Current Oncology

12 pages, 966 KiB

Open AccessArticle

The Clinical Characteristics of a Stage II Colorectal Cancer T4 Tumor: A Ten-Year Single-Center Research Report

by Bo-Zhi Lin, Chang-Lin Lin, Feng-Fan Chiang, Chou-Chen Chen, Ming-Cheng Chen, Chun-Yu Lin and Shang-Chih Huang

Curr. Oncol. 2024, 31(12), 7924-7935; https://doi.org/10.3390/curroncol31120584 (registering DOI) - 12 Dec 2024

Abstract

Aim: The tumor staging of colorectal cancer (CRC) plays a significant role in both treatment and prognosis, impacting surgical planning and adjuvant therapy decisions. Currently, the staging of CRC is based on the TNM system developed by the American Joint Committee on Cancer. [...] Read more.

Aim: The tumor staging of colorectal cancer (CRC) plays a significant role in both treatment and prognosis, impacting surgical planning and adjuvant therapy decisions. Currently, the staging of CRC is based on the TNM system developed by the American Joint Committee on Cancer. Prior studies have suggested that survival rates and recurrent rates of T4a tumors appear to be worse than that of T4b tumors, although there is currently no consensus. Therefore, we collected patient data from Taichung Veterans General Hospital over the past decade in order to conduct further research. Method: Between 2010 and 2018, a total of 5760 newly diagnosed CRC patients were seen at the hospital. To eliminate the influence of any local lymph node involvement or distant organ metastasis on the research results, we focused on patients with pathologic Stage IIc disease (T4a-bN0M0). Patients with rectal cancer who had received neoadjuvant concurrent chemoradiotherapy were excluded. Ultimately, 132 patients were included in this study. A multivariate Cox regression analysis was conducted to identify independent risk factors for both 10-year cancer-specific survival (CSS) and overall survival (OS). Results: A total of 132 patients were included in the study, with 90 classified as T4a and 42 as T4b. The 10-year CSS for pT4a and pT4b was 72.5% and 56.5%, respectively, with a p-value of 0.011. The 10-year OS for pT4a and pT4b was 48.4% and 42.5%, respectively, with a p-value of 0.086. There was no significant difference in the site of first recurrence between the pT4a and pT4b groups (p-value = 0.936). Overall, patients who received adjuvant chemotherapy therapy had a significantly better prognosis (p-value < 0.05). However, there was no significant difference in prognosis between oral 5-FU and FOLFOX. Conclusion: Based on our data, patients diagnosed with pathologic T4aN0M0 CRC appeared to experience a trend toward better 10-year OS when compared to those with T4bN0M0 disease, but this trend lacks statistical significance. Patients with locally advanced Stage II colon cancer clearly benefited from adjuvant chemotherapy therapy; therefore, FOLFOX may not necessarily be required. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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10 pages, 741 KiB

Open AccessArticle

Real-World Oncological Outcomes of Nivolumab Plus Ipilimumab in Advanced or Metastatic Renal Cell Carcinoma: A Multicenter, Retrospective Cohort Study in Japan

by Tomoki Taniguchi, Koji Iinuma, Kei Kawada, Takashi Ishida, Kimiaki Takagi, Masayuki Tomioka, Makoto Kawase, Kota Kawase, Keita Nakane, Yuki Tobisawa and Takuya Koie

Curr. Oncol. 2024, 31(12), 7914-7923; https://doi.org/10.3390/curroncol31120583 - 11 Dec 2024

Abstract

A combination of nivolumab and ipilimumab (NIVO + IPI) is the only approved combination of two immune checkpoint inhibitors for metastatic or advanced renal cell carcinoma (mRCC). Inadequate evidence of treatment with NIVO + IPI has been reported in Japanese cohorts. We evaluated [...] Read more.

A combination of nivolumab and ipilimumab (NIVO + IPI) is the only approved combination of two immune checkpoint inhibitors for metastatic or advanced renal cell carcinoma (mRCC). Inadequate evidence of treatment with NIVO + IPI has been reported in Japanese cohorts. We evaluated the clinical efficacy of NIVO + IPI treatment. Patients with mRCC who received NIVO + IPI at nine Japanese facilities between August 2018 and March 2023 were enrolled in this study. The primary endpoint in this study was the assessment of oncological outcomes in patients with mRCC who received NIVO + IPI. Eighty-four patients with mRCC were enrolled. The median follow-up period was 18.3 months, and median progression-free and overall survival were 13.3 and 50.9 months, respectively. The objective response rate was 47.6%, and the disease control rate was 78.6%. To our knowledge, this is the largest study that evaluates Japanese patients with mRCC receiving NIVO + IPI treatment. In this study, the real-world oncological outcomes after NIVO + IPI treatment were comparable to those in the CheckMate 214 study. Full article

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11 pages, 891 KiB

Open AccessArticle

Longitudinal Follow-Up of the Psychological Well-Being of Patients with Colorectal Cancer: Final Analysis of PICO-SM

by Konstantinos Kamposioras, Panagiotis Ntellas, Katerina Dadouli, Eleftherios Christodoulis, Marios Adamou, Daniel Anderson, Anup Shanthappa, Jacqueline Connell, Joseph Williams, Lilly Simpson, Theodora Germetaki, Michael Braun, Jorge Barriuso, Jurjees Hasan, Saifee Mullamitha, Kalena Marti, Mark Saunders and Kok Haw Jonathan Lim

Curr. Oncol. 2024, 31(12), 7903-7913; https://doi.org/10.3390/curroncol31120582 - 11 Dec 2024

Abstract

PICO-SM was a prospective longitudinal study investigating the psychological impact of the COVID-19 pandemic on patients with colorectal cancer treated in a large UK tertiary cancer centre. Here, we present the impact of the third wave of the pandemic (December 2021 to February [...] Read more.

