Current Oncology

15 pages, 275 KiB

Open AccessReview

Cognitive Decline in Glioblastoma (GB) Patients with Different Treatment Modalities and Insights on Untreated Cases

by Keyvan Ghadimi, Imane Abbas, Alireza Karandish, Celina Crisman, Emad N. Eskandar and Andrew J. Kobets

Curr. Oncol. 2025, 32(3), 152; https://doi.org/10.3390/curroncol32030152 - 6 Mar 2025

Abstract

Background: Cognitive decline is common in patients with Glioblastoma (GB), occurring in both treated and untreated cases. It frequently presents as impairments in memory, attention, language, or other cognitive functions. In addition, these cognitive deficits can affect quality of life, functional independence, and [...] Read more.

Background: Cognitive decline is common in patients with Glioblastoma (GB), occurring in both treated and untreated cases. It frequently presents as impairments in memory, attention, language, or other cognitive functions. In addition, these cognitive deficits can affect quality of life, functional independence, and overall survival, and they are associated with psychiatric conditions such as anxiety and depression. Methods: This narrative review evaluates cognitive deficits in GB patients, both with and without treatment. It also explores the impact of tumor features such as size, location, and histology, along with patient characteristics such as age and education, and discusses the effects of standard therapies, such as surgery, chemotherapy, and radiotherapy, on cognitive outcomes. Results: Cognitive impairment in GB is influenced by tumor- and patient-specific factors, as well as treatment modalities. Initially, combination therapies such as surgery, radiotherapy, and chemotherapy may improve cognitive domains by reducing tumor burden, relieving cerebral edema, and reducing mass effects, subsequently bringing indirect effects of improved mental health and mood. While certain treatments like radiotherapy and chemotherapy carry risks of delayed neurotoxicity, studies indicate that, on balance, treated patients generally show better preservation or improvement in cognitive function than those who go untreated. However, excessive treatment aggressiveness and cumulative neurotoxic effects may diminish cognitive benefits. Conclusion: Cognitive function is an independent factor in GB, which could affect survival in GB patients, therefore making routine cognitive assessments essential for prognosis, treatment planning, and rehabilitation. Neuroprotective agents, cognitive rehabilitation, and personalized, multidisciplinary strategies can help optimize both survival and cognitive preservation. Full article

(This article belongs to the Section Neuro-Oncology)

13 pages, 2415 KiB

Open AccessArticle

Real-World Treatment Patterns, Healthcare Resource Utilization, and Healthcare Costs in the First-Line Treatment of Metastatic Non-Small Cell Lung Cancer in the US

by Divyan Chopra, David M. Waterhouse, Ihtisham Sultan and Björn Stollenwerk

Curr. Oncol. 2025, 32(3), 151; https://doi.org/10.3390/curroncol32030151 - 5 Mar 2025

Abstract

This study characterizes real-world treatment patterns and economic and healthcare resource utilization (HCRU) burden associated with first-line (1L) treatment of metastatic non-small cell lung cancer (NSCLC) without actionable alterations in the United States. This retrospective observational study used Optum Clinformatics^® data. A [...] Read more.

This study characterizes real-world treatment patterns and economic and healthcare resource utilization (HCRU) burden associated with first-line (1L) treatment of metastatic non-small cell lung cancer (NSCLC) without actionable alterations in the United States. This retrospective observational study used Optum Clinformatics^® data. A total of 15,659 patients with metastatic NSCLC who started 1L treatment between January 2020 and March 2023 were included (52% male; mean age at the start of 1L treatment 71.7 years; 86% Medicare Advantage). The most frequent 1L regimens were immune checkpoint inhibitor (ICI) + platinum-based chemotherapy (PBCT) (47%), PBCT only (26%), and ICI only (20%). The median 1L treatment duration was 4.2 months (range 2.7–6.5) and was shorter with chemotherapy-only regimens. Outpatient visits accounted for the majority of HCRU (mean 6.6 visits per patient per month [PPPM]). Outpatient, inpatient, and emergency department visits were highest for chemotherapy-only regimens. Mean total (all-cause) healthcare costs were $32,215 PPPM and were highest for ICI + chemotherapy ($34,741–38,454 PPPM). Inpatient costs PPPM were highest for PBCT ($4725) and ICI + non-PBCT ($4648). First-line treatment of metastatic NSCLC without actionable alterations imposes a notable HCRU and cost burden, underscoring the need for better treatment options to improve outcomes and reduce economic impact. Full article

(This article belongs to the Section Health Economics)

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21 pages, 1386 KiB

Open AccessArticle

Heart Rate Variability Biofeedback Training Can Improve Menopausal Symptoms and Psychological Well-Being in Women with a Diagnosis of Primary Breast Cancer: A Longitudinal Randomized Controlled Trial

by Karina Dolgilevica, Elizabeth Grunfeld and Nazanin Derakshan

Curr. Oncol. 2025, 32(3), 150; https://doi.org/10.3390/curroncol32030150 - 4 Mar 2025

Abstract

Breast cancer survivors experience numerous chronic symptoms linked to autonomic dysfunction including anxiety, stress, insomnia, menopausal symptoms, and cognitive impairment. Effective non-pharmacological solutions to address these are currently lacking. Methods: Our three-armed longitudinal randomized controlled trial assessed the effectiveness of a 4-week remote [...] Read more.

