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

{"title":"Stereotactic Body Radiation Therapy Combined With Immune Checkpoint Inhibitors in Unresectable Hepatocellular Carcinoma: A Comprehensive Single-Arm Meta-Analysis Approach.","authors":"Justin Dreyer, Raksha M Narasimhan, Ana R Dias Neto, Yalda Zarnegarnia, Lauren Nagel, Anika Varsani, William Jin, Benjamin Spieler, Jonathan Bell, John Bryant, Neil B Newman","doi":"10.1097/COC.0000000000001341","DOIUrl":"10.1097/COC.0000000000001341","url":null,"abstract":"<p><strong>Objectives: </strong>In locally advanced hepatocellular carcinoma (HCC), immune checkpoint inhibitors (ICI) are the frontline regimen, but the benefit of stereotactic body radiation (SBRT) in combination is unclear. Given randomized evidence for survival benefit with SBRT plus sorafenib, we performed a systematic review and meta-analysis to assess whether adding SBRT improves survival and response outcomes with acceptable toxicity.</p><p><strong>Methods: </strong>Per PRISMA guidelines, we reviewed studies published from 2020 onward evaluating adults with intermediate or advanced HCC (BCLC B/C) treated with SBRT plus ICI. Eligible studies included phase II-III RCTs, prospective cohorts, prospective single-arm studies, and retrospective comparative cohorts (≥20 patients with confounding adjustment). Primary outcomes were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and grade 3+ toxicity. A single-arm meta-analysis was performed using the REML method; logit transformation was applied for proportions, and heterogeneity was assessed through I 2 and Q-test.</p><p><strong>Results: </strong>Of 1120 screened studies, 6 (258 patients) met the inclusion criteria. Pooled median OS was 22.7 months (95% CI: 17.4-29.5; I2 =68.5%). Pooled median PFS was 7.9 months (95% CI: 5.6-11.2; I2 =92.1%). DCR was 93.4% (95% CI: 56.5-99.4%) and ORR was 56.3% (95% CI: 38-73%). Grade ≥3 toxicity occurred in 17.5% of patients (95% CI: 12.9-23.3%; I2 =0%).</p><p><strong>Conclusions: </strong>SBRT combined with ICI demonstrates encouraging survival and response outcomes with manageable toxicity in unresectable HCC. Prospective randomized trials are needed to confirm efficacy and define optimal treatment algorithms.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303954","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":"Early Versus Delayed Pancreatic Enzyme Replacement Therapy After Pancreatic Cancer Surgery: A Real-World Cohort Study.","authors":"Arkadeep Dhali, Jyotirmoy Biswas, Fayaz Khan, Ashish Sharma, Dushyant S Dahiya, Saikat Mandal, Manideepa Maji","doi":"10.1097/COC.0000000000001344","DOIUrl":"10.1097/COC.0000000000001344","url":null,"abstract":"<p><strong>Objectives: </strong>The optimal timing of pancreatic enzyme replacement therapy (PERT) after pancreatic surgery for pancreatic cancer remains uncertain. We compared outcomes after early versus delayed PERT initiation in a real-world cohort.</p><p><strong>Methods: </strong>This retrospective cohort study used the TriNetX US Collaborative Network database. Adults with pancreatic cancer undergoing pancreatic surgery were categorized as early PERT if treatment was started within 1 month after surgery, and late PERT if started between 2 and 3 months after surgery. Outcomes were assessed from 90 to 730 days after the index event. Comparative analyses were performed after 1:1 propensity score matching.</p><p><strong>Results: </strong>Before matching, 3960 patients were identified in the late PERT cohort and 9807 in the early PERT cohort; after matching, 3948 patients were retained in each group. All-cause mortality was similar between the late and early PERT cohorts (1076/3871 [27.8%] vs. 1022/3831 [26.7%]; risk ratio [RR]: 1.042; 95% CI: 0.969-1.121; P =0.270; hazard ratio [HR]: 1.018; 95% CI: 0.935-1.109; log-rank P =0.677). Emergency department visits were also similar (35.7% vs. 34.3%; RR: 1.042; 95% CI: 0.981-1.107; P =0.179). Late PERT was associated with higher risk of diarrhoea (31.0% vs. 28.9%; RR: 1.072; 95% CI: 1.002-1.147; P =0.044) and albumin <3.5 g/dL (62.7% vs. 58.8%; RR: 1.066; 95% CI: 1.029-1.105; P <0.001; HR: 1.076; 95% CI: 1.017-1.139; log-rank P =0.011).