Cell cycle dysregulation in cancer

Cancer is a systemic manifestation of aberrant cell cycle activity and dysregulated cell growth. Genetic mutations can determine tumor onset by either augmenting cell division rates or restraining normal controls such as cell cycle arrest or apoptosis. As a result, tumor cells not only undergo uncontrolled cell division but also become compromised in their ability to exit the cell cycle accurately. Regulation of cell cycle progression is enabled by specific surveillance mechanisms known as cell cycle checkpoints, and aberrations in these signaling pathways often culminate in cancer. For instance, DNA damage checkpoints, which preclude the generation and augmentation of DNA damage in the G1, S, and G2 cell cycle phases, are often defective in cancer cells, allowing cell division in spite of the accumulation of genetic errors. Notably, tumors have evolved to become dependent on checkpoints for their survival. For example, checkpoint pathways such as the DNA replication stress checkpoint and the mitotic checkpoint rarely undergo mutations and remain intact because any aberrant activity could result in irreparable damage or catastrophic chromosomal missegregation leading to cell death. In this review, we initially focus on cell cycle control pathways and specific functions of checkpoint signaling involved in normal and cancer cells and then proceed to examine how cell cycle control and checkpoint mechanisms can provide new therapeutic windows that can be exploited for cancer therapy. SIGNIFICANCE STATEMENT: DNA damage checkpoints are often defective in cancer cells, allowing cell division in spite of the accumulation of genetic errors. Conversely, DNA replication stress and mitotic checkpoints rarely undergo mutations because any aberrant activity could result in irreparable damage or catastrophic chromosomal missegregation, leading to cancer cell death. This review focuses on the checkpoint signaling mechanisms involved in cancer cells and how an emerging understanding of these pathways can provide new therapeutic opportunities for cancer therapy.

Controversies in the organization and structure of management for rare tumors

More than half of all gynecological cancers are classified as rare (annual incidence <6 per 100,000), and present significant challenges in diagnosis, management, and research. Rare cancers collectively comprise more than 20% of new cancer diagnoses and exceed the burden of individual common cancers. Their rarity complicates evidence-based guideline development, clinical trial design, and drug access, and is exacerbated by variations in epidemiology, histology, and biological behavior. Key controversies include the need for centralized pathological reviews and harmonized diagnostic criteria. Recent World Health Organization classification updates, such as the redefinition of ovarian and fallopian tube cancers, illustrate the impact of evolving guidelines on epidemiology and patient management. Variations in the classification among pathologists and limited access to molecular diagnostics further hinder effective management. Multidisciplinary care in expert centers improves outcomes; however, significant geographic and resource disparities persist. National and international collaborations including European Reference Network for rare adult solid tumors, Gynecologic Cancer Intergroup, Gynecologic Oncology Group, Asia-Pacific Gynecologic Oncology Trials Group, and European Network for Gynaecological Oncology Trials have made strides in standardizing care and advancing research. Novel trial designs, such as basket and umbrella trials, alongside synthetic control arms, are essential for addressing the small sample sizes typical of rare tumors. Emerging consortia, such as International Ovarian Tumor Tissue Analysis Consortium and International Consortium for Low-grade Serous Ovarian Cancer, provide robust platforms for translational research and biomarker validation. However, challenges remain in fostering cross-border collaboration, streamlining regulatory pathways, and ensuring equitable access to trials and therapy. To optimize outcomes, a comprehensive approach that integrates centralized care, innovative trial designs, and international networks is imperative. This paradigm fosters the harmonization of care, accelerates translational research, and bridges the gap between scientific innovation and patient benefits.

Comprehensive assessment in uro-oncologic geriatric patients: interdisciplinary management to improve survival

Urological cancers represent 13.1% of cancer cases in the world, with a mean age of diagnosis of 67 years, making it a geriatric disease. The lack of participation and evaluation of treatments by the geriatric oncologic population has made their mortality rate higher than that of other oncologic population groups, urologic cancers being no exception. The comprehensive management of older people with urological cancers is a bet that is presented to improve the quality of life and survival of this group. Managing elements such as nutritional, physical, cognitive, psychosocial, and sexual status improves the chances of adherence and treatment, contributing significantly to improving the quality of life. The integrated management of the geriatric oncology population has brought positive effects on quality of life, enhancing levels of depression and anxiety and also allowing the classification of oncology patients based on other criteria in addition to their chronologic age, contributing to the management of specialized treatments that have allowed the implementation of more specific interventions with better results.

Association Between Lupus Nephritis and Renal Clear-Cell Carcinoma: A Case Report and Review of the Literature

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting several organs, including the kidneys, potentially leading to lupus nephritis (LN). SLE has also been associated with several neoplasias, but its relation to renal cell carcinoma (RCC) has been little explored. We report a young women diagnosed concomitantly with LN and RCC. The latter was discovered incidentally during an investigation of nephrotic syndrome and confirmed on histology and renal microscopy. The patient was submitted to partial nephrectomy and immunosuppression, with good outcome, as shown by the improvement in proteinuria and other symptoms. Our case highlights the complexity of diagnosing SLE in combination with RCC and the importance of permanent surveillance and multidisciplinary approach to optimize treatment.

Minimal change glomerular disease associated with solid neoplasms: a systematic review

BACKGROUND

Paraneoplastic minimal change disease (MCD) has been associated with hematological malignancies, whereas solid malignancies are commonly associated with membranous glomerulonephritis. In this systematic review of the literature, we describe the clinical features, treatment and outcome of MCD associated with solid neoplasms.

METHODS

We performed a systematic review of the MEDLINE, COCHRANE, EMBASE and SCOPUS databases, including case reports of adult patients with biopsy-proven MCD and solid malignancy, without language or time restrictions.

RESULTS

Sixty-seven papers were included, presenting 86 cases with a mean age of 57.8 ± 14.7 years; 41.0% were women. Nephrotic syndrome was the initial presentation in 96.2% of patients; 67.2% had kidney function impairment, and 21.2% required kidney replacement therapy. The most frequent malignancies were malignant thymoma (34.9%), kidney (14.0%), lung (12.8%), and gastrointestinal tumors (12.8%). In 40.7% of cases, the neoplasm diagnosis preceded MCD by 33.8 ± 46.1 months, while in 31.4%, it followed diagnosis of MCD by 12.4 ± 22.6 months. In 27.9%, the neoplasm and kidney disease were diagnosed simultaneously. Immunosuppressive therapy was started in 79.1% of cases and tumor-specific treatment in 83.7%. Remission of MCD was achieved in 80.2% of patients: 38.2% responded to immunosuppressive treatment alone and 29.6% to oncological treatment alone.

CONCLUSIONS

The association between MCD and solid neoplasms is well-documented. Immunosuppressive therapy alone induced nephrotic syndrome remission in over one-third of cases; most others responded to tumor-specific treatment. Solid tumor screening should be considered in MCD independently of the steroid response, though more data on solid tumor-associated MCD prevalence are needed for a definitive statement.

PROSPERO TRIAL REGISTRATION NUMBER

CRD42024521854.

Computed tomography-determined high visceral adipose tissue and sarcopenic obesity and their associations with survival in vulnerable or frail older adults with cancer considered for systemic anticancer treatment

INTRODUCTION

Treatment decisions are challenging in older adults with solid tumors. Geriatric 8 (G8)-screening and comprehensive geriatric assessment (CGA) are important but additional methods are needed. We examined the association of computed tomography (CT)-derived high visceral adipose tissue index (VATI) with or without low skeletal muscle index (SMI) on three-month and overall survival (OS).

MATERIALS AND METHODS

Vulnerability was evaluated with G8 in patients ≥75 years referred for systemic anticancer treatment. Vulnerable/frail patients (G8 ≤ 14) received CGA and were included. VATI and SMI were retrospectively measured from CT scans. We examined associations between high VATI with or without low SMI and three-month and OS with Cox regression models and Kaplan-Meier estimation.

RESULTS

Seventy-nine patients with median age of 80 (range 75-91) years were evaluated. In the palliative-intent group (n = 58), three-month OS rates were 88 % and 58 % in the normal and high VATI groups, respectively (hazard ratio 4.3; 95 % confidence interval 1.3-14), and 88 % vs. 47 % in group without and with 'high VATI+low SMI', respectively (5.5; 1.9-17). The median OS was 12.7 vs. 9.5 months in normal VATI/SMI and 'high VATI+low SMI' (1.9; 1.1-3.2), respectively. In Cox multivariable models with established predictive factors (ECOG PS, Clinical Frailty Scale, and sex), only high VATI (4.9; 1.0-24) or 'high VATI+low SMI' (8.9; 1.7-46) remained significant predictors of three-month OS.

