Journal of the National Comprehensive Cancer Network : JNCCN最新文献

{"title":"Whole-Exome Sequencing Reveals High Prevalence of Germline Alterations in Neuroendocrine Neoplasms.","authors":"Vineeth Sukrithan, Isaiah Boateng, Sandya Liyanarachchi, Prachi Jain, Jill Buss, Anil Parwani, Manisha H Shah, Komal Das, Martha Yearsley, Bhavana Konda, Pamela Brock, Ann-Kathrin Eisfeld","doi":"10.6004/jnccn.2025.7035","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7035","url":null,"abstract":"<p><strong>Background: </strong>Beyond syndromic tumor-predisposing conditions, germline susceptibility to neuroendocrine neoplasms (NENs) is not well understood. Familial clustering of cases and the co-occurrence of additional malignancies in patients suggest that additional, thus far unrecognized, germline predispositions to NEN development may exist.</p><p><strong>Methods: </strong>We conducted whole-exome sequencing of germline and somatic DNA from a prospective cohort of patients with NENs (n=144) treated at The Ohio State University. Gene ontology analysis was performed using the DAVID algorithm. Multiplex immunofluorescence (mIF) was conducted on samples with germline MUTYH (gMUTYH) alterations. Clinical data from patients with gMUTYH alterations who were treated with immune checkpoint inhibition (ICI) were also abstracted.</p><p><strong>Results: </strong>A total of 144 samples were sequenced, revealing 3,400 variants, including 75 pathogenic and 99 likely pathogenic. Pathogenic/likely pathogenic variants were found in 78% of patients (112/144), across 127 genes. Pathogenic variants alone were identified in 45% (65/144), across 57 genes. Recurrent alterations were detected in 37 genes (frequency, false discovery rate), including MEN1 (5%; 1.22E-17), MUTYH (5%; 0.003), PKD1 (5%; 0.003), ATP4A (4%; 0.04), and PAH (4%; 0.003). The 3 most commonly involved pathways were DNA repair (26%), cellular calcium signaling (14%), and epigenetic regulation (7%). gMUTYH alterations were associated with high somatic tumor mutational burden in 3 of 6 patients. Among 5 subjects with gMUTYH, 2 showed a high levels of CD3+ and CD11c+ immune infiltration on mIF. Separately, we reported 2 cases of gMUTYH-altered NENs with robust responses to ICI.</p><p><strong>Conclusions: </strong>Approximately 45% of patients with NENs harbor pathogenic germline variants on whole-exome sequencing. A subset of patients with gMUTYH alterations demonstrate a high tumor mutational burden, rich immune infiltration, and significant responses to ICI.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Polypharmacy and Potentially Inappropriate Medications With Outcomes in Older Adults With DLBCL: A Population Study.","authors":"Inna Y Gong, Abi Vijenthira, Zharmaine Ante, Andrew Calzavara, Tammy T Hshieh, Clark DuMontier, Gregory A Abel, Jane A Driver, Shabbir M H Alibhai, Anca Prica, Matthew C Cheung, Lee Mozessohn","doi":"10.6004/jnccn.2025.7029","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7029","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy and potentially inappropriate medications (PIMs) may be associated with survival and health care utilization in older patients undergoing treatment for diffuse large B-cell lymphoma (DLBCL).</p><p><strong>Methods: </strong>This population-based study examined patients with DLBCL aged ≥66 years receiving rituximab-based therapy from January 1, 2006, to December 31, 2017, and followed them until March 31, 2019. Polypharmacy was defined as taking ≥5 or ≥8 concurrent medications within 90 days of treatment initiation. PIMs were assessed using the Anticholinergic Risk Scale (ARS) and the Geriatric Oncology Potentially Inappropriate Medications (GO-PIM) scale. Cox regression and negative binomial models were conducted, adjusting for age, sex, frailty, and comorbidity burden (Aggregated Diagnosis Groups [ADGs]). The primary outcome was all-cause mortality, and the secondary outcome was health care utilization, measured by unplanned emergency department visits and hospitalizations.