ONCOLOGIST

"Treatable not curable": trade-offs in the use of treatment-oriented language with patients who have incurable cancer
Batten JN, Kennedy KM, Wong BO, Kraft SA, Hanks W, Magnus D and Schapira L
Treatment-oriented language is used by physicians to convey to patients that treatment is available for their cancer (eg, "our usual treatment for this is…," "we can treat this," "your cancer is still treatable"). For patients who have incurable cancer, especially for patients with a poor prognosis or who are at the end of life, it is important to understand how physicians conceptualize and use this "everyday" clinical language. We conducted a qualitative interview study with a multidisciplinary group of physicians (n = 30) who may care for patients with cancer at different points in their clinical course, from diagnosis to end of life. Physicians report a wide range of reasons for using treatment-oriented language in conversations with patients who have incurable cancer. However, physicians also reported concerns that this language can be ambiguous, can convey unintended positive prognostic information, and can shift attention away from important matters such as the non-curative nature of treatment or the inevitability of death. On the basis of these concerns, physicians should (1) consider whether their aims in using treatment-oriented language can be better achieved using other evidence-based communication strategies, and (2) recognize and proactively mitigate potential adverse effects of treatment-oriented language, which may manifest much later in the patient's clinical course.
Genomic alterations associated with early-stage disease and early recurrence in patients with colorectal cancer
Pappas L, Quintanilha JCF, Huang RSP and Parikh AR
The molecular characterization of early-stage (1-3) colorectal cancer (CRC) remains incomplete, as opposed to metastatic disease, where comprehensive genomic profiling (CGP) is routinely performed. This study aimed to characterize the genomics of stages 1-3 versus IV CRC, and the genomics of patients recurring within 1 year of diagnosis.
Trends in complexity of single-agent and combination therapies for solid tumor cancers approved by the US Food and Drug Administration
Chen EY, Rai M, Tadikonda Y, Roy P, Nollner DW, Chitkara A, Hamilton J and Thawani R
Many FDA-approved cancer therapies, whether as a multiagent combination or as a single agent, have demonstrated only modest clinical benefit. To investigate the drug development landscape, this analysis focuses on whether newly approved drugs are added to existing standards as combination therapy or replace a former drug as monotherapy.
Immunotherapy benefits for large brain metastases in non-small cell lung cancer
Sadagopan N, Komlodi-Pasztor E and Veytsman I
Non-small cell lung cancer (NSCLC) patients with large brain metastases (BrM) defined as >2 cm in diameter historically face grim prognoses. With immunotherapy emerging as a promising avenue for BrM management and being commonly used in NSCLC, its application in addressing large BrM remains underexplored.
Bilateral orthotopic lung transplantation for the patient with lung-limited invasive mucinous adenocarcinoma: a case-based literature review
Chae YK, Oh Y, Kim L, Park JH, Djunadi TA, Shah Z, Chung LI, Yoon SM, Duan R, Lee J, Kim S and Bharat A
Invasive mucinous adenocarcinoma (IMA) of lung is a unique subset of adenocarcinomas characterized by an intrapulmonary aerogenous spread resulting in multicentric, multilobar, and bilateral lesions with a low frequency of distant metastasis. The treatment options for IMA are limited, and advanced IMA has a poor prognosis, with a median survival of less than a year. Lung transplantation performed in a handful of selected patients showed improved survival outcomes and clinical improvement. However, high postoperative recurrence rates have been observed and recurrence appeared to originate from the primary tumor in many cases. Techniques, such as non-sequential double lung transplantation utilizing cardiopulmonary bypass, have been performed to reduce recurrence. Here, we present the first case of bilateral lung transplantation employing cardiopulmonary bypass in a patient with stage ⅣA lung-limited IMA without lymph node or distant metastasis. At 15 months post-transplantation, the patient remains stable with no evidence of disease recurrence or organ rejection. Additionally, we describe the classification, clinical outcomes, protein expression, and genetic characteristics of IMA. IMA was previously classified as a subset of bronchioalveolar carcinoma (BAC), which is invasive and mucinous with goblet or columnar cells secreting mucin. We reviewed and summarized the lung transplantation cases reported to date for BAC. The 5-year overall survival and disease-free survival have been reported approximately 50% (range, 39-100) and 50% (range, 35-100), respectively. The literature shows these outcomes are comparable to bilateral lung transplantation performed for non-cancerous pulmonary disease.
Management of severe immune-related adverse events and outcomes in patients with advanced non-small cell lung cancer receiving immune checkpoint inhibitors
Naidoo J, Johnson DB, Doran C, Wang Y, Zhang Y, Le TK, Hopson S, Dreyfus B, Lal LS, Vyas C, Goldstein S and Izadi Z
Immune checkpoint inhibitors (ICIs) are associated with severe immune-related adverse events (s-irAEs) that result in hospitalization, emergency department (ED) visits, treatment discontinuation, or death. This study examined the impact of s-irAEs and their earliest management strategies on clinical outcomes in advanced non-small cell lung cancer (NSCLC).
