Current Oncology

19 pages, 2239 KiB

Open AccessSystematic Review

Resistance Mutation Profiles Associated with Current Treatments for Epidermal Growth Factor Receptor-Mutated Non-Small-Cell Lung Cancer in the United States: A Systematic Literature Review

by Pratyusha Vadagam, Dexter Waters, Anil Bhagat, Yuting Kuang, Jennifer Uyei and Julie Vanderpoel

Curr. Oncol. 2025, 32(4), 191; https://doi.org/10.3390/curroncol32040191 - 25 Mar 2025

Abstract

Treatment resistance due to gene alterations remains a challenge for patients with EGFR-mutated advanced or metastatic non-small-cell lung cancer (a/mNSCLC). A systematic literature review (SLR) was conducted to describe resistance mutation profiles and their impact on clinical outcomes in adults with a/mNSCLC in [...] Read more.

Treatment resistance due to gene alterations remains a challenge for patients with EGFR-mutated advanced or metastatic non-small-cell lung cancer (a/mNSCLC). A systematic literature review (SLR) was conducted to describe resistance mutation profiles and their impact on clinical outcomes in adults with a/mNSCLC in the United States (US). A comprehensive search of MEDLINE and Embase (2018–August 2022) identified 2986 records. Among 45 included studies, osimertinib was the most commonly reported treatment (osimertinib alone: 15 studies; as one of the treatment options: 18 studies), followed by other tyrosine kinase inhibitors (TKIs; 5 studies) and non-TKIs (1 study). For first-line (1L) and second-line (2L) osimertinib, the most frequent EGFR-dependent resistance mechanisms were T790M loss (1L: 15.4%; 2L: 20.5–49%) and C797X mutation (1L: 2.9–12.5%; 2L: 1.4–22%). EGFR-independent mechanisms included MET amplification (1L: 0.6–66%; 2L: 7.2–19%), TP53 mutation (1L: 29.2–33.3%), and CCNE1 amplification (1L: 7.9%; 2L: 10.3%). For patients receiving osimertinib, EGFR T790M mutation loss, EGFR/MET/HER2 amplification, RET fusion, and PIK3CA mutation were associated with worse progression-free survival. Resistance mechanisms resulting from current NSCLC treatments in the US are complex, underscoring the need to address such heterogeneous resistance profiles and improve outcomes for patients with EGFR-mutated a/mNSCLC. Full article

(This article belongs to the Section Thoracic Oncology)

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11 pages, 3483 KiB

Open AccessArticle

The Prognostic Role of Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 Expressions in Gastric Carcinomas

by Duygu Ayaz, Gülden Diniz, Ayşe Gül Pulular, Dudu Solakoğlu Kahraman, Umut Varol, Nuket Özkavruk Eliyatkın, Sevil Sayhan and Ali Kemal Kayapınar

Curr. Oncol. 2025, 32(4), 190; https://doi.org/10.3390/curroncol32040190 - 25 Mar 2025

Abstract

Background: The survival rate among stomach adenocarcinoma patients is exceedingly low. NGAL (neutrophil gelatinase-associated lipocalin) has pivotal roles in cell proliferation, immunity, and tumorigenesis. KIM-1 (Kidney Injury Molecule-1), also referred to as TIM-1 and HAVcr-1, is a transmembrane glycoprotein located in healthy immune [...] Read more.

Background: The survival rate among stomach adenocarcinoma patients is exceedingly low. NGAL (neutrophil gelatinase-associated lipocalin) has pivotal roles in cell proliferation, immunity, and tumorigenesis. KIM-1 (Kidney Injury Molecule-1), also referred to as TIM-1 and HAVcr-1, is a transmembrane glycoprotein located in healthy immune cells and epithelial cells, and its upregulated form is generally found in several human cancers. Aim: The aim of this study was to investigate the prognostic significance of the expression of KIM-1 and NGAL in stomach cancers and identify NGAL-positive inflammatory cells in the tumor microenvironment. Materials and Methods: We immunohistochemically evaluated the expression of NGAL and KIM1 in 172 cases of stomach adenocarcinomas. Result: The mean age of the patients was 64.07 ± 12.35 years, and the mean and median follow-up period were 25.5 and 20.3 months, respectively. The expression rates of KIM-1 and NGAL in tumor cells were identical at 31.4% (n = 54). In 27 of these cases, both proteins were present. Among the deceased patients, the rate of simultaneous KIM-1 and NGAL positivity was relatively higher (p = 0.041). NGAL-positive inflammatory cells were observed in 13.4% of cases, with no significant correlation between these cells and survival times (p = 0.497). However, there was a negative correlation between survival times and KIM-1 (p = 0.037) and NGAL (p = 0.016) expressions in tumor cells. Conclusions: The present study has shown that KIM-1- and NGAL-positive tumor cells are influential in gastric tumorigenesis. Given the progress in anti-KIM-1 therapy, the presence of KIM-1 expression could contribute to the development of new treatment options for aggressive gastric cancer. However, these discoveries need to be validated in larger-scale studies. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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12 pages, 1099 KiB

Open AccessArticle

Real-World Clinical Outcomes of Trilaciclib for the Prevention of Myelosuppression in Patients with Esophageal Cancer Undergoing Chemotherapy

by Hui Chen, Jingze Yan, Zeyuan Liu, Xiaolin Ge, Xinchen Sun and Xiaojie Xia

Curr. Oncol. 2025, 32(4), 189; https://doi.org/10.3390/curroncol32040189 - 24 Mar 2025

Abstract

This study aims to evaluate the clinical effectiveness of trilaciclib in preventing myelosuppression in patients with esophageal cancer undergoing chemotherapy. Based on the use of trilaciclib, 81 patients were divided into a primary prevention group (PP group, n = 49) and a secondary [...] Read more.

