BACKGROUND: Cancer and its treatments frequently compromise skin integrity, leading to xerosis, pruritus, dermatitis, radiation-induced skin damage, and secondary infections. These cutaneous adverse events (cAEs) are not...BACKGROUND: Cancer and its treatments frequently compromise skin integrity, leading to xerosis, pruritus, dermatitis, radiation-induced skin damage, and secondary infections. These cutaneous adverse events (cAEs) are not merely superficial; they profoundly impact patient quality of life (QoL), contributing to physical discomfort, psychosocial distress, and poorer treatment adherence. Even mild skin toxicities elevate dermatology-specific QoL measures, affecting mood and social function. Additionally, new targeted therapies, such as daraxonrasib-a KRAS inhibitor under development for pancreatic cancer-can cause a dose-limiting acneiform facial rash. METHODS: In this study, relevant literature on skin care in cancer patients was identified using PubMed. Evidence from clinical studies, reviews, and expert guidelines was summarized. RESULTS: Evidence supports proactive skincare with gentle pH-balanced cleansers, ceramide- or urea-based moisturizers, and broad-spectrum photoprotection to lessen symptom severity and improve QoL. Sun protection remains essential because chemotherapy and immunomodulatory therapies increase photosensitivity, accelerate photoaging, and raise the risk of secondary skin cancers. Supportive skincare interventions have also shown emotional and functional benefits, including improved mood and self-image during chemotherapy and radiation treatment. CONCLUSION: Despite strong data supporting moisturization, barrier repair, and photoprotection, oncologic treatment plans often overlook these interventions. By integrating dermatologic education and skincare maintenance into standard oncologic practice, we can minimize cAEs, foster treatment compliance, and enhance patients' physical comfort and psychosocial well-being. This narrative review synthesizes mechanistic insights, clinical evidence, and practical recommendations for oncologists to champion comprehensive skincare in all cancer patients, whether directly affected by skin issues or not.
BACKGROUND: Brain metastases in advanced thyroid cancer may be underrecognized due to lack of routine brain imaging. We characterized the clinical and molecular features, risk factors, and survival outcomes of patients w...BACKGROUND: Brain metastases in advanced thyroid cancer may be underrecognized due to lack of routine brain imaging. We characterized the clinical and molecular features, risk factors, and survival outcomes of patients with non-anaplastic follicular cell-derived thyroid carcinoma (FCDTC) with brain metastases. METHODS: This retrospective cohort study included patients with advanced non-anaplastic FCDTC treated in the Medical Oncology Department at Princess Margaret Cancer Centre between 2007 and 2022. Clinicopathologic and treatment data were extracted from electronic records, and all tumors underwent targeted next-generation sequencing. Risk factors for brain metastasis were assessed using logistic regression, and overall survival was analyzed with Kaplan-Meier and Cox proportional hazards models. RESULTS: Of 187 patients with advanced non-anaplastic FCDTC, 32 (17%) were diagnosed with brain metastases. Dedicated brain imaging was performed in 56% of patients, and most metastases (78%) were asymptomatic and incidentally detected. Lung metastases were associated with higher risk of developing brain metastases (aOR 8.27, 95% CI 1.87-36.46). ARID2 mutations were enriched in patients with brain metastases (9% vs 1%, P = .02). Survival did not differ between patients with and without brain metastases. Patients with brain metastases who had an ECOG performance status ≥2 (aHR 6.30, 95% CI 1.61-24.64) or ≥4 brain metastases (aHR 4.92, 95% CI 1.45-16.64) had worse survival. Molecular alterations were not predictive of survival. CONCLUSION: Brain metastases occurred more frequently than previously reported. Lung metastases were associated with higher risk of developing brain metastases, and performance status and lesion number were associated with survival. These findings support consideration of brain metastasis screening in advanced thyroid cancer and may inform future prognostic and treatment strategies.