Breast cancer survivors experience numerous chronic symptoms linked to autonomic dysfunction including anxiety, stress, insomnia, menopausal symptoms, and cognitive impairment. Effective non-pharmacological solutions to address these are currently lacking. Methods: Our three-armed longitudinal randomized controlled trial assessed the effectiveness of a 4-week remote smartphone-based heart rate variability biofeedback intervention which involved daily paced breathing at 6 breaths p/min; active (12 breaths p/min) and waitlist controls were included. Heart rate variability and self-reported cancer-related symptoms were assessed at baseline, post-, and 6 months-post intervention. Participants were 60 UK-based women with primary breast cancer history (6 to 60 months post-active treatment). Results: The intervention group showed significant increases in low-frequency heart rate variability over time (F (4, 103.89) = 2.862, p = 0.027, d = 0.33), long-lasting improvement in sleep quality (F (4, 88.04) = 4.87, p = 0.001, d = 0.43) and cessations in night sweats (X² (2, N = 59) = 6.44, p = 0.04, Cramer’s V = 0.33), and reduced anxiety post-intervention compared to the active and waitlist controls (F (4, 82.51) = 2.99, p = 0.023, d = 0.44). Other findings indicated that the intervention and active control participants reported lasting improvements in cognitive function, fatigue, and stress-related symptoms (all ps < 0.05). The waitlist group reported no symptom changes across time. Conclusion: Heart rate variability biofeedback is a feasible intervention for addressing diverse chronic symptoms commonly reported by breast cancer survivors. Full article

(This article belongs to the Special Issue Pathways to Recovery and Resilience in Breast Cancer Survivorship)

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26 pages, 1132 KiB

Open AccessReview

Hepatoblastoma: From Molecular Mechanisms to Therapeutic Strategies

by Ling Fan, Jintong Na, Tieliu Shi and Yuan Liao

Curr. Oncol. 2025, 32(3), 149; https://doi.org/10.3390/curroncol32030149 - 4 Mar 2025

Abstract

Hepatoblastoma (HB) is the most common malignant liver tumor in children under five years of age. Although globally rare, it accounts for a large proportion of liver cancer in children and has poor survival rates in high-risk and metastatic cases. This review discusses [...] Read more.

Hepatoblastoma (HB) is the most common malignant liver tumor in children under five years of age. Although globally rare, it accounts for a large proportion of liver cancer in children and has poor survival rates in high-risk and metastatic cases. This review discusses the molecular mechanisms, diagnostic methods, and therapeutic strategies of HB. Mutations in the CTNNB1 gene and the activation of the Wnt/β-catenin pathway are essential genetic factors. Furthermore, genetic syndromes like Beckwith–Wiedemann syndrome (BWS) and Familial Adenomatous Polyposis (FAP) considerably heighten the risk of associated conditions. Additionally, epigenetic mechanisms, such as DNA methylation and the influence of non-coding RNAs (ncRNAs), are pivotal drivers of tumor development. Diagnostics include serum biomarkers, immunohistochemistry (IHC), and imaging techniques. Standard treatments are chemotherapy, surgical resection, and liver transplantation (LT). Emerging therapies like immunotherapy and targeted treatments offer hope against chemotherapy resistance. Future research will prioritize personalized medicine, novel biomarkers, and molecular-targeted therapies to improve survival outcomes. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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12 pages, 1428 KiB

Open AccessArticle

First-Line Pyrotinib Combination Therapy for HER2-Mutated Advanced NSCLC: A Retrospective Cohort Analysis

by Yan Xiang, Meiling Zhang, Qian Wang, Jingwen Liu, Lulin Zeng, Ao Sun and Kaihua Lu

Curr. Oncol. 2025, 32(3), 148; https://doi.org/10.3390/curroncol32030148 - 4 Mar 2025

Abstract

Background: HER2 mutations are rare driver events in advanced NSCLC, with limited relief from current targeted therapies. This study aimed to characterize the molecular features of HER2-mutant NSCLC and to evaluate the clinical efficacy of pyrotinib-based combination therapy as a first-line treatment, providing [...] Read more.