DISCUSSION

High VATI with or without low SMI were associated with impaired three-month OS in the palliative-intent group and with OS in the whole cohort independently of oncologic and geriatric functional status measures; thus, they may aid in treatment decision-making.

Body Image and Self-Identity in Transgender Patients: A Comprehensive Review from a Psycho-Oncological Perspective

As the number of transgender and gender-diverse (TGD) individuals seeking gender-affirming care continues to increase, it is crucial for healthcare providers to acknowledge the distinct challenges that this community faces and to offer personalized care. This article proposes a comprehensive review aimed at synthesizing current knowledge on the psycho-oncological challenges faced by TGD individuals. By exploring existing literature, it seeks to identify research gaps and provide a framework for addressing the intersection of gender identity, body image, and cancer-related healthcare needs. We aim to explore the complex relationship between being transgender and an oncologic patient, focusing primarily on the effects of gender-affirming hormone therapy (GAHT) and the implications of anatomical structures that remain after gender-affirming surgeries. The complex interplay between GAHT and cancer risks is highlighted, emphasizing the need for ongoing monitoring and tailored healthcare strategies. Psychological aspects of body image and self-identity among transgender individuals, particularly in the context of cancer treatment, are explored, as these treatments may involve significant bodily changes. For TGD individuals, these changes are intricately linked to their sense of identity and self-worth, leading to heightened distress and impaired quality of life. The disruption of sexual function due to cancer treatments can profoundly impact sexual identity and relationships, areas already vulnerable in the TGD population due to societal stigma. The role of social factors in shaping the experiences of TGD individuals in healthcare settings is also discussed, noting how these stressors can influence both the accessibility and quality of care. Research and clinical practice currently face gaps, and more comprehensive studies and guidelines that address the specific healthcare needs of TGD patients are warranted. The importance of an interdisciplinary approach, combining oncological care with gender-affirming practices, is underscored as essential for improving the overall health outcomes and quality of life for TGD individuals facing cancer.

Radioresistant, Rare, Recurrent, and Radioinduced: 4Rs of Hadrontherapy for Patients Selections

Purpose

To describe the role of hadrontherapy (HT) in treating radioresistant, rare, recurrent, and radio-induced tumors, which can be defined, in assonance with the 4Rs of radiobiology, the "4Rs" of HT indications.

Materials and Methods

This is a narrative review written by a multidisciplinary team consisting of radiation oncologists, radiobiologists, and physicists on the current literature on HT, particularly carbon ion radiation therapy. To refine HT indications within the context of the "4Rs" framework, we evaluated tumor histologies across different clinical indication settings and emphasized the radiobiological mechanisms contributing to the effectiveness of HT.

Results

For rare, radioresistant, recurrent, and radio-induced tumors, HT has proven to be effective and safe, achieving high rates of local response with mild toxicity. The current review shows that the biological parameters can assist clinicians in identifying appropriate cases for HT treatment.

Conclusion

Biological characteristics of the tumor support the administration of HT in radioresistant, rare, recurrent, and radio-induced tumors and should be considered during multidisciplinary discussions.

[Rare subtypes of lung cancer]

In Europe, a rare cancer is defined as having an incidence rate of less than 6/100,000. Rare lung cancers encompass many entities defined by the 2021 WHO classification of thoracic tumors, and represent around 10% of all lung cancers. Rare lung cancers involve several histological types (carcinoma, sarcoma and lymphoma), each of which comprises several entities. The management of these patients with rare cancers requires specific medical expertise at every level (diagnosis, treatment and follow-up). These patients should therefore be referred to expert centers affiliated with national networks, giving them appropriate care and better access to innovative treatments. The deployment of systematic molecular characterization of these tumors has allowed for the identification and better characterization of specific entities. Some entities are specific to the lung, while others are more commonly found in other organs. In this review, we will only consider malignant lung tumors with an incidence of less than 1%.

Advancing Breast Cancer Care in Patients Aged 80 and Above: A Personalized and Multidisciplinary Management to Better Outcomes

Background: Breast cancer in women aged 80 years and older accounts for about 12% of cases, but its management is challenging due to the population's heterogeneity and the lack of relevant evidence-based guidelines. Treatment decisions must consider biological age, comorbidities, life expectancy, therapy-related toxicities, and tumor biology. This study evaluates the clinical outcomes of elderly breast cancer patients treated with a multidisciplinary approach, including oncologists, surgeons, and geriatric specialists. Materials and Methods: A retrospective analysis of breast cancer patients aged ≥80 years treated at Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy, from January 2016 to December 2020 was conducted. The study reviewed clinicopathological data, surgery, adjuvant therapies, and clinical outcomes. Treatment decisions were guided by multidisciplinary evaluations, including onco-geriatric assessments (GA) and guided treatment decisions. Primary outcomes included overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS). Surgical and treatment-related complications were also documented. Results: A total of 238 patients aged ≥80 years were included in the study. Of these, 203 (85.3%) underwent breast-conserving surgery, while 35 (14.7%) underwent mastectomy. Axillary surgery was performed in 129 (54%) cases. Regarding adjuvant treatments, 93 (39.1%) patients received radiotherapy, and 101 (42.4%) received endocrine therapy alone. Chemotherapy was administered to six high-risk patients following GA, with no reported toxicities. Over a median follow-up of 42.3 months, the study reported one local recurrence (0.5%), one regional node recurrence (0.5%), and 19 cases of distant metastases (9%). A total of 19 patients (9%) died due to breast cancer. The overall complication rate was low, with 10% experiencing wound dehiscence, hematoma, lymphedema, or similar issues. Five-year survival outcomes were OS 73.3%, DFS 66.6%, and CSS 88.5%. Conclusions: This study highlights that a multidisciplinary approach to breast cancer management in patients aged ≥80 years yields favorable clinical outcomes with low recurrence, metastasis, and complication rates. The personalized treatment strategies, guided by onco-geriatric assessments, balance survival benefits with quality of life while minimizing risks of overtreatment or undertreatment. These findings emphasize the importance of individualized care in this complex patient population and offer valuable insights for optimizing management strategies as the elderly demographic continues to grow.

Nurse-community health mediator pairs: a promising model for promoting the health of populations in remote areas of the French Amazon

Multicultural Amazonian populations in remote areas of French Guiana face challenges in accessing healthcare and preventive measures. They are geographically and administratively isolated. Health mediation serves as an interface between vulnerable people and the professionals involved in their care. This approach aims to improve the health of Amazonian populations by addressing their unique challenges, including social and health vulnerabilities, as well as language and cultural barriers. A Mobile Public Health Team (MPHT) relying on health mediation was created in 2019. Comprising six nurse-community-health mediator pairs who receive ongoing specialised training, along with a coordination team of one physician and two public health nurses, the MPHT is connected to the 17 Prevention and Care Remote Centres across the territory. This article presents a community case study of the MPHT of the remote areas in French Guiana and the description of the activities of this health promotion programme in the context of the COVID-19 pandemic in 2021. The MPHT carried out health promotion initiatives, often in collaboration with partners, focusing on health priorities of the Amazonian territories. The interventions were co-designed with community leaders and local populations to ensure relevance and effectiveness. In response to the COVID-19 pandemic, the MPHT reached over 6,000 individuals in addition to more than 3,000 participants in a water, hygiene and sanitation education programme. The team performed 83 health promotion interventions on eight different topics, including 28 in the general population (922 people reached) and 55 in schools (n = 930). The MPHT produced 20 communication tools, which were adapted and translated into eight languages. The team also participated in managing six simultaneous epidemic events, including malaria, diphtheria, and tuberculosis. This study highlights how the combined expertise of healthcare professionals and the mediation skills of community health workers effectively addressed the specific health needs of the multicultural Amazonian populations. This model for addressing social and health inequities should encourage institutional recognition of the community health mediator model.

What do patients with a rare cancer living in rural, regional or remote areas and stakeholders want from a peer support program? A qualitative study

BACKGROUND

Patients with a rare cancer in rural, regional, and remote Australia experience heightened challenges in their illness journey, including significant psychosocial impacts. Although peer support has shown benefits for common cancer patients living in urban areas, these programs often do not reach underserved groups for instance those with a rare cancer, or those living in rural, regional or remote areas. This study aimed to explore the characteristics of peer support programs for patients with a rare cancer living in rural, regional or remote areas.

METHODS

Focus groups and interviews were conducted with 39 people with a rare cancer and 10 healthcare providers to explore key points for inclusion in a peer support service for people diagnosed with a rare cancer living in rural, regional or remote areas. Data were transcribed verbatim and analysed thematically, using Nvivo.

RESULTS

Participants described their peer support needs using the key terms who, what, how, where, and when. Participants advocated for a flexible, multicomponent intervention that could meet the varied and fluctuating needs of this group. Participants also noted challenges with the practical delivery of such a service, specifically, the risk of receiving misinformation, adverse emotional reactions, interpersonal challenges and implementation issues.

