Oncologist最新文献

{"title":"Validation of the FACIT-Fatigue Scale in Patients With Locally Advanced or Metastatic Breast Cancer.","authors":"Alessandra Fabi, Steven Hager, Laura Lourdes, Chiara Gandini, Elizabeth M Gavioli, Renuka Wakade, Enrico M Minnella, Marcello Allegretti","doi":"10.1093/oncolo/oyaf292","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf292","url":null,"abstract":"<p><strong>Background: </strong>Cancer-related fatigue (CRF) is a common symptom in patients with locally advanced or metastatic breast cancer (LA/M BC) receiving taxane-based chemotherapy (CT). CRF is commonly assessed as a subjective experience by patient questionnaires, such as the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue. The aim of this study was to extend validity of the FACIT-Fatigue and estimate clinically meaningful group-level differences in this patient population.</p><p><strong>Materials and methods: </strong>This was a prospective, noninterventional, multinational study conducted in the United States and Italy from October 2021 to August 2023 in adult patients with LA/M BC eligible to receive cycle 1 of taxane-based CT. Patients completed a FACIT-Fatigue survey before starting CT and every 3 to 4 weeks for ∼16 weeks; a group of patients participated in a qualitative substudy to explore additional fatigue factors via semistructured, phone-based cognitive interviews.</p><p><strong>Results: </strong>Sixty-two female patients with a mean (standard deviation) age of 55.5 (12.2) years were included. Baseline (visit 1) mean (95% confidence interval) FACIT-Fatigue score was 39.0 (36.8, 41.2), and fatigue worsened over time from 36.6 at visit 2 to 31.9 at visit 5. All FACIT-Fatigue items were relevant, with patients frequently reporting physical and psychological fatigue during treatment; the most highly relevant items were \"I feel listless\" and \"I have to limit my social activity because I am tired.\" Triangulation of anchor-based, distribution-based, and qualitative-based methods determined a meaningful group-level difference of 2.4 points.</p><p><strong>Conclusion: </strong>The FACIT-Fatigue survey includes items relevant to patients with LA/M BC on taxane-based CT.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180443","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":"A multicenter retrospective study of PD-1 blockade plus chemotherapy as first-line therapy in advanced hepatoid adenocarcinoma of the stomach.","authors":"Jingru Wang, Jinbo Zhan, Zhen Rao, Gang Su, Yan He, Ling Zhou, Jianhua Wu, Xiaowei Sun, Xiaojun Xiang","doi":"10.1093/oncolo/oyaf312","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf312","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate the efficacy and safety of PD-1 blockade in combination with chemotherapy for patients with advanced hepatoid adenocarcinoma of the stomach (HAS).</p><p><strong>Materials and methods: </strong>This study retrospectively collected data from 25 patients with advanced HAS who received first-line PD-1 blockade combined with chemotherapy across 6 centers between January 2018 and January 2024. Progression-Free Survival (PFS) and Overall Survival (OS) were assessed using Kaplan-Meier (KM) curves.</p><p><strong>Results: </strong>This study included 25 patients with HAS, all of whom received a first-line treatment regimen combining PD-1 blockade and chemotherapy. The Objective Response Rate (ORR) and Disease Control Rate (DCR) were 76.0% and 88.0%, respectively. The median follow-up time was 13.1 months, with a median Progression-Free Survival (mPFS) of 10.2 months (95% CI: 6.3-14.1) and a median Overall Survival (mOS) of 20.3 months (95% CI: 11.3-29.4). A total of 20 patients (80.0%) experienced adverse reactions of varying degrees, with white blood cell (WBC) count decreased (12, 48.0%) being the most common adverse event. Two patients experienced fatal adverse events (grade 5),both of which were unrelated to the PD-1 blockade.</p><p><strong>Conclusion: </strong>Patients with HAS can derive survival benefits from first-line treatment with PD-1 blockade combined with chemotherapy, and the treatment is well tolerated. Furthermore, this pathological subtype may serve as a predictive indicator of favorable efficacy for PD-1 blockade, regardless of the patients' PD-L1 combined positive score (CPS).