Background: HER2 mutations are rare driver events in advanced NSCLC, with limited relief from current targeted therapies. This study aimed to characterize the molecular features of HER2-mutant NSCLC and to evaluate the clinical efficacy of pyrotinib-based combination therapy as a first-line treatment, providing evidence for optimizing treatment strategies. Methods: NSCLC patients diagnosed at Jiangsu Province People’s Hospital from 2016 to 2024 were enrolled. HER2-positive cases were screened by IHC/FISH and further profiled by NGS. Treatment response was assessed by RECIST 1.1, and survival analysis was performed using Kaplan–Meier and log-rank tests. Results: Among 144 HER2-mutant NSCLC cases confirmed by NGS, 10 insertion mutations, 26 missense mutations, and 2 fusion mutations were identified. The most common mutation was the exon 20 p.A775_G776insYVMA (47.9%), and TP53 was the most frequent co-mutation (10.4%). In terms of efficacy, the pyrotinib-based combination therapy demonstrated significant clinical benefit, with an ORR of 33.3%, DCR of 95.2%, median PFS (mPFS) of 11.3 months (95% CI: 10.27–12.26), and median OS (mOS) of 21.0 months (95% CI: 18.00–23.94). Subgroup analysis revealed no significant impact of mutation subtype or co-mutation status on the treatment efficacy, but patients with brain metastases had a significantly worse prognosis than those without metastasis (mPFS: 5.1 vs. 12.9 months, p < 0.01; mOS: 9.3 vs. 26.5 months, p < 0.01). All TRAEs were grade 1–3 (any grade: 90.5%; grade 3: 14.3%), with the most common TRAE being diarrhea (any grade: 85.7%; grade 3: 9.5%). Conclusions: Pyrotinib-based combination therapy is a feasible first-line treatment for HER2-mutant NSCLC, demonstrating significant survival benefits and manageable toxicity. However, brain metastasis patients require enhanced comprehensive management. Full article

(This article belongs to the Section Thoracic Oncology)

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9 pages, 504 KiB

Open AccessArticle

COVID-19 Pandemic Impact on Delays in Diagnosis and Treatment for Cervical Cancer in Montreal, Canada

by Yohan Kerbage, Elise Hillmann, Jessica Ruel-Laliberté and Vanessa Samouelian

Curr. Oncol. 2025, 32(3), 147; https://doi.org/10.3390/curroncol32030147 - 3 Mar 2025

Abstract

Introduction. The COVID-19 pandemic has been responsible for a major reorganization of healthcare systems, with less access for cancer screening. Few data exist on the impact of cervical cancer treatment during the pandemic. Methods. The purpose of this study was to compare the [...] Read more.

Introduction. The COVID-19 pandemic has been responsible for a major reorganization of healthcare systems, with less access for cancer screening. Few data exist on the impact of cervical cancer treatment during the pandemic. Methods. The purpose of this study was to compare the cervical cancer stage at diagnosis and the surgical and medical treatment delays before and during the COVID-19 pandemic. This is a retrospective cohort study of all cervical cancers diagnosed at any stages between 1 January 2018 and 28 February 2022 at the Centre Hospitalier de l’Université de Montréal. Stage at diagnosis, time to initial referral, time from diagnosis to treatment before and during the COVID-19 pandemic were compared. Results. A total of 244 cervical cancers were diagnosed during the study period. No differences were observed between the number of cases diagnosed before and after pandemic (p = 0.237). Most patients and disease characteristics did not differ between the study periods, but the patients were significantly younger (p = 0.007), with higher BMI (p = 0.024) in the pandemic period. The mean time between initial diagnosis and referral was longer during the pandemic by 13 days (p = 0.042). The mean time between diagnosis and MRI and diagnosis and PET CT was not longer during the pandemic (p = 0.481 and p = 0.384). There were no significant differences in the mean time from the initial referring to the first visit at the CHUM (p = 0.895) or in the mean time from diagnosis to treatment (0.668) and duration of treatment (p = 0.181) Conclusion. Minor delays were observed during the COVID-19 pandemic. Cervical cancer patients treated at the CHUM, a tertiary and quaternary Canadian public health center, were globally referred and treated similarly, as those who were treated before pandemic. Full article

(This article belongs to the Section Gynecologic Oncology)

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15 pages, 264 KiB

Open AccessReview

Lung Cancer: Targeted Therapy in 2025

by Nicole Bouchard and Nathalie Daaboul

Curr. Oncol. 2025, 32(3), 146; https://doi.org/10.3390/curroncol32030146 - 2 Mar 2025

Abstract

Lung cancer treatment has changed in the last twenty years since the discovery of EGFR mutations. In this article, we will review the current state of the art for non-small cell lung cancer (NSCLC) actionable genomic alterations (AGA). AGAs are mostly found in [...] Read more.

Lung cancer treatment has changed in the last twenty years since the discovery of EGFR mutations. In this article, we will review the current state of the art for non-small cell lung cancer (NSCLC) actionable genomic alterations (AGA). AGAs are mostly found in lung adenocarcinomas, a subtype of non-small cell lung cancers. We will focus on the current treatment for EGFR mutations, ALK fusions, ROS1 fusions, BRAF V600E mutations, MET exon 14-skipping mutations, RET fusions, KRAS G12C mutations, ERBB2 mutations (also called HER2 mutations), and NTRK fusions. We will also touch on the key toxicities associated with these medications. Treatments are mostly available for the metastatic stage, but we will also discuss adjuvant therapy for EGFR mutations and ALK fusions, as well as stage III post-chemoradiotherapy treatment for EGFR lung cancer. Full article

(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)

