BMJ oncology最新文献

{"title":"Incidence of new-onset depression after colorectal cancer diagnosis and associated mortality: a population-based cohort study.","authors":"Vicki Cheng, Eric C Sayre, Jonathan M Loree, Sharlene Gill, Rachel A Murphy, Mary A De Vera","doi":"10.1136/bmjonc-2026-001215","DOIUrl":"https://doi.org/10.1136/bmjonc-2026-001215","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the incidence of and factors associated with new-onset depression following colorectal cancer (CRC) diagnosis and its association with all-cause and CRC-specific mortality.</p><p><strong>Design: </strong>Population-based retrospective cohort study using linked administrative health databases.</p><p><strong>Setting: </strong>British Columbia, Canada.</p><p><strong>Participants: </strong>Individuals diagnosed with CRC from 2010 to 2017 without a history of physician-recorded depression diagnoses in the 5 years preceding the CRC diagnosis.</p><p><strong>Main outcome measures: </strong>New-onset depression following CRC diagnosis was identified using International Classification of Diseases (ICD)-9 and ICD-10 diagnostic codes. Cumulative incidence and incidence rates of new-onset depression were estimated, and factors associated with new-onset depression were examined using Cox proportional hazards models. Depression was modelled as a time-varying exposure in mortality analyses, with Cox proportional hazards models used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and CRC-specific mortality.</p><p><strong>Results: </strong>Among 13 986 patients with CRC (55.2% males, mean age 66.0), the 5-year cumulative incidence of new-onset depression among those without a history of depression was 6.63% following CRC diagnosis. Incidence rates were highest in the first year post-CRC diagnosis (3.54 per 100 person-years), indicating that new-onset depression was most common early after diagnosis. Factors associated with new-onset depression included female sex (HR 1.40 (95% CI 1.22 to 1.61)) and stage 4 disease (HR 1.77 (95% CI 1.34 to 2.33)). New-onset depression after CRC diagnosis was associated with 97% higher all-cause mortality (HR 1.97 (95% CI 1.74 to 2.23)) and 73% higher CRC-specific mortality (HR 1.73 (95% CI 1.48 to 2.03)).</p><p><strong>Conclusions: </strong>The cumulative incidence of new-onset depression increased over time, with incidence rates highest in the first year following CRC diagnosis. New-onset depression after CRC diagnosis was associated with higher all-cause and CRC-specific mortality. Findings highlight the importance of early identification of patients at high risk for depression and consideration of longitudinal mental healthcare in CRC care.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001215"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13636315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active surveillance for a small low-risk papillary thyroid cancer: a 10-year prospective, observational study in an Italian tertiary care centre.","authors":"Eleonora Molinaro, Arianna Ghirri, Alessandro Prete, Valeria Tascini, Antonio Matrone, Paolo Piaggi, Gabriele Materazzi, Liborio Torregrossa, Clara Ugolini, Rossella Elisei","doi":"10.1136/bmjonc-2026-001154","DOIUrl":"https://doi.org/10.1136/bmjonc-2026-001154","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term safety and feasibility of active surveillance (AS) for Italian patients with low-risk papillary thyroid microcarcinoma (mPTC) and to analyse trends in patient enrolment and factors associated with discontinuation of surveillance. This study represents the first prospective European investigation with long-term follow-up assessing AS for mPTC.</p><p><strong>Design: </strong>Prospective, observational, non-randomised study with a duration of 10 years (2014-2024).</p><p><strong>Setting: </strong>Single tertiary referral centre (University Hospital of Pisa, Italy).</p><p><strong>Participants: </strong>260 adult patients with a mPTC (≤13 mm) who voluntarily opted for AS instead of immediate surgery.</p><p><strong>Interventions: </strong>AS consisting of periodic clinical evaluation and neck ultrasonography every 6 months for the first 2 years and annually thereafter. Surgery was recommended only in the presence of predefined disease progression or at patient request.</p><p><strong>Main outcome measures: </strong>Rates of disease progression, delayed surgical intervention, oncologic outcomes after surgery and patient discontinuation of AS.