Current Oncology

12 pages, 7522 KiB

Open AccessArticle

Complications Following Irinotecan-Loaded Microsphere Chemoembolization of Colorectal Metastatic Liver Lesions Associated with Hepatic-Artery Branch Temporary Stasis

by Marcin Szemitko, Elzbieta Golubinska-Szemitko, Jerzy Sienko and Aleksander Falkowski

Curr. Oncol. 2021, 28(3), 2296-2307; https://doi.org/10.3390/curroncol28030211 - 20 Jun 2021

Cited by 3 | Viewed by 2438

Abstract

Chemoembolization with irinotecan-loaded microspheres has proven effective in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC). Most researchers recommend slowly administering the embolizate at the level of the lobar arteries, without obtaining visible stasis. However, there are reports [...] Read more.

Chemoembolization with irinotecan-loaded microspheres has proven effective in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC). Most researchers recommend slowly administering the embolizate at the level of the lobar arteries, without obtaining visible stasis. However, there are reports of a relationship between postoperative embolizate retention in metastatic lesions and the response to treatment. To retain residual embolizate throughout the entire neoplastic lesion requires a temporary flow stop (stasis) within all supply vessels, which may cause temporary stasis in subsegmental or even segmental vessels. Objective: To assess the risk of complications and post-embolization syndrome severity following chemoembolization of CRC metastatic liver lesions with microspheres loaded with Irinotecan, with regard to hepatic-artery branch level of temporary stasis. Patients and methods: The study included 52 patients (29 female, 23 male) with liver metastases from CRC, who underwent 202 chemoembolization treatments (mean: 3.88 per patient) with microspheres loaded with 100 mg irinotecan. Postembolization syndrome (PES) severity and complication occurrence were assessed with regard to the hepatic-artery branch level of temporary stasis. Adverse events were assessed according to Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events. Results: Median survival from the start of chemoembolization was 13 months. From 202 chemoembolization sessions, 15 (7.4%) significant complications were found. The study found a significant relationship between the branch level of temporary stasis and the presence of complications (p < 0.001), with the highest number of complications observed with temporary stasis in segmental vessels. PES was diagnosed after 103 (51%) chemoembolization treatments. A significant association was found between PES severity and the branch level of temporary stasis (p < 0.001). Conclusions: The branch level of temporary stasis affected the severity of post-embolization syndrome. A significant association was found between the branch level of temporary stasis obtained in chemoembolization procedures and the presence of complications. The apparent lack of change in numbers of complications when stasis was applied at tumor supply vessels or subsegmental arteries may indicate the safe use of temporary stasis in some cases where colorectal cancer metastases are treated. Further research is needed to determine the most effective chemoembolization technique. Full article

► Show Figures

Figure 1

15 pages, 4043 KiB

Open AccessArticle

Transcriptomic Landscape of Lower Grade Glioma Based on Age-Related Non-Silent Somatic Mutations

by YoungJoon Park, JeongMan Park, Ju Won Ahn, Jeong Min Sim, Su Jung Kang, Suwan Kim, So Jung Hwang, Song-Hee Han, Kyoung Su Sung and Jaejoon Lim

Curr. Oncol. 2021, 28(3), 2281-2295; https://doi.org/10.3390/curroncol28030210 - 19 Jun 2021

Cited by 2 | Viewed by 2452

Abstract

Glioma accounts for 80% of all malignant brain tumours and is the most common adult primary brain tumour. Age is an important factor affecting the development of cancer, as somatic mutations accumulate with age. Here, we aimed to analyse the significance of age-dependent [...] Read more.

Glioma accounts for 80% of all malignant brain tumours and is the most common adult primary brain tumour. Age is an important factor affecting the development of cancer, as somatic mutations accumulate with age. Here, we aimed to analyse the significance of age-dependent non-silent somatic mutations in glioma prognosis. Histological tumour grade depends on age at diagnosis in patients with IDH1, TP53, ATRX, and EGFR mutations. Age of patients with wild-type IDH1 and EGFR increased with increase in tumour grade, while the age of patients with IDH1 or EGFR mutation remained constant. However, the age of patients with EGFR mutation was higher than that of patients with IDH1 mutation. The hierarchical clustering of patients was dominantly separated by IDH1 and EGFR mutations. Furthermore, patients with IDH1 mutation were dominantly separated by TP53 and ATRX double mutation and its double wild-type counterpart. The age of patients with ATRX and TP53 mutation was lower than that of patients with wild-type ATRX and TP53. Patients with the double mutation showed poorer prognosis than those with the double wild type genotype. Unlike IDH1 mutant, IDH1 wild-type showed upregulation of expression of epithelial mesenchymal transition associated genes. Full article

(This article belongs to the Section Neuro-Oncology)

► Show Figures

Figure 1

Figure 1
Frequencies of mutated and wild-type genes and logistic regression results showing the relationship of mutations with age in patients with lower grade glioma (a) and glioblastoma (b). Genes shown have mutation rates >5%. OR, odds ratio; *, significant. Full article ">Figure 2
Comparison of tumour grades of patients with IDH1 wild-type and IDH1 mutation with respect to age at initial pathologic diagnosis. p-value <0.0001 are indicated by ****. ns is not significant (a). Survival analysis comparing patients with IDH1 wild-type or IDH1 mutation in each tumour grade. 0 indicates wild-type; 1 indicates mutation. Time up to which 50% patients survived is shown by the dotted line in every type. The unit of overall survival (OS) time is day (b). Full article ">Figure 3
Heatmap with hierarchical tree of patients by gene expression pattern with information gain (IG) over 0.35. The top annotations show tumour grade and mutation status (IDH1 mutant or wild-type). WT indicates wild-type; MT indicates mutation (a). Statistically significant results of the pathway enrichment analysis of gene clusters in the IDH1 hierarchical group (b). Full article ">Figure 4
Mutational patterns of IDH1, TP53, ATRX, and EGFR in the hierarchical tree (a). Survival analysis of patients with mutant or wild-type genes in terms of overall survival and progression-free survival (b). 0 indicates wild-type; 1 indicates mutation. Full article ">Figure 5
Comparison of patients harbouring ATRX and TP53 wild-type and mutation with age of glioma onset at initial pathological diagnosis in the background of IDH1 mutation. p-values less than 0.001 and 0.0001 are shown by *** and ****, respectively. As the number of glioblastoma (GBM) patients with IDH1 mutation is few, GBM is excepted in analysis (a,b). Heatmap with the hierarchical tree of patients by gene expression pattern with information gain (IG) over 0.35. The top annotations show the grade and mutational status (mutant or wild-type) of ATRX and TP53. WT indicates wild-type; MT indicates mutation (c). Statistically significant results of pathway enrichment analysis of gene clusters in the ATRX and TP53 hierarchical group (d). Full article ">Figure 6
Variation in TERT expression level with the mutation statuses of ATRX and TP53 in tumours with IDH1 mutation (a). TERT expression level in tumours with IDH1 mutation with separated mutation statuses of ATRX and TP53 for each grade. WT indicates wild-type; MT indicates mutation. p-values < 0.0001 are shown as ****. ns is not significant (b). Full article ">Figure 7
Comparison of ages at initial pathological diagnosis of tumours with EGFR wild-type and those with EGFR. p-values <0.0001 are shown as ****. p-values <0.01 are shown as **. ns is not significant (a). Survival analysis comparing EGFR mutant or wild-type and each grade with overall survival. 0 indicates wild-type; 1 indicates mutation. The unit of overall survival time is day (b). Heatmap with hierarchical tree of patients based on gene expression pattern with IG over 0.35. Top annotations show tumour grade and genotype (mutant or wild-type) of EGFR. WT indicates wild-type; MT indicates mutation (c). Statistically significant results of pathway enrichment analysis of gene clusters in the EGFR hierarchical group (d). Full article ">Figure 8
The flow chart of entire process of analysis. Full article ">

11 pages, 250 KiB

Open AccessArticle

First-Line Treatment with a Cyclin-Dependent Kinase 4/6 Inhibitor Plus an Aromatase Inhibitor for Metastatic Breast Cancer in Alberta

by Carla P. Amaro, Atul Batra and Sasha Lupichuk

Curr. Oncol. 2021, 28(3), 2270-2280; https://doi.org/10.3390/curroncol28030209 - 18 Jun 2021

Cited by 6 | Viewed by 2670

Abstract

In this analysis, we describe population-based outcomes for first-line treatment with a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) combined with an aromatase inhibitor (AI). All patients who were prescribed CDK4/6i + AI from January 2016 through June 2019 were included. Patient demographics, tumour and [...] Read more.