CONCLUSIONS

This study highlights the role of peer support in addressing unmet needs of patients with a rare cancer, particularly in rural areas, emphasising the importance of tailored, flexible, and multimodal interventions for the delivery of peer support that addresses diverse needs.

Diagnostic utility of MRI-based convolutional neural networks in soft tissue sarcomas: a mini-review

Purpose

This review assesses the diagnostic performance of MRI-based convolutional neural networks for identifying and grading soft tissue sarcomas, evaluating therapy responses, and assessing the risk for metastases and recurrences.

Methods

Electronic databases, specifically PubMed/MEDLINE and Google Scholar, were diligently scoured for studies that delved into the intersection of convolutional neural networks, soft tissue sarcomas, and MRI. Three topics were included: 1) differentiating and grading soft tissue sarcomas, 2) assessing therapy response, and 3) predicting metastases and recurrences.

Results

This review included 12 articles. Seven articles investigated the differentiation and grading of soft tissue sarcomas. Sensitivity for that issue ranged from 0.85 to 0.95, specificity from 0,33 to 1, and the area under the curve (AUC) from 0.74 to 0.96. Three articles investigated therapy responses, and two discussed metastasis and recurrence prediction. Only one article out of the five articles above presented accurate diagnostic values. That article examined the prediction of lung metastases and demonstrated a sensitivity of 0.47, a specificity of 0.97, and an AUC of 0.83.

Conclusion

AI applications using CNNs demonstrated robust capabilities in differentiating and grading soft tissue sarcomas using MRI. However, studies on therapy response and prediction of metastases and recurrences are still lacking.

Efficacy and safety of lenvatinib in a case of thymic carcinoma complicated with interstitial lung disease and anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis: A case report

Based on the results of a multicenter phase II study of patients with previously treated thymic carcinoma, lenvatinib administration for unresectable thymic cancer has been covered under insurance in Japan since 2021. However, patients with interstitial lung disease (ILD) were excluded from that study; therefore, the efficacy and safety of lenvatinib in these patients remain unknown. Herein, we report the case of a woman in her 50s who was diagnosed with thymic carcinoma complicated with ILD. In August 2016, the patient developed ILD with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM). She received triple therapy comprising prednisolone, tacrolimus and azathioprine. In October 2021, the patient complained of lateral chest pain and back pain. In January 2022, computed tomography (CT) revealed an anterior mediastinal tumor, and percutaneous biopsy resulted in a diagnosis of thymic carcinoma with Masaoka classification IVb. In March 2022, first-line treatment with four cycles of carboplatin (area under the curve, 6) + paclitaxel (200 mg/m2) was initiated. Although a partial response was achieved, in September 2022, CT demonstrated progressive disease (PD). Therefore, in October 2022, Lenvatinib (24 mg) was started as the second-line treatment. The best response was stable disease; moreover, although lenvatinib dose reduction was required owing to adverse events, such as biliary-tract infection and stomatitis. The patient did not experience ILD exacerbation. Lenvatinib (14 mg) was continued until PD was observed in March 2023. Our findings suggest that lenvatinib is a viable treatment option for thymic carcinoma with ILD.

Understanding Diagnostic Costs Using Hospital-Based Encounters in the Year Before Diagnosis for Canadian Patients with Malignant Central Nervous System Tumours Compared to Common Cancers

Rare cancers pose significant diagnostic challenges, leading to more tests and higher healthcare expenditures (HEs). Understanding the financial implications of diagnosing rare cancers is crucial, particularly in Canada, where overall HEs are high (12% of the GDP in 2023). We investigated the pre-diagnostic hospital-based HE for patients with malignant central nervous system (CNS) tumours and compared it to patients with common cancers across Canadian provinces, using in-patient and ambulatory care data (2010-2014) from the Canadian Institute for Health Information. Pre-diagnostic HE was calculated as the change in total HE (in-patient and out-patient) during the 12 months before diagnosis, calculated as the HE within this period minus the average annual HE estimated over the two preceding years. Comparison groups included pediatric patients diagnosed with leukemia and patients aged over 15 diagnosed with colorectal cancer and lung cancer. We used quantile regression to estimate the adjusted effect of diagnosis with a CNS tumour on pre-diagnostic HE. The results indicated that HE for CNS patients was higher compared to those with common cancers. The top three factors contributing to HE variation were encounter type (in-patient/out-patient), province (Alberta/Ontario), and comorbidities (yes/no). Further investigation is warranted to understand the drivers of the cost differences.

Implementation of a Multi-Disciplinary Geriatric Oncology Clinic in Toronto, Canada

Older adults with cancer tend to face more complex health needs than their younger counterparts. Patients > 65 years of age are recommended for comprehensive geriatric assessment (CGA) to capture and address age-related vulnerabilities. Access to geriatrics services is limited, and our baseline audit of geriatric referrals in 2019 from the cancer program revealed that only 30% of patients referred received a CGA. The aim of this study was to assess the implementation of a geriatric oncology (GO) clinic that employs CGA and determine patient outcomes. We conducted a retrospective cohort study at a single institution. Data collection included baseline characteristics, GO clinic findings and characteristics, recommendations/referrals, and emergency room (ER) visits/hospitalizations within 6 months of CGA. Descriptive statistics were used for analysis. A total of 100 patients were included, with a median (range) age of 80 (63-97) years; 70% were female, and the most common cancer type was breast (31%). Through the GO clinic, patients were seen in a timely manner, with a median of 3 weeks, compared to our historical baseline of 11 weeks. Cognitive decline (32%) and pre-treatment CGA (22%) were the most common reasons for referral, and the most common new diagnosis was cognitive impairment (65%). For pre-treatment CGA, 16 (48%) patients were deemed suitable for treatment and 10 (30%) were recommended for modified treatment; 34 (94%) referring physicians followed the recommendation. In addition, most (68%) patients received an allied health referral. One third of patients visited the ER and 30 (30%) patients were hospitalized. Overall, the GO clinic resulted in greater access to CGA in a timely manner, enhanced access to allied health, and assisted in treatment decision-making.

Improving drug repositioning with negative data labeling using large language models

INTRODUCTION

Drug repositioning offers numerous advantages, such as faster development timelines, reduced costs, and lower failure rates in drug development. Supervised machine learning is commonly used to score drug candidates but is hindered by the lack of reliable negative data-drugs that fail due to inefficacy or toxicity- which is difficult to access, lowering their prediction accuracy and generalization. Positive-Unlabeled (PU) learning has been used to overcome this issue by either randomly sampling unlabeled drugs or identifying probable negatives but still suffers from misclassification or oversimplified decision boundaries.

RESULTS

We proposed a novel strategy using Large Language Models (GPT-4) to analyze all clinical trials on prostate cancer and systematically identify true negatives. This approach showed remarkable improvement in predictive accuracy on independent test sets with a Matthews Correlation Coefficient of 0.76 (± 0.33) compared to 0.55 (± 0.15) and 0.48 (± 0.18) for two commonly used PU learning approaches. Using our labeling strategy, we created a training set of 26 positive and 54 experimentally validated negative drugs. We then applied a machine learning ensemble to this new dataset to assess the repurposing potential of the remaining 11,043 drugs in the DrugBank database. This analysis identified 980 potential candidates for prostate cancer. A detailed review of the top 30 revealed 9 promising drugs targeting various mechanisms such as genomic instability, p53 regulation, or TMPRSS2-ERG fusion.

CONCLUSION

By expanding our negative data labeling approach to all diseases within the ClinicalTrials.gov database, our method could greatly advance supervised drug repositioning, offering a more accurate and data-driven path for discovering new treatments.

Real-World Efficacy and Toxicity of Ipilimumab and Nivolumab as First-Line Treatment of Metastatic Renal Cell Carcinoma (mRCC) in a Subpopulation of Elderly and Poor Performance Status Patients

BACKGROUND

Ipilimumab and nivolumab (ipi/nivo) improved overall survival (OS) compared to sunitinib in the pivotal Checkmate 214 trial of metastatic renal cell carcinoma (mRCC) with International Metastatic RCC Database Consortium (IMDC) intermediate/poor risk disease. We evaluated the efficacy and toxicity of ipi/nivo in older and frailer populations in a real-world mRCC cohort.

METHODS

Analysis was conducted on a real-world cohort with mRCC (N = 551) treated with first-line ipi/nivo from the Canadian Kidney Cancer information system (CKCis) database from January 2014 to December 2021. A comparison was made between outcomes and toxicity in patients 1. <70 versus (vs.) ≥70 yo, 2. <75 vs. ≥75 yo, and 3. KPS ≥70 vs. <70 yo. OS, progression-free survival (PFS), and time to treatment failure (TTF) were calculated by Kaplan-Meier analysis. Log-rank tests were used for comparison between groups.