PICO-SM was a prospective longitudinal study investigating the psychological impact of the COVID-19 pandemic on patients with colorectal cancer treated in a large UK tertiary cancer centre. Here, we present the impact of the third wave of the pandemic (December 2021 to February 2022), when the Omicron variant became prevalent in the UK, and the complete longitudinal comparison across the entire duration of this study. Patients were invited to complete a questionnaire, including screening psychometric tools. In total, n = 312 patients were included in the final analysis. Specifically, in this Omicron-predominant wave, n = 96 patients were studied in detail: the mean age was 64 years, 64% were male, 33% reported poor well-being, 27% anxiety, 11% depressive symptoms, and 3% trauma-related symptoms. The participants who had investigations cancelled (OR 9.22, 95% CI 1.09–77.85; p = 0.041) or felt that the pandemic would affect their mental health (OR 3.82, 95% CI 1.96–7.44; p < 0.001) had an increased risk of anxiety according to a multivariate analysis. Similarly, independent predictors of poor well-being included concern that the pandemic would affect their cancer treatment (OR 4.59, 95% CI 1.03–20.56; p = 0.046) or mental health (OR 3.90, 95% CI 1.38–11.03; p = 0.010). The psychological distress experienced by patients, particularly anxiety, remained high during the third wave of the COVID-19 pandemic. These results align with our previously reported findings, emphasising the importance of continuing cancer treatment amidst an ongoing humanitarian emergency. Full article

(This article belongs to the Section Psychosocial Oncology)

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13 pages, 750 KiB

Open AccessArticle

First-Line (1L) Treatment Decision Patterns and Survival of Hormone Receptor (HR)-Positive/HER2-Negative Advanced Breast Cancer (ABC) Patients in a Latin American (LATAM) Public Institution

by Guillermo Valencia, Patricia Rioja, Miguel Chirito, Olenka Peralta, Jorge Sánchez, Connie Rabanal, Raúl Mantilla, Zaida Morante, Hugo Fuentes, Carlos Castaneda, Tatiana Vidaurre, Cristian Pacheco, Silvia Neciosup and Henry L. Gomez

Curr. Oncol. 2024, 31(12), 7890-7902; https://doi.org/10.3390/curroncol31120581 - 9 Dec 2024

Abstract

Advanced breast cancer is an incurable disease, with a median overall survival of 3 years, including in countries without access problems. Although chemotherapy is reserved in some cases, it is still used in many countries as a first-line therapy. The aim of our [...] Read more.

Advanced breast cancer is an incurable disease, with a median overall survival of 3 years, including in countries without access problems. Although chemotherapy is reserved in some cases, it is still used in many countries as a first-line therapy. The aim of our study is to evaluate the first-line treatment choices and the factors that influence therapeutic decisions. A retrospective analysis was conducted of hormone receptor (+)/HER2 (−) advanced breast cancer patients classified into three groups according to the first-line and second-line treatment received: endocrine therapy–chemotherapy, endocrine therapy–endocrine therapy and chemotherapy–endocrine therapy. Additionally, we explored the overall survival of sequencing therapy groups. First-line chemotherapy was chosen in 34% of patients. Also, around 60% of our patients met the “aggressive disease” criteria from the RIGHT Choice trial, justifying the use of chemotherapy in a population with poor prognosis. Furthermore, de novo and progressive disease were prognostic factors that influenced the use of chemotherapy as a first-line treatment. Regarding overall survival, the sequencing treatment groups in this trial saw an increase in survival compared with patients of the MONALEESA trials (endocrine therapy alone arms). No significant differences in progression-free survival or overall survival were found in the treatment sequencing groups. There was a higher use of chemotherapy as a first-line therapy, with de novo and “aggressive disease” criteria being the main factors to influence the decision. Full article

(This article belongs to the Special Issue Social Determinants of Health and Breast Cancer: Impacts on Diagnosis, Treatment, and Outcomes)

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18 pages, 291 KiB

Open AccessArticle

Assessing Barriers to Cancer Screening and Early Detection in Older Adults in Saudi Arabia: A Mixed-Methods Approach to Oncology Nursing Practice Implications

by Abdulaziz M. Alodhialah, Ashwaq A. Almutairi and Mohammed Almutairi

Curr. Oncol. 2024, 31(12), 7872-7889; https://doi.org/10.3390/curroncol31120580 - 8 Dec 2024

Abstract

Background: Access to cancer screening services is crucial for early detection and improved survival rates, yet older adults in Saudi Arabia face significant barriers. Recent data from the Saudi Health Ministry indicate that cancer incidence in this demographic is rising, underscoring the urgent [...] Read more.

