Assessing novel analogues of nilutamide as a human androgen receptor antagonist: A detailed investigation of drug design using a bioisosteric methodology including ADMET profiling, molecular docking studies and molecular dynamics simulation

Cancer is a significant health and economic concern worldwide. Prostate cancer (PC) ranks as the fourth leading cause of global death and is the second most prevalent malignancy in males. Androgens are essential for the progress and growth of the prostate gland. PC is caused by androgens binding to receptors, which activates genes that promotes the development of PC. Nilutamide (NLM) is an antiandrogen medicine used in the treatment of PC. However, throughout treatment, it induces various toxicities and leads to resistance in patients. The objective of the work was to designed and evaluated safer NLM analogues using computational approaches with optimized pharmacokinetic profiles and less toxicity. Newer bioisosteres of the designed NLM analogues and their ADMET scores were calculated using the MolOpt and ADMETlab 3.0 tools, respectively. We conducted docking investigations of the designed ligands using AutoDock Vina software. The MolOpt web server produces 1575 bioisosteres of NLM using the scaffold transformation method. The 47 bioisosteres were selected based on pharmacokinetic profiles, drug likeness (DL) and drug score (DS) prediction scores and were determined to be optimum to excellent in comparison to NLM. The analogues NLM28, NLM31, NLM34, NLM38, NLM40, NLM44, NLM45, and NLM47 exhibited favorable interactions and docking scores with the protein (PDB ID: 2AM9). The molecular dynamics (MD) simulation results revealed that the NLM34 and NLM40 complexes were found stable during the 100 ns run. The findings indicate that the NLM analogues, particularly NLM34 and NLM40 have the potential to be used as promising antiandrogen agents for PC therapy.

Increasing Life Expectancy in Patients with Genitourinary Malignancies: Impact of Treatment Burden on Disease Management and Quality of Life

BACKGROUND AND OBJECTIVE

Treatment burden refers to the overall impact of medical treatments on a patient's well-being and daily life. Our objective is to evaluate the impact of treatment burden on quality of life (QoL) in patients with genitourinary (GU) malignancies, highlighting the importance of patient-reported outcomes (PROs) in clinical trials to inform treatment decisions and improve patient care.

METHODS

We conducted a narrative review of clinical trials focused on GU malignancy (prostate, bladder, and kidney) between January 2000 and June 2024, analyzing related PROs and findings regarding treatment burden.

KEY FINDINGS AND LIMITATIONS

Recent landmark clinical trials demonstrate significant improvements in overall survival across GU malignancies with novel therapies. However, the reporting of QoL outcomes in these trials is often inadequate, with many lacking comprehensive data or long-term impact. Current publications are increasingly evaluating treatment burden and its impact on patient well-being as a critical outcome, but most clinical trials to date have failed to assess treatment burden across key domains including financial, time and travel, and medication management.

CONCLUSIONS AND CLINICAL IMPLICATIONS

While advancements in treatment have extended longevity in patients with GU malignancies, the treatment burden associated with the receipt of novel agents and its implications for QoL remain inadequately uncharacterized.

Current biological, chemical and physical gene delivery approaches for producing induced pluripotent stem cells (iPSCs)

The discovery of induced pluripotent stem cells (iPSCs) has revolutionized the research platform for disease modeling, drug discovery, cell therapy and regenerative medicine. Due to the importance of iPSCs over the past decade, various studies have focused on finding a safe and efficient gene delivery system to introduce reprogramming factors (RFs) into somatic cells, particularly for clinical applications. However, generated iPSCs from any source must undergo genomic, epigenomic, and functional characterizations to ensure they are free of somatic memories and safe for clinical application. In this review, almost all the employed cargos for delivering RFs into somatic cells were investigated, focusing on biological, chemical, and physical approaches to promote reprogramming efficiency and reduce exogenous factors. Moreover, the advantages and disadvantages of each approach were highlighted and cutting-edge technologies in iPSCs technology were also discussed. This review aims to provide a comprehensive overview discussing how to improve the efficiency and quality of iPSCs production.

Clinical Frailty Scale versus Geriatric-8 in predicting quality of life among older adults receiving curative cancer treatment

INTRODUCTION

Frailty assessment is fundamental to geriatric oncology (GO), with GO guidelines endorsing Geriatric-8 (G8) as a frailty screening tool. Although the Clinical Frailty Scale (CFS) is widely used in geriatrics, no studies have examined its quality of life (QoL) utility in GO. We compare CFS and G8 in their ability to predict quality of life among older adults receiving curative cancer treatment.

PATIENTS AND METHODS

One hundred thirteen patients (age ≥ 65 years) were recruited from a 2000-bed university-affiliated tertiary hospital between August 2020 and May 2024. Patient demographics, CFS and G8 were collected. The EORTC QLQ-ELD14 and the EQ5D-VAS were measured at start of treatment, and monthly after for 3 months. Patients were stratified by CFS or G8 and compared with QoL at various time points controlled for age, gender, BMI, and G8.

RESULTS

Using CFS, frail subjects had poorer QoL in the EORTC QLQ-ELD14 subscales for mobility (p < 0.001), joint stiffness (p < 0.001), maintaining purpose (p = 0.03), and EQ5D-VAS (p = 0.003) at start of treatment; mobility (p = 0.004 and p = 0.009) and EQ5D-VAS (p = 0.03 and p = 0.009) scores at one and 2 months. QoL scores between groups were similar at 3 months. Using G8, only EQ5D-VAS was poorer for frail subjects at start of treatment (p = 0.02). CFS remained a significant indicator of poor QoL controlled for age, gender, BMI, and G8.

CONCLUSION

CFS is a significant and better indicator of poor QoL in older adults with cancer receiving curative treatment compared to G8. Further research should explore implementation of supportive care for specific QoL deficit detected by CFS.

TRIAL REGISTRATION

NCT04513977; Date 2020-08-14.

TFOX versus FOLFOX in first-line treatment of patients with advanced HER2-negative gastric or gastro-oesophageal junction adenocarcinoma (PRODIGE 51- FFCD-GASTFOX): an open-label, multicentre, randomised, phase 3 trial

BACKGROUND

Perioperative FLOT (fluorouracil, oxaliplatin, and docetaxel) triplet chemotherapy is the standard of care for localised and resectable gastric and gastro-oesophageal junction adenocarcinoma. We aimed to compare a modified FLOT regimen (also known as TFOX) with FOLFOX as first-line treatment for patients with HER2-negative advanced gastric and gastro-oesophageal junction adenocarcinoma.

METHODS

PRODIGE 51-FFCD-GASTFOX is an open-label, multicentre, randomised, phase 3 trial conducted at 96 medical centres in France. Eligible individuals were aged 18 years or older, had histologically confirmed, HER2-negative adenocarcinoma of the stomach or gastro-oesophageal junction that was locally advanced unresectable or metastatic and previously untreated, measurable disease per Response Evaluation Criteria in Solid Tumours, an Eastern Cooperative Oncology Group performance status of 0 or 1, and adequate organ function. Patients were randomly assigned (1:1), using the minimisation method, to receive FOLFOX (folinic acid 400 mg/m2, oxaliplatin 85 mg/m2, and 5-fluorouracil bolus 400 mg/m2 then 5-fluorouracil 2400 mg/m2 as a continuous 46 h infusion every 2 weeks) or TFOX (docetaxel 50 mg/m2, folinic acid 400 mg/m2, and oxaliplatin 85 mg/m2 then 5-fluorouracil 2400 mg/m2 as a continuous 46 h infusion every 2 weeks). Randomisation was stratified by centre, ECOG performance status, (neo)adjuvant chemotherapy or chemoradiotherapy, tumour stage, tumour location, and pathological histological subtype. The primary endpoint was progression-free survival (assessed in the intention-to-treat population), defined as time from randomisation to the first radiological or clinical progression (or both), or death due to any cause, whichever occurred first. Secondary endpoints included overall survival (defined as time from randomisation to death due to any cause) and objective response rate (defined as the proportion of patients with a best overall complete or partial response). Hazard ratio and 95% CIs were estimated using an unstratified Cox proportional hazards model. When the proportional hazards assumption was violated, the restricted mean survival time was used to estimate the treatment effect size. This study is registered with ClinicalTrials.gov, NCT03006432, and EudraCT, 2016-002331-16.

FINDINGS

Between Dec 19, 2016, and Dec 26, 2022, 507 patients were randomly assigned (254 to the TFOX group and 253 to the FOLFOX group [intention-to-treat population]). The median age was 64·2 years (IQR 56·7-70·8), and 399 (79%) participants were male and 108 (21%) were female. At median follow-up of 42·8 months (25·8-49·9), the median progression-free survival was 7·59 months (95% CI 7·06-7·95) in the TFOX group versus 5·98 months (5·65-6·97) in the FOLFOX group. The assumption of proportional hazards was violated (p=0·013); therefore, the 12-month restricted mean progression-free survival was calculated: 7·52 months (7·06-7·97) in the TFOX group versus 6·62 months (6·16-7·09) in the FOLFOX group (p=0·0072). The median overall survival was 15·08 months (13·70-16·72) in the TFOX group versus 12·65 months (10·94-14·00) in the FOLFOX group (proportional hazards assumption was confirmed; HR 0·82 [0·68-0·99]; p=0·048) and the objective response rate was 62·3% (56·0-68·3) versus 53·4% (47·0-59·8; p=0·045). The most common grade 3 and 4 treatment-emergent adverse events were diarrhoea (37 [15%] in the TFOX group vs 18 [7%] in the FOLFOX group), peripheral neuropathy (80 [32%] vs 49 [20%]), neutropenia (67 [27%] vs 44 [18%]), and fatigue (40 [16%] vs 20 [8%]). Serious treatment-related adverse events occurred in 66 (27%) participants in the TFOX group and 33 (13%) in the FOLFOX group. There were two (<1%) treatment-related deaths in the TFOX group (one due to septic shock and one due to gastrointestinal perforation) and one (<1%) in the FOLFOX group (due to septic shock).