15 pages, 1758 KiB

Open AccessArticle

The Extent to Which Artificial Intelligence Can Help Fulfill Metastatic Breast Cancer Patient Healthcare Needs: A Mixed-Methods Study

by Yvonne W. Leung, Jeremiah So, Avneet Sidhu, Veenaajaa Asokan, Mathew Gancarz, Vishrut Bharatkumar Gajjar, Ankita Patel, Janice M. Li, Denis Kwok, Michelle B. Nadler, Danielle Cuthbert, Philippe L. Benard, Vikaash Kumar, Terry Cheng, Janet Papadakos, Tina Papadakos, Tran Truong, Mike Lovas and Jiahui Wong

Curr. Oncol. 2025, 32(3), 145; https://doi.org/10.3390/curroncol32030145 - 2 Mar 2025

Abstract

The Artificial Intelligence Patient Librarian (AIPL) was designed to meet the psychosocial and supportive care needs of Metastatic Breast Cancer (MBC) patients with HR+/HER2− subtypes. AIPL provides conversational patient education, answers user questions, and offers tailored online resource recommendations. This study, conducted in [...] Read more.

The Artificial Intelligence Patient Librarian (AIPL) was designed to meet the psychosocial and supportive care needs of Metastatic Breast Cancer (MBC) patients with HR+/HER2− subtypes. AIPL provides conversational patient education, answers user questions, and offers tailored online resource recommendations. This study, conducted in three phases, assessed AIPL’s impact on patients’ ability to manage their advanced disease. In Phase 1, educational content was adapted for chatbot delivery, and over 100 credible online resources were annotated using a Convolutional Neural Network (CNN) to drive recommendations. Phase 2 involved 42 participants who completed pre- and post-surveys after using AIPL for two weeks. The surveys measured patient activation using the Patient Activation Measure (PAM) tool and evaluated user experience with the System Usability Scale (SUS). Phase 3 included focus groups to explore user experiences in depth. Of the 42 participants, 36 completed the study, with 10 participating in focus groups. Most participants were aged 40–64. PAM scores showed no significant differences between pre-survey (mean = 59.33, SD = 5.19) and post-survey (mean = 59.22, SD = 6.16), while SUS scores indicated good usability. Thematic analysis revealed four key themes: AIPL offers basic wellness and health guidance, provides limited support for managing relationships, offers limited condition-specific medical information, and is unable to offer hope to patients. Despite showing no impact on the PAM, possibly due to high baseline activation, AIPL demonstrated good usability and met basic information needs, particularly for newly diagnosed MBC patients. Future iterations will incorporate a large language model (LLM) to provide more comprehensive and personalized assistance. Full article

(This article belongs to the Section Breast Cancer)

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14 pages, 1875 KiB

Open AccessCase Report

Dramatic Responses to High-Dose Ipilimumab Plus Temozolomide After Progression on Standard- or Low-Dose Ipilimumab in Advanced Melanoma

by Julie Williamson, Muhammad Zaki Hidayatullah Fadlullah, Magdalena Kovacsovics-Bankowski, Berit Gibson, Umang Swami, Alyssa Erickson-Wayman, Debra Jamison, Dan Sageser, Joanne Jeter, Tawnya L. Bowles, Donald M. Cannon, Ben Haaland, Joyce D. Schroeder, David A. Nix, Aaron Atkinson, John Hyngstrom, Jordan McPherson, Aik-Choon Tan and Siwen Hu-Lieskovan

Curr. Oncol. 2025, 32(3), 144; https://doi.org/10.3390/curroncol32030144 - 28 Feb 2025

Abstract

Patients with advanced melanoma who progress on standard-dose ipilimumab (Ipi) + nivolumab continue to have poor prognosis. Studies support a dose–response activity of Ipi, and one promising combination is Ipi 10 mg/kg (Ipi10) + temozolomide (TMZ). We performed a retrospective cohort analysis of [...] Read more.

Patients with advanced melanoma who progress on standard-dose ipilimumab (Ipi) + nivolumab continue to have poor prognosis. Studies support a dose–response activity of Ipi, and one promising combination is Ipi 10 mg/kg (Ipi10) + temozolomide (TMZ). We performed a retrospective cohort analysis of patients with advanced melanoma treated with Ipi10 + TMZ in the immunotherapy refractory/resistant setting (n = 6, all progressed after prior Ipi + nivolumab), using similar patients treated with Ipi3 + TMZ (n = 6) as comparison. Molecular profiling by whole-exome sequencing (WES) and RNA-sequencing (RNA-seq) of tumors harvested through one responder’s treatment was performed. With a median follow up of 119 days, patients treated with Ipi10 + TMZ had a statistically significant longer median progression-free survival of 144.5 days (range 27–219) vs. 44 (26–75) in Ipi 3 mg/kg (Ipi3) + TMZ, p = 0.04, and a trend of longer median overall survival of 154.5 days (27–537) vs. 89.5 (26–548). Two patients in the Ipi10 + TMZ cohort had a partial response, and both responders had BRAF V600E mutant melanoma. RNA-seq showed enrichment of inflammatory signatures, including interferon responses in metastases after Ipi10 + TMZ compared to the primary tumor, and downregulated negative immune regulators. Ipi10 + TMZ demonstrated efficacy, including dramatic responses in patients refractory to prior Ipi + anti-PD1. Molecular data suggest a potential threshold of Ipi dose for activation of sufficient anti-tumor immune response, and higher doses are required for some patients. Full article

