Clinical Medicine Insights-Oncology最新文献

{"title":"Comparing Immunotherapy Versus Chemotherapy Alone as Second-Line Therapy for Malignant Tumors of the Biliary Tract: A Retrospective Study.","authors":"Chengzhi Jiang, Liu Yang, Ling Yang Kong, Tianyuan Fang, Lele Chang, Lei He, Qian Ma, YiBo Cheng, Wanying Wang, Zhigang Ma, Qingwei Li, Ji Tao","doi":"10.1177/11795549251317012","DOIUrl":"10.1177/11795549251317012","url":null,"abstract":"<p><strong>Background: </strong>Bile duct carcinoma (BTC) is an uncommon malignant tumor of the gastrointestinal tract. Management is limited after the progress of first-line treatment. Immune checkpoint inhibitors (ICIs) have been proven popular in solid tumors. Immunotherapy plus chemotherapy has been a standard scheme in the management of multiple types of cancer. However, their efficacy and safety still need further exploration in patients who diagnosed BTC. This research mainly discusses the efficacy of immunotherapy in the second-line use of cholangiocarcinoma.</p><p><strong>Methods: </strong>In total, 126 individuals with BTC diagnosis from 2014 to 2024, who were treated with first-line or neoadjuvant treatment but were evaluated for progression or intolerance, were retrospectively included. All patients received standard chemotherapy, 57 received ICIs in combination with targeted therapy or not, and 69 did not. Patients were divided into simple chemotherapy (SC) and CT. Differences in efficacy, adverse events, progression-free survival (PFS), overall survival (OS), progressive disease (PD), and efficacy of multiple factors and efficacy were analyzed. The primary endpoint is defined as OS. The secondary endpoint is defined as PFS, objective response rate (ORR), disease control rate (DCR), and treatment-related adverse reactions (TRAEs).</p><p><strong>Results: </strong>The PFS and OS of 4.68 and 30.26 months for ICIs with or without targeted therapy were proven statistically significant (<i>P</i> = .0012; <i>P</i> < .001). The ORR was 5.26% (3/57) in the CT group and 1.45% (1/69) in the SC group, and the DCR was 54.39% (31/57) compared with 33.33% (23/69). Cox analysis showed that TNM stage, T stage, histology grade, CA199 level, and treatment assessment grade were associated with OS (<i>P</i> < .05). Histologic differentiation (<i>P</i> = .009) and CA199 reduced (<i>P</i> = .003) were proven as independent prognostic factors. The highest grade of 3 to 4 adverse reactions (TRAEs) was a reduction in hemoglobin (29.37%).</p><p><strong>Conclusion: </strong>Our work concluded that immunocombined chemotherapy with or without specific treatment showed significant antitumor activity and acceptable safety. Immune checkpoint inhibitors are likely to be a reliable second-line therapy for advanced BTC.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"19 ","pages":"11795549251317012"},"PeriodicalIF":1.9,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifiable Risk Factors Including Self-Perceived Stress for Breast Cancer in Hong Kong: A Case-Control Study of 10 757 Subject.","authors":"Winnie Yeo, Lok-Wa Yuen, Kelvin Kam-Fai Tsoi, Emily Ying-Yang Chan, Carol C Kwok, Inda Soong, Ting-Ying Ng, Joanne Chiu, Miranda Chan, Sharon Wing-Wai Chan, Ting-Ting Wong, Yolanda Ho-Yan Chan, Lawrence Pui-Ki Li, Chun-Chung Yau, Wai-Ka Hung, Polly Suk-Yee Cheung","doi":"10.1177/11795549251314434","DOIUrl":"10.1177/11795549251314434","url":null,"abstract":"<p><strong>Background: </strong>In Hong Kong, breast cancer is the commonest female cancer. In addition to intrinsic risk factors that cannot be modified, other factors may be potentially modifiable. The objective of this report was to determine modifiable risk factors in association with breast cancer among Chinese women in our locality.</p><p><strong>Methods: </strong>This is a case-control study that enrolled breast cancer patients from the Hong Kong Breast Cancer Registry and healthy matched controls from the local community between 2014 and 2017. Potential risk factors were analyzed using multiple logistic regression.</p><p><strong>Results: </strong>In total, 5186 breast cancer patients and 5571 controls were recruited. Several modifiable risk factors were identified. Self-perceived high stress level (adjusted odd ratios [AOR]= 3.44; 95% confidence intervals [CI] = 3.13-3.78), dairy-rich diet (AOR = 3.33; 95% CI = 2.01-5.52), delayed child-bearing (AOR = 2.23; 95% CI = 1.79-2.79), meat-rich diet (AOR = 1.77; 95% CI = 1.54-2.04), ever use of oral contraceptives (AOR = 1.34; 95% CI = 1.22-1.47), nulliparity (AOR = 1.21; 95% CI = 1.08-1.35), and being overweight/obese (AOR = 1.21; 95% CI = 1.10-1.32) were found to be associated with an increased risk of breast cancer. On the other hand, breastfeeding (AOR = 0.76; 95% CI = 0.69-0.83) and exercise (odds ratio = 0.62; 95% CI = 0.56-0.68) were associated with decreased risk.