In this analysis, we describe population-based outcomes for first-line treatment with a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) combined with an aromatase inhibitor (AI). All patients who were prescribed CDK4/6i + AI from January 2016 through June 2019 were included. Patient demographics, tumour and treatment characteristics were collected and described. Survival distributions were estimated using the Kaplan–Meier method. Multivariate analysis (MVA) was constructed to examine associations between potentially prognostic clinical variables and progression-free survival (PFS). In total, 316 patients were included. The median age was 61 years. After a median follow-up of 28.1 months, the median PFS was 37.9 months (95% CI, 26.7–NR). In the MVA, PR-negative tumour (HR, 2.37; 95% CI, 1.45–3.88; p = 0.001) and CDK4/6i dose reduction (HR, 1.51; 95% CI, 1.06–2.16; p = 0.022) predicted worse PFS. Median overall survival (OS) was not reached. The 30-month and 36-month OS rates were 74% and 68%, respectively. Of patients who progressed, 89% received second-line treatment. Median time to progression on second-line chemotherapy was 9.0 (5.8–17.6) months, and median time to progression on second-line hormonal therapy +/− targeted agent was 4.0 (3.4–8.6) months (p = 0.012). CDK4/6i + AI as first-line treatment for HR-positive, HER2-negative MBC in Alberta is justified based on favourable PFS and early OS outcomes. Full article

10 pages, 388 KiB

Open AccessArticle

Long Term Real-World Outcomes of Trifluridine/Tipiracil in Metastatic Colorectal Cancer—A Single UK Centre Experience

by Daniel Tong, Lei Wang, Jeewaka Mendis and Sharadah Essapen

Curr. Oncol. 2021, 28(3), 2260-2269; https://doi.org/10.3390/curroncol28030208 - 18 Jun 2021

Cited by 4 | Viewed by 3733

Abstract

In the UK, Trifluridine-tipiracil (Lonsurf) is used to treat metastatic colorectal cancer in the third-line setting, after prior exposure to fluoropyrimidine-based regimes. Current data on the real-world use of Lonsurf lack long-term follow-up data. A retrospective evaluation of patients receiving Lonsurf at our [...] Read more.

In the UK, Trifluridine-tipiracil (Lonsurf) is used to treat metastatic colorectal cancer in the third-line setting, after prior exposure to fluoropyrimidine-based regimes. Current data on the real-world use of Lonsurf lack long-term follow-up data. A retrospective evaluation of patients receiving Lonsurf at our Cancer Centre in 2016–2017 was performed, all with a minimum of two-year follow-up. Fifty-six patients were included in the review. The median number of cycles of Lonsurf administered was 3. Median follow-up was 6.0 months, with all patients deceased at the time of analysis. Median progression-free survival (PFS) was 3.2 months, and overall survival (OS) was 5.8 months. The median interval from Lonsurf discontinuation to death was two months, but seven patients received further systemic treatment and median OS gained was 12 months. Lonsurf offered a slightly better PFS but inferior OS to that of the RECOURSE trial, with PFS similar to real-world data previously presented. Interestingly, 12.5% had a PFS > 9 months, and this cohort had primarily left-sided and RAS wild-type disease. A subset received further systemic treatment on Lonsurf discontinuation with good additional OS benefit. Lonsurf may alter the course of disease for a subset of patients, and further treatment on progression can be considered in carefully selected patients. Full article

► Show Figures

Figure 1

12 pages, 1292 KiB

Open AccessArticle

The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

by Fiona Wu, Oloruntobi Rotimi, Roberto Laza-Cagigas and Tarannum Rampal

Curr. Oncol. 2021, 28(3), 2248-2259; https://doi.org/10.3390/curroncol28030207 - 17 Jun 2021

Cited by 39 | Viewed by 5386

Abstract

Patients awaiting cancer treatment were classified as “vulnerable” and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during [...] Read more.

Patients awaiting cancer treatment were classified as “vulnerable” and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention. Full article

► Show Figures

Figure 1

9 pages, 238 KiB

Open AccessArticle

Colorectal Cancer Surgery Quality in Manitoba: A Population-Based Descriptive Analysis

by Iresha Ratnayake, Jason Park, Natalie Biswanger, Allison Feely, Grace Musto and Kathleen Decker

Curr. Oncol. 2021, 28(3), 2239-2247; https://doi.org/10.3390/curroncol28030206 - 16 Jun 2021

Cited by 2 | Viewed by 2395

Abstract

Unwarranted clinical variation in healthcare impacts access, productivity, performance, and outcomes. A strategy proposed for reducing unwarranted clinical variation is to ensure that population-based data describing the current state of health care services are available to clinicians and healthcare decision-makers. The objective of [...] Read more.

Unwarranted clinical variation in healthcare impacts access, productivity, performance, and outcomes. A strategy proposed for reducing unwarranted clinical variation is to ensure that population-based data describing the current state of health care services are available to clinicians and healthcare decision-makers. The objective of this study was to measure variation in colorectal cancer surgical treatment patterns and surgical quality in Manitoba and identify areas for improvement. This descriptive study included individuals aged 20 years or older who were diagnosed with invasive cancer (adenocarcinoma) of the colon or rectum between 1 January 2010 and 31 December 2014. Laparoscopic surgery was higher in colon cancer (24.1%) compared to rectal cancer (13.6%). For colon cancer, the percentage of laparoscopic surgery ranged from 12.9% to 29.2%, with significant differences by regional health authority (RHA) of surgery. In 86.1% of colon cancers, ≥12 lymph nodes were removed. In Manitoba, the negative circumferential resection margin for rectal cancers was 96.9%, and ranged from 96.0% to 100.0% between RHAs. The median time between first colonoscopy and resection was 40 days for individuals with colon cancer. This study showed that high-quality colorectal cancer surgery is being conducted in Manitoba along with some variation and gaps in quality. As a result of this work, a formal structure for ongoing measuring and reporting surgical quality has been established in Manitoba. Quality improvement initiatives have been implemented based on these findings and periodic assessments of colorectal cancer surgery quality will continue. Full article

(This article belongs to the Section Surgical Oncology)

12 pages, 253 KiB

Open AccessArticle

“What We Want Is More Access…”: Experiences of Supportive Cancer Care and Strategies for Advancement in a Canadian Provincial Cancer Care Organization

by Jonathan Avery, Hannah K. Schulte, Kristin L. Campbell, Alan Bates, Lisa McCune and Amanda Fuchsia Howard

Curr. Oncol. 2021, 28(3), 2227-2238; https://doi.org/10.3390/curroncol28030205 - 15 Jun 2021

Cited by 3 | Viewed by 2689

Abstract

Objectives: Despite calls for better supportive care, patients and families still commonly bear significant responsibility for managing the physical and mental health and social challenges of being diagnosed with and treated for cancer. As such, there is increased advocacy for integrated supportive care [...] Read more.

Objectives: Despite calls for better supportive care, patients and families still commonly bear significant responsibility for managing the physical and mental health and social challenges of being diagnosed with and treated for cancer. As such, there is increased advocacy for integrated supportive care to ease the burden of this responsibility. The purpose of this study was to understand patient and caregiver experiences with supportive care to advance its delivery at a large provincial cancer care organization in Canada. Method: We used a qualitative descriptive approach to analyze focus groups with patients and caregivers from seven sites across the large provincial cancer care organization. Results: Focus group participants (n = 69) included cancer patients (n = 57) and caregivers (n = 12). Participants highlighted positive and negative aspects of their experience and strategies for improvement. These are depicted in three themes: (1) improving patient and provider awareness of services; (2) increasing access; (3) enhancing coordination and integration. Participants’ specific suggestions included centralizing relevant information about services, implementing a coach or navigator to help advocate for access, and delivering care virtually. Conclusions: Participants highlighted barriers to access and made suggestions for improving supportive care that they believed would reduce the burden associated with trying to manage their cancer journey. Full article

28 pages, 262 KiB

Open AccessConference Report

Abstracts of the 2021 Canadian Association of Medical Oncologists Annual Meeting

by Jonathan Loree, Erin Powell, Sharlene Gill, Stephen Welch, Bruce Colwell and Desiree Hao

Curr. Oncol. 2021, 28(3), 2199-2226; https://doi.org/10.3390/curroncol28030204 - 15 Jun 2021

Cited by 1 | Viewed by 4189

Abstract

On behalf of the Canadian Association of Medical Oncologists, we are pleased to present the Abstracts of the 2021 Annual Meeting. The National CAMO Residents Research Day was held virtually on 1 April 2021 and the CAMO Virtual Annual Scientific Meeting (ASM) & [...] Read more.

On behalf of the Canadian Association of Medical Oncologists, we are pleased to present the Abstracts of the 2021 Annual Meeting. The National CAMO Residents Research Day was held virtually on 1 April 2021 and the CAMO Virtual Annual Scientific Meeting (ASM) & Annual General Meeting (AGM) took place on 22 April 2021. Twenty (20) abstracts were selected for presentation as oral presentations and rapid-fire presentations. Awards for the top three (3) abstracts were presented during the ASM and AGM. All of them were marked as “Award Recipient”. We congratulate all the presenters on their research work and contribution. Full article

9 pages, 233 KiB

Open AccessArticle

Staging Investigations in Asymptomatic Early Breast Cancer Patients at the Cancer Centre of Southeastern Ontario

by Dalia Kamel, Veronica Youssef, Wilma M. Hopman and Mihaela Mates

Curr. Oncol. 2021, 28(3), 2190-2198; https://doi.org/10.3390/curroncol28030203 - 12 Jun 2021

Cited by 4 | Viewed by 2694

Abstract

Background: In 2012, the American Society for Clinical Oncology (ASCO) identified five key opportunities in oncology to improve patient care, recommending against imaging tests for the staging of patients with early breast cancer (EBC) at low risk for metastases. Similarly, the European Society [...] Read more.