RESULTS

Ipi/nivo treatment had no impact on survival outcomes or toxicity for patients >70 yo and >75 yo when controlled for IMDC. However, when comparing patients with KPS > 70 vs. KPS < 70, patients with a poor performance status had decreased median OS at 54.5 m vs. 10.8 m (p-value < 0.0001) and PFS at 11.6 vs. 3.1 m (p-value < 0.0001).

CONCLUSIONS

The use of ipi/nivo in mRCC demonstrated similar survival outcomes and toxicity in an older patient population. In patients with a poor performance status, it was associated with inferior OS and PFS. We believe that ipi/nivo is a reasonable treatment option for these patient populations, particularly in older patients.

Evaluation of claims-based frailty measurements in older patients with cancer: a retrospective cohort study

BACKGROUND

Frailty is associated with poor outcomes in older adults with cancer. Several efforts have been made to assess frailty using the administrative claims data based on the number of clinical diagnosis codes, yet the literature reporting on this is scarce. This study aimed to evaluate the impact of frailty measures using administrative databases in Japan.

DESIGN

A retrospective cohort study.

SETTING AND PARTICIPANTS

5176 patients with cancer aged ≥65 years who underwent cancer treatment in hospitals.

METHODS

The Electronic Frailty Index (eFI) and Veterans Affairs Frailty Index (VA-FI), based on diagnostic codes recorded were calculated. We plotted Kaplan-Meier survival curves and calculated hazard ratios (HR) using Cox regression analyses. The primary outcome was mortality, whereas the composite secondary outcome included a decline in care-need level, admission to a long-term care facility (LTCF) or mortality.

RESULTS

The Kaplan-Meier survival curve demonstrated a significant association between the eFI and VA-FI and each research outcome. Compared to the lowest frailty group, the highest frailty group exhibited an HR of 2.59 [95% confidence interval (CI), 1.66-4.06] for eFI and 2.45 (95%CI, 1.02-5.91) for VA-FI in relation to a decline in care-need level, an LTCF admission and mortality. The trend test indicated a significant increase in the rate of each outcome with higher frailty levels.

CONCLUSIONS

Higher frailty levels are associated with an increased risk of composite outcomes in older adults with cancer. This study suggests the potential application of frailty measurements in oncology care settings.

Frailty in Older Adults with Prostate Cancer

Older adults with all stages of prostate cancer are prone to developing frailty. These patients should have a frailty assessment and be managed by a multidisciplinary team. Lifestyle measures and tailoring of cancer-related treatment to the patient's fitness level can help in mitigating the adverse effects of frailty.

Carcinoma of the ampulla of Vater with membranous nephropathy: a case report

Nephrotic syndrome can occur secondary to malignancy, and its resolution is sometimes observed following tumor resection. We herein report the case of a 67-year-old Asian man who presented with membranous nephropathy associated with carcinoma of the ampulla of Vater. The patient initially presented with edema, hypoalbuminemia, and significant proteinuria with positive PLA2R antibody. Following surgical removal of the tumor, his urinary protein levels normalized, his serum albumin returned to normal, and the nephrotic syndrome achieved complete remission. This case underscores the importance of screening for secondary causes, such as malignancies, in patients with nephrotic syndrome. For those with malignancy-associated nephrotic syndrome, prompt and targeted treatment of the underlying tumor is critical to avoid missing the window for surgical intervention. This report aims to provide insights into the diagnosis and management of tumor-associated nephrotic syndrome, contributing to a better understanding of this rare clinical entity.

Development of a virtual multidisciplinary meeting framework for less common cancers

Less common cancers are underserved with expertise compared to other cancers. This is accentuated in regional areas where patients may need to travel for expert opinion. Development of a virtual multidisciplinary meeting (MDM) can help overcome this disadvantage but can be a challenge to establish. We describe the development of a framework for future less common cancer MDMs.

Transcriptomic and proteomic profiling identifies feline fibrosarcoma as clinically amenable model for aggressive sarcoma subtypes

Fibrosarcomas (FSA) are malignant mesenchymal tumors characterized by low chemo- and radiosensitivity. Development of novel treatment strategies for human adult FSA is hindered by the low incidence and the absence of suitable clinical models. Interestingly, aggressive FSA occur more frequently in domestic cats, hence potentially representing a clinically amenable model to assess novel therapies such as targeted imaging or theranostics. However, a lack of molecular characterization of FSA and adjacent normal tissue (NT) in both species hinders identification of tumor-specific targets and undermines the translational potential of feline FSA. Combining laser-capture microdissection, RNAsequencing and liquid chromatography-tandem mass spectrometry, we perform comprehensive profiling of 30 feline FSA and matched skeletal muscle, adipose and connective tissue. Clear inter-tissue differences allow identification of significantly upregulated and tumor-exclusive features that represent potential targets for diagnostic and therapeutic approaches. While feline FSA are characterized by hyperactive EIF2, TP53 and MYC signaling, immune-related and neuronal pathways emerge as modulators of tumor aggressiveness and immunosuppression. A high degree of molecular similarity with canine and adult FSA allows identification of tumor targets that are conserved across species. Significant enrichment in DNA repair pathways in feline FSA correlate with aggressive clinical behavior in human soft-tissue sarcoma. Finally, we leverage the molecular profiles to identify vulnerabilities, including sensitivity to ATR and PARP inhibition as potential treatment for feline FSA. In conclusion, this detailed landscape provides a rich resource to identify target candidates and therapeutic vulnerabilities within and across species and supports feline FSA as relevant models for the human disease.

Prediction Model for Brain Metastasis in Patients With Metastatic Germ-Cell Tumors

BACKGROUND

Brain metastasis (BM) is an independent adverse prognostic factor in metastatic germ cell tumors (mGCT). We aimed to establish an effective and practical BM prediction model.

PATIENTS AND METHODS

Between January 1990 and September 2017, 2291 patients with mGCT who were treated at Indiana University were identified. Patients were divided into two categories: BM present (N = 154) and BM absent (N = 2137). Kaplan-Meier methods were used to analyze progression free survival (PFS) and overall survival (OS). Logistic regression was used to determine a predictive model for whether BM was present. The data was separated into training and validation datasets with equal numbers of events in each.

RESULTS

The 2-year PFS and OS for patients with versus without BM: 17% versus 65% (p < 0.001) and 62% versus 91% (p < 0.001) respectively. Among the 154 patients with BM, 64 (42%) had radiation only (whole-brain radiotherapy or gamma knife), 22 (14%) had BM-surgery only, 14 (9%) had both radiation and BM-surgery. 54 patients (35%) did not receive local therapy for BM. Stepwise selection was used to determine the best model with p < 0.15 as the entry and staying criteria. The model with the largest ROC AUC was used moving forward. The model was tested in the validation dataset. A model was generated including age at diagnosis ≥ 40, choriocarcinoma predominant histology, pre-chemotherapy hCG≥ 5000, presence of pulmonary metastases size < 3, or ≥ 3 cm, and presence of bone metastasis. Patients with score of 0, 1, 2, 3, 4, 5, 6, 7, 8 points had a 0.6%, 1.4%, 3.5%, 8.2%, 18.3%, 36%, 58%, 78%, 90% probability of having BM, respectively.

CONCLUSIONS

The prediction model developed in this study demonstrated discrimination capability of predicting BM occurrence in mGCT and can be used to identify high-risk patients.

Management of Patients with Advanced Prostate Cancer. Report from the 2024 Advanced Prostate Cancer Consensus Conference (APCCC)

BACKGROUND AND OBJECTIVE

Innovations have improved outcomes in advanced prostate cancer (PC). Nonetheless, we continue to lack high-level evidence on a variety of topics that greatly impact daily practice. The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) surveyed experts on key questions in clinical management in order to supplement evidence-based guidelines. Here we present voting results for questions from APCCC 2024.

METHODS

Before the conference, a panel of 120 international PC experts used a modified Delphi process to develop 183 multiple-choice consensus questions on eight different topics. Before the conference, these questions were administered via a web-based survey to the voting panel members ("panellists").

KEY FINDINGS AND LIMITATIONS

Consensus was a priori defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. The voting results show varying degrees of consensus, as discussed in this article and detailed in the Supplementary material. These findings do not include a formal literature review or meta-analysis.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The voting results can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers in prioritising areas for future research. Diagnostic and treatment decisions should always be individualised on the basis of patient and cancer characteristics, and should incorporate current and emerging clinical evidence, guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2024 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials.

