Treatment Options for Distal Rectal Cancer in the Era of Organ Preservation
Opinion statementThe introduction of total mesorectal excision into the radical surgery of rectal cancer has significantly improved the oncological outcome with longer survival and lower local recurrence. Traditional treatment modalities of distal rectal cancer, relying on radical surgery, while effective, take their own set of risks, including surgical complications, potential damage to the anus, and surrounding structure owing to the pursuit of thorough resection. The progress of operating methods as well as the integration of systemic therapies and radiotherapy into the peri-operative period, particularly the exciting c...
Source: Current Treatment Options in Oncology - March 22, 2024 Category: Cancer & Oncology Source Type: research

Social Determinants of Health and the Link to Colorectal Cancer Outcomes
Opinion   statementColorectal cancer (CRC) remains the second most deadly cancer in the United States, behind only lung cancer. Despite improvements in incidence due to screening and mortality in part due to better treatments, there are some groups that have not seen these promising changes. American Indian/Alaska Native and non-Hispanic Black individuals, certain geographic regions, and lower socioeconomic groups have all been shown to have worse CRC outcomes. A significant body of evidence has linked these disparities in outcomes to social determinants of health (SDH). SDH are defined by the WHO as “the non-medical fa...
Source: Current Treatment Options in Oncology - March 18, 2024 Category: Cancer & Oncology Source Type: research

Ovarian Suppression: Early Menopause and Late Effects
Opinion statementAround 90% of breast tumours are diagnosed in the early stage, with approximately 70% being hormone receptor-positive. The cornerstone of adjuvant therapy for early-stage hormone receptor-positive breast cancer is endocrine therapy, tailored according to disease stage, biological characteristics of the tumour, patient ’s comorbidities, preferences and age. In premenopausal patients with hormone receptor-positive breast cancer, ovarian function suppression is a key component of the adjuvant endocrine treatment in combination with an aromatase inhibitor or tamoxifen. Moreover, it can be used during chemoth...
Source: Current Treatment Options in Oncology - March 13, 2024 Category: Cancer & Oncology Source Type: research

Update on Dosing and Fractionation for Neoadjuvant Radiotherapy for Localized Soft Tissue Sarcoma
Opinion statementNeoadjuvant radiotherapy (RT) over 5 –6 weeks with daily doses of 1.8–2.0 Gy to a total dose of 50–50.4 Gy is standard of care for localized high-grade soft tissue sarcomas (STS) of the extremities and trunk wall. One exception is myxoid liposarcomas where the phase II DOREMY trial applying a preoperative dose of 36 Gy in 2 Gy fr actions (3–4 weeks treatment) has achieved excellent local control rates of 100% after a median follow-up of 25 months.Hypofractionated preoperative RT has been investigated in a number of phase II single-arm studies suggesting that daily doses of 2.75 –8 Gy over 1–3 w...
Source: Current Treatment Options in Oncology - March 13, 2024 Category: Cancer & Oncology Source Type: research

Circulating Tumor DNA (ctDNA) and Its Role in Gynecologic Malignancies
Opinion statementCirculating tumor DNA (ctDNA) refers to small fragments of DNA released into the bloodstream by cancer cells. It is obtained through “liquid biopsy;" which most commonly refers to plasma or blood samples, but can be obtained from a number of bodily fluids including ascitic fluid, saliva, and even urine and stool. ctDNA is detected via polymerase chain reaction (PCR) or next-generation sequencing (NGS). The DNA from these samples is analyzed for the detection of point mutations, copy-number alterations, gene fusion, and DNA methylation. These results have the potential for use in cancer diagnosis, de...
Source: Current Treatment Options in Oncology - March 12, 2024 Category: Cancer & Oncology Source Type: research

Neoadjuvant Short- Vs. Long-Course Radiation for Locally Advanced Rectal Cancer: How to Choose
Opinion statementOver the past decades, the treatment of locally advanced rectal cancer has evolved dramatically due to improvements in diagnostic imaging, surgical technique, and the addition of radiotherapy and/or chemotherapy. Fractionation of neoadjuvant radiotherapy with or without concurrent chemotherapy remains the subject of discussion and the question multiple recent trials have aimed to answer. In light of recent data and concern for locoregional recurrence, our institution favors long-course chemoradiation in most cases, especially in low-lying primaries, threatened circumferential resection margin, consideratio...
Source: Current Treatment Options in Oncology - February 22, 2024 Category: Cancer & Oncology Source Type: research

A Comprehensive Review of Cancer Drug –Induced Cardiotoxicity in Blood Cancer Patients: Current Perspectives and Therapeutic Strategies
This article intricately unveils how cancer treatments cause cardiotoxicity, which is exacerbated by patient-specific risks. In particular, drugs like anthracyclines, alkylating agents, and tyrosine kinase inhibitors pose a risk, along with factors such as hypertension and diabetes. Mechanistic insights into oxidative stress and topoisomerase-II-B inhibition are crucial, while cardiac biomarkers show early damage. Timely intervention and prompt treatment, especially with specific agen ts like dexrazoxane and beta-blockers, are pivotal in the proactive management of CDIC. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - February 19, 2024 Category: Cancer & Oncology Source Type: research