INTERPRETATION

The modified FLOT/TFOX regimen significantly improved progression-free survival, overall survival, and objective response rate compared with FOLFOX in previously untreated patients with advanced HER2-negative gastric and gastro-oesophageal junction adenocarcinoma. The modified FLOT/TFOX regimen might represent a new first-line treatment option for patients eligible for this docetaxel triplet chemotherapy.

FUNDING

Fédération Francophone de Cancérologie Digestive.

Designing Clinical Trials for Patients With Rare Cancers: Connecting the Zebras

The field of rare cancer research is rapidly transforming, marked by significant progress in clinical trials and treatment strategies. Rare cancers, as defined by the National Cancer Institute, occur in fewer than 150 cases per million people each year, yet they collectively represent a significant portion of all cancer diagnoses. Because of their infrequency, these cancers pose distinct challenges for clinical trials, including limited patient populations, geographical dispersion, and a general lack of awareness of treatment options. Economic limitations further complicate drug development, making initiatives such as the Orphan Drug Act essential for incentivizing research. The advent of next-generation sequencing (NGS) and precision medicine has been instrumental in identifying actionable genetic alterations in parallel with an explosion in the development of genomically targeted therapies, immunotherapies, and antibody drug conjugates. Advances in clinical NGS, precision medicine, and tumor-agnostic therapies have become central to the progress in rare cancer research. The development and approval of tumor-agnostic drugs, such as BRAF, NTRK, and RET inhibitors, and immunotherapy for mismatch repair deficient/microsatellite instability-high status cancers highlight the potential of personalized treatments across diverse cancer types and across the age spectrum. Collaborative trials from cooperative groups including SWOG DART, ASCO TAPUR, NCI-MATCH, pediatric COG-match, DRUP, IMPRESS, and innovative registrational basket and platform trials (eg, VE-Basket, ROAR, LIBRETTO-001, ARROW), along with patient advocacy group-run trials like TRACK, are enhancing access to clinical trials. In addition, artificial intelligence has the potential to improve the trial matching process. An integrated approach, combining these innovations in collaboration with multiple stakeholders, is crucial for advancing rare cancer research, offering hope for better patient outcomes and quality of life.

Standard-Dose Versus High-Dose Cisplatin for Intermediate/Poor-Risk Extracranial Malignant Germ Cell Tumors: Re-Analysis of Pediatric Oncology Group 9049 and Children's Cancer Group 8882 Trial Using Updated MaGIC Risk Stratification

BACKGROUND

Cisplatin, etoposide, and bleomycin (PEb) have been the standard of care for patients with germ cell tumors (GCT). In the 1990s, an intergroup trial (POG9049/CCG8882) randomized patients with high-risk GCT, as defined by the 1990 criteria, to high-dose (HDPEb) versus standard-dose PEb. HDPEb resulted in improved event-free survival (EFS), but no difference in overall survival (OS), thus standard-dose PEb has remained the standard of care. Subsequently, the Malignant Germ Cell International Consortium (MaGIC) updated the risk stratification for pediatric and adolescent patients with GCT. Currently, patients are categorized as intermediate or poor risk if they are ≥11 years of age with Stage IV ovarian GCT, or testicular, mediastinal, or retroperitoneal GCT with intermediate or poor prognosis using the International Germ Cell Consensus Classification criteria.

METHODS

We re-analyzed data from the POG9049/CCG8882 trial using the updated MaGIC risk stratification to determine whether HDPEb improved outcomes over PEb in patients with intermediate/poor-risk GCTs.

RESULTS

Among 299 patients in the trial, 57 patients (48 males, nine females) met the inclusion criteria for this analysis. There were no statistically significant differences in 5-year EFS (0.72 vs. 0.70, p-value = 0.82) or OS (0.76 vs. 0.74, p-value = 0.91) among patients treated with HDPEb versus PEb, respectively. Also, of note patients with mediastinal primaries had significantly worse 5-year EFS (0.51 vs. 0.83, p-value = 0.0062) and OS (0.49 vs. 0.89, p-value = 0.0013) compared to other sites, with no difference in outcome between HDPEb and PEb.

CONCLUSIONS

Treatment with HDPEb did not improve outcomes for intermediate/poor-risk GCT patients compared to standard-dose PEb.

ERK activation by Rab2B in the early secretory pathway impacts the ERGIC-Golgi interface

The Golgi complex is a hub for several signal transduction networks that regulate Golgi morphology, membrane transport, and glycosylation. The Rab2 (A, B isoforms) protein participates in membrane trafficking to and from the Golgi and is also linked to signaling molecules. In that regard, Rab2A in breast cancer stem cells binds and blocks (p)ERK1/2 inactivation by MAP kinase phosphatase 3. However, the cellular role of Rab2B in ERK1/2 signaling activity at the endoplasmic reticulum-Golgi intermediate compartment (ERGIC/IC) and cis Golgi where Rab2B immunolocalizes and functions is unknown. To address this question, normal rat kidney (NRK) cells were transfected with Rab2B cDNA to mimic Rab2 overexpression as found in cancer cells. Rab2B overexpressing NRK cells had a significant increase in steady state activated ERK. Studies were then performed to identify the Rab2-ERK1/2 substrate(s) that locate and function in the early secretory pathway. To that end, GRASP65 was identified as a target of ERK1/2 phosphorylation. In Rab2B overexpressing NRK cells, GRASP65 co-distributed with GM130 on membranes of the ERGIC/IC that increased in size and number with the concomitant appearance of unlinked cis Golgi elements. Additionally, we observed GRASP65 labeled ERGIC/IC membranes that accumulated at 15°C and remained prominent after temperature shift to 37 °C to promote transport. However, addition of a MEK inhibitor reversed the transport block indicating that ERK1/2 phosphorylation of GRASP65 effected ERGIC/IC redistribution to the cis Golgi. Since several glycosyltransferases cycle between the Golgi and ERGIC/IC, a potential consequence of Golgi structural changes is modification of protein glycosylation. Indeed, we found changes in total and cell surface O-glycosylation in Rab2B overexpressing cells. These results suggest that phosphoGRASP65 plays an important role in the protein sorting and recycling process from the ERGIC/IC to cis Golgi: Dysregulation results in cis Golgi discontinuities and aberrant glycosylated proteins that are potentially pro-oncogenic.

Key Updates in Testicular Cancer: Optimizing Survivorship and Survival

Testicular cancer is a rare but highly curable malignancy, predominantly affecting young men. Advances in multimodal therapy, including cisplatin-based chemotherapy, radiotherapy, and surgical interventions, have resulted in excellent cancer-specific survival. However, with improved survival rates, long-term health consequences and survivorship issues have emerged as critical concerns. Testicular cancer survivors (TCSs) are at risk of adverse health outcomes, including endocrine dysfunction, cardiovascular disease, secondary malignancies, chemotherapy-induced neuropathy, and psychosocial challenges. Endocrine disturbances such as hypogonadism and infertility require careful monitoring, while cardiovascular risks necessitate long-term preventive strategies. Survivors also face an elevated risk of secondary malignancies, necessitating tailored follow-up. Recent advances in the de-escalation of therapy, particularly for stage II seminoma and metastatic germ cell tumors, aim to balance oncologic efficacy with minimizing toxicity. This review discusses the evolving landscape of testicular cancer survivorship, the impact of treatment-related complications, and contemporary management strategies, emphasizing a multidisciplinary approach to optimize long-term outcomes and quality of life.

A New Health Networking Infrastructure on Cancer Is Taking Shape in Europe: A Not-to-Miss Opportunity for the EU Regulatory System

At the inaugural EAA convention in Copenhagen (Europe’s Evolving HTA Regulation and Its Relevance for ‘Beating Cancer’, in May 2022), it was suggested that, in the future, the pillars necessary to fully address the problem of cancer should be communicated (i [...]

Clinical characteristics and treatment of patients with small cell prostate cancer: analysis of a real-world cohort from an oncology database

BACKGROUND

Small cell prostate cancer (SCPC) is a rare, aggressive disease with limited clinical data to guide treatment. In this retrospective study, we evaluated clinical, treatment, and outcomes data for patients with SCPC.

METHODS

Patients with SCPC were selected from CancerLinQ Discovery®, a United States-based de-identified clinical database derived from the electronic health records of over 60 medical oncology organizations. A diagnosis of SCPC was made based on a tumor histology code of small cell carcinoma. The primary outcome of this study was assessing first-line systemic therapy within 1 year of diagnosis of SCPC.

RESULTS

74 patients with SCPC who received systemic therapy between 2010-2023 were identified. The majority had documented metastatic disease (45 patients, 60.8%) and a low PSA (median 2.8 ng/dL) at SCPC diagnosis. Platinum chemotherapy plus etoposide was the most common systemic treatment (62, 83.8%) and carboplatin plus etoposide was the most common regimen (42, 56.8%) used in the first line. Median overall survival (OS) was 8.3 months for patients with metastatic SCPC. Patients treated with cisplatin plus etoposide had improved survival versus those receiving carboplatin plus etoposide (odds ratio 3.15, 95% CI 1.57-6.30; p = 0.001). 45.9% of patients with SCPC received second-line systemic therapies, which were highly varied.

CONCLUSIONS

This contemporary real-world data represent one of the largest descriptions of the treatment of SCPC. Clear consensus on the optimal systemic therapy for SCPC is lacking. While additional research is needed, real-world practice patterns can serve as a resource when considering a treatment approach for this rare disease.

