Current Oncology

Introducing [¹⁷⁷Lu]Lu-PSMA-617 into metastatic hormone-sensitive prostate cancer (mHSPC) raises questions about patient selection and treatment sequencing. This non-systematic narrative review examines PSMAddition alongside evidence on alternative treatments, prostate-specific membrane antigen (PSMA) imaging, safety, and subsequent therapy. In the peer-reviewed analysis, with a data cutoff of 13 January 2025, adding radioligand therapy to androgen-deprivation therapy and an investigator-selected androgen receptor pathway inhibitor improved radiographic progression-free survival (hazard ratio 0.72; 95% confidence interval 0.58–0.90). Overall survival was immature and did not meet the prespecified interim significance threshold (hazard ratio 0.84; 95% confidence interval 0.63–1.13). A subsequent non-peer-reviewed sponsor update supported the radiographic findings, although the updated analysis was not controlled for type I error and overall survival remained immature. Radioligand intensification increased grade ≥3 adverse events (51% versus 43%). Prespecified composite quality-of-life and pain endpoints showed no statistically significant differences, although their interpretation is limited by the inclusion of progression or death. Control-arm crossover after progression was optional. Direct mHSPC evidence is distinguished from contextual castration-resistant evidence. Neither a preferred hormonal partner nor superiority over docetaxel-containing triplet therapy has been established. A non-prescriptive five-domain framework integrates target expression, disease characteristics, patient fitness, subsequent treatment options, and delivery capacity to support multidisciplinary assessment.

The use of immune checkpoint inhibitors (ICIs) after liver transplantation (LT) remains controversial, because immune activation may cause allograft rejection. Evidence in non-hepatocellular carcinoma (HCC) malignancies is limited. We retrospectively reviewed three LT recipients treated with pembrolizumab for advanced non-HCC malignancies at the McGill University Health Centre; treatment began between May 2020 and January 2025, and follow-up was censored on 31 January 2026. A patient with PD-L1-negative non-small cell lung cancer (NSCLC) achieved stable disease for approximately seven months, whereas a patient with PD-L1-high NSCLC achieved a durable partial response with progression-free survival of approximately 36 months. A third patient with cutaneous squamous cell carcinoma achieved a near-complete radiologic and metabolic response after two cycles. Pembrolizumab was held after this response; subsequent liver-test abnormalities raised concern for graft injury, but biopsy showed no histologic rejection and supported treatment resumption. No clinical or biochemical evidence of rejection was observed in Cases 1 and 2. At cutoff, Case 3 was alive and receiving pembrolizumab after seven cycles. These cases support a cancer-specific, individualized risk-benefit assessment in which expected oncologic benefit, alternatives, graft history, immunosuppression, and acceptance of graft-loss risk guide multidisciplinary treatment and close graft surveillance.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) affects two-thirds of patients who receive neurotoxic chemotherapy. In almost half of these patients, CIPN is persistent, with limited treatment options. Exercise-based rehabilitation shows promising results in improving CIPN-related outcomes, but high-quality research is needed with CIPN symptoms and disability as primary endpoints. Methods: We conducted a phase I single-arm, multi-method pilot study of a 10-week remotely delivered exercise-based rehabilitation program (EX-CIPN) for adult (≥18-years) cancer survivors experiencing CIPN symptoms ≥6 months post-chemotherapy. Primary outcomes were feasibility (accrual, retention, and adherence), acceptability (interviews and surveys), and safety (CTCAE v5). Secondary outcomes included pain, CIPN symptoms, CIPN-related disability, and physiologic assessments. Assessments were conducted at baseline (T1), post-program (T2), and 3 months post-program (T3). Post-program feedback surveys were completed at T2 and semi-structured qualitative video interviews were completed between T2 and T3. Results: In total, 36 participants (median age: 59, 83% female) consented to participate in the study. T1 retention rate (90%), adherence rates (77–96%), and no reported serious adverse events (Grade 3 CTCAE v5) supported study feasibility and safety. Interviews and surveys supported intervention acceptability. Retention rates at T2 (68%) and T3 (63%) did not reach feasibility targets. CIPN symptoms and CIPN-related disability showed significant improvement at T3 (p < 0.001). Conclusions: Results suggest that EX-CIPN has encouraging feasibility outcomes and is acceptable and safe. Preliminary clinical outcome results are promising. Based on these study results, we can proceed to test this intervention, with a few modifications, in a prospective randomised trial with a CIPN-related primary outcome.