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) harboring ALK fusions is exceptionally rare, with limited data on clinical outcomes with ALK inhibitor therapy. CASE SUMMARY: A 70-year-old man presented with stage IV...BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) harboring ALK fusions is exceptionally rare, with limited data on clinical outcomes with ALK inhibitor therapy. CASE SUMMARY: A 70-year-old man presented with stage IV PDAC (pancreatic tail primary with liver and lymph node metastases). Following progression on first-line gemcitabine/nab-paclitaxel, tumor next-generation sequencing identified an ITSN1-ALK fusion (62.12% abundance) and TP53 mutation. The patient received alectinib 600 mg twice daily beginning at Month 4. Tumor markers declined markedly (CA19-9 from 234 to 12.7 U/mL by Month 7), and radiographic stability was maintained through Month 22. Upon progression at Month 23, treatment was switched to lorlatinib followed by capecitabine plus nimotuzumab. The patient remains alive at last follow-up (Month 29). Progression-free survival on alectinib was 19 months-substantially exceeding the median of 5.0 months reported for ALK fusion-positive gastrointestinal cancers. CONCLUSION: This first report of ITSN1-ALK fusion in PDAC demonstrates that ALK inhibition can produce durable, clinically meaningful benefit. This case reinforces the importance of comprehensive genomic profiling in KRAS-wildtype PDAC to identify actionable rare fusions. IMPLICATIONS FOR PRACTICE: Oncologists should consider broad next-generation sequencing, including fusion detection, for patients with KRAS-wildtype PDAC. When an ALK fusion is identified, ALK inhibitor therapy can yield durable disease control.
BACKGROUND: Most research about the high costs of cancer care has focused on characterizing and mitigating the financial hardship patients and families experience after cancer-directed therapy. Few studies have examined...BACKGROUND: Most research about the high costs of cancer care has focused on characterizing and mitigating the financial hardship patients and families experience after cancer-directed therapy. Few studies have examined how these costs prospectively influence treatment decision-making. Even fewer address how costs impact decisions about symptom-directed therapies. We aim to describe how patient-facing costs of care influence decisions about cancer-directed and symptom-directed therapies for advanced cancer. MATERIALS AND METHODS: We analyzed semi-structured interviews with patients, care partners, clinicians, and health system leaders and clinical observations collected by investigators at 3 National Care Institute-designated US cancer centers between July 2019 and May 2021. Two analysts conducted thematic analysis based on the Model of Financial Burden After Cancer Diagnosis. RESULTS: Analysis of 157 interviews and 92 observations identified 4 themes: (1) insurance influenced treatment choice and location; (2) medical costs influenced treatment choice, location, and timing; (3) non-medical costs influenced treatment location and timing; and (4) employment changes influenced treatment choice and timing. Patients and care partners emphasized costs of symptom-directed therapies; staff focused on costs of cancer-directed therapies. Patients and care partners described how employment influenced decisions about starting or continuing cancer-directed therapy, while staff noted how employment affected decisions about symptom-directed therapy. CONCLUSIONS: Patient-facing costs profoundly influence treatment decisions in advanced cancer care, but differences in perspective among patients, care partners, and clinicians can lead to oversights in treatment decision-making. Eliciting and incorporating patients' varied priorities into treatment decisions can minimize these oversights, better align treatment with goals of care, and reduce financial hardship.
BACKGROUND: Basal cell carcinoma (BCC) is common in older adults, many of whom are poor surgical candidates, especially for curved and cosmetically sensitive facial sites. High-dose-rate (HDR) surface brachytherapy is ef...BACKGROUND: Basal cell carcinoma (BCC) is common in older adults, many of whom are poor surgical candidates, especially for curved and cosmetically sensitive facial sites. High-dose-rate (HDR) surface brachytherapy is effective, but standard flat applicators may fit poorly and increase dose heterogeneity. Patient-specific 3D-printed applicators could improve conformity, yet geriatric BCC data are limited. OBJECTIVE: To assess the feasibility and 12-month outcomes of personalized 3D-printed HDR surface brachytherapy in geriatric patients with BCC. METHODS: In this prospective single-arm study, 15 patients aged ≥65 years with histologically confirmed BCC (predominantly facial) who were unsuitable for surgery received HDR surface brachytherapy using custom 3D-printed applicators. Treatment delivered 51 Gy in 17 fractions with CT-based planning. Repeat CT imaging evaluated applicator fit/reproducibility and target coverage. Acute skin toxicity was graded by RTOG. At 12 months, response was assessed clinically and dermoscopically; cosmesis and quality of life (Dermatology Life Quality Index [DLQI]) were recorded. RESULTS: All patients completed treatment. Positioning was highly reproducible (mean setup error <1 mm) with >90% target dose coverage. At 12 months, all lesions achieved complete remission, with no local recurrence on dermoscopy. Acute reactions were mostly mild (73% grade 1), with 13% grade 2 and 13% grade 3; no grade 4 toxicity or serious adverse events occurred. Cosmesis was favorable, and DLQI improved (mean, 10.5 pre-treatment vs 2.9 at 1 year; P < .01). CONCLUSIONS: Personalized 3D-printed HDR surface brachytherapy appears feasible and well tolerated in this small, single-center cohort of older patients with BCC, with favorable 1-year local control and quality-of-life improvement when surgery is contraindicated. However, the limited sample size and single-center design represent limitation, and the observed benefit should be regarded as suggestive rather than definitive.