(This article belongs to the Section Dermato-Oncology)

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31 pages, 1715 KiB

Open AccessReview

Breast Cancer and Tumor Microenvironment: The Crucial Role of Immune Cells

by Tânia Moura, Paula Laranjeira, Olga Caramelo, Ana M. Gil and Artur Paiva

Curr. Oncol. 2025, 32(3), 143; https://doi.org/10.3390/curroncol32030143 - 28 Feb 2025

Abstract

Breast cancer is the most common type of cancer in women and the second leading cause of death by cancer. Despite recent advances, the mortality rate remains high, underlining the need to develop new therapeutic approaches. The complex interaction between cancer cells and [...] Read more.

Breast cancer is the most common type of cancer in women and the second leading cause of death by cancer. Despite recent advances, the mortality rate remains high, underlining the need to develop new therapeutic approaches. The complex interaction between cancer cells and the tumor microenvironment (TME) is crucial in determining tumor progression, therapy response, and patient prognosis. Understanding the role of immune cells in carcinogenesis and tumor progression can help improve targeted therapeutic options, increasing the likelihood of a favorable prognosis. Therefore, this review aims to critically analyze the complex interaction between tumor cells and immune cells, emphasizing the clinical and therapeutic implications. Additionally, we explore advances in immunotherapies, with a focus on immune checkpoint inhibitors. Full article

(This article belongs to the Special Issue Advances in Immunotherapy for Breast Cancer)

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13 pages, 1135 KiB

Open AccessReview

Optimal Use of Bispecific Antibodies for the Treatment of Diffuse Large B-Cell Lymphoma in Canada

by Isabelle Fleury, David MacDonald, Mona Shafey, Anna Christofides and Laurie H. Sehn

Curr. Oncol. 2025, 32(3), 142; https://doi.org/10.3390/curroncol32030142 - 28 Feb 2025

Abstract

CAR-T cell therapy has significantly improved outcomes for patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), but challenges such as limited resources, manufacturing timelines, and notable toxicities persist. Bispecific antibodies (BsAbs), including glofitamab and epcoritamab, have demonstrated promising efficacy and [...] Read more.

CAR-T cell therapy has significantly improved outcomes for patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), but challenges such as limited resources, manufacturing timelines, and notable toxicities persist. Bispecific antibodies (BsAbs), including glofitamab and epcoritamab, have demonstrated promising efficacy and represent a new treatment option in patients who are unsuitable for or have relapsed following CAR-T therapy. Bispecific antibodies have a manageable safety profile and are generally more widely accessible than CAR-T cell therapy. Case discussions in this paper illustrate the potential real-world application of BsAbs, highlighting their role in treating patients who have relapsed after or are unable to undergo CAR-T cell therapy. Overall, glofitamab and epcoritamab represent valuable treatment options in the evolving landscape of R/R DLBCL. Full article

(This article belongs to the Section Cell Therapy)

15 pages, 2202 KiB

Open AccessConference Report

Toward Timely and Equitable Advanced Biomarker Testing for Patients with Metastatic Cancer in Canada

by Brandon S. Sheffield, Shantanu Banerji, Allen Chankowsky, Shaan Dudani, Sharlene Gill, Zuzanna Gorski, Shaqil Kassam, Cassandra Macaulay, Mita Manna, Kirstin Perdrizet, Ravi Ramjeesingh, Monika Slovinec D’Angelo and Filomena Servidio-Italiano

Curr. Oncol. 2025, 32(3), 141; https://doi.org/10.3390/curroncol32030141 - 27 Feb 2025

Abstract

The explosion in biomarker testing over the past two decades continues to transform cancer care in Canada and around the world. Precision medicine is supported by identifying actionable mutations that direct therapeutic choices, thus improving survival and quality of life, especially for patients [...] Read more.

The explosion in biomarker testing over the past two decades continues to transform cancer care in Canada and around the world. Precision medicine is supported by identifying actionable mutations that direct therapeutic choices, thus improving survival and quality of life, especially for patients with advanced/metastatic disease. In addition, our growing understanding of the genetic basis of cancer is advanced by research employing ever-expanding databases of genetic mutations, therapies and outcomes. Despite this promising progress, however, access to biomarker testing remains inequitable across Canada, to the detriment of patients. Several underlying factors contribute to this situation, including the need for investment in and standardization of laboratory medicine infrastructure and processes, and the lack of suitable methods for cost/benefit evaluations to inform funding decisions. In 2024, a Canadian conference brought together patients, clinicians, researchers, policy-makers and scientists to address “Equitable Access to Advanced Biomarker Testing for Canadian Metastatic Cancer Patients”. Two major themes arose from the conference: the urgent need to adopt comprehensive genomic profiling (CGP) as a standard of care across Canada, and the emerging role of liquid biopsy in accelerating access to biomarker testing for patients with advanced/metastatic cancer. Full article

