Current Treatment Options in Oncology最新文献

{"title":"The Improving Outcomes in Relapsed-Refractory Diffuse Large B Cell Lymphoma: The Role of CAR T-Cell Therapy.","authors":"Vibor Milunović, Dora Dragčević, Martina Bogeljić Patekar, Inga Mandac Smoljanović, Slavko Gašparov","doi":"10.1007/s11864-025-01305-9","DOIUrl":"10.1007/s11864-025-01305-9","url":null,"abstract":"<p><strong>Opinion statement: </strong>Diffuse large B cell lymphoma, not otherwise specified (DLBCL-NOS) is the most common aggressive lymphoma and can be cured with CHOP-R immunochemotherapy in 60% of cases. The second-line therapy includes salvage regimens followed by autologous stem cell transplantation (ASCT), which offers a cure to a minority of patients due to limitations in efficacy and eligibility. These data present the unmet need in the field, and this review article focuses on how second-generation chimeric antigen receptor T (CAR T) cell therapy targeting CD19 antigen may improve the outcomes with relapsed/refractory DLBCL. In heavily pretreated patients, who have dismal outcomes with conventional therapy, all three approved products-tisangenlecleucel (tisa-cel), axicabtagene ciloleucel (axi-cel), and lisocabtagene maraleucel (liso-cel) have shown durable, unprecedented complete responses with the potential for cure. When compared to salvage regimens and ASCT as the standard of care, axi-cel and liso-cel, unlike tisa-cel, have demonstrated superiority in long-term control. In ASCT-ineligible r/r DLBCL, liso-cel has shown a favourable benefit-risk ratio. Regarding safety, two adverse events of interest have emerged: cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, both of which are manageable. Real-world evidence reflects the results of pivotal trials while favouring axi-cel in heavily pretreated patients, albeit with higher toxicity. The main barrier to the implementation of this treatment modality is the cost associated with the process of CAR T therapy, along with complications and reimbursement issues. However, the barriers can be overcome, and CAR T therapy has the potential to become the standard of care in relapsed/refractory DLBCL. Furthermore, with advances in the scientific engineering of CAR products and the understanding of novel treatment modalities currently being tested in clinical trials, we believe that targeted cellular therapy will become the future of relapsed/refractory DLBCL treatment.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"445-464"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Targeted Therapy for Metastatic Prostate Cancer.","authors":"Kabir Grewal, Tanya B Dorff, Sagar S Mukhida, Neeraj Agarwal, Andrew W Hahn","doi":"10.1007/s11864-025-01323-7","DOIUrl":"10.1007/s11864-025-01323-7","url":null,"abstract":"<p><strong>Opinion statement: </strong>Over the past few years, treatment for advanced prostate cancer has begun shifting away from a one-size-fits-all approach toward biomarker-based therapies for select groups of patients. This review highlights the role of poly-ADP-ribose-polymerase (PARP) inhibitors in metastatic prostate cancer, emerging strategies to target the androgen receptor (AR), and innovative therapies aimed at cell surface proteins, including radioligand therapies, bispecific T cell engagers, and antibody-drug conjugates. For patients with homologous recombination repair (HRR)-mutated metastatic castration-resistant prostate cancer (CRPC), we favor combining a PARP inhibitor (PARPi) with an AR pathway inhibitor (ARPI), provided they can tolerate a more aggressive treatment strategy. In our opinion, patients with BRCA1 or BRCA2 mutations who are unable to handle combination therapy benefit from PARPi monotherapy. We are enthusiastic about the potential of ongoing clinical trials for new AR-directed therapies, such as AR ligand-directed degraders and CYP11A1 inhibitors, in metastatic CRPC. These treatments are expected to be most beneficial for patients whose cancer continues to rely on AR pathway signaling, suggesting they might also be effective in earlier stages of the disease. Progress in drug development and understanding of protein structures has led to new therapies that target cell surface proteins predominantly found in prostate cancer. We use ¹⁷⁷Lu-PSMA-617 for patients with PSMA avid metastatic CRPC who have progressed on an ARPI and a taxane chemotherapy. Additionally, we see promising potential in bispecific T-cell engagers (e.g., STEAP1-CD3 and PSMA-CD3) and novel radioligand therapies, including those utilizing actinium, to target these proteins. These advances show great promise in further enhancing survival for patients with metastatic prostate cancer.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"465-475"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Radiotherapy in PCNSL within the Current Therapeutic Landscape: a Comprehensive Review.","authors":"Min Li, Ran Peng, Fang Bao, Hongmei Jing, Hao Wang","doi":"10.1007/s11864-025-01327-3","DOIUrl":"10.1007/s11864-025-01327-3","url":null,"abstract":"<p><strong>Opinion statement: </strong>The therapeutic landscape for primary central nervous system lymphoma (PCNSL) continues to evolve, raising critical questions about the optimal integration of whole-brain radiotherapy (WBRT) to improve patient outcomes. Historically, WBRT has been a cornerstone in PCNSL management, offering effective disease control and relapse prevention. However, the use of high-dose WBRT (HD-WBRT) (≥ 36 Gy), while efficacious, has been associated with significant neurotoxicity, particularly in elderly patients, which has curtailed its long-term applicability. In recent years, high-dose chemotherapy combined with autologous stem cell transplantation (HDT-ASCT) has emerged as a consolidative treatment option, demonstrating efficacy comparable to WBRT, especially in younger patients and those with better performance status, thereby reshaping the therapeutic paradigm. As the therapeutic paradigm shifts, efforts to explore advances in WBRT techniques, such as dose reduction (23.4 Gy) and hyperfractionated protocols, have been aimed at mitigating neurotoxicity while maintaining therapeutic efficacy. These innovations make WBRT a viable option for carefully selected patient populations. Furthermore, this review explores emerging strategies, including localized radiotherapy, novel therapeutic combinations, and individualized treatment paradigms, while identifying key directions for future research to optimize outcomes for PCNSL patients.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"486-499"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination Immunotherapy for Mucosal Melanoma: Molecular Mechanism, Research Status, and Future Directions.","authors":"Jie Yang, Xuerui Wang, Yuan Meng, Meiying Zhu, Fanming Kong","doi":"10.1007/s11864-025-01321-9","DOIUrl":"10.1007/s11864-025-01321-9","url":null,"abstract":"<p><strong>Opinion statement: </strong>Mucosal melanoma is a rare and aggressive subtype of melanoma, accounting for 1%-2% of new cases in the United States in 2023, and 20%-30% in China and other Asian countries. Its origin is often occult, with the lack of early clinical features, the absence of actionable driver mutations, and poor response to immunotherapy, all contributing to its poor prognosis. The rarity of this subtype leads to limited awareness and interventions. Furthermore, due to its immune evasion mechanisms, mucosal melanoma shows resistance to traditional immune checkpoint inhibitors. Consequently, new therapeutic strategies are urgently needed to improve patient outcomes. Recent clinical trials have suggested that combination immunotherapy can overcome immune evasion, reduce resistance to treatment, produce synergistic anti-tumor effects, and improve survival. Epidemiological factors and clinical characteristics play significant roles in diagnosis and prognosis, while the mutational landscape influences responses to immunotherapy. This review provides an overview of these aspects and systematically discusses current research on combination therapies and emerging immunotherapy approaches for mucosal melanoma. It also explores potential future directions for treatment, aiming to enhance therapeutic strategies for this rare cancer and improve patient outcomes.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"431-444"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunotherapy-Boosted Stereotactic Ablative Radiotherapy in Inoperable Early-Stage Non-Small Cell Lung Cancer.","authors":"Jie Lian, Li Sun, Shuling Zhang, Letian Huang, Jietao Ma, Chengbo Han","doi":"10.1007/s11864-025-01324-6","DOIUrl":"10.1007/s11864-025-01324-6","url":null,"abstract":"<p><strong>Opinion statement: </strong>The combination of stereotactic ablative radiotherapy (SABR) with immune checkpoint inhibitors, known as iSABR, marks a significant evolution in treating early-stage, inoperable non-small cell lung cancer (NSCLC). Managing these cases requires a multidisciplinary approach involving radiation and medical oncologists. Clinical evidence from a meta-analysis of seven studies, including 462 patients, indicates that iSABR may offer better outcomes than SABR alone. The analysis showed significantly improved progression-free survival (PFS) rates at 1-, 2-, and 3-year follow-ups for iSABR compared to SABR. There was also a trend toward better overall survival (OS) with iSABR. Subgroup analyses highlighted enhanced 3-year PFS with programmed death-1 (PD-1) inhibitors and doses per fraction ≥ 12.5 Gy. While iSABR slightly increased the risk of grade ≥ 3 adverse events like pneumonitis, fatigue, and skin reactions, these risks are generally manageable within a multidisciplinary treatment framework. In conclusion, iSABR demonstrates potential benefits and manageable risks in phase I/II trials for early-stage, inoperable NSCLC, with improved PFS and acceptable toxicity. These findings warrant further investigation in a larger phase III prospective randomized controlled trial to validate efficacy, optimize protocols, and establish long-term safety.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"500-515"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Stage IVB Cervical Cancer Including the Role of Radiotherapy.","authors":"Ulysses G Gardner, Akila N Viswanathan","doi":"10.1007/s11864-025-01325-5","DOIUrl":"10.1007/s11864-025-01325-5","url":null,"abstract":"<p><strong>Opinion statement: </strong>The treatment of stage IVB cervical cancer is undergoing a paradigm shift, moving beyond palliation toward strategies that may improve survival rates in select patients. Radiation therapy is a key component of this shift, not only for local control, but also for enhancing systemic treatment efficacy and improving survival time. Stereotactic body radiation therapy (SBRT) for oligometastatic disease and image-guided brachytherapy improve tumor control while minimizing toxicity. The incorporation of immune checkpoint inhibitors into frontline therapy represents a significant advancement, particularly for PD-L1-positive tumors. However, durable responses remain a challenge, necessitating continued research into novel biomarkers and combination therapies. Personalized treatment approaches, integrating molecular profiling and adaptive therapy strategies, are essential for optimizing outcomes. Future clinical trials should evaluate the synergy between radiation and immunotherapy in order to refine curative approaches in stage IVB cervical cancer.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"524-532"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Sexual Health in Breast Cancer Survivors: Evidence-Based Practices and Clinical Considerations.","authors":"Laila S Agrawal","doi":"10.1007/s11864-025-01309-5","DOIUrl":"10.1007/s11864-025-01309-5","url":null,"abstract":"<p><strong>Opinion statement: </strong>Sexual health concerns are extremely prevalent among breast cancer survivors. The treatments used to treat and cure breast cancer - surgical removal of part or the whole breast, chemotherapy, radiation, and endocrine therapy - can have devastating impact on sexual function. Unfortunately, most patients are not given adequate preparation for these impending effects and can be blindsided by the resulting loss of sexual desire, vaginal dryness and decreased lubrication, pain with sex, vaginal stenosis, loss of nipple and breast sensation, muted or loss of orgasms and the resulting impact on sexuality and intimate relationships. Education about female sexual health is still lacking in most training programs and few cancer centers offer sexual health programs for cancer survivors. Oncology professionals and others who provide care for patients with breast cancer have the opportunity address sexual health, a vital aspect of quality of life. A focus on training and education, development of sexual health programs, and focus on sexual health in research is vital.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"476-485"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epithelioid Hemangioendothelioma: Treatment Landscape and Innovations for an Ultra-Rare Sarcoma.","authors":"Erica M Pimenta, Anirudh Goyal, Orly N Farber, Elizabeth Lilley, Paul B Shyn, Jiping Wang, Michael J Wagner","doi":"10.1007/s11864-025-01328-2","DOIUrl":"10.1007/s11864-025-01328-2","url":null,"abstract":"<p><strong>Opinion statement: </strong>Epithelioid hemangioendothelioma (EHE) is an ultra-rare sarcoma with a paucity of data on best practices for management. Pathogenic translocations involving the YAP or TAZ genes lead to constitutive activation of TEAD and TEAD-associated pathways. As our understanding of the molecular drivers of EHE has advanced, investigational treatment strategies have shifted away from cytotoxic chemotherapy toward more targeted approaches. This review focuses on the historical context and evolving landscape of systemic therapies for patients with EHE. For newly diagnosed patients, we recommend consultation at a high-volume sarcoma center whenever possible. If the disease is localized and resectable, surgical excision by a sarcoma-focused surgical oncologist