</p><p><strong>Conclusions: </strong>Delayed PERT initiation was not associated with higher mortality or emergency department utilization but was associated with higher diarrhea and hypoalbuminemia risk.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279786","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":"Early Economic and Patient-Centered Outcomes Before Spine Metastases Radiation Therapy From an Ongoing Phase II Randomized Controlled Trial.","authors":"Ena C Oboh, Momina Anwar, Lisa Perry, Nancy Cleaver, Shearwood McClelland","doi":"10.1097/COC.0000000000001346","DOIUrl":"https://doi.org/10.1097/COC.0000000000001346","url":null,"abstract":"<p><strong>Objectives: </strong>The incidence of metastatic spine cancer is increasing, with up to 40% of patients with metastatic disease developing spine involvement. Radiotherapy options involve conventional external beam radiation therapy (EBRT) and stereotactic body radiotherapy (SBRT). However, comparative economic impact and patient-reported financial burden remain poorly defined. This study evaluates early economic and patient-centered outcomes using prospective data from an ongoing randomized trial.</p><p><strong>Methods: </strong>This analysis is embedded within the multicenter phase II/III Spine Patient Optimal Radiosurgery Treatment for Symptomatic Metastatic Neoplasms (SPORTSMEN) trial (ClinicalTrials.gov: NCT05617716). Patients with MRI-confirmed spinal metastases and histologically confirmed primary malignancy are randomized to SBRT (24 Gy/2 fractions or 19 Gy/1 fraction) or conventional EBRT (8 Gy/1 fraction). Patient-reported financial toxicity (FT) and health-related quality of life are assessed using the COST-FACIT and EQ-5D-5L instruments.</p><p><strong>Results: </strong>Of patients with baseline data, 60% reported grade 1 to 2 financial toxicity, while 40% reported none. All patients with individual FT also endorsed familial financial strain, with a strong positive correlation between individual and familial FT (r=0.71). Baseline EQ-5D-5L scores demonstrated moderate impairment in mobility (3.3), self-care (2.6), and usual activities (3.3), severe pain (3.9), and mild anxiety/depression (2.2).</p><p><strong>Conclusions: </strong>Preliminary findings suggest that financial toxicity is present in a majority of SPORTSMEN patients before treatment and is strongly associated with familial financial strain, highlighting the importance of early financial screening and intervention at the time of diagnosis. Baseline EQ-5D-5L data further demonstrate substantial functional impairment and pain burden, underscoring the need for early supportive and multidisciplinary interventions.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267056","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":"Effect of Treatment Delay on Outcomes With Adjuvant Chemotherapy Versus Chemoradiotherapy in R1-Resected Biliary Tract Cancers.","authors":"Muhammet Ozer, Suleyman Goksu, Timothy J Brown, Brandon Rose, Nilesh Verma, Amy L Jones, Syed M A Kazmi, Ilyas Sahin","doi":"10.1097/COC.0000000000001338","DOIUrl":"10.1097/COC.0000000000001338","url":null,"abstract":"<p><strong>Objectives: </strong>R1 margins after biliary tract cancer (BTC) resection confer a high recurrence risk. The roles of adjuvant chemoradiotherapy and treatment timing remain incompletely defined. We compared overall survival (OS) with adjuvant chemotherapy (AC) versus adjuvant chemoradiotherapy (ACRT) and assessed whether treatment delay modifies outcomes in R1-resected BTC.