Background: Access to cancer screening services is crucial for early detection and improved survival rates, yet older adults in Saudi Arabia face significant barriers. Recent data from the Saudi Health Ministry indicate that cancer incidence in this demographic is rising, underscoring the urgent need for enhanced screening efforts. This study explores the factors influencing cancer screening behaviors among older adults in Riyadh, using a mixed-methods approach to identify and address these barriers effectively. Methods: The study integrated quantitative data from 100 participants aged 60 and above who attended King Saud University-affiliated healthcare centers, and qualitative insights from 20 semi-structured interviews. The Barriers to Cancer Screening Scale (BCSS) quantitatively assessed barriers, while the thematic analysis of interview data helped identify key themes. Results: Findings revealed significant barriers, categorized into three primary themes: accessibility challenges, psychological barriers, and social influences. These include logistical difficulties related to transportation and service availability, fears and anxieties regarding cancer diagnoses, and a lack of family support and cultural stigma, all of which impact participants’ willingness to engage in screening. Conclusion: The study underscores the multifaceted barriers faced by older adults in accessing cancer screening in Saudi Arabia. Tailored interventions that address logistical, psychological, and social factors are essential to enhance screening uptake and ensure equitable access to preventive services. These findings contribute to the ongoing discussions on public health strategies and underscore the necessity for community and healthcare provider engagement to improve cancer screening rates in this population. Full article

(This article belongs to the Special Issue Feature Reviews in Section "Oncology Nursing")

9 pages, 1049 KiB

Open AccessArticle

Assessment of the American College of Surgeons Surgical Risk Calculator (ACS-SRC) for Prediction of Early Postoperative Complications in Patients Undergoing Cytoreductive Surgery for Ovarian Peritoneal Carcinomatosis

by Cedric Kabeya, Charif Khaled, Laura Polastro, Michel Moreau, Dario Bucella, Maxime Fastrez and Gabriel Liberale

Curr. Oncol. 2024, 31(12), 7863-7871; https://doi.org/10.3390/curroncol31120579 - 7 Dec 2024

Abstract

Ovarian cancer (OC) is diagnosed at a locally advanced stage in two-thirds of cases. The first line of treatment consists of cytoreductive surgery (CRS) combined with neoadjuvant and/or adjuvant chemotherapy. However, CRS can be associated with high rates of postoperative complications (POCs), and [...] Read more.

Ovarian cancer (OC) is diagnosed at a locally advanced stage in two-thirds of cases. The first line of treatment consists of cytoreductive surgery (CRS) combined with neoadjuvant and/or adjuvant chemotherapy. However, CRS can be associated with high rates of postoperative complications (POCs), and detection of fragile patients at high risk of POCs is important. The American College of Surgeons Surgical Risk Calculator (ACS-SRC) provides a predictive model for early POCs (30 days) for any given surgical procedure. This study aimed to evaluate the performance of the ACS-SRC in predicting the occurrence of early POCs for patients undergoing CRS for OC. This was a retrospective study that included patients undergoing CRS for advanced OC between January 2010 and December 2022. Early POCs were reviewed, and the rate of POCs was compared with those predicted by the ACS-SRC to evaluate its accuracy (i.e., discrimination and calibration). A total of 218 patients were included, 112 of whom underwent extensive surgery/resection. A total of 94 complications were recorded. This cohort demonstrated correct calibration of the ACS-SRC for the prediction of surgical site infection, readmission, and the need for nursing care post-discharge (NCPD; transfer to revalidation center or need for nursing care at home). Using both the discrimination and calibration methods, the score only predicted NCPD. In this study, the ACS-SRC was shown to be of little value for patients undergoing cytoreductive surgery for ovarian peritoneal carcinomatosis, as it only accurately predicted NCPD. Full article

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

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11 pages, 1191 KiB

Open AccessArticle

The Role of Frailty and Myosteatosis in Predicting All-Cause Mortality in Older Adults with Cancer

by Efthymios Papadopoulos, Andy Kin On Wong, Sharon Hiu Ching Law, Sarah Costa, Angela M. Cheung, Dmitry Rozenberg and Shabbir M. H. Alibhai

Curr. Oncol. 2024, 31(12), 7852-7862; https://doi.org/10.3390/curroncol31120578 - 6 Dec 2024

Abstract

Frailty and myosteatosis are each prognostic of all-cause mortality (ACM) in patients with cancer. However, it is unclear whether myosteatosis adds value to frailty for predicting ACM. We assessed whether myosteatosis improves the predictive ability of frailty for ACM in older adults undergoing [...] Read more.

Frailty and myosteatosis are each prognostic of all-cause mortality (ACM) in patients with cancer. However, it is unclear whether myosteatosis adds value to frailty for predicting ACM. We assessed whether myosteatosis improves the predictive ability of frailty for ACM in older adults undergoing chemotherapy. This was a retrospective study of older adults (≥65 years) initiating chemotherapy between June 2015 and June 2022. Frailty was assessed using a 24-item frailty index (FI). Myosteatosis was evaluated via computed tomography scans at the third lumbar vertebra (L3).. Multivariable Cox regression and Uno’s c-statistic determined the predictive performance of the FI and myosteatosis. In total, 115 participants (mean age: 77.1 years) were included. Frailty alone (adjusted hazards ratio (aHR) = 1.68, 95% confidence intervals (CIs) = 1.03–2.72, p = 0.037) and myosteatosis alone (aHR = 2.14, 95%CI = 1.07–4.30, p = 0.032) exhibited similar performance (c-statistic = 0.66) in predicting ACM in multivariable analyses adjusted for age, sex, body mass index, and treatment intent. However, the highest predictive performance for ACM was observed after inclusion of both myosteatosis and frailty in the multivariable model (c-statistic = 0.70). Myosteatosis improves the performance of frailty for predicting ACM in older adults with cancer. Prospective studies to assess the effect of exercise on myosteatosis in older patients are warranted. Full article

