American Journal of Clinical Oncology-Cancer Clinical Trials最新文献

{"title":"Early Cancer Screening Impressions of African-American Breast Cancer Patients Enrolled on the Navigator-Assisted Hypofractionation (NAVAH) Trial.","authors":"Jessica Y Aduwo, Ursula J Burnette, Louisa Onyewadume, Maya J Stephens, Kamryn J Davis, Shearwood McClelland","doi":"10.1097/COC.0000000000001189","DOIUrl":"https://doi.org/10.1097/COC.0000000000001189","url":null,"abstract":"<p><strong>Objectives: </strong>African-Americans have the highest cancer mortality rates and the lowest survival rates compared with other racial groups in the US. The Navigator-Assisted Hypofractionation (NAVAH) program includes a culturally sensitive survey to assess the impact of patient navigation on access to hypofractionated radiation therapy (RT) for African-American breast cancer patients. This study reports cancer screening impressions of participants enrolled in the ongoing NAVAH phase I clinical trial, marking a significant first in this field.</p><p><strong>Methods: </strong>After a referral for RT from a multidisciplinary tumor board, trial-eligible patients were invited to participate in the NAVAH trial. Surveys were administered before RT to assess overall cancer screening knowledge, categorizing responses as outstanding (18 to 23 points), excellent (24 to 29 points), good (30 to 35 points), average (36 to 42 points), or below average (>43 points). Knowledge was further stratified through 3 specific criteria: early screening, prognosis, and toxicity awareness with responses categorized as excellent, good, or average for each domain. Correlations between education levels and responses were analyzed using variance analysis (P<0.05).</p><p><strong>Results: </strong>An initial cohort of 35 trial participants was assessed. The average cancer screening and treatment knowledge score was 27.6. Participants showed excellent understanding of early screening and prognosis and good knowledge of toxicity. There was no significant correlation between educational attainment and cancer knowledge or income levels. This ongoing phase I clinical trial highlights a relative deficiency in toxicity knowledge compared with prognosis and early screening.</p><p><strong>Conclusions: </strong>Early impressions indicate that African-American breast cancer patients have an overall excellent knowledge of cancer screening and treatment, not correlated with socioeconomic or educational status, except treatment toxicity knowledge. Future education initiatives should focus on treatment toxicity to optimize patient awareness before adjuvant breast cancer RT.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Matched Cohort Analysis of Ultra-hypofractionated Versus Standard Fractionation Preoperative Radiation Therapy for Soft Tissue Sarcoma.","authors":"Cong Fan, Lukas Nystrom, Nathan W Mesko, Zachary D Burke, Zachary S Mayo, Chirag S Shah, Shlomo A Koyfman, Jacob Scott, Shauna R Campbell","doi":"10.1097/COC.0000000000001185","DOIUrl":"https://doi.org/10.1097/COC.0000000000001185","url":null,"abstract":"<p><strong>Objective: </strong>This study compares toxicity and oncologic outcomes in a matched cohort of soft tissue sarcoma (STS) patients receiving ultra-hypofractionated preoperative radiation therapy (RT) or standard fractionated RT.</p><p><strong>Methods: </strong>This IRB-approved study included patients with STS of the extremity, pelvis, or trunk treated with preoperative RT followed by surgical resection. Patients received either standard RT or ultra-hypofractionated RT (≥30 Gy over 5 fractions) between 2016 and 2023 with intensity-modulated RT at a single institution. Ultra-hypofractionated RT patients proceeded to surgical resection 0 to 7 days after RT and standard fractionated RT group 4 to 6 weeks after completion. The cohorts were matched based on tumor location and type of surgical closure. An inverse propensity weighting (IPW) method was used to balance group covariates.</p><p><strong>Results: </strong>A total of 74 patients were included in this study. 37 patients treated with ultra-hypofractionated RT were matched with 37 patients treated with standard fractionation RT. Median follow-up time was 21.00 [IQR 11.00, 45.00] months for ultra-hypofractionated RT and 29.00 [IQR 13.00, 43.00] months for standard fractionated RT (P=0.58). Rates of major wound complications (MWC) were 44.4% ultra-hypofractionated RT versus 29.7% standard RT (P=0.289). On logistic regression, MWC (OR 1.9, 95% CI 0.97-3.76, P=0.06) and wound dehiscence (OR 3.91, 95% CI 1.81-8.73, P=0.0006) were more common in the ultra-hypofractionated RT group. Clinically significant late toxicity (grade ≥2 fibrosis, joint stiffness, or edema) did not differ significantly. There was no difference in local control (P=1.00) or distant metastases (P=0.465).