</p><p><strong>Conclusions: </strong>In our locality, high-stress level, meat- and dairy-rich diet, reproductive history, use of oral contraceptives, and being overweight/obese were identified to be modifiable risk factors for breast cancer. Lifestyle modification may help reduce breast cancer incidence in the coming decades.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"19 ","pages":"11795549251314434"},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and Predictive Recurrence Value of Plasma Fibrinogen in Patients With Adrenocortical Carcinoma.","authors":"Chengquan Ma, Bin Yang, Quanzong Mao","doi":"10.1177/11795549241271657","DOIUrl":"https://doi.org/10.1177/11795549241271657","url":null,"abstract":"<p><strong>Background: </strong>The correlation between fibrinogen levels and adrenocortical carcinoma (ACC) remains unclear. This study aimed to explore the value of preoperative plasma fibrinogen as a biomarker for ACC.</p><p><strong>Methods: </strong>We identified 40 patients with ACC and 170 patients with adrenal adenoma (AA) who underwent surgery at our institution between 2015 and 2022. Plasma fibrinogen levels and postoperative tumor recurrence information of the patients were also recorded. For intergroup comparisons, data obtained from the AA and ACC groups were evaluated using a <i>t</i>-test. The cutoff value of fibrinogen level was determined using a receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Mean fibrinogen levels in the AA and ACC groups were 2.81 ± 0.59 g/L and 3.88 ± 1.75 g/L, respectively (<i>P</i> < .001). Fibrinogen level, which can help distinguish between AA and ACC, was evaluated using the ROC curve. The cutoff fibrinogen level was estimated as 3.87 g/L according to the Youden index. With this value, the sensitivity was 62.5%, specificity was 95.7%, and the area under the ROC curve (AUC) was 0.74 (<i>P</i> < .001). Fibrinogen level, which can help distinguish between recurrence and non-recurrence, was evaluated using the ROC curve. The cutoff fibrinogen level was estimated as 3.96 g/L according to the Youden index. The sensitivity, specificity, and AUC were 90%, 71.4%, and 0.85, respectively (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>According to the data in this study, plasma fibrinogen could be used to distinguish ACC from AA. Most importantly, plasma fibrinogen may be used to identify recurrence of postoperative ACC.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"19 ","pages":"11795549241271657"},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive Treatment of Metastatic Prostate Cancer Using Generative Artificial Intelligence.","authors":"Youcef Derbal","doi":"10.1177/11795549241311408","DOIUrl":"https://doi.org/10.1177/11795549241311408","url":null,"abstract":"<p><p>Despite the expanding therapeutic options available to cancer patients, therapeutic resistance, disease recurrence, and metastasis persist as hallmark challenges in the treatment of cancer. The rise to prominence of generative artificial intelligence (GenAI) in many realms of human activities is compelling the consideration of its capabilities as a potential lever to advance the development of effective cancer treatments. This article presents a hypothetical case study on the application of generative pre-trained transformers (GPTs) to the treatment of metastatic prostate cancer (mPC). The case explores the design of GPT-supported adaptive intermittent therapy for mPC. Testosterone and prostate-specific antigen (PSA) are assumed to be repeatedly monitored while treatment may involve a combination of androgen deprivation therapy (ADT), androgen receptor-signalling inhibitors (ARSI), chemotherapy, and radiotherapy. The analysis covers various questions relevant to the configuration, training, and inferencing of GPTs for the case of mPC treatment with a particular attention to risk mitigation regarding the hallucination problem and its implications to clinical integration of GenAI technologies. The case study provides elements of an actionable pathway to the realization of GenAI-assisted adaptive treatment of metastatic prostate cancer. As such, the study is expected to help facilitate the design of clinical trials of GenAI-supported cancer treatments.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"19 ","pages":"11795549241311408"},"PeriodicalIF":1.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11701910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Cystatin S (CST4): A Novel Prognostic Marker for Gastric Cancer.","authors":"Chao Gu, Shan Chen, Lining Huang, Chenliang Cao, Renshun Yuan, Zhongyang Kou, Weiwei Chen, Haihua Shi, Xiaodong Gu","doi":"10.1177/11795549241311404","DOIUrl":"https://doi.org/10.1177/11795549241311404","url":null,"abstract":"<p><strong>Background: </strong>Serum Cystatin S (CST4), a secretory protein that inhibits cellular matrix degradation, significantly influences the tumor microenvironment and tumor progression. However, the prognostic value of serum CST4 in gastric cancer (GC) remains unclear. This study aims to explore serum CST4's utility in GC prognostic assessment.