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24 pages, 520 KiB

Open AccessSystematic Review

Peripheral Neuropathy Instruments for Individuals with Cancer: A COSMIN-Based Systematic Review of Measurement Properties

by Silvia Belloni, Arianna Magon, Chiara Giacon, Francesca Savioni, Gianluca Conte, Rosario Caruso and Cristina Arrigoni

Curr. Oncol. 2024, 31(12), 7828-7851; https://doi.org/10.3390/curroncol31120577 - 6 Dec 2024

Abstract

Although the literature on patient-reported outcomes (PROMs) continues to expand, challenges persist in selecting reliable and valid instruments for assessing peripheral neuropathy (PN) in patients with cancer. This systematic review aimed to identify all validated self-report PN scales and critically appraise their measurement [...] Read more.

Although the literature on patient-reported outcomes (PROMs) continues to expand, challenges persist in selecting reliable and valid instruments for assessing peripheral neuropathy (PN) in patients with cancer. This systematic review aimed to identify all validated self-report PN scales and critically appraise their measurement properties. This review was conducted using the COSMIN methodology for PROMs and the PRISMA statement. Five databases were searched from inception to August 2024, identifying 46 eligible studies and 16 PROMs. Evidence quality ranged from “very low” to “moderate”, with notable inconsistencies in the content and structural validity phases of most instruments. Instruments such as the Chemotherapy-induced peripheral neuropathy assessment tool and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity demonstrated moderate quality and potential utility in clinical practice, while others, including the Location-based assessment of sensory symptoms in cancer and the Measure of Ovarian Symptoms and Treatment, had insufficient evidence to support their use. Importantly, all PROMs focused on chemotherapy-induced peripheral neuropathy, highlighting a significant gap in instruments addressing other PN causes, such as radiotherapy or tumor-related nerve damage. Further research should prioritize developing and validating instruments for distinct cancer populations, ensuring robust psychometric properties and clinical applicability. Full article

8 pages, 1437 KiB

Open AccessArticle

Oncologic and Operative Outcomes of Robotic Staging Surgery Using Low Pelvic Port Placement in High-Risk Endometrial Cancer

by Jeeyeon Kim and Jiheum Paek

Curr. Oncol. 2024, 31(12), 7820-7827; https://doi.org/10.3390/curroncol31120576 - 5 Dec 2024

Abstract

Upper para-aortic lymph node dissection (PALND) is one of the most challenging gynecologic robotic procedures. This study aimed to evaluate the oncologic and operative outcomes of robotic staging surgery, including upper PALND, using low pelvic port placement (LP3) in 22 patients with high-risk [...] Read more.

Upper para-aortic lymph node dissection (PALND) is one of the most challenging gynecologic robotic procedures. This study aimed to evaluate the oncologic and operative outcomes of robotic staging surgery, including upper PALND, using low pelvic port placement (LP3) in 22 patients with high-risk endometrial cancer. High-risk was defined as patients who showed deep myometrial invasion with grade III, cervical involvement, or high-risk histology. The mean patient age and body mass index were 58 years and 24 kg/m². The mean operative time was 263 min. The mean number of total LNs and upper PALNs obtained was 31 and 10. Two patients received lymphangiography to reduce the amount of drained lymphatic fluid after surgery. The recurrence rate was 13.6% (3/22). There were two LN recurrences and one at the peritoneum in the intra-abdominal cavity. Robotic staging surgery using LP3 was feasible for performing PALND as well as procedures in the pelvic cavity simultaneously. It provides important techniques for performing optimal surgical procedures when surgeons decide to perform comprehensive PALND in instances of isolated recurrence or unexpected LN enlargement as well as high-risk endometrial cancer. Consequently, surgeons can achieve surgical consistency and reproducibility for PALND, leading to improved operative and survival outcomes in high-risk endometrial cancer. Full article

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11 pages, 262 KiB

Open AccessArticle

Implementation of an Oncogeriatric Unit for Frail Older Patients with Breast Cancer: Preliminary Results

by Helena Hipólito-Reis, Joana Santos, Paulo Almeida, Luciana Teixeira, Fernando Rodrigues, Nuno Teixeira Tavares, Darlene Rodrigues, Jorge Almeida and Fernando Osório

Curr. Oncol. 2024, 31(12), 7809-7819; https://doi.org/10.3390/curroncol31120575 - 4 Dec 2024

Abstract

(1) Background: Breast cancer (BC) has a high incidence in Europe, particularly in older adults. Traditionally under-represented in clinical trials, this age group is often undertreated due to ageism. This study aims to characterize frail older adults (≥70 years) with BC based on [...] Read more.

