BACKGROUND: Immune checkpoint inhibitors (ICIs) are widely used in clinical practice. The primary objective of this study is to evaluate the safety and efficacy of ICIs in patients diagnosed with cancer who also have chr...BACKGROUND: Immune checkpoint inhibitors (ICIs) are widely used in clinical practice. The primary objective of this study is to evaluate the safety and efficacy of ICIs in patients diagnosed with cancer who also have chronic hepatitis B virus (HBV) infection. METHODS: We reviewed the charts of patients who received an ICI between 2016 and 2023 at three tertiary cancer centers. We included those who had known chronic HBV infection. RESULTS: Of the 1352 patients screened, we identified 65 (4.8%) with concurrent hepatitis B. Of the 65 patients, 8 (12.3%) experienced irAEs (immune-related adverse events) of any grade, with 1 (1.5%) having grade 3 pneumonitis. No cases of reactivation were seen except for one patient (1.5%) with poor compliance with his antiviral drug developed hepatitis B reactivation 9 months after discontinuation of ICI. CONCLUSION: ICIs appear safe in patients with chronic hepatitis B, especially when antiviral treatment is given. We believe these patients should not be deprived of the potential benefits of ICIs solely because of chronic viral infection, neither in daily practice nor in clinical trials.
INTRODUCTION: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has become an indispensable tool in oncology, offering both metabolic and anatomical insights into tumor behavior. Most diffe...INTRODUCTION: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has become an indispensable tool in oncology, offering both metabolic and anatomical insights into tumor behavior. Most differentiated thyroid carcinomas (DTC) are indolent and therefore FDG PET/CT is not routinely incorporated into management. However, in biologically aggressive DTCs, FDG PET/CT plays a crucial role in detecting recurrence and metastases. AREAS COVERED: This narrative review with articles from the last 25 years from PubMed database, explores the evolving role of FDG PET/CT, focusing on its utility in recurrence detection, staging, and follow-up of radioactive iodine (RAI)-refractory cases. Current guidelines recommend FDG PET/CT primarily for high-risk patients with elevated thyroglobulin levels and negative RAI scans (TENIS syndrome). We also examine advancements in PET imaging, novel radiotracers and theragnostic approaches that enhance diagnostic accuracy and treatment monitoring. EXPERT OPINION: While FDG PET/CT has proven valuable in biologically aggressive DTC, its routine use remains limited by cost, accessibility, and concerns regarding radiation exposure in younger patients requiring repeated imaging studies. Future developments in molecular imaging, including novel tracers and artificial intelligence-driven analysis, are expected to refine its role, leading to more personalized and effective management, though economic and reimbursement challenges remain important considerations for broader adoption.
INTRODUCTION: Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality, with metastasis being a key determinant of poor prognosis. Understanding the molecular mechanisms governing CRC metasta...INTRODUCTION: Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality, with metastasis being a key determinant of poor prognosis. Understanding the molecular mechanisms governing CRC metastasis is crucial for developing targeted therapeutic strategies. This review focuses on the involvement of major signaling pathways in CRC metastasis and their potential as therapeutic targets. AREAS COVERED: This review discusses the role of key signaling pathways, including PI3K/Akt, MAPK/ERK, Notch, Wnt/β-catenin, Hippo, and Hedgehog in CRC metastasis. We conducted a literature review using databases such as PubMed and Web of Science to identify recent studies on the molecular mechanisms of metastasis and the efficacy of pathway-targeted therapies. EXPERT OPINION: The complexity of CRC metastasis underscores the need for multi-targeted therapeutic approaches. While significant advances have been made in pathway-specific inhibitors, clinical translation remains challenging. Further research is needed to refine biomarker-driven treatments and develop novel combination therapies to improve patient outcomes.