Kiladjian JJ, Borate U, Abruzzese E
… +13 more, De Stefano V, Gong T, Breccia M, Palandri F, Pane F, Patriarca A, Reikvam H, Rein L, Yacoub A, Zhou F, Stouffs M, Assad A, Vannucchi AM
BACKGROUND: Ruxolitinib (JAK1/JAK2 inhibitor) is indicated for adults with intermediate or high-risk myelofibrosis; however, a subset of patients may exhibit a suboptimal response due to persistent PI3K/AKT activation. T...BACKGROUND: Ruxolitinib (JAK1/JAK2 inhibitor) is indicated for adults with intermediate or high-risk myelofibrosis; however, a subset of patients may exhibit a suboptimal response due to persistent PI3K/AKT activation. The phase 3, randomized, double-blind, placebo-controlled LIMBER-304 study (NCT04551053) investigated the efficacy and safety of add-on parsaclisib (highly selective PI3Kδ inhibitor) in patients with myelofibrosis and suboptimal or declining response to stable ruxolitinib monotherapy. PATIENTS AND METHODS: Adults with primary or secondary myelofibrosis who received ruxolitinib with palpable spleen and Myelofibrosis Symptom Assessment Form (MFSAF) total symptom score (TSS) ≥10 were eligible. Primary end point was proportion of patients achieving ≥25% spleen volume reduction (SVR; baseline to week 24); key secondary end point was proportion of patients with ≥50% MFSAF-TSS reduction (baseline to week 24). RESULTS: In total, 90 patients received parsaclisib/ruxolitinib; 87 received placebo/ruxolitinib. At week 24, 16.7% of patients receiving parsaclisib/ruxolitinib achieved ≥25% SVR vs 9.7% for placebo/ruxolitinib; this difference was not statistically significant. By week 24, ≥50% reduction in MFSAF-TSS was observed in 17.1% of patients receiving parsaclisib/ruxolitinib vs 14.1% for placebo/ruxolitinib. Higher rates of infections (including cytomegalovirus) and gastrointestinal disorders were observed with parsaclisib/ruxolitinib. Grade ≥3 treatment-emergent adverse events occurred in 60.0% of patients receiving parsaclisib/ruxolitinib vs 42.5% with placebo/ruxolitinib. The study was terminated early based on efficacy findings. CONCLUSIONS: Study results suggested adding parsaclisib to stable-dose ruxolitinib was unlikely to offer clinically meaningful benefits. Further research is needed on the potential of JAK and PI3K inhibitor-based combination therapy for patients with myelofibrosis.