Identification and Management of Medical Comorbidities in Patients With HR+/HER2- Metastatic Breast Cancer Treated With CDK4/6 Inhibitors: Literature Review and Recommendations From Experts in Spain Opinion

Approximately one-third of patients with breast cancer have comorbidities at the time of their diagnosis. Recommendations for managing metastatic breast cancer are usually based on the results of clinical trials, which often limit patients with comorbidities. However, comorbidities greatly influence the quality of life, patient survival rate and treatment choice, particularly in older patients. The objective of this review was to identify clinically relevant comorbidities in patients with metastatic breast cancer, analyze the clinical approach to the treatment of these comorbidities, and propose recommendations from experts. An expert panel of eight medical oncologists identified seven therapeutic areas associated with the most relevant comorbidities in metastatic breast cancer: cardiovascular, gastrointestinal, endocrine/metabolic, renal, geriatric, psychological, and pain related. A clinical specialist from each therapeutic area specific to the relevant comorbidities (n = 8) joined the panel of experts (n = 8) to provide guidance on the appropriate management of these comorbidities. The specific comorbidities analyzed were hypertension, atrial fibrillation, venous thromboembolism, obesity, diabetes mellitus, cancer cachexia, chronic kidney disease, age-related disorders, arthritis, and fibromyalgia. In most cases, patients with metastatic breast cancer and medical comorbidities are polymedicated and/or vulnerable to toxicity. The oncologists provided recommendations on initial assessment and monitoring, follow-up recommendations, and warning signs and symptoms for referral to corresponding specialists based on their experience. The panel of experts also explored clinical scenarios related to each comorbidity and recommended a preferred CDK4/6 inhibitor based on available evidence regarding drug-drug interactions and potential for toxicity.

Efficacy and Feasibility of Cabazitaxel for Very Elderly Patients of ≥ 80 Years of Age With Metastatic Castration-Resistant Prostate Cancer: A Real-World Multi-Intuitional Analysis

BACKGROUND

Cabazitaxel (CBZ) is a key drug used for metastatic castration-resistant prostate cancer (mCRPC). However, clinical trial data on CBZ in very elderly patients are still lacking. This study aimed to investigate the efficacy and feasibility of CBZ for mCRPC patients of ≥ 80 years of age.

METHODS

We retrospectively reviewed 484 patients with mCRPC who started CBZ treatment between September 2019 and March 2024. Therapeutic efficacy (PSA response, progression-free survival, overall survival, and safety profile) was compared between patients of < 80 years of age (< 80 group) and those of ≥ 80 years of age (≥ 80 group). In addition, risk factors associated with grade ≥ 3 neutropenia in the ≥ 80 group were investigated using a logistic regression model.

RESULTS

Seventy-three (15.1%) patients were included in the ≥ 80 group. Although more patients in the ≥ 80 group received a reduced dose relative to the < 80 group, there was no significant difference in therapeutic efficacy between the two groups. The incidence of grade ≥ 3 neutropenia was similar between two groups (< 80: 27.5% vs. ≥ 80: 31.5%). In the ≥ 80 group, BMI < 22 kg/m2 and neutrophil count ≤ 5000 cells/µL were significantly associated with grade ≥ 3 neutropenia, with odds ratios of 5.28 (p = 0.005) and 4.00 (p = 0.023), respectively.

CONCLUSION

In mCRPC patients of ≥ 80 years of age, CBZ showed similar safety and efficacy to younger patients. Our findings suggest that CBZ treatment with appropriate dose modification and prophylactic AE treatments may be still beneficial for elderly mCRPC patients in the current aging population.

Effects of high-intensity interval training on cardiometabolic biomarkers in patients with prostate cancer undergoing active surveillance: a randomized controlled trial

PURPOSE

To report the effects of a 12-week high-intensity interval training (HIIT) program on cardiometabolic biomarkers in patients with prostate cancer on active surveillance (AS) from the Exercise During Active Surveillance for Prostate Cancer (ERASE) Trial.

METHODS

Fifty-two men with prostate cancer on AS were randomized to either an exercise (HIIT; n = 26) or usual care (UC; n = 26) group. The HIIT intervention consisted of progressive, supervised, aerobic HIIT at an intensity of 85 to 95% VO2peak for 28 to 40 min per session performed three times/week for 12 weeks. Blood samples were collected at baseline and postintervention to analyze cardiometabolic biomarkers. Analysis of covariance was used to examine between-group mean differences.

RESULTS

Blood data were obtained from 49/52 (94%) participants at postintervention. Participants were aged 63.4 ± 7.1 years and 40% were obese. The HIIT group attended 96% of the planned exercise sessions. No significant between-group changes in weight were observed after the intervention. Compared to UC, HIIT significantly improved total cholesterol (-0.40 mmol/L; 95% confidence interval[CI], -0.70 to -0.10; p = 0.011), non-high-density lipoprotein-c (-0.35 mmol/L; 95% CI, -0.60 to -0.11; p = 0.006), insulin (-13.6 pmol/L; 95% CI, -25.3 to -1.8; p = 0.025), insulin-like growth factor (IGF)-1 (-15.0 ng/mL; 95% CI, -29.9 to -0.1; p = 0.048), and IGF binding protein (IGFBP)-3 (152.3 ng/mL; 95% CI, 12.6 to 292.1; p = 0.033). No significant differences were observed for fasting glucose, HbA1c, other lipid markers, IGFBP-1, adiponectin, and leptin.

CONCLUSIONS

The ERASE Trial showed that a 12-week aerobic HIIT program improved several cardiometabolic biomarkers in patients with prostate cancer on AS that may contribute to cardiovascular health benefits and potentially influence signaling pathways in the progression of prostate cancer. Further research is needed to confirm the effects of exercise on cardiometabolic markers in men with prostate cancer on AS and determine if these effects are associated with improved long-term clinical outcomes.

Optimal Treatment Strategies for Early-Stage Primary Mediastinal Germ Cell Tumors

BACKGROUND

Data on optimal therapy for patients with primary mediastinal germ cell tumors consist primarily of single-institution studies with small sample sizes. The objective of this study was to assess the association of survival outcomes with surgery vs nonoperative management for patients with early-stage primary mediastinal germ cell tumors.

METHODS

Overall survival of all patients with seminomas and nonseminomatous primary germ cell tumors in the mediastinum who received (1) chemotherapy, or (2) surgery with or without chemotherapy (hereafter referred to as the "surgery" group) for early-stage disease from 2004 to 2015 in the National Cancer Database was assessed by Kaplan-Meier analysis, propensity score-matched analysis, and multivariable Cox proportional hazards analysis.

RESULTS

For patients with seminomas, chemotherapy alone was used in 120 (80.5%) patients and surgery was used in 29 (19.5%) patients. There was no significant difference in 5-year survival between surgery and chemotherapy in unadjusted and propensity score-matched analysis. For patients with nonseminomatous tumors, chemotherapy alone was used in 91 (46.7%) patients and surgery was used in 104 (53.3%) patients. Surgery was associated with improved 5-year survival compared with chemotherapy in unadjusted, multivariable-adjusted, and propensity score-matched analysis.

CONCLUSIONS

In this national analysis, multimodality treatment involving surgery was associated with improved survival compared with chemotherapy alone for early-stage primary mediastinal nonseminomatous germ cell tumors. For seminomas of the mediastinum, chemotherapy was associated with similar long-term outcomes compared with multimodality treatment involving surgery.

Age-dependent differences in breast tumor microenvironment: challenges and opportunities for efficacy studies in preclinical models

Immunity suffers a function deficit during aging, and the incidence of cancer is increased in the elderly. However, most cancer models employ young mice, which are poorly representative of adult cancer patients. We have previously reported that Triple-Therapy (TT), involving antigen-presenting-cell activation by vinorelbine and generation of TCF1+-stem-cell-like T cells (scTs) by cyclophosphamide significantly improved anti-PD-1 efficacy in anti-PD1-resistant models like Triple-Negative Breast Cancer (TNBC) and Non-Hodgkin's Lymphoma (NHL), due to T-cell-mediated tumor killing. Here, we describe the effect of TT on TNBC growth and on tumor-microenvironment (TME) of young (6-8w, representative of human puberty) versus adult (12 m, representative of 40y-humans) mice. TT-efficacy was similar in young and adults, as CD8+ scTs were only marginally reduced in adults. However, single-cell analyses revealed major differences in the TME: adults had fewer CD4+ scTs, B-naïve and NK-cells, and more memory-B-cells. Cancer-associated-fibroblasts (CAF) with an Extracellular Matrix (ECM) deposition-signature (Matrix-CAFs) were more common in young mice, while pro-inflammatory stromal populations and myofibroblasts were more represented in adults. Matrix-CAFs in adult mice displayed decreased ECM-remodeling abilities, reduced collagen deposition, and a different pattern of interactions with the other cells of the TME. Taken together, our results suggest that age-dependent differences in the TME should be considered when designing preclinical studies.