</p><p><strong>Results: </strong>A total of 260 patients were enrolled and followed for up to 10 years. Disease progression occurred in approximately 5% of patients. All patients who underwent delayed surgery achieved excellent outcomes, with no evidence of recurrence after a median postoperative follow-up of 43.5 months. No disease-specific deaths occurred during AS or after surgery. Over the study period, patient enrolment progressively increased, reflecting growing acceptance of AS. However, 18.5% of patients discontinued surveillance without evidence of progression, most frequently within the first year. Younger age and cytology suspicious for malignancy were associated with higher dropout rates.</p><p><strong>Conclusions: </strong>This study provides the first long-term prospective evidence that AS is a safe and feasible management strategy for patients with mPTC also in a European country. These findings support AS as a valid first-line approach and reinforce the need for improved patient education to optimise adherence and reduce unnecessary surgery.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001154"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytotoxic T-cell exhaustion analyses by in situ single-cell immunofluorescence in relation to colorectal cancer patient age, tissue bacteria and mortality.","authors":"Nobuhiro Nakazawa, Kosuke Matsuda, Satoko Ugai, Satoshi Miyahara, Atsushi Kondo, Mayu Higashioka, Yuxue Zhong, Alessandro Mannucci, Giulia Martina Cavestro, Andrew T Chan, Jonathan A Nowak, Mingyang Song, Hiroshi Saeki, Marios Giannakis, Juha P Väyrynen, Tomotaka Ugai, Shuji Ogino","doi":"10.1136/bmjonc-2026-001159","DOIUrl":"10.1136/bmjonc-2026-001159","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We hypothesised that cytotoxic T-cell exhaustion status in colorectal cancer (CRC) microenvironment relates to age of diagnosis (eg, early-onset CRC), pathogenic bacteria and clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Population-based prospective cohort study using the prospective cohort incident-tumour biobank method (PCIBM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Two US nationwide prospective cohort studies, the Nurses' Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Among 4476 incident CRC cases identified during follow-up, 857 patients with available tumour tissue were included in the present tissue-based analysis. Patients with colon and rectal adenocarcinomas were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Not applicable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;In situ single-cell multispectral immunofluorescence combined with computational machine learning for CD3, CD8, CD274 (PD-L1), HAVCR2 (TIM-3), PDCD1 (PD-1) and KRT (keratin) was used to characterise non-exhausted, progenitor-exhausted and exhausted CD3&lt;sup&gt;+&lt;/sup&gt;CD8&lt;sup&gt;+&lt;/sup&gt; cells according to PDCD1 (PD-1) and HAVCR2 (TIM-3) expression. Primary measures included densities of CD3&lt;sup&gt;+&lt;/sup&gt;CD8&lt;sup&gt;+&lt;/sup&gt; cell exhaustion subsets and their associations with clinicopathological characteristics, age at CRC diagnosis, selected tumour tissue bacteria, CRC-specific mortality and spatial proximity to tumour cells.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Younger age of CRC diagnosis generally correlated with lower densities of CD3&lt;sup&gt;+&lt;/sup&gt;CD8&lt;sup&gt;+&lt;/sup&gt; cells. Multivariable-adjusted ORs (with 95% CI) in age &lt;55 (vs age ≥70) for overall, progenitor-exhausted and exhausted CD3&lt;sup&gt;+&lt;/sup&gt;CD8&lt;sup&gt;+&lt;/sup&gt; cell stromal densities (all quartiles) were 0.39 (0.22 to 0.69; P&lt;sub&gt;trend&lt;/sub&gt;=0.0033), 0.40 (0.23 to 0.68; P&lt;sub&gt;trend&lt;/sub&gt;=0.0048) and 0.44 (0.25 to 0.78; P&lt;sub&gt;trend&lt;/sub&gt;=0.0082), respectively. Multivariable-adjusted ORs (with 95% CI) for stromal non-exhausted CD3&lt;sup&gt;+&lt;/sup&gt;CD8&lt;sup&gt;+&lt;/sup&gt; cells (quartiles) were 0.81 (0.56 to 1.17) and 0.52 (0.37 to 0.74) (P&lt;sub&gt;trend&lt;/sub&gt;=0.0004) for low-level and high-level &lt;i&gt;Bacteroides fragilis&lt;/i&gt; (vs negativity), respectively. Multivariable-adjusted ORs for stromal exhausted CD3&lt;sup&gt;+&lt;/sup&gt;CD8&lt;sup&gt;+&lt;/sup&gt; cells (quartiles) were 0.37 (0.19 to 0.72) and 0.60 (0.30 to 1.17) (P&lt;sub&gt;trend&lt;/sub&gt;=0.0081) for low-level and high-level enterotoxigenic &lt;i&gt;Bacteroides fragilis&lt;/i&gt; (vs negativity), respectively. Multivariable-adjusted CRC-specific mortality