</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152124","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":"Immune checkpoint Inhibitor-Related Myocarditis: A Comprehensive Analysis of Clinical Manifestations and Prognostic Factors.","authors":"Yue Fan, Yan Xu, Xiaoyan Liu, Guangcheng Liu, Bin Zhang, Wei Wu, Shuyang Zhang","doi":"10.1093/oncolo/oyaf285","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf285","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors-related myocarditis (ICI-myocarditis) is a rare but potentially lethal complication of cancer immunotherapy. Extensive information concerning risk factors and outcomes is still insufficient.</p><p><strong>Methods: </strong>This multi-center retrospective study enrolled 161 patients diagnosed with biopsy-proven or clinically diagnosed ICI-myocarditis. We performed thorough studies of clinical characteristics and management approaches. Time-to-event analyses, encompassing landmark analysis and competing risk models, were employed to identify early mortality predictors and evaluate long-term prognosis in survivors.</p><p><strong>Results: </strong>ICI-myocarditis typically generally manifested early (median 4 weeks following ICI initiation), with mortality primarily occurring within 60 days. Significantly elevated cardiac troponin I (cTnI ≥ 50 times the upper reference limit) and reduced left ventricular ejection fraction (LVEF < 50%) were strong predictors of shortened survival. Landmark analyses revealed these factors influenced early but not long-term mortality beyond 60 days. Patients with concomitant myositis exhibited more fulminant presentations and higher early mortality, though long-term outcomes were comparable to those of isolated myocarditis. Multivariable analysis identified four independent predictors of cardiotoxicity-related death: initial LVEF < 50%, alanine aminotransferase (ALT), creatine kinase-MB (CKMB) and concomitant ICI-myositis.</p><p><strong>Conclusions: </strong>Our study identifies multiple key predictors of early mortality in ICI-myocarditis. These results underscore the significance of early detection and vigorous intervention, particularly in patients with extreme troponin elevation or overlapping myositis. Despite higher short-term mortality in high-risk patients, long-term prognosis among survivors appears comparable.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139353","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":"Less Frequent Intravenous Dosing of Nemvaleukin Alfa in Patients With Advanced Solid Tumors: The Phase 1/2 ARTISTRY-3 trial.","authors":"Sarina A Piha-Paul, Justin A Call, Alexander I Spira, Jorge Bartolomé, Maria de Miguel, Xiwei Chen, Sarah S Donatelli, Nehal J Lakhani","doi":"10.1093/oncolo/oyaf301","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf301","url":null,"abstract":"<p><strong>Background: </strong>Intravenous (IV) nemvaleukin alfa (nemvaleukin, ALKS 4230) administered daily on days 1-5 in 21‑day cycles demonstrated antitumor activity and manageable safety in heavily pretreated advanced solid tumors. We present results from cohort 2 of the open-label phase I/II ARTISTRY-3 (NCT04592653) study, which evaluated less frequent IV dosing of nemvaleukin in advanced solid tumors.</p><p><strong>Methods: </strong>Eligible patients received escalating IV nemvaleukin doses in 21-day cycles on three schedules: day 1, days 1 and 8, and days 1 and 4. The primary endpoint was incidence of dose-limiting toxicities (DLTs).</p><p><strong>Results: </strong>From April 2022 to June 2024, 52 patients received nemvaleukin. No DLTs were reported. Most nemvaleukin-related treatment-emergent adverse events (TRAEs) were grade 1-2. Six patients (12%) experienced grade 3 TRAEs, the most common being neutropenia. Nemvaleukin exposure increased with escalating doses. NK and CD8+ T-cell expansion in whole blood was observed, with minimal regulatory T-cell expansion. Nemvaleukin at 30 μg/kg on days 1 and 8 was the recommended phase II dose. No objective responses were observed; 16 (31%) patients had stable disease (6 [12%] for ≥3 months). Increased tumor microenvironment infiltration of NK and CD8+ T-cells was observed in on-treatment biopsies.</p><p><strong>Conclusion: </strong>Less frequent IV doses of nemvaleukin demonstrated pharmacodynamic proof of mechanism and was tolerable with some disease stabilization.