</p><p><strong>Results: </strong>A total of 5,527 patients were included (median age, 75 years; 48% female), of whom 69% and 40% had polypharmacy defined as ≥5 and ≥8 medications, respectively. In terms of PIMs, 27% of patients had at least one PIM based on ARS, whereas 70% had a high-risk medication based on the GO-PIM scale. Polypharmacy was associated with increased risk of all-cause mortality in the adjusted analysis, with an adjusted hazard ratio (aHR) of 1.14 (95% CI, 1.05-1.23; P=.0021) for patients taking ≥5 medications, and 1.18 (95% CI, 1.09-1.27; P<.0001) for those taking ≥8 medications. Increasing number of PIMs was associated with increased mortality risk. Polypharmacy was associated with an increased relative risk of health care utilization, with an adjusted rate ratio (aRR) of 1.14 (95% CI, 1.06-1.22; P=.0004) for patients taking ≥5 medications, and 1.16 (95% CI, 1.08-1.24; P<.0001) for those taking ≥8 medications. For PIMs, a higher score on the GO-PIM scale was associated with greater risk of health care utilization (aRR for ≥3 medications, 1.20; 95% CI, 1.09-1.32; P=.0003), whereas ARS was not.</p><p><strong>Conclusions: </strong>Polypharmacy and PIMs are associated with an increased relative risk of mortality and health care utilization among older adults with DLBCL undergoing treatment, independent of frailty and comorbidity.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a Digital Tool That Uses National Testing Guidelines to Identify Individuals at Risk for Hereditary Cancer.","authors":"Heather Fecteau, Haley Pfleger, Deepika Nathan, Sarah Siddiqui, Carrie Horton, Carrie Milliard, Robert Pilarski, Elyse Ryan, Devon Thrush, John Ranola, Jacob Clifford, Lukas Lyon, Shannon Kieran","doi":"10.6004/jnccn.2025.7025","DOIUrl":"10.6004/jnccn.2025.7025","url":null,"abstract":"<p><strong>Background: </strong>NCCN publishes genetic testing criteria based on personal and family cancer history (PFHx). Digital risk stratification tools may aid clinicians in the challenging task of systematically collecting this history and accurately identifying individuals who meet the criteria. A HIPAA-compliant digital tool (The Ambry CARE Program) integrates NCCN Guidelines and identifies patients who meet the NCCN criteria for hereditary breast, ovarian, pancreatic, and prostate cancer (HBOP), as well as Lynch syndrome and familial adenomatous polyposis (both related to hereditary colorectal cancer [CRC]). The purpose of this study was to validate the analytic accuracy of the tool's interpretation of the NCCN Guidelines compared with a certified genetic counselor (CGC).</p><p><strong>Methods: </strong>This study, conducted by a diagnostic laboratory, included 2 phases: (1) development and internal verification of the tool using 1,300 theoretical clinical scenarios (913 HBOP and 394 CRC scenarios), with testing eligibility determined by internal CGC consensus and the tool; and (2) external analytical validation comparing CARE's interpretation of 400 deidentified real-world cases against CGC interpretation. Of the 400 cases, 200 met and 200 did not meet the criteria. Of the cases that met the criteria, based on CARE's interpretation, 150 met the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic (Version 2.2022), and 50 met the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal (Version 1.2021).</p><p><strong>Results: </strong>There were no discrepancies in the internal verification when comparing the final consensus outcomes with the CARE outputs. In external validation, CARE accurately assessed 398 (99.5%) cases. In 17 cases, CARE made correct risk assessments, whereas CGCs did not.</p><p><strong>Conclusions: </strong>CARE accurately identifies individuals who meet NCCN testing criteria to aid in risk stratification. Digital tools such as this may be helpful in clinical practice for collecting PFHx and identifying candidates for genetic testing of hereditary cancers.