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Current Oncology
Special Issues
The Role of Real-World Evidence (RWE) in Thoracic Malignancies
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The Role of Real-World Evidence (RWE) in Thoracic Malignancies

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Thoracic Oncology".

Deadline for manuscript submissions: closed (31 August 2025) | Viewed by 6247

Special Issue Editors

Dr. Paul Wheatley-Price

E-Mail Website
Guest Editor
1. Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H8L6, Canada
2. Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
Interests: thoracic malignancies; carcinoma unknown primary; real world evidence; medical education; advocacy
Special Issues, Collections and Topics in MDPI journals
Dr. Sara Kuruvilla

E-Mail Website
Guest Editor
Verspeeten Family Cancer Center, London Health Sciences Center, London, ON N6A 5W9, Canada
Interests: clinical care; thoracic oncology; head and neck oncology; clinical Trials; evaluating factors that could impact survivorship in the treatment of thoracic and head/neck cancers; medical education; real world evidence generation

Special Issue Information

Dear Colleagues,

Real-world data (RWD) and real-world evidence (RWE) are increasingly important components of a broad research portfolio. RWE has the ability to see clinical care as it really is, complicated and messy, full of idiosyncrasies and oddities that are excluded from the purified world of prospective clinical trials. RWE is now accepted by regulatory bodies such as the FDA, NICE, EMA, and Health Canada, sometimes in a supportive role and sometimes as primary data. In lung cancer, the explosion of rare subtypes is a fertile opportunity for RWE research, but also, with lung cancer being so common, it is possible to generate RWE for large numbers of patients to answer different questions.

In this Special Issue of Current Oncology, we invite submissions of RWE projects with clinical data or papers on the methodology and challenges of RWE. We are interested in the future of RWE, which might involve AI, the increasing capacity of EMRs, or the novel field of synthetic data. By fostering a dialogue around RWE, we aspire to advance the field of thoracic oncology and improve patient care, ultimately leading to better outcomes for those affected by this disease.

We look forward to your submissions.

Dr. Paul Wheatley-Price
Dr. Sara Kuruvilla
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • real-world evidence (RWE)
  • real word data (RWD)
  • lung cancer
  • thoracic cancers (malignancies)
  • observational studies
  • health economic outcomes research (HEOR)
  • registry(ies)

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Published Papers (5 papers)

