Comprehensive geriatric assessment and early treatment failure in nonagenarian patients with cancer, a retrospective monocentric study

BACKGROUND

The incidence of cancer among patients aged over 90 is increasing, but this population is poorly described in literature. This underrepresentation complicates decision-making for cancer treatments, despite the contribution of comprehensive geriatric assessment (CGA). This study aimed to describe early failure of specific anti-cancer treatments in a population of nonagenarians treated in a Comprehensive Cancer Center after undergoing a CGA.

METHODS

This retrospective, monocentric cohort study included patients aged over 90 referred to an oncogeriatric team for CGA between 2019 and 2023, regardless of cancer type or planned treatment. The primary endpoint was the early treatment failure rate within 3 months of the initiation of treatment, defined as unplanned discontinuation, progression, or death.

RESULTS

119 patients were included, with a median age of 91 years (range: 90-99 years), 53 % were men. The most common cancers were skin (30 %), head and neck (24 %), genito-urinary (12 %), and breast cancers (11 %). Most patients were independent for activities of daily living with a median ADL score of 6/6 and IADL score of 3/4. They had an average of 1.3 severe comorbidities. Half of them suffered from undernutrition. The geriatric oncology team recommended 53.8 % treatment modifications (94.5 % de-escalation). The most common treatments received were radiotherapy (27 %), surgery (18 %), hormonal therapy (10 %) and chemotherapy (9 %). A quarter of the patients received exclusive supportive care. Among patients receiving specific treatment, early failure occurred in 22.7 % (20/88). The 6-month survival probability from initiation of treatment was 69.2 % (95 % CI: 60.3 %, 76.8 %), varying significantly by treatment intent: 93.9 % (95 % CI: 80.4 %, 98.3 %) for curative treatments, 77.4 % (95 % CI: 64.5 %, 86.6 %) for palliative treatments, and 26.8 % (95 % CI: 14.3 %, 44.6 %) for exclusive supportive care.

CONCLUSION

In this population of nonagenarians, who benefit from a CGA to identify and manage patient frailties, anti-cancer treatments were carried out with few early treatment failures.

Prostate Cancer Diagnosis and Treatment in Elderly Patients: A Cross-Sectional Survey Exploring Practice Patterns and Preferences of Uro-Oncologists in Northeast Italy

Background: The optimal diagnostic and therapeutic strategies for prostate cancer (PCa) in patients aged ≥75 years (mild-old and oldest-old) are still contentious. Resource allocation and ideal treatment for older patients are challenges, mainly due to their comorbidities and reduced life expectancy. This survey aims to assess current clinical practices and the experiences of healthcare providers in the diagnosis and management of elderly patients with PCa. Materials and Methods: In Northeast Italy, members of the Gruppo Uro-Oncologico del Nord-Est (GUONE) conducted a survey involving 104 physicians of different specialties (Nuclear Medicine, Medical Oncology, Radiation Oncology, Radiology, Urology) between 1 November 2024 and 30 November 2024. The survey encompassed 51 questions, evaluating various diagnostic and therapeutic scenarios. Results: Digital rectal exam (DRE) was recommended by 35.9% of physicians for patients aged 75 or older at risk of PCa. PSA testing was continued in 76.3% of these patients. For 36.5% of the physicians, there should be no age limit for prostate biopsy. Moreover, 42.6% of physicians recommended a magnetic resonance imaging (MRI)-guided prostate biopsy regardless of age. A prostate biopsy was deemed mandatory before initiating any form of hormonal therapy by 57.7% of the participants. For 22.3% and 34.7% of physicians, there should be no age limit for prostate MRI and PET/CT for staging purposes. Interestingly, PET/CT was not recommended in 52% of cases as a staging tool for patients older than 85 years. For patients without comorbidities, the age limit to consider radical prostatectomy (RP) was 75, with 58.6% of physicians in favor. There were no definitive limits for radiotherapy (RT). Chemotherapy had an age limit for 81.6% of the respondents; for 18.4%, 22.5%, and 26.5% of physicians, age limits were 75, 80, and 85 years, respectively. The use of androgen receptor pathway inhibitors (ARPIs) had no definitive age limits for 46.5% of respondents. For patients with no comorbidities and low-volume metastatic PCa, the preferred option was androgen deprivation therapy + ARPIs + RT. The follow-up schedule after RP or RT exhibited heterogeneity with no consensus regarding the frequency of PSA testing or the age at which it should be discontinued. Conclusions: This survey highlights the need for consensus guidelines in diagnosing and managing mild-old and oldest-old elderly PCa patients. With the aging population, standardized protocols are essential to ensure optimal care.

Efficacy of 5-hydroxytryptamine 3 receptor antagonists versus metoclopramide for preventing nausea and vomiting during azacitidine chemotherapy in patients with myelodysplastic syndromes or acute leukemia: a retrospective observational study

BACKGROUND

5-Hydroxytryptamine 3 receptor antagonists (5-HT3RAs) and dexamethasone are recommended to prevent azacitidine-induced nausea and vomiting. In clinical practice, 5-HT3RAs or metoclopramide is often used without dexamethasone. In this study, we aimed to determine whether 5-HT3RAs or metoclopramide is more effective for suppressing nausea and vomiting during azacitidine-based chemotherapy.

METHODS

This study was a single-center retrospective observational study. Patients with myeloid malignancies receiving azacitidine-based regimens were treated with a 5-HT3RA (ramosetron or granisetron, n = 32) or metoclopramide (n = 18) for preventing nausea and vomiting. The occurrence of nausea and vomiting was assessed using total control (TC), complete control (CC), and complete response (CR) rates (chi-squared test), and the time to the first emetic episode or rescue medication (Cox proportional hazard regression analysis).

RESULTS

The 5-HT3RA group had significantly higher rates of TC, CC, and CR than the metoclopramide group (84% vs. 22%, 91% vs. 33%, and 91% vs. 33%, respectively). The time until the first emetic episode or rescue medication was also significantly longer in the 5-HT3RA group than in the metoclopramide group (p < 0.001).

CONCLUSIONS

5-HT3RAs may prevent azacitidine-induced nausea and vomiting more effectively than metoclopramide.

TRIAL REGISTRATION

Retrospectively registered.

Case Report: Two cases of chemotherapy refractory aggressive variant prostate cancer with extreme durable response to PARP inhibitor

Background

Aggressive variant prostate cancer (AVPC) represents a distinct clinical subset characterized by resistance to novel hormone therapies and an unfavorable prognosis, frequently associated with the concurrent loss of tumor suppressor genes (TSG) such as PTEN, RB1, and TP53. While the progression-free survival (PFS) and overall survival (OS) of AVPC are relatively short, the optimal first-line treatment remains unclear.

Presentation

In this case report, we presented two de novo AVPC cases who have ultimately benefited from the usage of PARP inhibitors. The first patient was a 64-year-old male who was diagnosed during prostate biopsy featured by mutations in PTEN, and loss of RB1, BRCA2, ATM, and FANCA. He was treated with docetaxel/albumin-bound paclitaxel and cisplatin in the first line. Second-line therapy was applied with radiotherapy and Olaparib after failure of first-line therapy, resulting in a PSA response sustained for three years. The second case was a 75-year-old male with localized neuroendocrine feature and mutations in TP53, loss of RB1 and HDAC2. He was treated with sustained ADT and chemotherapy in the first-line treatment. Radiotherapy and Fluzoparib + abiraterone was applied as subsequent treatments with a PSA response for 2 years.

Conclusions

These two cases demonstrating a satisfactorily durable response to PARP inhibitors indicating its clinical benefit in AVPC population with detected DNA damage response (DDR) defects. The survival improvement with PARP inhibitors observed in our clinical experiences, along with current advances in tumor sequencing provide more information on future clinical trials and explorations of innovative therapies in AVPC population.

Frailty and malnutrition scores in predicting postoperative complications in minimally invasive prostatectomy for malignancy of the prostate

Prostate cancer (PCa), the second most common cancer in men, is typically diagnosed between ages 65 and 74. When planning radical prostatectomy, patient frailty and nutritional status must be carefully evaluated. This study investigates the association between frailty, malnutritional status, and postprostatectomy complications in PCa patients. We analyzed the ACS-NSQIP prostatectomy series (2019-2022), focusing on minimally invasive procedures, including only malignant neoplasm diagnoses. The modified 5-index frailty (mFI-5) was calculated, where values of 2 or higher indicated frailty. Nutritional risk was assessed using a Nutritional Risk Index (NRI) of ≤ 97.5 and preoperative hypoalbuminemia (≤ 3.5) as indicators of malnutrition. Incomplete records were excluded, and remaining data were analyzed using R 4.3.3. The study included 21,067 patients. Compared to non-frail patients, frail individuals were significantly older and showed higher rates of diabetes, smoking, elevated BMI, and ASA scores > 2 (all p < 0.001). Frail patients also experienced longer hospital stays and operative times (p < 0.001), along with higher rates of renal insufficiency (p = 0.018), urinary infections (p = 0.001), systemic shock (p = 0.003), and overall complications (p = 0.002) compared to non-frail patients. Of the 9,932 patients evaluated for nutritional status, 342 met malnutrition criteria. Those identified by NRI criteria, experienced longer hospital stays and higher rates of myocardial infarction, and those identified by low albumin levels, showed increased length of stay (p = 0.044), major complications (p = 0.013), and rates of return to the operating room (p = 0.005), when compared to the normal cohort. Frailty and malnutrition are independent risk factors for postoperative complication in minimally invasive prostatectomy, highlighting the need for preoperative optimization.

Machine Learning to Predict Mortality in Older Patients With Cancer: Development and External Validation of the Geriatric Cancer Scoring System Using Two Large French Cohorts

PURPOSE

Establishing an accurate prognosis remains challenging in older patients with cancer because of the population's heterogeneity and the current predictive models' reduced ability to capture the complex interactions between oncologic and geriatric predictors. We aim to develop and externally validate a new predictive score (the Geriatric Cancer Scoring System [GCSS]) to refine individualized prognosis for older patients with cancer during the first year after a geriatric assessment (GA).