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistance Mechanism for Zanubrutinib in Marginal Zone Lymphoma.","authors":"John Sharp, Arwa Y Shana'ah, Timothy J Voorhees, David A Bond, Yazeed Sawalha, Audrey Sigmund, Walter Hanel, Lalit Sehgal, Lapo Alinari, Robert Baiocchi, Kami Maddocks, Dan Jones, Beth Christian, Narendranath Epperla","doi":"10.6004/jnccn.2025.7045","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7045","url":null,"abstract":"<p><p>Marginal zone lymphoma (MZL) is the third most common B-cell non-Hodgkin lymphoma and tends to follow the relapsing course typical of other indolent lymphomas, meaning that many patients receive multiple lines of therapy. Brüton's tyrosine kinase inhibitors (BTKis) have been a promising addition to the treatment landscape of relapsed MZL; however, development of resistance to these agents remains a significant problem that warrants further characterization. This case report presents a patient with relapsed MZL receiving the BTKi zanubrutinib who experienced large cell transformation of their lymphoma in concert with the development of mutations predictive of resistance to BTKi therapy, specifically BTK C481S and PLCG2 D334H. To our knowledge, this is the first reported case of a patient with MZL acquiring co-mutations in BTK and PLCG2 in concert with the development of disease progression while receiving BTKi therapy. Outcomes for patients with MZL who develop resistance to BTKis have not been fully characterized, but are poor in other B-cell malignancies that have acquired BTKi resistance, such as mantle cell lymphoma and chronic lymphocytic leukemia. Improved understanding of the genetic and molecular drivers of MZL is leading to new treatment strategies. Further studies of novel therapeutic approaches are ongoing to improve outcomes for patients with MZL, including those who acquire resistance to BTKis.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic Classification of T-Cell Acute Lymphoblastic Leukemia: Current Paradigms and Future Biomarkers.","authors":"Jason Xu, David T Teachey","doi":"10.6004/jnccn.2025.7028","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7028","url":null,"abstract":"<p><p>Over the past 20 years, long-term cure rates in T-lymphoblastic leukemia/lymphoma (T-ALL) have improved from 60% to 65% to >80%, largely due to the intensification of chemotherapy regimens. In B-lymphoblastic leukemia/lymphoma (B-ALL), outcomes have been improved through risk stratification, integrating clinical and demographic features, response to therapy, and disease biology to identify patients more or less likely to respond to conventional treatment, allowing for the use of regimens adapted to relative risk. Unfortunately, in T-ALL, few features have been identified that can independently predict the risk of poor outcomes beyond response to therapy. Accordingly, most cooperative groups do not use disease biology for T-ALL risk stratification. Recently, several T-ALL genomic initiatives have improved understanding of disease biology, enhanced the ability to classify T-ALL into different biological subtypes, and identified genomic alterations that predict outcome independent of response to treatment. Among these biomarkers is a newly defined high-risk \"ETP [early T-cell precursor]-like\" transcriptional subtype, which reclassifies immature T-ALL based on transcriptomic rather than immunophenotypic features; a treatment-refractory \"bone-marrow-progenitor-like\" leukemia fraction enriched in relapsed/refractory T-ALL; and intron-mediated noncanonical NOTCH1 dysregulation. The integration of these new biomarkers into clinical treatment holds promise to inform rapid upfront risk stratification, support new targeted therapeutic approaches, and guide future validation and preclinical studies for high-risk T-ALL.