Oncologist最新文献

{"title":"Global disparities in the availability and reimbursement of systemic therapies for renal cell carcinoma: results of the International ARON-AID Survey.","authors":"Yuksel Urun, Kannan Sridharan, Anca Zgura, Anas Zayed, Martin Ignacio Zapata Laguado, Tarkan Yetisyigit, Akihiro Yano, Mike Wenzel, Nuno Vau, Deniz Tural, Karine Trindade, Ben Tran, Frederic Ivan Leong Ting, Arnoud J Templeton, Hideki Takeshita, Kaisa Sunela, Vinicius Carrera Souza, Mopa Alina Sooro, Andrey Soares, Shankar Siva, Ashish Singh, Glauco Silveira, Shamik Shah, Emmanuel Seront, Fabio A Schutz, Maitê de Liz Vassen Schurmann, Timothy Schieber, Sarah Scagliarini, Amalya Sargsyan, Carlos Salinas Simonetti, Marine Rushanyan, Giandomenico Roviello, Alejo Rodriguez-Vida, Orion Erenhu Rodriguez Gonzalez, Robin Roberts, Astrid A M Van der Veldt, Mimma Rizzo, Alessandro Rizzo, Alexandr Poprach, Alina Pirshtuk, Alvaro Pinto, Erin Pierce, Jose Mauricio Peñaloza, Martino Pedrani, Se Hoon Park, Ibukun Adewumi Okunade, Karen Flora Odounga, Julio Noriega, Edriss Noorzai, Maria Tereza Nieto Coronel, Jiri Navratil, Zin W Myint, Vladan Mutavdzic, Olivier Mukuku, Robert Mugarura, Fernando Sabino Marques Monteiro, Abdikarim Hussein Mohamed, Daniel Mmereki, Carlo Messina, Bohuslav Melichar, Pitchou Mukaz Mbey, Ernesto Maturana, Diana Matthews, Francesco Massari, Esther Martínez, Priyamvada Maitre, Patrick Maison, Beaud Conrad Mabika Ndjembidouma, Kevin Lu, Jiakun Li, Haoran Li, Luciana de Moura Leite, Aly-Khan A Lalani, Zsófia Küronya, Jakub Kucharz, Arnaud Boris Koumba, Ray Manneh Kopp, Jindrich Kopecky, Alba J Kihn-Alarcón, Özge Keskin, Kymbat Kabdullina, Álvaro Juarez, María José Juan Fita, Denis Leonardo Jardim, Laurianne Grégoria James, Enrique Grande, Alfonso Gómez De Liaño, Patrizia Giannatempo, Marwan Ghosn, Cinthia Gauna, Maria Natalia Gandur Quiroga, Kazutoshi Fujita, Marcelo Roberto Pereira Freitas, Ondřej Fiala, Mauricio Fernandez Lazzaro, Glenda M Falcon Pacheco, Theophilus Olaide Esan, Deborah Tolulope Esan, Danelo Du Plessis, Silvia Neciosup Delgado, Simon J Crabb, Rafael Correa Cano, Luis Corrales, Jixiang Chen, Federico Cayol, Clarissa Cavalin Silva, André Paternò Castello Dias Carneiro, Georgiana Anca Caprinciu, Saul Campos, Thomas Büttner, Sebastiano Buti, Nedal Bukhari, Tomas Buchler, Maria T Bourlon, Hatice Bolek, Martin Boegemann, Mehmet A Bilen, Laura Bernal Vaca, Diogo Assed Bastos, Philippe Barthelemy, Samvel Bardakhchyan, Maria Alexandra Barbu, Jalal Baranseh, Aristotelis Bamias, Alex Bakenga, Georgia Anguera, Martin Angel, Carolina Alves Costa Silva, Teresa Alonso-Gordoa, Fahad Almugbel, Roula Almufti, Thiago Lins Almeida, Altay Aliyev, Carlos Aliaga, Umair Aleem, Erman Akkus, Luis Garcia Aceituno, Syed Hani Abidi, Halima Abahssain, Francesca Tartari, Javier Molina-Cerrillo, Matteo Santoni","doi":"10.1093/oncolo/oyag397","DOIUrl":"10.1093/oncolo/oyag397","url":null,"abstract":"<p><strong>Background: </strong>Renal Cell Carcinoma (RCC) represents a growing global health burden, with rising incidence and mortality worldwide. Despite major therapeutic advances, access to novel systemic treatments remains uneven across countries and regions.</p><p><strong>Methods: </strong>We conducted a cross-sectional, web-based international survey to assess the availability and reimbursement status of 20 innovative systemic therapies for RCC. Responses were collected from 144 clinicians, including medical oncologists, radiation oncologists, urologists, and nuclear medicine specialists, across 58 countries. Analyses examined associations between national income level, gross domestic product (GDP), and treatment availability.</p><p><strong>Findings: </strong>Thirty-six percent of the countries analyzed had at least 15 of the 20 therapies available. Full reimbursement for at least 15 of the selected innovative therapies was reported in six countries (10%), while 21 countries (36%) fully reimbursed 10-14 therapies and 13 countries (23%) reimbursed 1-9 therapies. In contrast, no full reimbursement for any of the assessed therapies was reported in 18 countries (31%). Higher national income level was significantly associated with greater availability of innovative therapies (Kruskal-Wallis test, P < .0001). Armenia (0.709), Greece (0.685), and Israel (0.666) exhibited the highest GDP-adjusted Drug Availability Index (DAI), whereas India (5.195), Nigeria (4.612), and Morocco (3.794) demonstrated the greatest number of available therapies per US$1000 of GDP per capita.