</p><p><strong>Conclusions: </strong>Ultra-hypofractionated RT for STS results in excellent disease control. To reduce the risk of MWC, we have adopted delayed surgical resection for ultra-hypofractionated RT patients of 4 to 6 weeks.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Validation of An Inpatient Metastatic Spine Neoplasm Score To Assess the Optimal Radiation Therapy Intervention Modality.","authors":"Shearwood McClelland","doi":"10.1097/COC.0000000000001184","DOIUrl":"https://doi.org/10.1097/COC.0000000000001184","url":null,"abstract":"<p><strong>Objectives: </strong>Metastatic spine disease is typically treated with conventional external beam radiation therapy (EBRT) or stereotactic body radiation therapy (SBRT). Recently, an inpatient metastatic spine score evaluated retrospectively produced promising results in selecting patients with prognoses favorable enough to benefit from the durability advantages of SBRT over EBRT, with scores of 0 to 3 warranting recommendation of SBRT over EBRT compared with scores of 4 to 7 yielding median survival <90 days. This study represents a prospective evaluation of this algorithm to further assess its potential utility.</p><p><strong>Methods: </strong>From July to November 2023, 11 spine metastases referred for inpatient radiation oncology consultation were prospectively assessed according to the inpatient metastatic spine score: scores of 0 to 3 were recommended for SBRT, and 4 to 7 for EBRT or no radiation therapy. The timeframe from consultation to death/hospice was correlated with the cumulative score.</p><p><strong>Results: </strong>The median age was 68.5 years. Patients with a score of 0 to 3 (n=5) had a median survival of 278 days, compared with scores of 4 to 7 (n=6) having a median survival of 37.5 days; this difference was statistically significant (P=0.0146).</p><p><strong>Conclusions: </strong>Prospective validation of the inpatient metastatic spine score reveals the prognosis of patients with scores of 4 to 7 have median survival too brief to benefit from the durability advantages of SBRT over EBRT, while scores of 0 to 3 have a prognosis long enough to benefit from SBRT. These results concur with previous retrospective evaluation, and indicate that the inpatient metastatic spine score is a reliable tool for determining which inpatients with spine metastases are appropriate for SBRT over EBRT.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Racism and Physician Trust Impressions of African-American Breast Cancer Patients Enrolled on the Navigator-Assisted Hypofractionation (NAVAH) Phase I Clinical Trial.","authors":"Kamryn J Davis, Ursula J Burnette, Yilun Sun, Maya J Stephens, Louisa Onyewadume, Shearwood McClelland","doi":"10.1097/COC.0000000000001183","DOIUrl":"https://doi.org/10.1097/COC.0000000000001183","url":null,"abstract":"<p><strong>Objectives: </strong>The historical distrust between the African-American community and the medical system, rooted in systemic racism, continues to affect health care outcomes today. Although Caucasian women have the largest incidence of breast cancer diagnoses, African-American women have the highest mortality rate. Furthermore, studies show African-American women are less likely to receive hypofractionated radiation therapy (RT). The Navigation-Assisted Hypofractionation (NAVAH) program was designed to identify the barriers preventing equal access to adjuvant hypofractionated RT while also addressing the inequities by utilizing patient navigation services to improve breast cancer survivorship in African-American women. This study explored patients' perceptions of racism in medicine, offering new insights into this critical, yet understudied aspect of health care disparities.</p><p><strong>Methods: </strong>This is a prospective study of African-American breast cancer patients enrolled in the ongoing NAVAH phase I clinical trial. Following consent to receive RT, pretreatment surveys were administered. Surveys assessed participants' distrust of medical professionals and if care was impacted as a result. Each patient answered a series of questions with responses on a scale from strongly agree to strongly disagree. The significance of patients' views on medical racism and physician trust was evaluated using the Kendall tau correlation. A P-value of ≤0.05 was considered statistically significant.</p><p><strong>Results: </strong>The Kendall tau test was used to analyze the data accounting for the possible nonlinear, monotonic nature of the data. Patients believing harmful events have taken place at medical centers were significantly less likely to trust doctors (P=0.03). Of the remaining sets of questions assessed, only the correlation between the belief that African-Americans receive the same care as other patients and the likelihood of following hospital-given advice approached statistical significance (P=0.055).