Mascaró-Baselga P, Rodellar Sanz JM, Nunes da Silva T
… +21 more, Hernando J, García-Álvarez A, González Merino C, Molina-Cerrillo J, Fernandez-Pombo A, Iglesias-Alvarez G, Ceballos Lenza I, Plana Serrahima M, Bella Cueto MR, Isidro ML, Martinez Trufero J, Marquina G, Martinez N, Crespo G, Jimeno R, Lorenzo I, Ayala de Miguel P, Alcazar V, Martínez-Badal S, Capdevila J, Alonso-Gordoa T
BACKGROUND: Anaplastic thyroid cancer (ATC) is an extremely rare cancer with very poor prognosis. Targeted therapies have improved outcomes in selected patients, but molecular testing is often difficult because of the ag...BACKGROUND: Anaplastic thyroid cancer (ATC) is an extremely rare cancer with very poor prognosis. Targeted therapies have improved outcomes in selected patients, but molecular testing is often difficult because of the aggressive course, rapid clinical deterioration, and long turnaround times. This study aimed to provide real-world evidence on the management and outcomes of ATC and to evaluate the prognostic impact of molecular testing. MATERIALS AND METHODS: This multicentric, retrospective study included patients diagnosed with ATC between 1992 and 2024 from the REGETNE-Thyroid Network. Factors associated with overall survival (OS) were analyzed using Cox proportional hazards models. RESULTS: 214 patients were included (median age 70.8 years; 56.5% female). Median OS was 4.5 months. Access to molecular testing (HR 0.42, p = 0.001) and BRAF V600E mutation (HR 0.50, p = 0.008) were associated with longer OS, whereas TERT promoter mutations were associated with shorter survival (HR 2.80, p = 0.014). Local surgery showed a favorable prognostic association, regardless of stage (IVa/IVb: HR 0.54, p = 0.026; IVc: HR 0.36, p < 0.001). In metastatic disease, immunotherapy (HR 0.31; p < 0.001), tyrosine kinase inhibitors (HR 0.40; p = 0.002) and their combination (HR 0.24; p = 0.001) significantly improved OS, whereas chemotherapy did not (HR 0.76; p = 0.096). Targeted therapy, used predominantly (>95%) in BRAF V600E-mutated ATC, was also associated with longer survival (HR 0.40; p = 0.001). CONCLUSION: Molecular testing was associated with improved survival in ATC, likely driven by the identification of actionable alterations with effective targeted therapies. Local management is key in all stages. Our findings also support immunotherapy, tyrosine kinase inhibitors and their combinations as key therapeutic options.
The seventh Kidney Cancer Research Summit was held as a hybrid virtual/in-person event in Boston, MA during July 17-18, 2025. This conference, which aims to help guide the design of kidney cancer clinical trials and rese...The seventh Kidney Cancer Research Summit was held as a hybrid virtual/in-person event in Boston, MA during July 17-18, 2025. This conference, which aims to help guide the design of kidney cancer clinical trials and research, centers around projects that showcase the most impactful basic, translational, and clinical data evolving in renal cell carcinoma (RCC), and brings together clinical oncologists, physician scientists, translational researchers, and patient advocates. The abstract presentations were published as a supplement in The Oncologist (https://academic.oup.com/oncolo/issue/30/Supplement_2). This perspective will provide the layout of the current RCC research landscape as discussed and debated among the stakeholders at the conference as well as more recent updates.
BACKGROUND: Phase 1 oncology clinical trials have become increasingly complex, resource-intensive, but essential to modernize drug development. Despite strong academic infrastructure, Canada remains underrepresented in e...BACKGROUND: Phase 1 oncology clinical trials have become increasingly complex, resource-intensive, but essential to modernize drug development. Despite strong academic infrastructure, Canada remains underrepresented in early-phase cancer trials relative to international peers. METHODS: To advance this vision, this perspective summarizes barriers and opportunities impacting the conduct of phase 1 oncology clinical trials in Canada, based on discussions from sponsor, patient advocate, ethics, and clinical research site representatives across national major phase 1 units at the inaugural "Practical Workshop of Conducting Phase 1 Trials in Canada." RESULTS: Current challenges include overly restrictive and complex trial design that increases participant burden, study activation delays, operational inefficiencies, and limited access to investigational therapies following disease progression. However, Canada's integrated academic cancer centers, publicly funded healthcare system, and ongoing advances in harmonization strategies present opportunities to strengthen national competitiveness in global site selection. CONCLUSION: Participant-centric strategies, earlier collaboration amongst stakeholders, and targeted operational improvements at local, provincial, and national levels are crucial to elevate Canada as a global leader (CANLead) in phase 1 oncology clinical research. Together, the approaches position Canada to advance its competitiveness and take a more prominent role on the international stage, while also providing a practical framework for developing and optimizing phase 1 units globally.