INTRODUCTION: Radical cystectomy in women with bladder cancer traditionally involves removal of reproductive organs, often leading to significant impairment in quality of life. Organ-preserving radical cystectomy (OPRC)...INTRODUCTION: Radical cystectomy in women with bladder cancer traditionally involves removal of reproductive organs, often leading to significant impairment in quality of life. Organ-preserving radical cystectomy (OPRC) has emerged as an alternative approach aimed at maintaining functional outcomes without compromising oncological safety. METHODS: This systematic review evaluates current evidence on oncological, surgical, and functional outcomes of OPRC. A comprehensive literature search was conducted using the PubMed, Scopus, and Cochrane databases up to April 2025. Studies were assessed for methodological quality and risk of bias. RESULTS: Fifteen studies (946 female patients) were included in the review. Data on patient selection criteria, operative parameters, recurrence, survival, continence, and sexual outcomes were discussed. CONCLUSION: OPRC is a safe and effective option for selected women with organ-confined disease. It offers superior functional outcomes and quality of life compared to standard radical cystectomy without compromising oncologic control. Several studies applied strict criteria, including premenopausal, sexually active women with organ-confined (≤T2) disease, away from bladder neck and no genital organ involvement on imaging. However, considerable heterogeneity existed in patient selection and definitions of functional outcomes. Further prospective trials and standardized criteria are warranted. Integrating these findings into practice guidelines could enhance patient-centered care in women undergoing cystectomy. REGISTRATION: PROSPERO (CRD420251045355).
INTRODUCTION: Tumor protein 53 gene () is the most frequently mutated gene in human cancers. mutation status may have prognostic value across malignancy types, and its use as a predictive biomarker is limited. Selinexor...INTRODUCTION: Tumor protein 53 gene () is the most frequently mutated gene in human cancers. mutation status may have prognostic value across malignancy types, and its use as a predictive biomarker is limited. Selinexor is a novel oral exportin 1 (XPO1) inhibitor with preliminary efficacy data as a maintenance treatment in advanced/recurrent wild-type (wt) endometrial cancer (EC), suggesting wt may be a predictive biomarker for this therapy. XPO1 mediates nuclear to cytoplasmic trafficking of transcriptionally active p53, where it is degraded and rendered functionally inactive. Selinexor prevents this export to restore nuclear p53 and increase the transcription of p53 activated target genes. AREAS COVERED: This review examines the mechanism of action of selinexor related to p53, contextualizes the effectiveness of selinexor among EC subtypes within the context of the evolving diagnostic, predictive, and therapeutic landscape for treatment, and presents the relevant clinical studies for selinexor dose for its use in gynecological malignancies. Literature review was conducted on the PubMed database. EXPERT OPINION: The promising efficacy signal suggests selinexor has potential as a maintenance therapy for wt EC to address current treatment gaps. A phase 3 study is currently enrolling to further evaluate its role in patients with advanced/recurrent EC.
OBJECTIVE: RasGEF domain family member 1C (RASGEF1C), primarily acting in neurological disorders, remains largely enigmatic regarding its function in lung cancer (LC). METHODS: Bioinformatics analysis assessed the differ...OBJECTIVE: RasGEF domain family member 1C (RASGEF1C), primarily acting in neurological disorders, remains largely enigmatic regarding its function in lung cancer (LC). METHODS: Bioinformatics analysis assessed the differential expression and prognosis of RASGEF1C in LC and analyzed the enriched pathways. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and western blot (WB) analyses were employed to assess the expression of RASGEF1C and polo-like kinase 1 (PLK1). Biological functions were detected by cell counting kit-8 (CCK-8), flow cytometry, colony formation assay, cell scratch assay, and Transwell assay. Glycolysis-related proteins were detected by Western blot, and ATP levels, glucose content, lactate production, extracellular acidification rate, and oxygen consumption rate were measured to assess glycolysis flux changes in a mouse xenograft tumor model. Immunohistochemistry was applied to detect levels of RASGEF1C, PLK1, and Ki67. WB was employed to assess the expression of RASGEF1C, PLK1, pyruvate kinase M2 (PKM2), and hexokinase 2 (HK2). RESULTS: The upregulation of RASGEF1C in LC reinforced the malignant progression of tumors ( < 0.01). RASGEF1C activation of the PLK1 pathway enhanced aerobic glycolysis, promoting proliferation, migration, and anti-apoptotic behaviors in LC cells. CONCLUSIONS: RASGEF1C affects aerobic glycolysis through the PLK1 signaling pathway, thereby acting as a pro-cancer factor driving LC progression.