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worse Survival and Gastrointestinal Toxicity Outcomes Among Patients Receiving Proton Pump Inhibitors During Checkpoint Inhibitor Therapy.","authors":"Malek Shatila, Samanthika Devalaraju, Kei Takigawa, Christine Catinis, Irene Lee, Elliot Baerman, Sean Ngo, Nitish Mittal, Stephen Glombicki, Antonio Pizuorno Machado, Linfeng Lu, Abdullah Sagar Aleem, John Thompson, Pauline Funchain, Shilpa Grover, Hao Chi Zhang, Anusha Shirwaiker Thomas, Yinghong Wang","doi":"10.6004/jnccn.2025.7023","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7023","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) for cancer carry a risk of immune-related adverse events (irAEs). Upper and lower gastrointestinal tract inflammation are common toxicities. Proton pump inhibitors (PPIs) are used to treat upper gastrointestinal irAEs. Studies have suggested these agents may also worsen lower gastrointestinal irAEs. Our study evaluated the effect of PPI exposure on gastrointestinal irAE severity.</p><p><strong>Methods: </strong>This was a single-center retrospective chart review including all patients receiving ICIs between January 2010 and February 2024 who developed upper or lower gastrointestinal toxicity. Patients were grouped based on PPI use, defined as receiving a PPI any time from 3 months before ICI initiation until gastrointestinal toxicity diagnosis.</p><p><strong>Results: </strong>A total of 1,228 patients were included: 88 (7.2%) with upper gastrointestinal toxicity and 1,140 (92.8%) with lower toxicity. Upper gastrointestinal irAEs were more severe among PPI users (69.6% with grade 3 toxicity in the PPI group vs 29.6% in the non-PPI group; P<.05). Similarly, lower gastrointestinal irAEs were more severe among PPI users, with a higher need for multiple lines of biologic treatment, higher hospitalization rates, and longer hospital stays (P<.05 for all). PPI use was associated with significantly worse overall survival among patients receiving ICIs (P<.05).</p><p><strong>Conclusions: </strong>Our study is the largest to date showing the impact of PPI use on immunotherapy toxicity. PPI use may predispose to more severe toxicities and worse outcomes. PPIs may also reduce immunotherapy efficacy, as reflected by worse overall survival. These findings support the judicious use of PPIs in patients receiving ICIs and call for prospective studies to validate our results.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-of-Life Care Among Patients With Neuroendocrine Tumors: Underutilization of Palliative Care and Racial Disparities.","authors":"Suriya Baskar, Udhayvir Singh Grewal","doi":"10.6004/jnccn.2025.7024","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7024","url":null,"abstract":"<p><strong>Background: </strong>Neuroendocrine tumors (NETs) are a diverse group of malignancies with increasing incidence. Early diagnosis is challenging-most patients present with advanced disease, which is associated with a heavy symptom burden. The role of palliative care in the management of NETs is critical but inadequately explored. We sought to investigate the utilization of palliative care and examine racial disparities in end-of-life (EoL) care among patients with NETs.</p><p><strong>Methods: </strong>We analyzed National Inpatient Sample (NIS) data from 2016 to 2020, including hospitalizations involving patients with NETs who experienced inpatient mortality. Palliative care consultation rates, do-not-resuscitate (DNR) status, and aggressive treatment interventions were assessed. Comparative analysis between White and Black patients was conducted using logistic regression to determine associations with palliative care consultation and EoL care.</p><p><strong>Results: </strong>Among 7,215 patients with NETs, 60.7% received palliative care consultation at EoL. Palliative care consultation was more frequent in males and patients aged 50-75 years. It was associated with a higher likelihood of DNR code status (OR, 5.2; 95% CI, 4.7-5.8) and a reduced incidence of aggressive treatments such as mechanical ventilation (OR, 0.47; 95% CI, 0.43-0.52) and vasopressor administration (OR, 0.70; 95% CI, 0.60-0.82). Black patients were less likely to receive palliative care consultation (adjusted OR, 0.70; 95% CI, 0.62-0.80) and to have DNR code status (adjusted OR, 0.81; 95% CI, 0.71-0.92), and were more likely to undergo aggressive interventions such as mechanical ventilation at EoL (adjusted OR, 1.54; 95% CI, 1.35-1.76).