(1) Background: Breast cancer (BC) has a high incidence in Europe, particularly in older adults. Traditionally under-represented in clinical trials, this age group is often undertreated due to ageism. This study aims to characterize frail older adults (≥70 years) with BC based on a comprehensive geriatric assessment, to guide individualized treatment decision-making. (2) Methods: A descriptive analysis of older adults with BC treated from January 2021 to December 2022 was performed. Data were analyzed based on anonymized electronic medical records. (3) Results: Of 123 patients (mean age 84.0 ± 5.6 years), 122 (99.2%) were women. The mean G8 screening score was 12.1 ± 2.5. Most had functional dependence (69.9% Barthel Index, 81.3% Lawton/Brody Scale) and a moderate-to-high risk of falling (76.4% Tinetti index). Cognitive impairment and malnutrition risk were present in 15.4% and 30.1%, respectively. Prehabilitation inclusive strategies led to adapted treatment in 55.3% of cases. Endocrine therapy, surgery, radiotherapy, and chemotherapy was used in 99.2%, 56.1%, 35.0%, and 8.9% of patients, respectively. (4) Conclusions: Our comprehensive oncogeriatric strategy promotes personalized oncologic treatment, improves outcomes by addressing frailty, and enhances treatment tolerability in older patients with BC, validating the expansion of this combined team approach to other cancer types and institutions. Full article

16 pages, 3132 KiB

Open AccessArticle

Survival Outcomes with Regorafenib and/or Trifluridine/Tipiracil Sequencing to Rechallenge with Third-Line Regimens in Metastatic Colorectal Cancer: A Multicenter Retrospective Real-World Subgroup Comparison from the ReTrITA Study

by Carlo Signorelli, Maria Alessandra Calegari, Annunziato Anghelone, Alessandro Passardi, Giovanni Luca Frassineti, Alessandro Bittoni, Jessica Lucchetti, Lorenzo Angotti, Emanuela Di Giacomo, Ina Valeria Zurlo, Cristina Morelli, Emanuela Dell’Aquila, Adele Artemi, Donatello Gemma, Domenico Cristiano Corsi, Alessandra Emiliani, Marta Ribelli, Federica Mazzuca, Giulia Arrivi, Federica Zoratto, Mario Giovanni Chilelli, Marta Schirripa, Maria Grazia Morandi, Fiorenza Santamaria, Manuela Dettori, Antonella Cosimati, Rosa Saltarelli, Alessandro Minelli, Emanuela Lucci-Cordisco and Michele Basso Show full author list Hide full author list

Curr. Oncol. 2024, 31(12), 7793-7808; https://doi.org/10.3390/curroncol31120574 - 4 Dec 2024

Abstract

Background: There is ongoing discussion around the optimal course of treatment for metastatic colorectal cancer (mCRC) following the second line. Trifluridine/tipiracil (T) and regorafenib (R) have been the mainstay of therapy in this situation, as they both increased overall survival (OS) in comparison [...] Read more.

Background: There is ongoing discussion around the optimal course of treatment for metastatic colorectal cancer (mCRC) following the second line. Trifluridine/tipiracil (T) and regorafenib (R) have been the mainstay of therapy in this situation, as they both increased overall survival (OS) in comparison to a placebo. Despite the paucity of evidence, therapy rechallenge is also recognized as an option for practical use. In the third-line scenario of mCRC, we planned to investigate the survival outcomes using (T) and (R), both with and without prior rechallenge treatment. Materials and methods: Between 2012 and 2023, we examined the medical records of 1156 patients with refractory mCRC who were enrolled in the multicenter retrospective ReTrITA study. We then separated the patients into two cohorts based on the rechallenge therapy that was given before regorafenib and/or trifluridine/tipiracil at 17 Italian centres. Results: A total of 981 patients underwent T and/or R therapy, while 175 patients had therapy rechallenge before T and/or R. The median overall survival (mOS) for patients treated with T/R and R/T sequences in the rechallenge therapy cohort was 14.5 months and 17.6 months, respectively (p = 0.1955). A statistically significant survival benefit was observed in patients who received monotheraphy with R (mOS: 6 months) compared to the T group (mOS: 4.2 months) (p = 0.0332). In the same cohort, a median progression-free survival (mPFS) benefit was demonstrated in favour of the R/T group (11.3 months) vs. 9 months of the reverse sequence (p = 0.4004). In the no-rechallenge cohort, the mOS was statistically longer in the R/T sequence than in the T/R sequence (16.2 months vs. 12.3 months, respectively; p = 0.0014). In terms of the mPFS, we saw the same significant result for the adoption of R/T treatment (11.5 months vs. 8.4 months, respectively; p < 0.0001). The two monotherapy groups did not reveal any significant differences. Conclusions: This study suggests that rechallenge therapy may improve survival rates in the third-line treatment of mCRC, particularly if it is administered before sequential R/T treatment. This could allow for the extension of mCRC treatment choices until prospective studies are finished or randomised trials are performed. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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6 pages, 1282 KiB

Open AccessCase Report

Planned Abscopal Effect with Concurrent Pembrolizumab and Ablative Radiotherapy to Pulmonary Metastasis: A Case Report and Review of the Literature

by Yu-Ting Lee, Chien-Chin Chen, Hsiya Chao, Chih-Chia Chang and Cheng-Yen Lee

Curr. Oncol. 2024, 31(12), 7787-7792; https://doi.org/10.3390/curroncol31120573 - 4 Dec 2024

Abstract

Most abscopal effects are reported as sporadic and unpredictable events following radiotherapy at symptomatic sites. Herein, we report a case in which a planned abscopal effect was induced following deliberate radiotherapy and concurrent systemic immunotherapy. A 53-year-old man with a combined positive score [...] Read more.