</p><p><strong>Methods: </strong>This retrospective National Cancer Database study included adults with intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), or gallbladder cancer (GBC) diagnosed from 2011 to 2019 who underwent R1 resection and received adjuvant therapy. Treatment was categorized as AC or ACRT and stratified by initiation timing: timely (<60 d) versus delayed (≥60 d). Kaplan-Meier analyses, log-rank tests, and multivariable Cox regression compared OS, adjusting for age, sex, race/ethnicity, facility type, Charlson-Deyo comorbidity score, and stage.</p><p><strong>Results: </strong>Of 87,340 BTC patients, 1182 (1.4%) met inclusion criteria; 616 (52.1%) initiated therapy within 60 days, and 566 (47.9%) had delayed treatment. Groups were: timely AC (29.6%), delayed AC (26.2%), timely ACRT (22.5%), and delayed ACRT (21.7%). Timely ACRT was associated with improved median OS versus timely AC (25.2 vs. 13.7 mo; HR: 0.59, 95% CI: 0.48-0.73; P<0.001). Site-specific analyses demonstrated OS benefit with ACRT in ECC and GBC, but not ICC. In GBC, delayed ACRT remained associated with improved OS.</p><p><strong>Conclusions: </strong>In R1-resected BTC, ACRT was associated with improved OS over AC alone, particularly in ECC and GBC. In GBC, delayed ACRT still conferred benefit, suggesting radiotherapy may mitigate the adverse impact of treatment delay in high-risk patients.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267029","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 Inpatient Metastatic Spine Score: Prospective Validation on an Ongoing Multicenter Phase II Randomized Controlled Trial.","authors":"Shearwood McClelland","doi":"10.1097/COC.0000000000001343","DOIUrl":"https://doi.org/10.1097/COC.0000000000001343","url":null,"abstract":"<p><strong>Objectives: </strong>The low historical accuracy rate (25%) of Medical Oncology prognosis for inpatients with spinal metastatic disease presents several challenges. This study examines the prognostic accuracy of the Inpatient Metastatic Spine Score for inpatients prospectively considered for enrollment on the Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) multicenter phase II randomized controlled trial.</p><p><strong>Methods: </strong>From May 2025 to February 2026, inpatients at a single center were prospectively considered for SPORTSMEN inclusion. Prognosis was assessed per the Inpatient Metastatic Spine Score; scores of 0 to 3 were recommended for stereotactic body radiation therapy (and potential SPORTSMEN enrollment) due to a predicted positive prognosis (3+ mo before death/hospice). Scores 4 to 7 were deemed SPORTSMEN-ineligible due to predicted negative prognosis (<3 mo before death/hospice). Scores were correlated with actual patient prognosis. The Fisher test was used for statistical analysis.</p><p><strong>Results: </strong>Twenty-five inpatients were evaluated. 7/11 (64%) with scores from 0 to 3 had a positive prognosis, while 3/14 (21%) with scores from 4 to 7 had a positive prognosis; this difference was statistically significant (P=0.0486). The accuracy of the Inpatient Metastatic Spine Score (7/11 positive + 11/14 negative=18/25 patients=72%) was significantly greater than the historical rate of Medical Oncology prognosis (P=0.0351).</p><p><strong>Conclusions: </strong>The accuracy of the Inpatient Metastatic Spine Score for prospectively assessing the prognosis of inpatients with spine metastases for a randomized controlled trial was 72%, significantly superior to that historically provided by Medical Oncology prognosis. These findings strongly support that the prognosis of inpatients with spinal metastases may be most accurately determined by the Inpatient Metastatic Spine Score.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267041","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":"Upper Extremity Lymphedema​​​: Performance of a Risk Prediction Model in Women Undergoing Surgery for Breast Cancer.","authors":"Alessandra Mendes Silva, Samantha K Lopes de Almeida Rizzi, Fernanda Baptista Rodrigues, Amanda Estevão, Simone Elias","doi":"10.1097/COC.0000000000001339","DOIUrl":"https://doi.org/10.1097/COC.0000000000001339","url":null,"abstract":"<p><strong>Introduction: </strong>Upper extremity lymphedema is a common complication following breast cancer treatment, and supportive tools are valuable for screening, preventive strategies, and early therapeutic intervention. In 2020, Kwan and colleagues proposed a formula to predict the risk of lymphedema.