INTRODUCTION: Large cell neuroendocrine carcinoma (LCNEC) of the lung is a high-grade non-small cell carcinoma featuring neuroendocrine morphology and neuroendocrine markers. Despite being credited since decades as an in...INTRODUCTION: Large cell neuroendocrine carcinoma (LCNEC) of the lung is a high-grade non-small cell carcinoma featuring neuroendocrine morphology and neuroendocrine markers. Despite being credited since decades as an independent tumor entity, it continues to represent a diagnostic and therapeutic challenge probably because makes up a heterogeneous melting pot of genetic and epigenetic alterations closely intertwined with host microenvironment. AREAS COVERED: LCNEC of the lung was untangled according to three converging outlooks: (i) diagnostic criteria and molecular alterations as conveyors of pathogenetic diversification; (ii) microenvironmental changes, including immune system, as culprits behind tumor development; and (iii) available clinical trials, including immune-oncology studies as clinical decision-making drivers. EXPERT OPINION: LCNEC of the lung unveils different developmental trajectories, which may account for troubles in diagnosis and clinical decision-making but, at the same time, offer a rationale for personalized targeted treatments or immunotherapy in patient subsets. Currently, the question is fascinating: are we actually ready for a radical route change in the understanding of LCNEC? The answer is still open, but future studies will need to frame LCNEC in its own overarching context among lung cancers according to a holistic vision, which does not limit us to its perception as being 'just one tumor.'
INTRODUCTION: Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome caused by pathogenic/likely pathogenic germline TP53 variants. Core cancers include sarcomas, brain tumors, adrenocortical carcinoma and breast...INTRODUCTION: Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome caused by pathogenic/likely pathogenic germline TP53 variants. Core cancers include sarcomas, brain tumors, adrenocortical carcinoma and breast cancer. Surveillance with whole-body MRI (WBMRI) and other modalities is used for early cancer detection, regardless of the individual's personal cancer history. With the increasing use of diagnostic multigene panels in oncology, more diverse phenotypic presentations have emerged, and subsequent cascade testing identifies more asymptomatic cancer-free individuals - 'previvors.' AREAS COVERED: This review analyzes aspects of early cancer detection screening programs in asymptomatic germline TP53 variant carriers including current guidelines, specific founder variant populations, health economics and emerging strategies including liquid biopsies and wearable devices. A literature search with PubMed included publications in English until April 2025. EXPERT OPINION: Current guidelines recommend WBMRI in all LFS individuals, regardless of their prior cancer history, due to its demonstrated survival advantage. Guidelines for use of other modalities such as endoscopy, ultrasound or laboratory tests are less well-established. Therefore, longitudinal prospective studies including all these modalities and their cancer detection rates are needed. In the future, a one-size-fits-all approach toward surveillance will be replaced by more precise patient-centered tailor-made screening programs incorporating noninvasive methods.
BACKGROUND: This study investigates the efficacy of paclitaxel combined with bevacizumab in the treatment of malignant gastrointestinal tumors with malignant ascites and screens for biomarkers that predict efficacy. RESE...BACKGROUND: This study investigates the efficacy of paclitaxel combined with bevacizumab in the treatment of malignant gastrointestinal tumors with malignant ascites and screens for biomarkers that predict efficacy. RESEARCH DESIGN AND METHODS: A prospective cohort study was conducted, enrolling 92 eligible patients who received either paclitaxel combined with bevacizumab or paclitaxel monotherapy. Efficacy was assessed, and biomarkers predictive of treatment efficacy were screened using indicators such as disease control rate, objective response rate, LA, LDH, and CD4/CD8 ratios. RESULTS: The disease control rate (91.18%) and objective response rate (61.76%) in both the treatment group and the control group were significantly better than those in the control group. In the treatment group, non-PD group, and remission group, LA and LDH levels decreased significantly with increasing number of treatments, while the CD4/CD8 ratio increased significantly. There was no significant difference between the control group and the non-relief group after treatment. The trend of changes after PD treatment was opposite to that mentioned above. There was no statistically significant difference in adverse reactions between the two groups. CONCLUSION: This study demonstrated that the combination of paclitaxel and bevacizumab is more effective and that LA, LDH, and CD4/CD8 can predict treatment efficacy.
INTRODUCTION: Twenty years ago, surgery was the centerpiece of treatment for cutaneous melanoma, including for resectable stage III and IV patients. The arrival of effective systemic therapies in the early 2010s has led...INTRODUCTION: Twenty years ago, surgery was the centerpiece of treatment for cutaneous melanoma, including for resectable stage III and IV patients. The arrival of effective systemic therapies in the early 2010s has led to the abandonment of less effective traditional chemotherapeutic agents, a reduction in surgical excision margins, and a smaller set of indications for lymph node dissection. A more recent shift has been from adjuvant to neo-adjuvant immunotherapy for resectable macroscopic stage III melanoma. The speed at which the field is progressing, and the frequency of important publications on the topic, mean that regular review articles are useful to the scientific and wider community to keep abreast of this rapidly changing environment. PubMed and Cochrane databases were used to perform the literature search. AREAS COVERED: We have contextualized the emergence of ipilimumab and nivolumab in the adjuvant and neo-adjuvant treatment of resectable stage III melanoma with discussion of pivotal studies, and how they influence the current guidelines. EXPERT OPINION: The future is looking brighter for patients with Stage III melanoma. The pendulum has swung away from radical surgery, and toward less invasive procedures and bespoke systemic treatment options based on tumor characteristics, patient factors, and response to neo-adjuvant therapy.
INTRODUCTION: The efficacy of abiraterone in metastatic hormone-sensitive prostate cancer (mHSPC) across different disease volumes remains uncertain. This meta-analysis aims to clarify benefit of abiraterone in low- and...INTRODUCTION: The efficacy of abiraterone in metastatic hormone-sensitive prostate cancer (mHSPC) across different disease volumes remains uncertain. This meta-analysis aims to clarify benefit of abiraterone in low- and high-volume mHSPC. RESEARCH DESIGN AND METHODS: Phase III randomized clinical trials of abiraterone were selected. Individual patient data (IPD) for overall survival (OS), progression-free survival (PFS), and cancer-specific survival were reconstructed. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled to assess the efficacy. Survival analysis was performed using Cox hazards model. RESULTS: Data for 3374 patients were analyzed. In the overall population, abiraterone improved OS (HR: 0.66, 95% CI 0.59-0.73) and PFS (HR: 0.51, 95% CI 0.45-0.58). Subgroup analyses showed consistent OS benefit of abiraterone across low- and high-volume subgroups (HR: 0.71 and 0.64), and PFS benefit in counterparts (HR: 0.49 and 0.46). Grade 1-2 adverse events were reduced in abiraterone group (RR 0.66), while grade 3-4 events increased (RR 1.33). The Kaplan-Meier curves showed that abiraterone significantly improved OS and PFS across all subgroups (All < 0.05). CONCLUSIONS: Adding abiraterone provided significant survival benefits in patients with mHSPC regardless of disease volume. Future investigation shouldvalidate these findings in real world setting. REGISTRATION: (CRD420251028079).
BACKGROUND: Immunotherapy combined with chemotherapy has emerged as a potential strategy to overcome tyrosine kinase inhibitors (TKIs)-resistant for advanced non-small-cell lung cancer (NSCLC); however, the efficacy and...BACKGROUND: Immunotherapy combined with chemotherapy has emerged as a potential strategy to overcome tyrosine kinase inhibitors (TKIs)-resistant for advanced non-small-cell lung cancer (NSCLC); however, the efficacy and safety of PD-1/PD-L1 inhibitors plus chemotherapy (PIC) compared to chemotherapy alone require further investigation. RESEARCH DESIGN AND METHODS: Phase III randomized controlled trials (RCTs) were systematically searched from 6 databases. Pooled hazard ratios (HRs) for survival outcomes and risk ratios (RRs) for responses and adverse events (AEs) were calculated. RESULTS: Three phase III RCTs were included in the final analysis. The PIC therapy significantly improved overall survival (OS) (HR: 0.86, 95% CI: 0.75-1.00, = 0.04) and progression-free survival (PFS) (HR: 0.78, 95% CI: 0.68-0.90, = 0.0005) compared to chemotherapy alone. While PIC therapy improved survival in the overall population, no significant benefit was observed for patients with brain metastases and non-sensitizing EGFR mutations. However, the incidence of immune-related AEs (irAEs) (RR: 2.02, 95% CI: 1.45-2.81, < 0.0001) and grade 3-5 irAEs (RR: 2.02, 95% CI: 1.03-3.98, = 0.04) were increased. CONCLUSIONS: PIC therapy may provide a survival benefit for patients with TKIs-resistant, EGFR-mutant advanced NSCLC. Moreover, this potential benefit should be weighed against the increased risk of irAEs. REGISTRATION: PROSPERO (CRD42024615907).
INTRODUCTION: Breast cancer (BC) is the most common malignancy in women, classified by histopathological type, grade, receptor status, and stage. PET/CT, particularly with F-FDG, plays a vital role in staging, detecting...INTRODUCTION: Breast cancer (BC) is the most common malignancy in women, classified by histopathological type, grade, receptor status, and stage. PET/CT, particularly with F-FDG, plays a vital role in staging, detecting metastases, and assessing treatment response. This review explores the role of PET/CT in BC management and emerging radiotracers for enhanced diagnosis. A comprehensive literature search was conducted in PubMed and Scopus, covering studies from January 2000 to March 2025. AREAS COVERED: The paper examines how F-FDG-PET/CT findings are influenced by BC classifications such as histopathological type, grade, receptor status, and stage. FDG uptake varies across subtypes, affecting prognosis and treatment decisions, with limitations noted in hormone receptor-positive cancers. The review also investigates emerging radiotracers, including those targeting estrogen and HER2 receptors, which may improve diagnostic accuracy and potentially replace F-FDG in specific settings. Additionally, theranostic approaches are highlighted, offering personalized treatment based on molecular profiles. EXPERT OPINION: We recommend that physicians incorporate pathological analysis, including histopathological type, grade, and molecular status, when selecting the most appropriate radiotracer for BC diagnostics and treatment. Further research and clinical trials on emerging tracers and theranostic agents are essential to confirm their efficacy and safety.
INTRODUCTION: Lung cancer is the leading cause of cancer-related deaths. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have opened up a new therapeutic avenue for EGFR-sensitive mutated non-smal...INTRODUCTION: Lung cancer is the leading cause of cancer-related deaths. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have opened up a new therapeutic avenue for EGFR-sensitive mutated non-small cell lung cancer (NSCLC), but their resistance is unavoidable. Overcoming the resistance is desperately desired. Combined treatments are partially efficient to address EGFR-TKIs resistance. AREAS COVERED: Combination therapies function through various mechanisms, prevent the enrichment of resistant clones, synergistically enhance efficacy, and delay the onset of resistance. This article reviews the current research of combination therapy based on EGFR-TKIs for EGFR-mutated NSCLC to identify the most effective and least harmful combined regimen. A search of the literature on PubMed, Web of Science, and Embase databases was performed without filters. EXPERT OPINION: The optimal treatment for EGFR-mutated NSCLC is still an open issue. EGFR-TKIs combined with anti-angiogenic drugs can bring short-term efficacy, but not benefit long-term survival and instead increase adverse reactions (AEs). The short-term efficacy of EGFR-TKIs combined with chemotherapy is clear, but the long-term efficacy varies in different studies, with significant benefits in certain subgroups. EGFR-TKIs combined with immune checkpoint inhibitors (ICIs) show a trend toward efficacy benefit; however, their high AEs require further optimization of the combination regimen.