This study aims to evaluate the clinical effectiveness of trilaciclib in preventing myelosuppression in patients with esophageal cancer undergoing chemotherapy. Based on the use of trilaciclib, 81 patients were divided into a primary prevention group (PP group, n = 49) and a secondary prevention group (SP group, n = 32). The incidence of myelosuppression, antibiotic usage rate, survival outcomes, and other treatment-related toxicities were analyzed using chi-square tests and Kaplan–Meier survival curves. The incidence of chemotherapy-induced myelosuppression in the SP group was significantly higher than that in the PP group (96.9% vs. 79.6%), with a significantly higher proportion of grade III and above events (37.6% vs. 8.2%, p < 0.05). For chemotherapy-induced neutropenia, the incidence of grade III/IV events in the SP group was significantly higher than in the PP group (28.1% vs. 8.2%, p = 0.017). Additionally, the SP group experienced higher rates and severity of chemotherapy-induced anemia and thrombocytopenia. The PP group provided better protection against grade III/IV leukopenia and neutropenia (p < 0.05). Non-hematological toxicities and efficacy outcomes were similar between groups (p > 0.05). The study is the first to demonstrate that trilaciclib is a safe and effective option for the prevention of myelosuppression in esophageal cancer patients. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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Graphical abstract

10 pages, 219 KiB

Open AccessArticle

Predictive Factors for Malignancy in Atypiai of Undetermined Significance (AUS) Thyroid Nodules: A Comprehensive Retrospective Analysis

by Samet Şahin, Hikmet Pehlevan Özel and Yunus Nadi Yüksek

Curr. Oncol. 2025, 32(4), 188; https://doi.org/10.3390/curroncol32040188 - 24 Mar 2025

Abstract

This retrospective study aimed to identify predictive factors for malignancy in thyroid nodules classified as atypia or follicular lesion of undetermined significance (AUS/FLUS). The analysis included 165 patients who underwent thyroid nodule surgery at Ankara Numune Training and Research Hospital. Data on demographics, [...] Read more.

This retrospective study aimed to identify predictive factors for malignancy in thyroid nodules classified as atypia or follicular lesion of undetermined significance (AUS/FLUS). The analysis included 165 patients who underwent thyroid nodule surgery at Ankara Numune Training and Research Hospital. Data on demographics, surgical procedures, ultrasonographic features, and pathology results were extracted and analyzed. The cohort consisted predominantly of women (79.39%) with a mean age of 46.68 years. Surgeries performed included total thyroidectomy (88%), total thyroidectomy with central lymph node dissection (6%), and modified radical neck dissection (3%). Malignancies, largely papillary thyroid carcinoma (PTC), were identified in 81 cases. Univariate analysis revealed significant associations between malignancy and ultrasonographic features like calcification, spiculated margins, and nuclear inclusions. Multivariate analysis pinpointed calcification as the only independent risk factor. Histopathological findings indicated heterogeneity within malignancies, noting lymphovascular and capsular invasion in PTC cases. These findings emphasize calcification as a key predictor of malignancy in AUS thyroid nodules and underscore the role of surgical intervention in this challenging diagnostic category, contributing to enhanced risk stratification and clinical decision-making for managing AUS/FLUS thyroid nodules. Full article

(This article belongs to the Section Surgical Oncology)

14 pages, 1329 KiB

Open AccessArticle

Real-World Clinical Outcomes with First-Line Systemic Treatment and Avelumab Maintenance in US Patients with Locally Advanced or Metastatic Urothelial Carcinoma: The SPEAR Bladder-II Study

by Sneha Sura, Manojkumar Bupathi, Valerie Morris, Paul Conkling, Karen Todoroff, Abhijeet Bhanegaonkar and Chiemeka Ike

Curr. Oncol. 2025, 32(4), 187; https://doi.org/10.3390/curroncol32040187 - 24 Mar 2025

Abstract

Avelumab first-line maintenance (1LM) is approved for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) who do not have disease progression after platinum-based chemotherapy (PBC). This retrospective study describes real-world treatment patterns and clinical outcomes in patients with la/mUC who initiated first-line [...] Read more.