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Research

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9 pages, 828 KB  
Article
Myasthenia Gravis and Thymectomy at a Tertiary-Care Surgical Centre: A 20-Year Retrospective Review
by Olivia Lauk, Alexandre Sarmento De Oliveira, Caroline Huynh, Sohat Sharma, Arthur Vieira, Michelle Mezei, Kristine Chapman, Hannah Briemberg, Kristin Jack, John Yee and Anna L. McGuire
Curr. Oncol. 2025, 32(12), 662; https://doi.org/10.3390/curroncol32120662 - 27 Nov 2025
Viewed by 355
Abstract
Background: Myasthenia gravis (MG) is frequently associated with thymic abnormalities, including thymomas and hyperplasia. This study aims to analyze the clinical and pathological characteristics of thymectomized patients over a 20-year period, focusing on the relationship between thymoma subtype and MG incidence, as well [...] Read more.
Background: Myasthenia gravis (MG) is frequently associated with thymic abnormalities, including thymomas and hyperplasia. This study aims to analyze the clinical and pathological characteristics of thymectomized patients over a 20-year period, focusing on the relationship between thymoma subtype and MG incidence, as well as post-thymectomy remission outcomes. Methods: We retrospectively analyzed 420 patients who underwent thymectomy (open or VATS), with a mean age of 54.4 years and 59% female. Thymic pathology included thymomas (56.2%), thymic cysts (14.3%), and other lesions. 39.5% of patients had MG, of which 48.8% were thymomatous MG. Multivariate regression was used to identify predictors of MG and remission outcomes. Results: MG was significantly associated with younger age (p < 0.005), germinal hyperplasia (p < 0.001), and thymoma, especially WHO B2 subtype (p = 0.016). Six-month complete remission rates did not differ between thymomatous and non-thymomatous MG. In the subgroup undergoing VATS, median length of stay decreased to 3 days compared to 5 days in the overall cohort. The intraoperative complication rate for VATS was 1.5%, compared to 11.6% for open surgery. Conclusions: This is one of the largest single-center studies to evaluate the link between thymoma histology and MG. WHO type B2 thymoma and germinal hyperplasia were more commonly associated with MG. Comparable remission outcomes support the role of thymectomy in both thymomatous and non-thymomatous MG, emphasizing the need for individualized surgical strategies. Full article
(This article belongs to the Special Issue The Role of Real-World Evidence (RWE) in Thoracic Malignancies)
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12 pages, 536 KB  
Article
A Retrospective Analysis of Endovascular Stent Insertion for Malignant Superior Vena Cava Obstruction, Focusing on Anticoagulation Practices
by Joshua Walker, Amsajini Ravinthiranathan, Athanasios Diamantopoulos, Spyridon Gennatas and Alexandros Georgiou
Curr. Oncol. 2025, 32(11), 601; https://doi.org/10.3390/curroncol32110601 - 27 Oct 2025
Viewed by 850
Abstract
Background/Objectives: A knowledge gap persists regarding anticoagulation therapy after endovascular stent insertion for malignant superior vena cava obstruction (mSVCO). Guidelines are supported by retrospective studies with a radiological focus and lack specific drug recommendations. No studies to date have captured the multi-disciplinary nature [...] Read more.
Background/Objectives: A knowledge gap persists regarding anticoagulation therapy after endovascular stent insertion for malignant superior vena cava obstruction (mSVCO). Guidelines are supported by retrospective studies with a radiological focus and lack specific drug recommendations. No studies to date have captured the multi-disciplinary nature of decision-making over time. Methods: This single-center retrospective service evaluation includes patients with solid organ malignancy who received a stent for mSVCO between July 2016 and May 2022. Patient and treatment characteristics, clinical outcomes and prescribing decisions were collected from medical records and analyzed. Results: Of 49 patients (55% female, mean age 59), 73% had metastatic extra-thoracic disease at stent insertion. Technical success was achieved in 98% of cases and 92% survived to discharge. Forty-eight patients were followed until death. Median survival was 2.4 months. Post-procedure imaging (performed in 55% of patients) revealed 10 (21%) cases of systemic venous thromboembolism and 7 cases of stent thrombosis. Forty-four (91%) patients received anticoagulation therapy (62% therapeutic dose low molecular weight heparin). Those with thrombotic complications were fitter pre-procedurally than the rest of the cohort. There was one case of major bleeding. Twenty-two instances of therapy modification occurred following the initial plan, including nine changes due to a patient preference for oral therapy. Conclusion: Patients undergoing stenting for mSVCO demonstrate high thrombotic risk and a poor prognosis. Anticoagulation plans are frequently modified post discharge due to changing risk profiles and patient preferences. Multi-disciplinary collaboration is essential to support patient-centered and individualized management. Future research should investigate direct oral anticoagulants and anti-platelet therapy and develop risk assessment tools for this population. Full article
(This article belongs to the Special Issue The Role of Real-World Evidence (RWE) in Thoracic Malignancies)
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20 pages, 2340 KB  
Article
Characterization of the Population, Treatment Patterns, and Outcomes of Patients with Advanced or Metastatic Non-Small-Cell Lung Cancer (NSCLC) with Epidermal Growth Factor Receptor Mutation (EGFRm): A Retrospective Cohort Study from IPO Porto
by Ana Rodrigues, Marta Pina, Rita Calisto, Pedro Leite-Silva, Pedro Medeiros, Catarina Silva, Ana Sofia Silva, Patrícia Redondo, João Ramalho-Carvalho, Susana Ferreira Santos and Maria José Bento
Curr. Oncol. 2025, 32(8), 414; https://doi.org/10.3390/curroncol32080414 - 24 Jul 2025
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Abstract
Most patients with non-small-cell lung cancer (NSCLC) present with advanced/metastatic disease at diagnosis, and molecular profiling is critical in guiding treatment decisions. This retrospective cohort study aimed to characterize EGFR mutations (EGFRm) in advanced/metastatic NSCLC patients, treatment patterns, and real-world outcomes. Adults diagnosed [...] Read more.
Most patients with non-small-cell lung cancer (NSCLC) present with advanced/metastatic disease at diagnosis, and molecular profiling is critical in guiding treatment decisions. This retrospective cohort study aimed to characterize EGFR mutations (EGFRm) in advanced/metastatic NSCLC patients, treatment patterns, and real-world outcomes. Adults diagnosed between 2018 and 2021 and treated at a Comprehensive Care Center were included. Time-to-event outcomes were analyzed using the Kaplan–Meier method. A total of 110 patients were included, with a median age of 69.0 years (range, 37–93), 76.4% female, and 83.2% non-smokers. About 97.3% had adenocarcinomas, with 93.6% at stage IV, 40.9% with ≥ three metastatic sites (brain metastases in 24.5%), 33.6% ECOG 2–4, and 58.2% with an EGFR exon-19 deletion. A minority started supportive care or curative-intent treatment, and 81.8% underwent first-line palliative systemic therapy (TKIs, 91.1%; chemotherapy, 8.9%). Median real-world overall survival (rwOS) was 18.9 months (95% CI, 13.8–28.1). Worse rwOS was observed in patients with ECOG 2–4 versus ECOG 0–1 (10.3 vs. 22.8 months; HR 1.82, 95% CI 1.17–2.85; p = 0.008) and in patients with exon-21 L858R versus exon 19 deletions (15.8 vs. 24.2 months; HR 1.59, 95% CI 1.00–2.54; p = 0.048). In patients treated with palliative systemic treatment, median progression-free survival was 10.9 months (95% CI, 8.8–13.6). This study provides important insights regarding real-world characteristics, treatment patterns, and outcomes from a cohort of EGFRm advanced/metastatic NSCLC patients. Full article
(This article belongs to the Special Issue The Role of Real-World Evidence (RWE) in Thoracic Malignancies)
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14 pages, 1373 KB  
Article
Cost Disparities with Age in the Treatment of Advanced Non-Small-Cell Lung Cancer (NSCLC) in Ontario, Canada
by Ying Wang, Greg Pond, Amiram Jacob Gafni, Chung Yin Kong and Peter M. Ellis
Curr. Oncol. 2025, 32(6), 346; https://doi.org/10.3390/curroncol32060346 - 12 Jun 2025
Viewed by 920
Abstract
Previous studies have noted associations between age and healthcare costs in non-small-cell lung cancer (NSCLC). However, the drivers of cost disparities have not yet been fully examined. This retrospective cohort study included deceased patients diagnosed with stage IV NSCLC in Ontario from 1 [...] Read more.
Previous studies have noted associations between age and healthcare costs in non-small-cell lung cancer (NSCLC). However, the drivers of cost disparities have not yet been fully examined. This retrospective cohort study included deceased patients diagnosed with stage IV NSCLC in Ontario from 1 April 2008 to 30 March 2014. Variables of interest were extracted from the Institute for Clinical Evaluative Sciences. Average monthly cancer-attributable costs (CACs), defined as the net additional costs due to cancer, determined by subtracting pre-diagnosis costs from post-diagnosis costs, were calculated by phases of care (staging, initial, continuing, and end-of-life). Regression analyses assessed predictors of cost variability. The median age of the 14,655 patients was 65 to 69 years; 54% were male and 29% had received chemotherapy. On both univariate and multivariate analysis, CACs decreased with age after cancer diagnosis across all phases of care (p < 0.001). Receiving chemotherapy contributed to higher costs in staging, initial, and continuing phases (OR 2.11, 95% C.I. 1.90–2.33, p < 0.01), and lower costs in the end-of-life phase (OR 0.77, 95% C.I. 0.72–0.81, p < 0.01). Our study showed that older patients had higher baseline healthcare costs and lower cancer-attributable costs following diagnosis of advanced NSCLC. Cost drivers, including treatment and gender, varied by phase of care. Full article
(This article belongs to the Special Issue The Role of Real-World Evidence (RWE) in Thoracic Malignancies)
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Review