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132857","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":"Survival analysis of pyrotinib in HER2-positive metastatic breast cancer: a multicenter real-world study.","authors":"Shiyi Li, Ting Xu, Chengjun Zhu, Haixia Shan, Hong Xu, Jun Zhou, Lei Yang, Tongbo Yi, Xiaohong Wu, Yusong Zhang, Li Xie, Lili Zhang, Yuan Yuan","doi":"10.1093/oncolo/oyaf296","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf296","url":null,"abstract":"<p><strong>Background: </strong>In previous clinical trials, pyrotinib has shown good antitumor activity and manageable toxicity in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). However, real-world data on pyrotinib remain limited. In this study, we reported the latest real-world data on the efficacy and safety of pyrotinib in HER2-positive MBC.</p><p><strong>Methods: </strong>This multicenter retrospective study included 337 HER2-positive MBC patients treated with pyrotinib between October 2016 and October 2024. We reported the analysis of the efficacy and safety of pyrotinib in HER2-positive MBC. The primary endpoints were progression-free survival (PFS) and overall survival (OS).</p><p><strong>Results: </strong>As of 1st April 2025, the median follow-up duration was 42.6 months (range, 2.0-92.7). The median line of treatment was two. The median PFS was 15.3 months (95% CI, 12.9-17.6). By treatment line, the median PFS was 21.4 months (95% CI, 10.1-32.6) for first-line treatment, 14.8 months (95% CI, 11.4-18.1) and 10.9 months (95% CI, 8.1-13.7) for second-line and third-line or above treatment. The 3-year OS rate was 54.6% overall, with 63.2%, 61.1%, and 37.7% for first-line, second-line, and third-line or above treatment. The ORR, DCR, and CBR were 41.5%, 91.2%, and 80.0%. We further analyzed 57 patients with brain metastases (BM). The result showed that the median duration of response (DoR) and time to response (IQR) of radiotherapy-naïve ones were 12.6 months (95% CI, 6.8-18.4) and 1.7 months (95% CI, 1.3-2.2), respectively. The most frequent grade 3 or 4 adverse event was diarrhea. No treatment-related deaths were reported.</p><p><strong>Conclusion: </strong>The updated analysis demonstrated that pyrotinib could be a promising treatment option in HER2-positive MBC with acceptable toxicity in the real world. Survival is still under assessment with longer follow-up.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092889","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":"The Past, Present and Future of Myeloma Staging and Risk Prognostication.","authors":"Mehmet Baysal, Kelley Julian, Douglas Sborov, Amandeep Godara, Brian McClune, Jens G Lohr, Gliceida Galarza Fortuna, Ghulam Rehman Mohyuddin","doi":"10.1093/oncolo/oyaf299","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf299","url":null,"abstract":"<p><p>With the emergence of several new staging and risk stratification systems in myeloma, we have explored the evolution of these frameworks-past, present, and future. We examine how staging systems have evolved over time, the strengths of current models, and the limitations that future research can address to further improve prognostication.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092815","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":"\"Effect of a whole food plant based dietary intervention on cancer progression and inflammatory markers\".","authors":"Katherine K S Rieth, Erin Campbell, Luke J Peppone, Collen Netherby-Winslow, Eva Culakova, Jeremy McGuire, Hongying Sun, Thomas Campbell","doi":"10.1093/oncolo/oyaf294","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf294","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent inflammation and features of the tumor microenvironment are linked to poorer prognosis in breast cancer. This study examined the effects of a whole food, plant-based (WFPB) diet on serum biomarkers of proliferation, apoptosis, angiogenesis, and inflammation in women with metastatic breast cancer.</p><p><strong>Methods: </strong>Women with stage 4 breast cancer undergoing treatment were randomized to either a WFPB diet (n = 20) or usual care (n = 10) for 8 weeks. Blood samples collected at baseline, 4, and 8 weeks were analyzed for disease progression and inflammation markers, including IL-1β, IL-6, IL-8, IL-12, MCP-1, PDGF-AB/BB, FGF-2, MIF, sFasL, TNF-α, TRAIL, CA15-3, HGF, leptin, VEGF-A, VEGF-C, VEGF-D, and angiopoietin-2. Data were evaluated using t-tests, ANCOVA, and Pearson's correlations.</p><p><strong>Results: </strong>While no statistically significant between-group differences were found-likely due to the small control group-several within-group changes were observed in the WFPB group. TNF-α decreased significantly by week 8 (p < 0.05), as did leptin at both weeks 4 and 8 (p < 0.001). Novel findings include significant decline in CA15-3 and VEGF-C levels by week 8 (both p < 0.05). CA15-3 positively correlated with sFasL (R = 0.72, p < 0.001), TRAIL (R = 0.58, p < 0.05), and TNF-α (R = 0.52, p < 0.01).