</p><p><strong>Lessons: </strong>Patients' perception of treatment within the medical system can greatly impact their decision to seek care and adhere to treatment, which in return can have a substantial impact on oncologic outcomes. Our findings indicate that patient trust in physicians is significantly impacted by patient perceptions of the likelihood of harmful event occurrence at medical centers, with the correlation of perceived medical racism and obeying hospital-given advice trending towards significance.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05978232.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of PD-1/PD-L1 Inhibitor and Statin Combination Therapy on Overall Survival and Gastrointestinal Toxicity.","authors":"Jay Shah, Andres Caleb Urias Rivera, Irene Jeong-Ah Lee, Kei Takigawa, Antony Mathew, Deanna Wu, Eric Lu, Malek Shatila, Anusha S Thomas, Hao Chi Zhang, Mehmet Altan, Dan Zhao, Qinghuan Xiao, Yinghong Wang","doi":"10.1097/COC.0000000000001156","DOIUrl":"10.1097/COC.0000000000001156","url":null,"abstract":"<p><strong>Objectives: </strong>Immune checkpoint inhibitors (ICIs), such as programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors, have been approved to treat a variety of cancers. Recently, studies have suggested that ICIs and statins are synergistic. However, the addition of statins to ICI therapy may increase the risk of gastrointestinal immune-related adverse events (irAEs). We investigated the effect of combination therapy with PD-1 and/or L1 inhibitors and statins on overall survival and gastrointestinal irAEs.</p><p><strong>Methods: </strong>We reviewed the charts of patients with select cancers who received PD-1 and/or PD-L1 inhibitors and statins. The incidence of gastrointestinal irAEs and overall survival were compared with that in a matched control group of patients who received PD-1 and/or PD-L1 inhibitors without statins.</p><p><strong>Results: </strong>Of the 823 patients in the statin group, 707 received PD-1 inhibitors, 86 received PD-L1 inhibitors, and 30 received both. Patients taking any statins (10.8%) and those taking high-intensity statins (15.8%) had higher rates of gastrointestinal irAEs than patients not taking statins (8.7%; P =0.046 and 0.006, respectively). Compared with the nonstatin treatments, statin use was associated with improved overall survival for patients taking PD-1 inhibitors ( P <0.001) and for patients with ( P =0.021) and without ( P <0.001) gastrointestinal irAEs.</p><p><strong>Conclusions: </strong>Synergism of statins with PD-1 and PD-L1 inhibitors continues to be a developing field of interest. Our data demonstrate the survival benefit of combination therapy with PD-1 and/or PD-L1 inhibitors and statins, warranting further investigation.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"136-141"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications, Costs, and Health Care Resource Use with Tissue Biopsy Followed by Liquid Biopsy Versus Tissue Re-biopsy in Patients With Newly Diagnosed Metastatic Nonsmall-cell Lung Cancer.","authors":"Anne Shah, Jon Apple, Saad Aslam, Nicole M Engel-Nitz, Lisa Le, Marilou Terpenning","doi":"10.1097/COC.0000000000001155","DOIUrl":"10.1097/COC.0000000000001155","url":null,"abstract":"<p><strong>Objectives: </strong>We compared complications, costs, and health care resource utilization (HCRU) of patients with newly diagnosed metastatic nonsmall-cell lung cancer (mNSCLC) who had a tissue biopsy followed by either liquid biopsy (TFLB) (identified with a novel algorithm) or tissue re-biopsy (TRB).</p><p><strong>Methods: </strong>This claims-based retrospective analysis included commercial and Medicare Advantage members in the Optum Research Database with mNSCLC (January 2017 to June 2021) and ≥2 tissue biopsy claims (7 to 90 d apart) (TRB) or ≥1 tissue and ≥1 liquid biopsy claim within 90 days (TFLB). Patients in the TFLB group were matched 1:1 to patients in the TRB group using propensity score matching. Surgical biopsy-related complications and complication-related and all-cause medical costs and HCRU during the 6-month follow-up were compared.</p><p><strong>Results: </strong>Both groups had 235 patients post-match. During the follow-up, the surgical biopsy-related complication rate was lower in the TFLB group than the TRB group (65.1% [153/235] vs. 84.7% [199/235], P <0.001). Mean complication-related medical costs were significantly lower with TFLB ($8494 vs. $19,741, P <0.001) during the follow-up; mean (SD) duration of complication-related inpatient stays was significantly lower with TFLB (3.5 [7.0] vs. 6.6 [13.3] d, P =0.002). Mean all-cause medical costs were not significantly different between the groups; the TFLB group had fewer all-cause inpatient stays, inpatient days, and outpatient visits.</p><p><strong>Conclusions: </strong>Multiple tissue biopsy procedures may be associated with significantly higher biopsy complication rates, higher complication-related medical costs, and longer complication-related inpatient stays than TFLB. All-cause medical costs were similar between groups.