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9 pages, 1032 KiB

Open AccessCommunication

Enhancing Care Through a Virtual Canadian Community of Practice for Managing Immune-Related Adverse Events

by Khashayar Esfahani, John Walker, Kevin Bambury, Eoin O’Carroll and Stephanie Snow

Curr. Oncol. 2025, 32(3), 140; https://doi.org/10.3390/curroncol32030140 - 27 Feb 2025

Abstract

The advent of immune checkpoint inhibitors (ICIs) has significantly transformed cancer treatment outcomes. However, these therapies can induce immune-related adverse events (irAEs) that may affect any organ system, sometimes requiring specialized expertise. As ICIs are increasingly used across various tumor types and in [...] Read more.

The advent of immune checkpoint inhibitors (ICIs) has significantly transformed cancer treatment outcomes. However, these therapies can induce immune-related adverse events (irAEs) that may affect any organ system, sometimes requiring specialized expertise. As ICIs are increasingly used across various tumor types and in earlier treatment settings, not all practitioners have the necessary support network to handle complex irAEs. To address this gap, we collaborated with ONCOassist, a leading app for oncology professionals, to establish the first virtual Canadian Community of Practice (CoP) focused on irAEs. The CoP facilitates continuous learning and improves patient care among Canadian clinicians treating patients with immunotherapy by providing a platform for knowledge exchange and peer-to-peer support. This article outlines the development and growth of the CoP on irAEs, highlighting both successes and challenges. As of May 2024, over a year since its inception, the CoP on irAEs has attracted almost 130 Canadian oncology healthcare professionals, and peer-to-peer interactions and engagement continue to increase. To ensure its long-term sustainability, we plan to evolve and adapt the CoP to meet the needs of the oncology community and address clinical challenges associated with new therapies. Full article

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12 pages, 442 KiB

Open AccessConference Report

Putting Patients First: Pragmatic Trials in Gynecologic Oncology

by Laura Hopkins, Mark Clemons, Karen Bemister, Chris Booth, Shannon Kadar, Paul Karanicolas, Julie Mulligan, Marie-France Savard, Ian Tannock, Alicia Tone and Helen MacKay

Curr. Oncol. 2025, 32(3), 139; https://doi.org/10.3390/curroncol32030139 - 27 Feb 2025

Abstract

In November 2024, the Society of Gynecologic Oncology of Canada hosted a 2-day, interdisciplinary Pragmatic Clinical Trials (PCTs) Workshop with the goal of launching an initiative to develop and promote PCTs within the Canadian gynecologic oncology research environment. The programme brought together multiple [...] Read more.

In November 2024, the Society of Gynecologic Oncology of Canada hosted a 2-day, interdisciplinary Pragmatic Clinical Trials (PCTs) Workshop with the goal of launching an initiative to develop and promote PCTs within the Canadian gynecologic oncology research environment. The programme brought together multiple stakeholders, including patients with ovarian cancer, patient advocates, experts in PCTs, gynecologic oncologists, medical oncologists and clinical fellows. Foundational elements of pragmatism were emphasized in the context of the primary goal of PCTs, showing the real-world effectiveness of interventions in broad patient groups. Examples of how PCT outcomes can inform and influence clinical decision making and health policy were presented in the context of those outcomes that matter most to patients with cancer. The patients and patient advocates had the essential role of helping clinical investigators co-design PCT protocols to answer common, important, and practical questions that focus on outcomes that matter to patients. These endpoints included overall survival, quality of life and promotion of informed patient decision making. Tangible workshop outcomes included the development of several new proposals for PCTs inspirited and directed by the patient voice. Further educational initiatives to engage clinical gynecologic oncology investigators at all stages in their career are being planned. Full article

(This article belongs to the Special Issue Ovarian Cancer in the Age of Precision Medicine)

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22 pages, 2602 KiB

Open AccessArticle

Downregulation of the Unfolded Protein Response Links Metformin Treatment to Good Clinical Outcomes in Colorectal Cancer Patients

by Mary L. Fay, Chris Nicol, Christine Orr, Brooke Wilson, David Hurlbut, Harriet Feilotter and Scott Davey

Curr. Oncol. 2025, 32(3), 138; https://doi.org/10.3390/curroncol32030138 - 27 Feb 2025

Abstract

Type 2 diabetes is a risk factor for colorectal cancer (CRC) development and progression. However, metformin-treated diabetic CRC patients tend to have better clinical outcomes than those managed by other means. To better characterize the molecular underpinnings of metformin’s protective effects, we performed [...] Read more.