Avelumab first-line maintenance (1LM) is approved for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) who do not have disease progression after platinum-based chemotherapy (PBC). This retrospective study describes real-world treatment patterns and clinical outcomes in patients with la/mUC who initiated first-line (1L) systemic treatments, including avelumab 1LM, within iKnowMed, the US community oncology electronic health records database, between 1 December 2019 and 30 November 2023 and followed through 28 February 2024. In total, 1658 patients with la/mUC initiated 1L treatment: immuno-oncology (IO) monotherapy (41.2%), PBC only (32.4%), PBC followed by avelumab 1LM (11.2%), and other treatments (15.1%). The median OS (95% CI) from the start of 1L treatment was 20.4 (13.8, 30.0), 11.0 (8.5, 14.5), and 14.6 (12.6, 17.3) months for cisplatin-based only, carboplatin-based only, and IO monotherapy, respectively. Among the overall population, 36.1% and 11.8% of patients received second-line (2L) and third-line treatment, respectively. The median (95% CI) OS from the start of avelumab 1LM was 18.5 (13.8, 23.8) months. After discontinuation of avelumab 1LM, 43.5% received 2L treatment, and 59.3% of those received enfortumab vedotin (EV); the median (95% CI) OS from start of 2L EV was 12.7 (7.2, 16.5) months. Survival outcomes among patients treated with avelumab 1LM and 2L EV are consistent with respective clinical trials and other real-world studies. Full article

(This article belongs to the Section Genitourinary Oncology)

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13 pages, 851 KiB

Open AccessArticle

The Impact of Peri-Operative Nutritional Status on Survival in Gastroesophageal Adenocarcinoma

by Gary Tincknell, Tamara Bosward, Karen Fildes, Hayley Batchelor, Bronwyn Freeman, Mouhannad Jaber, Marie Ranson, Jennifer Haughton and Daniel Brungs

Curr. Oncol. 2025, 32(4), 186; https://doi.org/10.3390/curroncol32040186 - 21 Mar 2025

Abstract

In patients with gastric, gastroesophageal junction or esophageal adenocarcinoma (GOC), peri-operative multimodal therapies have improved survival; however, prognosis remains underwhelming. Pre-operative nutritional decline and weight are linked with poorer patient outcomes. This study retrospectively analyzed the impact of peri-operative nutritional status (as assessed [...] Read more.

In patients with gastric, gastroesophageal junction or esophageal adenocarcinoma (GOC), peri-operative multimodal therapies have improved survival; however, prognosis remains underwhelming. Pre-operative nutritional decline and weight are linked with poorer patient outcomes. This study retrospectively analyzed the impact of peri-operative nutritional status (as assessed by patient-generated subjective global assessment, PG-SGA), and weight loss on the survival of patients undergoing curative surgery for GOC (2013 to 2022). Of the 148 patients who underwent surgery, PG-SGA and weight data were available for 107 (72%) and 121 (82%), respectively. At presentation, 44% (n = 47) of patients were well nourished, dropping to 17% (n = 18) post-operatively. Lower post-operative nutritional status correlated to worse overall survival (OS) (p < 0.001). Patients who stayed well nourished or improved their nutritional status had better survival outcomes (HR: 2.7; 95%CI: 1.2–6.1; p = 0.01). Significant weight loss (>10%) was ubiquitously observed in 54% (n = 64) of patients, and this group had shorter OS (HR: 2.2; 95%CI: 1.2–4.1; p = 0.009). In conclusion, both nutritional decline and weight loss negatively impacted survival. Maintenance of nutritional status over the peri-operative period resulted in better outcomes. This study highlights the need for improved nutritional support during curative treatment in GOC. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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14 pages, 488 KiB

Open AccessReview

Tumor-Treating Fields and Related Treatments in the Management of Pediatric Brain Tumors

by Julien Rousseau, Sarah Lapointe and David Roberge

Curr. Oncol. 2025, 32(4), 185; https://doi.org/10.3390/curroncol32040185 - 21 Mar 2025

Abstract

Pediatric primary brain tumors pose significant therapeutic challenges due to their aggressive nature and the critical environment of the developing brain. Traditional modalities like surgery, chemotherapy, and radiotherapy often achieve limited success in high-grade gliomas and embryonal tumors. Tumor-treating fields (TTfields), a non-invasive [...] Read more.

Pediatric primary brain tumors pose significant therapeutic challenges due to their aggressive nature and the critical environment of the developing brain. Traditional modalities like surgery, chemotherapy, and radiotherapy often achieve limited success in high-grade gliomas and embryonal tumors. Tumor-treating fields (TTfields), a non-invasive therapy delivering alternating electric fields, has emerged as a promising approach to disrupt tumor cell division through mechanisms such as mitotic disruption, DNA damage, and tumor microenvironment modulation. TTfields are thought to selectively target dividing tumor cells while sparing healthy, non-dividing cells. While TTfields therapy is FDA-approved for the management of glioblastoma and other cancers, its application in pediatric brain tumors remains under investigation. Preclinical studies reveal its potential in medulloblastoma and ependymoma models, while observational data suggest its safety and feasibility in children. Current research focuses on optimizing TTfields’ efficacy through advanced technologies, including high-intensity arrays, skull remodeling, and integration with immunotherapies such as immune checkpoint inhibitors. Innovative device-based therapies like magnetic field-based technologies further expand the treatment possibilities. As clinical trials progress, TTfields and related modalities offer hope for addressing unmet needs in pediatric neuro-oncology, especially for tumors in challenging locations. Future directions include biomarker identification, tailored protocols, and novel therapeutic combinations to enhance outcomes in pediatric brain tumor management. Full article

(This article belongs to the Special Issue Clinical Outcomes and New Treatments in Pediatric Brain Tumors)