</p><p><strong>Interpretation: </strong>Access to innovative systemic therapies for RCC remains highly unequal at the global level, with reimbursement posing a major barrier even where drugs are available. Internationally coordinated efforts addressing health policy, infrastructure, and equitable pricing are urgently required to ensure that advances in RCC treatment translate into improved outcomes for patients across diverse economic settings.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision oncology at speed: workflow design determines clinical utility in rapid molecular testing for lung cancer.","authors":"Brandon S Sheffield, Katherina Baranova, Parneet Cheema, Miriam A Bredella, Champica Nicholas, Ibiayi Dagogo-Jack, Jochen K Lennerz","doi":"10.1093/oncolo/oyag388","DOIUrl":"10.1093/oncolo/oyag388","url":null,"abstract":"<p><strong>Purpose: </strong>Matching patients with effective targeted therapies requires timely molecular results; however, the challenge today how to embed it into routine clinical workflows in ways that meaningfully affect patient-level treatment decisions.</p><p><strong>Methods: </strong>Building on prior work, the authors systematically reviewed laboratory operations, interdepartmental coordination, and administrative processes from two distinct healthcare settings: a US-based academic tertiary care center and a Canadian community hospital. We identified shared themes, context-specific challenges, and operational elements that distinguished successful integration from assay availability alone.</p><p><strong>Results: </strong>Across both environments, the comparison revealed that rapid testing consistently accelerated treatment decisions and facilitated biomarker-informed patient management, but its successful implementation depended on re-engineering laboratory workflows, aligning personnel competencies, and establishing turnaround time monitoring; technical availability alone did not ensure clinically meaningful rapid testing. While the academic context integrated rapid testing within comprehensive molecular pipelines and research frameworks, the community hospital context focused on pragmatic adoption for frontline care, especially in urgent clinical settings and based on the organization of the Canadian health system.</p><p><strong>Conclusion: </strong>Implementing rapid molecular testing in NSCLC is fundamentally an implementation and systems-engineering challenge rather than a technical challenge. Clinical speed depended more on system design than assay availability alone and is influenced, in part, by the larger national healthcare context. Addressing laboratory, operational, and administrative barriers is essential to ensure that rapid testing improves outcomes. Lessons learned from both academic and community practice provide a practical, implementation-focused roadmap for broader adoption and equity in access to precision oncology.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-evaluating the role of adjuvant chemotherapy after neoadjuvant chemotherapy in resected gastric cancer.","authors":"Aravind Sreeram, Celine Yeh, Nicolas Toumbacaris, Marinela Capanu, Shoji Shimada, Ping Gu, Yelena Y Janjigian, David H Ilson, Vivian E Strong, Geoffrey Y Ku","doi":"10.1093/oncolo/oyag384","DOIUrl":"10.1093/oncolo/oyag384","url":null,"abstract":"<p><strong>Background: </strong>Perioperative chemotherapy is the standard of care for resectable gastric cancer (GC), but many patients do not complete adjuvant chemotherapy (AC). It remains unclear whether AC following neoadjuvant chemotherapy (NAC) improves survival. We sought to assess differences in survival between patients with resectable GC who did vs did not receive AC after NAC and surgery.</p><p><strong>Methods: </strong>A retrospective study was conducted at a tertiary cancer center to evaluate survival differences in patients who did vs did not receive AC. Patients with resected GC who received NAC were included.