Background: In 2012, the American Society for Clinical Oncology (ASCO) identified five key opportunities in oncology to improve patient care, recommending against imaging tests for the staging of patients with early breast cancer (EBC) at low risk for metastases. Similarly, the European Society of Medical Oncology (ESMO) guideline does not support radiological staging in asymptomatic EBC (aEBC). The purpose of this study was to assess local practice and outcomes of staging investigations (SIs) in aEBC at the Cancer Centre of Southeastern Ontario (CCSEO). Methods: A retrospective electronic and paper chart review was undertaken to identify all aEBC patients treated at our institution between January 2012 and December 2014. Patients with pathological staging of T1-T2 and N0-1 with any receptor status were included. We collected patient demographics, treatment and pathologic tumor characteristics. The use and outcomes of initial and follow-up SIs were recorded. Data were analyzed to determine associations between the use of SIs and clinical characteristics (chi-square tests, independent samples t-tests and Mann–Whitney U tests). Results: From 2012 to 2014, 295 asymptomatic EBC patients were identified. The mean age was 64, 81% were postmenopausal and 76% had breast conserving surgery. Stage distribution was as follows: stage I 42%, stage IIA 37% and stage IIB 21%. Receptor status was as follows: ER+ 84%, HER2+ 13% and triple negative 12%. Adjuvant chemotherapy was received by 36%, Trastuzumab by 10% and endocrine therapy by 76% of patients. Baseline SIs were performed in 168 patients (57%) for a total of 332 tests. Overt metastatic disease was found in five patients (one bone scan and four CT scans). Seventy-one out of the 168 patients (42%) who received initial staging imaging underwent 138 follow-up imaging tests, none of which were diagnostic for metastases. Nine patients with suspicious CT findings underwent biopsies, of which four were malignant (one metastatic breast cancer and three new primaries). Factors significantly associated with SI were as follows: younger age (p = 0.001), premenopausal status (p = 0.01), T2 stage (p < 0.001), N1 stage (p < 0.001), HER2 positive (p < 0.001), triple negative status (p = 0.007) and use of adjuvant chemotherapy (p < 0.001). Conclusions: Over a 3-year period at our institution, more than 50% of aEBC patients underwent a total of 470 initial and follow-up staging tests, yielding a cancer diagnosis (metastatic breast cancer or second primary cancer) in four patients. We, therefore, conclude that routine-staging investigations in aEBC patients have low diagnostic value, supporting current guidelines that recommend against the routine use of SI in this population. Full article

(This article belongs to the Section Medical Oncology)

10 pages, 827 KiB

Open AccessArticle

Comparison of Patient-Reported Experience of Patients Receiving Radiotherapy Measured by Two Validated Surveys

by Abdulla Al-Rashdan, Linda Watson, Demetra Yannitsos, Siwei Qi, Petra Grendarova and Lisa Barbera

Curr. Oncol. 2021, 28(3), 2180-2189; https://doi.org/10.3390/curroncol28030202 - 12 Jun 2021

Cited by 8 | Viewed by 2792

Abstract

Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient [...] Read more.

Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) or as recorded through Your Voice Matters (YVM) between February and August 2019. Six questions were compared (“overall experience with care”, “discussion of worries”, “involvement in decisions”, “trusting providers with confidential information”, “providing family with information”, and “knowing who to contact”). Positive experience scores were calculated by cohort and by tumor groups. Multivariable logistic regression models evaluated factors associated with positive experience. Two cohorts (220 and 200 patients) met the eligibility criteria for the AOPSS and YVM, respectively. Positive experience was reported similarly between the two PREMs for “overall experience with care”, “discussion of worries”, and “trusting providers with confidential information” with a score difference of 1–4% at the cohort level. Positive experience score difference ranged from 5% to 44% across questions at the tumor group level. Different experience gaps were identified with the two measures, mainly at the tumor group level. Programs interested in using these PREMS might consider this when designing projects. Full article

► Show Figures

Figure 1

7 pages, 374 KiB

Open AccessCommunication

Real World Outcomes and Hepatotoxicity of Infliximab in the Treatment of Steroid-Refractory Immune-Related Adverse Events

by Daniel V. Araujo, Thiago Pimentel Muniz, Anjie Yang, Sareh Keshavarzi, Hadas Sorotsky, Marcus O. Butler, Samuel Saibil, Anna Spreafico and David Hogg

Curr. Oncol. 2021, 28(3), 2173-2179; https://doi.org/10.3390/curroncol28030201 - 11 Jun 2021

Cited by 15 | Viewed by 2958

Abstract

Background and aims: Current guidelines state that infliximab is contraindicated for the treatment of immune checkpoint inhibitor-related hepatitis (ir-hepatitis) due to the risk of inducing further liver damage. As this recommendation is largely based on the use of infliximab for rheumatologic diseases, we [...] Read more.

Background and aims: Current guidelines state that infliximab is contraindicated for the treatment of immune checkpoint inhibitor-related hepatitis (ir-hepatitis) due to the risk of inducing further liver damage. As this recommendation is largely based on the use of infliximab for rheumatologic diseases, we evaluated the efficacy and hepatotoxicity of infliximab in patients with steroid-refractory immune-related adverse events (irAEs). Methods: We retrospectively reviewed consecutive patients treated with infliximab for irAEs at Princess Margaret Cancer Centre. To assess hepatotoxicity, we compared the mean value of ALT, AST, and total bilirubin (BT) before and after infliximab treatment. We used logistic regression to assess factors associated with infliximab efficacy. Results: Between January 2010 and February 2019, 56 patients were identified. The median age of the patients was 63 (27–84) years. Colitis was the most frequent toxicity (66%), followed by pneumonitis (11%). Infliximab was used to treat ir-hepatitis in one patient. The median number of infliximab doses was 1 (1–3) and led to toxicity resolution in 43 (76%) patients. The mean ALT, AST, and BT levels before and after infliximab treatment were not statistically different. The patient treated for ir-hepatitis had a complete recovery, with no incremental liver toxicity. Conclusions: In this dose-limited setting, infliximab was effective in resolving irAEs and did not induce hepatotoxicity. Full article

(This article belongs to the Section Medical Oncology)

► Show Figures

Figure 1

23 pages, 4301 KiB

Open AccessArticle

Dual Targeting of Sorafenib-Resistant HCC-Derived Cancer Stem Cells

by Ritu Shrestha, Kim R. Bridle, Lu Cao, Darrell H. G. Crawford and Aparna Jayachandran

Curr. Oncol. 2021, 28(3), 2150-2172; https://doi.org/10.3390/curroncol28030200 - 11 Jun 2021

Cited by 9 | Viewed by 4908

Abstract

Sorafenib, an oral multi-tyrosine kinase inhibitor, has been the first-line therapy for the treatment of patients with advanced HCC, providing a survival benefit of only three months in approximately 30% of patients. Cancer stem cells (CSCs) are a rare tumour subpopulation with self-renewal [...] Read more.

Sorafenib, an oral multi-tyrosine kinase inhibitor, has been the first-line therapy for the treatment of patients with advanced HCC, providing a survival benefit of only three months in approximately 30% of patients. Cancer stem cells (CSCs) are a rare tumour subpopulation with self-renewal and differentiation capabilities, and have been implicated in tumour growth, recurrence and drug resistance. The process of epithelial-to-mesenchymal transition (EMT) contributes to the generation and maintenance of the CSC population, resulting in immune evasion and therapy resistance in several cancers, including HCC. The aim of this study is to target the chemoresistant CSC population in HCC by assessing the effectiveness of a combination treatment approach with Sorafenib, an EMT inhibitor and an immune checkpoint inhibitor (ICI). A stem-cell-conditioned serum-free medium was utilised to enrich the CSC population from the human HCC cell lines Hep3B, PLC/PRF/5 and HepG2. The anchorage independent spheres were characterised for CSC features. The human HCC-derived spheres were assessed for EMT status and expression of immune checkpoint molecules. The effect of combination treatment with SB431542, an EMT inhibitor, and siRNA-mediated knockdown of programmed cell death protein ligand-1 (PD-L1) or CD73 along with Sorafenib on human HCC-derived CSCs was examined with cell viability and apoptosis assays. The three-dimensional spheres enriched from human HCC cell lines demonstrated CSC-like features. The human HCC-derived CSCs also exhibited the EMT phenotype along with the upregulation of immune checkpoint molecules. The combined treatment with SB431542 and siRNA-mediated PD-L1 or CD73 knockdown effectively enhanced the cytotoxicity of Sorafenib against the CSC population compared to Sorafenib alone, as evidenced by the reduced size and proliferation of spheres. Furthermore, the combination treatment of Sorafenib with SB431542 and PD-L1 or CD73 siRNA resulted in an increased proportion of an apoptotic population, as evidenced by flow cytometry analysis. In conclusion, the combined targeting of EMT and immune checkpoint molecules with Sorafenib can effectively target the CSC tumour subpopulation. Full article