</p><p><strong>Methods: </strong>A cohort of 334 patients with GC who underwent radical gastrectomy was assessed. Preoperative serum CST4 levels were measured alongside traditional tumor markers, correlating with clinical data and patient outcomes. The cohort was divided into training and test sets at a ratio of 3:1 for Cox regression analyses, which identified CST4 as an independent risk factor for overall survival (OS) and disease-free survival (DFS). A prognostic model was developed, validated with calibration curves, and its predictive value was evaluated using receiver operating characteristic (ROC) curves. In addition, CST4 expression was correlated with immune cell infiltration using data from The Cancer Genome Atlas (TCGA). Patients were stratified by median CST4 levels, and Kaplan-Meier curves for OS and DFS were plotted.</p><p><strong>Results: </strong>Cystatin S was confirmed as an independent risk factor for OS and DFS. Integrating CST4 with traditional markers and TNM pathological staging significantly enhanced the predictive value for prognosis. Cystatin S's impact on tumor progression is likely mediated through modulation of the immune microenvironment, including immune suppression and evasion.</p><p><strong>Conclusion: </strong>Cystatin S is an effective biomarker for GC prognostic assessment, assisting in the evaluation of prognosis and the selection of treatment strategies for patients with GC.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"19 ","pages":"11795549241311404"},"PeriodicalIF":1.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Intestinal Microbiota and Their Relationship With Patient Characteristics in Colorectal Cancer.","authors":"Lu Zhao, Yongkun Fang, Jingqiu Zhang, Chen Wei, Hao Ji, Jiahao Zhao, Daorong Wang, Dong Tang","doi":"10.1177/11795549241307632","DOIUrl":"10.1177/11795549241307632","url":null,"abstract":"<p><strong>Background: </strong>Gut microbiota are associated with the pathological features and development of colorectal cancer (CRC); however, how gut microbiota changes in patients with CRC is unknown. This study investigated the role of gut microbiota in the development and progression of CRC by retrospectively comparing the structural differences between the gut microbiota of patients with CRC and healthy individuals.</p><p><strong>Methods: </strong>Together with clinical data, we collected fecal samples from patients with CRC (n = 18) and healthy controls (n = 18) and performed 16S rRNA gene sequencing and alpha and beta diversity analysis to compare microbiota richness and diversity. Based on the differences in microbiota between the CRC and control groups, we identified disease-specific microbial communities after relevant factors. PICRUSt2 software was used to predict the differential microbial functions.</p><p><strong>Results: </strong>The CRC and control groups differed in both composition and abundance of intestinal microbiota. Firmicutes and Bacteroidetes were the most abundant phyla in both groups, while Verrucomicrobi was significantly more abundant in the CRC group. <i>Megamonas</i>, <i>Lachnospira</i>, and <i>Romboutsia</i> were more abundant in the control group; 18 genera differed significantly in abundance between the groups, which were found to involve 21 metabolic pathways. The distribution and abundance of gut microbiota differed significantly between patients with CRC with and without lymph node metastasis; at the genus level, the abundance of <i>Rothia</i> and <i>Streptococcus</i> was significantly higher and that of <i>Bacteroides</i>, <i>Parabacteroides</i>, and <i>Oscillibacter</i> was significantly lower in patients with lymph node metastasis.</p><p><strong>Conclusions: </strong>The gut microbiota is altered in CRC patients compared with healthy individuals, with specific changes in the microbiota associated with clinical and pathological features such as tumor stage, lymph node involvement, and tumor differentiation. Our findings elaborate to some extent on the link between the gut microbiota and CRC.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"18 ","pages":"11795549241307632"},"PeriodicalIF":1.