</p><p><strong>Results: </strong>Of 339 patients, 264 (78%) received AC. There were no significant differences in median event-free survival (EFS) (7.0 vs. 7.5 years, P = .089) or overall survival (OS) (10 vs. 7.8 years, P = .11) between AC and non-AC groups. In the node-negative (ypN-) cohort (n = 169), there was no association between AC receipt and EFS (12 vs. 10 years, P = .7) or OS (12 vs. 10 years, P = .5). In the node-positive (ypN+) cohort (n = 170), AC receipt was associated with longer EFS (4.8 vs. 2.7 years, P = .031) but not OS (5.5 vs. 2.8 years, P = .071). High-risk patients based on lymph node ratio (LNR > 0.0685; n = 112) who received AC (n = 87; 78%) had longer EFS (P = .014) and OS (P = .033). Finally, AC receipt was associated with longer EFS (P = .014) and OS (P = .024) in those with incomplete/poor response to NAC (Becker tumor regression grade [TRG] 2-3).</p><p><strong>Conclusions: </strong>AC following NAC was not associated with improved survival in resected ypN- GC. High LNR identified a ypN + subgroup in which AC receipt was associated with longer EFS and OS. In patients with incomplete/poor response to NAC (TRG 2-3), AC receipt was associated with longer EFS and OS.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct sleep and rest-activity profiles according to adjuvant treatment exposure in women treated for breast cancer.","authors":"Alicia Leclercq, Abderrahmane Rahmani, Baptiste Morel, Antoine Chatrenet, Hugues Bourgeois, Oana Cojocarasu, Clara Mathie, Caroline Fonsegrive, François Gernier, Marie Fernette, Jean-Michel Grellard, Florence Joly, Mylène Duivon, Benedicte Giffard, Joy Perrier, Tristan Martin","doi":"10.1093/oncolo/oyag378","DOIUrl":"10.1093/oncolo/oyag378","url":null,"abstract":"<p><strong>Background: </strong>The associations between adjuvant treatment combinations and sleep-wake processes in women treated for breast cancer remain poorly understood, thereby limiting the development of individualized supportive care. This exploratory study aims to investigate this effect in women treated for breast cancer receiving chemotherapy (CT) combined or not with radio- (RT) and endocrine (ET) therapies on sleep-wake processes and cancer-related fatigue.</p><p><strong>Patients and methods: </strong>Sixty participants were evaluated (21 patients receiving CT+RT+ET [CT group], 23 patients receiving RT+ET only [non-CT group], and 16 healthy control women [HC group]). Participants completed questionnaires assessing cancer-related fatigue and sleep complaints and wore a wrist actigraph for 72 hours to extract sleep-derived and rest-activity rhythm (RAR) parameters. General linear model served to compare groups when controlling for age and cancer stage. Correlation matrices were computed using Spearman's correlations to evaluate the links between variables in each patient' group.</p><p><strong>Results: </strong>Sleep complaints and cancer-related fatigue did not significantly differ between groups. The CT group had fewer but longer nocturnal awakenings and shorter sleep-onset latency compared to both non-CT and HC groups. The non-CT group had lower dichotomy index-reflecting robustness of the RAR-than the CT group but did not differ significantly from the HCs. Fatigue was negatively correlated with RAR amplitude in the non-CT group.</p><p><strong>Conclusion: </strong>This exploratory study suggests that distinct patterns of sleep-wake parameters may be observed across the treatment exposure- groups (ie, RT and ET + or-CT). These results should not be interpreted as evidence that treatment exposure itself explains the observed sleep-wake differences and require further investigation to be confirmed.</p><p><strong>Clinical trial registration number: </strong>NCT04391543 (https://clinicaltrials.gov/study/NCT04391543).</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The perils and consequences of payer step editing (\"Step Therapy\") in US medical oncology: evidence, case examples, and policy remedies.","authors":"Lucio N Gordan, Kristen Boykin, Michael Reff, Paul Chadwick, Kiana Mehring, Austin Cox, David Wenk, Matthew Fink, Josh Eaves, Ryan Ciarrocchi","doi":"10.1093/oncolo/oyag398","DOIUrl":"10.1093/oncolo/oyag398","url":null,"abstract":"<p><p>Step therapy (\"fail-first\") policies require patients to initiate treatment with a payer-preferred regimen, often selected for cost, before coverage is granted for the oncologist-recommended therapy. In medical oncology, where biologic heterogeneity, biomarker-directed therapy, and time-sensitive sequencing determine outcomes, step edits can function as an avoidable barrier to evidence-based care. We performed a narrative review