Most abscopal effects are reported as sporadic and unpredictable events following radiotherapy at symptomatic sites. Herein, we report a case in which a planned abscopal effect was induced following deliberate radiotherapy and concurrent systemic immunotherapy. A 53-year-old man with a combined positive score ≥10 developed extensive metastatic bladder cancer after progressing on conventional chemotherapy. Extensive metastases were identified in his liver, lungs, and bones. He later had four cycles of single-agent pembrolizumab and planned hypofractionated radiotherapy at an ablative dose to selected metastatic lung tumors and developed complete remission of disease even when pembrolizumab was discontinued. This is a clear demonstration that the abscopal effect could be harnessed in a systematic manner with a combined positive score and aggressive local radiotherapy. Full article

(This article belongs to the Section Genitourinary Oncology)

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17 pages, 2567 KiB

Open AccessReview

Canadian Consensus Recommendations for Predictive Biomarker Testing in Gastric and Gastroesophageal Junction Adenocarcinoma

by Christine Brezden-Masley, Pierre O. Fiset, Carol C. Cheung, Thomas Arnason, Justin Bateman, Martin Borduas, Gertruda Evaristo, Diana N. Ionescu, Howard J. Lim, Brandon S. Sheffield, Sara V. Soldera and Catherine J. Streutker

Curr. Oncol. 2024, 31(12), 7770-7786; https://doi.org/10.3390/curroncol31120572 - 4 Dec 2024

Abstract

Gastric cancer is common globally and has a generally poor prognosis with a low 5-year survival rate. Targeted therapies and immunotherapies have improved the treatment landscape, providing more options for efficacious treatment. The use of these therapies requires predictive biomarker testing to identify [...] Read more.

Gastric cancer is common globally and has a generally poor prognosis with a low 5-year survival rate. Targeted therapies and immunotherapies have improved the treatment landscape, providing more options for efficacious treatment. The use of these therapies requires predictive biomarker testing to identify patients who can benefit from their use. New therapies on the horizon, such as CLDN18.2 monoclonal antibody therapy, require laboratories to implement new biomarker tests. A multidisciplinary pan-Canadian expert working group was convened to develop guidance for pathologists and oncologists on the implementation of CLDN18.2 IHC testing for gastric and gastroesophageal junction (G/GEJ) adenocarcinoma in Canada, as well as general recommendations to optimize predictive biomarker testing in G/GEJ adenocarcinoma. The expert working group recommendations highlight the importance of reflex testing for HER2, MMR and/or MSI, CLDN18, and PD-L1 in all patients at first diagnosis of G/GEJ adenocarcinoma. Testing for NTRK fusions may also be included in reflex testing or requested by the treating clinician when third-line therapy is being considered. The expert working group also made recommendations for pre-analytic, analytic, and post-analytic considerations for predictive biomarker testing in G/GEJ adenocarcinoma. Implementation of these recommendations will provide medical oncologists with accurate, timely biomarker results to use for treatment decision-making. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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5 pages, 519 KiB

Open AccessBrief Report

Brief Report: Trends in Incidence, Mortality, and Disability-Adjusted Life Years for Early-Onset Colorectal Cancer in Canada Between 1990 and 2019

by Igor Stukalin, Mehul Gupta, Katherine Buhler, Nauzer Forbes, Steven J. Heitman and Christopher Ma

Curr. Oncol. 2024, 31(12), 7765-7769; https://doi.org/10.3390/curroncol31120571 - 4 Dec 2024

Abstract

Background: Colorectal cancer is the third most common malignancy globally. Early-onset colorectal cancer (EOCRC) is becoming a growing healthcare focus globally, particularly in North America. We estimated trends in incidence, mortality, and disability-adjusted life years (DALYs) for EOCRC in Canada between 1990 and [...] Read more.

Background: Colorectal cancer is the third most common malignancy globally. Early-onset colorectal cancer (EOCRC) is becoming a growing healthcare focus globally, particularly in North America. We estimated trends in incidence, mortality, and disability-adjusted life years (DALYs) for EOCRC in Canada between 1990 and 2019. Methods: We used the Global Burden of Diseases Study to evaluate trends in incidence, mortality, and DALYs for EOCRC in Canada between 1990 and 2019. Rates were estimated per 100,000 persons at risk with associated uncertainty intervals (UIs). Annual percentage changes (APC) were estimated using joinpoint regression with 95% confidence intervals (CIs). Results: In 2019, the incidence, mortality, and DALYs rates for EOCRC were 10.89 (95% UI 8.09, 14.34), 2.24 (95% UI 2.00, 2.51), and 111.37 (95% UI 99.34, 124.78) per 100,000 individuals, respectively. Incidence increased during the study period by 1.12%/year (95% CI 1.03%, 1.22%; p < 0.001). The largest increase in incidence in EOCRC occurred between 1990 and 2007, with an APC of 2.23% (95% CI 2.09%, 2.37%; p < 0.001). Mortality (APC 2.95%, 95% CI 1.89%, 4.02%; p < 0.001) and DALY (APC 2.96%, 95% CI 1.84%, 4.09%; p < 0.001) rates increased for males between 2001 and 2006. Conclusions: Our study reveals a substantial burden in EOCRC in Canada, with a significant increase in incidence. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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11 pages, 399 KiB