is preferred. When the disease is unresectable, we first assess for disease progression to determine whether active surveillance is appropriate. Some patients may experience indolent, asymptomatic disease for years-or even decades-without requiring intervention. In patients with progressive or symptomatic unresectable disease, systemic therapy is warranted. Setting realistic expectations about the goals of treatment is essential, as no current systemic therapies reliably reduce tumor burden. However, molecular profiling and ongoing correlative studies from clinical trials may soon identify more effective therapeutic targets. For this reason, we encourage referral to centers that routinely perform molecular profiling and offer clinical trials with eligibility criteria for EHE, even to be considered as a first-line approach. Outside of a clinical trial, cytotoxic chemotherapy remains the frontline standard of care for patients who require systemic treatment. Importantly, treatment decisions must incorporate patient preferences and recognition that symptomatic improvement alone can be a meaningful outcome for preserving quality of life.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":"516-523"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternate Dosing Regimens for Vismodegib: A Literature Review.","authors":"Kevin Yang, Hoang Ho-Pham, Collin Pieper, Conway C Huang, Daniel J Bergman","doi":"10.1007/s11864-025-01332-6","DOIUrl":"https://doi.org/10.1007/s11864-025-01332-6","url":null,"abstract":"<p><strong>Opinion statement: </strong>Vismodegib is a hedgehog inhibitor used in the treatment of basal cell carcinomas and basal cell nevus syndrome. However, treatment is associated with significant side effects that can impact compliance, including fatigue, muscle cramps, hair loss, and taste disturbance. Multiple strategies to change dosing frequency have been implemented to improve the tolerability. Vismodegib may be administered with non-daily dosing or with drug holidays to improve the side effects associated with administration. Intermittent dosing of vismodegib may be more appropriate for patients with locally advanced BCC and drug holidays may be more suited for patients with basal cell nevus syndrome. The most appropriate strategy in each case though will ultimately depend on patient preference.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking the Rare but Lethal Cardiac Complications of Immune Checkpoint Inhibitor Therapy: A Review of Mechanisms, Risk Factors, and Management Strategies.","authors":"Laudy Chehade, Noura Abbas, Kristel Dagher, Mohamad Mourad, Ghid Amhez, Mohamad B Moumneh, Lara Kreidieh, Firas Kreidieh, Maria Manuel Pereira, Ali Shamseddine","doi":"10.1007/s11864-025-01329-1","DOIUrl":"https://doi.org/10.1007/s11864-025-01329-1","url":null,"abstract":"<p><strong>Opinion statement: </strong>Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by enabling the immune system to effectively target and destroy cancer cells. While ICIs offer significant survival benefits across various malignancies, their use is associated with a unique profile of immune-related adverse events, including potentially fatal cardiovascular toxicities. Recent studies have highlighted various cardiac complications associated with ICIs, such as myocarditis, arrhythmias, heart failure, pericarditis, atherosclerosis, and hypertension. These complications arise from mechanisms involving T-cell activation and cytokine release. Patient-related factors such as pre-existing cardiovascular disease, diabetes mellitus, age, gender, and genetic predisposition, along with treatment-related factors like specific ICI regimens, contribute to these toxicities. To manage these complications effectively, comprehensive cardiovascular risk assessment and monitoring before, during, and after ICI therapy are crucial. Adhering to guidelines from the European Society of Cardiology (ESC) and other international organizations allows for early recognition of cardiovascular toxicities and tailored interventions. This review emphasizes the importance of cardioprotective measures, regular monitoring, and multidisciplinary collaboration between oncologists and cardiologists to mitigate cardiovascular risk and optimize patient outcomes. Ongoing research is essential to better understand the mechanisms of ICI-induced cardiovascular toxicities and to develop effective management strategies for affected patients. As we continue to expand the use of ICIs in oncology, balancing oncologic efficacy with cardiovascular safety remains critical.</p>","PeriodicalId":50600,"journal":{"name":"Current Treatment Options in Oncology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}