HRs (with 95% CI) in quartile 4 (Q4; vs Q1) of progenitor-exhausted CD3&lt;sup&gt;+&lt;/sup&gt;CD8&lt;sup&gt;+&lt;/sup&gt; cells in the intraepithelial region and their proximity to tumour cells were 0.42 (0.26 to 0.67; P&lt;sub&gt;trend&lt;/sub&gt;&lt;0.0001) and 0.50 (0.32 to 0.78; P&lt;sub&gt;trend&lt;/sub&gt;=0.0004), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This PCIBM-based study provides evidence that progenitor-exhausted CD3&lt;sup&gt;+&lt;/sup&gt;C","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001159"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralised oncology trials: decentralisation as a tool, not the goal.","authors":"Jordan E Cohen, Natalie Taylor, Angela C Webster, Jia Liu","doi":"10.1136/bmjonc-2026-001255","DOIUrl":"https://doi.org/10.1136/bmjonc-2026-001255","url":null,"abstract":"","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001255"},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ipsilateral recurrences after kidney-sparing surgery for upper tract urothelial carcinoma: a systematic review and meta-analysis.","authors":"Elin Ståhl, Sanjib Saha, Johannes Bobjer, Oskar Hagberg, Fredrik Liedberg","doi":"10.1136/bmjonc-2026-001138","DOIUrl":"10.1136/bmjonc-2026-001138","url":null,"abstract":"<p><strong>Objectives: </strong>Ipsilateral recurrence is a relevant outcome measure after kidney-sparing surgery (KSS) for urothelial upper tract carcinoma (UTUC). However, studies comparing ipsilateral recurrence after segmental ureterectomy (SU) and endourological treatment (ET) are lacking. This study aimed to quantitatively assess ipsilateral recurrence in ET and SU for UTUC to inform patient counselling and future study design.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>A systematic literature search, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), identified relevant studies from inception to September 2024. Random-effects meta-analysis was conducted to estimate the year-wise and pooled ipsilateral recurrence separately for ET and SU. Heterogeneity was explored by subgroup and meta-regression analyses and risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklist as well as funnel plots and Egger's regression test.</p><p><strong>Participants: </strong>Patients undergoing ET or SU included in eligible studies reporting ipsilateral recurrence outcomes.</p><p><strong>Main outcome measures: </strong>Time-to-event-derived ipsilateral recurrence probabilities and crude pooled ipsilateral recurrence proportions.</p><p><strong>Results: </strong>Seventy-four studies were included, of which 40 reported ipsilateral recurrence after ET and 34 after SU (n=3044). In 11 of these, time-to-event data were available. Time-to-event-derived ipsilateral recurrence probabilities after 4 years were 0.53 (95% CI 0.25 to 0.80) after ET and the corresponding crude ipsilateral recurrence proportion was 0.48 (95% CI 0.39 to 0.57) with considerable heterogeneity (p<0.001 Cochran's Q test). Time-to-event-derived ipsilateral recurrence probabilities after 4 years were 0.20 (95% CI 0.11 to 0.30) after SU with a crude ipsilateral recurrence proportion of 0.11 (95% CI 0.08 to 0.13) with moderate heterogeneity (p=0.20 Cochran's Q test). The estimates are derived from separate single-arm studies with differing tumour characteristics, treatment indications, surveillance protocols and other selection mechanisms that cannot be adjusted for. Results are limited by sparse reporting of numbers at risk and censoring, and lack of uniform reporting of outcome-related variables.</p><p><strong>Conclusions: </strong>Ipsilateral recurrence outcomes following SU were homogenous across studies. Direct comparative evidence evaluating ET versus SU remains lacking. Future studies should emphasise standardised reporting on outcomes and associated variables in KSS, as ipsilateral recurrence is a clinically important endpoint for patient counselling in UTUC.</p><p><strong>Prospero registration number: </strong>CRD42025640780.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001138"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aligning awareness, systems and policy to increase equitable access to genomically driven cancer care.","authors":"Kelly Kohut, Joshua Asaad Kuti, Sandra Balladares, Nicola Reents, Raza Sayyed, Benedito Mauro Rossi, Janina Balazar-Palacios, Bami Adenipekun, Nicolò Matteo Luca Battisti, Csaba László Dégi, Mev Dominguez-Valentin","doi":"10.1136/bmjonc-2025-000856","DOIUrl":"10.1136/bmjonc-2025-000856","url":null,"abstract":"<p><p>Genomic testing has the potential to transform cancer care across the patient pathway. However, its benefits remain unevenly realised across populations and health systems. Precision oncology is characterised by a strong promissory discourse, with expectations of improved outcomes and cost-effectiveness, yet real-world implementation remains variable and context dependent. This review examines how patient and public awareness interacts with, and is constrained by, structural, organisational and political-economic factors that shape equitable access to genomically driven cancer care across five themes: (1) the power of patient and public advocacy; (2) learning from the patient perspective; (3) culturally responsive communication; (4) structural and personal barriers and facilitators and (5) political economy of health. Examples are mapped across global regions to highlight how health system, structural and societal factors continue to limit the universal realisation of genomic medicine's benefits. We present four recommendations to strengthen the translation of awareness into equitable access and clinical impact: (1) expand and adequately power genomic studies in underserved populations; (2) improve risk communication and decision-making across the cancer pathway; (3) equitable validation and interpretation of emerging genomic technologies and (4) generate real-world evidence on access, uptake and outcomes of genome-matched therapies. Embedding awareness, trust, access and equity in future initiatives is imperative to realise the promise of precision medicine for all patients.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e000856"},"PeriodicalIF":0.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralised Oncology Trials in the UK: Evidence, Regulation and Academic Clinical Trials Units' Perspectives.","authors":"Oyeyemi Akala, Harriet S Walter, Claire Snowdon, Gianina-Ioana Postavaru, Judith M Bliss, Hannah Gribble, Abigail Botschka, Fay H Cafferty","doi":"10.1136/bmjonc-2026-001145","DOIUrl":"10.1136/bmjonc-2026-001145","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Decentralised clinical trials (DCTs) are increasingly promoted in UK research policy and practice; however, their benefits and implementation challenges in oncology remain unclear. We examined DCT use in oncology through a review of studies evaluating decentralised oncology trial delivery, UK regulatory and policy frameworks and a survey of UK academic Clinical Trials Units (CTUs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Multimethod study including a structured literature review, policy review and cross-sectional survey of UK Clinical Research Collaboration (UKCRC)-registered CTUs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;International literature, UK-based regulatory and policy documents and survey data from UKCRC-registered CTUs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;None.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Literature review: decentralised components evaluated and reported outcomes.Policy review: opportunities, barriers and gaps in UK regulatory and policy guidance relevant to DCTs.Survey: CTU awareness, uptake, perceived benefits and challenges related to decentralised trial delivery, comparing oncology and non-oncology settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 68 studies meeting broader eligibility criteria, only 8 formally evaluated decentralised elements within oncology trials and were included in the primary synthesis. Conducted across five countries, these studies primarily assessed feasibility, recruitment, usability and data completeness. Only one UK oncology study formally evaluated DCT methods, assessing use of remote electronic consent to support recruitment during the COVID-19 pandemic, highlighting limited published UK evaluation. Non-UK studies showed mixed findings, including improvements in trial processes or participant satisfaction in some contexts alongside operational challenges in others.The UK-based policy review identified strategic support for decentralisation but fragmented regulatory guidance and ambiguity around key decentralisation concepts. Temporary COVID-19-induced flexibilities demonstrated feasibility but have not been fully incorporated into permanent guidance.Survey responses were received from 27 CTUs (54% response rate). Awareness of decentralised approaches was high; however, use of these was lower in oncology than in non-oncology trials. Decentralisation was most commonly applied to patient follow-up. CTUs reported reduced participant burden and increased flexibility, but also challenges relating to governance, contracting, infrastructure, staffing and data management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Decentralised approaches in UK oncology trials are gaining momentum but remain unevenly adopted, alongside a limited oncology-specific evidence base, regulatory ambiguity and operational challenges. Oncology presents distinct challenges that may limit decentralisation of trials compared with other disease areas, including complex interventions, intensive safety monitoring require","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001145"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking global cancer guidelines.","authors":"Ishu Kataria, Richard Sullivan","doi":"10.1136/bmjonc-2026-001140","DOIUrl":"10.1136/bmjonc-2026-001140","url":null,"abstract":"","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001140"},"PeriodicalIF":0.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of immune checkpoint inhibitors on pregnancy: current evidence and future directions.","authors":"Iman Salehi, Christine Elser, Samuel D Saibil, Cynthia Vivianne Maxwell","doi":"10.1136/bmjonc-2026-001134","DOIUrl":"10.1136/bmjonc-2026-001134","url":null,"abstract":"<p><p>Cancer treatment has dramatically improved with the introduction of immune checkpoint inhibitors (ICIs). They are now common treatments for individuals of reproductive age, an important consideration when treating pregnant patients. Cancer in pregnancy is rare and guidelines available for ICI use during gestation are based on pre-clinical studies, single human case reports and spontaneous report databases. The immune pathways including PD-1 and PD-L1/PD-L2 and CTLA-4 provide critical immune inhibitory checkpoints at the maternal-fetal interface. These pathways support immune tolerance during implantation and the development of the placenta. Experimental animal studies demonstrated that inhibiting these immune pathways will result in increased frequency of adverse events such as spontaneous abortions and premature births. Human placental transfer of ICIs across the placenta is minimal in early gestation and increases in later gestation, coinciding with less exposure to developing organs during organogenesis and more exposure closer to term. There are now seventeen documented cases in the literature describing pregnant patients treated with ICIs. Most neonates developed normally in infancy, while there are a few documented cases of suspected neonatal immune-mediated complications. Experts including regulatory agencies and oncology professional organisations advise against the use of ICIs in pregnancy unless their use is critical to the survival of the patient and there is no safer alternative. Patient counselling regarding the risks of using ICIs during pregnancy, postpartum or both, involves a multidisciplinary team and requires shared decision making regarding maternal health, infant follow-up and standardised documentation for understanding potential delayed effects on neonate immunity as well as providing accurate information for future counselling.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e001134"},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and management of genetic susceptibility to cancer: UK perspective.","authors":"Ciaran McCarthy, Katie Snape","doi":"10.1136/bmjonc-2025-000849","DOIUrl":"10.1136/bmjonc-2025-000849","url":null,"abstract":"<p><p>Cancer is a genomic disease caused by variants in genes that impact on the regulation of cell division, cell growth and cell death. While the majority of cancers are caused by acquired genomic variation, a significant minority are influenced by inherited genetic variation which can increase the chance of a person developing cancer in their lifetime. Inherited genetic factors can be monogenic or polygenic and also interact with other cancer risk factors to create an individualised risk profile. Understanding personalised cancer risk can facilitate precision screening, prevention and early detection strategies. In this review, we give an overview of constitutional genetic susceptibility to cancer, how to assess and identify enhanced susceptibility and exemplars of how this influences precision management.</p>","PeriodicalId":72436,"journal":{"name":"BMJ oncology","volume":"5 2","pages":"e000849"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}