Cancer Institute (WIA)

Mitochondrial electron transport flavoprotein (ETF) insufficiency causes metabolic diseases known as a multiple acyl-CoA dehydrogenase deficiency (MADD). In contrast to muscle, ETFDH is a non-essential gene in acute lymphoblastic leukemia NALM6 cells, and its expression is reduced across human cancers. In various human cancer cell lines and mouse models, ETF insufficiency caused by decreased ETFDH expression limits flexibility of OXPHOS fuel utilisation but paradoxically increases bioenergetics and accelerates neoplastic growth via activation of the mTORC1/BCL-6/4E-BP1 axis. Collectively, these findings reveal that while ETF insufficiency is rare and has detrimental effects in non-malignant tissues, it is common in neoplasia, where ETFDH downregulation leads to bioenergetic and signaling reprogramming that accelerates neoplastic growth.

The end-of-life phase in individuals with chronic and life-threatening illnesses such as cancer is a clinically significant and emotionally vulnerable period. During this time, patients may report vivid dreams and visions that typically occur in the hours, days or weeks preceding death, which are deeply subjective. There is a lacuna in the literature about end-of-life dreams and visions (ELDV), as they often go unreported due to fear of stigma. This case describes the experience of a young female with metastatic cancer who encountered disturbing and distressing ELDV. This case highlights the therapeutic value of basic counselling skills in palliative care, particularly validation and normalisation, to alleviate the psychological distress and ensure patient comfort during the final stages of life. As one of the few cases reported from India, this report contributes to existing literature and underscores the need for open dialogue about ELDVs in palliative care.

This study aimed to identify sociodemographic predictors of stereotactic body radiotherapy (SBRT) use and assess temporal trends in first-line SBRT use among patients with spinal metastatic renal cell carcinoma (mRCC) in relation to National Comprehensive Cancer Network guidelines. Using the PearlDiver Database, adults with spinal mRCC were identified. The database includes patients from 2010 to 2023. Patients with documented first-line radiotherapy were grouped as either receiving SBRT or conventional external beam radiation therapy (EBRT). Cohorts were compared using the χ2 tests for categorical variables and independent-samples t tests for continuous variables (P<0.05). Utilization trends were examined before versus after guideline implementation in 2019, and predictors of SBRT utilization were evaluated using multivariate logistic regression. Of 86,482 patients with spinal metastatic RCC, 10,988 met the inclusion criteria (SBRT=453; EBRT=10,535). Cohorts differed significantly by age, sex, insurance coverage, and US region. After multivariate analysis, younger age, male sex, commercial insurance, and Midwest or Northeast residence were associated with higher odds of receiving first-line SBRT (P<0.05). SBRT use decreased after 2019, while EBRT use exceeded SBRT in every study year. From 2010 to 2023, EBRT remained the predominant first-line radiotherapy for spinal mRCC. Higher commercial insurance rates among SBRT recipients and regional variability in SBRT use suggest that payer mechanisms and institutional variation may influence first-line SBRT use. Policy alignment with contemporary evidence and expansion of SBRT infrastructure may enhance patient access.

Mitochondrial electron transport flavoprotein (ETF) insufficiency causes metabolic diseases known as a multiple acyl-CoA dehydrogenase deficiency (MADD). In contrast to muscle, ETFDH is a non-essential gene in acute lymphoblastic leukemia NALM-6 cells, and its expression is reduced across human cancers. ETF insufficiency caused by decreased ETFDH expression limits flexibility of OXPHOS fuel utilization but paradoxically increases cancer cell bioenergetics and accelerates neoplastic growth by activation of the mTORC1/BCL-6/4E-BP1 axis. Collectively, these findings reveal that while ETF insufficiency is rare and has detrimental effects in non-malignant tissues, it is common in neoplasia, where ETFDH downregulation leads to bioenergetic and signaling reprogramming that accelerate neoplastic growth.

Conventional neoadjuvant chemotherapy yields limited benefits for locally advanced head and neck squamous cell carcinoma (LA-SCCHN) patients. Emerging neoadjuvant immunochemotherapy (ICT) holds potential; however, existing evidence remains conflicting. This study systematically evaluated the efficacy and safety of neoadjuvant ICT in this cohort. In accordance with PRISMA guidelines, a systematic literature search was performed in PubMed, Web of Science, MEDLINE, and Scopus from inception to July 2025. Cochrane and Joanna Briggs Institute tools were used for bias assessment. The primary endpoints were pathologic complete response (pCR), major pathologic response (mPR), and CR; secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and grade 3 to 4 adverse events. Nine studies involving 2507 patients were included. Neoadjuvant ICT significantly improved pCR (6.90% vs. 1.46%; OR=6.07, 95% CI:2.39-15.43; P=0.0002), CR (47.99% vs. 33.14%; OR=2.52, 95% CI:1.29-4.91; P=0.007), and ORR (83.51% vs. 80.04%; OR=2.03, 95% CI:1.17-3.52; P=0.01), with no significant differences in OS, PFS, mPR, or DCR. Grade ≥3 adverse events were more frequent in the neoadjuvant ICT group (56.34% vs. 47.96%; OR=1.32, 95% CI:1.09-1.61; P=0.005). Neoadjuvant ICT enhances short-term pathologic and tumor responses in LA-SCCHN versus neoadjuvant chemotherapy, but increases toxicity and lacks proven survival benefits. Further high-quality trials are needed to optimize ICT regimens and identify predictive biomarkers.

Abstract Recurrence scores based on a 21-gene assay are clinically useful for predicting prognosis and chemotherapy benefit in postmenopausal node-positive breast cancer patients, but its performance in premenopausal patients is inconsistent. Here, we evaluated Ataraxis Breast RISK (ATX), an AI test that predicts recurrence risk, and compared it with the genomic assay. ATX identified high risk patients misclassified as low risk by the genomic assay and therefore may refine selection of patients for adjuvant chemotherapy.