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of the systemic inflammation-nutrition index for treatment response and prognosis in patients with locally advanced gastrointestinal stromal tumors receiving neoadjuvant imatinib therapy: a dual-center retrospective cohort study.","authors":"Zhiming Cai, Jinhu Chen, Zhenrong Yang, Lv Lin, Tao Lin, Xincheng Su, Shichai Hong, Weibin Song, Xinyu Chen, Yongjian Zhou","doi":"10.1177/17588359251378286","DOIUrl":"10.1177/17588359251378286","url":null,"abstract":"<p><strong>Background: </strong>Although systemic inflammation- and nutrition-related indices have demonstrated predictive value for treatment response and prognosis in various malignancies, their role in locally advanced gastrointestinal stromal tumors (LA-GIST) undergoing neoadjuvant imatinib therapy (NIT) remains unclear.</p><p><strong>Objectives: </strong>To evaluate the predictive value of the Systemic Inflammation-Nutrition Index (SINI) for pathological response and prognosis in patients with LA-GIST receiving NIT.</p><p><strong>Designs: </strong>A retrospective, two-center study was conducted to evaluate the prognostic value of high pathological response, and to develop a nomogram incorporating SINI for predicting high pathological response in patients with LA-GIST undergoing NIT.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 200 patients with LA-GIST receiving NIT. Least Absolute Shrinkage and Selection Operator regression was used to construct the SINI from key hematological markers and to evaluate its association with relapse-free survival (RFS). A nomogram for predicting high response was established based on independent predictors identified by multivariate analysis, and the performance and prognostic values were validated in an external cohort.</p><p><strong>Results: </strong>High response was independently associated with improved 5-year RFS. The 5-year RFS showed a significant stepwise gradient across the low-, medium-, and high-SINI groups (46.0% vs 75.3% vs 94.8%, all <i>p</i> < 0.05). SINI independently predicted high response. A nomogram incorporating preoperative imatinib duration, tumor size, and SINI demonstrated good discrimination in both the training and validation cohorts (area under the curve = 0.798 and 0.849, respectively), with well-fitted calibration curves and favorable net clinical benefit per decision curve analysis. Patients predicted to have a low response showed significantly shorter RFS than those with a high response (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>The SINI is an effective predictor of pathological response and prognosis in LA-GIST patients receiving NIT. The validated nomogram offers a practical tool for individualized treatment decision-making.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251378286"},"PeriodicalIF":4.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A recurrence risk score model evaluating effects of postmastectomy radiotherapy in breast cancer patients with pathologically negative lymph nodes after neoadjuvant chemotherapy: a multicenter, retrospective study.","authors":"Dan-Qiong Wang, Zhou Huang, Hong-Fen Wu, Dong-Xing Shen, Hao Jing, Hui Fang, Li Zhu, Xiao-Bo Huang, Liang-Fang Shen, Mei Shi, Jia-Yi Chen, Min Liu, Jing Cheng, Ye-Xiong Li, Jian Tie, Yu Tang, Shu-Lian Wang","doi":"10.1177/17588359251367347","DOIUrl":"10.1177/17588359251367347","url":null,"abstract":"<p><strong>Background: </strong>The role of postmastectomy radiotherapy (PMRT) in breast cancer patients achieving pathologically negative lymph nodes (ypN0) after neoadjuvant chemotherapy (NAC) remains controversial due to heterogeneous recurrence risks and lack of prospective evidence.</p><p><strong>Objectives: </strong>To evaluate the effects of PMRT in ypN0 patients after NAC.</p><p><strong>Design: </strong>Multicenter retrospective study.</p><p><strong>Methods: </strong>Data of 624 breast cancer patients with ypN0 was assessed to establish a recurrence risk score model based on a disease-free survival (DFS) rate-based multivariate Cox model. Moreover, the locoregional control (LRC), DFS, and overall survival (OS) rates in PMRT and non-PMRT patients were calculated using the Kaplan-Meier method.