Leptin levels are associated with coronary artery calcification in patients with advanced prostate cancer
Koutroumpakis E, Venkatesh N, Aparicio A, Song J, Panaretakis T, Deswal A, Logothetis CJ, Frigo DE and Hahn AW
Convergent data suggest that advanced prostate cancer and coronary heart disease (CHD) share biological vulnerabilities that may be linked to adiposity. Here we explore whether leptin, as a marker and mediator of adiposity, could link prostate cancer to CHD.
Targeting RAF1 gene fusions with MEK inhibition in metastatic melanoma
Khaddour K, Haq R, Buchbinder EI, Liu D, Manos MP, Ott PA, Hodi FS and Insco ML
The biological and clinical relevance of gene fusions in melanoma is unknown. Reports and preclinical data have suggested that tumor cells with specific rearrangements such as RAF1 gene fusions could be therapeutically targeted. To investigate the relevance of targeted therapy in patients with melanoma harboring RAF1 gene fusions, we reviewed records of 1268 melanoma patients with targeted sequencing data at the Dana-Farber Cancer Institute. We identified 9 cases and report here on their clinicopathologic characteristics. We describe the favorable outcome of 2 patients who received MEK inhibitor therapy, including 1 patient with a durable response. We coalesced our data with published reports of patients with RAF1 gene fusions who were treated with targeted therapy. We find that single-agent MEK inhibition has anti-tumor activity in melanoma patients harboring an RAF1 gene fusion, and we propose that patients with RAF1 gene fusions should be considered for single-agent MEK inhibitor therapy.
Relapse-free survival with adjuvant dabrafenib/trametinib therapy after relapse on a prior adjuvant CPI in BRAF V600-mutated stage III/IV melanoma
Weber J, Haque W, Markovic SN, Salama AKS, Mehmi I, Sullivan RJ, Najjar YG, van Akkooi ACJ, Menzies AM, Long GV, Taylor AM, Haanen J, Zijlker LP, Davis KL, Karanth S, Norton D and Connolly L
In BRAF-mutated high-risk melanoma, targeted therapy (BRAF/MEK inhibitors) and checkpoint inhibitor (CPI) immunotherapy have durable benefits as first-line (1L) adjuvant therapy. Based on differing action mechanisms of BRAF/MEK inhibitors and CPI immunotherapies, there is interest in evaluating the activity of 2L adjuvant targeted therapy in decreasing the risk of subsequent recurrence after repeat resection following relapse on/after 1L adjuvant CPI.
Barriers to adherence of posttreatment follow-up after positive primary cervical cancer screening in Ethiopia: a mixed-methods study
Alemayehu R, Stroetmann CY, Wondimagegnehu A, Rabe F, Addissie A, Kantelhardt EJ and Gizaw M
Even though it is preventable, cervical cancer contributes significantly to cancer-related mortality among Ethiopian women. Follow-up visits after treatment of precancerous lesions are essential to monitor lesion recurrence. In our previous study, we found a level of adherence to follow-up of 44.7%, but the reasons for low adherence have not been comprehensively explored within the Ethiopian context. This study aimed to identify these reasons by interviewing 167 women who had missed their follow-up appointments as well as 30 health professionals with experience in the field.
Anthracyclines-induced cardiotoxicity in patients with early breast cancer carrying germline BRCA1/2 mutation: the BRCAN study
Cortés-Salgado A, Serrano JJ, Cordero Pereda D, Menacho M, Del Rey JM, Del Campo-Albendea L, Saavedra C, Chamorro J, Rosero D, Sotoca P, Guillén-Ponce C, Guerra E, Fernández-Abad M, López-Miranda E, Martínez-Jáñez N, Gion M, Salazar MT, Agudo-Quílez P, Garrido P and Alonso Salinas GL
BRCA1/2 genes play a critical role in genome stability and DNA repair. In animal models, loss of cardiomyocyte-specific BRCA1/2 is associated with DNA damage, apoptosis, cardiac dysfunction, and mortality following anthracycline exposure. However, whether these preclinical findings translate to humans remains unclear.
Correction to: Long-term safety of selpercatinib for Rearranged during transfection (RET)-activated advanced solid tumors in LIBRETTO-001: differing patterns of adverse events over time
Real-world effectiveness and prognostic factors of durvalumab plus chemotherapy in a multicentric cohort with advanced biliary tract cancer
Huang WK, Tang YJ, Wu CE, Hou MM, Hsu HC, Su PJ, Chiang NJ, Chen SC, Yeh CN, Chen JS, Chen MH, Hsieh CH and Chou WC
Biliary tract cancer (BTC) is an aggressive biliary tract cancer, arising from the bile ducts and gallbladder, with a poor prognosis. The TOPAZ-1 trial of durvalumab plus first-line chemotherapy (gemcitabine plus cisplatin) showed improved survival vs chemotherapy alone. This real-world study aimed to confirm the effectiveness of this regimen.