</p><p><strong>Conclusions: </strong>Our study shows that approximately 40% of hospitalized patients with NETs do not receive palliative care consultation at EoL, and that significant racial disparities exist. These findings underscore the need for enhanced integration of palliative care and targeted interventions to address racial disparities in EoL care among patients with NETs.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned About Acute and Late Toxicity After Two Decades of Experience With Pancreatic SBRT.","authors":"Susannah G Ellsworth, Mohamed Abdelhakiem, Baher Elgohari, Mohammed Mohammed, Jeffrey Shogan, Alberto Vera, Steven A Burton, Adam C Olson, Kenneth K W Lee, Alessandro Paniccia, Janie Y Zhang, Michael T Lotze, Amer H Zureikat","doi":"10.6004/jnccn.2025.7013","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7013","url":null,"abstract":"<p><strong>Background: </strong>Stereotactic body radiotherapy (SBRT) is increasingly used to treat pancreatic cancer. However, data on acute morbidity, mortality, and late gastrointestinal toxicity risk following SBRT have not been reported. This study analyzed acute (≤90 days) morbidity and mortality rates and the incidence of grade ≥3 gastrointestinal toxicity at any point following SBRT for pancreatic cancer.</p><p><strong>Methods: </strong>We analyzed 507 patients from a single-institution registry, abstracting outcomes from electronic medical records. Toxicity risk was quantified using descriptive statistics and Cox regression.</p><p><strong>Results: </strong>The median patient age was 70 years (range, 32-91), with 49.7% of patients being women. SBRT was administered perioperatively in 190 (37.5%) patients (75 preoperatively, 115 postoperatively). Other indications included unresectable disease (n=198; 39.1%), medically inoperable disease (n=53; 10.5%), and locally recurrent disease (n=38; 7.5%). Most patients received 9 to 12 Gy in 3 fractions (n=278; 54.8%); 78 (15.4%) received single-fraction SBRT (18-25 Gy), and 147 (29.0%) received 5 to 8 Gy in 5 fractions. Within 90 days of SBRT, 38 (7.5%) patients died, most commonly due to disease progression. Hospitalization occurred in 123 (24.3%) patients, most often for infection. Severe gastrointestinal toxicity was predominantly a late occurrence (median onset, 10.9 months post-SBRT), with a crude rate of 13.3% (59/445). Higher-dose regimens and lack of surgical resection were associated with an increased risk of late grade ≥3 toxicity. The 2-year actuarial risk of high-grade gastrointestinal toxicity was 25.0%, 19.4%, and 16% for very-high, high, and moderate biologically effective dose regimens, respectively, with corresponding crude rates of 12.8%, 13.3%, and 8.2%, respectively.</p><p><strong>Conclusions: </strong>Acute mortality rates following SBRT for pancreatic cancer are relatively low. However, infections and early disease progression contribute significantly to hospitalization and death in this medically fragile population. Severe gastrointestinal toxicity occurs primarily as a late effect, with risk potentially modified by radiation dosing and the use of more protracted fractionation schedules.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of the Integrated Cancer Care Access Network on Cancer Treatment Completion and Quality of Life.","authors":"Francesca Gany, Irina Melnic, Yuelin Li, Jackie Finik, Minlun Wu, Julia Ramirez, Caroline Hwang, Jennifer Leng, Victoria Blinder","doi":"10.6004/jnccn.2025.7017","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7017","url":null,"abstract":"<p><strong>Background: </strong>We prospectively examined the effect of a multilingual, multidisciplinary patient navigation and essential needs access program on oncology treatment completion and patient-reported outcomes among medically underserved patients with cancer. Medically underserved patients have limited socioeconomic/geographic access to medical care.