</p><p><strong>Results: </strong>All patients received a median of four NAC cycles, followed by mastectomy and axillary lymph node dissection; moreover, 257 (41.2%) patients underwent PMRT. Over a median follow-up duration of 74 months, the 5-year LRC, DFS, and OS rates for all patients were 96.6%, 90.1%, and 95.7%, respectively. The differences in the LRC, DFS, and OS rates between PMRT and non-PMRT patients were nonsignificant in the univariate and multivariate analyses. By using our recurrence risk score model based on four factors (i.e., age, clinical N stage, NAC cycle number, and pathological tumor stage after NAC), we stratified the patients into low- and high-risk groups; their 5-year rates of LRC (98.8% vs 93.9%), DFS (95.1% vs 83.8%), and OS (98.4% vs 92.4%) were significantly different (all p < 0.05). PMRT improved LRC (97.6% vs 90.8%, p = 0.027) but not DFS or OS in high-risk patients and had no benefit in low-risk patients.</p><p><strong>Conclusion: </strong>Our recurrence risk score model effectively distinguished ypN0 patients with different recurrence risk stratifications. PMRT improved LRC but not DFS or OS in high-risk patients and low-risk patients did not benefit from PMRT.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251367347"},"PeriodicalIF":4.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-to-lymphocyte ratio as a prognostic biomarker in patients with human epidermal growth factor receptor 2-negative breast cancer undergoing taxane-carboplatin-based neoadjuvant chemotherapy.","authors":"Qiuyan Huang, Kai Huang, Jinxian Qian, Yinlong Yang","doi":"10.1177/17588359251369041","DOIUrl":"10.1177/17588359251369041","url":null,"abstract":"<p><strong>Background: </strong>Taxane-carboplatin-based neoadjuvant chemotherapy (NAC) improves the pathological complete response (pCR) rate in human epidermal growth factor receptor 2 (HER2)-negative breast cancer. However, its effect on long-term survival remains unclear. Reliable prognostic biomarkers are needed to guide personalized postoperative strategies.</p><p><strong>Objectives: </strong>To evaluate the prognostic significance of the platelet-to-lymphocyte ratio (PLR) and to construct a predictive model for overall survival (OS) in this clinical setting.</p><p><strong>Design: </strong>This was a retrospective, multicenter cohort study involving an internal development cohort and an external validation cohort.</p><p><strong>Methods: </strong>We retrospectively analyzed 178 HER2-negative breast cancer patients treated with taxane-carboplatin NAC at Fudan University Shanghai Cancer Center (FUSCC). The optimal PLR cutoff (129.75) was identified via receiver operating characteristic (ROC) analysis. Logistic regression assessed the association between PLR and pCR, and multivariate Cox regression evaluated its prognostic value for OS. A nomogram incorporating PLR, estrogen receptor (ER) status, and clinical stage was built using the FUSCC cohort. The nomogram was externally validated in 34 patients from Fujian Cancer Hospital.</p><p><strong>Results: </strong>Among the 178 patients, 94 (52.8%) had high PLR and 84 (47.2%) had low PLR. High PLR was not independently associated with pCR (odds ratio = 1.006; 95% confidence interval (CI): 0.999-1.013; <i>p</i> = 0.079). However, in non-pCR patients, high PLR was significantly linked to poorer OS (<i>p</i> = 0.001). Multivariate analysis identified high PLR (hazard ratio = 5.718; 95% CI: 1.664-19.646; <i>p</i> = 0.006), clinical stage III disease, and ER positivity as independent OS predictors. The nomogram integrating these factors demonstrated strong predictive performance in both cohorts.</p><p><strong>Conclusion: </strong>This is the first study to evaluate PLR as a prognostic marker in HER2-negative breast cancer treated with taxane-carboplatin NAC. High PLR was independently associated with poorer survival. The proposed nomogram provides a practical tool for postoperative risk stratification and personalized care.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251369041"},"PeriodicalIF":4.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12475336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S-1 plus oxaliplatin versus modified FOLFIRINOX for advanced pancreatic adenocarcinoma after gemcitabine plus nab-paclitaxel failure.","authors":"Hui Tang, Zhengxia Li, Tingting You, Jinrong Ying, Mingming Yuan, Yuejuan Cheng, Yingyi Wang, Huanwen Wu, Chunmei Bai","doi":"10.1177/17588359251378698","DOIUrl":"10.1177/17588359251378698","url":null,"abstract":"<p><strong>Background: </strong>There is no clear consensus on second-line chemotherapy for patients with advanced pancreatic ductal adenocarcinoma (PDAC) after failure of first-line gemcitabine plus nab-paclitaxel (GnP).