► Show Figures

Figure 1

4 pages, 174 KiB

Open AccessCase Report

Clinical Benefit from Lenvatinib and Pembrolizumab Observed in Mullerian Adenosarcoma: A Case Report

by Thierry Alcindor, Sungmi Jung and Lucy Gilbert

Curr. Oncol. 2021, 28(3), 2146-2149; https://doi.org/10.3390/curroncol28030199 - 10 Jun 2021

Cited by 3 | Viewed by 2812

Abstract

A 32-year-old woman with chemorefractory mullerian adenosarcoma showed clinical benefit in response to administration of lenvatinib plus pembrolizumab. In this case report, we describe the course of her illness and her response to this treatment. Full article

12 pages, 422 KiB

Open AccessReview

Canadian Resources, Programs, and Models of Care to Support Cancer Survivors’ Transition beyond Treatment: A Scoping Review

by Claudia Romkey-Sinasac, Stephanie Saunders and Jacqueline Galica

Curr. Oncol. 2021, 28(3), 2134-2145; https://doi.org/10.3390/curroncol28030198 - 9 Jun 2021

Cited by 8 | Viewed by 4189

Abstract

(1) Background: One in two Canadians will be diagnosed with cancer in their lifetime, but as a result of the progress in diagnosis and treatment, more individuals are surviving cancer than ever before. However, the impact of cancer does not end with treatment. [...] Read more.

(1) Background: One in two Canadians will be diagnosed with cancer in their lifetime, but as a result of the progress in diagnosis and treatment, more individuals are surviving cancer than ever before. However, the impact of cancer does not end with treatment. The objectives of this review are to (1) provide a broad overview of the supportive care interventions and models of care that have been researched to support Canadian post-treatment cancer survivors; and (2) analyze how these supportive care interventions and/or care models align with the practice recommendations put forth by Cancer Care Ontario (CCO) and the Canadian Association of Psychosocial Oncology/Canadian Partnership Against Cancer (CAPO/CPAC). (2) Methods: An electronic search was completed in MEDLINE, Embase, PsycINFO, and CINAHL in January 2021. Included studies described supportive care interventions or models of care utilized by adult Canadian cancer survivors. (3) Results: Forty-two articles were included. Survivors utilized a multitude of supportive care interventions, with peer support and physical activity programs being most frequently cited. Four models of follow-up care were identified: primary care, oncology care, shared-care, and transition clinics. The supportive care interventions and models of care variably aligned with the recommendations set by CCO and CAPO/CPAC. The most commonly followed recommendation was the promotion of self-management and quality resources for patients. (4) Conclusions: Results indicate an inconsistency in access to supportive care interventions and the delivery of survivorship care for cancer survivors across Canada. Current efforts are being made to implement the recommendations by CCO and CAPO/CPAC; however, provision of these guidelines remains varied. Full article

(This article belongs to the Section Palliative and Supportive Care)

► Show Figures

Figure 1

11 pages, 572 KiB

Open AccessArticle

Immunohistochemistry for Prostate Biopsy—Impact on Histological Prostate Cancer Diagnoses and Clinical Decision Making

by Philipp Mandel, Mike Wenzel, Benedikt Hoeh, Maria N. Welte, Felix Preisser, Tahir Inam, Clarissa Wittler, Clara Humke, Jens Köllermann, Peter Wild, Christoph Würnschimmel, Derya Tilki, Markus Graefen, Luis A. Kluth, Pierre I. Karakiewicz, Felix K.-H. Chun and Andreas Becker

Curr. Oncol. 2021, 28(3), 2123-2133; https://doi.org/10.3390/curroncol28030197 - 9 Jun 2021

Cited by 11 | Viewed by 4933

Abstract

Background: To test the value of immunohistochemistry (IHC) staining in prostate biopsies for changes in biopsy results and its impact on treatment decision-making. Methods: Between January 2017–June 2020, all patients undergoing prostate biopsies were identified and evaluated regarding additional IHC staining for diagnostic [...] Read more.

Background: To test the value of immunohistochemistry (IHC) staining in prostate biopsies for changes in biopsy results and its impact on treatment decision-making. Methods: Between January 2017–June 2020, all patients undergoing prostate biopsies were identified and evaluated regarding additional IHC staining for diagnostic purpose. Final pathologic results after radical prostatectomy (RP) were analyzed regarding the effect of IHC at biopsy. Results: Of 606 biopsies, 350 (58.7%) received additional IHC staining. Of those, prostate cancer (PCa) was found in 208 patients (59.4%); while in 142 patients (40.6%), PCa could be ruled out through IHC. IHC patients harbored significantly more often Gleason 6 in biopsy (p < 0.01) and less suspicious baseline characteristics than patients without IHC. Of 185 patients with positive IHC and PCa detection, IHC led to a change in biopsy results in 81 (43.8%) patients. Of these patients with changes in biopsy results due to IHC, 42 (51.9%) underwent RP with 59.5% harboring ≥pT3 and/or Gleason 7–10. Conclusions: Patients with IHC stains had less suspicious characteristics than patients without IHC. Moreover, in patients with positive IHC and PCa detection, a change in biopsy results was observed in >40%. Patients with changes in biopsy results partly underwent RP, in which 60% harbored significant PCa. Full article

(This article belongs to the Section Genitourinary Oncology)

► Show Figures

Figure 1

8 pages, 1195 KiB

Open AccessCase Report

Emergency Use of Targeted Osmotic Lysis for the Treatment of a Patient with Aggressive Late-Stage Squamous Cell Carcinoma of the Cervix

by Harry J. Gould III, Paige R. Miller, Samantha Edenfield, Kelly Jean Sherman, Chad K. Brady and Dennis Paul

Curr. Oncol. 2021, 28(3), 2115-2122; https://doi.org/10.3390/curroncol28030196 - 8 Jun 2021

Cited by 3 | Viewed by 4197

Abstract

Upregulation of voltage-gated sodium channels (VGSCs) and Na⁺/K⁺-ATPase (sodium pumps) is common across most malignant carcinomas. Targeted osmotic lysis (TOL) is a developing technology in which the concomitant stimulation of VGSCs and pharmacological blockade of sodium pumps causes rapid [...] Read more.

Upregulation of voltage-gated sodium channels (VGSCs) and Na⁺/K⁺-ATPase (sodium pumps) is common across most malignant carcinomas. Targeted osmotic lysis (TOL) is a developing technology in which the concomitant stimulation of VGSCs and pharmacological blockade of sodium pumps causes rapid selective osmotic lysis of carcinoma cells. This treatment of cervical carcinoma is evidence that TOL is a safe, well-tolerated and effective treatment for aggressive advanced carcinomas that has the potential to extend life without compromising its quality. TOL is likely to have broad application for the treatment of advanced-stage carcinomas. Full article

► Show Figures

Figure 1

Figure 1
The photomicrographs depict the immunohistochemical labeling of voltage-gated sodium channels (VGSCs) (green) in a biopsy of the stage IIB carcinoma of the cervix obtained from the patient prior to treatment with targeted osmotic lysis (TOL). Sections were incubated and then processed with a goat-anti-rabbit 488 Alexa fluorophore secondary antibody, 1:800 dilution. Nuclei were counterstained with DRAQ5 (blue; dilution 1:600). Twelve images taken with a Leica DMi8 confocal microscope at 40× oil magnification were reviewed for evidence of VGSC labeling. Panel (A) depicts a representative portion of the biopsy where many cells, approximately 40% of the total, highly expressed VGSCs. Cellular profiles from three sections were outlined and the mean fluorescence intensity was measured using the ImageJ-FIJI software (<a href="http://imagej.nih.gov" target="_blank">imagej.nih.gov</a>; accessed on 19 May 2021) to quantify the sodium channel expression. The histogram (B) presents the average mean fluorescence intensity measured from 50 intensely stained and 50 weakly stained cell profiles compared to the background indicative of the level of VGSC expression in highly expressing tumor cells and minimally expressing neoplastic and stromal cells, respectively. A one-way ANOVA was significant (p < 0.00001); * = p < 0.001 compared to the background; ** = p < 0.001 compared to weakly expressing cells (Student’s t-test with Scheffe’s adjustment). Calibration bar in A = 25 µm. Full article ">Figure 2
The photograph depicts the patient in the bore of the custom-built coaxial ring device used to deliver the uniform pulsed electric fields necessary for opening the VGSCs in TOL (The Phantom Laboratory, Salem, NY, USA). Full article ">Figure 3
Transverse computed tomographic images of the Stage IIB carcinoma of the cervix obtained from the patient before (A) and 3 (B) and 21 days (C) after treatment with TOL. The images were chosen to depict cuts through the tumor at levels as closely similar as possible. Adjustments of magnifications were made to match the dimensions of bony landmarks of the femoral head and acetabulum. Adjustments of contrast and brightness for optimum clarity of the images were applied equally to all the three images. Note that the size of the tumor increases with each successive image. By contrast-enhanced CT, areas of hypodensity observed within the tumor mass appear larger and much more prominent after treatment with TOL, consistent with the reduction in measured tissue densities from 70 HU pre-treatment (A) to 56 HU (B) by day 3 and 47 HU (C) by day 21 post-treatment. Additional region-of-interest (ROI) reference measurements were made for each scan over the left gluteal musculature revealing values of 127 HU (A), 120 HU (B) and 125 HU (C), respectively. Calibration bar in C = 5 cm. Full article ">