Induction of SOX17 with stimulation of WNT, TGF-beta, and FGF signaling drives embryonal carcinomas into the yolk-sac tumor lineage resulting in increased cisplatin resistance

Relapsing germ cell tumor (GCT) patients often harbor components of the aggressive subtype yolk-sac tumor (YST), suggesting that YST formation is an escape mechanism under therapy. Nevertheless, the molecular mechanisms inducing YST development from its stem cell-like precursor embryonal carcinoma (EC) are largely unexplored. We demonstrated that the induction of the transcription factor SOX17 together with the stimulation of WNT, TGF-beta / Activin, and FGF signaling drives EC cells into the YST lineage. Single cell RNA sequencing revealed that this cell fate switch was accompanied by the upregulation of the typical YST factors AFP, ANKRD1, APOA1, CST1, FOXA2, GATA6, and GPC3 and microRNAs, while pluripotency-related genes NANOG, POU5F1, and SOX2 were downregulated. Chromatin immunoprecipitation followed by sequencing analysis revealed that SOX17 may act in concert with FOXA2 and GATA factors to initiate YST formation. Xenografting of the YST-like cells into nude mice led to the growth of mixed GCT with YST components, confirming that these cells are able to form a YST in vivo. Moreover, the expression of cisplatin resistance factors was induced in a subpopulation of YST-like cells, suggesting that the formation of a YST is accompanied by the acquisition of cisplatin resistance. Indeed, the YST-like cells presented as less sensitive to cisplatin than their parental cells. Our study deciphered the molecular mechanisms forcing EC to differentiate into the YST lineage, which is accompanied by the acquisition of cisplatin resistance, confirming that YST formation is an escape mechanism for GCT under therapy. Thus, GCT patients should be screened for YST elements under therapy to identify patients at risk of developing therapy resistance.

Evaluation of drug lag and drug loss in Japan: participation in global phase III oncology trials

BACKGROUND

Despite efforts to mitigate drug lag, discrepancies in drug approval timelines persist between Japan and the US, and increase in unapproved drugs has become a significant challenge. This study aimed to evaluate potential drug lag and drug loss by assessing Japan's participation in global phase III multinational/multiregional clinical trials (MRCTs) targeted cancers.

METHODS

Phase III MRCTs of anticancer drugs initiated between 2008 and 2022 were collected. Information of participant countries, study sponsor, study design, and cancer type were collected and analyzed by logistic regression analysis to identify factors affected Japan's participation.

RESULTS

Of 999 phase III MRCTs, Japan's participation every 5 years increased over 15 years (2008-2012: 34.3%, 2013-2017: 51.6%, 2018-2022: 60.2%), while Japan's non-participation numbers did not change (2008-2012: 157, 2013-2017: 167, 2018-2022: 165). In the multivariate logistic regression analysis, the absence of an operational base in Japan and minor cancers were negatively associated with Japan's participation in phase III MRCTs. Japan's participation was also associated with some cancer organs and drug modalities.

CONCLUSION

Potential future drug lag and increases of unapproved drugs were expected to increase. Since the inclusion of Japan in MRCTs results in shorter or no approval lag, Japan should promote to make circumstances where small overseas companies can include Japan in MRCTs.

Extra-anatomical urinary diversion for malignant ureteric obstruction: our clinical experience

INTRODUCTION AND OBJECTIVES

Ureteral stenosis and upper urinary tract obstruction present significant clinical challenges, especially in cases involving complex, long strictures. Traditional management options like ureteral stents and percutaneous nephrostomy tubes often result in complications and diminished quality of life. Extra-anatomical urinary diversion (EAUD) offers an alternative approach, particularly for oncologic patients requiring palliative care.

MATERIALS AND METHODS

From 2015 to 2019, eight patients with cancer-related ureteral strictures underwent EAUD. In all patients cancer-specific prognosis exceeded one year. The procedure was performed using a standard surgical technique.

RESULTS

The mean patient age was 62.5 years, ranging from 22 to 82 years. The mean follow-up duration was 62.8 months. Improvement in renal function was observed in some patients, while the early complication rate was 62.5%. Notable complications included infections and encrustation of the prosthesis. Two patients experienced multiple infections of the overlying skin and soft tissue necessitated the dislodgement of the prothesis after 38 and 101 months, respectively.

CONCLUSIONS

Extra-anatomical stent placement constitutes a somewhat effective and safe option in the context of complex ureteral obstruction management in oncologic patients. The lack of external devices and its longer duration without the need for substitution compared with conventional double J stents can theoretically assure a better quality of life. However, a careful patient selection is needed in order to maximize the patients' benefit.

Clinical significance of risk factor analysis in pancreatic cancer by using supervised model of machine learning

Introduction

Pancreatic cancer (PC) poses a significant global health challenge due to its aggressive nature, late-stage diagnosis, and high mortality despite advancements in treatment. Early detection remains crucial for timely intervention. This study aimed to identify clinically relevant predictors of pancreatic cancer using a supervised machine learning approach and to develop a risk stratification tool with diagnostic capabilities.

Methods

A matched case-control study was conducted retrospectively at the Tenth People's Hospital of Tongji University (2017-2023), involving 353 cases and 370 matched controls. Demographic and hematological data were extracted from medical records. Variables were pre-selected using cluster dendrograms and subsequently refined using logistic regression with backward elimination and Support Vector Machine (SVM) models. A final risk scoring model was developed based on the best-performing model and internally validated.

Results

Key predictors retained in the final logistic regression model included Hemoglobin A1c (HbA1c) (OR 1.28; 95% CI: 1.08-1.52), Alkaline Phosphatase (ALP) (OR 1.02; 95% CI: 1.01-1.03), CA19-9 (OR 1.01; 95% CI: 1.01-1.01), Carcinoembryonic Antigen (CEA) (OR 1.41; 95% CI: 1.20-1.66), and Body Mass Index (BMI) (OR 0.88; 95% CI: 0.81-0.97). The final model demonstrated excellent diagnostic performance (AUC = 0.969, p < 0.001), with high accuracy, sensitivity, and specificity. A nomogram was constructed to facilitate individualized PC risk assessment.

Conclusion

HbA1c, ALP, CA19-9, CEA, and BMI were independently associated with pancreatic cancer. The machine learning-derived risk scoring model demonstrated high predictive accuracy and may serve as a valuable clinical tool for early detection and screening of pancreatic cancer.

Should magnetic resonance imaging be considered in every patient before a bladder outflow obstruction procedure?

To the Editor Benign prostatic hyperplasia (BPH) is a highly prevalent histological condition in aging men that can commonly cause lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). BPH typically begins developing after the age of 40 and affects approximately 50-60% of men by age 60.....

Comparative efficacy of adjuvant chemotherapy and immunotherapy after radical surgery for upper tract urothelial carcinoma: A systematic review and meta-analysis

To evaluate the effects of adjuvant chemotherapy (AC) and adjuvant immunotherapy (AI) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). A systematic review and meta-analysis was conducted using studies identified from PubMed, Cochrane Library, Embase, CENTRAL, and ClinicalTrials.gov up to September 2024. We performed pair-wise and network meta-analyses to evaluate survival outcomes, focusing on overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), recurrence-free survival, and metastasis-free survival. A total of 43 studies involving 13,132 patients were included. Pair-wise meta-analysis showed that AC significantly improved OS (HR 0.74, 95% CI 0.63-0.86, P = 0.0001), CSS (HR 0.74, 95% CI 0.60-0.90, P < 0.00001), and DFS (HR 0.61, 95% CI 0.51-0.75, P < 0.00001). A pooled analysis of three RCTs with 384 UTUC patients showed that AI did not significantly improve DFS (HR 1.19, 95% CI 0.87-1.64, P = 0.28) or OS (HR 1.28, 95% CI 0.81-2.03). Network meta-analysis suggested that combining AC with AI could offer better DFS than AC alone, with AC outperforming AI. Ranking analysis indicated that MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) was the most effective for OS and CSS improvement, followed by GC (gemcitabine and cisplatin). AC improves the prognosis of UTUC patients, whereas the results with AI are less promising. AC shows better outcomes than AI after RNU. Preliminary evidence suggests that combining AC with AI may enhance DFS, but further research is needed to confirm its effectiveness.

Management of Testicular Cancer

Testicular cancer is the most common malignancy in males age 15-40 years and one of the most curable cancers, with a cumulative 10-year survival rate exceeding 90%. Management strategies depend on the histologic subtype, stage at diagnosis, sites of disease, tumor markers, and risk classification. Germ cell tumors, including seminomas and nonseminomas, constitute the majority of testicular cancers and require distinct therapeutic approaches. For localized disease, radical orchidectomy remains the cornerstone of treatment, followed by active surveillance, chemotherapy, or primary retroperitoneal lymph node dissection, depending on the histology and the risk of relapse. Seminomas are highly curable, with low-stage patients often managed through surveillance or postoperative single-agent carboplatin. By contrast, nonseminomas typically require adjuvant multiagent chemotherapy, such as bleomycin, etoposide, and cisplatin, particularly in higher-risk patients. For metastatic disease, chemotherapy remains the standard of care, achieving excellent cure rates even in patients with bulky tumors. Surgical resection of residual masses is especially critical in nonseminomatous germ cell tumors to remove viable cancer or teratoma components. The treatment of refractory or relapsed disease frequently involves second-line standard-dose or high-dose chemotherapy with autologous stem-cell transplantation, ideally performed in specialized high-volume centers. Before, during, and after treatment, multidisciplinary care is essential to addressing psychosocial challenges, optimizing fertility preservation, and enhancing quality of life. After curative treatments, long-term management involves regular follow-up to monitor for recurrence, late toxicities, and secondary malignancies, with survivorship programs playing a crucial role in meeting patients' ongoing needs. Advances in molecular diagnostics for early relapse detection and the introduction of targeted therapies continue to improve outcomes, particularly in resistant patients.

Association between proteinuria changes and colorectal cancer incidence: evidence from a nationwide cohort study

BACKGROUND

The presence of excess proteins in the urine, known as proteinuria, has been linked to various health conditions, including chronic kidney disease and cancer. Emerging evidence suggests an association between proteinuria and colorectal cancer, a leading global cause of cancer-related morbidity and mortality. However, the impact of changes in proteinuria status on colorectal cancer risk remains unclear. Understanding this relationship may identify proteinuria as a modifiable risk factor for colorectal cancer prevention.