</p><p><strong>Objectives: </strong>This study aimed to compare the efficacy and safety of oxaliplatin plus S-1 (SOX) versus modified FOLFIRINOX (mFFX) as second-line chemotherapy in this patient population.</p><p><strong>Design: </strong>A retrospective cohort study was conducted.</p><p><strong>Methods: </strong>Patients with advanced PDAC who received second-line SOX or mFFX after GnP failure at Peking Union Medical College Hospital were reviewed. Efficacy (disease control rate (DCR), overall survival (OS), progression-free survival (PFS)), and safety were analyzed. Molecular features were explored in a subgroup using targeted next-generation sequencing (NGS).</p><p><strong>Results: </strong>In total, 113 patients were included (65 SOX, 48 mFFX). The mFFX group had a significantly higher DCR than the SOX group (68.8% vs 40.0%, <i>p</i> = 0.005). Median PFS (4.8 vs 2.4 months, <i>p</i> = 0.001) and OS (10.4 vs 6.1 months, <i>p</i> = 0.001) were significantly longer with mFFX, even after propensity score matching adjustment. However, grade ⩾3 adverse events, particularly severe neutropenia (42.9% vs 13.5%, <i>p</i> = 0.004) and diarrhea (17.1% vs 1.9%, <i>p</i> = 0.031), were more frequent with mFFX. Multivariate analysis confirmed mFFX as an independent predictor for improved PFS (hazard ratio (HR) = 0.52, <i>p</i> = 0.004) and OS (HR = 0.46, <i>p</i> = 0.002). Exploratory NGS analysis in 45 patients suggested ARID1A, INPP4A, NTRK2, and PTPRS alterations may predict poor survival, but did not influence the relative efficacy of either regimen.</p><p><strong>Conclusion: </strong>The mFFX regimen demonstrated superior efficacy over SOX as second-line chemotherapy after GnP failure in advanced PDAC, significantly prolonging PFS and OS. However, this benefit was accompanied by a higher incidence of severe toxicities. Molecular alterations may hold prognostic value but did not guide regimen selection in this study.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251378698"},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintenance therapy-a potential strategy to prolong the survival of advanced soft tissue sarcoma patients.","authors":"Ming-Jing Lee, Yeh Chen Lee, Prabhat Bhargava, Zola Chia-Chen Li, Tom Wei-Wu Chen","doi":"10.1177/17588359251377584","DOIUrl":"10.1177/17588359251377584","url":null,"abstract":"<p><p>Anthracycline-based chemotherapy remains the cornerstone of first-line systemic treatment for most subtypes of advanced soft tissue sarcoma (STS). However, cumulative cardiotoxicity and a decline in quality of life limit the treatment duration of free-form anthracycline, restricting its long-term benefits. Maintenance therapy-defined as the continuation of a less toxic systemic treatment following initial disease control-includes two main strategies: continuation maintenance and switch maintenance. Continuation maintenance involves the extended use of the same agent or one with a similar mechanism of action to preserve the efficacy of the prior treatment while minimizing the toxicities. By contrast, switch maintenance uses a different, potentially less toxic agent to extend disease control after prior treatment. Both approaches are established in other solid tumors and have been explored in STS. The LMS-04 trial demonstrated improved outcomes with doxorubicin plus trabectedin induction followed by trabectedin maintenance in leiomyosarcoma patients. However, this strategy is limited to leiomyosarcoma patients who received first-line doxorubicin plus trabectedin and is associated with high-grade toxicity (grade 3/4 adverse events in 97% of patients). Switch maintenance strategies, such as ridaforolimus and regorafenib, have limitations in efficacy and tolerability, preventing their widespread adoption. Pegylated liposomal doxorubicin (PLD), a liposome-encapsulated formulation of doxorubicin, offers a potential continuation maintenance option. With a similar mechanism of action to free-form anthracycline but reduced cumulative cardiac toxicity, PLD may be both effective and better tolerated in STS patients who have derived benefit from anthracycline-based chemotherapy. A clinical trial investigating continuation maintenance PLD in this patient population is warranted.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251377584"},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardioprotective effectiveness of SGLT2 inhibitors in older diabetic women with early-stage breast cancer following anthracycline- and/or trastuzumab-based treatment.","authors":"Yi-Shao Liu, Jamie C Barner, Kenneth A Lawson, Yan Liu, Chanhyun Park","doi":"10.1177/17588359251378245","DOIUrl":"10.1177/17588359251378245","url":null,"abstract":"<p><strong>Background: </strong>Real-world evidence on protective effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) against anthracycline- or trastuzumab-induced cardiotoxicity in patients with breast cancer is limited.</p><p><strong>Objectives: </strong>To examine the cardioprotective benefits of SGLT2i in older women with early-stage breast cancer (EBC) following anthracycline- and/or trastuzumab-based therapies.</p><p><strong>Design: </strong>This was a retrospective cohort study using the 2011-2019 SEER-Medicare database.</p><p><strong>Methods: </strong>We identified women aged over 65.5 years and diagnosed with stage I-III BC who received anthracycline and/or trastuzumab and subsequently initiated antidiabetic medications. Propensity scores were used to match one new-user episode of SGLT2i with four new-user episodes of other antidiabetic medications (OAMs). The primary outcome was a composite endpoint consisting of heart failure (HF), stroke, myocardial infarction, and arrhythmia. Secondary outcomes included hospitalization due to HF (HHF) and incident HF or cardiomyopathy (CM). Cause-specific hazard ratios (csHR) between SGLT2i and OAMs groups were assessed for each outcome, with all-cause death treated as a competing event.</p><p><strong>Results: </strong>From 1195 women examined, 1777 new-user episodes were identified. After 1:4 matching, there were 131 episodes in the SGLT2i group and 469 in the OAM group. Covariates were well-balanced between groups. No statistically significant differences were observed in the composite cardiovascular (csHR = 0.71; 95% confidence interval (CI): 0.44-1.15; <i>p</i> = 0.24), HHF (csHR = 0.92; 95% CI: 0.10-8.27; <i>p</i> = 0.94), or incident HF/CM (csHR = 0.77; 95% CI: 0.45-1.34; <i>p</i> = 0.36) outcomes. Results were consistent across individual SGLT2i and clinical subgroups, including those with/without established cardiovascular diseases and those exposed to various cardiotoxic cancer treatments.</p><p><strong>Conclusion: </strong>No significant differences in cardiovascular risks were found between women with EBC who initiated SGLT2i versus OAMs after anthracycline or trastuzumab treatments, which might be due to the limited sample size. Further investigation through clinical trials is necessary to confirm the cardioprotective potential of SGLT2i among patients with EBC.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251378245"},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and hereditary breast cancer: advances in risk stratification and imaging approaches.","authors":"Viviana Cortiana, Shreevikaa Kannan, Harshitha Vallabhaneni, Jade Gambill, Soumiya Nadar, Vraj Jigar Kumar Rangrej, Chandler H Park, Yan Leyfman","doi":"10.1177/17588359251349677","DOIUrl":"10.1177/17588359251349677","url":null,"abstract":"<p><p>Breast cancer (BC) remains a leading global health challenge, characterized by significant heterogeneity that complicates its detection, diagnosis, and management. The integration of imaging biomarkers and radiomics into clinical workflows has revolutionized early detection, risk stratification, and personalized treatment strategies. Established modalities, such as mammography and magnetic resonance imaging, in conjunction with biomarkers like hormone receptor status, continue to play a pivotal role in guiding therapeutic decisions. Simultaneously, advancements in radiomics and artificial intelligence (AI) have enabled the extraction and analysis of high-dimensional imaging data, offering novel insights into tumor biology and predicting treatment outcomes. This review explores the synergy of imaging biomarkers, radiomics, and AI, emphasizing their potential to transform BC care through enhanced precision and optimized patient outcomes.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251349677"},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}