Type 2 diabetes is a risk factor for colorectal cancer (CRC) development and progression. However, metformin-treated diabetic CRC patients tend to have better clinical outcomes than those managed by other means. To better characterize the molecular underpinnings of metformin’s protective effects, we performed a targeted transcriptomic analysis of primary CRC tissue samples (n = 272). A supervised learning algorithm pinpointed molecular features that discriminate between metformin-treated and diet-controlled diabetic CRC samples, as well as those that discriminated between non-diabetic samples based on their five-year overall survival status. Our results show downregulation of TMEM132 in metformin-treated samples (p = 0.05) and non-diabetics with good clinical outcomes (p = 0.05) relative to diet-controlled and non-diabetics with poor survival, respectively. Furthermore, upregulation of SCNN1A is observed in metformin-treated samples (p = 0.04) and non-diabetics with good clinical outcomes (p = 0.01) relative to diet-controlled samples and those with poor clinical outcomes, respectively. We also show that the antiapoptotic protein sFas is downregulated in metformin-treated samples relative to diet-controlled samples (p = 0.005). These findings suggest a role for the unfolded protein response in mediating metformin-related CRC-protective effects by enhancing apoptosis and suggest the investigation of these proteins as targets for novel CRC therapies. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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11 pages, 2010 KiB

Open AccessReview

Cryotherapy in the Treatment of Extra-Abdominal Desmoid Tumors—A Review

by Kadhim Taqi, Cecily Stockley, Melissa Wood, Stefan Przybojewski, Antoine Bouchard-Fortier and Lloyd Mack

Curr. Oncol. 2025, 32(3), 137; https://doi.org/10.3390/curroncol32030137 - 27 Feb 2025

Abstract

The management of desmoid tumors (DTs) often poses challenges due to their variable clinical behavior, with treatment options including active surveillance, systemic therapy, and local therapies including surgery, ablation, and radiation. More recently, cryotherapy has emerged as a promising localized treatment for DTs. [...] Read more.

The management of desmoid tumors (DTs) often poses challenges due to their variable clinical behavior, with treatment options including active surveillance, systemic therapy, and local therapies including surgery, ablation, and radiation. More recently, cryotherapy has emerged as a promising localized treatment for DTs. We aimed to conduct a review of the indications, techniques, and outcomes of cryotherapy in the treatment of extra-abdominal DTs. The review suggests that cryotherapy can be effectively used for both curative and debulking purposes, with a significant number of patients achieving symptom relief, disease stabilization, or regression. Although generally safe, cryotherapy is associated with potential risks, particularly when critical structures are in proximity. Overall, cryotherapy offers a viable, minimally invasive treatment option for DTs, with favorable outcomes in both symptom relief and tumor control. Full article

(This article belongs to the Special Issue An In-Depth Review of Desmoid Tumours)

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19 pages, 1549 KiB

Open AccessArticle

Clinical Impact of MRI-Guided Intracavitary–Interstitial Brachytherapy in the Curative Management of Advanced-Stage Cervical Cancer

by Antje Wark, Laura Hüfner, Eva Meixner, Jan Oelmann, Laila König, Simon Höne, Katja Lindel, Jürgen Debus and Nathalie Arians

Curr. Oncol. 2025, 32(3), 136; https://doi.org/10.3390/curroncol32030136 - 26 Feb 2025

Abstract

This study investigates the clinical efficacy of MRI-based adaptive brachytherapy (IGABT) using combined intracavitary and interstitial techniques in the curative treatment of patients with advanced cervical cancer (LACC). A retrospective analysis was conducted on 149 LACC patients treated at a single center. The [...] Read more.

This study investigates the clinical efficacy of MRI-based adaptive brachytherapy (IGABT) using combined intracavitary and interstitial techniques in the curative treatment of patients with advanced cervical cancer (LACC). A retrospective analysis was conducted on 149 LACC patients treated at a single center. The therapeutic protocol included intensity-modulated external beam radiotherapy (IMRT) and IGABT. Dosimetric parameters were evaluated for relevance for local control (LC), progression-free survival (PFS), and overall survival (OS) using Kaplan–Meier estimation, Cox regression, and log-rank test. Patients predominantly presented with stage III/IV tumors (81%, FIGO 2018). The median high-risk clinical target volume (hrCTV) was 34 cm³, with a median D90% dose of 88.9 GyEQD2. At 24 months, OS, PFS, and LC rates were 86%, 57%, and 81%, respectively. FIGO stage, tumor volume, and histology were significant predictors of PFS. Higher total hrCTV doses were strongly correlated with improved LC and PFS, emphasizing the importance of precise dosimetric optimization in IGABT and confirming the critical role of IGABT in achieving very good LC rates for LACC. The reported LC rates are comparable to landmark studies, such as INTERLACE and KEYNOTE-A18. This study validates the effectiveness of MRI-guided IGABT in enhancing local tumor control in advanced-stage cervical cancer while providing insights into the prognostic implications of dosimetric parameters such as hrCTV and point A. Future research should address the persistent challenge of distant metastases by exploring the integration of novel systemic treatment options. Full article

(This article belongs to the Special Issue Clinical Management of Cervical Cancer)