of peer-reviewed literature (2010-2025) and relevant US regulatory and policy documents to summarize the clinical, economic, and equity implications of step therapy as applied to systemic anticancer treatments. Evidence from cancer-specific and cross-cutting utilization management research suggests that coverage restrictions can delay initiation or continuation of therapy and increase treatment discontinuation. We synthesize mechanisms of harm (time-to-treatment delays, forced non-guideline-concordant sequencing, and toxicity exposure), describe contemporary case examples across therapeutic areas, and propose actionable policy remedies. Oncology-specific safeguards, including transparent clinical criteria, rapid exceptions and appeals, continuity-of-care protections, and provider performance-based exemptions (\"gold-carding\"), are essential to balance payer oversight with the imperatives of precision oncology.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169094","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":"Non-conventional histologies of prostate cancer: from morphology to biology-driven precision oncology.","authors":"Fabiano Flauto, Giuseppe Neola, Alessia Cimadamore, Michele Maffezzoli, Akash Maniam, Sarah Scagliarini, Fabio Calabrò, Luigi Formisano, Pasquale Rescigno, Giuseppe Luigi Banna","doi":"10.1093/oncolo/oyag391","DOIUrl":"10.1093/oncolo/oyag391","url":null,"abstract":"<p><p>Non-conventional prostate cancer histologies represent a small but clinically significant subset characterized by aggressive behavior, atypical biomarker profiles, and reduced dependence on androgen receptor signaling. Evidence indicates these histologies reflect dynamic biological states driven by genomic instability, lineage plasticity, and therapeutic selection rather than static morphologic entities, with several morphologies acting as accessible, if imperfect, surrogates for actionable alterations. We performed a translational narrative review integrating anatomic pathology, genomic and epigenomic biology, and biomarker-selected therapy, searching PubMed/MEDLINE, Embase, Cochrane CENTRAL, the ASCO Meeting Library, ESMO publications, and APCCC through May 2026, spanning neuroendocrine, ductal, intraductal, cribriform, adenosquamous, sarcomatoid, adenoid cystic, signet ring cell, and mucinous subtypes. These histologies are individually uncommon but are consistently associated with advanced stage and inferior survival. Neuroendocrine prostate cancer is the most aggressive phenotype and a major mechanism of resistance to AR-directed therapy, driven by combined RB1 and TP53 loss, epigenetic reprogramming, and lineage plasticity, and marked by DLL3 expression. Cribriform and intraductal carcinoma are often enriched for BRCA2 and DNA-repair deficiency, whereas ductal differentiation is associated with mismatch-repair deficiency in a subset, with implications for PARP inhibition and checkpoint blockade. Emerging strategies include platinum-based chemoimmunotherapy and investigational lineage-directed agents targeting DLL3, STEAP1, KLK2, and TROP-2, alongside radioligands. These histologies are best viewed as biologically distinct, evolving disease states. By integrating pathology, molecular biology, and biomarker-selected therapy into one translational pathway, this review reframes non-conventional histology as a prompt for early molecular characterization and adaptive, biology-driven treatment.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis assessment in oncology patients-evaluation survey: understanding usage patterns in a rural radiation cohort in Kentucky.","authors":"Evans Amoah, Waleed F Mourad, Marcus E Randall, Eddy S Yang, Brent J Shelton, Aradhana Kaushal","doi":"10.1093/oncolo/oyag370","DOIUrl":"10.1093/oncolo/oyag370","url":null,"abstract":"<p><strong>Background: </strong>Research on self-administration of unprescribed cannabis remains limited because of its evolving legal status in the United States. We conducted, to our knowledge, the first fully independent tablet application-executed oncology survey without research staff oversight in urban and rural radiation oncology practices. Objectives were to: (1) characterize symptoms motivating cannabis use, (2) compare urban and rural patterns of use, (3) assess concomitant use with opioids and gabapentin in an opioid-endemic region, and (4) evaluate associations with patient-reported quality of life.