METHODS

This retrospective cohort study analyzed data from 3,043,138 adults aged over 19 years who participated in biennial health screenings by the South Korean National Health Insurance Service in 2010 and 2012. Participants were classified into four groups based on changes in proteinuria status: no proteinuria, newly developed proteinuria, recovered proteinuria, and persistent proteinuria. Proteinuria was measured using dipstick urinalysis, and colorectal cancer diagnoses were identified using medical records. Cox proportional hazards models adjusted for age, sex, body mass index, lifestyle behaviors, and other confounders were used to estimate cancer risk.

RESULTS

Over a median follow-up period of 9.19 years, 36,846 participants (1.2%) developed colorectal cancer. After adjusting for multiple confounding factors, including age, sex, lifestyle behaviors, medication use, diabetes, hypertension, dyslipidemia, and chronic kidney disease, the persistent proteinuria group demonstrated a significantly higher risk of colorectal cancer compared with the proteinuria-free group (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.13-1.42). Additionally, greater severity of proteinuria was associated with progressively increased colorectal cancer risk (aHR for overt proteinuria [+ 2 to + 4], 1.17; 95% CI, 1.05-1.29).

CONCLUSIONS

Changes in proteinuria status are significantly associated with colorectal cancer risk. Persistent proteinuria poses the highest risk, while transient proteinuria also elevates risk compared to individuals without proteinuria. Regular monitoring and management of proteinuria could potentially be beneficial in identifying individuals at higher colorectal cancer risk, suggesting its possible role as an indicator for targeted prevention strategies. However, further research, including randomized controlled trials, is necessary to confirm any causal relationship.

Facilitators of, and barriers to, prostate cancer screening uptake: A descriptive phenomenological study of adult men in Namibia

BACKGROUND

Prostate cancer poses a significant health risk for aging men, with a higher prevalence observed in individuals aged 40 and above. The objectives of this study were to describe the facilitators of, and barriers to, prostate cancer screening among men between the ages of 50 and 70.

METHODS

The study employed a qualitative descriptive phenomenological design. Data were collected at the oncology and urology departments of an intermediate hospital in Oshana region, Namibia using a semi-structured interview guide. Individual, face-to-face interviews were held between September and October 2022, after which the data gathered were analyzed thematically following Colaizzi's 7-step method.

RESULTS

Fifteen (15) participants took part in this study. The two major themes that were generated were: (1) Value of early detection, which described the participants' perceptions regarding the facilitators of prostate cancer screening; and (2) Potential threats to PCa screening, which described the participants' perceptions regarding the barriers to taking up cancer screening.

CONCLUSIONS

The study revealed modifiable barriers to PCa screening, including fear of stigmatization, lack of knowledge, and insufficient screening access, as well as facilitators that can be strengthened for successful prostate cancer screening, such as advanced age, history of prostate cancer, and social support. These findings emphasize the need to implement gender-specific campaigns that address masculinity, lack of knowledge, and cultural stigmatization.

Outcomes of Patients With International Germ Cell Cancer Collaborative Group Good Prognosis Metastatic Seminoma Undergoing De-Escalation Chemotherapy: A Single-Center Retrospective Study

OBJECTIVE

To compare the survival outcomes of de-escalation chemotherapy with those of standard first-line chemotherapy in patients with International Germ Cell Cancer Collaborative Group (IGCCCG) good prognosis metastatic seminoma.

METHODS

The cohort of this retrospective, observational, single-center study comprised 35 patients with clinical Stage I (CSI)-relapsed or de novo IGCCCG good prognosis metastatic seminoma who had undergone induction chemotherapy at our institution between 2007 and 2021. Patients were allocated to standard or de-escalation therapy groups according to average relative dose intensity (ARDI) of induction chemotherapy: ARDI ≥ 90 and ARDI < 90. Overall and recurrence-free survival were compared between these groups using Kaplan-Meier curves and the log-rank test.

RESULTS

The de-escalation therapy regimen included three cycles of etoposide and cisplatin (66.7%). Overall and relapse-free survival of patients undergoing de-escalation therapy and that of patients undergoing standard therapy were comparable. In addition, rates of adverse events, including hearing impairment and peripheral neuropathy induced by cisplatin-containing chemotherapy, were slightly, but not significantly, lower in the de-escalation therapy group than in the standard therapy group.

CONCLUSIONS

Our findings provide a preliminary experimental basis for the development of de-escalation therapy for IGCCCG good prognosis metastatic seminoma. If sufficient tumor regression is achieved, de-escalation therapy incorporating three cycles of etoposide/cisplatin therapy could be considered acceptable for patients with relatively low metastatic tumor burdens, such as those with Stage II CSI-relapsed seminoma. Further studies to validate the efficacy of de-escalation therapy are warranted.

Predicting medical prognosis in patients with glioblastoma during inpatient rehabilitation using bed mobility function

BACKGROUND

Determining appropriate suitability and goals for inpatient rehabilitation of patients with glioblastoma, isocitrate dehydrogenase-wildtype (GBM) requires real-time prognostic information. Functional measures, such as bed mobility, are standardized scores that can be assessed by members of the care team at the bedside and may aid medical prognostication.

OBJECTIVE

To analyze the association between bed mobility function during inpatient rehabilitation and 6-month survival post rehabilitation in people with GBM.

DESIGN

Retrospective cohort study.

SETTING

Academic inpatient rehabilitation facility (IRF).

PATIENTS

One hundred seventy patients with GBM admitted to an IRF over 4.5 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Survival 6 months post rehabilitation, regardless of disease progression or events.

RESULTS

Univariate analyses showed admission (odds ratio [OR] = 1.63, 95% confidence interval [CI] 1.23-2.20; p < .001), discharge (OR = 1.72, 95% CI 1.39-2.16; p <. 001) and gain in bed mobility (OR = 1.64, 95%CI 1.26-2.20; p < .001) were associated with survival. In multivariate analyses adjusting for demographic and clinic variables, admission (OR = 1.91, 95% CI 1.39-2.69; p < .001), discharge (OR = 1.72, 1.38-2.19; p < .001), and gain in bed mobility (OR = 1.62, 95% CI 1.20-2.22; p = .002) were each independently associated with survival. Bed mobility was also independently associated with survival compared to other standard functional independence measures collected in IRF at discharge (OR = 1.88, 95% CI 1.14-3.23; p = .017) and for gain (OR = 1.65, 95% CI 1.10-2.53; p = .018). There was a significant difference in survival between patients with admission bed mobility scores of ≤1 or ≥2 (HR = 3.68, p < .001), discharge scores of ≤1 or ≥2 (HR = 5.72, p<. 001), or a gain of ≤0 or ≥1 (HR = 3.13, p < .001).

CONCLUSIONS

Bed mobility function may serve as a predictor of survival in GBM, suggesting that it could be used during inpatient rehabilitation to help determine functional goals for patients with GBM.

Exploring therapeutic and diagnostic potential of cysteine cathepsin as targets for cancer therapy with nanomedicine

Cysteine cathepsins have been discovered to be substantially expressed in multiple types of cancer. They play a key role in the progression and growth of these cancers, rendering them appealing targets for nanoscale delivery and noninvasive diagnostic imaging. This review explores cathepsins from the papain-like enzyme family (C1) within the cysteine peptidase clan (CA), emphasizing the role of cathepsin-responsive nanoparticles in tumor growth. Furthermore, it also explores how nanotechnology can harness cathepsin activity to enable targeted drug delivery, improve tumor imaging, and reduce systemic toxicity. By examining the molecular mechanisms governing cathepsin function and evaluating different nanocarrier systems, this work aims to enhance our understanding of targeted cancer treatment. Despite significant advances, challenges remain in translating these nanomedicine platforms into clinical use, including improving delivery efficiency, biocompatibility, long-term safety, and addressing issues such as interspecies protease variability and scalable nanomanufacturing. Future advancement, integrating advanced biomaterials, patient-derived organoid models, bispecific immune-protease targeting, CRISPR-based cathepsin editing, and artificial intelligence-driven pharmacokinetic modeling and analysis will be critical to fully realizing the clinical potential of cathepsin targeted nanomedicines. These innovations hold promises for advancing precision oncology by overcoming current limitations and improving patient outcomes.

Local Therapy Can Enhance the Prognosis of Certain Patients with Pathologically Diagnosed Neuroendocrine Prostate Carcinoma

Neuroendocrine prostate cancer (NEPC) has a poor prognosis. We performed a retrospective analysis of the factors contributing to survival in patients with histologically diagnosed NEPC. Patients pathologically diagnosed with NEPC between 2007 and 2018 were retrospectively analyzed. Overall survival (OS) from the time of the initial prostate cancer diagnosis was evaluated using the Kaplan-Meier method. Cox proportional hazards analyses were performed to evaluate the association of OS with variables including the presence of metastasis, receipt of local therapy, and disease classification (primary NEPC [p-NEPC] or treatment-related NEPC [t-NEPC]). Among 32 patients (p-NEPC, 22; t-NEPC, 10), distant metastases were identified in 25 (78%) patients, and local therapies including radical prostatectomy and local radiotherapy were provided to 21 (66%) patients. In the univariate Cox proportional hazard analyses, patients who received local therapy had a significantly lower risk of death than those who did not receive local therapy (hazard ratio = 0.284, 95% confidence interval = 0.109-0.738, p = 0.01). OS was significantly longer for patients receiving local therapy than for those who did not receive local therapy (36 months vs. 13 months, p = 0.0058). Our findings suggest the potential benefit of local therapy in the treatment of NEPC.