Major A, Ma E, Masaquel A
… +12 more, Tsang M, Di M, Kaur S, Pophali P, Werner S, Bungay R, Latrémouille-Viau D, Guerin A, Reyes C, Wu M, Cassoli L, Torka P
BACKGROUND: Several bispecific antibodies (BsAbs), including mosunetuzumab, glofitamab, and epcoritamab, are approved for non-Hodgkin lymphoma (NHL). However, real-world patient-centered data evaluating treatment-related...BACKGROUND: Several bispecific antibodies (BsAbs), including mosunetuzumab, glofitamab, and epcoritamab, are approved for non-Hodgkin lymphoma (NHL). However, real-world patient-centered data evaluating treatment-related time burden and preferences are lacking. METHODS: We conducted an online survey of 120 patients with relapsed/refractory follicular lymphoma (FL; N = 60) and diffuse large B-cell lymphoma (DLBCL; N = 60) receiving BsAbs. Participants reported all-cause healthcare visits and time spent on cancer-related healthcare resource utilization over the past 30 days, including travel, treatment administration, recovery, and impact on daily activities. Participants also evaluated two hypothetical treatment profiles to assess preference for fixed-duration versus treat-to-progression therapy. RESULTS: Participants with FL reported a mean of 2.5 healthcare visits in the past 30 days, with significantly fewer visits for mosunetuzumab versus epcoritamab (1.7 vs 3.3, respectively; P < .01). In DLBCL, the mean was 2.6 visits, with fewer visits for glofitamab versus epcoritamab (2.2 vs 3.0; P =.01). Although epcoritamab visits were shorter in FL, more frequent visits and longer recovery time resulted in significantly lower monthly time burden with mosunetuzumab versus epcoritamab (31.2 vs 61.9 hours; P < .05). Similarly, monthly time burden was also lower with glofitamab than epcoritamab in DLBCL (43.0 vs 87.7 hours; P < .05). Most participants reported little to moderate impact on daily activities. Across treatment groups, ≥92% preferred a hypothetical fixed-duration regimen over a treat-to-progression therapy. CONCLUSION: Our real-world data, including novel aspects of time toxicity, demonstrate clinically meaningful differences in time burden associated with BsAbs and emphasize the importance of incorporating patient convenience and preference into shared decision-making in NHL.
BACKGROUND: Neoplastic fever (NF) severely impairs quality of life and often limits antitumor therapy, yet effective treatment remains lacking. Given the central role of interleukin-6 (IL-6), we evaluated tocilizumab for...BACKGROUND: Neoplastic fever (NF) severely impairs quality of life and often limits antitumor therapy, yet effective treatment remains lacking. Given the central role of interleukin-6 (IL-6), we evaluated tocilizumab for NF management. METHODS: We retrospectively reviewed NF cases at 3 Chinese hospitals (2019-2023). Patients who received tocilizumab and had evaluable follow-up data were included in analyses of fever resolution, afebrile duration, Karnofsky Performance Status, inflammatory markers, antitumor outcomes, and adverse events (AEs). In patients with sequential exposure to non-steroidal anti-inflammatory drugs (NSAIDs) and tocilizumab, changes in inflammatory markers after each treatment were compared. RESULTS: Forty-five patients were identified (median age 65). All had elevated CRP and IL-6. Among 22 treated with tocilizumab, all achieved fever resolution within 24 hours, sustained for ≥2 weeks, with significant reductions in CRP (mean, 95.7-19.0 mg/L) and other inflammatory markers. Median afebrile duration was 3 weeks, extended to 4 weeks with re-treatment. Systemic therapy was subsequently administered in patients with poor baseline performance, who achieved an objective response rate of 50%, a median progression-free survival of 11.6 months, and an overall survival of 21.3 months. AEs occurred in 81.8% (grade ≥3, 31.8%) but were manageable. Compared with NSAIDs, tocilizumab uniquely improved anemia and inflammatory control. CONCLUSION: Tocilizumab provided rapid and durable fever resolution with systemic anti-inflammatory effects, accompanied by functional and hematologic improvement. These findings suggest IL-6 blockade as a promising therapeutic option for NF.