</p><p><strong>Objective: </strong>To evaluate the performance of a predictive model for lymphedema development (classified as low, moderate, or high risk) in a population of Brazilian women.</p><p><strong>Methods: </strong>This retrospective study included 190 women who underwent surgery for breast cancer, with at least 6 months of postoperative follow-up. Clinical data were collected, and arm volumetry was performed. The Kwan model was applied using the following variables: age, body mass index (BMI), mammographic density, number of positive lymph nodes, and type of axillary surgery (sentinel lymph node biopsy or axillary lymph node dissection). Predicted values were compared with observed outcomes and categorized into low, moderate, or high risk.</p><p><strong>Results: </strong>The model demonstrated low predictive accuracy (RMSE=223.54; R2=-0.18). The overall accuracy rate was 76%, but sensitivity was low (48%), with a positive predictive value of 22%. Specificity was acceptable (79%), and the negative predictive value was high (92%). However, the low incidence of lymphedema in the study population should be considered.</p><p><strong>Conclusion: </strong>The model showed limited performance in predicting positive cases of lymphedema, but may have utility as a rule-out (screening) tool. New models incorporating broader clinical variables and technologies, such as machine learning, may provide improved positive predictive accuracy.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334202","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":"Disparities in the Receipt of Palliative-Intent Treatment Among Disaggregated Hispanic Populations With Stage IV Liver Cancer in the United States.","authors":"Shriya K Garg, Perisa Ashar, Khushi Kohli, Coby Garcia, Cody Chou, Alessandro Hammond, Eliana DaCunha, Bhav Jain, Urvish Jain, Kaitlyn Lapen, Erin Jay G Feliciano, Y Helen Zhang, Puneeth Iyengar, Edward Christopher Dee","doi":"10.1097/COC.0000000000001312","DOIUrl":"10.1097/COC.0000000000001312","url":null,"abstract":"<p><strong>Objectives: </strong>Our study investigates disparities in receipt of palliative-intent care among broad racial/ethnic and disaggregated Hispanic subgroups with stage IV liver cancer.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with stage IV liver cancer diagnosed between 2004 and 2021 from the National Cancer Database. The primary outcome was the receipt of palliative-intent intervention. Multivariate regressions controlling for age group, country of origin, year group, sex, insurance status, 2016 median income quartiles, facility type, Charlson-Deyo comorbidity index score, stage group, and facility location quantified disparities in palliative-intent intervention. Further difference-in-differences analyses were conducted.</p><p><strong>Results: </strong>Among 37,987 patients with stage IV liver cancer, 6573 (17.30%) received palliative-intent treatment. Compared to non-Hispanic White (NHW) patients, disaggregated analyses revealed significantly lower odds of receiving palliative-intent interventions for Black patients (AOR=0.93, 95% CI: 0.86-1.00, P =0.050) and patients of Hispanic descent (AOR=0.76, CI: 0.69-0.84, P <0.001). Furthermore, patients with stage IV liver cancer of Mexican and Cuban descent had lower odds of obtaining palliative-intent treatment compared with NHW patients (AOR=0.70, 95% CI: 0.54-0.90, P =0.006; AOR=0.44, 95% CI: 0.19-1.02, P =0.056). Difference-in-differences analyses revealed a significant association between palliative-intent intervention and 2014 to 2021, suggesting potential temporal differences in the primary outcome.