8 pages, 235 KiB

Open AccessCommunication

Nurse Navigators’ Views on Patient and System Factors Associated with Navigation Needs among Women with Breast Cancer

by Sally D. Miller, Robin Urquhart, George Kephart, Yukiko Asada and Tallal Younis

Curr. Oncol. 2021, 28(3), 2107-2114; https://doi.org/10.3390/curroncol28030195 - 5 Jun 2021

Cited by 3 | Viewed by 3200

Abstract

Coordinating breast cancer treatment is a complex task that can overwhelm patients and their support networks. Though the Cancer Patient Navigator (CPN) program in Nova Scotia (NS) provides professional assistance to patients, certain groups of patients may still face barriers to accessing its [...] Read more.

Coordinating breast cancer treatment is a complex task that can overwhelm patients and their support networks. Though the Cancer Patient Navigator (CPN) program in Nova Scotia (NS) provides professional assistance to patients, certain groups of patients may still face barriers to accessing its services. Employing interviews and a modified Delphi approach with CPN participants, this study sought to identify factors associated with the need for navigation to help better target CPN program referrals among breast cancer patients. Six CPNs were recruited directly through the CPN program manager for interviews and surveys. The CPNs identified 27 different factors, which were divided into 4 categories: sociodemographic, psychological, clinical and health systems. While these patient factors (particularly sociodemographic) are not directly modifiable, awareness of their association with the need for navigation could be used to better target patients with a high need for navigation for referral to CPN services. Full article

(This article belongs to the Section Psychosocial Oncology)

10 pages, 783 KiB

Open AccessArticle

The Screening and COnsensus Based on Practices and Evidence (SCOPE) Program–Results of a Survey on Daily Practice Patterns for Patients with mCRC

by Gerald Prager, Claus-Henning Köhne, Juan Manuel O’Connor, Fernando Rivera, Daniele Santini, Harpreet Wasan and Jean Marc Phelip

Curr. Oncol. 2021, 28(3), 2097-2106; https://doi.org/10.3390/curroncol28030194 - 4 Jun 2021

Cited by 5 | Viewed by 3641

Abstract

The SCOPE project aimed to better understand practice patterns, identify drivers for treatment goals, and determine third- and fourth-line treatment choices for patients with metastatic colorectal cancer (mCRC). The survey was developed by an expert panel of gastrointestinal oncologists. Questions concerned general practice [...] Read more.

The SCOPE project aimed to better understand practice patterns, identify drivers for treatment goals, and determine third- and fourth-line treatment choices for patients with metastatic colorectal cancer (mCRC). The survey was developed by an expert panel of gastrointestinal oncologists. Questions concerned general practice patterns, and treatment decisions for three hypothetical patient case scenarios. Participants had to routinely manage patients with mCRC. We present results from 629 participants who provided input on patient treatment scenarios (data cutoff: 17/01/2020). Prolonging overall survival (OS; 51%) was the main aim in first line. In third line, quality of life (QOL) was the primary goal (34%). Forty-three percent also cited efficacy-focused goals; 18% and 13% noted prolonging OS and improving progression-free survival as main aims, respectively. For fit and active patients, 89% of respondents considered trifluridine-tipiracil an appropriate third-line treatment; regorafenib (31%) or clinical trial enrollment (29%) were the fourth-line options. For patients with comorbidities and limited caregiver support, trifluridine-tipiracil was the preferred third-line treatment (70%). For KRAS-mutated patients with comorbidities and adverse events who received prior oxaliplatin, 90% considered oxaliplatin rechallenge an unsuitable third-line treatment, mainly due to the risk of cumulative toxicity (75%). In the third/fourth-line settings, trifluridine-tipiracil followed by regorafenib was the most common option (54%); 17% chose regorafenib followed by trifluridine-tipiracil. Efficacy coupled with QOL are important goals in third-line treatment. Daily practice patterns reflect the guideline recommendations in third- and fourth-line settings, with a trend toward using trifluridine-tipiracil versus regorafenib in KRAS-wildtype and KRAS-mutant tumors. Full article

(This article belongs to the Section Gastrointestinal Oncology)

► Show Figures

Figure 1

Figure 1
Percentage of physicians who consider tumor sidedness when making treatment decisions for patients with KRAS wildtype across (A) different regions and (B) Western Europe. AUS = Austria; BEL = Belgium; FR = France; GER = Germany; ITA = Italy; SPA = Spain; SWI = Switzerland; UK = United Kingdom. a Small sample size, so caution should be taken when interpreting these data. Schemes follow the same formatting. Full article ">Figure 2
Treatment goals in the first-(1L) and third-line (3L) settings. Full article ">Figure 3
Physicians’ responses on why oxaliplatin rechallenge is an unsuitable third-line treatment in a KRAS-mutant patient with comorbidities and previous tolerability issues. ECOG = Eastern Cooperative Oncology Group. Full article ">Figure 4
(A) Physicians’ responses on why oxaliplatin rechallenge is an unsuitable third-line treatment in a KRAS-mutant patient with comorbidities and previous tolerability issues, and (B) physicians’ responses on the preferred treatment strategy for a patient with KRAS-mutant tumor, comorbidities, and previous tolerability issues. 3L = third line; 4L = fourth line; 5-FU = 5-fluorouracil; VEGF = vascular endothelial growth factor. a Defined as unspecified. Full article ">

10 pages, 622 KiB

Open AccessReview

Possible Therapeutic Potential of Disulfiram for Multiple Myeloma

by Denisa Weiser Drozdkova and Katerina Smesny Trtkova

Curr. Oncol. 2021, 28(3), 2087-2096; https://doi.org/10.3390/curroncol28030193 - 3 Jun 2021

Cited by 2 | Viewed by 3744

Abstract

Multiple myeloma (MM) is a malignant disease of the plasma cells representing approximately 10% of all hemato-oncological diseases. Detection of the disease is most probable at around 65 years of age, and the average survival of patients is estimated to be 5–10 years, [...] Read more.

Multiple myeloma (MM) is a malignant disease of the plasma cells representing approximately 10% of all hemato-oncological diseases. Detection of the disease is most probable at around 65 years of age, and the average survival of patients is estimated to be 5–10 years, specifically due to frequent relapses and resistance to the therapy used. Thus, the search for new therapeutic approaches is becoming a big challenge. Disulfiram (DSF), a substance primarily known as a medication against alcoholism, has often been mentioned in recent years in relation to cancer treatment for its secondary anti-cancer effects. Recent studies performed on myeloma cell lines confirm high inhibition of the cell growth activity if a complex of disulfiram and copper is used. Its significant potential is now being seen in the cure of haematological malignities. Full article

(This article belongs to the Section Medical Oncology)

► Show Figures

Figure 1

8 pages, 631 KiB

Open AccessFeature PaperArticle

Quality of Colon Cancer Care in Patients Undergoing Emergency Surgery

by Keegan Guidolin, Rebecca Withers, Farhana Shariff, Shady Ashamalla and Ashlie Nadler

Curr. Oncol. 2021, 28(3), 2079-2086; https://doi.org/10.3390/curroncol28030192 - 3 Jun 2021

Cited by 8 | Viewed by 3409

Abstract

Thirty percent of colon cancer diagnoses occur following emergency presentations, often with bowel obstruction or perforation requiring urgent surgery. We sought to compare cancer care quality between patients receiving emergency versus elective surgery. We conducted an institutional retrospective matched (46 elective:23 emergency; n [...] Read more.