Phase 2 Study of Preoperative Tislelizumab in Combination with Low-dose Nab-Paclitaxel in Patients with Muscle-invasive Bladder Cancer

BACKGROUND AND OBJECTIVE

Combinations of immune checkpoint inhibitors and nab-paclitaxel have achieved significant therapeutic effects in the treatment of advanced urothelial carcinoma. Our aim was to assess the efficacy and safety of tislelizumab combined with low-dose nab-paclitaxel in patients with muscle-invasive bladder cancer (MIBC).

METHODS

TRUCE-01 was a single-arm phase 2 study that included 62 patients with T2-4a N0/X M0 MIBC tumors with predominant urothelial carcinoma histology. Eligible patients received three 21-d cycles of intravenous 200 mg tislelizumab on day 1 plus intravenous 200 mg nab-paclitaxel on day 2, followed by surgical assessment. The primary study endpoint was a clinical complete response (cCR). Treatment-related adverse event (TRAE) profiles were recorded according to Common Terminology Criteria for Adverse Events version 5.0.

KEY FINDINGS AND LIMITATIONS

The safety analysis included all 62 patients and the efficacy analysis included 48 patients. The primary efficacy endpoint (cCR) was met by 25 patients (52%) patients. Among the 62 patients in the safety analysis, six (9.7%) had grade ≥3 TRAEs.

CONCLUSIONS

Tislelizumab combined with low-dose nab-paclitaxel showed promising antitumor effectiveness and was generally well tolerated, which makes it an excellent preoperative therapy option for MIBC.

PATIENT SUMMARY

We found that a combination of the drugs tislelizumab and low-dose nab-paclitaxel had satisfactory efficacy and safety for preoperative treatment of muscle-invasive bladder cancer.

The Surgical Management of Intracranial Metastasis Secondary to Follicular Cell-Derived Thyroid Carcinoma

BACKGROUND

Intracranial metastases (ICM) from follicular cell-derived thyroid carcinoma (FCDTC) are rare and are associated with a poor prognosis. The objective of this study is to report our experience in the surgical management of patients with ICM secondary to FCDTC.

METHODS

Patients with FCDTC who underwent surgical resection of an ICM were identified at our institution from 1998 to 2018.

RESULTS

Thirty-two patients were included in this study. Nineteen patients (59%) had involvement of the brain parenchyma only, 8 (25%) had a dural-based metastasis, 3 (9%) had a calvarial metastasis with dural extension, and 2 (6%) had a skull base metastasis with dural extension. In patients who had an R0-1 resection, the estimated lesional control at the site of resection was 91% at 3 years. However, overall ICM control was 37% at 3 years due to the progression of other ICM lesions. The 1-year disease-specific survival (DSS) was 87% and 5-year DSS was 37%.

CONCLUSIONS

ICM management in FCDTC is based on the size, number, and location of metastatic lesions. Complete resection of ICM may provide lesional control at the site of resection, however, DSS is poor due to the presence of other ICMs and metastases at multiple distant sites.

Pain and Health-related Quality of Life with Biweekly Versus Triweekly Cabazitaxel Schedule in Older Men with Metastatic Castration-resistant Prostate Cancer in the Multicenter, Randomized CABASTY Trial

BACKGROUND AND OBJECTIVE

The CABASTY study showed that more frequent administration of a lower dose of cabazitaxel (CBZ) reduced toxicity in older men with metastatic castration-resistant prostate cancer (mCRPC), without compromising efficacy. Here, we investigated the impact of a biweekly CBZ schedule on patient-reported pain and health-related quality of life (HRQoL).

METHODS

We randomized 196 patients from 25 centers (1:1, stratified by age and G8 score) to the biweekly CBZ16 (CBZ 16 mg/m2) experimental arm or the triweekly CBZ25 (CBZ 25 mg/m2) control arm (CABASTY study, NCT02961257). We assessed pain using the Numeric Pain Rating Scale and HRQoL using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire.

KEY FINDINGS AND LIMITATIONS

A total of 141 patients were available for a pain and 160 for an HRQoL analysis. Median time to pain progression (stratified hazard ratio [HR]: 1.7, confidence interval [CI]: 0.67-4.22, p = 0.3) and median time to first opiate use (stratified HR: 1.05, CI: 0.44-2.55, p = 0.9) did not differ between arms. We did not see a significant difference in median time to deterioration of FACT-P total score between treatments (stratified HR: 0.88, CI: 0.47-1.7, p = 0.7). Interestingly, the time to onset of several adverse events was significantly longer in the biweekly CBZ16 group.

CONCLUSIONS AND CLINICAL IMPLICATIONS

HRQoL did not significantly differ between the biweekly CBZ16 and the standard schedule. Additionally, onset of some adverse events was delayed. These results may increase health care providers' confidence in using CBZ in older patients with mCRPC who are denied chemotherapy.

PATIENT SUMMARY

Androgen receptor pathway inhibitors are often preferred to taxane chemotherapy as a treatment of second or subsequent line in older metastatic castration-resistant prostate cancer patients due to more frequent treatment-related toxicities. Here, we showed that quality of life and pain did not differ significantly with an adapted schedule of cabazitaxel (CBZ), compared with the standard regimen. This CBZ schedule could increase eligibility of older patients for chemotherapy.

Dynamics in the Prostate Immune Microenvironment Induced by Androgen Deprivation Therapy

BACKGROUND

The influence of testosterone on the prostate's immune microenvironment remains unclear. This study aims to elucidate the dynamics of immune cells in the prostate following androgen deprivation therapy (ADT).

METHODS

We retrospectively compared prostate needle biopsy and radical prostatectomy specimens from 33 patients who underwent both procedures, along with neoadjuvant ADT at a single institution. Immune cell infiltration in the cancer and stroma areas was assessed using multiplex fluorescence immunohistochemistry.

RESULTS

Post-ADT, all immune cells, including CD4+ T cells, CD8+ T cells, Foxp3+ regulatory T cells, CD204+ macrophages, and CD20+ B cells, significantly increased in the prostatectomy specimen. However, few immune cells were detected in the biopsy of the same patients (p < 0.001). The number of CD20+ B cells in the cancer area was significantly lower post-ADT in high-risk cases according to the NCCN classification (p = 0.020). This difference was significantly associated with the Gleason Grade Group, rather than PSA levels or T classification (p < 0.001). However, no significant difference was observed in the recurrence rate between Grade Groups 1, 2, 3 and 4, 5 (p = 0.991). There was no significant difference in immune cells other than CD20+ B cells when divided into NCCN classifications.

CONCLUSIONS

The marked increase in immune cells following ADT suggests an intensified immune response against prostate cancer.

Clinical, Diagnostic and Therapeutic Framework of mHSPC and nmCRPC: A Multidisciplinary Consensus Project of the Italian Society for Uro-Oncology (SIUrO)

The recent evidences provided in metastatic hormone sensitive prostate cancer (nmHSPC) and in nonmetastatic castration resistant (nmCRPC) introduced the possibility to adopt Androgen Receptor Signaling inhibitor (ARSi) alone (both settings) or with chemotherapy (in mHSPC). In daily clinical practice there are some opening questions regarding the inclusion of next generation imaging, mainly PSMA-PET, how integrate local treatment as radiotherapy, how to select patients or drugs in a multiple-choice scenario, and how to manage patients with comorbidities and polypharmacy. These issues led the Italian Society for Uro-Oncology (SIUrO) to develop a consensus project involving all of the most important Italian scientific societies engaged in the multidisciplinary and multiprofessional management of the disease. This paper describes the items and statements approved, with the aim to support clinicians in managing metastatic hormone sensitive and nonmetastatic castration resistant prostate cancer patients.

Surgical Management of Genitourinary Cancer Liver Metastases

Genitourinary cancers are common. Liver metastases from genitourinary cancers are uncommon; isolated liver metastasis is rare. Liver resection in select patients with metastatic renal cell carcinoma can lead to prolonged survival. Patients with metachronous and low-burden disease are most likely to benefit. Chemotherapy is first-line treatment of metastatic germ cell tumors. Liver resection is dependent on germ cell lineage and initial response to chemotherapy. Prognosis with liver metastases from prostate cancer is poor; liver-only lesions are rare. Liver resection generally is not indicated. Cumulative experience with liver resection for metastatic bladder cancer is limited. Liver metastases are poor prognostic indicators for metastasectomy.

Real-world Clinical Outcomes and Prognostic Factors in Neuroendocrine Prostate Cancer

BACKGROUND

Neuroendocrine prostate cancer (NEPC) encompasses pure NEPC and tumors with mixed adenocarcinoma and neuroendocrine histology. While NEPC is thought to confer a poor prognosis, outcome data are sparse, making risk stratification and treatment decisions difficult for clinicians.

METHODS

This retrospective study identified patients with morphological and/or immunohistochemical NEPC features on pathological review of high-grade prostate cancer cases. Median overall survival (OS) was calculated by stage and castration sensitivity. Prognostic factors were assessed via multivariate analysis. OS and progression-free survival on first-line metastatic systemic treatment were also evaluated.