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13 pages, 1747 KiB

Open AccessSystematic Review

Efficacy and Safety of Perioperative Immunotherapy for Patients with Non-Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis

by Zhijuan Du, Siyuan Chen, Yuhui Qin, Yahui Lv, Xiangyu Du, Heying Yu and Zhefeng Liu

Curr. Oncol. 2025, 32(3), 184; https://doi.org/10.3390/curroncol32030184 - 20 Mar 2025

Abstract

Background: The objective of this study is to indirectly compare the efficacy and safety of all currently available neoadjuvant chemoimmunotherapy and perioperative chemoimmunotherapy in randomized controlled trials (RCTs) involving patients with resectable non-small cell lung cancer (NSCLC) to identify optimal treatment regimens. Methods: [...] Read more.

Background: The objective of this study is to indirectly compare the efficacy and safety of all currently available neoadjuvant chemoimmunotherapy and perioperative chemoimmunotherapy in randomized controlled trials (RCTs) involving patients with resectable non-small cell lung cancer (NSCLC) to identify optimal treatment regimens. Methods: Eligible studies evaluating neoadjuvant chemoimmunotherapy and perioperative chemoimmunotherapy-based regimens in resectable NSCLC patients were included. Clinical outcomes were extracted for event-free survival (EFS) and overall survival (OS), as well as the incidence of pathological complete response (pCR), major pathological response (MPR), any-grade adverse events (AEs), and treatment-related adverse events (TRAEs) in the Bayesian framework. A subgroup analysis of EFS was conducted according to PD-L1 expression, histological type and reaching pCR or not. Results: We selected eight RCTs involving 3113 patients. Our analysis found no significant differences between perioperative immunotherapy and neoadjuvant immunotherapy in terms of MPR (RR 0.72, 95% CI 0.39 –1.3), pCR (RR 0.73, 95% CI 0.24–2.3), EFS (HR 0.95, 95% CI 0.56–1.7), and OS (HR 95% CI 3.9–4.2). Subgroup analyses revealed that neoadjuvant immunotherapy demonstrated superiority in the programmed death-ligand 1 (PD-L1) high-expression cohort, the non-squamous cell carcinoma cohort, and the non-smoking cohort. Conversely, perioperative immunotherapy ranked first in the PD-L1 low-expression cohort, squamous cell carcinoma cohort, and non-pCR cohort. Conclusions: Our findings indicate that neoadjuvant immunotherapy and perioperative immunotherapy exhibit comparable efficacy in patients with NSCLC. These results provide valuable evidence for guiding the treatment of patients with resectable NSCLC. Full article

(This article belongs to the Section Thoracic Oncology)

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14 pages, 3024 KiB

Open AccessArticle

Contemporary Patterns of Care for Low-Grade Glioma in Australia and New Zealand

by Meghana Maddula, Nicholas McNamee, Hui K. Gan, Laveniya Satgunaseelan, Eng-Siew Koh, Catherine H. Han and Subotheni Thavaneswaran

Curr. Oncol. 2025, 32(3), 183; https://doi.org/10.3390/curroncol32030183 - 20 Mar 2025

Abstract

Aim: The management of low-grade gliomas (LGGs) is evolving with new insights into disease biology. Furthermore, recently, the phase III INDIGO¹ study highlighted the benefits of an IDH inhibitor, vorasidenib, in treating residual or recurrent grade 2 IDH-mutant gliomas following surgery alone. [...] Read more.

Aim: The management of low-grade gliomas (LGGs) is evolving with new insights into disease biology. Furthermore, recently, the phase III INDIGO¹ study highlighted the benefits of an IDH inhibitor, vorasidenib, in treating residual or recurrent grade 2 IDH-mutant gliomas following surgery alone. We aimed to characterise the current patterns of care for patients with LGGs in Australia and New Zealand, including the role of vorasidenib. Methods: An online survey examining respondents’ practice setting, caseload, and preferred treatment approach to three clinical scenarios was distributed through the Cooperative Trials Group for Neuro-Oncology, New Zealand Aotearoa Neuro-Oncology Society, and the Australian and New Zealand Society for Neuropathology in December 2023 with three reminders in April, June, and September of 2024. Results: The survey response rate was 19.6% (57/291), 87.7% from Australia, and 12.3% from New Zealand, spanning medical oncology (45.7%), pathology (22.8%), radiation oncology (17.5%), and neurosurgery (14.0%). Case 1 examined an IDH-mutant grade 2 astrocytoma following gross total resection. Observation alone was recommended by 93%. Case 2 examined an incompletely resected IDH-mutant grade 2 astrocytoma. If feasible, 38% recommended further surgery and 83% adjuvant chemotherapy and radiotherapy. After 12 months of disease stability, 53% of the respondents preferred vorasidenib over the existing therapies. Case 3 examined an incompletely resected IDH-mutant grade 3 oligodendroglioma. No respondents recommended observation alone, with 26% recommending salvage surgery and 97% recommending further chemotherapy and radiotherapy. Conclusions: This study describes current management practices for LGGs in Australia and New Zealand, showing ongoing variation and a cautious approach to integrating IDH inhibitors. This highlights the critical role of multidisciplinary team-based decision-making in increasingly complex clinical situations. Full article