INTRODUCTION: Endometrial cancer is one of the most common gynecologic malignancies, with increasing incidence, in developed countries. Advances in minimally invasive surgery, particularly laparoscopic with or without th...INTRODUCTION: Endometrial cancer is one of the most common gynecologic malignancies, with increasing incidence, in developed countries. Advances in minimally invasive surgery, particularly laparoscopic with or without the use of computer-assisted ('robotic') platforms, have transformed its management, improving surgical outcomes and patient recovery. AREAS COVERED: This review explores recent innovations in laparoscopic management of endometrial cancer, including robotic-assisted laparoscopic surgery, sentinel lymph node mapping, and the integration of artificial intelligence in surgical navigation. A comprehensive literature search was conducted using PubMed and clinical trial databases to assess the impact of these advancements on surgical precision, oncologic outcomes, and patient recovery. Major studies comparing robotic-assisted laparoscopy, traditional laparoscopy, and open surgery are reviewed, along with new technologies that support real-time decision-making during surgery. EXPERT OPINION: Minimally invasive approaches have become the standard of care for early-stage endometrial cancer, offering superior perioperative outcomes. While robotic-assisted surgery provides technical advantages, cost and accessibility remain challenges. Sentinel lymph node mapping reduces morbidity compared to full lymphadenectomy, and artificial intelligence holds promise in optimizing surgical precision. Future research should focus on refining these technologies, improving patient selection criteria, and ensuring equitable access to advanced surgical techniques.
INTRODUCTION: Thymic epithelial tumors are rare cancers originating from the thymus, with an annual incidence of 0.13 per 100,000 persons. Therefore, the standard of care was approved primarily based on the results of si...INTRODUCTION: Thymic epithelial tumors are rare cancers originating from the thymus, with an annual incidence of 0.13 per 100,000 persons. Therefore, the standard of care was approved primarily based on the results of single-arm phase II trials. If the disease is resectable and localized, a multidisciplinary treatment combining surgical resection, radiotherapy, and pharmacotherapy should be considered. Pharmacotherapy is the mainstay of treatment for metastatic and recurrent diseases. AREAS COVERED: This review delineates the distinct difference in treatment strategies of chemotherapy in patients with thymomas and thymic carcinomas. Thymomas typically respond to a cisplatin and anthracyclines, often supplemented with steroids, whereas thymic carcinomas, which do not typically involve anthracyclines as key drugs, are treated with platinum-based doublet chemotherapy. Lenvatinib has emerged as a pivotal key drug for refractory thymic carcinoma. In addition, single-agent cytotoxic chemotherapy, molecular targeted therapies, and immune checkpoint inhibitors is considered as key drugs for thymic carcinomas. EXPERT OPINION: Current research is focused on developing novel therapeutics such as antibody-drug conjugates (ADCs), angiogenesis inhibitors, multi-kinase inhibitors, and further immune checkpoint inhibitors, expanding the prospects for pharmacotherapy in thymic malignancies.
INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy frequently arising with nonspecific and overlooked gastrointestinal symptoms. Gastroenterologists are typically the first specialists to encoun...INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy frequently arising with nonspecific and overlooked gastrointestinal symptoms. Gastroenterologists are typically the first specialists to encounter these patients, positioning them to play a pivotal role not only in early diagnosis, but also in the ongoing management of the disease's complex symptom burden. AREAS COVERED: This review explored gastrointestinal symptoms in patients with PDAC (ranging from pain and diarrhea to anorexia, jaundice, and nausea) and outlined both tumor- and treatment-related causes. A literature review based on non-systematic PubMed search updated to April 2025 was conducted to summarize current diagnostic strategies, medical, endoscopic therapies, and multidisciplinary management approaches. In addition, we present original data from a single-center cohort, suggesting that the involvement of gastroenterologists leads to more comprehensive management of gastrointestinal symptom control and supportive care. EXPERT OPINION: Collaboration among specialists is essential for optimizing patient outcomes in the multidisciplinary management of PDAC. Gastroenterologists' 'stewardship' significantly contributes to prompt diagnosis, symptom control, quality of life preservation, and prognosis. Future priorities should focus on strengthening integration within care pathways, fostering interdisciplinary coordination, and implementing shared clinical tools to enhance comprehensive patient care. A well-structured team-based approach is key to advancing holistic PDAC management.
BACKGROUND: Immune checkpoint inhibitors (ICIs) elicit strong antitumour responses but may cause immune-related adverse events (irAEs) requiring treatment interruption. Resuming ICIs after irAEs remains a clinical challe...BACKGROUND: Immune checkpoint inhibitors (ICIs) elicit strong antitumour responses but may cause immune-related adverse events (irAEs) requiring treatment interruption. Resuming ICIs after irAEs remains a clinical challenge. METHODS: This single-center retrospective study included 97 patients with solid tumors treated with anti-PD-1 ± anti-CTLA-4 agents between January 2016 and September 2024. All patients developed irAEs that led to treatment interruption and subsequently resumed the same ICI regimen. Predictors of irAE recurrence were evaluated using LASSO regression followed by backward stepwise selection. RESULTS: The patient cohort had a median age of 60 years. 63.9% had received anti-PD-1 monotherapy and 36.1% had received combination therapy. Common first irAEs included colitis (37.1%) and hepatitis (24.7%), with 40.2% being grade ≥ 3. Upon resumption, 46.4% experienced recurrent irAEs. Overall survival did not differ significantly between patients with and without recurrence (84.3 vs. 74.6 months, = 0.866). Younger age, high-grade irAE, colitis, elevated monocytes, and need for nonsteroidal immunosuppressants were independently associated with recurrence. A nomogram constructed using these factors demonstrated good discriminative ability (AUC = 0.818). CONCLUSION: Resuming ICI therapy after an irAE is generally feasible, although nearly 50% of patients experience recurrent toxicity. The developed nomogram may support risk-based clinical decisions.
BACKGROUND: There is a lack of dedicated studies addressing the epidemiology, prognostic factors, and optimal management strategies for secondary esophageal cancer (SEC). METHODS: This study sourced data from the SEER da...BACKGROUND: There is a lack of dedicated studies addressing the epidemiology, prognostic factors, and optimal management strategies for secondary esophageal cancer (SEC). METHODS: This study sourced data from the SEER database and an independent external cohort. Annual percentage change (APC) was calculated to qualify the incidence trend. Cox regression was employed for survival analysis. RESULTS: A total of 13,792 sec cases from the SEER database and 63 cases from the validation cohort were included in this study. The incidence of SEC increased from 0.95 per 100,000 persons in 2000 to 1.2 per 100,000 in 2008, stabilizing thereafter. Survival analysis identified disease stage, age, and tumor location as significant prognostic factors (All < .05). A prognostic model incorporating these variables demonstrated robust predictive accuracy across training, testing, and validation cohorts, with a C-index of around 0.73. In terms of treatment, radiotherapy and chemotherapy were associated with improved survival, while no significant benefit for younger patients and those with early-stage or squamous cell carcinoma. CONCLUSIONS: There remains a critical need for early detection methods and the implementation of more personalized treatment strategies. The developed prognostic model provides a framework for risk stratification, supporting the optimization of therapeutic decisions and improving patient outcomes.