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 Paclitaxel-Based PD-1/PD-L1 Immunotherapies for Triple-Negative Breast Cancer: A Systematic Review and Network Meta-Analysis.","authors":"Youran Dai, Tianyin Ruan, Wenhui Yang, Shan Liu, Jiahao Chen, Yingying Fang, Qiushuang Li","doi":"10.1177/11795549241308072","DOIUrl":"10.1177/11795549241308072","url":null,"abstract":"<p><strong>Background: </strong>Triple negative breast cancer (TNBC) is a deadly subtype of breast cancer with limited treatment options. Currently, programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have become the first choice for breast cancer immunotherapies. Despite paclitaxel being considered a cornerstone drug in breast cancer treatment, the effectiveness, safety, and optimal drug selection for its combination with PD-1/PD-L1 inhibitors remain uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review and network meta-analysis, performing a comprehensive literature search across PubMed, Embase, and the Cochrane Library from the inception of each database through May 18, 2024. Selected trials were those that assessed the efficacy and safety of paclitaxel-based PD-1/PD-L1 therapies for the treatment of TNBC. The primary endpoint assessed was overall survival (OS), while secondary outcomes included progression-free survival (PFS), adverse events (AEs), overall response rate (ORR), and Pathological complete response (pCR). This study is registered in PROSPERO under registration number CRD42023429651.</p><p><strong>Results: </strong>A total of 8 RCTs meeting our eligibility criteria were included, involving 4626 patients who received either Paclitaxel (Paclitaxel-placebo/chemotherapy) or a combination of durvalumab, pembrolizumab, atezolizumab, toripalimab with paclitaxel. The pooled results demonstrated that Durvalumab combined with Paclitaxel significantly reduced the hazard ratio for OS (surface under the cumulative ranking [SUCRA]: 91.05%) and PFS compared with Paclitaxel alone (SUCRA: 83.52%). Additionally, Durvalumab plus Paclitaxel significantly improved the ORR compared with Paclitaxel (odds ratio [OR]: 2.30; 95% credible interval [CrI]: 1.10-5.20). For safety outcomes, Atezolizumab plus Paclitaxel showed a favorable profile in AEs, with no significant differences observed between groups. In the pCR study, Pembrolizumab plus Paclitaxel was the most effective treatment option (SUCRA: 81.85%).</p><p><strong>Conclusions: </strong>When combined with paclitaxel, PD-1/PD-L1 inhibitors exhibit a favorable survival benefit. The combination of Durvalumab and paclitaxel represents the optimal treatment option. In the future, attention should be paid to the TNBC subtypes and drug dosage, as these factors may help to design personalized TNBC treatment programs.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"18 ","pages":"11795549241308072"},"PeriodicalIF":1.9,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Cancer Type on Stroke Incidence: A Retrospective Study.","authors":"İbrahim Acır, Hacı Ali Erdoğan, Ertuğrul Toka, Vildan Yayla","doi":"10.1177/11795549241308090","DOIUrl":"10.1177/11795549241308090","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to examine the hematological and biochemical variables in patients diagnosed with cancer-related stroke who have different types of cancer and to evaluate the effects of these variables.</p><p><strong>Methods: </strong>This retrospective study was conducted at a tertiary hospital stroke center and included 153 patients diagnosed with cancer-related stroke. Comprehensive etiological investigations were performed, and patients were classified according to the Trial of Org 101072 in Acute Stroke Treatment (TOAST) classification. Laboratory parameters including d-dimer, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen levels were collected from blood samples taken at the time of stroke. Statistical analysis was performed using 1-way analysis of variance to assess differences in laboratory parameters across different cancer types.</p><p><strong>Results: </strong>The study found significant variations in hematological and biochemical parameters among different cancer types. Specifically, glomerular filtration rate, activated partial thromboplastin time, prothrombin time, and international normalized ratio levels showed significant differences across cancer types (<i>P</i> < 0.05), indicating that these factors may play distinct roles in the pathophysiology of cancer-related strokes. d-dimer, CRP, and sedimentation levels were significantly elevated in certain cancer types such as rectal, endometrial, and pancreatic cancers (<i>P</i> < .01). These findings suggest a strong association between hypercoagulability and increased risk of stroke in these patients.</p><p><strong>Conclusions: </strong>This retrospective study highlights the importance of considering cancer-specific factors in the management of stroke risk, particularly in cancers such as pancreatic and colon, which show a predisposition to earlier stroke occurrence. The elevated coagulation factors in these patients suggest the potential need for early preventive treatment with anticoagulants or thrombin inhibitors.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"18 ","pages":"11795549241308090"},"PeriodicalIF":1.