RESULTS

Of 135 NEPC cases, 25.9% had NEPC documented in the original pathological report. Mixed pathology was found in 91.9% of cases. Median OS from NEPC diagnosis was 59.2, 42.3, 14.3, 17.6 and 9.6 months for localized, nonmetastatic castration-sensitive, nonmetastatic castration-resistant, metastatic castration-sensitive and metastatic castration-resistant prostate cancer, respectively. Anemia (hazard ratio [HR]: 1.66; 95% CI 1.05-2.16; P = .031) and elevated neutrophil-lymphocyte ratio (NLR) (HR: 1.51; 95% CI 1.01-2.52; P = .045), were associated with increased risk of death on multivariate analysis. 67 patients received first-line metastatic treatment beyond androgen deprivation, with a median progression-free survival of 5.2 months and OS of 15 months. Of these, 50.7% received more than 1 line of systemic treatment.

CONCLUSION

We observed underdiagnosis of NEPC in pathology specimens. NEPC is associated with poorer prognosis than would be expected in pure adenocarcinoma populations, with rapid progression on first-line metastatic treatment and sharp drop-off between subsequent treatment lines. Anemia and elevated NLR were associated with poor survival.

Navigating management of localized prostate cancer in the geriatric population

Prostate cancer (PCa) is highly prevalent among aging men and a significant contributor to global mortality. Balancing early detection and treatment of "clinically significant" disease with avoiding over-detection and overtreatment of slow-growing tumors is challenging, especially for elderly patients with competing health risks and potentially aggressive disease phenotypes. This review emphasizes the importance of individualized approaches for diagnosing and treating PCa in geriatric patients. Active surveillance and watchful waiting are common strategies, while surgical interventions are less frequent but considered based on comorbidities, disease risk, and patient preferences. Radiotherapy, often combined with androgen deprivation therapy, is typical for higher-risk cases, and focal therapy is emerging to reduce morbidity. An inclusive approach combining advanced diagnostics, life expectancy considerations, and minimally invasive interventions can improve decision-making. Integrating multidisciplinary strategies with better risk stratification and less invasive options can significantly enhance care and outcomes for elderly patients with significant PCa.

Measuring healthy life expectancy and determinants of poor perceived health: A population-based study among a subset of rare and common cancer survivors

BACKGROUND

As the survival proportions for rare cancers are on average worse than for common cancers, assessing the expected remaining life years in good health becomes highly relevant. This study aimed to estimate the healthy life expectancy (HLE) of a subset of rare and common cancer survivors, and to assess the determinants of poor perceived health in rare cancer survivors.

METHODS

To calculate HLE, survival data from the population-based Netherlands Cancer Registry of survivors of a rare cancer (i.e., ovarian cancer, thyroid cancer, Hodgkin lymphoma, non-Hodgkin lymphoma) (n=21,376) and a common cancer (i.e., colorectal cancer (CRC)) (n=76,949) were combined with quality of life (QoL) data from the PROFILES registry on a random sample of the rare (n=1025) and common cancer (n=2400) survivors. A flexible parametric relative survival model was used to estimate life expectancy (LE) and years of life lost, and multivariate logistic regression was applied to determine factors related to reported poor perceived health.

RESULTS

Patients previously diagnosed with a rare cancer had an average LE of 8-36 years and were expected to spend ≥67 % of their remaining life in good health. CRC survivors had an average LE of 10 years with approximately 65 % of their remaining life expected to spend in good health. For all cancer types, those aged ≥65 years or with stage IV had the lowest HLE. Low socioeconomic status, advanced stage, and having received radiotherapy only were important predictors of poor perceived health among rare cancer survivors.

CONCLUSION

HLE can provide meaningful perspective for patients and practitioners for all cancer types, including rare cancers. Yet, data on QoL for rare cancers should be routinely collected, as such will serve as an indicator for monitoring and improving cancer care, and for enabling HLE measurements in cancer survivors.

Adding checkpoint inhibitors to first-line chemotherapy for NUT carcinoma patients

Rare cancers present significant challenges in diagnosis, treatment, and research, accounting for up to 25% of global cancer cases. Due to their rarity and atypical presentations, they are often misdiagnosed, resulting in late-stage detection and poor outcomes. Here, we describe a patient case with advanced metastatic nasopharynx NUT carcinoma, one of the rarest and most aggressive cancers. We conducted a comprehensive analysis of this patient's tumor, including Tumor Mutation Burden, Microsatellite Instability, and genetic profiling to explore further putative druggable targets. The tumor exhibited high PD-L1 expression and showed a notable response to immune checkpoint inhibitors when combined with platinum-based radio-chemotherapy. Our findings indicate that checkpoint inhibitors could play a critical role in treating NUT carcinoma, offering new therapeutic avenues and hope for patients with this challenging diagnosis. Whether PD-L1 expression may be a useful predictor of immune checkpoint inhibitor efficacy warrants further research.

Preoperative myosteatosis and perioperative serum chloride levels predict 180 day major complications after radical cystectomy

This study aimed to investigate the role of myosteatosis, sarcopenia, and perioperative serum biomarkers as independent predictors of major complications within 180 days following radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). We retrospectively analyzed of 127 MIBC patients who underwent RC between 2013 and 2023 at a single institution. Preoperative body composition was assessed using CT scans at the L3 vertebral level to measure psoas muscle density (PMD), skeletal muscle density (SMD), axial muscle density (AMD), and muscle indices. Novel inflammatory and nutritional markers, including serum chloride levels within 24 h post-surgery, were also evaluated. Major complications were defined as Clavien-Dindo grade ≥ 3. Multivariate analysis was performed to identify independent predictors of postoperative complications. Among the cohort, 30.7% of patients experienced major complications within 90 days, and 36.2% within 180 days. Sepsis was the most common major complication (19 of 241 complications, 7.9%). Ten patients died during the observation period. Myosteatosis (p = 0.002) and postoperative serum chloride levels (p < 0.001) were significant independent predictors of 180-day major complications. Patients with low PMD had an adjusted odds ratio (OR) of 3.959 for developing major complications, while increased serum chloride levels were associated with a reduced risk of complications (OR = 0.985). Multivariate analysis reveals associations between myosteatosis, aging, and anemia. Myosteatosis and perioperative serum chloride levels are significant predictors of major complications after RC for MIBC. Incorporating body composition analysis and early serum chloride monitoring into perioperative care may improve risk stratification and patient outcomes following RC.

Health-Related Quality of Life (HRQoL) Assessments in Research on Patients with Adult Rare Solid Cancers: A State-of-the-Art Review

BACKGROUND

Health-related quality of life (HRQoL) is an important patient-reported outcome for all cancer patients, including adult patients with rare solid cancers. However, current knowledge of HRQoL in this population is limited, which hinders the delivery of personalized care. This review aimed to explore the heterogeneity of HRQoL among adult patients with a solid rare cancer across the ten European Reference Network for Rare Adult Solid Cancers (EURACAN) domains and to summarize the HRQoL measures used in clinical research.

METHODS

A systematic literature search was conducted to identify all clinical studies assessing HRQoL in adult patients with a solid rare cancer. Four databases (MEDLINE, PubMed, PsycINFO, and Web of Science/Scopus) were searched (February 2023).

RESULTS

The search yielded 18,704 articles, of which 1416 articles were fully screened and 463 were eligible for analysis. Of these, 397 studies used generic tools to assess HRQoL, while 270 used tumor-specific instruments. Three EURACAN domains (sarcoma, endocrine tumors, and thoracic tumors) primarily assessed HRQoL using generic questionnaires. Additionally, the rare gynecological tumor, rare male genitourinary, and sarcoma EURACAN domains lacked specific HRQoL measures. Brain, head and neck, and uveal melanoma EURACAN domains used tumor- or domain-specific questionnaires in more than half of the studies.

CONCLUSIONS

This state-of-the-art literature review shows that HRQoL assessment is gradually becoming more prevalent in adult solid rare cancer research. A combination of generic, tumor-specific, and domain-specific questionnaires across various rare cancer domains has proven effective in capturing a broad range of HRQoL issues. However, many EURACAN domains still lack specific strategies for assessing HRQoL, which limits the ability to fully understand and address patients' experiences. Future research should prioritize developing comprehensive and robust HRQoL measurement strategies and tools to enable meaningful clinical research and to ensure that the patient voice is incorporated in their clinical care.

Frailty and gynecologic cancer: a cross-sectional analysis of the Canadian Longitudinal Study on Aging

OBJECTIVE

There is significant heterogeneity in the recovery of individuals after gynecological cancer treatment. The Canadian Longitudinal Study on Aging provided a distinct opportunity to evaluate the associations between psychosocial and functional factors and long-term health outcomes. We sought to examine the prevalence of frailty and utilization of social and community support among community-dwelling older adults with a history of gynecologic cancer.

METHODS

We conducted a cross-sectional analysis of female participants in the Canadian Longitudinal Study on Aging, a population-based cohort comprising over 50,000 individuals aged 45 to 85 years old. Frailty was operationalized using the deficit accumulation model (frailty defined as Frailty Index >0.21). Associations were evaluated using multivariate regression analyses adjusted for sociodemographic, lifestyle, economic, and social support factors.

RESULTS

Data points to measure frailty were available for 15,149 of the 15,320 (98.8%) female participants. The prevalence of frailty was 19.9% in those with a history of gynecologic cancer compared to 9.1% in those without (p < .001; adjusted OR 2.2, 95% CI 1.6 to 2.9). For all female participants, regardless of a history of gynecologic cancer, history of smoking, alcohol use, lower income, lower educational level, never having been married, living alone, and less social support availability were significantly associated with frailty in univariate analysis. Those with a history of gynecologic cancer classified as frail were more likely to require assistance from family members (OR 3.4, 95% CI 2.0 to 5.7) and professional community supports (OR 7.9, 95% CI 4.1 to 15.0) than those who were not frail.

CONCLUSIONS

In this large national cohort study, a history of gynecological cancer was independently associated with frailty. We identified the factors of social vulnerability that may affect health outcomes. These novel findings can be instrumental in advocating for resource allocation and designing proactive strategies.

Development of a nomogram for overall survival in patients with esophageal carcinoma: A prospective cohort study in China

BACKGROUND

Esophageal carcinoma (EC) presents a significant public health issue in China, with its prognosis impacted by myriad factors. The creation of a reliable prognostic model for the overall survival (OS) of EC patients promises to greatly advance the customization of treatment approaches.

AIM

To create a more systematic and practical model that incorporates clinically significant indicators to support decision-making in clinical settings.

METHODS

This study utilized data from a prospective longitudinal cohort of 3127 EC patients treated at Chongqing University Cancer Hospital between January 1, 2018, and December 12, 2020. Utilizing the least absolute shrinkage and selection operator regression alongside multivariate Cox regression analyses helped pinpoint pertinent variables for constructing the model. Its efficacy was assessed by concordance index (C-index), area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).

RESULTS

Nine variables were determined to be significant predictors of OS in EC patients: Body mass index (BMI), Karnofsky performance status, TNM stage, surgery, radiotherapy, chemotherapy, immunotherapy, platelet-to-lymphocyte ratio, and albumin-to-globulin ratio (ALB/GLB). The model demonstrated a C-index of 0.715 (95%CI: 0.701-0.729) in the training cohort and 0.711 (95%CI: 0.689-0.732) in the validation cohort. In the training cohort, AUCs for 1-year, 3-year, and 5-year OS predictions were 0.773, 0.787, and 0.750, respectively; in the validation cohort, they were 0.772, 0.768, and 0.723, respectively, illustrating the model's precision. Calibration curves and DCA verified the model's predictive accuracy and net benefit.

CONCLUSION

A novel prognostic model for determining the OS of EC patients was successfully developed and validated to help clinicians in devising individualized treatment schemes for EC patients.

Radical Ring-Opening Polymerization: Unlocking the Potential of Vinyl Polymers for Drug Delivery, Tissue Engineering, and More

Synthetic vinyl polymers have long been recognized for their potential to be utilized in drug delivery, tissue engineering, and other biomedical applications. The synthetic control that chemists have over their structure and properties is unmatched, allowing vinyl polymer-based materials to be precisely engineered for a range of therapeutic applications. Yet, their lack of biodegradability compromises the biocompatibility of vinyl polymers and has held back their translation into clinically used treatments for disease thus far. In recent years, radical ring-opening polymerization (rROP) has emerged as a promising strategy to render synthetic vinyl polymers biodegradable and bioresorbable. While rROP has long been touted as a strategy for preparing biodegradable vinyl polymers for biomedical applications, the translation of rROP into clinically approved treatments for disease has not yet been realized. This review highlights the opportunities for leveraging rROP to render vinyl polymers biodegradable and unlock their potential for use in biomedical applications.

Didemnins as marine-derived anticancer agents: mechanistic insights and clinical potential

Didemnins, a class of cyclic depsipeptides derived from marine organisms exhibit notable anticancer properties. Among them, Didemnin B has been extensively researched for its strong antitumor activity and progression to clinical trials. Nonetheless, its clinical application has been impeded by challenges like poor bioavailability and dose-limiting toxicity. This review aims to provide a comprehensive analysis of the anticancer mechanisms of Didemnins, particularly Didemnin B, by examining studies that investigate their anticancer properties, mechanisms of action, pharmacokinetics, and clinical outcomes, while exploring their potential as therapeutic agents in cancer treatment. A comprehensive review of the literature was conducted using scientific databases, including PubMed, Google Scholar and ScienceDirect. Didemnin B has been shown to exert its anticancer effects primarily through the inhibition of protein synthesis, induction of apoptosis, and disruption of cell-cycle progression. Despite promising preclinical results, clinical trials have revealed substantial toxicity, particularly neuromuscular and hepatic, which significantly constrains its therapeutic potential. Recent progress in developing semisynthetic derivatives, including Dehydrodidemnin B (Plitidepsin, Aplidin), have led to improved efficacy and reduced toxicity. Didemnins, especially Didemnin B, hold promise as anticancer agents. However, future research should focus on optimizing delivery methods, reducing toxicity, and exploring combination therapies to enhance their therapeutic potential in oncology.

Emerging role of metabolic reprogramming in the immune microenvironment and immunotherapy of thyroid cancer

The metabolic reprogramming of cancer cells is a hallmark of many malignancies. To meet the energy acquisition needs of tumor cells for rapid proliferation, tumor cells reprogram their nutrient metabolism, which is caused by the abnormal expression of transcription factors and signaling molecules related to energy metabolic pathways as well as the upregulation and downregulation of abnormal metabolic enzymes, receptors, and mediators. Thyroid cancer (TC) is the most common endocrine tumor, and immunotherapy has become the mainstream choice for clinical benefit after the failure of surgical, endocrine, and radioiodine therapies. TC change the tumor microenvironment (TME) through nutrient competition and metabolites, causing metabolic reprogramming of immune cells, profoundly changing immune cell function, and promoting immune evasion of tumor cells. A deeper understanding of how metabolic reprogramming alters the TME and controls immune cell fate and function will help improve the effectiveness of TC immunotherapy and patient outcomes. This paper aims to elucidate the metabolic communication that occurs between immune cells around TC and discusses how metabolic reprogramming in TC affects the immune microenvironment and the effectiveness of anti-cancer immunotherapy. Finally, targeting key metabolic checkpoints during metabolic reprogramming, combined with immunotherapy, is a promising strategy.

Acidic Microenvironment Enhances Cisplatin Resistance in Bladder Cancer via Bcl-2 and XIAP

Cisplatin (CDDP) remains a key drug for patients with advanced bladder cancer (BC), despite the emergence of new therapeutic agents; thus, the identification of factors contributing to CDDP treatment resistance is crucial. As acidity of the tumor microenvironment has been reported to be associated with treatment resistance and poor prognosis across various cancer types, our objectives in this study were to investigate the effects of an acidic environment on BC cells and elucidate the mechanisms behind CDDP resistance. Our findings show that BC cells cultured under acidic conditions developed cisplatin resistance as acidity increased. Notably, CDDP administered to BC cells in a pH 6.0 environment required double the concentration, compared to those in a pH 7.5 environment, to achieve equivalent toxicity. Using chloroquine and navitoclax, we identified the involvement of the Bcl-2 and LC3B pathways in the acquisition of CDDP resistance under acidic conditions. A Western blot analysis revealed that the activations of Bcl-2 and XIAP expression appear to inhibit both apoptotic and autophagic cell death. Taken together, these results suggest that alleviating the acidity of the tumor microenvironment in clinical settings might enhance BC sensitivity to CDDP.

Enhancing rare cancer care in developing countries through patient advocacy: insights from the Desmoid Tumor Brazilian Association

Introduction

Desmoid tumors are soft-tissue neoplasms that can have profound impacts on the lives of people living with such diseases. As they are rare tumors, patients often have difficulty finding teams specialized in sarcomas and support networks. In low- and middle-income countries, the challenges are exacerbated due to a need for established networks and medication access.

Discussion

In this setting, patient advocacy groups are important in supporting affected people. To this end, the Desmoid Tumor Brazilian Association (DTBA) was established to help mitigate those challenges. This paper highlights the perspectives of patients with desmoid tumors living in Brazil, obtained in a nationwide survey, and discusses aspects related to access to specialists, medications, education, and awareness in Brazil.