</p><p><strong>Materials and methods: </strong>An IRB-approved, de-identified survey was administered to 237 adults receiving radiation therapy between July 2023 and February 2024, from an urban practice and a rural satellite of an NCI/NCCN-designated cancer center. The survey assessed demographics, symptoms, quality of life, financial toxicity, and cannabis procurement. McNemar's test compared cannabis use before vs after cancer diagnosis; Fisher's exact and Cochran-Mantel-Haenszel tests evaluated associations.</p><p><strong>Results: </strong>Of 237 participants, 121 (51%) reported lifetime unprescribed medicinal cannabis use. Recent use after cancer diagnosis was reported by 35 patients (14.7%) vs 30 (12.7%) before diagnosis (P = 0.0625). Users most commonly reported cannabis for pain, nausea, anxiety, depression, poor appetite, and sleep disturbance; at least 80% reported symptom and quality-of-life improvement. Recent users were more likely to reside in urban than rural areas.</p><p><strong>Conclusion: </strong>Self-administration of unprescribed medicinal cannabis use was common across demographic groups and was primarily directed toward symptom management. This study demonstrates the feasibility of fully tablet-based research in rural oncology populations and provides novel data from an opioid-endemic region.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018891","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":"Dose response relationship of medical cannabis and symptom control in patients with pancreatic cancer: an analysis of the CANPAN trial.","authors":"Arjun Gupta, Kendall Lin, Ella Chrenka, Grace Gilmore, Jordan Cowger, David Rak, Dylan Zylla","doi":"10.1093/oncolo/oyag374","DOIUrl":"10.1093/oncolo/oyag374","url":null,"abstract":"<p><strong>Background: </strong>In a pilot waitlist-control randomized trial, a personalized medical cannabis intervention improved certain symptoms among patients with pancreatic cancer over 8 weeks. Longer-term and dose-response data can guide future trial design.</p><p><strong>Methods: </strong>CANPAN enrolled 32 cannabis-naïve patients with newly diagnosed locally advanced/metastatic pancreatic adenocarcinoma (NCT06605430). Patients were randomized to early (0-8 weeks) or delayed (9-16 weeks) cannabis intervention. Primary efficacy results over the first 8 weeks were previously reported. We investigated cannabis use and patient-reported outcome (PRO) completion over 9-16 weeks, and the relationship between tetrahydrocannabinol (THC) dose and symptom efficacy.</p><p><strong>Results: </strong>Among 32 participants, 23 (72%) used cannabis during their assigned 8-week period (12/16 in early arm and 11/16 in delayed arm). Of these, 16 (50%) had both pre-cannabis and 8-week post-cannabis initiation PRO data available. At the end of the 16-week study period, PRO data were available for 16 (50%) participants (9/16 early arm, 7/16 delayed arm). Median daily THC dose 4 weeks after starting cannabis was similar in early vs delayed arms (10 mg vs 9.3 mg). A higher average daily THC dose was associated with improvements in anxiety (r = 0.52, P = .038) and insomnia (r = 0.53, P = .033). A ≥ 10 mg daily THC dose (vs <10 mg) was associated with mean improvement in 4 vs 2.1 symptoms.</p><p><strong>Conclusions: </strong>The 50% complete data availability at 16 weeks, dose-response relationship with psychological symptoms, and threshold dose for multi-symptom efficacy will guide future trials. Similar cannabis use patterns across arms raise confidence in the waitlist-control design.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxicity attribution during enfortumab vedotin plus pembrolizumab therapy in urothelial carcinoma: a practical framework.","authors":"Jabra Zarka, Daniel S Childs, Miguel Muniz Rincon, Ali Tarhini, Albert Jang, Lisa A Kottschade, Svetomir N Markovic, Megan Spychalla, Morgan Sitenga, Giang Nguyen, Lance Pagliaro, Brian A Costello, Jacob J Orme","doi":"10.1093/oncolo/oyag371","DOIUrl":"10.1093/oncolo/oyag371","url":null,"abstract":"<p><p>Enfortumab vedotin (EV), pembrolizumab, and EV plus pembrolizumab (EV/P) have rapidly reshaped the treatment landscape of advanced urothelial carcinoma, but toxicity increasingly determines treatment delivery, treatment continuity, and real-world benefit. As EV/P moves into