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Antibody-Drug Conjugates in Urothelial Cancer: A Review of Recent Advances in the Treatment of Locally Advanced and Metastatic Urothelial Cancer.","authors":"Evangelia Vlachou, Burles Avner Johnson, Jean Hoffman-Censits","doi":"10.1177/11795549241290787","DOIUrl":"10.1177/11795549241290787","url":null,"abstract":"<p><p>Locally advanced and metastatic urothelial cancer (la/mUC) is an aggressive disease with poor prognosis. Platinum-based chemotherapy has remained the first-line treatment for decades and until recently no other treatment options existed. Today, novel agents called antibody drug conjugates (ADCs), including enfortumab vedotin (EV) and sacituzumab govitecan (SG), have been approved for la/mUC offering patients treatment options following or instead of traditional chemotherapy. The EV consists of the chemotherapy monomethyl auristatin E linked to anti-nectin-4 antibody. Single-agent response rates for EV are 40% to 52% including activity in patients with liver metastases, a phenotype associated with worse outcomes. In 2023, EV in combination with pembrolizumab almost doubled progression-free and overall survival versus platinum-based chemotherapy, which led to accelerated FDA approval as first-line treatment for all patients with la/mUC. Safety profile of EV monotherapy and combination with pembrolizumab is generally manageable with peripheral neuropathy and cutaneous toxicity among the most common treatment-related adverse events (TRAEs). The SG is another ADC targeting TROP-2 with SN-38 as payload. It is approved as late-line treatment for la/mUC with ORR 27% and most common TRAEs include gastrointestinal symptoms and neutropenia. Finally, a recent cancer agnostic accelerated approval for trastuzumab deruxtecan (T-DXd) in HER2-positive (IHC3+) solid tumors provides another active ADC option for biomarker-selected patients with treatment refractory la/mUC. Several new ADCs are being investigated in urothelial cancer (UC) clinical trials. This review summarizes the clinical studies and real-world data regarding the use of ADCs in UC.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"18 ","pages":"11795549241290787"},"PeriodicalIF":1.9,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synthesizing Efficiency Tools in Radiotherapy to Increase Patient Flow: A Comprehensive Literature Review.","authors":"Duvern Ramiah, Daniel Mmereki","doi":"10.1177/11795549241303606","DOIUrl":"10.1177/11795549241303606","url":null,"abstract":"<p><p>The promise of novel technologies to increase access to radiotherapy in low- and middle-income countries (LMICs) is crucial, given that the cost of equipping new radiotherapy centres or upgrading existing machinery remains a major obstacle to expanding access to cancer treatment. The study aims to provide a thorough analysis overview of how technological advancement may revolutionize radiotherapy (RT) to improve level of care provided to cancer patients. A comprehensive literature review following some steps of systematic review (SLR) was performed using the Web of Science (WoS), PubMed, and Scopus databases. The study findings are classified into different technologies. Artificial intelligence (AI), knowledge-based planning, remote planning, radiotherapy, and scripting are all ways to increase patient flow across radiation oncology, including initial consultation, treatment planning, delivery, verification, and patient follow-up. This review found that these technologies improve delineation of organ at risks (OARs) and considerably reduce waiting times when compared with conventional treatment planning in RT. In this review, AI, knowledge-based planning, remote radiotherapy treatment planning, and scripting reduced waiting times and improved organ at-risk delineation compared with conventional RT treatment planning. A combination of these technologies may lower cancer patients' risk of disease progression due to reduced workload, quality of therapy, and individualized treatment. Efficiency tools, such as the application of AI, knowledge-based planning, remote radiotherapy planning, and scripting, are urgently needed to reduce waiting times and improve OAR delineation accuracy in cancer treatment compared with traditional treatment planning methods. The study's contribution is to present the potential of technological advancement to optimize RT planning process, thereby improving patient care and resource utilization. The study may be extended in the future to include digital integration and technology's impact on patient safety, outcomes, and risk. Therefore, in radiotherapy, research on more efficient tools pioneers the development and implementation of high-precision radiotherapy for cancer patients.</p>","PeriodicalId":48591,"journal":{"name":"Clinical Medicine Insights-Oncology","volume":"18 ","pages":"11795549241303606"},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}