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17 pages, 4950 KiB

Open AccessReview

Influence of Vitamin D and Its Analogues in Type-B Lymphomas

by Valerio Basile, Alessandro Allegra, Herbert Ryan Marini, Massimiliano Berretta, Barbara Granata, José Freni, Domenico Puzzolo, Fabio Stagno, Paola Midiri, Valentina Urzì Brancati and Letteria Minutoli

Curr. Oncol. 2025, 32(3), 135; https://doi.org/10.3390/curroncol32030135 - 26 Feb 2025

Abstract

Lymphomas represent a heterogeneous group of blood tumors, generally divided into non-Hodgkin lymphoma (NHL) (90% of all lymphomas) and Hodgkin lymphoma (HL). High-grade NHL can rapidly progress so that new strategies and potentially therapeutical options are needed. Recently, it was shown that Vitamin [...] Read more.

Lymphomas represent a heterogeneous group of blood tumors, generally divided into non-Hodgkin lymphoma (NHL) (90% of all lymphomas) and Hodgkin lymphoma (HL). High-grade NHL can rapidly progress so that new strategies and potentially therapeutical options are needed. Recently, it was shown that Vitamin D (VitD) inhibits the growth of cancer cells, controls their invasion and metastasis, and strengthens the antitumor activity of various types of chemotherapeutic anticancer agents. Therefore, we reviewed the recent literature about the influence of VitD and its analogues (VDAs) on the treatment and the prognosis of B-cell lymphomas. As to the in vitro studies in different cell lines, VitD3 and VDAs enhanced the anti-proliferative efficacy of various chemotherapeutics and increased the expression of VitD receptor. In in vivo studies, blood levels of VitD were considered: higher values of plasma bioavailable VitD were correlated with better progression-free survival (PFS) and overall survival (OS), while an unfavorable PFS and OS were observed in VitD deficient groups. No clinical trial was made on the analogs, thus confirming the absence of in vivo positive role of these synthetic drugs. In conclusion, higher levels of circulating VitD are related to improved OS, reduced cancer-specific mortality, and better disease-free survival. VitD and analogs showed also positive effects in in vitro studies, while only VitD was able to improve clinical parameters. Furthermore, a complex approach with plant-based diet, adequate levels for motor exercise, and/or eventual VitD supplementation could be a valuable strategy to challenge lymphomas. Full article

(This article belongs to the Special Issue Advances in B-cell Lymphoma: From Diagnostics to Cure)

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18 pages, 669 KiB

Open AccessSystematic Review

PTSD in Patients Who Undergo Head and Neck Cancer Treatment: A Systematic Review

by Orli Weiss, Juliana Runnels, Daniel R. Dickstein, Kristin Hsieh, Lauren Jacobs, Anuja Shah, Danielle Arons, Samuel Reed, Kunal K. Sindhu, Richard Bakst and Julie Bloom

Curr. Oncol. 2025, 32(3), 134; https://doi.org/10.3390/curroncol32030134 - 26 Feb 2025

Abstract

Background/Objectives: Post-traumatic stress disorder (PTSD) can develop after exposure to real or perceived threats to life and is characterized by symptoms including intrusive thoughts, hyperarousal, and emotional numbness. While PTSD is well-studied in populations affected by disasters and combat, the impact of serious [...] Read more.

Background/Objectives: Post-traumatic stress disorder (PTSD) can develop after exposure to real or perceived threats to life and is characterized by symptoms including intrusive thoughts, hyperarousal, and emotional numbness. While PTSD is well-studied in populations affected by disasters and combat, the impact of serious medical conditions like cancer and its treatments remain under-researched. Due to the aggressive nature of the disease, fear of recurrence, and disfiguring nature of treatments, patients with head and neck cancer (HNC) may experience a real or perceived risk of death. This systematic review synthesizes current knowledge on PTSD in patients with HNC. Methods: A systematic review was conducted per PRISMA guidelines. Five databases (PubMed, EMBASE, SCOPUS, CINAHL, and COCHRANE) were searched for studies describing PTSD in patients with and survivors of HNC. Studies with PTSD diagnosis and/or symptom data specific to patients with HNC were included. Results: Of 80 studies, 14 met the inclusion criteria. The most commonly used scale was the PTSD Checklist-Civilian Version. The prevalence of PTSD ranged from 8% to 41% across the studies. No significant differences were found with regards to PTSD prevalence by HNC tumor site, disease stage, or treatment modality. Two studies identified significant associations between PTSD after treatment and depression at the time of diagnosis. Patients with PTSD who received cognitive behavioral therapy showed improvement in their PTSD symptoms compared to those who did not. Conclusions: PTSD is common in individuals with HNC; however, the lack of a standardized approach to diagnosing PTSD in patients with and survivors of HNC creates challenges in identifying patients who may benefit from treatment. Given that HNC is the seventh most common cancer worldwide, with increasing incidence, there is a need to better understand the relationship between HNC and PTSD to allow for better PTSD screening, identification, and treatment to improve patients’ health-related quality of life and provide optimal patient care. Full article

(This article belongs to the Section Head and Neck Oncology)

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