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"127-135"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584916","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":"Phase 2, Multicenter, Open-label, Nonrandomized Study of Neoadjuvant Chemotherapy Liposomal Irinotecan With 5-Fluorouracil, Leucovorin, and Oxaliplatin, Followed by Chemoradiotherapy in Patients With Rectal Cancer in a Watch-and-Wait Program.","authors":"César Muñoz, María-C Riesco Martinez, Lisardo Ugidos, Pilar García-Alfonso, Rafael Alvarez-Gallego, Paloma Peinado, Carmen Toledano, Luka Mihic-Góngora, Justo Gabriel Ortega Anselmi, Enrique Sanz Garcia, Emilio Vicente, Yolanda Quijano, Hipólito J Durán, Eduardo Díaz, Valentina Ferri, Carmen Rubio, Ovidio HernandoRequejo, Mercedes López González, Susana Prados, Ulpiano López, María Allona, Virginia PérezDueñas, María Angeles Perez-Escutia, Antonio Cubillo","doi":"10.1097/COC.0000000000001157","DOIUrl":"10.1097/COC.0000000000001157","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of neoadjuvant chemotherapy combination with liposomal irinotecan, 5-fluorouracil, leucovorin, and oxaliplatin in patients with locally advanced rectal cancer.</p><p><strong>Methods: </strong>This was a phase 2, nonrandomized, multicenter study in adults with stage II or III rectal cancer and an Eastern Cooperative Oncology Group performance status of 0 to 1. Total neoadjuvant therapy (TNT) consisted of neoadjuvant chemotherapy combination with liposomal irinotecan (60 mg/m 2 ), oxaliplatin (60 mg/m 2 ), leucovorin (400 mg/m 2 ), and fluorouracil (2400 mg/m²), followed by chemoradiotherapy [ie, capecitabine (825 mg/m 2 ) and radiotherapy according to the standard of care]. The primary efficacy endpoint was the proportion of patients who achieved clinical complete response (cCR), defined as the normalization of pelvic magnetic resonance imaging, rectoscopy, computed tomography scan, and tumor markers.</p><p><strong>Results: </strong>The median follow-up was 32.3 months. Of the 30 patients who underwent TNT and were evaluated, 6 (20.0%; 95% CI: 5.2%-34.8%) patients achieved a cCR. There were no deaths. The median disease-free survival (DFS) for patients with cCR was not reached after a follow-up of 32 months; the 1-year DFS rate was 90.0% (95% CI: 71.0%-100%), and the 2-year and 3-year DFS rates were 80.0% (95% CI: 55.0%-100%). No grade ≥4 adverse events (AEs) were observed. Grade 3 AEs occurred in 18 patients (60%), most frequent was diarrhea (n = 9, 30%). Eleven (36.7%) patients experienced serious AEs, with diarrhea being the most frequent (n = 6, 20.0%).</p><p><strong>Conclusion: </strong>TNT with 5-fluorouracil, leucovorin, and oxaliplatin and chemoradiation is a safe and effective therapeutic alternative for the management of locally advanced rectal cancer.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"142-147"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating N-acetylcysteine as a Protective Agent Against Chemotherapy-induced Neuropathy in Breast Cancer: A Triple-blind, Randomized Clinical Trial.","authors":"Elyas Hassanzadeh, Abdolazim Sedighi Pashaki, Ehsan Akbari Hamed, Maryam Mehrpooya, Kamal Mohammadian, Reyhaneh Bayani, Kamran Sheikhi, Hossein Ranjbar, Mohammad Abbasi","doi":"10.1097/COC.0000000000001153","DOIUrl":"10.1097/COC.0000000000001153","url":null,"abstract":"<p><strong>Objectives: </strong>Chemotherapy-induced peripheral neuropathy (CIPN) is a significant clinical issue that affects patients' quality of life and can limit the dosing of chemotherapeutic agents. N-acetylcysteine (NAC) has been proposed as a potential chemoprotective agent against CIPN due to its antioxidant properties. This study aimed to investigate the efficacy of oral NAC in preventing and controlling taxane-induced neuropathy in patients with breast cancer.</p><p><strong>Methods: </strong>This randomized, triple-blind, placebo-controlled trial included 80 breast cancer patients undergoing taxane-based chemotherapy. Participants were divided into 2 groups: an intervention group receiving 1200 mg of oral NAC in divided doses per day and a placebo group. Patients were evaluated for neuropathy grade and functional status at 1 and 12 weeks postintervention.</p><p><strong>Results: </strong>Our analysis revealed no significant difference in the incidence and severity of neuropathy between the intervention and placebo groups at 1 ( P =0.328) and 12 weeks ( P =0.569) postchemotherapy. Baseline characteristics such as age, number of treatment cycles, and disease stage were similar between groups, indicating a homogeneous population.</p><p><strong>Conclusions: </strong>Oral NAC at a dose of 1200 mg per day did not significantly reduce the incidence or severity of taxane-induced neuropathy. These findings suggest that the oral bioavailability of NAC may be insufficient to exert a protective effect and that future studies should consider alternative dosing strategies or routes of administration. The need for further research to optimize NAC's chemoprotective role in CIPN remains evident.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"122-126"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Executive Summary of the American Radium Society Appropriate Use Criteria: Regional Nodal Irradiation for Breast Cancer.","authors":"J Isabelle Choi, Gary M Freedman, David M Guttmann, Kamran Ahmed, Wendy Gao, Eleanor M Walker, Eleanor E Harris, Victor Gonzalez, Jason Ye, Kevin Nead, Neil Taunk, Audree B Tadros, Chau T Dang, Parima Daroui, Kristina Novick","doi":"10.1097/COC.0000000000001154","DOIUrl":"10.1097/COC.0000000000001154","url":null,"abstract":"<p><strong>Objectives: </strong>Recent literature has provided additional data to further individualize treatment recommendations on regional nodal irradiation (RNI) patient selection and delivery techniques, but controversies surrounding optimal RNI utilization remain, including radiation technique, modality selection, and internal mammary lymph node (IMN) inclusion. The American Radium Society (ARS) Breast Appropriate Use Criteria (AUC) Committee performed a systematic review and developed a consensus guideline to summarize recent data and provide evidence-based recommendations.</p><p><strong>Methods: </strong>A multidisciplinary panel comprised of 15 members representing radiation oncologists, medical oncologists, and surgical oncologists specializing in the treatment of breast cancer conducted an analysis of the medical literature from January 1, 2011 to April 1, 2024. Modified Delphi methodology was used to rate the appropriateness of treatments for variants across 3 key questions.</p><p><strong>Results: </strong>Patients with intermediate-risk breast cancer, such as limited nodal involvement or large primary tumor size, are reasonable candidates for RNI, although a subset of patients with overall favorable clinicopathologic features may be considered for treatment de-escalation. Data on the use of advanced radiation techniques for RNI were limited in scope and strength, and the panel agreed that careful patient selection is needed when using these tools. Evidence suggests that the IMN should be included when delivering RNI given the absolute benefit demonstrated in multiple randomized trials.</p><p><strong>Conclusion: </strong>A systematic review and evidence-based summary of recommendations are provided in these consensus guidelines from the ARS Breast AUC Committee to provide current comprehensive guidance on the optimal management of non-metastatic breast cancer patients being considered for RNI.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":"48 3","pages":"111-121"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Probiotics as Adjunctive Therapy in Cancer Treatment: A Comprehensive Systematic Review and Meta-Analysis.","authors":"Zaheer Qureshi, Abdur Jamil, Faryal Altaf, Rimsha Siddique","doi":"10.1097/COC.0000000000001158","DOIUrl":"10.1097/COC.0000000000001158","url":null,"abstract":"<p><strong>Objectives: </strong>The gut microbiome is crucial in influencing cancer progression and response to treatment. We evaluate the efficacy and safety of probiotics and synbiotics in cancer treatment, focusing on the incidence of diarrhea, significant complications, surgical site infections, length of hospital stay, progression-free survival (PFS), and overall survival (OS).</p><p><strong>Methods: </strong>Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL up to June 2024. The risk of bias was assessed using the Cochrane Risk-of-Bias tool. Meta-analysis was performed using a random-effects model.</p><p><strong>Results: </strong>Fifteen studies involving 2197 participants were included. Probiotic use was associated with a significant reduction in the incidence of diarrhea (OR=0.39, 95% CI: 0.15-1.00, P =0.049) with moderate heterogeneity ( I2 =64%). No significant differences were found in major complications (OR=0.50, 95% CI: 0.05-4.92, P =0.4053, I2 =73%), surgical site infections (OR=0.36, 95% CI: 0.12-1.09, P =0.058, I2 =0%), length of hospital stay (SMD=-0.30, 95% CI: -1.00 to 0.41, P =0.2726, I2 =62%), PFS (HR=0.61, 95% CI: 0.03-10.82, P =0.2715, I2 =0%), or OS (HR=0.52, 95% CI: 0.00-58.82, P =0.3298, I2 =0%).</p><p><strong>Conclusions: </strong>Probiotics significantly reduced the incidence of chemotherapy-induced diarrhea, highlighting their potential as supportive care agents in oncology. However, their impact on significant complications, surgical site infections, length of hospital stay, and survival outcomes remains inconclusive.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"148-161"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}