BACKGROUND: Chemotherapy is an essential component of comprehensive cancer care and timely access can improve survival outcomes. The objective of this study was to assess the time to chemotherapy initiation and patient-r...BACKGROUND: Chemotherapy is an essential component of comprehensive cancer care and timely access can improve survival outcomes. The objective of this study was to assess the time to chemotherapy initiation and patient-reported barriers to cancer care among patients from Addis Ababa, Ethiopia. METHODS: We conducted a retrospective study using a randomly selected sample of 350 patients with common cancers (breast [ICD-10: C50], cervical [C53], colorectal [C18-20], oesophageal [C15], gastric [C16] and ovarian [C56]) registered at the population-based Addis Ababa City Cancer Registry (AACCR) in 2021. Patients or their relatives were followed-up via questionnaire-based telephone interview and treatment data were extracted from their medical records. The time from pathological diagnosis to initiation of chemotherapy (time to treatment) was calculated. Regression analyses were conducted to identify predictors of chemotherapy initiation and treatment delays. RESULTS: Most patients (71.7%) received chemotherapy and the median time to treatment was 63 days (IQR 36.5 to 128 days). Patients reported considerable barriers to treatment regarding fear, cost and waiting times. Having health insurance (OR 2.70; 95% CI 1.33 to 5.50) and trust in healthcare professionals (OR 1.76; 95% CI 1.16 to 2.68) were associated with higher odds of receiving chemotherapy. Patients with cervical (OR 0.07; 95% CI 0.03 to 0.18), gastric (OR 0.21; 95% CI 0.05 to 0.86) or oesophageal cancer (OR 0.10; 95% CI 0.02 to 0.53) were less likely to initiate chemotherapy compared to breast cancer patients. Longer time to treatment was not associated with any of the assessed characteristics or perceived barriers. CONCLUSION: Over half of the cancer patients from Addis Ababa wait more than two months to initiate chemotherapy after a pathological diagnosis. Expanding oncology services and health insurance coverage could enhance access to treatment. Health professionals should promote patient trust by appropriately addressing their psychosocial needs, including cancer-related fear, to improve the uptake of treatment and thus clinical outcomes. IMPLICATIONS FOR PRACTICE: Improving access to timely chemotherapy requires coordinated action across multiple levels. Strengthening health system capacity and care coordination is essential to reduce delays, while improving provider-patient communication and integrating psychosocial support can address fear and enhance treatment uptake and adherence. Expanding health insurance coverage may reduce financial barriers but must be accompanied by increased service availability to be effective.
BACKGROUND: Trastuzumab-based chemotherapy is the standard first-line treatment for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced or metastatic gastric cancer (GC). However, evidence on...BACKGROUND: Trastuzumab-based chemotherapy is the standard first-line treatment for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced or metastatic gastric cancer (GC). However, evidence on real-world outcomes according to the chemotherapy backbone remains limited. METHODS: A total of 2399 patients with GC treated with trastuzumab-based chemotherapy were analyzed, of whom 486 patients were treated with trastuzumab/5-fluorouracil/cisplatin (HFP) and 1913 patients were treated with trastuzumab/capecitabine/cisplatin (HXP). Time to subsequent treatment (TST) and overall survival (OS) were analyzed according to the type of chemotherapy backbone. RESULTS: With a median follow-up of 10.5 months, the median TST was 6.08 months (95% confidence interval [CI], 5.65-6.60) in the HFP group and 8.02 months (95% CI, 7.72-8.57) in the HXP group (P < .0001). The median OS was 9.89 months (95% CI, 8.94-10.87) for the HFP group and 13.27 months (95% CI, 12.75-14.00) for the HXP group (P < .0001). Specifically, HXP followed by trastuzumab and capecitabine maintenance (HXP-HX) demonstrated the best outcomes with median TST of 13.44 months (95% CI, 12.52-15.61) and median OS of 22.18 months (95% CI, 20.83-24.44) compared with HXP followed by trastuzumab maintenance (HXP-H) and HXP alone (both P < .0001), which were also significant in multivariable analysis. CONCLUSIONS: Trastuzumab/capecitabine/cisplatin followed by trastuzumab/capecitabine maintenance showed the best survival outcomes for patients with locally advanced unresectable or metastatic HER2-positive GC based on real-world big data analysis of the Trastuzumab for Gastric Cancer regimen, suggesting that HXP-HX is recommended over HXP-H. In the current immunotherapy era for HER2-positive GC, the potential role of capecitabine maintenance as part of combination strategies should be interpreted cautiously and warrants further investigation.