</p><p><strong>Patients and methods: </strong>We conducted an unblinded, 2-arm randomized controlled trial among patients with stage I-III cancer at 2 New York City safety-net cancer clinics (2013-2016), where social work and appointment navigation support were generally available. Patients were randomized by permuted block to either the Integrated Cancer Care Access Network (ICCAN) intervention or the institution's usual and customary care (U&C). The primary outcome, treatment completion, was assessed at 12 months. Quality of life (EuroQol 5-Dimension [EQ-5D]), depression symptoms (Patient Health Questionnaire-9 [PHQ-9]), and stress (4-item Perceived Stress Scale [PSS-4]) scores were assessed at baseline and 12 months.</p><p><strong>Results: </strong>All 152 participants were assessed for the primary outcome (ICCAN, n=76; U&C, n=76). Most patients (57%) were foreign-born; 64% preferred English, and 36% preferred Spanish. Treatment completion was higher in the ICCAN arm compared with the U&C arm (92% vs 78%; P=.022). Both arms showed improvements in EQ-5D (effect sizes [ES]: U&C, 0.75; ICCAN, 1.47), PHQ-9 (U&C, 1.06; ICCAN, 1.33), and PSS-4 scores (U&C, 0.29; ICCAN, 1.13). Improvements in EQ-5D (P=.001), PHQ-9 (P=.046), and PSS-4 (P=.001) scores were significantly greater among patients in the ICCAN arm.</p><p><strong>Conclusions: </strong>Patients in the ICCAN arm had significantly better treatment completion and patient-reported outcomes than those receiving U&C. Future studies should explore service utilization and resource access to clarify the reasons for these differences. Comprehensive multidisciplinary patient navigation may improve outcomes for underserved patients with cancer.</p><p><strong>Clinicaltrials: </strong>gov identifier: NCT01742143.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of Chronic Health Conditions Among People With HIV and Common Non-AIDS-Defining Cancers.","authors":"Gaurav Goyal, Ene M Enogela, Greer A Burkholder, Mari M Kitahata, Heidi M Crane, Vanessa Eulo, Chad J Achenbach, Claire E Farel, Peter W Hunt, Jeffrey M Jacobson, Julia Fleming, Edward R Cachay, Michael S Saag, Smita Bhatia, Joshua Richman","doi":"10.6004/jnccn.2025.7018","DOIUrl":"https://doi.org/10.6004/jnccn.2025.7018","url":null,"abstract":"<p><strong>Background: </strong>With advances in antiretroviral therapy, aging people with HIV (PWH) are increasingly at risk for non-AIDS-defining cancers (NADCs) and chronic morbidities. This study examines whether PWH with NADCs face a higher risk of new-onset chronic health conditions compared with those without cancer.</p><p><strong>Patients and methods: </strong>We conducted a retrospective cohort study using data from the CFAR (Centers for AIDS Research) Network of Integrated Clinical Systems (CNICS) for PWH enrolled between 1995 and 2018 from 8 US academic institutions. We included PWH with the 5 most common NADCs: anal cancer, non-small cell lung cancer (NSCLC), prostate cancer, classic Hodgkin lymphoma (HL), and hepatocellular carcinoma (HCC). A 1:2 matching for each NADC subgroup was performed based on age, cohort entry year, and sex (noncancer cohort). Chronic health conditions were graded using the CTCAE, with the primary outcome being the risk of new-onset grade ≥3 morbidities, analyzed using Cox regression.</p><p><strong>Results: </strong>The study included 693 PWH with NADCs and 1,345 matched PWH without cancer. At a median follow-up of 13.7 years for PWH with NADCs and 10.7 years for the noncancer group, the prevalence of grade ≥3 morbidities was significantly higher in the NADC group (24.8% vs 13.8%; P≤.01). Multivariable Cox regression showed a higher risk of new-onset grade ≥3 conditions in the NADC group (hazard ratio, 2.94; P<.0001), specifically diabetes mellitus (all NADCs), myocardial infarction (NSCLC and HL), and congestive heart failure (prostate cancer).</p><p><strong>Conclusions: </strong>Our study showed an excess risk of new-onset morbidities among PWH with NADCs. These findings have critical implications for the care of survivors of HIV and cancer and underscore the importance of integrated care approaches to address late effects in this vulnerable population.</p>","PeriodicalId":520697,"journal":{"name":"Journal of the National Comprehensive Cancer Network : JNCCN","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}