(This article belongs to the Section Neuro-Oncology)

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26 pages, 1497 KiB

Open AccessReview

Extramedullary Multiple Myeloma: Challenges and Opportunities

by Matthew Ho, Luca Paruzzo, Janna Minehart, Neel Nabar, Julia Han Noll, Thomas Luo, Alfred Garfall and Saurabh Zanwar

Curr. Oncol. 2025, 32(3), 182; https://doi.org/10.3390/curroncol32030182 - 20 Mar 2025

Abstract

Extramedullary multiple myeloma (EMM), defined in this review as soft tissue plasmacytomas resulting from hematogenous spread, is characterized by the ability of MM cells to proliferate outside of the bone marrow microenvironment. It is aggressive, often associated with high-risk cytogenetics and early relapse, [...] Read more.

Extramedullary multiple myeloma (EMM), defined in this review as soft tissue plasmacytomas resulting from hematogenous spread, is characterized by the ability of MM cells to proliferate outside of the bone marrow microenvironment. It is aggressive, often associated with high-risk cytogenetics and early relapse, and independently portends significantly shorter progression-free and overall survival, even in the era of highly effective immunotherapies. The molecular and microenvironmental factors underlying extramedullary MM dissemination continue to be studied to inform the development of better treatments. In this review, we discuss our current understanding of the biology of EMM, focusing on its distinct molecular and microenvironmental characteristics vis-à-vis MM. We also review the current treatment strategies, acknowledging the paucity of large, randomized studies specific to this population. Full article

(This article belongs to the Section Hematology)

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10 pages, 224 KiB

Open AccessArticle

Exploring Healthcare Provider Experiences with the EXCEL Exercise Referral Pathway for Individuals Living with and Beyond Cancer

by Alexandra Finless, Mannat Bansal, Thomas Christensen, S. Nicole Culos-Reed, Colleen A. Cuthbert, Julianna Dreger, Jodi E. Langley and Melanie R. Keats

Curr. Oncol. 2025, 32(3), 181; https://doi.org/10.3390/curroncol32030181 - 20 Mar 2025

Abstract

Exercise is an evidence-based strategy shown to reduce the negative side effects associated with cancer treatment for individuals living with and beyond cancer (LWBC). Healthcare providers (HCPs) play a critical role in promoting exercise for these individuals. Notwithstanding, several barriers hinder HCPs’ ability [...] Read more.

Exercise is an evidence-based strategy shown to reduce the negative side effects associated with cancer treatment for individuals living with and beyond cancer (LWBC). Healthcare providers (HCPs) play a critical role in promoting exercise for these individuals. Notwithstanding, several barriers hinder HCPs’ ability to discuss and support exercise in clinical practice. EXCEL is an exercise intervention designed to address health disparities in access to exercise oncology resources for rural/remote individuals LWBC, including a referral pathway for HCPs to use. The purpose of this study was to evaluate HCP experiences using the EXCEL exercise referral pathway. We employed an interpretive description methodology, using semi-structured interviews to assess HCP experiences with EXCEL. Overall, HCPs felt empowered to refer to exercise when they were supported in doing so. The findings highlighted (1) a need for a better understanding of the role of exercise professionals and their integration into cancer care; (2) the need for efficient referral systems including embedding referrals into existing health care electronic record systems; and (3) sharing patient feedback with exercise oncology programs back to the HCPs to drive continued referrals. Full article

(This article belongs to the Special Issue Building Hope for the Next Decade of Psychosocial Oncology: Optimizing the Integration of Supportive Care into Oncology Care)

28 pages, 1398 KiB

Open AccessReview

Pediatric CNS Radiation Oncology: Recent Developments and Novel Techniques

by Justin Oh, Samir Patel, Mary-Pat Schlosser, Andrew J. Arifin, Carol Oliveira, Anne-Marie Charpentier and Derek S. Tsang

Curr. Oncol. 2025, 32(3), 180; https://doi.org/10.3390/curroncol32030180 - 20 Mar 2025

Abstract

Radiation therapy (RT) is a cornerstone in the management of pediatric central nervous system (CNS) tumors. Recent advancements in RT delivery and techniques aim to enhance therapeutic effectiveness while minimizing both acute and long-term complications associated with pediatric brain RT. This paper highlights [...] Read more.

Radiation therapy (RT) is a cornerstone in the management of pediatric central nervous system (CNS) tumors. Recent advancements in RT delivery and techniques aim to enhance therapeutic effectiveness while minimizing both acute and long-term complications associated with pediatric brain RT. This paper highlights innovative developments in the field, including the clinical indications, benefits, and challenges of proton therapy and stereotactic radiotherapy. The ongoing refinement of risk-adapted RT volumes is highlighted, with examples of newly proposed germinoma RT volumes and hippocampal-sparing RT. Additionally, emerging experimental approaches, including FLASH therapy and theranostics, are also discussed as promising future directions. Further prospective, multi-institutional collaborative studies are essential to validate and expand upon the benefits outlined in this review. Full article

(This article belongs to the Special Issue Clinical Outcomes and New Treatments in Pediatric Brain Tumors)