BACKGROUND: Age is a prognostic factor in thyroid cancer. However, little is known about benefits and risks of systemic therapy in older adults with advanced thyroid cancer. PATIENTS AND METHODS: We performed a retrospec...BACKGROUND: Age is a prognostic factor in thyroid cancer. However, little is known about benefits and risks of systemic therapy in older adults with advanced thyroid cancer. PATIENTS AND METHODS: We performed a retrospective review of patients ≥ 65 years of age with advanced thyroid cancer referred to medical oncology at our institution for consideration of systemic therapy between 2010 and 2025 (n = 114). Clinicopathologic, treatment, adverse event, and outcomes data were analyzed. RESULTS: 65/114 patients received first-line systemic therapy. Median overall survival (OS) was 4.04 years (95% CI, 3.09-not estimable) in the whole cohort and 3.91 years (95% CI, 2.84-not estimable) in the treated cohort. First-line time-to-treatment discontinuation (TTD) in the treated cohort was 1.59 years (95% CI, 0.75-4.45). Age, male sex, and anaplastic histology predicted shorter OS in the whole cohort. Age, male sex, increasing Charlson comorbidity index, and BRAF and/or TERT mutation predicted worse OS and/or TTD amongst treated patients. For patients receiving lenvatinib (n = 37), adverse events led to significant proportions of patients requiring dose reductions (65%), treatment breaks (78%), emergency department (ED) visits (16%), and drug discontinuation (14%). Adverse events led to treatment breaks (56%), ED visits (67%), and drug discontinuation (22%) in patients receiving dabrafenib + trametinib (n = 9). Female sex, geriatric oncology referral, polypharmacy, and BRAF mutation predicted higher number of ED visits. CONCLUSION: Although survival outcomes were comparable to those described in younger adults, adverse events were common and impactful in older adults.
Rebuzzi SE, Ghose A, Rudman S
… +66 more, Venugopal B, Young K, Frazer RD, Ayodele O, Stares M, O'Carrigan B, Ali W, McGrane J, Jain A, Fiala O, Chauhan V, Michael A, Zarkar A, Kapur G, Charnley N, Afshar M, Vengalil S, Forde C, Brown J, Ürün Y, Bianchini D, Bahl A, Srihari N, Di Costanzo F, Smalley B, Parkes J, Crabb S, Vasudev N, Poprach A, Brown N, James L, Haywood S, Tapia J, Vijay A, Parry J, Cheung M, Mahajan I, Moon NO, Abrol R, Tkadlecová M, Soe YSY, Zargham A, Smith M, Ashley S, Hardy O, Patel G, Tun KK, Johnston E, Sarwer A, Bölek H, Shrestha R, Challapalli A, Meegan J, Anpalakhan S, Buono F, Kolarikova E, Leung DK, Murianni V, Catalano F, Bimbatti D, Buti S, Signori A, Fornarini G, Rescigno P, Teoh JYC, Banna GL
BACKGROUND: Effective risk stratification is essential for guiding treatment decisions in patients with metastatic renal cell carcinoma (mRCC). The Meet-URO score is a novel prognostic model that integrates the Internati...BACKGROUND: Effective risk stratification is essential for guiding treatment decisions in patients with metastatic renal cell carcinoma (mRCC). The Meet-URO score is a novel prognostic model that integrates the International Metastatic RCC Database Consortium (IMDC) criteria with neutrophil-to-lymphocyte ratio (NLR) and the presence of bone metastases. Developed in the immunotherapy era, it has demonstrated superior prognostic accuracy compared to the IMDC score across various clinical settings and treatment strategies. Its validation in the context of first-line immune-based combinations has been awaited. METHODS: External validation of Meet-URO was performed using a large retrospective real-world cohort of mRCC patients treated with first-line immune-based combinations. Secondary analyses included a comparison with the IMDC score for predicting overall survival (OS) and progression-free survival (PFS). Additionally, restricted mean survival time (RMST) was assessed. RESULTS: A total of 1,418 patients were included in the analysis: 54% received ICI-ICI regimen (nivolumab plus ipilimumab), while 46% received the ICI-TKI combination. At baseline, 52.5% of patients had an NLR ≥ 3.2, and 32% had bone metastases. After a median follow-up of 26.8 months, the median OS and median PFS were 34.7 and 11.3 months, respectively. Meet-URO demonstrated effective prognostic stratification, identifying patient groups with markedly different outcomes (median OS 11.5-51.4 months; 3-year OS 26-66%; RMST 20.0-42.8 months). Compared to IMDC, Meet-URO showed a significantly better OS (c-index 0.675 vs 0.643; Δc = 0.032, P < .001) and PFS (c-index 0.60 vs 0.58; P < .001) prediction performance. CONCLUSIONS: Meet-URO demonstrated robust prognostic accuracy. Its integration into routine clinical practice and use as a stratification factor in clinical trials may support more personalized treatment strategies and enhance clinical trial design.