Accumulation of Small-Size, Highly Dispersive Mesoporous Silica Nanoparticles in a Tumor in Both Chorioallantoic Membrane and Mouse Models

(1) Background: The chorioallantoic membrane (CAM) model has the potential to contribute to the development of personalized medicine based on individual cancer patients. We previously established the CAM model using patient-derived CIC-DUX4 sarcoma cells. We also used the CAM model for characterization and a comparison with the mouse model by examining the tumor accumulation of small-size, highly dispersive mesoporous silica nanoparticles (MSNs). (2) Method: In this study, we transplanted a variety of cancer cell lines, including patient-derived osteosarcoma (OS) and extraskeletal osteosarcoma (ESOS) cells. Patient-derived OS, ESOS and other cell lines were transplanted onto CAMs. The proliferation of cancer cells within CAM tumors was confirmed using H&E staining. For the comparison of the CAM and mouse models, rhodamine B-labeled MSNs were administered intravenously to CAMs and to xenograft mice. Tumor accumulation was evaluated by examining fluorescence and by confocal microscopy. The biodistribution of MSNs was examined by measuring the Si content by ICP. (3) Results: H&E staining demonstrated the proliferation of cancer cells of OS, ESOS and others on CAMs. While growth patterns and morphologies varied among different cancer types, H&E staining confirmed the establishment of tumors. As for the tumor accumulation, both the CAM and mouse models showed that MSNs were selectively accumulated in the tumors in both the CAM and mouse models. (4) Conclusions: We have expanded the range of CAM models by using a variety of cancer cells, including patient-derived cell lines. We also report that the small-size, highly dispersive MSNs exhibit excellent tumor accumulation in both the CAM and mouse models. These results point to the usefulness of the CAM model for patient-derived cancer cells as well as for evaluating drug carriers for tumor targeting.

Proposal for a New Classification of Rare Cancers Adopting Updated Histological Tumor Types

Several classifications have been proposed to define rare cancers; however, the pathophysiological understanding of tumors evolves rapidly. We propose a New Classification of Rare Cancer (NCRC) using the updated International Classification of Diseases for Oncology 3.2 coding system and World Health Organization Classification of Tumors 5th edition. We applied patient data recorded in the National Cancer Registry of Japan to the new classification, setting a cut-off of a crude incidence rate of 6 cases/100 000/year to define rare cancers, and developed a list of rare cancers in Japan from 2016 to 2019. The NCRC system identified various rare cancers, comprising 20.0% of all cancer diagnoses in this period. To examine this classification system's performance, we compared rare/non-rare labeling of cancers by the Surveillance of Rare Cancers in Europe (RARECARENet) project and NCRC system. Compared with cases using the RARECARENet classification in Europe, 69 351 cases/year (6.8%) switched status with our classification, with 45 293 and 232 109 cases (4 years) switching from rare and non-rare, respectively. Major differences included diffuse large B-cell lymphomas, some thyroid cancers, oral cavity and lip cancers, and squamous cell carcinoma of the uterine cervix. As the NCRC includes newly classified tumor entities, it warrants validation using other diverse cohorts.

Progress of antibody-drug conjugates in the treatment of locally advanced or metastatic urothelial carcinoma: opportunities and challenges

PURPOSE OF REVIEW

The objective of this review is to provide an overview of the clinical progress, administration methods, efficacy, safety, and treatment-related adverse events associated with antibody-drug conjugates.

RECENT FINDINGS

Locally advanced or metastatic urothelial carcinoma is an aggressive and lethal malignancy. Cisplatin-based chemotherapy has been the first-line therapy for most patients over the past two decades. However, approximately 50% of patients with locally advanced or metastatic urothelial carcinoma are ineligible for cisplatin-based chemotherapy due to inadequate renal function, poor performance status, or complications. Furthermore, patients who exhibit suboptimal responses or disease progression following platinum-based chemotherapy face therapeutic uncertainty regarding the selection of alternative agents. The emergence of antibody-drug conjugates has provided new options for patients afflicted with this disease, particularly enfortumab vedotin combined with pembrolizumab as a new first-line therapy for advanced urothelial carcinoma or for patients ineligible for platinum-based therapy. Additionally, in the TROPICS-04 trial, sacituzumab govitecan failed to demonstrate significant improvement in overall survival or progression-free survival compared with the physician's choice of treatment for patients with advanced urothelial carcinoma progressing after platinum-based chemotherapy and PD-(L)1 inhibitor therapy; the FDA withdrew its approval for this indication. ADCs are also being considered for the treatment of muscle-invasive bladder cancer, with ongoing clinical trials.

Landscape of ultra-rare sarcomas: a nationwide study for epidemiology and prognosis

BACKGROUND

The concept of 'ultra-rare sarcoma' was established to raise awareness of the clinical challenges resulting from its rarity. Given the novelty of this classification and the consequent paucity of data, this study aimed to investigate the epidemiology and prognosis of ultra-rare sarcomas.

DESIGN

We analyzed data from the Bone and Soft Tissue Tumor Registry in Japan from 2001 to 2019, comparing ultra-rare and non-ultra-rare sarcomas. To assess the prognostic impact of ultra-rare sarcomas, we used Kaplan-Meier survival analysis with propensity score matching, multivariate analysis, and a machine learning technique known as random survival forest.

RESULTS

Among the 22 821 patients analyzed, ultra-rare sarcomas accounted for 18.9% of the cases. Ultra-rare bone sarcomas were older than non-ultra-rare bone sarcomas (mean age: 57.6 versus 39.2 years, P < 0.001), while ultra-rare soft tissue sarcomas appeared in younger patients (mean age: 49.4 versus 62.2 years, P < 0.001). For patients >80 years old with bone sarcomas and those <20 years old with soft tissue sarcomas, ultra-rare sarcomas constituted approximately half of the cases. Survival analysis indicated that ultra-rare bone sarcomas were associated with longer survival (P = 0.022), whereas ultra-rare soft tissue sarcomas showed no significant difference in overall survival (P = 0.052). When stratified by age, however, patients <40 years old with ultra-rare soft tissue sarcomas had shorter survival (P < 0.001). Multivariate analysis indicated hazard ratios of 0.73 for ultra-rare bone and 1.25 for ultra-rare soft tissue sarcomas. Random survival forest showed that the importance of ultra-rare sarcomas was relatively low compared with other parameters.

CONCLUSION

Ultra-rare sarcomas are more common among older bone sarcoma patients and younger soft tissue sarcoma patients. Young patients with ultra-rare soft tissue sarcomas have a significantly worse prognosis. Overall, while ultra-rare sarcomas have a generally minor impact on prognosis, their effects are more pronounced in specific age groups.

Effect of chemotherapy on cancer specific mortality in female locally advanced urethral cancer

OBJECTIVE

To quantify the effect of chemotherapy (CHT) in locally advanced female primary urethral cancer (fPUC).

METHODS

In the Surveillance, Epidemiology and Ends Results (SEER) database (2000-2021), we identified 295 fPUC patients with locally advanced stage treated with local therapy (surgery or radiation or both) with or without CHT. Multivariable Cox regression models addressed cancer specific mortality free survival (CSM). Sample power analyses were computed.

RESULTS

Of 295 fPUC patients, 141 (48%) underwent CHT. CHT rates increased from 40 to 61% (Δ22%) over the study span (2000-2021). Five-year CSM rates of CHT exposed vs. CHT-naïve patients were 58 vs. 43% (Δ15%). In multivariable Cox regression models (age and histology adjusted) CHT independently predicted lower CSM (HR = 0.67, p = 0.027). In squamous cell carcinoma (SCC) subgroup, CHT also independently predicted lower CSM (HR = 0.64, p = 0.01). In urothelial carcinoma (HR = 0.63, p = 0.2) and adenocarcinoma (HR = 0.7, p = 0.7) independent predictor status could not be demonstrated. Small sample sizes in urothelial carcinoma subgroup (UC) and adenocarcinoma subgroup (ADK) undermined the power of the analyses to as low as 48% in UC and 46% in ADK, respectively, versus ideal 80% power.

CONCLUSION

In fPUC patients, CHT independently predicts lower CSM. This effect is generalizable to SCC patients. The same relationship between CHT status and CSM is also operational in UC and ADK subgroups, but limited power undermined confirmation of its' statistical significance.

Influence of best objective response to first-line treatment on survival outcomes in advanced urothelial carcinoma in the era of sequential therapy with enfortumab vedotin

OBJECTIVE

This study evaluated whether first-line treatment affects survival outcomes in patients with advanced urothelial carcinoma undergoing sequential therapy with chemotherapy, immune checkpoint inhibitors, and enfortumab vedotin.

METHODS

This multicenter retrospective study included 57 patients treated at Hiroshima University Hospital and its affiliated institutions between 2009 and 2024. Patients received chemotherapy as a first-line treatment (gemcitabine plus cisplatin or carboplatin), followed by second-line immune checkpoint inhibitors (pembrolizumab or avelumab) and third-line enfortumab vedotin. Assessed outcomes included overall survival and time to treatment failure. Cox regression analysis identified prognostic factors for overall survival.

RESULTS

Over a median follow-up of 20.5 months, median overall survival was not reached after first-line treatment. Gemcitabine with cisplatin was selected in 31.6% of cases, while gemcitabine and carboplatin was chosen in 68.4% of cases as the first-line treatment; subsequently, 66.7% received pembrolizumab, and 33.3% received avelumab in the second-line treatment. Patients who achieved a complete or partial response with the first-line treatment had significantly longer overall survivals from both first-line and enfortumab vedotin initiation than those with stable or progressive disease. In cases that achieved complete or partial responses, avelumab was more frequently selected as a second-line therapy. However, in the first-line treatment, multivariate analysis identified only stable or progressive disease as a significant predictor of worse overall survival.

CONCLUSION

The best response to first-line treatment predicted both overall survival from first-line initiation and outcomes following enfortumab vedotin treatment, underscoring its prognostic value in sequential therapy for patients with advanced urothelial carcinoma.

Multicenter analysis of high-dose chemotherapy regimens for the treatment of patients with refractory or recurrent germ cell tumors

BACKGROUND

High-dose chemotherapy (HDCT) is an established salvage treatment for recurrent germ cell tumors (GCTs). Comparative analyses of contemporary carboplatin-based HDCT regimens are limited. This study provides a multicenter analysis of commonly used regimens.

PATIENTS AND METHODS

Data from four referral centers included patients treated with HDCT for recurrent GCTs between January 2010 and January 2024. Fisher's exact test and the Wilcoxon rank sum test were used for statistical analyses. Kaplan-Meier and log-rank tests assessed relapse-free survival (RFS) and overall survival (OS).

RESULTS

Among 111 patients (median age 28.5 years), 76.6% had non-seminomatous GCT, and 43.2% had poor-risk disease per the International Germ Cell Cancer Collaborative Group (IGCCCG) classification. HDCT regimens included CE (50 patients; carboplatin and etoposide for two cycles) and TICE (32 patients; paclitaxel and ifosfamide, followed by carboplatin and etoposide for three cycles). HDCT was second-line in 26.1% and third-line or beyond in 73.9%. After 55.5 months' follow-up, no significant difference in RFS was observed [10.2 versus 5.9 months; hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.54-1.51, P = 0.706]. TICE showed a trend toward longer OS (57.2 versus 19.8 months; HR 0.67, 95% CI 0.37-1.2, P = 0.18) and significantly improved OS in IGCCCG intermediate-/poor-risk patients (57.2 versus 14.0 months; HR 0.44, 95% CI 0.2-0.99, P = 0.047).

CONCLUSIONS

No significant difference in RFS or OS was observed between CE and TICE overall. However, TICE may offer more benefit to patients with higher-risk disease. Prospective studies are needed to validate these findings.

Current Evidence on Cabazitaxel for Prostate Cancer Therapy: A Narrative Review

The incidence of prostate cancer (PC) has recently increased in Japan. Androgen deprivation therapy (ADT) has been a key treatment in patients with castration-sensitive PC (CSPC); however, resistance typically emerges through multiple mechanisms, leading to metastatic castration-resistant PC (mCRPC). Taxane-based therapy (i.e., docetaxel, cabazitaxel) has been standard care in patients with mCRPC. New evidence supporting the addition of androgen receptor signaling inhibitors (ARSIs, e.g., enzalutamide, abiraterone) to docetaxel and ADT for patients with metastatic CSPC (mCSPC) raises questions about the role of taxane-based therapies and their optimal sequencing, as well as how to identify patients who may benefit from taxane-based therapy. Here we review the evidence on taxane-based therapy, including cabazitaxel, in the treatment of PC, with a focus on clinical and real-world evidence from Japan. Cabazitaxel has proven effective for patients with mCRPC who have a history of ARSI and docetaxel use, and it is preferable to a second alternative ARSI, as indicated in the CARD study. The safety profile of cabazitaxel (particularly, the incidence of neutropenia) can be managed through prophylactic use of granulocyte colony-stimulating factor, as well as a lower dosage and possibly variation of the dosage interval. However, a certain dose intensity is required because neutropenia has been identified as a potential prognostic indicator for treatment effectiveness. In the ARSI era for mCSPC, evidence on mCRPC treatment sequencing is limited. A better understanding of PC biology and the collection of real-world data is essential for effective treatment and improved safety-benefit outcomes.

Targeting Triple-Negative Breast Cancer: Resistance Mechanisms and Therapeutic Advancements

BACKGROUND

Triple-negative breast cancer (TNBC) is one of the most heterogeneous and menacing forms of breast cancer, with no sustainable cure available in the current treatment landscape. Its lack of targets makes it highly unresponsive to various treatment modalities, which is why chemotherapy continues to be the primary form of treatment, despite the high rates of patients developing chemoresistance. In recent years, however, there has been significant progress in identifying and understanding the role of several aspects that might contribute to genomic instability and other hallmarks of cancer, including cellular proteins, immune targets, and epigenetic mechanisms, which are desirable as they permit reversibility easier than the often-adamant genetic changes.

METHODS

A literature review was conducted on the role of various TNBC associated biomarkers, their therapeutic applications, and their role in tumorigenesis and tumor maintenance, with a focus on linking both the driving biological mechanisms and emerging treatment options for TNBC.

CONCLUSIONS

Shifting the focus of treatment to identify crucial tumor cell subpopulations and associated biomarkers, such as local immune cell populations and cancer stem cells, could potentially solve or simplify decades' worth of problems that are associated with TNBC, bolstering early detection and the evolution of precision medicine and treatment. The techniques that can be used here are epigenetic analysis and RNA sequencing. Biomarkers, such as PD-L1, survivin, and ABC transporters, are implicated in several crucial processes that maintain tumors, such as cell proliferation, metastasis, immunosuppression, and stemness. Complex treatment options such as, immunotherapy, pathway inhibition, PARP inhibition, virotherapy, and RNA targeting have been considered for TNBC. Phytochemicals are also being considered as a treatment modality for TNBC, as a supplement to chemotherapy and radiation therapy, or as sole treatment.

Docetaxel and cisplatin induction chemotherapy with or without fluorouracil in locoregionally advanced head and neck squamous cell carcinoma: A real-world data study

OBJECTIVE

To evaluate outcomes of locoregionally advanced patients with Head and Neck Squamous Cell Carcinoma (HNSCC) treated with Induction Therapy (ICT).

METHODS

Toxicity, response rate, and Event-Free Survival (EFS) and Overall Survival (OS) were evaluated in patients treated with docetaxel, cisplatin, and 5-Fluorouracil (TPF) or docetaxel and Cisplatin (TP).

RESULTS

ICT regimens did not alter response to ICT, and patients' EFS and OS. Cox multivariate analysis identified stable or progressive disease (HR = 5.56) and interval between cycles ≥28 days (HR = 2.79) as predictors of lower EFS, and ECOG ≥ 1 (HR = 3.42), stable or progressive disease (HR = 4.67), and interval between cycles ≥28 days (HR = 2.73) as predictors of lower OS.

CONCLUSION

Our findings indicate TP as a good treatment option for locoregionally advanced HNSCC, especially in socioeconomically limited settings.

LEVEL OF EVIDENCE: 3

Advancing Research on Rare Cancers Through 3D Bioprinting

Rare cancers are a diverse group of malignancies with low incidence, posing significant challenges for research due to the scarcity of cases and the lack of well-established in vitro and in vivo models. In this letter, we describe how 3D bioprinting can address these challenges by enabling the construction of more accurate tumor models that capture the essential characteristics and heterogeneity of rare cancers. The technology allows for the creation of multicellular microenvironments, the incorporation of diverse extracellular matrix substrates, and the deployment of additional components like growth factors, nanoparticles, and genetic modulators. This versatility facilitates the study of complex tumor behaviors, such as perineural invasion, and enables high-throughput drug screening for personalized therapies. We emphasize the transformative potential of 3D bioprinting in advancing rare cancer research and overcoming the longstanding challenges associated with these malignancies, with a particular focus on salivary gland cancers.

Impact of Comorbidities on the Mortality Benefits of Lung Cancer Screening: A Post-Hoc Analysis of the PLCO and NLST Trials

OBJECTIVES

To evaluate how comorbidities affect mortality benefits of lung cancer screening (LCS) with low-dose computed tomography.

METHODS

We developed a comorbidity index (Prostate, Lung, Colorectal, and Ovarian comorbidity index [PLCO-ci]) using LCS-eligible participants' data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial (training set) and the National Lung Screening Trial (NLST) (validation set). PLCO-ci predicts five-year non-lung cancer (LC) mortality using a regularized Cox model; with performance evaluated using the area under the receiver operating characteristics curve. In NLST, LC mortality (per original publication) was compared between low-dose computed tomography and chest radiograph arms across the PLCO-ci quintile (Q1-5) using a cause-specific hazard ratio (csHR) with 95% confidence intervals (CIs).

RESULTS

Analyses included 34,690 PLCO and 53,452 NLST participants (mean age: 62 y [±5 y] and 61 y [±5 y], 58% and 59% male individuals, and 39% and 41% active smokers, respectively). PLCO-ci predicted five-year non-LC mortality with an area under the receiver operating characteristics curve of 0.72 (95% CI: 0.71-0.74) in PLCO and 0.69 (95% CI: 0.67-0.70) in NLST. In NLST, at a median follow-up of 6.5 years, LC mortality was significantly reduced for participants with intermediate comorbidity (Q2, Q3, and Q4): csHR 0.62 (95% CI: 0.41-0.95), 0.68 (95% CI: 0.48-0.96), and 0.72 (95% CI: 0.54-0.96) respectively, with a nonstatistically significant reduction for Q1 (csHR = 0.72, 95% CI: 0.45-1.17) and no reduction for Q5 participants (csHR = 0.99, 95% CI: 0.79-1.23). Participants in Q2, Q3, and Q4 (60%) accounted for 89% of LC deaths averted among all NLST participants. Q1 participants had low LC incidence, whereas Q5 had higher localized LC lethality, more squamous cell carcinomas, and untreated LC.

CONCLUSIONS

The PLCO-ci developed in this work shows that individuals with intermediate comorbidity benefited the most from LCS, highlighting the need of addressing comorbidities to achieve LC mortality benefits.

A nomogram for predicting survival in patients with primary testicular lymphoma: A population-based study

BACKGROUND

Primary testicular lymphoma (PTL) is a rare malignancy whose epidemiology and prognosis have not been studied.

MATERIALS AND METHODS

PTL patient data were collected from the SEER online database, and the data were divided into a training cohort and a validation cohort according to random assignment. The training cohort was subjected to a one-way COX regression analysis, and statistically significant differences were included in the multi-factor COX regression analysis and constructed nomograms. Forest plots were constructed based on risk factors. The validity of the nomograms was verified by observing the C-index size of the nomograms, the percentage of area under the ROC curve, and the degree of fit of the prediction curve in the calibration plot. The validation cohort verified the accuracy and applicability of the nomograms.

RESULT

The patient's age, tumor histologic type, Ann Arbor stage, grade of differentiation, and whether or not they received radiation and chemotherapy were significantly associated with poor prognosis in PTL.

CONCLUSION

The nomogram constructed based on multivariate COX regression analysis can predict the prognosis of PTL patients. The online visualization nomogram can help clinicians calculate the survival rate of PTL tumor patients and conduct personalized prognostic assessments for PTL tumor patients.

Evaluation of Treatment Response and Survival Outcomes in Anaplastic Thyroid Cancer Patients Following Surgery With and Without Other Treatment Modalities: A Systematic Review

Background and Aims

Anaplastic thyroid carcinoma (ATC) is a rare type of malignancy ranking among the most aggressive diseases globally, with an extremely poor prognosis. No optimal standardized treatment has been established yet to promote ATC's prognosis and increase the patients' median survival. We aim to assess the effectiveness of surgery alone or combined with other treatment approaches for ATC patients.

Methods

PubMed, Web of Science, and Scopus databases were systematically searched until June 1st, 2023. Study selection was limited to English retrospective studies. A citation search was also performed for the final articles that were included. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

Results

During our search, we came to include 56 articles containing 16,246 patients suffering from ATC. We assessed the overall survival by treatment method and stage, emphasizing surgery's role. The most common efficacious treatment option in patients with resectable cancer is a combination of surgery with adjuvant chemoradiotherapy. However, surgery for stage IVC patients is controversial. Additionally, surgery and multimodality treatment can be affected by patients' characteristics, such as tumor size.

Conclusions

Stage IVA and IVB resectable cancers may benefit from the combination of surgery and adjuvant therapies. However, the effectiveness of invasive treatments and the selection of appropriate adjuvant therapy options for IVC-stage patients are still controversial.

Potential drug-drug interactions among geriatric oncology patients: a retrospective study in Saudi Arabia

BACKGROUND

Drug-drug interactions (DDIs) are significant causes of adverse drug reactions among patients with cancer. We aimed to identify the prevalence, severity, and predictors of potential DDIs among geriatric oncology patients.

METHODS

A cross-sectional, retrospective study was conducted at two tertiary medical centers. Geriatric patients (≥ 65 years) who were diagnosed with solid tumors and received outpatient prescriptions with a minimum of two drugs between January 2018 and December 2022 were included in the study. Patients' medications were screened for DDIs using Lexi-Interact. Univariate and multivariable logistic regression models were used to explore factors associated with DDIs.

RESULTS

The study included 247 geriatric patients with a mean age of 74.0 ± 7.3 years, and 48.6% of the patients were female. The most common type of cancer was gastrointestinal cancer (35.6%), followed by genitourinary cancer (20.6%), and 50.6% of the patients had metastasized tumors. Approximately one-half of the patients (49.0%) received anticancer therapy, and hormonal therapy (21.9%) or chemotherapy (16.6%) was the most common therapy. The mean number of medications used per patient was 6.9 ± 3.5. The majority of patients (79.4%) had at least one DDI, with a mean of 5.6 ± 5.3 DDIs per patient. Most of the interactions were classified as moderate (58.9%), and only 19.3% were classified as major. Multiple logistic regression revealed that females were more vulnerable to DDIs than their male counterparts were (adjusted odds ratio (AOR) = 37.4; 95% CI 4.13-338.3). The number of medications used was significantly associated with the risk of DDIs (AOR = 4.07; 95% CI 2.53-6.54). Compared with patients with gastrointestinal cancers, patients with breast or gynecologic cancers had lower odds of experiencing DDI (AOR = 0.02; 95% CI < 0.01-0.24 and AOR = 0.04; 95% CI < 0.01-0.29, respectively).

CONCLUSION

This study revealed a high prevalence of DDIs among geriatric oncology patients, with most interactions classified as moderate. Female patients and patients taking multiple medications had a greater risk of experiencing DDIs. Routine screening for potential DDIs is essential for this vulnerable population, and the factors identified in this study should be carefully considered.

Efficacy and safety of PD-1/PD-L1 inhibitor monotherapy or combination therapy versus platinum-based chemotherapy as a first-line treatment of advanced urothelial cancer: A systematic review and meta-analysis

Background

Recent clinical trials have shown that inhibitors targeting programmed cell death protein 1 (PD-1) or its ligand (programmed cell death-ligand 1 [PD-L1]) provide significant efficacy and clinical benefit in the treatment of advanced or metastatic urothelial carcinoma (UC). This systematic review and meta-analysis aimed to compare the effectiveness and safety of PD-1/PD-L1 inhibitors in combination with chemotherapy or PD-1/PD-L1 inhibitor monotherapy versus platinum-based chemotherapy as a first-line treatment for advanced UC.

Materials and methods

From the beginning of the database construction to February 4, 2024, a combination of medical subject headings and free-text words was searched using the Population Intervention Comparison Outcome Study design framework. The PubMed, Cochrane Library, Embase, and Web of Science electronic databases were searched. Meta-analyses of progression-free survival, overall survival, objective response rate (ORR), complete remission rate, duration of remission, and grade ≥3 adverse events were performed.

Results

Four studies were included in the meta-analysis. The PD-1/PD-L1 inhibitors plus chemotherapy therapy is associated with significantly better ORR compared with chemotherapy. Unfortunately, there were no significant differences between PD-1/PD-L1 inhibitor monotherapy and chemotherapy in terms of ORR, duration of remission, or overall survival.

Conclusions

Our findings indicate that PD-1/PD-L1 inhibitors plus chemotherapy therapy provides more oncological advantages than standard chemotherapy and should be recommended as a first-line treatment for advanced or metastatic UC. Attention must also be paid to the adverse effects of the combination of PD-1/PD-L1 inhibitors and chemotherapy.

Deciphering the role of liquid-liquid phase separation in sarcoma: Implications for pathogenesis and treatment

Liquid-liquid phase separation (LLPS) is a significant reversible and dynamic process in organisms. Cells form droplets that are distinct from membrane-bound cell organelles by phase separation to keep biochemical processes in order. Nevertheless, the pathological state of LLPS contributes to the progression of a variety of tumor-related pathogenic issues. Sarcoma is one kind of highly malignant tumor characterized by aggressive metastatic potential and resistance to conventional therapeutic agents. Despite the significant clinical relevance, research on phase separation in sarcomas currently faces several major challenges. These include the limited availability of sarcoma samples, insufficient attention from the research community, and the complex genetic heterogeneity of sarcomas. Recently, emerging evidence have elaborated the specific effects and pathways of phase separation on different sarcoma subtypes, including the effect of sarcoma fusion proteins and other physicochemical factors on phase separation. This review aims to summarize the multiple roles of phase separation in sarcoma and novel molecular inhibitors that target phase separation. These insights will broaden the understanding of the mechanisms concerning sarcoma and offer new perspectives for future therapeutic strategies.

Progress on liposome delivery systems in the treatment of bladder cancer

Bladder cancer (BC) in the urinary system remains one of the most prevalent malignancies with high recurrence rate globally. Current treatment schemes against BC such as surgery, chemotherapy, and radiotherapy have substantial limitations including side effects, drug resistance, and poor tumor targeting. Considering the above-mentioned challenges, nanotechnology has become a current research hotspot, particularly liposome-based drug delivery systems, which offer promising novel therapeutic strategies aimed at reducing systemic toxicity, overcoming drug resistance, and enhancing drug targeting. This review systematically elaborates the current research progress on liposomal drug delivery systems in BC treatment, focusing on their application in chemotherapy, immunotherapy, and gene therapy. Additionally, we provide a comprehensive assessment of the benefits and limitations of liposome nanocarriers used in BC treatment. The advanced targeting strategies and combination treatments via liposomal therapies are also discussed, demonstrating that liposomal formulations have great potential application value in the treatment of BC owing to their superior bioavailability, stability, and targeting and minimal adverse effects.

Urethral sarcomatoid urothelial carcinoma with heterologous elements in a dog

Sarcomatoid carcinoma is a biphasic tumour characterized by the co-existence of epithelial and mesenchymal differentiation that may contain heterologous components. These tumours are rare in domestic animals and have only been reported in the kidney and prostate gland. In this report we describe a French Bulldog with a perianal swelling that resulted in dyschezia. Ultrasound confirmed the presence of a mass in the lower abdominal cavity and surgery identified and removed a tumour close to the urethra. The dog was euthanized 3 weeks later due to poor condition. Histopathological analysis of the tumour revealed a biphasic morphology of malignant epithelial and mesenchymal cells, within which lay foci of cartilage and bone. Regions of neoplastic cells were immunopositive for GATA3, confirming urothelial origin, or for SATB2, confirming the presence of osseous differentiation. Electron microscopy revealed an epithelial cell population and a predominant population of irregular, spindle-shaped fibroblast-like cells. Based on these findings, the diagnosis was urethral sarcomatoid urothelial carcinoma (UC) with heterologous elements of chondrosarcoma and osteosarcoma. This is the first report of sarcomatoid UC of the urethra in domestic animals and the neoplasm had strong parallels with sarcomatoid UC of the lower urinary tract in humans, further supporting the One Medicine approach.