MATERIALS AND METHODS

Data were collected from two French prospective multicenter cohorts of patients with cancer 70 years and older, referred for GA: ELCAPA (training set January 2007-March 2016) and ONCODAGE (validation set August 2008-March 2010). Candidate predictors included baseline oncologic and geriatric factors and routine biomarkers. We built predictive models using Cox regression, single decision tree (DT), and random survival forest (RSF) methods, comparing their predictive performance for 3-, 6-, and 12-month mortalities by computing time-dependent area under the receiver operator curve (tAUC).

RESULTS

A total of 2,012 and 1,397 patients were included in the training and validation set, respectively (mean age: 81 ± 6 years/78 ± 5 years; women: 47%/70%; metastatic cancer: 50%/34%; 12-month mortality: 43%/16%). Tumor site/metastatic status, cancer treatment, weight loss, ≥five prescription drugs, impaired functional status and mobility, abnormal G-8 score, low creatinine clearance, and elevated C-reactive protein (CRP)/albumin were identified as relevant predictors in the Cox model. DT and RSF identified more complex combinations of features, with G-8 score, tumor site/metastatic status, and CRP/albumin ratio contributing most to the predictions. The RSF approach gave the highest tAUC (12 months: 0.87 [RSF], 0.82 [Cox], 0.82 [DT]) and was retained as the final model.

CONCLUSION

The GCSS on the basis of a machine learning approach applied to two large French cohorts gave an accurate externally validated mortality prediction. The GCSS might improve decision making and counseling in older patients with cancer referred for pretherapeutic GA. GCSS's generalizability must now be confirmed in an international setting.

Assessment of a Systematic Screening of Occupational Exposures in Malignant Hemopathies in the Rhone-Alpes Area: Prolymphome Study

BACKGROUND

Several studies have highlighted the role of environmental exposures in malignant hemopathies etiology. Some patients with malignant hemopathies can be compensated as occupational diseases. The Prolymphome research aimed to assess a systematic screening of occupational exposures in patients with lymphoma or myeloma treated in three hospitals in the Rhône-Alpes region.

METHODS

Patients received a self-administered questionnaire to fill in at home to collect their job history and potential occupational exposures to carcinogens. A physician assessed the questionnaire to determine if a dedicated consultation was required and the possibility of claiming compensation. Patients were systematically assisted by a social worker for administrative procedures.

RESULTS

In 12 months, 754 patients were enrolled in the study, and 361 (48%) returned the questionnaire. A specialized consultation was proposed for 123 patients, and 98 patients attended the consultation. Overall, a compensation claim was proposed to 18 patients: 11 have been occupationally exposed to pesticides and seven to trichloroethylene.

CONCLUSIONS

Our results confirmed the feasibility of the systematic screening procedure. Barriers were observed at every step of the process, and it underlined that patients are rarely  nformed about occupational exposures. As the prevalence of occupational exposures in malignant hemopathies remains scarce, a systematic targeted screening could be relevant in this population.

HPMA Copolymers: A Versatile Platform for Targeted Peptide Drug Delivery

Peptide drugs have been broadly applied in cancer treatment and diagnosis due to their ability to accurately identify biomarkers with good biocompatibility. However, their clinical application is limited by protease degradation, which induces short circulation half-life, low bioavailability, and high renal clearance. In recent years, delivery systems based on nanomaterial technology have become an important strategy to break through the bottleneck of peptide drug delivery. Among them, N-(2-hydroxypropyl) methacrylamide (HPMA) copolymers have attracted much attention due to their good biocompatibility, hydrophilicity, and low immunogenicity. The high molecular weight of HPMA copolymer-peptide can circumvent renal clearance, significantly prolong the circulation time in the body, and achieve drug accumulation and microenvironment-triggered release synergistically with EPR effects and active targeting. This review introduces the basic properties of HPMA copolymers, including solubility, biocompatibility, and tunable chemical structure. The important applications of HPMA copolymer-peptide in tumor diagnosis and treatment are discussed. This review deepens our understanding of the future development of HPMA copolymers and will provide more references for improving peptides by simple copolymers.

Systemic treatment options for metastatic castration resistant prostate cancer: A living systematic review

Background

Optimal treatment selection for metastatic castration resistant prostate cancer (mCRPC) remains challenging due to evolving standards of care in castration sensitive setting.

Purpose

To synthesize and appraise evidence on systemic therapy for mCRPC patients stratified by prior therapy and HRR alterations informing a clinical practice guideline.

Data Sources

MEDLINE and EMBASE (inception to 5 March 2025) using living search.

Study Selection

Randomized clinical trials assessing systemic therapy in mCRPC.

Data Extraction

Primary outcomes assessed were progression free survival (PFS) and overall survival (OS).

Data Synthesis

This report of the living systematic review (LSR) includes 143 trials with 17,523 patients (59 phase III/IV trials, 8,941 patients; 84 phase II, 8,582 patients). In the setting of prior androgen deprivation therapy (ADT) alone or ADT+docetaxel, treatment benefit was observed with poly (ADP-ribose) polymerase inhibitors (PARPi) in combination with androgen receptor pathway inhibitors (ARPI) for BRCA+ subgroup. In the setting of prior ADT+ARPI or ADT+ARPI+docetaxel, treatment benefit was observed with PARPi monotherapy for BRCA+ subgroup. Treatment benefit with PARPi may be observed for select non-BRCA homologous recombination repair (HRR) alterations (CDK12, PALB2). Treatment benefit was observed with abiraterone, enzalutamide, cabazitaxel, docetaxel (if no prior docetaxel), and Lu177 (if PSMA+) for patients without HRR alterations.

Limitations

Study-level data and indirectness in evidence.

Conclusion

Findings from the current LSR suggest that optimal treatment for mCRPC should be individualized based on prior therapy and HRR alterations. Current evidence favors PARPi alone (ARPI exposed) or in combination with ARPI (ARPI naïve) for patients with BRCA alterations, while ARPI alone, chemotherapy, and Lu177 remain potential options for patients without HRR alterations.

Efficacy and safety of modified bleomycin administration with EP chemotherapy in adult male patients with germ cell tumors: a retrospective study

BACKGROUND

Given the substantial inconvenience caused by weekly bleomycin administration, we initiated a study to evaluate the efficacy and toxicity of the modified bleomycin combined with EP (modified-BEP) regimen in Chinese adult male patients with germ cell tumors (GCTs).

METHODS

We conducted a retrospective analysis of 274 adult male GCT patients treated with modified-BEP at the Sun Yat-sen University Cancer Center between 2005 and 2022. The regimen involved a tri-weekly 5-day schedule with 30 IU modified bleomycin (administered on days 1, 3, and 5), 20 mg/m2 cisplatin (days 1-5), and 100 mg/m2 etoposide (days 1-5). The survival rates and safety profiles of the patients were analyzed.

RESULTS

Among the patients, 42 patients received BEP in adjuvant setting, while 232 were treated with BEP in curative setting. With a median follow-up of 41.03 months among the curative patient population, the 5-year progression-free survival (PFS) rate was 79.33%, and the 5-year overall survival (OS) rate was 86.26%. Stratified by the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic groups, the 5-year OS rates of the good, intermediate, and poor risk groups were 99.05%, 92.84%, and 55.96% (P < 0.0001), respectively. Favorable responses, including complete remission and partial response with negative tumor markers, were achieved in 91.07% of good-risk, 84.13% of intermediate-risk, and 52.63% of poor-risk patients, with a significant difference (P < 0.0001). Multivariate analysis indicated that non-seminoma, poor risk group, mediastinal primary tumor, and Eastern Cooperative Oncology Group (ECOG) 2 status were significantly associated with inferior PFS. In the entire cohort, major grade 3-4 adverse events included neutropenia (38.69%), anemia (4.74%), thrombocytopenia (5.11%), and febrile neutropenia (6.2%), with no death due to pulmonary toxicity.

CONCLUSION

The modified-BEP regimen showed an effective and tolerable treatment alternative for adult male GCT patients in China, offering greater convenience compared to the standard BEP regimen.

Mechanisms of resistance to NAMPT inhibitors in cancer

A common barrier to the development of effective anticancer agents is the development of drug resistance. This obstacle remains a challenge to successful clinical translation, particularly for targeted agents. Nicotinamide phosphoribosyltransferase (NAMPT) inhibitors represent a clinically applicable drug class that exploits the increased dependence of cancer cells on nicotinamide adenine dinucleotide (NAD+), a coenzyme essential to metabolism and other cellular functions. NAMPT catalyzes the rate-limiting step in the NAD+ salvage pathway of mammalian cells and is overexpressed in numerous types of cancers. Preclinical research has demonstrated that pharmacological targeting of NAMPT may be an effective strategy against certain cancers, and while several early-phase clinical trials testing NAMPT inhibitors in refractory cancers have been completed, drug resistance is a concern. Preclinical work in a variety of cancer models has demonstrated the emergence of resistance to multiple NAMPT inhibitors through several recurrent mechanisms. This review represents the first article summarizing the current state of knowledge regarding the mechanisms of acquired drug resistance to NAMPT inhibitors with a particular focus on upregulation of the compensatory NAD+ production enzymes nicotinate phosphoribosyltransferase (NAPRT) and quinolinate phosphoribosyltransferase (QPRT), acquired mutations in NAMPT, metabolic reprogramming, and altered expression of the ATP-binding cassette (ABC) efflux transporter ABCB1. An understanding of how these mechanisms interact with the biology of each given cancer cell type to predispose to the acquisition of NAMPT inhibitor resistance will be necessary to develop strategies to optimize the use of these agents moving forward.

Four cycles of docetaxel plus cisplatin as neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in stage N2-3 nasopharyngeal carcinoma: phase 3 multicentre randomised controlled trial

OBJECTIVE

To compare the effects of four cycles of docetaxel with cisplatin as a neoadjuvant chemotherapy followed by concurrent chemoradiotherapy with concurrent chemoradiotherapy alone by assessing reductions in distant metastasis and improvements in survival in patients with stage N2-3nasopharyngeal carcinoma.

DESIGN

Phase 3, multicentre, randomised controlled trial.

SETTING

Six sites in China from 23 February 2016 to 18 February 2019.

PARTICIPANTS

186 participants aged ≤70 years with a diagnosis of untreated stage T1-4N2-3M0 nasopharyngeal carcinoma.