Thirty percent of colon cancer diagnoses occur following emergency presentations, often with bowel obstruction or perforation requiring urgent surgery. We sought to compare cancer care quality between patients receiving emergency versus elective surgery. We conducted an institutional retrospective matched (46 elective:23 emergency; n = 69) case control study. Patients who underwent a colon cancer resection from January 2017 to February 2019 were matched by age, sex, and cancer stage. Data were collected through the National Surgical Quality Improvement Program and chart review. Process outcomes of interest included receipt of cross-sectional imaging, CEA testing, pre-operative cancer diagnosis, pre-operative colonoscopy, margin status, nodal yield, pathology reporting, and oncology referral. No differences were found between elective and emergency groups with respect to demographics, margin status, nodal yield, oncology referral times/rates, or time to pathology reporting. Patients undergoing emergency surgery were less likely to have CEA levels, CT staging, and colonoscopy (p = 0.004, p = 0.017, p < 0.001). Emergency cases were less likely to be approached laparoscopically (p = 0.03), and patients had a longer length of stay (p < 0.001) and 30-day readmission rate (p = 0.01). Patients undergoing emergency surgery receive high quality resections and timely post-operative referrals but receive inferior peri-operative workup. The adoption of a hybrid acute care surgery model including short-interval follow-up with a surgical oncologist or colorectal surgeon may improve the quality of care that patients with colon cancer receive after acute presentations. Surgeons treating patients with colon cancer emergently can improve their care quality by ensuring that appropriate and timely disease evaluation is completed. Full article

(This article belongs to the Section Gastrointestinal Oncology)

► Show Figures

Figure 1

14 pages, 1792 KiB

Open AccessReview

Interventions and Outcomes for Neoadjuvant Treatment of T4 Colon Cancer: A Scoping Review

by Flora Jung, Keegan Guidolin, Michael Ho-Yan Lee, Kimberley Lam-Tin-Cheung, Grace Zhao, Sachin Doshi, Tyler Chesney, Marina Englesakis, Jelena Lukovic, Grainne O’Kane, Fayez A. Quereshy and Sami A. Chadi

Curr. Oncol. 2021, 28(3), 2065-2078; https://doi.org/10.3390/curroncol28030191 - 29 May 2021

Cited by 6 | Viewed by 3928

Abstract

While adjuvant treatment of colon cancers that penetrate the serosa (T4) have been well-established, neoadjuvant strategies have yet to be formally evaluated. Our objective was to perform a scoping review of eligibility criteria, treatment regimens, and primary outcomes for neoadjuvant approaches to T4 [...] Read more.

While adjuvant treatment of colon cancers that penetrate the serosa (T4) have been well-established, neoadjuvant strategies have yet to be formally evaluated. Our objective was to perform a scoping review of eligibility criteria, treatment regimens, and primary outcomes for neoadjuvant approaches to T4 colon cancer. A librarian-led, systematic search of MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL up to 11 February 2020 was performed. Primary research evaluating neoadjuvant treatment in T4 colon cancer were included. Screening and data abstraction were performed in duplicate; analyses were descriptive or thematic. A total of twenty studies were included, most of which were single-arm, single-center, and retrospective. The primary objectives of the literature to date has been to evaluate treatment feasibility, tumor response, disease-free survival, and overall survival in healthy patients. Conventional XELOX and FOLFOX chemotherapy were the most commonly administered interventions. Rationale for selecting a specific regimen and for treatment eligibility criteria were poorly documented across studies. The current literature on neoadjuvant strategies for T4 colon cancer is overrepresented by single-center, retrospective studies that evaluate treatment feasibility and efficacy in healthy patients. Future studies should prioritize evaluating clear selection criteria and rationale for specific neoadjuvant strategies. Validation of outcomes in multi-center, randomized trials for XELOX and FOLFOX have the most to contribute to the growing evidence for this poorly managed disease. Full article

(This article belongs to the Section Gastrointestinal Oncology)

► Show Figures

Figure 1

Figure 1
Article selection. Full article ">Figure 2
Heatmap graphic showing the distribution of primary outcomes in the current literature on neoadjuvant therapy for T4 colon cancer. Each box in the grid represents the number of studies (color coded per the legend) that use the primary outcome listed on the y-axis to evaluate the neoadjuvant therapy listed on the x-axis. NAT, neoadjuvant therapy; R0, microscopically negative margins; DFS, disease-free survival; OS, overall survival. Full article ">Figure 3
Neoadjuvant therapies in the current literature. (Categories are not mutually exclusive. Some trials evaluated more than one neoadjuvant therapy). DTS, direct-to-surgery; CRT, chemoradiotherapy; FOLFOX, folinic acid + 5-fluorouracil + oxaliplatin; FOLFOXIRI, FOLFOX + irinotecan; mFOLFIRI: 5-fluorouracil + irinotecan; XELOX, capecitabine + oxaliplatin; XELOXIRI, XELOX + irinotecan; XELIRI, capecitabine + irinotecan; NAC, neoadjuvant chemotherapy; NAR, neoadjuvant radiotherapy. Full article ">Figure 4
Heatmap graphics showing the rationale (A) and eligibility criteria (B) for neoadjuvant therapy for T4 colon cancer. Each box in the grid represents the number of studies (color coded per the legend) that use the rationale (A) or eligibility criteria (B) listed on the y-axis, corresponding to the neoadjuvant therapy listed on the x-axis. (Categories are not mutually exclusive). NAT, neoadjuvant therapy; CRC, colorectal cancer; R0, microscopically negative margins; AC, adjuvant chemotherapy; CT, computed tomography. Full article ">

13 pages, 1122 KiB

Open AccessArticle

Geographic and Socioeconomic Disparity of Gastric Cancer Patients in Canada

by Leila Cattelan, Feras M. Ghazawi, Michelle Le, François Lagacé, Elham Rahme, Andrei Zubarev, Denis Sasseville, Ivan V. Litvinov, Kevin A. Waschke and Elena Netchiporouk

Curr. Oncol. 2021, 28(3), 2052-2064; https://doi.org/10.3390/curroncol28030190 - 28 May 2021

Cited by 7 | Viewed by 5613

Abstract

Gastric cancer is the 5th most common malignancy worldwide, representing ~5–10% of all new cancer cases. Although its incidence is declining, it is estimated that 1 in 98 Canadians will develop gastric cancer in their lifetime. The epidemiology and distribution of gastric cancer [...] Read more.

Gastric cancer is the 5th most common malignancy worldwide, representing ~5–10% of all new cancer cases. Although its incidence is declining, it is estimated that 1 in 98 Canadians will develop gastric cancer in their lifetime. The epidemiology and distribution of gastric cancer throughout Canada, however, remains poorly understood. A retrospective analysis of demographic data across Canada between 1992 and 2010 was performed using 2 population-based cancer registries. The incidence of gastric cancer was examined at the levels of provinces, cities, and postal codes. In addition, 43,955 patients were diagnosed with gastric cancer in Canada between 1992 and 2010; 66% were male and the average age of diagnosis was 68.4 years. The age-adjusted incidence rate was 5.07 cases per 100,000 individuals per year. The incidence decreased over the study period by 30%. High incidence rates were identified in rural areas of Newfoundland and Labrador, New Brunswick, and Quebec. Our study found a significant association between gastric cancer incidence rates and lower socioeconomic status, as well as Hispanic ethnicity. This is the first study to provide a comprehensive analysis of the incidence of gastric carcinoma in Canada, identifying high-risk populations that may benefit from increased primary and secondary prevention. Full article

(This article belongs to the Section Gastrointestinal Oncology)

► Show Figures

Figure 1

12 pages, 395 KiB

Open AccessConference Report

Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20–22 February 2020

by Christina W. Lee, J. Gregory McKinnon and Noelle Davis

Curr. Oncol. 2021, 28(3), 2040-2051; https://doi.org/10.3390/curroncol28030189 - 27 May 2021

Cited by 1 | Viewed by 2437

Abstract

Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online [...] Read more.

Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online voting process was undertaken at the 13th and 14th annual Canadian Melanoma Conferences (CMC) to collect expert opinions relating to “who, what, where, and when” HRS should be conducted. Initial opinions were gathered via audience participation software and used as the basis for a second iterative questionnaire distributed online to attendees from the 13th CMC and to identified melanoma specialists from across Canada. A third questionnaire was disseminated in a similar fashion to conduct a final vote on HRS that could be implemented. Results: The majority of respondents from the first two iterative surveys agreed on stages IIB to IV as high risk. Surveillance should be conducted by an appropriate specialist, irrespective of association to a cancer centre. Frequency and modality of surveillance favoured biannual visits and Positron Emission Tomography Computed Tomography (PET/CT) with brain magnetic resonance imaging (MRI) among the systemic imaging modalities available. No consensus was initially reached regarding the frequency of systemic imaging and ultrasound of nodal basins (US). The third iterative survey resolved major areas of disagreement. A 5-year surveillance schedule was voted on with 92% of conference members in agreement. Conclusion: This final recommendation was established following 92% overall agreement among the 2020 CMC attendees. Full article

► Show Figures

Figure 1

11 pages, 428 KiB

Open AccessArticle

Testing Mayo Clinic’s New 20/20/20 Risk Model in Another Cohort of Smoldering Myeloma Patients: A Retrospective Study

by Camille Tessier, Thomas Allard, Jean-Samuel Boudreault, Rayan Kaedbey, Vincent Éthier, Fléchère Fortin and Michel Pavic

Curr. Oncol. 2021, 28(3), 2029-2039; https://doi.org/10.3390/curroncol28030188 - 26 May 2021

Cited by 3 | Viewed by 3500

Abstract

Background—smoldering multiple myeloma (SMM) risk of progression to multiple myeloma (MM) is highly heterogeneous and several models have been suggested to predict this risk. Lakshman et al. recently proposed a model based on three biomarkers: bone marrow plasma cell (BMPC) percentage > 20%, [...] Read more.