Who Should Receive Immunotherapy for Advanced Gastroesophageal Cancer?
Opinion StatementThis paper shines a light on the exciting progress being made in using immunotherapy to treat advanced gastroesophageal cancers. The positive results from trials using drugs like Pembrolizumab and Nivolumab are certainly encouraging and open new possibilities for treating this challenging disease. However, it is clear that we still have a lot to learn about how to predict which patients will benefit most from these treatments. The exploration of combining therapies and using machine learning to guide treatment shows promise. Moving forward, it is crucial that researchers and healthcare professionals contin...
Source: Current Treatment Options in Oncology - February 19, 2024 Category: Cancer & Oncology Source Type: research

Harnessing the Potential of Real-World Evidence in the Treatment of Colorectal Cancer: Where Do We Stand?
Opinion statementTreatment guidelines for colorectal cancer (CRC) are primarily based on the results of randomized clinical trials (RCTs), the gold standard methodology to evaluate safety and efficacy of oncological treatments. However, generalizability of trial results is often limited due to stringent eligibility criteria, underrepresentation of specific populations, and more heterogeneity in clinical practice. This may result in an efficacy-effectiveness gap and uncertainty regarding meaningful benefit versus treatment harm. Meanwhile, conduct of traditional RCTs has become increasingly challenging due to identification...
Source: Current Treatment Options in Oncology - February 17, 2024 Category: Cancer & Oncology Source Type: research

Antiepileptic Strategies for Patients with Primary and Metastatic Brain Tumors
Opinion statementSeizure activity is common in patients with primary and metastatic brain tumors, affecting more than 50% of cases over the course of their disease. Several mechanisms contribute to brain tumor –related epilepsy (BTRE), including a pro-inflammatory environment, excessive secretion of glutamate and an increase in neuronal excitatory tone, reduction of GABAergic inhibitory activity, and an increase in 2-hydroxygluturate production in isocitrate dehydrogenase mutant tumors. After a verified seizure in a brain tumor patient, the consensus is that BTRE has developed, and it is necessary to initiate an antiepil...
Source: Current Treatment Options in Oncology - February 14, 2024 Category: Cancer & Oncology Source Type: research

Preoperative Strategies for Locally Advanced Colon Cancer
Opinion statementNeoadjuvant chemotherapy is safe for patients with locally advanced colon cancer (LACC). The FOxTROT trial demonstrated a reduction in residual and recurrent cancer at 2 years with neoadjuvant chemotherapy for patients with cT3-4 LACC. Preoperative chemotherapy should be avoided, if possible, for patients with dMMR LACC, as over 50% of dMMR cancers have no pathologic response. Early universal testing of MMR status is critical to selecting the appropriate neoadjuvant therapy. Concerns about CT staging of LACC have limited uptake of neoadjuvant chemotherapy, as approximately 25% of patients with cT3-T4 cance...
Source: Current Treatment Options in Oncology - February 13, 2024 Category: Cancer & Oncology Source Type: research

A Comprehensive Review on the Role of Lurbinectedin in Soft Tissue Sarcomas
Opinion statementSoft tissue sarcoma (STS), a substantial group of aggressive and rare tumors with tissue heterogeneity, is infrequently represented in clinical trials with an urgent necessity for newer treatment options. Lurbinectedin, an analog of trabectedin, is currently approved, in various countries, as a single agent, for the treatment of patients with relapsed small cell lung cancer (SCLC). However, preclinical and phase I and phase II trials have demonstrated the efficacy of lurbinectedin in different tumor types, including STS. The better understanding of the pathophysiology and evolution of STS as well as the me...
Source: Current Treatment Options in Oncology - February 7, 2024 Category: Cancer & Oncology Source Type: research

One Size Fits Some: Approaching Rare Malignancies of the Urinary Tract
Opinion StatementUrothelial carcinoma is the predominant cancer of the urinary tract but when divergent and subtype histology (non-urothelial) are identified at time of pathologic diagnosis, therapeutic and diagnostic challenges transpire. To this end, pathologic review to confirm any non-urothelial histology is key since these subtypes can often be overlooked. Few prospective trials are dedicated to understanding these non-urothelial histologic types; however, current, and past trials did allow patients with these non-urothelial histologic types to enroll, and inferences can be made about treatment efficacy and survival. ...
Source: Current Treatment Options in Oncology - February 5, 2024 Category: Cancer & Oncology Source Type: research

Evaluation of Homologous Recombination Deficiency in Ovarian Cancer
Opinion statementHomologous recombination deficiency (HRD) is an important biomarker guiding selection of ovarian cancer patients who will derive the most benefit from poly(ADP-ribose) polymerase inhibitors (PARPi). HRD prevents cells from repairing double-stranded DNA damage with high fidelity, PARPis limit single-stranded repair, and together these deficits induce synthetic lethality. Germline or somatic BRCA mutations represent the narrowest definition of HRD, but do not reflect all patients who will have a durable PARPi response. HRD can also be defined by its downstream consequences, which are measured by different me...
Source: Current Treatment Options in Oncology - February 1, 2024 Category: Cancer & Oncology Source Type: research

Integrating Systemic Therapies into the Multimodality Therapy of Patients with Craniopharyngioma
In conclusion, targeted therapy with BRAF/MEK inhibitors holds great promise for improving outcomes and quality of life for patients with BRAF-mutated craniopharyngiomas. However, additional research is needed to address the questions that remain about its optimal use and integration into comprehensive treatment plans. (Source: Current Treatment Options in Oncology)
Source: Current Treatment Options in Oncology - February 1, 2024 Category: Cancer & Oncology Source Type: research