Journal

Future Oncology

Papers (52)

Fibrinolysis markers as predictive indicators of neoadjuvant chemotherapy efficacy in ovarian cancer patients

Ovarian cancer (OC) is a prevalent gynecological malignancy with high mortality due to its asymptomatic progression and advanced stage at diagnosis. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is beneficial for patients unsuitable for primary debulking surgery (PDS). Effective markers for assessing NACT outcomes could significantly aid clinical decision-making and personalized treatment strategies. In this retrospective study, we examined fibrinolytic markers, including D-dimer, fibrinogen (FIB), and fibrinogen degradation products (FDP), among 167 OC patients and 110 healthy controls. Plasma levels of these markers were measured before and after four NACT cycles in OC patients, and receiver operating characteristic (ROC) analysis was conducted to evaluate their diagnostic and predictive value. OC patients exhibited significantly elevated baseline levels of D-dimer, FIB, and FDP compared to healthy controls. Post-NACT measurements showed that responders had a substantial decrease in these markers, while non-responders showed minimal changes. ROC analysis confirmed the diagnostic accuracy of D-dimer, FIB, and FDP, with high sensitivity and specificity for predicting NACT effectiveness. D-dimer, FIB, and FDP are elevated in OC patients and demonstrate a potential role as noninvasive markers for assessing NACT efficacy, offering valuable insights for treatment planning.

Efficacy of PD-1/PDL-1 inhibitors for ovarian cancer: a systematic review and network meta-analysis

Randomized controlled trials (RCTs) have assessed the efficacy of anti-programmed cell death 1 (PD- 1)/programmed cell death ligand 1 (PD-L1), alone or combined with other therapies, for ovarian cancer. However, the optimal strategy remains unclear. This study evaluated their effectiveness as monotherapy and in combination. We conducted a systematic review and Frequentist network meta-analysis (NMA) by searching PubMed, ScienceDirect, Web of Science, Scopus, Cochrane Library, and Clinicaltrials.gov databases. This analysis included RCTs comparing PD-L1/PD-1 inhibitors, alone or in combination with other therapies. Six studies involving 3,895 patients and eight treatment combinations were included. PD1/PDL1 inhibitors plus chemotherapy and PD1/PDL1 inhibitors plus ipilimumab showed the greatest progression-free survival (PFS) benefit (hazard ratio (HR) = 0.82, 95% confidence interval [CI]: 0.52-1.07; HR = 0.82, 95% CI:0.51-1.33) and overall survival (OS) (HR = 0.85, 95% CI:0.64-1.14; HR = 0.83, 95% CI:0.45-1.54). These combinations also improved overall response rates (ORR), especially with chemotherapy (OR = 3.06; 95% CI:1.42-6.60). Subgroup analysis suggested that PD-1/PD-L1 inhibitors plus chemotherapy provided the best PFS and OS in PD-L1-positive patients. Combining PD-1/PD-L1 inhibitors with chemotherapy or ipilimumab improved survival in ovarian cancer. However, PD-L1 expression may be a valuable biomarker for predicting the efficacy of PD-1/PD-L1 checkpoint inhibitors. This systematic review was preregistered in PROSPERO (CRD42022342057). Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022347967.

Detecting metabolic signatures in endometrial cancer: potential applications of Raman spectroscopy

Endometrial cancer (EC) is intricately linked to obesity, with metabolic reprogramming increasingly established to drive oncogenic transformation and influence treatment outcomes. Implementation of early detection strategy significantly reduces morbidity and mortality; however, screening strategies lack the required sensitivity, specificity, and accuracy to be successfully implemented in clinical practice. Current diagnostic approaches are also invasive, costly, and time-consuming, highlighting a gap in developing diagnostic and screening alternatives for EC among high-risk individuals, especially with sensitivity to capture cancer-specific changes. Raman Spectroscopy is an emerging tool in medical diagnostics. By exploiting the atomic vibrational absorption induced by the interaction of light with a biological sample, a unique spectral response namely a "metabolite fingerprint" can be generated. This nondestructive technique combined with multivariate statistical analysis can characterize metabolic discrimination between cancerous and healthy samples, demonstrating a promising role in cancer screening, diagnosis, and monitoring of treatment outcomes. This review aimed to collate available evidence on Raman's ability to capture metabolic abnormalities, particularly cancer-specific metabolites during malignant transformation and therapeutic resistance. Given that cellular metabolism is altered in EC, this review will provide insight into its potential applications for EC screening, diagnosis, and prospects, especially for monitoring treatment outcomes among high-risk patients.

The broad societal value of pembrolizumab for women’s cancer in Canada

The impact of women's cancers is multifaceted, with broad societal and economic consequences. Health technology assessments often rely solely on costs and outcomes directly relevant to the healthcare system. Our study incorporates the additional and novel value elements across three perspectives for pembrolizumab in four women's cancers in a Canadian setting. We analyzed the net monetary benefit (NMB) of pembrolizumab-based treatments of early-stage triple-negative breast cancer, metastatic triple-negative breast cancer, microsatellite instability-high endometrial cancer, and cervical cancer from three perspectives: traditional payer perspective (TPP), traditional societal perspective (TSP), and broad societal perspective (BSP). Indications and comparators were modeled independently, combined, and weighted by prevalence. Pembrolizumab-based therapy generated an NMB over four times greater with the BSP (Canadian dollars, CAD$925,078), compared with TPP (CAD$226,090) and TSP (CAD$222,556). The largest driver of results was the inclusion of insurance value. Results excluding insurance value still generated an NMB of CAD$484,384, more than twice the TPP. Broadening the perspective to include additional value elements considerably increased the overall value of treatment of women's cancer compared with the TPP, indicating that the perspective used by health technology bodies may not fully capture the societal value of therapeutics.

Knowledge, attitudes, and practices regarding HPV infection, cervical cancer, and HPV vaccination among Emirati women

This study aimed to investigate knowledge, attitudes, and practices (KAPs) regarding human papillomavirus (HPV) infection, cervical cancer (CC), and HPV vaccination among Emirati women with the goal of informing the development of targeted public health interventions. A community-based, cross-sectional study was conducted among Emirati women from January to May 2024 among Emirati women. A systematic sampling approach was used to recruit participants from Zayed University, Ajman University, and Al Tawam Hospital, in which context every third eligible adult female visitor was invited to participate in this research. The main outcome measures were KAPs practices regarding HPV infection, cervical cancer, and HPV vaccination. The study included 216 Emirati women (median age: 21 years, range: 18-60 years). While 64.4% of the participants reported good knowledge about HPV infection and CC, only 58.3% reported good knowledge regarding HPV vaccination. Negative attitudes toward HPV infection and CC were reported by 76.9% of the participants. Preventive practices were reportedly high (72.2%), but only 28.2% of the participants had actually received the HPV vaccination. Despite relatively high levels of CC awareness, misconceptions about HPV transmission and vaccination persist among Emirati women. Enhancing health education, involving healthcare providers, and addressing cultural concerns are essential for efforts to improve HPV prevention strategies and increase vaccine uptake in the United Arab Emirates (UAE).

Treatment patterns and outcomes by mismatch repair/microsatellite instability status among patients with primary advanced or recurrent endometrial cancer in the United States

To describe real-world patient characteristics, treatment patterns, and clinical outcomes in primary advanced/recurrent endometrial cancer (pA/R EC) by mismatch repair/microsatellite instability (MMR/MSI) status who initiated first-line therapy. Data from the Flatiron Health electronic health record-derived database were analyzed from patients with a diagnosis of pA/R EC who started treatment between 1 January 2013, and 31 August 2022, from ≈ 280 US clinics. MMR/MSI status and treatment patterns were summarized; time to next treatment (TTNT) and overall survival (OS) were estimated using Kaplan-Meier methods. Of 2022 patients, 11.03%, 27.79%, and 61.18% had MMR-deficient/MSI-high (dMMR/MSI-H), MMR-proficient/microsatellite stable (MMRp/MSS), and unknown MMR/MSI status, respectively. Platinum-based chemotherapy combinations, including carboplatin-paclitaxel, were the most frequent first-line regimens (dMMR/MSI-H, 49.33%; MMRp/MSS, 55.52%; unknown, 65.08%); treatment patterns differed between subgroups. Median TTNT with platinum-based combinations were 6.87, 8.08, and 7.85 months, respectively; OS medians were 41.89, 26.18, and 21.62 months, respectively. Platinum-based chemotherapy combinations, the recommended first-line treatment, were not used in ≈ 40% of patients. TTNT rates were similar to the PFS rates in the carboplatin-paclitaxel arms in the RUBY and GY-018 trials; OS rates were similar to RUBY, highlighting the potential for combination therapies to improve outcomes.

Publisher

Informa UK Limited

ISSN

1479-6694