</p><p><strong>Conclusions: </strong>Our study highlights the significant disparities in receipt of palliative-intent care among Hispanic subgroups upon disaggregation, underscoring the need for continued disaggregated research and targeted community- and patient-level solutions to close care gaps.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"287-294"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345755","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":"Disparities in the Receipt of Palliative-intent Treatment Across Disaggregated Hispanic Subgroups With Stage IV Gastric Cancer in the United States.","authors":"Cody Chou, Coby Y Garcia, Shriya K Garg, William Leung, Minji Kwon, Carolina Cano, Khushi Kohli, Kristin Hsieh, Juana Martinez, Matthew T McMillan, Isabella Nguyen, Lilac Nguyen, Miranda B Lam, William E Rosa, Erin Jay G Feliciano, Edward Christopher Dee","doi":"10.1097/COC.0000000000001297","DOIUrl":"10.1097/COC.0000000000001297","url":null,"abstract":"<p><strong>Objectives: </strong>Gastric cancer affects over 30,000 Americans annually and has a 5-year survival rate of roughly 40%. Palliative-intent interventions are critical for symptom relief and quality of life, yet access remains inequitable. We examined disparities in receipt of palliative-intent care among disaggregated Hispanic subgroups with gastric cancer.</p><p><strong>Methods: </strong>Using the National Cancer Database (2004 to 2021), we identified adults (≥18 y) with AJCC stage IV gastric cancer. The primary outcome was receipt of palliative-intent intervention, defined as treatment for symptom alleviation rather than cure. Patients were stratified into Hispanic subgroups (Mexican, Puerto Rican, Cuban, South/Central American, Dominican, Other Hispanic, Not Otherwise Specified [NOS], and Spanish surname only) and compared with non-Hispanic White patients. Multivariable logistic regression adjusted for demographic, socioeconomic, and clinical covariates.</p><p><strong>Results: </strong>Among 73,990 patients (median age 67 y), 65.2% were non-Hispanic White. Only 19.3% received palliative-intent treatment. Compared with non-Hispanic White patients, odds of receipt were lower for Mexican (AOR 0.74, 95% CI: 0.64-0.87), Cuban (AOR 0.57, 95% CI: 0.34-0.94), South/Central American (AOR 0.73, 95% CI: 0.61-0.88), and NOS Hispanic (AOR 0.82, 95% CI: 0.75-0.89) patients (all P <0.05).</p><p><strong>Conclusions: </strong>Several Hispanic subgroups experience significantly lower odds of receiving palliative-intent care for metastatic gastric cancer. These inequities likely reflect intersecting socioeconomic, linguistic, and structural barriers. Advancing equity will require culturally responsive communication, improved language access, and systemic reform in end-of-life care delivery.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"281-286"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183313","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":"A Real-World, Propensity-Matched Analysis of Second-Line FOLFIRI-Ramucirumab Versus Ramucirumab-Paclitaxel in Patients With Advanced Upper Gastrointestinal Cancers.","authors":"Jonathan M Hyak, Peifeng Ruan, Amy L Jones, Nilesh Verma, Victoria Chung, Udhayvir S Grewal, Deepak Vadehra, Nicholas Hornstein, Sam C Wang, Matthew R Porembka, Shahed Badiyan, Nina N Sanford, Syed Kazmi, Timothy J Brown","doi":"10.1097/COC.0000000000001283","DOIUrl":"10.1097/COC.0000000000001283","url":null,"abstract":"<p><strong>Objectives: </strong>There is an urgent need for effective second line treatments for advanced upper gastrointestinal (UGI) cancers. Ramucirumab and paclitaxel (Ram-Pac) has long been the standard therapy; however, this regimen is often complicated by cumulative neuropathy. FOLFIRI-Ramucirumab (FOLFIRI-Ram) may be an alternative second line option but real-world data to support its use are limited.