Evolution in the diagnosis and treatment of carcinoma of unknown primary: a multicenter Canadian analysis
Wong B, Liu J, Yeo S, Akurang D, Lo A, Xu YH, Wang Y, Welch S and Wheatley-Price P
Guidelines for the management of patients with cancer of unknown primary (CUP), who have metastatic disease without an identified primary tumor site, have evolved. We sought to describe the diagnostic work-up and outcomes of patients with CUP in Canada over the last decade. We also sought to identify factors associated with improved prognosis in CUP, including primary tumor site identification, identification of "favorable subtypes," and concordance with published guidelines.
Overestimation of clinical N-staging in microsatellite instable gastric cancers is associated with VEGF-C signaling and CD8+ T-cell dynamics
Tsai CY, Tai TS, Huang SC, Chen TH, Hsu JT, Yeh CN, Lai YC, Lin G and Yeh TS
Microsatellite instable (MSI) gastric cancers exhibit reduced lymph node (LN) metastasis and improved survival compared to microsatellite stable (MSS) counterparts. However, to our longstanding observation, clinical N-staging (cN) is frequently overestimated in MSI cases. The clinical implications and underlying mechanisms of this discrepancy warrant further investigation.
Correction to: Efficacy and Safety of Camrelizumab, Apatinib, and Capecitabine Combination Therapy in Advanced Biliary Tract Cancer: A Single-arm Prospective Study
Real-world application of disitamab vedotin (RC48-ADC) in patients with breast cancer with different HER2 expression levels: efficacy and safety analysis
Wang K, Xu T, Wu J, Yuan Y, Guan X and Zhu C
Disitamab vedotin (RC48-ADC), an antibody-drug conjugate (ADC), combines specific antibody disitamab with cytotoxicity monomethyl auristatin E to effectively target the human epidermal growth factor receptor 2 (HER2) protein on tumor cells for precise elimination. Recent studies have demonstrated that RC48-ADC offers therapeutic benefits for patients with HER2-positive and HER2-low-expression breast cancer (BC). However, a thorough exploration of its efficacy and safety in real-world settings for patients with metastatic breast cancer (mBC) is currently lacking.
Pegylated liposomal doxorubicin in partially platinum-sensitive, platinum-resistant, or platinum-refractory ovarian cancer: a prospective study
Zhang Y, Yuan Z, Zhang GN, Li QS, Cui MH, Cheng WJ, Meng YG, Wu XH, Yue Y, Wang L, Hou JQ, Li CZ, Qu PP, Sun LX, Tao GS, Li GL, Chen YQ, Ren F, Cao DY and Shen K
This study aimed to evaluate the efficacy and safety of pegylated liposomal doxorubicin (PLD) for patients with partially platinum-sensitive, platinum-resistant, or platinum-refractory ovarian cancer.
Three-year survival follow-up of patients with gastrointestinal cancer treated during the COVID-19 pandemic in Spain: data from the PANDORA-TTD20 study
García-Alfonso P, Jimenez-Fonseca P, Soto-Alsar J, Baraibar I, Santos C, La Casta A, Ghanem I, Pulido Cortijo G, Mariño Méndez A, Pazo-Cid R, Vera R, Melián M, Alcaide J, Graña B, Páez D, Gallego I, Lobo M, Borregón M, Fernández Montes A, Martínez de Castro E, Carmona-Bayonas A and Aranda E
The initial SARS-CoV-2 pandemic wave in Spain in 2020 precipitated significant paradigm shifts in gastrointestinal oncology patient management. This study captures the "Zeitgeist" of this period by analyzing adaptive strategies, treatment modifications, and survival outcomes, leveraging a 3-year follow-up perspective to extract insights from this unprecedented experience.
Breast cancer incidence and mortality, by age, stage and molecular subtypes, by race/ethnicity in Canada
Wilkinson AN, Ng C, Ellison LF and Seely JM
Breast cancer (BC) characteristics and outcomes in Canada related to race/ethnicity are not currently documented.
The use of wearable technology in studies in older adults with cancer: a systematic review
Duin JJ, Baltussen JC, Albalak G, van Dam van Isselt EF, Portielje JEA, Mooijaart SP, Soto-Perez-de-Celis E and van den Bos F
Despite the increasing integration of wearable technology in oncology, its application in the care of older adults, representing most patients with cancer, is poorly defined.