The National Comprehensive Cancer Network guidelines recommend tumor phenotyping for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 at initial breast cancer diagnosis, with repeat biopsy considered at disease progression. This study assessed the frequency, timing, regional variation, and predictors of repeat biopsies among patients with metastatic breast cancer (mBC) treated at community oncology practices in the United States. A weighted random sample of 911 mBC patients was selected from 15 practices within the ONCare Alliance network. The data included demographics, clinical characteristics, number and types of biopsies, and associated findings. Multivariate negative binomial regression, adjusted for disease duration, was used to identify predictors of biopsy frequency. Among the cohort, 42.2% had a history of early-stage disease, while 57.8% were diagnosed with de novo stage IV mBC. After adjusting for disease duration, patients with prior early-stage disease underwent significantly more biopsies (mean: 3.9; 95% CI: 3.7-4.0) than those with de novo mBC (mean: 2.2; 95% CI: 2.1-2.3; P<0.001). Factors associated with fewer biopsies included non-Black, non-Asian minority status (RR=0.80, P<0.001), longer time to metastatic progression (RR=0.93, P<0.001), poor performance status, and geographic region. A substantial proportion of patients with mBC, particularly those with de novo disease, did not undergo repeat biopsy at progression. These findings reveal disparities in biopsy practices and underscore the need for improved adherence to guideline-based care in community oncology settings.

Lung adenocarcinoma (LUAD), which is the most frequently diagnosed form of lung cancer, constitutes a major global health challenge due to its significant mortality rate. Palmitoylation, as a key post-translational modification of proteins, plays an important role in tumor progression. However, its influence on sculpting the tumor immune microenvironment (TME) and its subsequent impact on patient prognosis remains incompletely understood. This study was based on the TCGA-LUAD and GSE72094 cohort data sets to explore the potential role of palmitoylation-related genes (PRGs) in LUAD. Through the integration of differential analysis, weighted gene coexpression network analysis (WGCNA), univariate Cox analysis and least absolute shrinkage and selection operator (LASSO) regression analysis, prognostic genes for LUAD were screened. Furthermore, the infiltration patterns of immune cells across different groups were assessed by applying the ssGSEA and CIBERSORT algorithms. To elucidate the potential biological processes mediated by PRGs in LUAD pathogenesis, GSEA, GO and KEGG enrichment analyses, were used. In addition, the consensus clustering method was utilized for identify molecular subtypes of LUAD. This study identified 5 PRGs as prognostic genes for LUAD and constructed a robust prognostic model. Immune infiltration analysis indicated that the level of immune cell infiltration in patients of the high-risk group was significantly lower. Further enrichment analysis showed that the upregulated differentially expressed genes (DEGs) in the high and low risk groups were related to the cytoskeleton, while the downregulated DEGs were related to lipid metabolism. In addition, this study successfully classified LUAD into 2 molecular subtypes with significant differences. Our research delves into the intricate TME and molecular mechanisms of LUAD, providing new insights into the pathologic mechanism and treatment strategies of LUAD.

Cancer is a major health threat in sub-Saharan Africa (SSA). Patient navigation has emerged as a strategy to address this, but the scope and impact of patient navigation for cancer care in SSA remains unclear. We aimed to comprehensively map the existing literature on patient navigation interventions for cancer care in SSA. A scoping review was conducted using a standardized 3-step search strategy. Eligible studies involved a patient navigation intervention for cancer care in SSA. Data were extracted on study, participant and navigator characteristics, intervention outcomes and implementation barriers and facilitators. Twenty-two studies describing 20 distinct interventions across 10 countries were included. Most studies were descriptive, focused on breast and cervical cancers and targeted the treatment stage of care. Navigator roles included patient education, psychosocial support, care coordination, and attenuation of patient barriers to care. Patient navigation appeared feasible, acceptable, and beneficial across a variety of study populations in this setting, but limited funding was a commonly reported barrier to maintenance. Cancer patient navigation is a promising strategy to improve cancer outcomes in SSA. Strategic investment is needed to support sustainable scale-up and maximize the impact of cancer patient navigation in the region.

This trial served as a proof-of-concept for whether inhibition of protein kinase C iota (PKCι) with auranofin and sirolimus provide antineoplastic effects in patients with recurrent high-grade serous ovarian cancer. This drug combination was administered to patients with recurrent high-grade serous ovarian cancer. Dosing was based on unpublished phase 1 data and consisted of auranofin 6mg and sirolimus 5mg both orally per day of a 28-day cycle. The primary endpoint was tumor response. Available tumor tissue was assessed for PKCι protein expression by immunohistochemistry (IHC) and PRKCI copy number by fluorescence in-situ hybridization (FISH) after the start of cancer therapy. Twenty-two patients were enrolled, and 21 were evaluable for all clinical trial endpoints. One patient was unevaluable because she did not receive a full chemotherapy cycle. No tumor responses were seen in the first 21 patients, resulting in early trial termination per a priori trial design. The median progression-free survival was 2.1 months (95% CI: 1.8-3.7). The median overall survival was 4.4 months (95% CI: 2.6-12.5). Fourteen (67%) patients had at least one grade 3 or worse adverse event. Nineteen of 21 evaluable patients had available tumor tissue, which showed the median PKCι copy number averaged per cell of 3 (range: 2 to 7), and PKCι expression (at least 1+) in all. As prescribed here, auranofin and sirolimus manifested no antineoplastic activity in patients with recurrent high-grade serous ovarian cancer that expressed PKCι.

The systematic literature review was performed on the use of artificial intelligence (AI) algorithms in nonsmall cell lung cancer (NSCLC) prognostication. Studies were evaluated for the type of input data (histology and whether CT, PET, and MRI were used), cancer therapy intervention, prognosis performance, and comparisons to clinical prognosis systems such as TNM staging. Further comparisons were drawn between different types of AI, such as machine learning (ML) and deep learning (DL). Syntheses of therapeutic interventions and algorithm input modalities were performed for comparison purposes. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The initial database identified 3880 results, which were reduced to 513 after the automatic screening, and 309 after the exclusion criteria. The prognostic performance of AI for NSCLC has been investigated using histology and genetic data, and CT, PET, and MR imaging for surgery, immunotherapy, and radiation therapy patients with and without chemotherapy. Studies per therapy intervention were 13 for immunotherapy, 10 for radiotherapy, 14 for surgery, and 34 for other, multiple, or no specific therapy. The results of this systematic review demonstrate that AI-based prognostication methods consistently present higher prognostic performance for NSCLC, especially when directly compared with traditional prognostication techniques such as TNM staging. The use of DL outperforms ML-based prognostication techniques. DL-based prognostication demonstrates the potential for personalized precision cancer therapy as a supplementary decision-making tool. Before it is fully utilized in clinical practice, it is recommended that it be thoroughly validated through well-designed clinical trials.

The combination in patients with HER2-positive and HER2-low metastatic breast cancer (MBC) of Concurrent Trastuzumab Deruxtecan (T-DXd) and Radiation Therapy (RT) is not enough studied. We conducted a retrospective study including patients treated between 11/2020 and 01/2024. Patients with HER2-positive and HER2-low MBC who received concurrent T-DXd and RT were identified. Data on patient demographics, treatment regimens, radiation doses, toxicity profiles, efficacy, and treatment discontinuations were collected. The toxicities were graded using CTCAE V5.0. Population of 33 patients with HER2-positive and HER2-low MBC who underwent concurrent T-DXd&RT, were studied. The median follow-up (FU) was 14 months. There were 39.4 partial remissions and 9.4 attained complete remission. In addition, 39.4% experienced stable disease, and 12.1% faced disease progression necessitating a change in therapy. Safety assessment revealed that acute toxicities were mainly associated with systemic treatment. Survival analysis showed 11 deaths (33.3%) during the FU period, with a median overall survival of 26 months and median progression-free survival of 12 months. The combination of T-DXd with RT in demonstrates promising efficacy with a manageable safety profile. Further studies are warranted to fully elucidate the potential synergistic effects of this treatment regimen and its impact on patient outcome.