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12 pages, 221 KiB

Open AccessArticle

Patient and Healthcare Professional Reflections on Consenting for Extra Bone Marrow Samples to a Biobank for Research—A Qualitative Study

by Stuart G. Nicholls, Erika Camilleri, Taryn Chesser, Gary Davis, Katya Godard, Grace Fox, Madeleine Jane Gordon, Krystina B. Lewis, Jocelyn Lepage, Oksana Motalo, Wendy Nuttall, Craig Peleshok, Caryn Y. Ito, Pierre J. A. Villeneuve and Mitchell Sabloff

Curr. Oncol. 2025, 32(3), 179; https://doi.org/10.3390/curroncol32030179 - 19 Mar 2025

Abstract

Little is known about patient perspectives regarding consent for obtaining extra research-specific bone marrow (BM) samples during the diagnostic procedure for acute leukemia (AL). This study aimed to better understand patient experiences with consenting to provide these samples and identify potential areas for [...] Read more.

Little is known about patient perspectives regarding consent for obtaining extra research-specific bone marrow (BM) samples during the diagnostic procedure for acute leukemia (AL). This study aimed to better understand patient experiences with consenting to provide these samples and identify potential areas for practice improvement. Semi-structured interviews were conducted with patients treated for AL, 4–6 years prior to the interviews, and healthcare professionals involved with obtaining patient consent and sample collection. A total of 17 patients (14 agreed to provide a sample and 3 did not have a sample in the biobank) and 5 healthcare professionals were interviewed, achieving data saturation. Patients supported increasing public knowledge about research and noted the importance of friends and family in providing emotional support and retaining information. Despite time pressure and anxiety, the decision to donate a research sample did not require much deliberation. Proximal factors informing decisions included impact on patient health and family and anticipated, procedure-associated pain; distal factors included altruism and trust in healthcare professionals. Key information included expected pain and management, the purpose of research samples, and sample security and privacy. Our findings suggest that BM research sample collection may be facilitated through optimizing the environment where information is provided and the type of information provided, including pain management options and the value of the samples for current and future research. Full article

(This article belongs to the Section Hematology)

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12 pages, 1577 KiB

Open AccessArticle

Impact of Resection Margins and Adjuvant Therapy on Survival Outcomes in Lymph Node-Negative Distal Cholangiocarcinoma

by Hye Jin Kang and In Young Jo

Curr. Oncol. 2025, 32(3), 178; https://doi.org/10.3390/curroncol32030178 - 19 Mar 2025

Abstract

The prognostic value of the resection margin (RM) status and the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (CCC) are unclear. RM status appears particularly impactful in lymph node-negative distal CCC, representing early-stage disease. The prognostic value of RM status was investigated, [...] Read more.

The prognostic value of the resection margin (RM) status and the efficacy of adjuvant therapy (AT) in distal cholangiocarcinoma (CCC) are unclear. RM status appears particularly impactful in lymph node-negative distal CCC, representing early-stage disease. The prognostic value of RM status was investigated, and subpopulations of patients with lymph node-negative distal CCC who might benefit from AT were identified. Overall, 139 patients with distal CCC who underwent surgical resection between March 2006 and December 2023 were analyzed. RM status was categorized as wide (>5 mm) in 65 patients (46.8%), close (≤5 mm) in 32 patients (23.0%), or positive in 42 patients (30.2%). AT was administered to 48 patients (34.5%). Patients with close or positive RMs achieved significantly lower locoregional control (LRC) than those with wide RMs. However, overall survival (OS) did not differ across the three RM groups. The impact of RM status was more evident in patients not receiving AT. Patients with wide RMs exhibited better 3-year LRC, progression-free survival (PFS), and OS rates (79.0%, 66.5%, and 69.1%, respectively) than those with close (21.7%, 15.7%, and 34.4%) or positive RMs (44.3%, 25.3%, and 50.2%, respectively). No significant differences were found between close and positive RM groups. AT appears to have improved LRC and PFS in patients with close or positive RMs but not in those with wide RMs. Close RMs were associated with poor outcomes comparable to those with positive RMs. These results indicate that achieving adequate RM width is crucial for improving survival. Moreover, AT may improve survival when adequate RMs cannot be achieved. Nonetheless, larger studies are needed to validate these findings. Full article

(This article belongs to the Special Issue Biliary Tract Cancer Updates: Advancements and Insights)

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15 pages, 258 KiB

Open AccessReview

The Changing Role of Allogeneic Stem Cell Transplantation in Adult B-ALL in the Era of CAR T Cell Therapy

by Jana van den Berg, Claudia Meloni, Jörg Halter, Jakob R. Passweg and Andreas Holbro

Curr. Oncol. 2025, 32(3), 177; https://doi.org/10.3390/curroncol32030177 - 19 Mar 2025

Abstract

The treatment of B-cell acute lymphoblastic leukemia (B-ALL) in adults remains a significant therapeutic challenge. While advances in chemotherapy and targeted and immunotherapies have improved overall survival, relapsed or refractory (r/r) adult ALL is associated with poor outcomes. CD19-directed chimeric antigen receptor (CAR) [...] Read more.