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11 pages, 226 KB  
Review
A Narrative Review of the Strengths and Limitations of Real-World Evidence in Comparison to Randomized Clinical Trials: What Are the Opportunities in Thoracic Oncology for Real-World Evidence to Shine?
by Peter M. Ellis, Larissa Long, Courtney H. Coschi and Arani Sathiyapalan
Curr. Oncol. 2025, 32(11), 629; https://doi.org/10.3390/curroncol32110629 - 10 Nov 2025
Viewed by 1156
Abstract
Randomized clinical trials are considered the gold standard for the evaluation of new interventions and therapies. The results from randomized clinical trials are highly influential in treatment decision-making and decisions about the implementation of new therapeutic options within the field of oncology. This [...] Read more.
Randomized clinical trials are considered the gold standard for the evaluation of new interventions and therapies. The results from randomized clinical trials are highly influential in treatment decision-making and decisions about the implementation of new therapeutic options within the field of oncology. This article describes a narrative review of the literature to further explore the strengths and limitations of real-world evidence in comparison to randomized clinical trials and provides a commentary on opportunities for real-world evidence in thoracic malignancies. However, randomized trials often exclude oncology patients with poorer functional status or comorbidities which are routinely considered for treatment in real-world practice. Real-world data may complement existing data from randomized clinical trials and play an important role in evaluating patterns and outcomes of care, informing everyday oncology practice. While real-world data is increasingly reported in the medical literature, strengths and limitations exist which can also limit their applicability. More work is needed to standardize methodologies for real-world studies. Full article
(This article belongs to the Special Issue The Role of Real-World Evidence (RWE) in Thoracic Malignancies)
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