Open AccessArticle

Vulnerability in Colorectal Cancer: Adjusted Gross Income and Geography as Factors in Determining Overall Survival in Colorectal Cancer: A Single-Center Study Across a Broad Income Inequality in an American Context

by Cataldo Doria, Patrick G. De Deyne and Papachristou Charalampos

Curr. Oncol. 2024, 31(12), 7754-7764; https://doi.org/10.3390/curroncol31120570 - 3 Dec 2024

Abstract

Introduction: Regional differences in socioeconomic status (SES) are well known, and we believe that the use of geocoding (zip code) can facilitate the introduction of targeted interventions for underserved populations. This is a single-center, retrospective analysis of data extracted from the cancer [...] Read more.

Introduction: Regional differences in socioeconomic status (SES) are well known, and we believe that the use of geocoding (zip code) can facilitate the introduction of targeted interventions for underserved populations. This is a single-center, retrospective analysis of data extracted from the cancer registry at the Capital Health Cancer Center in Pennington, N. The Capital Health Cancer Center in central New Jersey primarily serves two counties, catering to a diverse patient population from a wide range of socioeconomic backgrounds. Methods: We abstracted 1269 consecutive cases of colorectal cancer (CRC) diagnosed and treated between 2000 and 2019 from the Cancer Registry of the Capital Health Cancer Center (CHCC). Using the definition of SES based on previously published work, and zip codes (geocoding), we created four SES levels. We stratified our subjects according to their stage at diagnosis, age at diagnosis, race, and ethnicity. The primary outcome variable was overall survival (OS). Results: There was a statistically significant difference in OS based on SES, with the highest overall survival (OS) in the high-SES group (47 months) and the shortest OS in the low and mid-low-SES groups (40.4 and 30 months, respectively). Subjects living in high-SES areas were predominantly white (88.2%) and diagnosed at a later age (mean of 68.9 years of age) compared to individuals who lived in a low-SES area, who were predominantly non-white (72.6%) and diagnosed somewhat earlier in life (65.1 years of age). White people were diagnosed later in life (70.9 years of age) compared to non-white populations, including Black (66.5), Asian (61.7), and Hispanic (58.5) (p = 0.001) populations, but this did not lead to a significant difference in OS (p = 0.56). Stage at diagnosis was a significant predictor of OS, but was unrelated to SES (p = 0.066). A Cox proportional hazard ratio (HR) model showed that the risk of dying from colorectal cancer decreases with a higher socioeconomic status (SES). Those from mid-high-SES backgrounds had a 19% lower risk (HR 0.81), and those from high-SES areas had a 45% lower risk (HR 0.55) compared to individuals from low-SES areas. Conclusions: The vulnerability of patients with CRC in central New Jersey is a complex issue, influenced by many different variables. Our results indicate that SES is the most critical factor affecting OS after being diagnosed with CRC. Full article

(This article belongs to the Section Gastrointestinal Oncology)

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16 pages, 576 KiB

Open AccessGuidelines

Management of Ductal Carcinoma In Situ: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline

by Muriel Brackstone, Lisa Durocher-Allen, Nadia Califaretti, Andrea Eisen, Sarah Knowles, Abeer Salim, Taude Plexman and C. Anne Koch

Curr. Oncol. 2024, 31(12), 7738-7753; https://doi.org/10.3390/curroncol31120569 - 3 Dec 2024

Abstract

(1) Background: To make recommendations on the most effective therapy options for Ductal Carcinoma of the Breast (DCIS) patients; (2) Methods: MEDLINE, EMBASE, Cochrane Library, PROSPERO databases, and main relevant guideline websites were searched. Draft versions of the guideline went through formal internal [...] Read more.

(1) Background: To make recommendations on the most effective therapy options for Ductal Carcinoma of the Breast (DCIS) patients; (2) Methods: MEDLINE, EMBASE, Cochrane Library, PROSPERO databases, and main relevant guideline websites were searched. Draft versions of the guideline went through formal internal and external reviews, with a final approval by the Program in Evidence Based Care and the DCIS Expert Panel. The Grading of Recommendations, Assessment, Development, and Evaluation approach was followed; (3) Results: Based on the current evidence from the systematic review and this guideline authors’ clinical opinions, initial draft recommendations were developed to improve the management of patients with DCIS. After a comprehensive internal and external review process, ten recommendations and 27 qualifying statements were eventually made. This guideline includes recommendations for the primary treatment of DCIS with surgical treatment and/or radiation therapy and the management of DCIS after primary treatment for patients with DCIS, including DCIS with microinvasion (<1 mm through the duct); (4) Conclusions: The current guideline was created after a systematic review and a comprehensive internal and external review process. We believe this guideline provides valuable insights that will be useful in clinical decision making for health providers. Full article

27 pages, 557 KiB

Open AccessReview

Braf-Mutant Melanomas: Biology and Therapy

by Elvira Pelosi, Germana Castelli and Ugo Testa

Curr. Oncol. 2024, 31(12), 7711-7737; https://doi.org/10.3390/curroncol31120568 - 3 Dec 2024

Abstract

The incidence of melanoma, the most lethal form of skin cancer, has increased mainly due to ultraviolet exposure. The molecular characterization of melanomas has shown a high mutational burden led to the identification of some recurrent genetic alterations. BRAF gene is mutated in [...] Read more.