</p><p><strong>Conclusion: </strong>This randomized trial is among the first to assess dietary intervention effects on progression-related biomarkers in metastatic breast cancer. The WFPB diet was associated with reductions in inflammatory and tumor markers, suggesting potential to reduce inflammation and slow disease progression. Further research is warranted.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093009","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":"First line atezolizumab/bevacizumab or durvalumab/tremelimumab in advanced hepatocellular carcinoma: a real world, multi-center retrospective study.","authors":"Ioannis Kournoutas, Paulina Marell, Jennifer Gile, Anina Peersen, Priyanshi Shah, Kyle VanDommelen, Suneel D Kamath, Garima Gupta, Mehmet Akce, Ju Dong Yang, Pin-Jung Chen, Nikolas Naleid, Amit Mahipal, Nicole Peterson, Vaibhav Sahai, Wen Wee Ma, Zhaohui Jin, Thorvardur Halfdanarson, Lionel Fonkoua Kankeu, Leslie A Washburn, Caitlin B Conboy, Michael Torbenson, Ajit Goenka, Scott Thompson, Sudhakar K Venkatesh, Patrick Starlinger, Lewis Roberts, Gregory J Gores, Hani Babiker, Daniel Ahn, Mitesh Borad, Tanios Bekaii-Saab, Aminah Jatoi, Robert R McWilliams, Fang-Shu Ou, Nguyen H Tran","doi":"10.1093/oncolo/oyaf286","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf286","url":null,"abstract":"<p><strong>Background: </strong>Unresectable hepatocellular carcinoma (uHCC) is a leading cause of cancer death. FDA-approved first-line systemic therapies include atezolizumab/bevacizumab (atezo/bev) and durvalumab/tremelimumab (durva/treme); however, there is a lack of comparative data.</p><p><strong>Methods: </strong>We reviewed outcomes of patients with uHCC who initiated atezo/bev or durva/treme between 2017 and 2024, across six institutions. Overall survival (OS) and time to treatment discontinuation (TTD) were analyzed using the Kaplan-Meier and Cox models, adjusting for baseline characteristics.</p><p><strong>Results: </strong>452 uHCC pts were included. Median age: 68 years; 77% male; 81% white. Most common etiologies were viral hepatitis (38.9%) and metabolic dysfunction-associated steatohepatitis (19.5%). Disease progression was the primary reason for treatment discontinuation, atezo/bev (56%) and durva/treme (42%). Outcomes were not statistically significant (median OS [month, m]: 14.0 vs. 14.6 [p = 0.66]; median TTD [m]: 4.9 vs. 3.9 [p = 0.42] for atezo/bev vs. durva/treme). Outcomes were significantly different between Child-Pugh classes (CP: A, B7, B8/9, C) respectively, median OS(m): 19.0, 6.1, 5.1, 2.0 (p < 0.001); median TTD(m): 6.1, 2.3, 3.0, 1.3 (p < 0.001).</p><p><strong>Conclusions: </strong>In this real-world study of uHCC, no significant difference in clinical outcomes was observed between atezo/bev and durva/treme in the first line setting. CP scores were a key prognostic variable with both regimens.</p><p><strong>Implications for practice: </strong>This study offers real-world comparative data on two first line regimens in uHCC. As multiple first-line regimen combinations emerge, assessment of differences in efficacy, safety, and patient selection outside of clinical trials remain an unmet need. These findings may help guide treatment decisions, particularly in settings where toxicity, comorbidities, or resource constraints influence regimen choice.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093056","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":"SUNRISE-CRC: a randomized phase II study of high-dose intermittent sunitinib versus trifluridine/tipiracil in metastatic colorectal carcinoma.","authors":"Jorien B E Janssen, Kirti K Iyer, Sophie L Gerritse, Eline Janssen, Elske C Gootjes, Mariette Labots, Tineke E Buffart, Miriam L Wumkes, Joeri A J Douma, Mirte M Streppel, Laurien M Buffart, Marianne A Jonker, Erik van den Hombergh, Nielka P van Erp, Jan Paul Medema, Daniele V F Tauriello, Dennis Poel, Henk M W Verheul","doi":"10.1093/oncolo/oyaf288","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf288","url":null,"abstract":"<p><strong>Background: </strong>Patients with metastatic colorectal cancer often have poor or short responses to currently available therapies. Drug repurposing with alternative dosing schedules may offer unexpected clinical benefit, even for agents that previously failed for this indication.</p><p><strong>Methods: </strong>We explored a high-dose treatment strategy for sunitinib, assessing its potential for both cancer cell killing and inducing immunogenic cell death in patient-derived tumour organoids (PDTOs) of metastatic colorectal cancer (mCRC). In a randomized clinical trial, we studied the efficacy of high-dose intermittent sunitinib (700 mg once every 2 weeks) in patients with advanced CRC compared to standard therapy with trifluridine/tipiracil. The primary outcome measure was progression-free survival (PFS); secondary outcomes included overall survival, safety and tolerability, quality of life, and exploratory biomarker analyses.</p><p><strong>Results: </strong>While high, intermittent dosing was found to effectively kill PDTOs in vitro, no support for immunogenic cell death was found. In our clinical trial, among a total of 63 evaluable patients, median PFS was 2.8 months (95% CI 0.9-4.7) for the investigation arm compared to 1.9 months (95% CI 1.6-2.3) for the trifluridine/tipiracil group (p = 0.78, HR 1.22; 95% CI 0.73-2.04). The trial was halted prematurely due to toxicities: in particular, hemorrhage, fever and gastrointestinal adverse events.</p><p><strong>Conclusion: </strong>High-dose intermittent sunitinib treatment did not improve PFS for patients with heavily pretreated mCRC compared to standard 3rd or 4th-line treatment with trifluridine/tipiracil, whereas significant toxicity was observed. In addition, this approach provoked no relevant immunological responses in vitro, discouraging further research for potential combinations with immunotherapeutics.</p><p><strong>Identifier: </strong>NCT03909724.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093057","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":"Large language model processing capabilities of ChatGPT 4.0 to generate molecular tumor board recommendations-a critical evaluation on real world data.","authors":"Maximilian Schmutz, Sebastian Sommer, Julia Sander, David Graumann, Johannes Raffler, Iñaki Soto-Rey, Seyedmostafa Sheikhalishahi, Lisa Schmidt, Leonhard Paul Unkelbach, Levent Ortak, Tina Schaller, Sebastian Dintner, Kathrin Hildebrand, Michaela Kuhlen, Frank Jordan, Martin Trepel, Christian Hinske, Rainer Claus","doi":"10.1093/oncolo/oyaf293","DOIUrl":"https://doi.org/10.1093/oncolo/oyaf293","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) like ChatGPT 4.0 hold promise for enhancing clinical decision-making in precision oncology, particularly within molecular tumor boards (MTBs). This study assesses ChatGPT 4.0's performance in generating therapy recommendations for complex real-world cancer cases compared to expert human MTB (hMTB) teams.</p><p><strong>Methods: </strong>We retrospectively analyzed 20 anonymized MTB cases from the Comprehensive Cancer Center Augsburg (CCCA), covering breast cancer (n = 3), glioblastoma (n = 3), colorectal cancer (n = 2), and rare tumors. ChatGPT 4.0 recommendations were evaluated against hMTB outputs using metrics including recommendation type (therapeutic/diagnostic), information density (IDM), consistency, quality (level of evidence [LoE]), and efficiency. Each case was prompted thrice to evaluate variability (Fleiss' Kappa).</p><p><strong>Results: </strong>ChatGPT 4.0 generated more therapeutic recommendations per case than hMTB (median 3 vs. 1, p = 0.005), with comparable diagnostic suggestions (median 1 vs. 2, p = 0.501). Therapeutic scope from ChatGPT 4.0 included off-label and clinical trial options. IDM scores indicated similar content depth between ChatGPT 4.0 (median 0.67) and hMTB (median 0.75; p = 0.084). Moderate consistency was observed across replicate runs (median Fleiss' Kappa=0.51). ChatGPT 4.0 occasionally utilized lower-level or preclinical evidence more frequently (p = 0.0019). Efficiency favored ChatGPT 4.0 significantly (median 15.2 vs. 34.7 minutes; p < 0.001).</p><p><strong>Conclusion: </strong>Incorporating ChatGPT 4.0 into MTB workflows enhances efficiency and provides relevant recommendations, especially in guideline-supported cases. However, variability in evidence prioritization highlights the need for ongoing human oversight. A hybrid approach, integrating human expertise with LLM support, may optimize precision oncology decision-making.</p>","PeriodicalId":54686,"journal":{"name":"Oncologist","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093041","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}