This practice parameter was revised collaboratively by the American College of Radiology (ACR), and American Radium Society (ARS). Image-guided radiation therapy (IGRT) uses various imaging modalities to maximize the accuracy and precision of radiation treatment delivery. This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. This practice parameter for IGRT addresses qualifications and responsibilities of personnel, clinical IGRT implementation, documentation, quality control and improvement, safety, and patient education. Since the publication of the ACR-ASTRO Practice Parameter in 2019, there is now more clarity as to what criteria and parameters need to be documented in the medical record, a better appreciation of the large amount of imaging data, how to interpret such data, as well as the complex interactions of multiple systems in the implementation of IGRT. This practice parameter assists practitioners in the clinical use of IGRT. IGRT should complement and be used in combination with other quality assurance processes. IGRT is a rapidly evolving field, and practitioners should have a thorough understanding of its strengths and potential limitations.

To investigate the association between social determinants of health, as measured by the social vulnerability index (SVI), with outcomes in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). This study included patients from Illinois with HPV-OPSCC from 2007 to 2022. State-level SVI measured neighborhood-level disadvantage and associations between SVI and clinicodemographic factors, clinical presentation, and outcomes were analyzed using logistic regression for advanced preliminary staging, while survival and recurrence were assessed within the framework of a Cox proportional hazards model. Higher overall (high vulnerability) and racial-ethnicity SVI scores were significantly associated with increased odds of advanced clinical staging (OR=1.12, P =0.041; OR=1.16, P =0.026) on univariable analysis. Multivariable analysis showed that minority race was significantly associated with advanced clinical staging (OR=5.50, P <0.001). Overall survival was significantly associated with insurance payer type and age, where Medicaid/uninsured status had higher mortality compared with Medicare in both the univariable and multivariable setting (HR=4.47, P =0.006; HR=7.93, P =0.019). The same held for age, where increased age at diagnosis was significantly associated with higher mortality (HR=1.07, P <0.001; HR=1.10, P <0.001). Recurrence-free survival was significantly associated with age (HR=1.04, P =0.004) and payer type, with Medicaid/uninsured patients having 4 times the hazard of patients with Medicare (HR=4.16, P =0.009). Higher overall and racial ethnicity SVI may be associated with advanced clinical staging upon presentation. Individual factors such as race, age, and insurance status are significantly associated with patient prognosis.

To reveal the global trends in the burden and quality of care for childhood ALL from 1990 to 2021, along with inequalities in quality of care across regions, thus identifying regions requiring targeted interventions for optimizing health care resource allocation. Utilizing Global Burden of Disease Study 2021 data, this research analyzed the temporal trends in the global burden of childhood ALL from 1990 to 2021. The quality of care index (QCI) was used to quantify care quality, and the gender disparity ratio (GDR) was used to assess gender disparities. Trend analyses were conducted using the estimated annual percentage change (EAPC), and the associations between QCI, GDR, and the sociodemographic index (SDI) were explored. Inequalities in QCI and GDR across regions were evaluated using the slope index of inequality (SII) and health inequality concentration index. From 1990 to 2021, the incidence and death rates, as well as disability-adjusted life years (DALYs) and years of life lost (YLLs) due to childhood ALL, significantly decreased. However, the number of prevalence and prevalence crude rate increased by 66.818% and 37.923%, respectively. Global care quality continued to improve, with an EAPC of 2.566 (95% CI: 2.488-2.645). In 2021, regions with high QCI were concentrated in high-income areas like Western Europe, while low QCI regions were primarily in low-income areas like sub-Saharan Africa and Oceania. Although the health inequality concentration index of global quality of care decreased from 0.550 in 1990 to 0.395 in 2021, the SII increased from 35.396 to 87.141. Care quality was consistently higher in females than in males, particularly in low and low-middle SDI regions, while the disparities in high and middle SDI regions were gradually narrowing. Despite the gradual decrease in the burden of childhood ALL globally and the steady improvement in quality of care, absolute inequalities remain a significant challenge. Future efforts should focus on increasing health care resource allocation in low SDI regions, enhancing international cooperation, improving the quality and accessibility of care in priority regions, and promoting global health equity.