</p><p><strong>Methods: </strong>The deidentified Flatiron Health Research Database was queried for patients treated for unresectable or metastatic UGI cancers with second line Ram-Pac or FOLFIRI-Ram from January 2011 to June 2024. Study cohorts were propensity score matched 1:6 (FOLFIRI-Ram:Ram-Pac) from key clinical and laboratory characteristics. The endpoints of interest were overall survival (OS) and real-world time to treatment discontinuation (rwTTD).</p><p><strong>Results: </strong>Of 15,908 patients with UGI cancer, 631 received second line Ram-Pac and 40 received second line FOLFIRI-Ram. After matching, 40 FOLFIRI-Ram and 240 Ram-Pac patients were included. Median OS was 9.7 months with FOLFIRI-Ram (95% CI: 6.9-12.3) and 7.7 months with Ram-Pac (95% CI: 6.2-8.8), with a hazard ratio (HR) for death of 0.74 with FOLFIRI-Ram versus Ram-Pac (95% CI: 0.50-1.11, P =0.14). The median rwTTD with FOLFIRI-Ram was 5.2 months (95% CI: 4.1-6.2), compared with 3.7 months with Ram-Pac (95% CI: 3.2-4.3), HR for treatment discontinuation =0.70 (95% CI: 0.48-1.00, P =0.048).</p><p><strong>Conclusions: </strong>In a real-world propensity-score matched analysis, no survival difference was noted with the combination of FOLFIRI-Ram compared with Ram-Pac; however, FOLFIRI-Ram was associated with a significantly longer rwTTD. Altogether, these data suggest FOLFIRI-Ram is a potential alternative for second line treatment of UGI cancers.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"268-274"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702547","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":"Disparities in Biopsy Practice in Metastatic Breast Cancer Patients Managed in Community Oncology Practices in the United States: Implications for Guideline-Concordant Care.","authors":"George Dranitsaris, Heather Neuhalfen, Nik Seifter, Aaron Peevyhouse, Lee Ann Dietz, Ajithkumar Puthillath, Gene Felber, Julie Katz, Sibel Blau","doi":"10.1097/COC.0000000000001281","DOIUrl":"10.1097/COC.0000000000001281","url":null,"abstract":"<p><strong>Objectives: </strong>The National Comprehensive Cancer Network guidelines recommend tumor phenotyping for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 at initial breast cancer diagnosis, with repeat biopsy considered at disease progression. This study assessed the frequency, timing, regional variation, and predictors of repeat biopsies among patients with metastatic breast cancer (mBC) treated at community oncology practices in the United States.</p><p><strong>Methods: </strong>A weighted random sample of 911 mBC patients was selected from 15 practices within the ONCare Alliance network. The data included demographics, clinical characteristics, number and types of biopsies, and associated findings. Multivariate negative binomial regression, adjusted for disease duration, was used to identify predictors of biopsy frequency.</p><p><strong>Results: </strong>Among the cohort, 42.2% had a history of early-stage disease, while 57.8% were diagnosed with de novo stage IV mBC. After adjusting for disease duration, patients with prior early-stage disease underwent significantly more biopsies (mean: 3.9; 95% CI: 3.7-4.0) than those with de novo mBC (mean: 2.2; 95% CI: 2.1-2.3; P <0.001). Factors associated with fewer biopsies included non-Black, non-Asian minority status (RR=0.80, P <0.001), longer time to metastatic progression (RR=0.93, P <0.001), poor performance status, and geographic region.</p><p><strong>Conclusions: </strong>A substantial proportion of patients with mBC, particularly those with de novo disease, did not undergo repeat biopsy at progression. These findings reveal disparities in biopsy practices and underscore the need for improved adherence to guideline-based care in community oncology settings.</p>","PeriodicalId":50812,"journal":{"name":"American Journal of Clinical Oncology-Cancer Clinical Trials","volume":" ","pages":"257-263"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726699","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}