INTERVENTION

Participants were prospectively enrolled and randomly allocated to either the neoadjuvant chemotherapy plus concurrent chemoradiotherapy group (four cycles of neoadjuvant chemotherapy (docetaxel 75 mg/m2 on day 1 and cisplatin 37.5 mg/m2 on days 2-3, every 3 weeks) followed by concurrent chemoradiotherapy (intensity modulated radiotherapy plus weekly cisplatin 40 mg/m2) or the concurrent chemoradiotherapy only group, in a 1:1 ratio.

MAIN OUTCOME MEASURES

Five year distant metastasis-free survival and overall survival were analysed using the intention-to-treat approach.

RESULTS

93 participants were assigned to each of the neoadjuvant chemotherapy plus concurrent chemoradiotherapy and concurrent chemoradiotherapy only groups. After a median follow-up time of 76.9 (interquartile range 65.4-85.9) months, the neoadjuvant chemotherapy plus concurrent chemoradiotherapy group had superior five year distant metastasis-free survival (91.3% (95% confidence interval (CI) 85.4% to 97.2%) versus 78.2% (69.8% to 86.6%); hazard ratio 0.41 (95% CI 0.19 to 0.87); P=0.02) and five year overall survival (90.3% (84.2% to 96.4%) versus 82.6% (75.0% to 90.2%); hazard ratio 0.38 (0.18 to 0.82); P=0.01). Grade 3/4 acute toxicities were observed in 60 (65%) and 46 (51%) patients in the neoadjuvant chemotherapy plus concurrent chemoradiotherapy and concurrent chemoradiotherapy only groups, respectively (P=0.05). The higher acute toxicity observed in the neoadjuvant chemotherapy plus concurrent chemoradiotherapy group was primarily due to grade 3/4 neutropenia (43 (47%) v 10 (11%); P<0.001). No significant difference in any late toxicity was observed between the two groups, and participants in the neoadjuvant chemotherapy plus concurrent chemoradiotherapy group tended to have a better quality of life five years after enrolment.

CONCLUSIONS

Four cycles of docetaxel plus cisplatin neoadjuvant chemotherapy with concurrent chemoradiotherapy can effectively reduce distant metastasis and improve survival for patients with stage N2-3 nasopharyngeal carcinoma with manageable toxicities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02512315.

A concept-based interpretable model for the diagnosis of choroid neoplasias using multimodal data

Diagnosing rare diseases remains a critical challenge in clinical practice, often requiring specialist expertise. Despite the promising potential of machine learning, the scarcity of data on rare diseases and the need for interpretable, reliable artificial intelligence (AI) models complicates development. This study introduces a multimodal concept-based interpretable model tailored to distinguish uveal melanoma (0.4-0.6 per million in Asians) from hemangioma and metastatic carcinoma following the clinical practice. We collected a comprehensive dataset on Asians to date on choroid neoplasm imaging with radiological reports, encompassing over 750 patients from 2013 to 2019. Our model integrates domain expert insights from radiological reports and differentiates between three types of choroidal tumors, achieving an F1 score of 0.91. This performance not only matches senior ophthalmologists but also improves the diagnostic accuracy of less experienced clinicians by 42%. The results underscore the potential of interpretable AI to enhance rare disease diagnosis and pave the way for future advancements in medical AI.

Chemotherapy and Heart-Specific Mortality in Elderly Men with Prostate Cancer: A Propensity Score Matching Analysis

OBJECTIVE

Prostate cancer (PC) is the most common malignant tumour in men, and atherosclerotic cardiovascular disease (ASCVD) is the leading cause of non-cancer death in PC patients. The main purpose of this study was to investigate whether chemotherapy increases heart-specific mortality (HSM) in elderly patients with PC.

METHODS

Patient information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2018. We included all elderly patients with PC. The multivariate logistic regression model was used to explore the influencing factors of patients receiving chemotherapy. Confounders were excluded using a 1:1 proportional propensity score match, and a competing risk model and cumulative incidence plot were used to analyze HSM and other cause mortality (OCM) in patients who received chemotherapy versus those who did not.

RESULTS

A total of 135183 elderly prostate patients were enrolled in this study, of whom 1361 received chemotherapy. The multivariate logistic regression model showed that older patients were more likely to not receive chemotherapy, married patients were more likely to receive chemotherapy, and the higher the TNM stage and tumor histological grade, the more patients received chemotherapy. In the original cohort before unmatched, there was no significant difference in HSM between chemotherapy and non-chemotherapy patients (P = 0.27). After 1:1 matching, HSM was significantly higher in patients without chemotherapy than in patients with chemotherapy (HR 2.54; P =0.002).

CONCLUSIONS

Our results indicate that HSM is significantly higher in patients without chemotherapy than in those with chemotherapy. Therefore, although chemotherapy can lead to cardiotoxicity in elderly patients with PC, chemotherapy does not increase the HSM of patients and will benefit patients in the long-term survival.

Impact of comprehensive geriatric assessment on treatment decisions in older prostate cancer patients

BACKGROUND

Prostate cancer is the most common cancer in men aged above 75 years old. Given their heterogeneity, the International Society of Geriatric Oncology recommends using a comprehensive geriatric assessment (CGA) to adapt anticancer treatment management according to their geriatric status. While the theoretical value of this approach is in no doubt, the impact of the CGA on the final therapeutic decision remains elusive. This study therefore investigated the impact of comprehensive geriatric assessment on treatment decisions in older patients diagnosed with prostate cancer and described the factors associated with a change in treatment plan.

METHODS

This single-centre retrospective study included prostate cancer patients who received a CGA prior to a therapeutic decision from January 2012 to December 2022. The CGA included medical, nutritional, cognitive, social, functional and psychological evaluation.

RESULTS

140 patients were included, of whom 57 (40.7%) benefited from a change in their therapeutic plan after CGA, all in favour of a less aggressive treatment. There was no difference in event-free (EFS) or overall survival (OS) between patients with or without a therapeutic modification (HR for OS = 1.12 [0.68;1.84] p = 0.048). Factors associated with a change in treatment plan were a WHO performance status > 1, a high age-adjusted Charlson score, polymedication, an impaired functional independence with the ADL (Activities of Daily Living) scale and a 'frail' or 'vulnerable' geriatric profile according to Balducci's classification.

CONCLUSION

A comprehensive geriatric assessment prior to prostate cancer treatment plan initiation lead to therapeutic de-escalation in 40% of cases of without affecting overall survival or event-free survival. This adaptation offering a more tailored cancer management while preventing functional impact of treatment due to toxicity and improving patient quality of life.

TRIAL REGISTRATION

The study was registered as (number's register: F20240123102237) and MR004 (CNIL number: 23RDUROL01).

First-line talazoparib plus enzalutamide versus placebo plus enzalutamide for metastatic castration-resistant prostate cancer: patient-reported outcomes from the randomised, double-blind, placebo-controlled, phase 3 TALAPRO-2 trial

BACKGROUND

Patients with metastatic castration-resistant prostate cancer have poor prognoses, underscoring the need for novel therapeutic strategies. First-line talazoparib plus enzalutamide significantly improved radiographic progression-free survival compared with placebo plus enzalutamide in men with metastatic castration-resistant prostate cancer in the phase 3 TALAPRO-2 study. We aimed to evaluate patient-reported outcomes in the all-comers cohort of TALAPRO-2, which included patients with and without alterations in homologous recombination repair (HRR) genes.

METHODS

TALAPRO-2 is a randomised, double-blind, placebo-controlled, phase 3 trial conducted at 223 hospitals, cancer centres, and medical centres in 26 countries worldwide. Eligible participants were male patients aged 18 years or older (≥20 years in Japan) who were receiving ongoing androgen deprivation therapy, had asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer, Eastern Cooperative Oncology Group performance status of 0 or 1, and had not received previous life-prolonging systemic therapy for castration-resistant prostate cancer or metastatic castration-resistant prostate cancer. Patients were randomly assigned (1:1) using a centralised interactive web response system and a permuted block size of 4 to oral talazoparib 0·5 mg once daily or placebo, plus oral enzalutamide 160 mg once daily. The funder, patients, and investigators were masked to allocation of talazoparib or placebo; enzalutamide was open-label. Stratification factors were HRR gene alteration status (deficient vs non-deficient or unknown) and previous treatment with docetaxel or abiraterone, or both (yes vs no) in the castration-sensitive setting. The primary endpoint was radiographic progression-free survival by blinded independent central review and has been reported previously. Patient-reported outcomes were assessed as secondary endpoints in the patient-reported outcomes population, which comprised patients from the intention-to-treat population with a baseline patient-reported outcome assessment followed by at least one post-baseline patient-reported outcome assessment. Patient-reported outcomes included mean change from baseline in patient-reported pain symptoms (per Brief Pain Inventory-Short Form [BPI-SF]); global health status/quality of life (GHS/QoL), overall cancer and prostate cancer-specific functioning and symptoms (per European Organisation for Research and Treatment of Cancer [EORTC] Core Quality of Life Questionnaire [QLQ-C30] and Quality of Life Questionnaire-Prostate [QLQ-PR25]); and general health status (per EQ-5D-5L). Time to deterioration in patient-reported pain symptoms (per BPI-SF), and time to definitive deterioration in patient-reported GHS/QoL (per EORTC QLQ-C30) and prostate cancer-specific urinary symptoms (per EORTC-QLQ-PR25) were the other secondary endpoints. This study is registered with ClinicalTrials.gov, NCT03395197, and is ongoing.

FINDINGS

Between Jan 7, 2019, and Sept 17, 2020, 805 patients were enrolled and randomly assigned to treatment irrespective of HRR gene alteration status. 395 patients assigned to talazoparib plus enzalutamide and 398 assigned to placebo plus enzalutamide were included in the patient-reported outcome population. Median follow-up was 28·0 months (IQR 23·9-31·7) for talazoparib plus enzalutamide and 26·8 months (23·4-30·6) for placebo plus enzalutamide. Time to definitive deterioration in GHS/QoL was longer with talazoparib plus enzalutamide versus placebo plus enzalutamide (median 30·8 months [95% CI 27·0-non-estimable] vs 25·0 months [22·9-30·7]; hazard ratio [HR] 0·78 [95% CI 0·62-0·99]; two-sided p=0·038). Median time to definitive deterioration in urinary symptoms was non-estimable (95% CI non-estimable-non-estimable) in the talazoparib plus enzalutamide group and was 35·9 months (95% CI 32·3-non-estimable) in the placebo plus enzalutamide group (HR 0·76 [95% CI 0·54-1·06]; two-sided p=0·11). No clinically meaningful differences (≥10 points) in mean changes from baseline were observed in GHS/QoL, symptom, and functional scales between the treatment groups. No differences were observed between the groups in time to deterioration of pain as measured by the BPI-SF (HR 0·98 [95% CI 0·69-1·40]; two-sided p=0·93), mean pain scores (estimated mean difference in value of worst pain in the past 24 h between treatment groups was -0·1 [95% CI -0·3 to 0·1]; two-sided p=0·27), or general health status as measured by the EQ-5D-5L (estimated mean difference 0·0 [95% CI 0·0-0·0]; two-sided p=0·37).

INTERPRETATION

Talazoparib plus enzalutamide prolonged time to definitive deterioration in GHS/QoL versus placebo plus enzalutamide. Together with clinical efficacy and safety data, these results inform the risk-benefit assessment of talazoparib plus enzalutamide in patients with metastatic castration-resistant prostate cancer in TALAPRO-2.

FUNDING

Pfizer.

Comparison of definitive radiotherapy outcomes between younger and older patients with high- or very-high-risk prostate cancer

BACKGROUND AND PURPOSE

This study aimed to compare the oncologic outcomes of definitive intensity-modulated radiotherapy (IMRT) between younger and older high- or very-high-risk prostate cancer patients using propensity score matching (PSM) and competing risk analysis (CRA).

MATERIALS AND METHODS

A total of 569 patients were included in this analysis: 265 younger than 75 years (Group A) and 304 aged 75 years or above (Group B). All patients received IMRT with a daily fraction of 2.2 Gy, administered over 34 fractions, resulting in a total dose of 74.8 Gy. The primary outcomes included biochemical-failure-free survival (BCFFS), distant-metastasis-free survival (DMFS), clinical-failure-free survival (CFFS), cancer-specific survival (CSS), and overall survival (OS). PSM was used to balance the groups, employing a full matching method, while CRA distinguished between cancer-specific events and non-cancer-specific events.

RESULTS

Before PSM, the 7-year BCFFS, DMFS, CFFS, CSS, and OS rates in Groups A and B were 83.0 % vs. 66.7 % (p = 0.011), 84.1 % vs. 68.0 % (p = 0.002), 82.1 % vs. 66.7 % (p = 0.008), 95.6 % vs. 97.3 % (p = 0.704), and 87.4 % vs. 68.6 % (p < 0.001), respectively. After PSM, the 7-year survival rates were comparable between both groups for all outcomes except OS. CRA revealed that cancer-specific events were more frequent in Group A, whereas non-cancer-specific events predominated in Group B.

CONCLUSIONS

Both PSM and CRA indicated that definitive IMRT can be safely and effectively delivered to older patients with high- or very high-risk prostate cancer, achieving oncologic outcomes comparable to those in younger patients.

Experiences With an Intervention Based on Geriatric Assessment With Management: A Qualitative Study

AIMS

To describe: (i) Experiences of older patients with cancer after receiving an intervention based on geriatric assessment with management. (ii) Experiences of cancer nurses in municipal health care from implementing an intervention based on geriatric assessment with management and their perspectives on the intervention.

DESIGN

A qualitative, descriptive interview study reported according to COREQ.

METHODS

The sample comprises five men and three women with cancer, mean age 75 years, and 11 female cancer nurses. Data collection was performed as individual patient interviews, and individual and small group interviews with cancer nurses. Inductive, thematic analysis was performed.

RESULTS

Three main themes were generated: Systematic approach, Patient-centeredness and Regular and professional contact.

PATIENT OR PUBLIC CONTRIBUTION

Participants did not review transcripts, participate in analysis, or review results. This was not deemed appropriate, as all interviews were analysed as a whole. User representatives participated in the planning and conducting of the intervention study and implementation procedures.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03881137.

Comparison of efficacy and toxicity of chemotherapeutic regimens used as adjuvant and/or neoadjuvant chemotherapy in penile cancer patients

OBJECTIVE

To compare the efficacy and toxicity of different chemotherapeutic regimens used as adjuvant or neoadjuvant chemotherapy in penile cancer patients.

METHODOLOGY

This observational study was carried out at Mahavir Cancer Sansthan & Research Centre (MCSRC), Patna, involving 112 patients who received various chemotherapy regimens: 5-Fluorouracil with Cisplatin (FP), Paclitaxel with Carboplatin (TP1), Paclitaxel with Cisplatin (TP2), and Paclitaxel with Ifosfamide and Cisplatin (TIP). Efficacy was assessed based on tumor response after Neoadjuvant Chemotherapy (NACT) using RECIST v1.1, and Disease-Free Survival (DFS) was calculated with the Kaplan-Meier method. Chemotherapy toxicity was evaluated using CTCAE v4.03, and statistical analysis was performed with SPSS v22.

RESULTS

The mean age of the penile cancer patients was found to be 53.5 years. The most of the patients comes under stage-IIIb (62 patients - 55.4%). Out of 88 FP received patients, 28 were treated with NACT in which 24 had partial response (PR) and 4 had progressive disease (PD). The objective response rate (ORR) for this group was found to be 85.71%. Out of 21 TP1 received patients, 9 were treated with NACT in which 6 had CR and 3 had PR, therefore ORR was found to be 100%. Only one Patient received TIP as NACT had PR. The median DFS rate was found to be 6 months for ACT and 7 months for NACT in FP chemotherapy, whereas 10 months was found to be for ACT and NACT of TP1 combinations. The patients received TP1 combinations, had more than 6 months of DFS rate. The grade I-III haematological toxicity of anaemia, lymphocytopenia and thrombocytopenia was observed more in FP than TP1 and TP2 combinations. The grade I-III non-haematological toxicity was showed for all chemotherapy combinations.

CONCLUSION

Overall, the TP1 regimen stands out as the most effective and well-tolerated chemotherapy regimen for penile cancer, demonstrating both superior survival outcomes and a more favourable toxicity profile compared to the FP regimen.

Prevalence and indicators of cure of Italian women with vulvar squamous cell carcinoma: A population-based study

OBJECTIVE

Five-year net survival and conditional survival from vulvar squamous cell carcinoma (VSCC) patients in Italy have shown no progress during the past three decades. This study aims to estimate the complete prevalence and multiple indicators of cure.

METHODS

Observed prevalence was estimated using 31 Italian cancer registries covering 47 % of Italian women. A subset of 22 cancer registries was used to estimate model-based long-term survival and indicators of cure, i.e., complete prevalence, cure fraction (CF), time to cure (TTC), proportion of 'already cured' patients, and cure prevalence.

RESULTS

In 2018, VSCC patients alive in Italy (complete prevalence) were 6620 or 22 per 100,000 women. The cure fraction (the proportion of newly diagnosed patients who will not die of VSCC) did not change between 2000 and 2010 both for all patients (32 %) and in each age group. The time to cure (5-year conditional net survival >95 %) was 11 years for patients aged ≥44 years, but excess mortality remained for >15 years in the other age groups. This led to a negligible (5 %) proportion of 'already cured' patients (living longer than time to cure). The proportion of patients alive <2 years (21 %) was the same as that of patients surviving ≥15 years. The cure prevalence (patients who will not die of VSCC) was 64 %. A considerable proportion of patients will not be cured even among those who survived ≥5 years.

CONCLUSION

There is an urgent need to reshape the current vulvar care model in Italy.

Oncologic and fertility outcome in patients with advanced stage ovarian immature teratomas

Background

Immature teratomas represent rare malignant ovarian germ cell tumours, typically involving young women. The majority of germ cell tumors (60%-70%) are diagnosed at an early stage, showing an optimal prognosis. However, advanced stages represent about one third of these patients. We report the oncologic outcome of this population, investigating also fertility outcomes in patients who underwent fertility preservation.

Methods

Clinicopathological data were retrospectively collected and analysed from a cohort of 17 post-pubertal patients with advanced stage immature teratomas in a single centre between 1980 and 2024.

Results

Among 17 patients included in the study, 76.5 % (13/17) underwent fertility-sparing surgery (FSS) and 23.5 % (4/17) radical surgery. Adjuvant chemotherapy was administered in 82 % (14/17) of patients. After a median follow up of 237 months (range 68.0-289.0), 2 patients had persistent disease after receiving chemotherapy and 3 showed relapse. Of these, two had a second relapse. All patients are alive without evidence of disease at the last follow up. Also 46 % (6/13) of women treated with FSS reached pregnancy.

Conclusions

FSS appears to be safe and effective in the treatment of advanced stage immature teratoma. Despite surgical interventions and the administration of chemotherapy in the majority of patients, fertility outcome is satisfactory.

Therapeutic Drug-Drug Interactions (DDIs) Causing QT Prolongation in Patients With Cancer: A Systematic Review and Meta-Analysis

Therapeutic drug-drug interactions (DDIs) have the potential to harm the patient by causing serious and unwanted side effects. Patients suffering from cancer are exposed to numerous drugs, such as therapeutic drugs and adjuvant treatments for the comorbidities and the side effects of chemotherapy. The concomitant use of anticancer and adjuvant drugs makes such patients prone to QT prolongation, which could precipitate torsades de pointes or TdP. The current review aims to summarize the prevalence of therapeutic DDIs causing QT prolongation in these patients. A thorough literature search was performed using databases such as PubMed, Google Scholar, and Research Gate. Medical Subject Headings (MeSH) and alternate search terminologies such as "QT prolongation", "Drug interactions", and "Cancer" were used to identify all the relevant articles published in English to date. The data from all such published articles available on the day of the collection were considered and fed into the meta package of R software for measuring the outcomes. The literature search yielded seven unique and relevant articles, which were included in our study. In these studies, therapeutic DDIs causing QT prolongation were found to occur in 3558 out of 8013 patients undergoing evaluation. Their prevalence in patients with cancer was estimated to be 22% with a 95% CI between 4% and 63%. The patient characteristics, such as age, comorbid diseases, drugs for supportive care, and polypharmacy, were identified as risk factors associated with potential DDIs. Our data concluded that 22% of the patients administered anticancer drugs were exposed to concomitant drugs leading to DDIs, which prolonged the QT interval. Thus, the implementation of vigilant measures and precautionary safety interventions becomes vital to forestall QT prolongation and any other adverse cardiac events in this group of patients.

[Exposome and prostate cancer: Experience in a remote hospital in French Guiana]

INTRODUCTION

West Guiana is characterized by a precarious, poor, dispersed population, exposed to infectious and chemical factors. Prostate cancer is the leading cancer in terms of incidence in men. We examined its characteristics, management and main exposomes in this context.

METHODS

This is a retrospective, descriptive, observational, monocentric study. We considered general external expositions (medico-social status, precariousness, geographical remoteness, culture), specific external (viral serologies, occupation, hypothesizing chemical exposures), and risk factors (comorbidities, overweight), cross-referenced with two cancer characteristics (histopronostic grade and stage).

RESULTS

Over a 6-year period, 70 patients were managed: the majority at a metastatic stage (53%), with a high histopronostic grade. Possible exposures were precariousness 45%, scattered housing 39%, maroon culture 48%, exposure to chemical agents 53%, but no exposure to viruses or notable medical risk factors. None of the comparisons showed any significant difference, with the exception of a higher proportion of metastatic cancers in the case of precariousness (71% versus 39%; P=0.015) and a trend for patients living in rural areas (67% versus 45%; P=0.09).

CONCLUSION

These results lead us to propose two strategies: 1 - organization of care as close as possible to patients; 2 - prospective translational research which, after an exhaustive review of the literature, concerns the study of candidate carcinogenic microorganisms, in particular HPV, and chemical pollution, which is very prevalent in French Guiana.

Pembrolizumab-Mediated Complete Remission of a PLA2R-Positive Paraneoplastic Membranous Nephropathy: A Case Report

Management of paraneoplastic membranous nephropathy (MN) is directed toward the underlying malignancy, and prescriptions of immune checkpoint inhibitors (ICIs) are skyrocketing in the field of oncology. However, this drug category is usually discouraged for patients with autoimmune disorders (AIDs) because it might trigger immune-related adverse events (irAEs) in the form of flare-ups or even genesis of AID. Yet, nothing is known about the efficacy and safety of ICIs for cancers associated with paraneoplastic MN. Here, we report a rare case of PLA2R-positive MN related to a PDL1-positive locally advanced lung adenocarcinoma. Antineoplastic treatment with the anti-PD1 pembrolizumab as a first-line, single-drug therapy allowed for both cancer and nephropathy remissions. To date, to our knowledge, this is the first description of a (PLA2R-positive) paraneoplastic MN that was put into remission via an ICI monotherapy successfully targeting the associated neoplasia only, without additional immunosuppressive agents.

Rare gynaecological cancers in Malta - An analysis of incidence between 2010 and 2021

INTRODUCTION

Whilst about 18 % of all cancers in females are gynaecological cancers, more than 50 % of these can be classified as rare tumours (defined as an annual incidence of <6 per 100,000). Such cancers represent an important challenge for small countries like Malta where the small caseload may limit the expertise of clinicians in the diagnosis and treatment of such cancers.

METHODOLOGY

The study uses data from the Maltese population-based cancer registry to examine trends in incidence rate of the rare gynaecological cancers for the 12-year period between 2010 and 2021. It employs the RARECAREnet list to identify the rare gynaecological cancers by major rare gynaecological cancer categories and histological types and analyses the number of cases and incidence rates in Malta to monitor trends and provide an insight of the burden of such cancers.

RESULTS

A total of 709 new cases of rare gynaecological cancers were discovered during the 12-year period. Globally, these rare gynae cancers, constituted 42.6 % of all the gynae cancers that occurred during this period. Most of these rare cancers were ovarian (399 cases, 56.3 %), followed by rare cancers of the vulva and vagina (122 cases, 17.21 %), rare cancers of the corpus uteri (93 cases, 13.12 %) and rare cancers of the cervix uteri (73 cases, 10.3 %). Other rare gynaecological cancers (10 cases, 1.41 %) and cancers of the placenta (2 cases, 0.04 %) were much rarer. The outcomes in terms of 5-year survival was worse for the rare cancers compared with the commoner types of gynae cancers with an overall 5-year survival of 45.10 % and 45.48 % for rare gynae cancers for the 2010-2014 and 2015-2019 cohorts respectively and an overall 5-year survival of 69.94 % and 73.44 % for the common gynae cancers for the 2010-2014 and 2015-2019 cohorts respectively.

CONCLUSION

The study shows that globally rare gynaecological cancers in a small state like Malta are in fact not so rare - with a total of 709 rare gynaecological cancers in 12 years for Malta. These cases are however few when considering that they are divided into over 30 different histopathological groups. Numbers are also small when it comes to accumulating statistical power for analysis. The caseload for the individual sub-categories is small and will often be shared amongst the different individual gynaecologists and/or their clinical team. Thus, it might be difficult for these specialists to gather enough technical expertise that is crucial for early diagnosis and the treatment of these rare cancers. This study provides a rationale for international collaboration where there is scope for joint research and sharing of expertise. Establishment of common databases for the various types of rare gynaecological tumours will provide statistical power, enabling analysis of outcomes for these rare cancers and establishment of guidelines.

Incidence and survival of rare female genital tract cancers in Europe: The EUROCARE-6 study

Cancers of female genital tract (FGTC) account in Europe for 14 % of all female malignancies, and many of them are rare. FGTC epidemiological indicators are usually reported by anatomical site, but they are a heterogeneous group of diseases in terms of morphological characteristics and clinical management. We show incidence and survival population-based estimates and time trends in the European population for FGTC, defined combining topography and morphology codes. We analyzed data of females aged 15 years or more diagnosed with 25 FGTC of which 23 rare. Data were provided by 100 European population-based cancer registries to the EUROCARE-6 project. Incidence was estimated for the period of diagnosis 2001-2013 in terms of both crude and age-adjusted rates. Observed and relative survival was estimated with the complete approach for the period of diagnosis 2008-2013 and with the period approach for trends, considering years of follow-up from 2001 to 2014. Over a total of 793,715 considered diagnoses of FGTC, 279,667 were classified as rare entities. Their crude incidence rate per 100,000 largely varied from almost zero for adenoid cystic carcinoma of corpus uteri to 5.9 for squamous cell carcinoma of cervix uteri. During the period 2001-13, a significant increment was reported for clear cell adenocarcinoma, Mullerian mixed tumor and serous/papillary carcinoma of corpus uteri, for the Mullerian mixed tumor, adenocarcinoma of fallopian tube, and primary peritoneal serous/papillary carcinoma, and malignant/immature teratoma of ovary. Incidence rates significantly reduced for squamous cell carcinoma of cervix uteri, mucinous adenocarcinoma and sex cord tumor of ovary. Five-year relative survival was >84 % for all the non-epithelial tumors of ovary and for choriocarcinoma of placenta. Survival under 40 % was estimated for Mullerian mixed tumors and undifferentiated carcinomas of all the considered sites. Major survival improvements were observed for placenta choriocarcinoma, sex cord tumor, malignant/immature teratoma and mucinous adenocarcinoma of ovary, in adenocarcinoma of fallopian tube and in serous/papillary carcinoma of corpus uteri. Relative survival significantly reduced in squamous cell carcinoma of corpus uteri. The increasing incidence and survival of many rare FGTC can be in part attributed to better diagnostic ability and to a better organisation of care of patients with rare tumors. The epidemiological indicators here provided can be taken as a starting point to evaluate the effectiveness of the future activities of the European Rare Cancers Networks.

Unveiling Cognitive Impairment in Older Adults with Cancer on Systemic Anticancer Therapy: A Comprehensive Review

Cancer-related cognitive impairment significantly affects cancer management and decision-making. While the exact mechanisms underlying cancer-related cognitive dysfunction remain complex and multifaceted, different factors have been identified that may help predict which patients are at increased risk for cognitive decline. In this article, we provide a comprehensive overview of systemic cancer therapy-induced cognitive impairment in older adults, including signs and symptoms, diagnosis, and management. In addition, we discuss the evidence available on the impact of endocrine therapy, cytotoxic chemotherapy, immunotherapy and targeted agents on cognition in this population.

A phase II study of lurbinectedin with or without avelumab in small cell carcinoma of the bladder (laser)-design and rationale

Small cell carcinoma of the bladder is a rare, aggressive malignancy accounting for less than 1% of all bladder malignancies. Treatment regimens are drawn from the small cell lung cancer (SCLC) literature, with platinum and etoposide commonly used in the first-line setting. Unfortunately, responses are generally short-lived, and most patients relapse. There is little evidence to guide selection of later lines of therapy. Lurbinectedin is an alkylating agent with accelerated US FDA approval for use in patients with SCLC. Immune checkpoint inhibitors have also been approved for SCLC, improving survival when added to chemotherapy. This article describes the design and rationale behind LASER, an open-label phase II trial of lurbinectedin with or without avelumab.Clinical trial registration: NCT06228066 (ClinicalTrial.gov).

Patient and tumour characteristics in older patients (70 years or older) undergoing transperineal prostate biopsy: a retrospective cohort study

BACKGROUNDS

PSA screening is advocated in men with a life expectancy of >10 years. With a rising mean life expectancy of 81 years in Australia, many men in their 70s have life expectancies of >10 years. Additionally, advanced age is an independent risk factor for high grade prostate cancer. Hence, we aimed to identify patient and disease characteristics and outcomes of men >70 years undergoing transperineal prostate biopsies (TPB) for suspected prostate cancer.

METHODS

All patients aged 70 years old and above who underwent TPB for suspected prostate cancer between 1st January 2019 and 1st July 2022 at a large tertiary centre were identified. Data including patient Charlson Comorbidity Indices (CCI), pre-operative PSA, Multiparametric prostate MRI (mpMRI), histopathological results, subsequent intervention, and treatment intent (curative vs palliative) were obtained via scanned and electronic medical records.

RESULTS

Of 229 patients, median age was 74 years and 72.5% patients had a CCI of ≤4 (>53% estimated 10-year survival). 80.8% were diagnosed with prostate cancer and 65.9% had ISUP ≥ 2 disease. 86.4% of patients with PIRADS 4 or 5 lesions resulted in clinically significant prostate cancer. 3.9% had mild biopsy complications. 76.8% of those with prostate cancer underwent treatment with curative intent.

CONCLUSION

Men >70 years of age have a higher risk of clinically significant prostate cancer and low biopsy risk. Hence, many may benefit from early diagnosis and treatment. Decision on screening and further investigation should be based on assessment of individual risks, benefits and life expectancy.

The Association between All-Cause Mortality and Obstructive Sleep Apnea in Adults: A U-Shaped Curve

Rationale: The relationship between sleep apnea (SA) and mortality remains a topic of debate. Objectives: We explored the relationship between the severity of SA and mortality and the effect of age on this association. Methods: Using a veterans' database, we extracted an apnea-hypopnea index (AHI) from physician interpretations of sleep studies by developing a natural language processing pipeline (with 944 manually annotated notes), which achieved more than 85% accuracy. We categorized the participants into no SA (n-SA; AHI, <5), mild to moderate SA (m-SA; 5 ⩽ AHI < 30), and severe SA (s-SA; AHI, ⩾30). We propensity-matched the m-SA and s-SA categories with n-SA on the basis of age, sex, race, ethnicity, body mass index, and 38 components of the Elixhauser Comorbidity Index. Using logistic regression, we estimated the odds ratio (OR) for all-cause mortality using m-SA as a reference. Also, we stratified the findings on the basis of age: young, ⩽40; middle aged, >40 and <65; and older, ⩾65 adults. Results: We extracted the AHI on 179,121 propensity-matched participants (mean age = 45.85 [SD = 14.1]; BMI = 30.15 ± 5.37 kg/m2; male, 79.09%; White, 64.5%). All-cause mortality rates among three AHI categories showed a U-shaped curve (11.55%, 7.07%, and 8.15% for n-SA, m-SA, and s-SA, respectively), regardless of age group. Compared with m-SA, the odds of all-cause mortality in n-SA (OR, 1.72; 95% confidence interval = 1.65-1.79) and s-SA (OR, 1.17; 95% confidence interval = 1.12-1.22) were higher. Stratifying by age yielded consistent findings. Conclusions: All-cause mortality showed a U-shaped association with the AHI. Further investigations to understand the underlying mechanisms of this phenomenon are warranted.

[Clinical research in oncology in French Overseas Territories: Challenges, strengths, and available resources]

INTRODUCTION

Reducing territorial inequalities in access to care and innovations in oncology is an objective of the ten-year strategy to fight cancer. The populations of Overseas Territories (OT) face limits in terms of access to clinical research in oncology (CRO).

METHODS

The article aims to share an exhaustive inventory of the challenges observed in the development of CRO in the OT but also the means identified to respond to them, illustrated with recent successes in terms of setting up a CRO program.

RESULTS

CRO in the French OT presents unique challenges. To overcome these obstacles, the coverage of additional OT costs by supervisory authorities, legislative responses to remove regulatory constraints, the deployment of innovative solutions, telemedicine, continuing distance learning, patient partnerships, the contribution of HSS researchers and academic collaborations are all proven mechanisms. Several centres have recently demonstrated the feasibility of quality CRO from OT. These initiatives should be supported and extended. Indeed, by investing in OT, local and national authorities can strengthen the capacities of local actors to develop CRO that meets the needs of the population and the reality of these territories.

CONCLUSION

Overseas centers have been able to meet the challenges and have demonstrated the feasibility of carrying out CRO to provide overseas patients' access to innovative oncological treatments and contribute to the advancement of scientific knowledge in oncology.

[Implementation of geriatric oncology in a remote hospital in French Guiana]

INTRODUCTION

The aim was to analyze the implementation of the Onco-Geriatrics model in a remote ultramarine territory: West-French Guiana. The population is socially precarious in terms of income, social coverage and administrative status, and most often speaks a non-French language and has a non-Western culture.

METHODS

Narrative description of the implementation and retrospective study of anonymized data from the database of older patients managed for cancer between September 2014 and December 2020.

RESULTS

A total of 574 new patients were managed. Of these, 107 were aged 70 and over; 78 (73 %) had a G8 test. Forty-two patients had a multidimensional geriatric assessment (MGA). More than half the patients had dependency criteria, malnutrition and a high number of severe comorbidities. Difficulties encountered were language, level of education, clinical context (in 18 patients), but also insufficient involvement of health professional and the consequences of health organization and gradual implementation.

DISCUSSION

Implementation was impacted by the fact that quality criteria for implementation were not sufficient. Studies in high-middle-income countries in South America suggest that initial implementation of the MGA may be preferable, that frailty screening tests and the MGA procedure can be adapted to non-Western populations, and that the use of new technologies can improve the management of older patients in this context.

Describing the outcomes of frail patients undergoing treatment with systemic therapies for acute myeloid leukaemia: A systematic review

INTRODUCTION

Acute myeloid leukaemia (AML) is a disease of the older person. Due to the demands of intensive chemotherapy, there is a significant risk of over or undertreatment, leading to either iatrogenic harm or missed windows of opportunity for remission or cure. Better tools to aid clinical decision making and risk stratify patients are needed. We aimed to investigate the association between frailty and the treatment and disease-related outcomes of adults receiving systemic therapy for AML.

MATERIALS AND METHODS

A systematic search of PubMed, EMBASE, CINAHL, and Web of Science databases was undertaken for studies assessing frailty (defined as multi-dimensional assessment evaluating two or more geriatric relevant domains or usage of a validated geriatric assessment screening tool) in the setting of adults undergoing systemic therapy for AML.

RESULTS

We identified 6,644 publications, 16 of which met inclusion criteria for extraction. The most commonly described outcomes were overall survival (OS) (n = 12), mortality (n = 8), response rate (n = 6), and high grade toxicity (n = 5). Eleven studies correlated frailty with treatment outcomes: frailty was predictive of lower OS (n = 5), higher mortality (n = 3), and more high grade toxicity (n = 1). OS in particular retained this relationship when controlling for variables such as molecular markers and performance status. Significant heterogeneity in outcome reporting and frailty assessment precluded meta-analysis. Included studies were generally of moderate quality.

DISCUSSION

Frailty was predictive of poorer outcomes in patients with AML distinct from and complimentary to traditional disease prognostic schema. Routine implementation of frailty assessment could represent an important tool to risk stratify patients and improve clinical decision making.

Mitochondrial unfolded protein response-dependent β-catenin signaling promotes neuroendocrine prostate cancer

The mitochondrial unfolded protein response (UPRmt) maintains mitochondrial quality control and proteostasis under stress conditions. However, the role of UPRmt in aggressive and resistant prostate cancer is not clearly defined. We show that castration-resistant neuroendocrine prostate cancer (CRPC-NE) harbored highly dysfunctional oxidative phosphorylation (OXPHOS) Complexes. However, biochemical and protein analyses of CRPC-NE tumors showed upregulation of nuclear-encoded OXPHOS proteins and UPRmt in this lethal subset of prostate cancer suggestive of compensatory upregulation of stress signaling. Genetic deletion and pharmacological inhibition of the main chaperone of UPRmt heat shock protein 60 (HSP60) reduced neuroendocrine prostate cancer (NEPC) growth in vivo as well as reverted NEPC cells to a more epithelial-like state. HSP60-dependent aggressive NEPC phenotypes was associated with upregulation of β-catenin signaling both in cancer cells and in vivo tumors. HSP60 expression rendered enrichment of aggressive prostate cancer signatures and metastatic potential were inhibited upon suppression of UPRmt. We discovered that UPRmt promoted OXPHOS functions including mitochondrial bioenergetics in CRPC-NE via regulation of β-catenin signaling. Mitochondrial biogenesis facilitated cisplatin resistance and inhibition of UPRmt resensitizes CRPC-NE cells to cisplatin. Together, our findings demonstrated that UPRmt promotes mitochondrial health via upregulating β-catenin signaling and UPRmt represents viable therapeutic target for NEPC.

[Malaria control in French Guiana: What are the challenges in this last endemic French territory in 2024?]

French Guiana, the last malaria-endemic region of France, is facing an epidemic resurgence of malaria since the end of 2023. This epidemic, primarily caused by Plasmodium vivax, mainly affects populations that are far from the healthcare system. It has highlighted the difficulties of providing a full course of treatment. This includes both curative treatment with artemisinin derivatives (following the withdrawal of chloroquine from the market) and eradicative treatment with primaquine, with the challenge of excluding G6PD deficiency. The aim of this paper is to describe the problems of malaria diagnosis and management in this unique territory, to highlight the adaptations made and to propose diagnostic, therapeutic and follow-up schemes adapted to the possibilities of access to the health system, with a view to homogenizing practices. This article also highlights the innovative strategies implemented in French Guiana to deal with this new epidemic: health mediation, mobile malaria team, rapid diagnostic tests and immediate out-of-hospital treatment Test and Treat, development of self-diagnosis and self-treatment. These proposals are part of a campaign to eliminate malaria in France in the short term.

Clinical features and prognosis of small cell carcinoma of the bladder: a single center retrospective analysis

Background

Small cell carcinoma of the bladder (SCCB) is a rare and aggressive subtype, usually diagnosed at advanced stages. Due to its rarity, the clinical features, prognostic factors, and treatment strategies are not well defined, and data on long-term outcomes are limited. This study aims to analyze the clinical characteristics, treatment options, and prognostic factors of SCCB to enhance clinical understanding and guide practice.

Methods

A retrospective analysis of 41 SCCB cases treated at Changhai Hospital between 2006 and 2023 was conducted. Clinical, pathological, and treatment data were collected. The median follow-up duration was calculated as 41.0 months [95% confidence interval (CI): 31.3-50.7] using the reverse Kaplan-Meier method. Overall survival (OS) rates were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to identify prognostic factors.

Results

The median age was 71 years (range, 41-89 years). Pure SCCB accounted for 56.1% of cases, and 48.78% of tumors were located on the lateral bladder wall. Tumors ≥4 cm were found in 56.10% of cases. According to the tumor-node-metastasis (TNM) classification, 63.41% of patients underwent radical cystectomy, and 34.14% had lymph node or distant metastasis. None of the patients received neoadjuvant chemotherapy (NACT), while 41.03% underwent adjuvant chemotherapy post-surgery. The median OS was 30 months, with 1- and 3-year OS rates of 74.8% and 41.4%, respectively. Univariate analysis showed that T stage (P=0.002), lymph node metastasis (P<0.001), and distant metastasis (P<0.001) were associated with poor prognosis. Multivariate analysis confirmed T stage (P=0.04) and distant metastasis (P<0.001) as independent prognostic factors.

Conclusions

SCCB is often diagnosed at a late stage with gross hematuria as the most common symptom, Neoadjuvant therapy and immunotherapy can extend OS. T stage and distant metastasis are critical prognostic factors. Early diagnosis and intervention are crucial for improving outcomes.

A single centre experience of patients with rare cancers referred for early phase clinical trials

BACKGROUND

Cancers affecting < 6/100,000/year are classified as rare, but they account for up to 25% of all cancers and are associated with worse 5-year survival than common cancers. Early-phase clinical trials (EPCTs) may represent a viable treatment option for patients with rare cancers as they have evolved significantly with novel designs and the increasing use of precision medicine.

METHODS

A retrospective study of patients with rare cancers referred to a large EPCT team at a UK specialist centre over 5 years (2016-2020) was conducted. Patient demographics, medical and oncological history, genomic variants, EPCT participation, responses and survival outcomes were analysed.

RESULTS

In total, 240 patients with rare cancers were included. The mean age at diagnosis was 51.7 years (range 16-84), 54.2% of the patients were female. The most frequent rare cancers originated from the digestive system (27.1%), female genital tract (20%) and head and neck (H + N) (18.3%). Molecular profiling was offered to 45.5% of the population, median number of gene alterations was 3 per patient (range 1-20) while actionable gene alterations were reported in 60.2% (n = 50) of those with identified gene aberrations. Fifty-one patients participated in EPCTs, with 39.2% achieving SD and 11.8% PR. Median PFS for trial participants was three months (95% CI 1.12 - 4.88) while median OS in the trial patients was 16 months (95% CI 9.10 - 22.90) compared to 7 months for non-trial participants (95% CI 5.50 - 8.51). Finally, poor Royal Marsden Hospital (RMH) prognostic score (2-3) was correlated with worse survival when controlling for age and sex (HR 1.714, 95% CI 1.19 - 2.46, p = 0.004).

CONCLUSIONS

Participation of patients with rare cancers in EPCTs may be associated with a survival benefit and lead to the development of new treatments for these patients. Moreover, expanded use of precision medicine is paramount as it can inform targeted treatment selection in this heterogenous group.

Chinese management guidelines for radioactive iodine-refractory differentiated thyroid cancer (2025 edition)

PURPOSE

Radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) has become a challenge in clinical practice, particularly in China with a high incidence and undesirable survival outcome. Since the publication of first China consensus on the diagnosis and treatment of RAIR-DTC in 2019, significant and rapid advances have occurred in the field both in China and internationally. This guideline aims to inform Chinese clinicians, researchers, patients, and health policy makers on the latest evidence and recommendations, to further standardize the clinical diagnosis and treatment of RAIR-DTC.

METHODS

The structured clinical questions addressed in this guideline were derived from clinical diagnostic and treatment processes, with references to study, prior guidelines, expert consensus, and systematic reviews, etc. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used for quantitative and qualitative evaluation of the evidence. The editorial process was completely independent of the guideline development group.

RESULTS

The guideline addressed 26 clinical questions and formed 35 recommendations. In this guideline, the definition criteria for RAIR-DTC was optimized, prediction and identification was based on evidence including molecular testing, dynamic biochemical changes, and multimodal imaging. Comprehensive pre-treatment clinical evaluation was emphasized and tailored for individualized decision-making. The combination of systematic therapy and surgery, and the redifferentiation followed by RAI therapy were also reviewed and updated. Molecular imaging plays a unique role in the pre-assessing and therapeutic response evaluation for RAIR-DTC.

CONCLUSIONS

We have updated and developed evidence-based recommendations with the aim of providing scientific, rigorous, and comprehensive guidance for the clinical diagnosis and treatment of RAIR-DTC patients in China. We hope to share our guideline with colleagues out of China, with the expectation of further comments and suggestions.

Pathological complete response with cocktail chemotherapy in mediastinal seminoma

A mediastinal mass can present a diagnostic challenge, especially when symptoms necessitate urgent treatment. Mediastinal seminoma, a rare extragonadal germ cell tumour, shares clinical features with testicular seminoma, such as slow growth and high sensitivity to chemotherapy and radiotherapy. This case is of a man in his 40s presenting with cough and chest discomfort, with imaging revealing a large anterior mediastinal mass that was causing left diaphragmatic paralysis due to phrenic nerve involvement. Urgent CT of chest, abdomen and pelvis and tissue biopsy supported the diagnosis of mediastinal seminoma, prompting the immediate initiation of chemotherapy with an induction dose of etoposide and cisplatin, followed by the cisplatin, vincristine, methotrexate, bleomycin alternating with actinomycin D, cyclophosphamide, etoposide regimen. This approach led to significant tumour reduction, facilitating complete surgical resection and sparing of the right phrenic nerve. Despite early fluorodeoxyglucose-positron emission tomography suggesting residual activity, resection histopathology confirmed no malignant cells. The patient achieved a favourable outcome, underscoring the importance of rapid treatment initiation, effective chemotherapy regimens and multidisciplinary management in mediastinal seminoma cases.

'It Felt Like Finding Hope Only to Lose It Again': A Grounded Theory Study of Rare Cancer Policies in Bulgaria

Rare cancers, defined by an annual incidence of fewer than 6 per 100,000 cases, pose significant challenges due to their complexity, lack of expertise, and limited treatment options. In Bulgaria, these challenges are compounded by limited resources, fragmented care, and outdated policies. This study investigates policy stakeholder perspectives to identify gaps and propose policy alternatives for rare cancer care in Bulgaria, with implications for the broader European Union (EU) context. A grounded theory qualitative research design was employed to explore stakeholder insights. Eight key stakeholders, including policymakers, healthcare providers, patient advocates, and pharmaceutical representatives, participated in semi-structured interviews. Data was analyzed through thematic coding to map policy gaps and develop viable alternatives. Stakeholders highlighted significant gaps in funding, access to innovative therapies, and care organization. Four policy approaches emerged: Liberal, advocating for inclusivity and decentralized care; Conservative, emphasizing cost control and centralization; Balanced, integrating elements of both; and Status Quo, retaining the current system. While centered on Bulgaria, these findings address universal challenges in rare cancer care, offering a framework adaptable to other EU countries. Adopting tailored policies can reduce disparities, improve patient outcomes, and align national strategies with EU objectives, particularly under Europe's Beating Cancer Plan and the EU Cancer Mission.

Managing elderly patients with dual metastatic cancers-navigating diagnostic and treatment challenges

Prostate and colorectal adenocarcinoma are among the most common primary cancer diagnoses in the United States, with 29% of new cancer diagnoses among adult men in 2024 expected to arise from the prostate and another 15% across men and women being colorectal in origin. Given therapeutic advancements leading to improved survival, individuals with prostate cancer have the highest estimated probability of concurrent secondary primary malignancy. This represents a clinical dilemma as the treatment for each is distinct and impacted by histology, stage, and molecular findings. Herein, we describe a patient with significant comorbidities, found to have simultaneous metastatic prostate and colorectal adenocarcinomas, who achieved sustained complete remission of liver and lung metastases with a chemohormonal regimen.

Hospital care trajectories of older adults with cancer and the associated clinical profiles

BACKGROUND

The longitudinal hospital care experiences of older adults with cancer, from the treatment decision-making process until their end of life, remain unexplored. We examined the hospital care trajectories of these patients and identified associated clinical determinants.

MATERIALS AND METHODS

We linked the ELCAPA multicenter cohort study (patients aged ≥70 with a solid tumor and having been referred for a geriatric assessment between 2012 and 2019) and the Greater Paris University Hospitals' clinical data warehouse. Individual care trajectories, defined as series of consultations, hospital admissions (in day, acute, or rehabilitation units), and emergency room (ER) visits, were clustered using multichannel sequence analysis. Cluster membership determinants were identified among socio-demographic, oncological, and geriatric parameters by logistic regression analysis.

RESULTS

Seven hundred seven patients (median age: 82; metastatic cancer: 45.2%; 10 998 care episodes) were included. Four trajectory clusters were identified: cluster A (n = 149, 21.1%) with in-hospital surgical trajectories, cluster B (n = 198, 28.0%) with outpatient care trajectories with chemotherapy and/or radiotherapy, cluster C (n = 302, 42.7%) without any hospital cancer treatments, and cluster D (n = 58, 8.2%) with mostly chemotherapy and high hospital care consumption. Cluster belonging determinants included metastatic status and cancer site (for cluster A); cognition, mobility, and mood status (unimpaired parameters for cluster B and impaired for cluster C); and younger age (for cluster D).

CONCLUSIONS

While highlighting varied hospital care experiences among older patients with cancer, we found that age remains an independent determinant of chemotherapy-dominant care trajectories.

A systematic review and meta-analysis of intracorporeal versus extracorporeal urinary diversion after robotic-assisted radical cystectomy in elderly patients with malignancy

Recent studies have highlighted the progress of robotic-assisted radical cystectomy (RARC), yet information on intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD), especially in elderly patients, remains limited. This review seeks to address this gap in the literature. A systematic literature review was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases, following the PRISMA guidelines. Studies comparing ICUD to ECUD in patients aged ≥ 65 years. We combined the data using weighted mean differences (WMD) or odds ratios (OR) with random-effects models. For results showing moderate-to-high heterogeneity, a sensitivity analysis was performed by sequentially excluding individual studies. Nine studies comprising 4340 patients (1967 in ICUD and 2373 in ECUD) were included in the meta-analysis. ICUD was associated with significantly lower estimated blood loss (WMD: - 64.34 mL, 95% CI: - 113.26, - 15.42, P = 0.01), reduced blood transfusion rates (OR: 0.29, 95% CI: 0.11, 0.76, P = 0.01), and fewer overall gastrointestinal complications (OR: 0.65, 95% CI: 0.46, 0.92, P = 0.016) compared to ECUD in patients aged 65 and older. No significant differences were found in operative duration, length of hospitalization, or 30-day/90-day complication and readmission rates. Sensitivity analysis indicated low evidence for outcomes such as blood loss and transfusion rates. Overall, elderly patients undergoing RARC may benefit from ICUD in terms of reduced blood loss, lower blood transfusion rates, and fewer gastrointestinal complications. However, large prospective randomized studies are still required to confirm these findings.

Testicular Germ Cell Tumors: A Review

Importance

Testicular cancer is the most common solid malignancy among males aged 15 to 40 years in the US, with approximately 10 000 new cases diagnosed each year. Between 90% and 95% of testicular cancers are germ cell tumors (GCTs).

Observations

The mean age at diagnosis for testicular cancer is 33 years. GCTs are categorized as seminomas and nonseminomatous GCTs (NSGCTs) based on their embryonic origins and path of differentiation. Risk factors include cryptorchidism, family history of testicular cancer, gonadal dysgenesis, infertility, cannabis use, and genetic conditions such as Klinefelter syndrome. The most common presenting symptom of testicular cancer is a painless testicular mass. History, physical examination, scrotal ultrasound, laboratory assessment of GCT-associated serum tumor markers (α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase), and prompt referral to a urologist are indicated when testicular cancer is suspected. Early diagnosis and treatment, starting with a radical inguinal orchiectomy, are important to optimize outcomes. At diagnosis, GCT is stage I (localized to the testicle) in 70% to 75% of patients, stage II (metastatic only to the retroperitoneal lymph nodes) in 20%, and stage III (widely metastatic) in 10%. Treatment of GCTs is guided by histology, clinical staging, and risk classification, with 5-year survival rates of 99%, 92%, and 85% for those diagnosed at stages I, II, and III, respectively. Optimal treatment often involves a multidisciplinary team at high-volume, experienced medical centers and may include surveillance (serum tumor markers [α-fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase] and imaging of the chest, abdomen, and pelvis), surgery (retroperitoneal lymph node dissection), chemotherapy, and/or radiation. Treatment decisions should consider long-term survivorship concerns, including body image, fertility, hypogonadism, mental health, financial cost, adherence to follow-up, and late adverse effects of therapy such as cardiovascular disease, secondary malignancies, and potential psychosocial effects such as anxiety, depression, and social isolation.

Conclusions and Relevance

Testicular cancer is the most common solid malignancy in young men in the US, and 90% to 95% are GCTs. Patients with testicular GCT have a 5-year survival rate of 99%, 92%, and 85% for stages I, II, and III, respectively. Prompt diagnosis and treatment are important to optimize outcomes, and treatment decisions should balance oncologic control with survivorship concerns to minimize long-term adverse effects of treatment.

Real-world effectiveness and cardiovascular safety of abiraterone versus enzalutamide amongst older patients diagnosed with metastatic castration-resistant prostate cancer

INTRODUCTION

Abiraterone and enzalutamide are both approved in the United States for the treatment of metastatic castration-resistant prostate cancer (mCRPC). The objective of this study was to compare the real-world effectiveness and cardiovascular safety of these agents, drawing from a cohort of older adult patients diagnosed with mCRPC.

MATERIALS AND METHODS

The Surveillance, Epidemiology, and End Results-Medicare database was used to conduct an observational study comparing three-year overall survival and one-year risk of major adverse cardiovascular events (MACE) between initiators of abiraterone or enzalutamide between September 2012 and June 2017. Inverse-probability-of-treatment weighting was used to balance measured confounders. MACE was defined as a hospitalization for myocardial infarction, heart failure, or ischemic event (stroke or transient attack). Results were additionally stratified by levels of a claims frailty index (robust, prefrail, frail) and the presence of baseline cardiovascular comorbidities.

RESULTS

The study population consisted of 4622 male adults 66 years of age and older diagnosed with mCRPC, of which 2430 initiated abiraterone and 2192 enzalutamide. The adjusted three-year overall survival was lower in patients initiating abiraterone (27.9 %) than enzalutamide (31.5 %) (adjusted survival difference [aSD] = -3.6 %, 95 % CI: -6.2 %, -0.9 %). In frailty-stratified analysis, no survival difference was found for the robust (aSD = 0.6 %, 95 % CI: -5.0 %, 6.3 %) or frail (aSD = -1.2 %, 95 % CI: -6.1 %, 3.7 %) subgroups, but there was lower survival with abiraterone for the prefrail group (aSD = -5.9 %, 95 % CI: -9.6, -2.3). The adjusted one-year risk of MACE was higher in abiraterone initiators (5.5 %) than enzalutamide initiators (3.6 %) (adjusted risk difference [aRD] = 1.8 %, 95 % CI: 0.6 %, 3.1 %); the increase was significant in the frail (aRD = 4.8 %, 95 % CI = 1.4 %, 8.3 %) and pre-frail subgroups (aRD =1.9 %, 95 % CI: 0.1 %, 3.6 %) but not the robust subgroup (aRD = -0.3 %, 95 % CI: -1.8 %, 1.2 %).

DISCUSSION

The three-year survival of abiraterone initiators was slightly lower than that of enzalutamide initiators, though the agents showed similar survival for patients with robust fitness. A one-year increase in MACE risk was observed in abiraterone initiators, especially amongst frail individuals, highlighting the importance of assessing frailty during therapy selection.

Impact of a comprehensive geriatric assessment to manage elderly patients with locally advanced non-small-cell lung cancers: a multicenter prospective study

PURPOSE

Concurrent chemoradiotherapy (cCRT) is the standard treatment for locally advanced and unresectable non-small-cell lung cancer. Population is aging, and Geriatric assessment (GA) has demonstrated its paper to select fit patients for active treatment and vulnerable, frail patients for interventions and/or palliative care in many histologies. Its role in locally advanced, unresectable non-small-cell lung cancer has been less explored.

METHODS

To assess the capability of GA to detect frail patients not suitable for active treatment, we developed this exploratory non-interventional prospective study. All patients ≥ 70 years diagnosed with stage locally advanced and unresectable non-small-cell lung cancer were invited to undergo geriatric assessment. Secondary aims were description of population, exploring GA as prognostic factor, determination of toxicity profile and look for a frailty biomarker.

RESULTS

From June 2017 to June 2020, 51 patients were included, of whom 35% (n:18) were classified as frail. Frail patients had less overall survival and more grade 3-4 toxicity. Exploratory results for frailty phenotype are described in the text.

CONCLUSIONS

With the results of our study, we confirm that GA can detect frail patients unsuitable for treatment, with a higher risk of toxicity and less overall survival. A trend toward blood-test results for phenotype frailty can be hypothesis generation.

[Aggressive variant prostate cancer and transdifferentiated neuroendocrine prostate cancer: from diagnosis to therapy]

Aggressive variants of prostate cancer (AVPC) comprise a heterogeneous group of prostate carcinomas characterized by androgen-independent, aggressive tumor growth. Clinically, they are characterized by prostate-specific antigen (PSA)-negative progression and an atypical metastatic pattern with increased visceral and osteolytic metastasis. Based on immunohistochemistry and transcriptome profiling, AVPC are divided into four subgroups: neuroendocrine prostate cancer (NEPC), amphicrine prostate cancer, androgen receptor-low expressing prostate cancer and double-negative prostate cancer. However, differentiating between the subgroups can be challenging. For the transformation process of an adenocarcinoma into an AVPC, so-called transdifferentiation, the inactivation of the tumor suppressor genes RB1, PTEN and TP53 plays a crucial role. Epigenetic changes contribute to the development of stem cell-like properties. AVPC is mostly treated with platinum-based chemotherapy, depending on the subtype in combination with etoposide or a taxane. New therapeutic approaches are investigating the use of chemotherapy combinations with PARP inhibitors, checkpoint inhibitors or immunomodulators. In addition, T‑cell engagers have achieved initial promising results, particularly in NEPC. Treatment of AVPC patients in trials is desirable to improve evidence for this aggressive form of prostate cancer.

Optimal imaging techniques across the spectrum of testicular cancer

Over the years, several imaging techniques have been used in the diagnosis and management of testicular cancer. We compartmentalize disease stages into preorchiectomy, stage 1, initial stage 2 and 3 and postchemotherapy stage 2 and 3. We then elaborate on various imaging modalities that are relevant to each of these stages. We also describe evolving imaging tools that have shown promise. We attempt to provide a comprehensive review of these techniques over the spectrum of testicular cancer.

Systemic treatment among frail older patients with cancer: An observational cohort

INTRODUCTION

In the past, certain oncological therapies were not offered to frail older patients. However, the advancement of geriatric oncology, tailored chemotherapy regimens, the introduction of new treatments, and the optimization of supportive care have contributed to enhancing the therapeutic margin. We aimed to evaluate the benefit of systemic treatment among older adults by assessing the three-month survival of older frail patients with metastatic cancer.

MATERIALS AND METHODS

This retrospective cohort study included patients aged 70 and over with metastatic cancer who underwent pre-therapeutic geriatric assessment at Gustave Roussy Hospital between May 2020 and May 2022 and were categorized as "frail" according to the SIOG-1 classification, whether they received systemic treatment (ST group) or exclusive supportive care (SC group).

RESULTS

The ST group included 77 patients, and the SC group included 44 patients. Patients in the ST group had a median age of 80.6 years (82.7 years in SC group). The three-month overall survival rate was 81.8 % [95 % Confidence Interval (CI) 71.8; 88.9] in the ST group. The median survival rate was 10.6 months [95 % CI 6.3; 12.6] in the ST group. In multivariate analysis within the ST group, loss of autonomy assessed by activity of daily living (ADL) (HR 2.16 [1.09; 4.28]) and more frailty factors (HR 1.40 [1.01; 1.95]) were associated with lower three-month survival.

DISCUSSION

Older frail patients with metastatic cancer may benefit from systemic oncologic treatment. The introduction of such treatment for patients with loss of autonomy in ADL or cumulative frailty factors should be considered only with caution.