Background—smoldering multiple myeloma (SMM) risk of progression to multiple myeloma (MM) is highly heterogeneous and several models have been suggested to predict this risk. Lakshman et al. recently proposed a model based on three biomarkers: bone marrow plasma cell (BMPC) percentage > 20%, free light chain ratio (FLCr) > 20 and serum M protein > 20 g/L. The goal of our study was to test this “20/20/20” model in our population and to determine if similar results could be obtained in another cohort of SMM patients. Method—we conducted a retrospective, single center study with 89 patients diagnosed with SMM between January 2008 and December 2019. Results—all three tested biomarkers were associated with an increased risk of progression: BMPC percentage ≥ 20% (hazard ratio [HR]: 4.28 [95%C.I., 1.90–9.61]; p < 0.001), serum M protein ≥ 20 g/L (HR: 4.20 [95%C.I., 1.90–15.53]; p = 0.032) and FLCr ≥ 20 (HR: 3.25 [95%C.I., 1.09–9.71]; p = 0.035). The estimated median time to progression (TTP) was not reached for the low and intermediate risk groups and was 29.1 months (95%C.I., 3.9–54.4) in the high-risk group (p = 0.006). Conclusions—the 20/20/20 risk stratification model adequately predicted progression in our population and is easy to use in various clinical settings. Full article

(This article belongs to the Section Hematology)

► Show Figures

Figure 1

15 pages, 368 KiB

Open AccessArticle

Results from a Theory-Guided Survey to Support Breast Cancer Trial Participation: Barriers, Enablers, and What to Do about them

by Jamie C. Brehaut, Kelly Carroll, Jenn Gordon, Justin Presseau, Dawn P. Richards, Dean A. Fergusson, Ian D. Graham and Susan Marlin

Curr. Oncol. 2021, 28(3), 2014-2028; https://doi.org/10.3390/curroncol28030187 - 26 May 2021

Cited by 3 | Viewed by 3701

Abstract

Background: Ensuring adequate, informed, and timely participation in clinical trials is a multifactorial problem. We have previously developed a systematic, tailorable survey development approach that is informed by theory, can identify barriers and enablers to participation, and can suggest recruitment strategies to address [...] Read more.

Background: Ensuring adequate, informed, and timely participation in clinical trials is a multifactorial problem. We have previously developed a systematic, tailorable survey development approach that is informed by theory, can identify barriers and enablers to participation, and can suggest recruitment strategies to address these issues. In this study, we surveyed subscribers to the Canadian Breast Cancer Network (CBCN) in order to identify a comprehensive list of theory-informed barriers and enablers relevant to participation in a hypothetical breast cancer trial. Methods: We developed and conducted an online survey of breast cancer patients informed by the Theoretical Domains Framework and designed to determine previous experience with clinical trials, knowledge about clinical trials, and importance of a comprehensive list of barriers and enablers to trial participation. Participants were contacted by email or through social media. Results: From 2451 subscribers of the CBCN, we received 244 responses and 210 completed surveys (244/2451 or 9.9% participation, 210/244 or 86.1% completion). A total of 38% of respondents indicated experience in trial participation, but 83% indicated confidence in their knowledge about clinical trials. Those who had previously participated in clinical trials were more confident in their knowledge (χ²= 6.77, p = 0.009) and answered more knowledge questions (t = −3.90 p = 0.000). Endorsed barriers and enablers to participation included 39 factors across 12 of 14 domains relevant to behaviour change. Our approach identifies barriers that might be meaningfully addressed by careful knowledge provision (‘If I would learn more about my condition’; ‘If I find the trial documents hard to understand’), those that may require other theory-informed approaches to address (‘my feelings about the quality of my drug plan’; ‘my worry over unknown side effects’), and those that may require tailored approaches depending on participant differences such as previous experience in trials (‘If there were patient-friendly decision-making tools to help you make your participation decision’). Discussion: This work demonstrates that a comprehensive, theory-guided survey of barriers and enablers to participation in breast cancer clinical trials is feasible, can lead to detailed knowledge about the issues related to participation in specific trials, and most importantly, can lead to insights about evidence-based ways to better support patient participation. Full article

► Show Figures

Figure 1

7 pages, 208 KiB

Open AccessCommentary

Ethical Considerations in Chemotherapy and Vaccines in Cancer Patients in Times of the COVID-19 Pandemic

by Guido V. Schiappacasse

Curr. Oncol. 2021, 28(3), 2007-2013; https://doi.org/10.3390/curroncol28030186 - 26 May 2021

Cited by 2 | Viewed by 3942

Abstract

The COVID-19 situation is a worldwide health emergency with strong implications in clinical oncology. In this viewpoint, we address two crucial dilemmas from the ethical dimension: (1) Is it ethical to postpone or suspend cancer treatments which offer a statistically significant benefit in [...] Read more.

The COVID-19 situation is a worldwide health emergency with strong implications in clinical oncology. In this viewpoint, we address two crucial dilemmas from the ethical dimension: (1) Is it ethical to postpone or suspend cancer treatments which offer a statistically significant benefit in quality of life and survival in cancer patients during this time of pandemic?; (2) Should we vaccinate cancer patients against COVID-19 if scientific studies have not included this subgroup of patients? Regarding the first question, the best available evidence applied to the ethical principles of Beauchamp and Childress shows that treatments (such as chemotherapy) with clinical benefit are fair and beneficial. Indeed, the suspension or delay of such treatments should be considered malefic. Regarding the second question, applying the doctrine of double-effect, we show that the potential beneficial effect of vaccines in the population with cancer (or those one that has had cancer) is much higher than the potential adverse effects of these vaccines. In addition, there is no better and less harmful known solution. Full article

(This article belongs to the Section Medical Oncology)

19 pages, 292 KiB

Open AccessConference Report

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2019

by Joanna Gotfrit, Rachel Goodwin, Timothy Asmis, Angela J. Hyde, Thierry Alcindor, Francine Aubin, Scott Berry, Dominick Bossé, Colin Brown, Ronald Burkes, Margot Burnell, Bruce Colwell, Jessica Corbett, Jeff Craswell, Nathalie Daaboul, Mark Doherty, D. A. Barry Fleming, Luisa Galvis, Rakesh Goel, Mohammed Harb, Alwin Jeyakumar, Derek Jonker, Erin Kennedy, Michael Lock, Aamer Mahmud, Patrick H. McCrea, Vimoj Nair, Rami Nassabein, Carolyn Nessim, Ravi Ramjeesingh, Muhammad Raza, Wissam Saliba, Satareh Samimi, Simron Singh, Stephanie Snow, Mustapha Tehfé, Michael Thirlwell, Mario Valdes, Stephen Welch and Michael Vickers Show full author list Hide full author list

Curr. Oncol. 2021, 28(3), 1988-2006; https://doi.org/10.3390/curroncol28030185 - 26 May 2021

Cited by 4 | Viewed by 4107

Abstract

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2019 was held in Morell, Prince Edward Island, 19–21 September 2019. Experts in medical oncology, radiation oncology, and surgical oncology who are involved in the management of patients with gastrointestinal malignancies participated in presentations and [...] Read more.

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2019 was held in Morell, Prince Edward Island, 19–21 September 2019. Experts in medical oncology, radiation oncology, and surgical oncology who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of anal, colorectal, biliary tract, and gastric cancers, including: radiotherapy and systemic therapy for localized and advanced anal cancer; watch and wait strategy for the management of rectal cancer; role of testing for dihydropyrimidine dehydrogenase (DPD) deficiency prior to commencement of fluoropyrimidine therapy; radiotherapy and systemic therapy in the adjuvant and unresectable settings for biliary tract cancer; and radiotherapy and systemic therapy in the perioperative setting for early-stage gastric cancer. Full article

(This article belongs to the Section Gastrointestinal Oncology)

8 pages, 845 KiB

Open AccessCase Report

An Example of Personalized Treatment in HR+ HER2+ Long Survivor Breast Cancer Patient (Case Report)

by Martina Panebianco, Beatrice Taurelli Salimbeni, Michela Roberto and Paolo Marchetti

Curr. Oncol. 2021, 28(3), 1980-1987; https://doi.org/10.3390/curroncol28030184 - 25 May 2021

Cited by 2 | Viewed by 3732

Abstract

Background. Personalized therapy is becoming increasingly popular in oncological scenarios, not only based on molecular pharmacological targets, but also preventing any drug–drug–gene interaction (DDGI), which could lead to severe toxicities. Single nucleotide polymorphisms (SNPs), the individual germline sequence variations in genes involved in [...] Read more.