broader clinical use, clinicians must distinguish adverse events related to antibody-drug conjugate exposure from immune-mediated toxicities and recognize syndromes in which both mechanisms may contribute. In this practical, mechanism-informed review, we synthesize pivotal trials, mature follow-up reports, and representative real-world cohorts describing the safety of EV monotherapy, pembrolizumab monotherapy, and EV/P in urothelial carcinoma. Because adverse-event reporting and ascertainment are heterogeneous across studies, including differences in preferred terms, composite categories, grading frameworks, and treatment-related versus all-cause reporting, we emphasize clinically interpretable patterns rather than pooled estimates. Enfortumab vedotin monotherapy is characterized by cutaneous toxicity, peripheral neuropathy, hyperglycemia, dysgeusia, and ocular events, including early epithelial/metabolic events and cumulative neuropathy. Pembrolizumab monotherapy has a lower overall high-grade toxicity burden but is defined by immune-mediated endocrinopathies, pneumonitis, hepatitis, colitis, and nephritis. Combination therapy produces a predictable overlap of these toxicity domains, creating diagnostic and management challenges for syndromes such as skin toxicity, diarrhea, fatigue, and pulmonary symptoms. We provide comparative visual toxicity signatures, regimen-specific summary tables, temporal toxicity mapping, and a pragmatic attribution framework that classifies events as EV-predominant, immune-predominant, overlap/indeterminate, or high-risk requiring initial interruption of both agents. This review aims to support bedside recognition, provisional attribution, early management, and safer implementation of EV/P in contemporary urothelial carcinoma practice.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world patient-reported outcome comparing antibody-drug conjugates and conventional chemotherapy in metastatic breast cancer.","authors":"Manuela Milani, Francesco Riccetelli, Carla Strina, Marzia Alberio, Valeria Cervoni, Nicoletta Ziglioli, Donatella Caffi, Francesca Ferrè, Massimo Di Maio, Gabriella Pravettoni, Daniele Generali","doi":"10.1093/oncolo/oyag394","DOIUrl":"10.1093/oncolo/oyag394","url":null,"abstract":"<p><strong>Background: </strong>Antibody-drug conjugates (ADCs) have transformed second-line metastatic breast cancer (MBC) therapy, yet their multidimensional quality-of-life impact vs conventional intravenous chemotherapy in real-world practice, particularly on lifestyle and caregiver burden, remains poorly characterized.</p><p><strong>Materials and methods: </strong>This prospective cohort enrolled 122 consecutive patients with MBC starting second-line therapy: 51 received ADCs and 71 conventional intravenous chemotherapy, allocated by tumor biology and clinical factors. The DAMA (Digital Antibody drug conjugate Modulator in breAst cancer) framework collected electronic patient-reported outcome measures (ePROMs) on anthropometric, lifestyle, symptom, psychosocial, and caregiver-burden domains at baseline, 3 and 6 months, analyzed with linear mixed-effects models.</p><p><strong>Results: </strong>At baseline, measured lifestyle, symptom, psychosocial, and caregiver variables were broadly similar between cohorts, although treatment-related characteristics differed. At 3 months, ADC patients had greater mean weight loss (-3.1 vs -1.2 kg), a larger decline in weekly physical activity (-41 vs -22 min/wk), higher stress and caregiver burden, but lower pain scores (3.7 vs 5.3). By 6 months, several differences attenuated. In pooled descriptive analyses, weekly physical activity showed little association with pain (r = 0.03, P = .56), stress (r = -0.12, P = .03), anxiety (r = -0.02, P = .73), caregiver emotional wellbeing (r = 0.00, P = .97), or sleep duration (r = 0.04, P = .47).</p><p><strong>Conclusion: </strong>In this prospective real-world cohort, ADC and conventional chemotherapy cohorts showed different longitudinal patterns of patient- and caregiver-reported burden. Because treatment allocation was biology- and clinically driven, these findings are exploratory and should not be interpreted as causal treatment effects. Systematic ePROM collection within the DAMA framework was feasible and may support identification of supportive-care needs.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}