Therapeutic Advances in Medical Oncology最新文献

{"title":"Gastrointestinal side effects in hepatocellular carcinoma patients receiving transarterial chemoembolization: a meta-analysis of 81 studies and 9495 patients.","authors":"Nathalie Arendt, Maria Kopsida, Jaafar Khaled, Markus Sjöblom, Femke Heindryckx","doi":"10.1177/17588359251316663","DOIUrl":"10.1177/17588359251316663","url":null,"abstract":"<p><strong>Background: </strong>Transarterial chemoembolization (TACE) is a widely used treatment for hepatocellular carcinoma (HCC), combining targeted chemotherapy and embolization. While effective, TACE can be associated with significant gastrointestinal (GI) side effects, impacting a patient's quality of life.</p><p><strong>Objectives: </strong>Quantify the prevalence of key GI complications (diarrhea, nausea, GI toxicity, abdominal pain) following TACE.</p><p><strong>Design: </strong>Systematic review was performed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, focusing on studies that reported side effects of TACE. Studies not involving cTACE or drug-eluting bead TACE (DEB-TACE), non-HCC studies, meta-analyses or systematic reviews, and inaccessible publications were excluded.</p><p><strong>Data sources and methods: </strong>A PubMed search for clinical and randomized trials was conducted. Extracted data included study identifiers, demographics, TACE details, and GI side effect prevalences. The Mixed Methods Appraisal Tool assessed study quality and bias.</p><p><strong>Results: </strong>The analysis included data from 81 studies with 121 individual study arms and 9495 patients. Diarrhea was reported in 38 studies, with a mean prevalence of 23.46% (2.5; 95% confidence interval (CI): 18.39-28.544) and a weighted prevalence of 23.5%. Nausea was most frequently reported, mentioned in 67 studies, with a mean prevalence of 34.66% (2.4; 95% CI: 29.89-39.44) and a weighted prevalence of 32.5%. Abdominal pain was reported in 59 studies, with the highest mean prevalence of 48.07% (2.9; 95% CI: 42.20-53.93) and a weighted prevalence of 46.1%. GI toxicity was reported in 32 studies, with a mean prevalence of 8.85% (1.4; 95% CI: 5.99-11.70) and a weighted prevalence of 9.9%. DEB-TACE generally led to slightly higher rates of nausea, diarrhea, abdominal pain, and GI toxicity compared to conventional TACE. The type of chemotherapy agent influenced prevalence of GI-side effects, with high prevalences observed for agents such as zinostatin and cisplatin.</p><p><strong>Conclusion: </strong>This meta-analysis synthesizes current evidence on managing GI side effects in TACE. Standardizing reporting and developing effective management strategies are crucial to improving patient outcomes.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251316663"},"PeriodicalIF":4.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383357","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":"Comparative analysis of alectinib and brigatinib in real-world treatment of advanced NSCLC with ALK rearrangements.","authors":"Kyuhwan Kim, Kyu Yean Kim, Hye Seon Kang, Ah Young Shin, Sung Kyoung Kim, Chan Kwon Park, Sang Haak Lee, Seung Joon Kim, Jeong Uk Lim, Chang Dong Yeo","doi":"10.1177/17588359251316200","DOIUrl":"10.1177/17588359251316200","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to compare the efficacy of the second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) alectinib and brigatinib in the treatment of advanced non-small-cell lung cancer (NSCLC) with ALK rearrangements based on real-world data.</p><p><strong>Design and methods: </strong>We conducted a multicenter retrospective study using the Clinical Data Warehouse from seven university hospitals affiliated with the Catholic Medical Center. Patients diagnosed with ALK-positive advanced NSCLC and treated with alectinib or brigatinib were included. Key outcomes such as time to discontinuation (TTD), duration of response (DOR), overall survival (OS), and objective response rate (ORR) were analyzed.</p><p><strong>Results: </strong>A total of 143 patients were included (107 treated with alectinib, 36 with brigatinib). Alectinib was more frequently used as a first-line treatment (71% vs 44.4% for brigatinib, <i>p</i> = 0.008). Prior crizotinib treatment was more frequent in the brigatinib group (52.8% vs 22.4% for alectinib, <i>p</i> < 0.001). The best ORR was similar between the groups (84.1% for alectinib vs 83.3% for brigatinib, <i>p</i> = 0.518). The median TTD was 57.8 months (95% confidence interval (CI): 29.0-86.7) for alectinib and 39.6 months (95% CI: 21.7-57.4) for brigatinib (<i>p</i> = 0.462). No significant differences were observed in intracranial TTD, intracranial DOR, or OS between the groups. Prior crizotinib treatment significantly shortened TTD for second-generation TKIs (<i>p</i> = 0.025), but the overall TKI treatment duration did not show a significant difference between patients who received frontline second-generation ALK TKIs and those who received second-generation ALK TKIs sequentially after crizotinib.</p><p><strong>Conclusion: </strong>Alectinib and brigatinib demonstrated comparable efficacy in ALK-positive advanced NSCLC. Undergoing crizotinib followed by a second-generation TKI was not significantly different from initiating a second-generation TKI without prior crizotinib in terms of outcomes.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251316200"},"PeriodicalIF":4.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383393","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":"Desmoplastic reaction in the microenvironment of head and neck and other solid tumors: the therapeutic barrier.","authors":"Kohei Okuyama, Maiko Tsuchiya, Kala Chand Debnath, Shajedul Islam, Souichi Yanamoto","doi":"10.1177/17588359251317144","DOIUrl":"10.1177/17588359251317144","url":null,"abstract":"<p><p>Head and neck squamous cell carcinoma (HNSCC) remains a challenge due to limited prognostic biomarkers and therapeutic options. The tumor microenvironment (TME), particularly the desmoplastic reaction (DR) characterized by stromal fibrosis, plays a crucial role in cancer progression and resistance to therapy. This review aims to summarize the biological significance of DR in HNSCC initiation, progression, and treatment resistance. Histologically, DR in HNSCC correlates with invasion patterns and clinical outcomes, affecting disease-free and overall survival. The interaction between cancer-associated fibroblasts (CAFs) and TME influences immune responses, including resistance to immunotherapy. Notably, human papillomavirus-driven HNSCC exhibits distinct DR characteristics that further influence the prognosis. DR promotes epithelial-mesenchymal transition and cancer cell invasion through CAF-mediated extracellular matrix remodeling and signaling pathways such as transforming growth factor-beta. DR also affects bone invasion and chemotherapy resistance by modulating stromal responses. Therapeutic strategies targeting DR and stromal components show promise in overcoming therapeutic resistance including resistance to immune checkpoint inhibitors. Understanding the role of DR in HNSCC biology and its impact on treatment response is critical to developing effective therapeutic interventions.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251317144"},"PeriodicalIF":4.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383398","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":"TROPION-Breast04: a randomized phase III study of neoadjuvant datopotamab deruxtecan (Dato-DXd) plus durvalumab followed by adjuvant durvalumab versus standard of care in patients with treatment-naïve early-stage triple negative or HR-low/HER2- breast cancer.","authors":"Heather L McArthur, Sara M Tolaney, Rebecca Dent, Peter Schmid, Jamil Asselah, Qiang Liu, Jane Lowe Meisel, Naoki Niikura, Yeon Hee Park, Gustavo Werutsky, Giampaolo Bianchini, Jay C Andersen, Robert Kozarski, Nana Rokutanda, Barbara Pistilli, Sibylle Loibl","doi":"10.1177/17588359251316176","DOIUrl":"10.1177/17588359251316176","url":null,"abstract":"<p><strong>Background: </strong>Despite treatment advances for patients with early-stage triple-negative breast cancer (TNBC) and hormone receptor (HR)-low/human epidermal growth factor receptor 2-negative (HER2-) breast cancer, treatments that improve clinical outcomes while mitigating toxicity are needed. Datopotamab deruxtecan (Dato-DXd), a TROP2-directed antibody-drug conjugate consisting of a humanized IgG1 monoclonal antibody attached via a plasma-stable cleavable linker to a topoisomerase-I inhibitor payload, has shown efficacy alone or in combination with durvalumab, a selective, high-affinity anti-programmed cell death ligand 1 antibody, in early-phase clinical studies.</p><p><strong>Objectives: </strong>The primary objective of TROPION-Breast04 is to evaluate the efficacy and safety of neoadjuvant Dato-DXd plus durvalumab followed by adjuvant durvalumab with or without chemotherapy versus standard of care in patients with previously untreated early-stage TNBC or HR-low/HER2- breast cancer.</p><p><strong>Design: </strong>This is an ongoing, international, phase III, open-label, randomized controlled study.</p><p><strong>Methods and analysis: </strong>Approximately 1728 patients (aged ⩾18 years) will be randomized 1:1 to eight cycles of neoadjuvant Dato-DXd (6 mg/kg intravenously (IV) every 3 weeks (Q3W)) plus durvalumab (1120 mg IV Q3W) followed by nine cycles of adjuvant durvalumab (1120 mg IV Q3W) with or without chemotherapy versus eight cycles of pembrolizumab (200 mg IV Q3W) plus chemotherapy followed by nine cycles of adjuvant pembrolizumab (200 mg IV Q3W) with or without chemotherapy. Dual primary endpoints are pathological complete response by blinded central review and event-free survival by investigator assessment. Secondary endpoints include overall survival (key), distant disease-free survival, patient-reported outcomes, and safety.</p><p><strong>Ethics: </strong>The study is approved by independent ethics committees and/or institutional review boards at each study site. All patients will provide written informed consent.</p><p><strong>Discussion: </strong>This study will evaluate the potential use of neoadjuvant Dato-DXd plus durvalumab followed by adjuvant durvalumab with or without chemotherapy versus standard of care in patients with previously untreated early-stage TNBC or HR-low/HER2- breast cancer. The findings of this trial could lead to promising treatment options for these patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06112379.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251316176"},"PeriodicalIF":4.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365826","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":"Metastatic SQSTM1-NTRK1 fused non-small-cell lung cancer treated with larotrectinib and stereotactic radiosurgery resulting in durable complete response: a case report.","authors":"Colton Betts, Ari Kassardjian, Arya Amini","doi":"10.1177/17588359251317134","DOIUrl":"10.1177/17588359251317134","url":null,"abstract":"<p><p>Lung cancer is one of the most common malignancies and causes the most cancer deaths in the United States. Targeted therapies have improved the survival of patients with advanced disease. Neurotrophic tropomyosin receptor kinase (NTRK) fusions are a rare oncogenic driver that has been targeted with the tumor-agnostic drug, larotrectinib. There are limited data on the treatment of non-small-cell lung cancer (NSCLC) with larotrectinib because of the rarity of this fusion in this population. We present the case of a patient who was diagnosed with <i>SQSTM1-NTRK1</i> fused NSCLC with polymetastatic disease involving the brain and subsequently treated with a multidisciplinary approach via neurosurgical resection, radiotherapy, and larotrectinib. The combination of aggressive local treatments and systemic therapy is a relatively new treatment paradigm and represents a new area of research to optimize local control of metastatic lesions and potentially improve progression-free survival compared to the trials that show the efficacy of systemic monotherapies. The patient has experienced a sustained complete response to treatment almost 3 years later, and he has tolerated the drug without any significant adverse effects. The combination of systemic therapy with larotrectinib and aggressive local treatments could benefit patients with targetable fusions even with multiple metastatic lesions.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251317134"},"PeriodicalIF":4.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256721","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":"Efficacy and safety of immunotherapy in locally advanced or metastatic pulmonary lymphoepithelioma-like carcinoma: a multicenter retrospective study.","authors":"Xiongwen Yang, Yi Xiao, Yubin Zhou, Hao Hu, Huiyin Deng, Jian Huang, Maoli Liang, Zihao Yuan, Longyan Dong, Shaohong Huang","doi":"10.1177/17588359251316099","DOIUrl":"10.1177/17588359251316099","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary lymphoepithelioma-like carcinoma (pLELC) is a rare subtype of non-small-cell lung cancer that predominantly affects younger, non-smoking individuals in southern and southeast Asia, where Epstein-Barr virus (EBV) prevalence is high. The efficacy and safety of immunotherapy in pLELC, especially in second-line settings, remain inadequately explored.</p><p><strong>Objectives: </strong>This study aimed to evaluate the efficacy of immunotherapy, either alone or in combination with chemotherapy, in improving progression-free survival (PFS) and overall survival (OS) in patients with advanced pLELC.</p><p><strong>Design: </strong>This was a multicenter retrospective study.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 252 patients with stage IIIB-IV pLELC treated across six centers. Patients received chemotherapy, immunotherapy, or a combination of both (chemoimmunotherapy). The primary outcomes measured were PFS and OS across different treatment regimens.</p><p><strong>Results: </strong>Chemoimmunotherapy significantly improved both PFS and OS compared to chemotherapy alone, in both first- and second-line settings. In first-line treatment, chemoimmunotherapy resulted in a median PFS of 17.6 months and OS of 26.1 months, compared to chemotherapy alone (PFS 8.7 months, OS 19.2 months). In the second-line setting, chemoimmunotherapy achieved a median PFS of 5.1 months and OS of 13.5 months, surpassing the outcomes with chemotherapy alone (PFS 3.3 months, OS 8.9 months). High baseline EBV-DNA levels (>2000 copies/mL) and low programmed death ligand 1 (PD-L1) expression (<50%) were associated with poorer outcomes. In addition, patients with high baseline serum tumor markers (STMs) and a dynamic reduction of ⩽20% in STMs exhibited significantly worse PFS and OS.</p><p><strong>Conclusion: </strong>The study suggests that immunotherapy, particularly when combined with chemotherapy, offers significant survival benefits for patients with advanced pLELC. Baseline EBV-DNA levels, PD-L1 expression, and both baseline and dynamic STM changes serve as important predictors of treatment response, highlighting the need for personalized therapeutic approaches in this unique subtype of lung cancer.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251316099"},"PeriodicalIF":4.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079933","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":"Anti-programmed death-1 inhibitors and nimotuzumab in combination with induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score-matched analysis.","authors":"Ya-Ni Zhang, Yu-Pei Chen, Pu-Yun OuYang, Tai-Xiang Lu, Fang-Yun Xie, Fei Han, Chun-Yan Chen","doi":"10.1177/17588359251316094","DOIUrl":"10.1177/17588359251316094","url":null,"abstract":"<p><strong>Background: </strong>The poor prognosis of locoregionally advanced nasopharyngeal carcinoma (LANPC) due to the high incidence of metastasis necessitates effective treatment strategies. Synergistic effects have been observed when anti-programmed death-1 (PD-1) inhibitors are combined with chemotherapy or targeted therapy.</p><p><strong>Objectives: </strong>To compare the efficacy and safety of induction chemotherapy in combination with nimotuzumab with or without anti-PD-1 inhibitors for LANPC.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Methods: </strong>In total, 319 patients with LANPC were retrospectively enrolled between December 2017 and November 2022. The primary endpoint was progression-free survival (PFS). Propensity score matching was performed to adjust for potential confounders.</p><p><strong>Results: </strong>Overall, 150 patients were included after propensity score matching. The immunotherapy + nimotuzumab + chemotherapy (INC) group (<i>n</i> = 50) had a higher 3-year PFS rate (96.6% (95% confidence interval (CI): 93.2-100.0)) than the nimotuzumab + chemotherapy (NC) group (<i>n</i> = 100) (79.8% (95% CI: 75.6-84.0)). The INC group had a hazard ratio of 0.16 (95% CI: 0.02-1.22; <i>p</i> = 0.04). The objective response rates were 100% and 99% for the INC and NC groups, respectively. Grade ⩾3 treatment-related adverse events were reported in eight (5.3%) patients, and hyponatremia (2.0%) was the most common. Grade ⩾3 immune-related adverse events (rash and reactive capillary proliferation) were reported in two (4.0%) patients.</p><p><strong>Conclusion: </strong>INC demonstrated remarkable anti-tumor activity with acceptable safety for LANPC.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359251316094"},"PeriodicalIF":4.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081147","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":"Rare epithelial gastric cancers: a review of the current treatment knowledge.","authors":"Angelica Petrillo, Margaret Ottaviano, Luca Pompella, Emilio Francesco Giunta, Pasquale Pisapia, Gianpaolo Marte, Andrea Tufo, Sara Di Lorenzo, Jessica Orefice, Chiara Miceli, Umberto Malapelle, Bruno Daniele, Ferdinando De Vita","doi":"10.1177/17588359241255628","DOIUrl":"10.1177/17588359241255628","url":null,"abstract":"<p><p>Gastric cancer (GC), one of the tumours with the highest mortality worldwide, is not a homogeneous disease, showing different features according to location, macroscopic aspect, histotype and molecular alterations. Adenocarcinoma is the most frequent epithelial GC (95%), the remaining 5% comprising rare epithelial tumours with their peculiarities, behaviour and incidence <6 cases/100,000/year. Due to the low number of cases, many aspects must be elucidated in this context. In this narrative review, we highlight the importance of a better understanding of rare GCs to personalize the cures in the light of the precision medicine concept. Our main aim is to translate the scarce evidence from the literature into daily clinical practice, never forgetting that all the clinicians dedicated to rare GCs should encourage such patients' enrolment in clinical trials and promote international collaborations. Hence, we focused on the treatment of the following rare GCs: rare gastric adenocarcinomas (hepatoid adenocarcinoma, medullary carcinoma with lymphoid stroma, Paneth cell carcinoma and Salivary Gland carcinoma); squamous cell carcinoma; adenosquamous carcinoma; neuroendocrine gastric neoplasms; gastroblastoma.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359241255628"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047906","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 association between level IV/V metastasis and the recurrence, distant metastasis, and survival outcomes in hypopharyngeal squamous cell carcinoma.","authors":"Ruichen Li, Qi Wang, Siyuan Ma, Ji Li, Yang Zhao, Xiaoshen Wang","doi":"10.1177/17588359241312079","DOIUrl":"10.1177/17588359241312079","url":null,"abstract":"<p><strong>Background: </strong>The presence of level IV/V metastasis is a significant prognostic factor for patients with oral and oropharyngeal cancer, while level IV lymphadenopathy defines the N3 stage in nasopharyngeal carcinoma. However, the current staging system for hypopharyngeal squamous cell carcinoma (HPSCC) does not consider the location of involved nodes.</p><p><strong>Objectives: </strong>To evaluate the risk factors and prognostic impact of level IV/V metastasis in patients with HPSCC.</p><p><strong>Methods: </strong>The analysis included 2740 HPSCC patients from the SEER (Surveillance, Epidemiology, and End Results) database, followed by a validated study on 232 patients with pathologically positive nodes (pN+) at our center.</p><p><strong>Results: </strong>Of the 2740 patients, 1961 presented with metastatic lymph nodes (LNs), 20.8% and 14.1% had nodal involvement in level IV and level V, respectively. Multivariate analysis revealed that N3 and M1 stages were independently associated with level IV/V metastasis. Level IV metastasis was the sole independent adverse factor for overall survival (OS) among all LN regions (<i>p</i> < 0.05). Regarding cancer-specific survival (CSS), only level IV and V involvement were independent predictors of prognosis (<i>p</i> < 0.05). The rate of pN+ at levels IV and V in our center was 35.8% and 16.4%, respectively. The advanced pN stage was independently associated with metastasis to level IV or V. Patients with level IV/V metastasis had significantly higher rates of regional recurrence and distant metastases (<i>p</i> < 0.001). Multivariate analysis confirmed a significant association regarding OS, CSS, locoregional relapse-free survival (LRFS), or distant metastasis-free survival between patients with and without level IV metastasis (<i>p</i> < 0.05). Patients with level IV/V disease exhibited decreased survival rates across stages pN1 to pN3. Postoperative chemoradiotherapy improved LRFS in patients with level IV lymphadenopathy and OS/CSS in patients with level V metastasis.</p><p><strong>Conclusion: </strong>Metastasis to level IV/V was associated with a worse prognosis in HPSCC patients. The level IV/V should be considered for future improvements to the staging system.</p><p><strong>Design: </strong>A retrospective study.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359241312079"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047913","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":"Extracellular vesicles-a new player in the development of urinary bladder cancer.","authors":"Damian Kasiński, Kamil Szeliski, Tomasz Drewa, Marta Pokrywczyńska","doi":"10.1177/17588359241297529","DOIUrl":"10.1177/17588359241297529","url":null,"abstract":"<p><p>Bladder cancer was the 10th most commonly diagnosed cancer worldwide in 2020. Extracellular vesicles (EVs) are nano-sized membranous structures secreted by all types of cells into the extracellular space. EVs can transport proteins, lipids, or nucleic acids to specific target cells. What brings more attention and potential implications is the fact that cancer cells secrete more EVs than non-malignant cells. EVs are widely studied for their role in cancer development. This publication summarizes the impact of EVs secreted by urinary bladder cancer cells on urinary bladder cancer development and metastasis. EVs isolated from urinary bladder cancer cells affect other lower-grade cancer cells or normal cells by inducing different metabolic pathways (transforming growth factor β/Smads pathway; phosphoinositide 3-kinase/Akt pathway) that promote epithelial-mesenchymal transition. The cargo carried by EVs can also induce angiogenesis, another critical element in the development of bladder cancer, and modulate the immune system response in a tumor-beneficial manner. In summary, the transfer of substances produced by tumor cells via EVs to the environment influences many stages of tumor progression. An in-depth understanding of the role EVs play in the development of urinary bladder cancer is crucial for the development of future anticancer therapies.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"17 ","pages":"17588359241297529"},"PeriodicalIF":4.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029375","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}