Background. Personalized therapy is becoming increasingly popular in oncological scenarios, not only based on molecular pharmacological targets, but also preventing any drug–drug–gene interaction (DDGI), which could lead to severe toxicities. Single nucleotide polymorphisms (SNPs), the individual germline sequence variations in genes involved in drug metabolism, are correlated to interindividual response to drugs and explain both efficacy and toxicity profiles reported by patients. Case presentation. We present the case of a woman suffering from triple-positive breast cancer; she had early-stage disease at the onset and after four years developed metastatic disease. During her history, she presented different toxicities due to antineoplastic treatments. Particularly, hypertransaminasemia was found during every line of treatment. Nevertheless, we were able to guarantee the patient an excellent therapeutic adhesion thanks to the supportive treatments and the reduction of drug dosage. Moreover, we conducted a simultaneous analysis of the patient’s biochemical and genomic data thanks to Drug-PIN software, and we found several significant SNPs of the main enzymes and transporters involved in drug metabolism. Conclusion. Our case report demonstrated the relevance of DDGI in clinical practice management of a patient treated for advanced breast cancer, suggesting the role of Drug-PIN software as an easy-to-use tool to prevent adverse events during cancer treatment and to help physicians in therapeutic algorithms. However, further studies are needed to confirm these results. Full article

(This article belongs to the Special Issue Long-Term Effects of Systemic Therapies on Cancer Patients)

► Show Figures

Figure 1

18 pages, 3193 KiB

Open AccessArticle

Investigation of Nano-Bio Interactions within a Pancreatic Tumor Microenvironment for the Advancement of Nanomedicine in Cancer Treatment

by Abdulaziz Alhussan, Kyle Bromma, Ece Pinar Demirci Bozdoğan, Andrew Metcalfe, Joanna Karasinska, Wayne Beckham, Abraham S. Alexander, Daniel J. Renouf, David F. Schaeffer and Devika B. Chithrani

Curr. Oncol. 2021, 28(3), 1962-1979; https://doi.org/10.3390/curroncol28030183 - 24 May 2021

Cited by 11 | Viewed by 3515

Abstract

Pancreatic cancer is one of the deadliest types of cancer, with a five-year survival rate of only 10%. Nanotechnology offers a novel perspective to treat such deadly cancers through their incorporation into radiotherapy and chemotherapy. However, the interaction of nanoparticles (NPs) with cancer [...] Read more.

Pancreatic cancer is one of the deadliest types of cancer, with a five-year survival rate of only 10%. Nanotechnology offers a novel perspective to treat such deadly cancers through their incorporation into radiotherapy and chemotherapy. However, the interaction of nanoparticles (NPs) with cancer cells and with other major cell types within the pancreatic tumor microenvironment (TME) is yet to be understood. Therefore, our goal is to shed light on the dynamics of NPs within a TME of pancreatic origin. In addition to cancer cells, normal fibroblasts (NFs) and cancer-associated fibroblasts (CAFs) were examined in this study due to their important yet opposite roles of suppressing tumor growth and promoting tumor growth, respectively. Gold nanoparticles were used as the model NP system due to their biocompatibility and physical and chemical proprieties, and their dynamics were studied both quantitatively and qualitatively in vitro and in vivo. The in vitro studies revealed that both cancer cells and CAFs take up 50% more NPs compared to NFs. Most importantly, they all managed to retain 70–80% of NPs over a 24-h time period. Uptake and retention of NPs within an in vivo environment was also consistent with in vitro results. This study shows the paradigm-changing potential of NPs to combat the disease. Full article

(This article belongs to the Section Medical Oncology)

► Show Figures

Graphical abstract

Graphical abstract
Full article ">Figure 1
Exploring nano-bio interface in a tumor microenvironment (TME) of pancreatic origin. This schematic demonstrates the complexity of a TME and how nanotechnology can exploit the ability of different cell types to uptake different amounts of nanoparticles (NPs). NPs could be used as radiosensitizers or drug delivery carriers. TME consists of many types of cells. Upon the delivery of NPs into the different type of cells via the bloodstream, cancer cells and cancer associated fibroblasts (CAFs) uptake the highest number of NPs compared to normal cells. The surface-modified NPs enter the cells via endocytosis, and after a certain period of time, leave the cells via exocytosis. The window where cancer cells and CAFs retain the highest number of NPs could be used to deliver specified doses of ionizing radiation to reach a higher therapeutic index. Full article ">Figure 2
Characterization of GNPs. (A) Schematic diagram showing the presence of both PEG and RGD peptide molecules on GNPPEG-RGD complex used for the study. (B) TEM images of GNPs with a core size of ~17.73 nm (±0.17 nm). Scale bar is 50 nm. (C) DF and HSI images of as-made GNP. Scale bar is 40 µm. For (D–G), the GNPPEG are GNPs that are functionalized with a polyethylene glycol (PEG) molecule as a stabilizing agent, and the GNPPEG-RGD are GNP that are functionalized with PEG and with RGD peptides to improve GNPs uptake. (D–F) UV–Visible absorption spectra, hydrodynamic diameter, and ζ-potential measurements of pure GNPs, GNPPEG, and GNPPEG-RGD, respectively. (G) Summary of peak absorption wavelength, hydrodynamic diameter, and mean ζ-potential for pure GNPs, GNPPEG, and GNPPEG-RGD. (Note: the error is represented by the standard deviation over three different measurements). Full article ">Figure 3
Gold Nanoparticles (GNPs) uptake in cancer cells vs. normal cells. (A) A schematic diagram explains the path of GNPs within a cell. (B) Quantification of GNPs per cell in PANC-1, Mia PaCa-2, CAFs, and NFs. (C–J) Visualization of intracellular NP distribution in PANC-1 (first row), Mia PaCa-2 (second row), CAFs (third row) and NFs (fourth row) using confocal imaging (C–F) left-most panel (nucleus); middle panel (NPs); right-most panel (merged image), and dark-field (D,F) microcopy (G–J). (K–N) Hyperspectral Imaging (HSI) spectra collected from GNP clusters (bright specs) in images from G to J. Scale bars are 20 µm and 40 µm for confocal and DF, respectively. Full article ">Figure 4
Retention of GNPs in cancer cells vs normal cells. (A) GNPs retained per cell in PANC-1, Mia PaCa-2, CAFs, and NFs. (B) Percent of NP retention in PANC-1, Mia PaCa-2, CAFs, and NFs. (C–F) Confocal (leftmost panel; nucleus is stained in blue and NPs are in red), DF images (middle panel; bright specs represent GNP clusters), and HSI spectra (rightmost panel; spectra collected from bright specs as compared to background) of GNPs internalized in PANC-1 (C), Mia PaCa-2 (D), CAFs (E), and NFs (F). Scale bars are 20 μm and 40 μm for confocal and DF, respectively. Full article ">Figure 5
The dynamics of GNP distribution and retention in tumor. (A) A schematic diagram showing the escape of NPs from leaky blood vessels to tumor tissue. (B–C) Quantification of GNPs in tumor and blood (in circulation) over a period of 24 h. (D–F) GNPs distribution in tumor tissue after 2, 24, and 48 h of injection, respectively. Top and bottom rows represent tumor periphery and interior, respectively. Scale bar is 40 µm. Full article ">

5 pages, 983 KiB

Open AccessCase Report

A Case of Pathological Complete Response and Resolution of Dermatomyositis Following Neoadjuvant Chemotherapy in HER2-Positive Early Breast Cancer

by Marta Piras, Martina Panebianco, Matteo Garibaldi, Michela Roberto, Gioia Merlonghi, Patrizia Pellegrini and Paolo Marchetti

Curr. Oncol. 2021, 28(3), 1957-1961; https://doi.org/10.3390/curroncol28030182 - 24 May 2021

Cited by 3 | Viewed by 2565

Abstract

Introduction. Dermatomyositis (DM) is an idiopathic inflammatory myopathy (IIM) mainly characterized by subacute muscle weakness and skin rash sometimes associated with malignancy. Case Presentation. A 61-year-old female was admitted to our hospital because of progressive proximal muscular weakness, heliotropic rash and left breast [...] Read more.

Introduction. Dermatomyositis (DM) is an idiopathic inflammatory myopathy (IIM) mainly characterized by subacute muscle weakness and skin rash sometimes associated with malignancy. Case Presentation. A 61-year-old female was admitted to our hospital because of progressive proximal muscular weakness, heliotropic rash and left breast rash. Muscle biopsy findings were consistent with dermatomyositis (DM). A full panel of myositis associated (MAA) and specific antibodies (MSA) revealed the presence of anti-nuclear antibodies (1:160, speckled), Anti-Ro52 and anti TIF1-γ antibodies. A whole body Computed Tomography Scan showed three left mammary nodules and homolateral axillary lymphadenopathy. The breast biopsy confirmed the diagnosis of ductal carcinoma. Patient was initiated to neoadjuvant chemotherapy followed by surgery for cancer, and corticosteroid and intravenous immunoglobulins for DM with a complete resolution of muscle weakness and pathological complete response of breast cancer. Discussion and conclusion. Similar cases in literature are commonly referred to a first-line surgery and the role of neoadjuvant chemotherapy is debatable. Full article

► Show Figures

Figure 1

Journal Menu

Journal Browser

Curr. Oncol., Volume 28, Issue 3 (June 2021) – 65 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI