Real-world treatment outcomes of medicines used in special situations (off-label and compassionate use) in oncology and hematology: A retrospective study from a comprehensive cancer institution

Facts and figures of the compassionate use of onco-hematological drugs from 2016 to 2021: Results from the multicentric observational study Compass-O

BackgroundCompassionate drug use (CDU) is a topic of debate in the scientific community characterized by a lack of information, especially in the onco-hematology area.AimThe Compass-O study aimed to provide updated data on CDU of onco-hematological drugs for the period 2016-2021.MethodCompass-O is a retrospective observational study with data obtained from 7 Italian Units for cytotoxic drug preparations (Unità Farmaci Antiblastici, UFA). Drugs and Therapeutic Indications (TI) were described separately and as drug-TI combinations, providing the mean Patients Per Year (mPPY) and the Years of Use (YoU).ResultsA total of 783 requests of CDU were retrieved, referring to 156.3 mPPY (max: 272 in 2021; min: 84 in 2018). The 52.2% of subjects was female, and the 63.2% aged >60 years. A total of 709 (90.5%) CDUs referred to solid tumors and 74 (9.5%) to liquid tumors. CDU referred to 93 drug-TI combinations. The most recurrent drug-TIs were nivolumab-lung carcinoma (mPPY: 36.5; YoU: 2) for solid tumors, and azacytidine-acute myeloid leukemia (6.0; 1) for liquid tumors. The most frequent TIs were lung carcinoma (45.7; 6) and breast cancer (37.0; 4) for solid tumors, and chronic lymphocytic leukemia (5.0; 2) and multiple myeloma (4.7; 6) for liquid tumors.ConclusionCompass-O provided an updated framework of the CDU in onco-hematology, showing its large-scale phenomenon and the relevance of UFA as a data source, underlining the need for a national observatory to monitor CDU.

Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma

Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a universally lethal prognosis despite maximal standard therapies. Here, we present a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose is a source of carbon and ATP synthesis for tumor growth through glycolysis, while glutamine provides nitrogen, carbon, and ATP synthesis through glutaminolysis. As no tumor can grow without anabolic substrates or energy, the simultaneous targeting of glycolysis and glutaminolysis is expected to reduce the proliferation of most if not all GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism to therapeutic ketosis. The glucose-ketone index (GKI) is a standardized biomarker for assessing biological compliance, ideally via real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while also targeting glycolytic and glutaminolytic flux using specific metabolic inhibitors. Non-fermentable fuels, such as ketone bodies, fatty acids, or lactate, are comparatively less efficient in supporting the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be implemented as a synergistic metabolic priming baseline in GBM as well as other tumors driven by glycolysis and glutaminolysis, regardless of their residual mitochondrial function. Suggested best practices are provided to guide future KMT research in metabolic oncology, offering a shared, evidence-driven framework for observational and interventional studies.

Real-world treatment outcomes of immune checkpoint inhibitors used off-label in oncology: A comprehensive cancer institution experience

Off-label use (OLU) is quite common in oncology due to the complexity of cancer and the time-consuming regulatory process. However, outcomes of OLU in cancer treatment remain unclear. This study aimed to evaluate the overall survival (OS), event-free survival (EFS), duration of treatment (DOT), and reason for treatment discontinuation in patients receiving immune checkpoint inhibitors (ICI) as OLU for solid tumors from 2011 to 2020. The study collected data on 356 episodes (353 patients), with a median age of 64.4 years, 36.2% women, and 14.6% ECOG ≥ 2. Median OS was 15.7 (11.9-18.7) months, and median EFS was 5.4 (3.8-6.6) months. Men, patients with metastatic disease or ECOG-PS higher than 1, had worse survival outcomes. The findings derived from this study provide valuable information regarding the real-world use of ICI-OLU and contributes to enhancing the decision-making process for individuals with cancer. Further research on immunotherapy outcomes of OLU in cancer is needed.