Conclusions

The most commonly reported challenges in Brazil are access to educational material and specialists. The DTA continues to strive to improve support for people living in Brazil through initiatives such as Scientific and Educational Meetings, improving awareness, fostering science, and working on methods to facilitate access to medication and specialists.

An Evaluation of Rare Cancer Policies in Europe: A Survey Among Healthcare Providers

Rare cancers, defined as those with an annual incidence of fewer than six cases per 100,000 individuals, are associated with significant health inequalities. This study aimed to assess the knowledge, attitudes, and perceptions of healthcare providers with expertise in rare cancers regarding the effectiveness of enacted or planned rare cancer policies across Europe. Between 25 March 2023 and 5 March 2024, we conducted an online survey targeting 738 healthcare providers affiliated with the European Reference Networks and the Organization of European Cancer Institutes, yielding 92 complete responses from 28 European countries (response rate: 12.5%). While a significant portion of respondents were unaware of their country's legal definitions for rare cancers, 67.4% acknowledged that national cancer plans prioritized rare cancers. These plans received the highest ratings for their evidence-based interventions and monitoring efforts. The integration of rare cancer policies into broader oncology frameworks was the preferred policy model. National cancer registries were highly rated for confidentiality and validity but scored the lowest for cost-effectiveness. Government funding was deemed crucial for cancer screening programs. The disease burden and unmet health needs primarily influenced reimbursement decisions in the field of rare cancers. Respondents rated palliative care as more effective in adults with rare cancers compared to in children, particularly regarding symptom management. We confirmed significant variability in rare cancer policy evaluations across Europe, the necessity for a common EU-level definition for rare cancers, and a shift in reimbursement and policy framework models, highlighting the importance of policy integration and enhanced collaboration. However, given the limitations of the study, such as small sample size and possible unstudied confounding factors, we should interpret our findings with caution. A systematic policy review and multistakeholder assessment in the future could complement our results.

Comparing loss of contractual employment pre- and post-diagnosis in patients with rare versus common cancer types: a national registry-based study

PURPOSE

Patients with rare cancer often experience diagnostic delays and limited treatment options, potentially negatively impacting their working lives. We explored whether those with rare vs. common cancer have an increased risk of loss of contractual employment (1) up to 2 years pre-diagnosis, (2) up to 5 years post-diagnosis, and (3) which characteristics of rare cancer survivors are associated with loss of contractual employment 5 years post-diagnosis.

METHODS

Data from the Netherlands Cancer Registry and Statistics Netherlands were linked. Demographic, work-related, and cancer-related characteristics were obtained of 16,203 patients with rare cancer and 23,295 unmatched patients with common breast or colorectal cancer. Transitions in primary source of income were explored from contractual employment to work disability, unemployment, social welfare, (early) retirement, or self-employment. Logistic regression and competing risk survival analyses were applied.

RESULTS

Employees with rare vs. common cancer had increased odds of becoming work-disabled pre-diagnosis (OR = 1.83, 95%CI 1.30-2.58) and of becoming self-employed post-diagnosis (HR = 1.32, 95%CI 1.03-1.68). Younger age and having a temporary employment contract were associated with becoming self-employed among those with rare cancers.

CONCLUSIONS

Employees with rare vs. common cancer have an increased risk of loss of contractual employment pre- and post-diagnosis.

IMPLICATIONS FOR CANCER SURVIVORS

To reduce the risk of adverse work outcomes pre- and post-diagnosis, awareness and knowledge of rare cancers need to be increased to shorten time to diagnosis and accelerate access to adequate care.

Neoadjuvant darolutamide plus androgen deprivation therapy for high-risk and locally advanced prostate cancer: a multicenter, open-label, single-arm, phase II trial

PROPOSE

This study aimed to evaluate the efficacy and safety of neoadjuvant treatment of darolutamide, a next-generation androgen receptor inhibitor, plus androgen deprivation therapy (ADT) for patients with locally advanced prostate cancer (LAPC).

METHODS

This single-arm, multicenter, open-label phase II trial (ClinicalTrials.gov: NCT05249712, 2022-01-01), recruited 30 localized high-risk/very high-risk prostate cancer (HRPCa/VHRPCa) patients from three centers in China between 2021 and 2023. Following six months of neoadjuvant therapy combining darolutamide with ADT, the patients underwent radical prostatectomy (RP). The primary endpoint is pathologic complete response (pCR) or minimal residual disease (MRD). The secondary endpoints are progression-free survival (PFS), positive surgical margin rate and safety. Exploratory endpoint was the relationship between postoperative ctDNA and primary outcome.

RESULTS

The pCR or MRD rate was 40%(n = 12). Only four patients (13.3%) had positive surgical margins. The 12 months PFS was 90.0% (95% CI, 74.4-96.5%). The detection of circulating tumor DNA (ctDNA) accurately predicts the disease progression. No grade 3 or 4 adverse events were observed. The most frequent adverse events included hot flashes and elevated alanine aminotransferase or aspartate transaminase levels, which were observed in three patients (10%).

CONCLUSION

Neoadjuvant therapy with darolutamide plus ADT for six months followed by RP is effective and safe for HRPCa and LAPC. The detection of ctDNA can predict disease progression.

Clinical implementation of RTT-only CBCT-guided online adaptive focal radiotherapy for bladder cancer

Purpose

The study assesses the clinical implementation of radiation therapist (RTT)-only Conebeam CT (CBCT)-guided online adaptive focal radiotherapy (oART) for bladder cancer, by describing the training program, analyzing the workflow and monitoring patient experience.

Materials and methods

Bladder cancer patients underwent treatment (20 sessions) on a ring-based linac (Ethos, Varian, a Siemens Healthineers Company, USA). Commencing April 2021, 14 patients were treated by RTTs supervised by the Radiation Oncologist (RO) and Medical Physics Expert (MPE) in a multidisciplinary workflow. From March 2022, 14 patients were treated solely by RTTs. RTT training included target delineation lessons and practicing oART in a simulation environment. We analyzed the efficiency of the RTT-only workflow regarding session time, adjustments by RTTs, attendance of the RO and MPE at the linac, and qualitative assessment of gross tumor volume (GTV) delineation. Patient experience was monitored through questionnaires.

Results

A training program resulted in a skilled team of RTTs, ROs and MPEs.The RTT-only workflow demonstrated shorter session times compared to the multidisciplinary approach. Among 14 patients treated using the RTT-only workflow, RTTs adjusted 99% of bladder volumes and 44% of GTV. 79% of the sessions proceeded without MPEs and ROs. All GTV delineations were RO-approved, thus considered clinically acceptable, and 87% required minor or no adjustments. Patient satisfaction was reported in 18 of 21 cases.

Conclusions

The RTT-only oART workflow for bladder cancer, complemented by a training program and on-call support from ROs and MPEs, demonstrated success. Patient experience is positive. It is currently introduced as standard in our clinic.

Concomitant chemotherapy in trimodal treatment of patients with muscle invasive bladder cancer: A systematic review of prospective trials

BACKGROUND AND OBJECTIVE

For selected patients with muscle-invasive bladder cancer (MIBC), trimodal therapy (TMT) incorporating transurethral resection of the tumor and chemoradiotherapy is an alternative to radical cystectomy. Concurrent chemotherapy (CC) is a pivotal component of TMT, however, the optimal CC protocol remains unknown. This systematic review aims to assess efficacy and safety outcomes of CC protocols used in TMT.

METHODS

A systematic literature search in the PubMed and Embase databases was performed to identify eligible studies published between 1980 and March 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data extraction and risk of bias assessment were performed following predefined criteria.

KEY FINDINGS AND LIMITATIONS

50 studies met the inclusion criteria. Cisplatin-based CC protocols were the most reported. The highest level of evidence was found for 5-fluorouracil and Mitomycin C and for Carbogen-Nicotinamide. However, significant heterogeneity in patient selection, treatment modalities, follow-up and reported outcomes precluded comparison between trials. Outcomes were similar regardless of CC, with 5-year overall survival around 50 %. Bladder preservation rates ranged from 60 % to 90 %. Distant metastasis rates varied from 10 % to 45 %. Locoregional control rates seemed improved with cisplatin combinations despite an increased acute toxicity. Acute and late toxicity were however relatively low across CC protocols. There was no decrease in gastro-intestinal or urinary Quality of Life. Scarce data were available for elderly patients.

CONCLUSIONS AND CLINICAL IMPLICATIONS

With similar efficacy and toxicity profiles, and in the absence of comparability among trials, our review does not provide sufficient data to determine the optimal CC for TMT of MIBC. TMT is a well-tolerated and efficient approach with tailored strategy available for patients with localized MIBC.