The incidence of melanoma, the most lethal form of skin cancer, has increased mainly due to ultraviolet exposure. The molecular characterization of melanomas has shown a high mutational burden led to the identification of some recurrent genetic alterations. BRAF gene is mutated in 40–50% of melanomas and its role in melanoma development is paramount. BRAF mutations confer constitutive activation of MAPK signalling. The large majority (about 90%) of BRAF mutations occur at amino acid 600; the majority are BRAF^V600E mutations and less frequently BRAF^{v600K, V600D} and ^V600M. The introduction of drugs that directly target BRAF-mutant protein (BRAF inhibitors) and of agents that stimulate immune response through targeting of immune check inhibitor consistently improved the survival of melanoma BRAF^V600-mutant patients with unresectable/metastatic disease. In parallel, studies in melanoma stage II-III patients with resectable disease have shown that adjuvant therapy with ICIs and/or targeted therapy improves PFS and RFS, but not OS compared to placebo; however, neoadjuvant therapy plus adjuvant therapy improved therapeutic response compared to adjuvant therapy alone. Full article

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14 pages, 549 KiB

Open AccessSystematic Review

Features of the Nurse-Patient Relationship: Insights from a Qualitative Review Using Artificial Intelligence Interpretation

by Elsa Vitale, Luana Conte, Roberto Lupo, Stefano Botti, Annarita Fanizzi, Raffaella Massafra and Giorgio De Nunzio

Curr. Oncol. 2024, 31(12), 7697-7710; https://doi.org/10.3390/curroncol31120567 - 2 Dec 2024

Abstract

Introduction: This qualitative literature review explored the intersection of art, creativity, and the nurse–patient relationship in the context of oncology nursing. It delved into the perceptions and reflections of nurses as captured by Generative Artificial Intelligence (GAI) analysis from two specialized nursing databases. [...] Read more.

Introduction: This qualitative literature review explored the intersection of art, creativity, and the nurse–patient relationship in the context of oncology nursing. It delved into the perceptions and reflections of nurses as captured by Generative Artificial Intelligence (GAI) analysis from two specialized nursing databases. Methods: The protocol was registered on the Open Science Framework (OSF) Platform. A comprehensive search was conducted in CINAHL, the British Nursing Database, and the Nursing & Allied Health Database, using keywords related to art, cancer, creativity, nursing, and relationships. The extracted qualitative research studies were then analyzed using GAI to identify key themes and insights. Results: The analysis revealed profound considerations regarding the role of nurses in oncology and palliative patient care. Nurses acknowledged the spiritual dimension through religious and spiritual practices, while emphasizing authentic presence and empathic communication. They actively addressed patient concerns, adapted to challenges, and engaged in continuous professional development. The insights from the GAI interpretation underscored the significance of empathy, creativity, and artistry in nurturing meaningful nurse–patient connections. Conclusions: The GAI-enabled exploration provided valuable insights into several dimensions of care, emphasizing the importance of spiritual sensitivity, empathic communication, and ongoing professional growth. As technology and human care converge, integrating artistry into the nurse–patient relationship could enhance patient experiences, improve outcomes, and enrich the oncology nursing practice. Full article

(This article belongs to the Special Issue Feature Reviews in Section "Oncology Nursing")

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11 pages, 1261 KiB

Open AccessArticle

The Impact of Cancer Status on Anxiety in Prostate Cancer Patients: A Network Analysis

by Christopher F. Sharpley, Kirstan A. Vessey, Vicki Bitsika, Wayne M. Arnold and David R. H. Christie

Curr. Oncol. 2024, 31(12), 7686-7696; https://doi.org/10.3390/curroncol31120566 - 1 Dec 2024

Abstract

Prostate cancer (PCa) patients often also suffer from comorbid anxiety, which can impede treatment efficacy as well as be intrinsically unpleasant. Identification of the associations between particular symptoms of anxiety that are most likely to occur at different points in the PCa diagnosis–treatment [...] Read more.

Prostate cancer (PCa) patients often also suffer from comorbid anxiety, which can impede treatment efficacy as well as be intrinsically unpleasant. Identification of the associations between particular symptoms of anxiety that are most likely to occur at different points in the PCa diagnosis–treatment journey can inform anxiety treatment choices and potentially influence their overall treatment outcomes. Although simple correlational analyses and ANOVA models of data analysis have been used to address this issue, the possibility of confounds due to the inter-relationships between other anxiety symptoms argues for the use of network analysis, which calculates each symptom–symptom connection while also taking into account the entire range of symptom relationships. Responses to the GAD-10 self-report scale for Generalised Anxiety Disorder were collected from 415 PCa patients who were grouped according to whether (1) their PCa was just diagnosed and undergoing initial treatment; (2) their cancer was in remission; or (3) their cancer was recurring after initial treatment. The results of the network analysis indicated several areas where clinically relevant differences were present between the three PCa groups, but caution was applied to the results of statistical tests due to unequal sample sizes. Individual GAD symptom–symptom association differences are discussed in terms of their implications for directed and individualised anxiety-management treatment models. Full article

(This article belongs to the Special Issue New and Emerging Trends in Prostate Cancer)

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