The treatment of B-cell acute lymphoblastic leukemia (B-ALL) in adults remains a significant therapeutic challenge. While advances in chemotherapy and targeted and immunotherapies have improved overall survival, relapsed or refractory (r/r) adult ALL is associated with poor outcomes. CD19-directed chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative option, achieving high remission rates even in heavily pretreated patients. However, relapse is common. Allogeneic hematopoietic stem cell transplantation (allo-HCT), a traditional cornerstone of remission consolidation, may improve long-term outcomes but carries risks of transplant-related mortality (TRM) and morbidity. Most evidence for HCT after CAR T therapy comes from retrospective analyses of subgroups from CAR T cell trials, with small sample sizes and inconsistent data on transplant procedures and outcomes. Despite these limitations, consolidative allo-HCT appears to prolong relapse-free survival (RFS). While overall survival (OS) benefits are in question, extended remission duration has been observed. Nonrelapse mortality (including TRM), ranging from 2.4 to 35%, underscores the need for careful patient selection. Emerging real-world data affirm these findings but highlight the importance of individualized decisions based on disease and treatment history. This review examines current evidence on the sequential use of CD19-directed CAR T-cell therapy and allo-HCT in adults with r/r B-ALL. Full article

(This article belongs to the Special Issue Allogeneic Stem Cell Transplantation: Does the Conditioning Regimen Intensity Still Matter?)

7 pages, 180 KiB

Open AccessCommunication

Understanding the Role of Patient-Reported Outcomes for Decision-Making in Early-Phase Dose-Finding Clinical Trials

by Richard Brown, Nolan A. Wages, Li Liu, Arnethea L. Sutton and Andrew S. Poklepovic

Curr. Oncol. 2025, 32(3), 176; https://doi.org/10.3390/curroncol32030176 - 19 Mar 2025

Abstract

In early-phase dose-finding clinical trials, integrating patient-reported outcomes (PROs) is essential for enhancing patient-centered decision-making. This short communication advocates for several key practices to achieve such integration. Firstly, foster patient-centered communication that ensures patient understanding of the potential benefits of early-phase trials, thereby [...] Read more.

In early-phase dose-finding clinical trials, integrating patient-reported outcomes (PROs) is essential for enhancing patient-centered decision-making. This short communication advocates for several key practices to achieve such integration. Firstly, foster patient-centered communication that ensures patient understanding of the potential benefits of early-phase trials, thereby mitigating therapeutic misconceptions. Secondly, (a) facilitate partnerships to understand and address the underlying reasons for discrepancies between clinician and patient reports of adverse events and (b) facilitate partnerships among clinical trialists, statisticians, clinicians, patients, and advocates to gain diverse perspectives of adverse events and in so doing ensure that patients comprehend how their data will be used. Thirdly, optimize trial design and data collection by (a) determining optimal and feasible frequencies for PRO collection to minimize patient burden while maintaining data integrity and (b) effectively incorporating concordant PROs to guide dose recommendation decisions and adapt trial designs and statistical methods accordingly. Future research will involve investigating the application of these practices in patients within the Virginia Commonwealth University (VCU) Massey Comprehensive Cancer Center Catchment Area. By integrating these recommendations, early-phase dose-finding clinical trials have the potential to achieve more informed and patient-centered objectives. Full article

(This article belongs to the Special Issue Advancements in Clinical Trials in Oncology: Design, Enrichment, Safety, Operations, Patient Centricity, and Endpoints)

17 pages, 266 KiB

Open AccessConference Report

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2024

by Jennifer Leigh, Arwa Ahmed, Francine Aubin, Scott Berry, Melanie Boucher, Marie-Pierre Campeau, Bruce Colwell, Stacie Connors, Jessica Corbett, Shivani Dadwal, Shaan Dudani, Elena Elimova, Conrad Falkson, Luisa Galvis, Rakesh Goel, Joanna Gotfrit, Angela Hyde, Michela Febbraro, David T. Laidley, Gordon Locke, Aamer Mahmud, Thais Baccili Cury Megid, James Michael, Vimoj J. Nair, Stephen Quigley, Ravi Ramjeesingh, Setareh Samimi, Melanie Seal, Stephanie Snow, Silvana Spadafora, Teri Stuckless, Brooke Wilson, Timothy Asmis, Rachel Goodwin and Michael Vickers Show full author list Hide full author list

Curr. Oncol. 2025, 32(3), 175; https://doi.org/10.3390/curroncol32030175 - 18 Mar 2025

Abstract

The Eastern Canadian Gastrointestinal Cancer Consensus Conference was an annual meeting that was held in St. John’s, Newfoundland and Labrador, from 26 to 28 September 2024. This included experts in medical oncology, radiation oncology, surgical oncology, nuclear medicine, and general practitioners in oncology [...] Read more.

The Eastern Canadian Gastrointestinal Cancer Consensus Conference was an annual meeting that was held in St. John’s, Newfoundland and Labrador, from 26 to 28 September 2024. This included experts in medical oncology, radiation oncology, surgical oncology, nuclear medicine, and general practitioners in oncology (GPO) from across the eastern Canadian provinces who are involved in the management of patients with gastrointestinal malignancies. This consensus statement generated by the conference addresses multiple topics, including the management of localized rectal cancer, liver-limited colorectal cancer, systemic therapy for advanced biliary tract cancers, radioligand therapy for gastroenteropancreatic neuroendocrine tumors (GEP-NETs), systemic therapy for pancreatic and midgut well-differentiated NETs, and systemic therapy for HER2-positive gastroesophageal cancers. Full article

(This article belongs to the Section Gastrointestinal Oncology)

12 pages, 1305 KiB

Open AccessArticle

Unraveling Survival Determinants in Patients with Advanced Non-Small-Cell Lung Cancer with EGFR Exon 20 Insertions

by Kung-Yang Wang, Shih-Chieh Chang, Yu-Feng Wei, Jui-Chi Hung, Chung-Yu Chen and Cheng-Yu Chang

Curr. Oncol. 2025, 32(3), 174; https://doi.org/10.3390/curroncol32030174 - 18 Mar 2025

Abstract

Background: Lung cancer is the leading cause of cancer-related death in Taiwan. It is often associated with mutations in the epidermal growth factor receptor (EGFR) gene, with common mutations accounting for approximately 85% of all EGFR-related cases. However, the remaining [...] Read more.

Background: Lung cancer is the leading cause of cancer-related death in Taiwan. It is often associated with mutations in the epidermal growth factor receptor (EGFR) gene, with common mutations accounting for approximately 85% of all EGFR-related cases. However, the remaining 15% are caused by uncommon mutations in EGFR, mainly insertions in exon 20 (about 4%). The response to EGFR tyrosine kinase inhibitors (TKIs) can vary markedly with exon 20 insertions. However, few prior large-scale studies have examined patients with these EGFR mutations. Methods: This study combines the databases of several large hospitals in Taiwan to analyze the effects and clinical significance of rare EGFR mutations on responses to EGFR-TKIs, considering the changes in medication. Results: This study enrolled 38 patients with non-small-cell lung cancer and EGFR exon 20 insertions. It assessed the correlations of various predictors with progression-free survival (PFS) and overall survival (OS). It showed that among those with EGFR exon 20 insertions, the median PFS was 5.15 months, and OS reached 13 months. The median PFS was 5.4 months for afatinib, 5.7 months for chemotherapy, and 4.3 months for first-generation EGFR-TKIs. Conclusions: EGFR-TKIs may be considered as an alternative treatment option for patients with EGFR exon 20 insertions in cases where the currently recommended therapies, such as chemotherapy with or without amivantamab, are either unavailable or intolerable. The potential use of afatinib for specific patients in this context depends on the precise characteristics of their mutation and remains to be determined. Full article

(This article belongs to the Section Thoracic Oncology)

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13 pages, 709 KiB

Open AccessArticle

Enhancing CAR-T Efficacy in Large B-Cell Lymphoma with Radiation Bridging Therapy: A Real-World Single-Center Experience

by Eva Laverdure, Luigina Mollica, Imran Ahmad, Sandra Cohen, Silvy Lachance, Olivier Veilleux, Maryse Bernard, Eve-Lyne Marchand, Jean-Sébastien Delisle, Lea Bernard, Mélissa Boileau, Tony Petrella, Sarah-Jeanne Pilon, Philippe Bouchard, Denis-Claude Roy, Lambert Busque and Isabelle Fleury

Curr. Oncol. 2025, 32(3), 173; https://doi.org/10.3390/curroncol32030173 - 17 Mar 2025

Abstract

One challenge of chimeric antigen receptor T-cell therapy (CAR-T) for relapsed or refractory large B-cell lymphoma (LBCL) is achieving disease control during manufacturing. We report real-word outcomes of 100 patients treated with axicabtagene ciloleucel (axi-cel, n = 50) or tisagenlecleucel (tisa-cel, n = [...] Read more.

One challenge of chimeric antigen receptor T-cell therapy (CAR-T) for relapsed or refractory large B-cell lymphoma (LBCL) is achieving disease control during manufacturing. We report real-word outcomes of 100 patients treated with axicabtagene ciloleucel (axi-cel, n = 50) or tisagenlecleucel (tisa-cel, n = 50) at our center. Most patients received bridging therapy (BT) with 48 undergoing radiation BT (RBT) and 32 receiving systemic BT (SBT). The best overall response rate (ORR) was 84% (78% complete response (CR)) for axi-cel and 60% (42% CR) for tisa-cel. At a median follow-up of 16 months, 12-month progression-free survival (PFS) and overall survival (OS) were 72% and 82% for axi-cel, compared to 35% and 57% for tisa-cel. By the bridging approach, 12-month PFS was 60% with RBT, 59% without BT and 35% with SBT (p = 0.06). Notably, axi-cel patients without lymphoma progression during manufacturing (n = 24) achieved 12-month PFS and OS rates of 91% and 96%, respectively. Axi-cel was associated with more cytokine release syndrome (92% vs. 66%, p = 0.003) and neurotoxicity (all-grade 56% vs. 10%, p < 0.001, grade ≥ 328% vs. 4%, p = 0.002). Multivariate analysis identified RBT as independently associated with improved PFS (HR 0.46, 95% CI 0.22–0.96). Pending prospective validation, RBT shows promise for improving CAR-T outcomes in LBCL. Full article

(This article belongs to the Section Cell Therapy)

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