Annals of Oncology

Background: Neoadjuvant chemotherapy (NACT) facilitates de-escalation of breast and axillary treatment in breast cancer, but pathological responses may differ between the primary tumour and axillary lymph nodes. Understanding differential response is crucial for de-escalation strategies. Methods: This single university hospital retrospective study analysed operable breast cancers (cT1-cT3, cN0-cN3) treated with NACT (January 2013-November 2020). Two-tailed Fishers exact test or the Chi-squared test (for 2x2 comparisons) analysed concordance between breast and axillary pathological responses; Cox proportional hazards regression ascertained predictors of distant recurrence and survival; and logistic regression ascertained predictors of complete axillary response. Results: Among 413 patients (cN0=229; cN+=184) with a median age of 51, pathological response concordance between the breast and axilla was 81% (both pCR, 22.2%; concurrent residual disease, 58.8%). The cN0 group had a significantly higher ypN0 rate in breast pCR versus non-pCR (97.1% vs 80.8%, p<0.001). cN+ had axillary pCR concordant with breast pCR, compared to only 16.5% with residual breast disease. Breast pCR was the most significant predictor of axillary pCR (OR=11.6, p<0.001). Axillary pCR was highest in ER-/HER2+(66.7%) and triple-negative(46.9%) subtypes. Residual axillary disease was independently associated with the worst breast cancer-specific (HR=7.13, p=0.006) and overall Survival (HR=3.32, p=0.029). Kaplan-Meier analyses showed a trend towards worse survival outcomes with axillary residual disease, even with a breast pCR. Conclusions: In this limited series, breast pCR predicts axillary pCR in cN0 and cN+, particularly in HER2-positives and triple-negatives, supporting axillary de-escalation strategies in selected patients stratified by careful assessment of disease at the end of NACT.

Hypothyroidism has been associated with increased skin cancer risk, whereas greater genetic susceptibility to hypothyroidism is associated with lower risk. These opposing associations suggest that the average risk associated with hypothyroidism may conceal substantial heterogeneity among patients, and that genetic background could help identify those at highest risk. In this study, we analyzed more than 650,000 individuals across All of Us and FinnGen cohorts to determine whether a hypothyroidism polygenic risk score (H-PRS) stratifies skin cancer risk among patients with autoimmune hypothyroidism and whether integration of a skin cancer polygenic risk score (SC-PRS) further refines risk. In FinnGen, autoimmune hypothyroidism was associated with increased skin cancer hazard (hazard ratio [HR] = 1.10; 95% CI [1.06, 1.15]), whereas H-PRS was inversely associated with risk (HR=0.97 per 1-SD increase; 95% CI [0.95, 0.98]). The hypothyroidism x H-PRS interaction was also negative (HR=0.94; 95% CI [0.91, 0.98]), indicating greater hypothyroidism-associated risk at lower H-PRS. The hypothyroidism and H-PRS associations replicated in All of Us, and similar H-PRS risk gradients were observed for melanoma, basal cell carcinoma, and squamous cell carcinoma in both cohorts. Among hypothyroid patients, predicted 10-year risk increased with higher SC-PRS and lower H-PRS. Combined clinical-genetic profiles had HRs ranging from 2.32 at the 20th H-PRS/80th SC-PRS percentiles to 3.37 at the 5th/95th percentiles, exceeding published point estimates for the established dermatological risk factors. Among women aged 55, representing the more commonly affected sex at approximately the median age of diagnosis, 10-year risk of skin cancer was 14.9% (95% CI [8.4%, 20.9%]) in the highest-SC-PRS/lowest-H-PRS quartiles versus 2.8% (95% CI [1.0%, 4.7%]) in the opposite quartiles. Overall, these findings support PRS-guided risk stratification for targeted skin cancer prevention and surveillance.

Purpose: Cyclin-dependent kinase 4/6 inhibitors in combination with endocrine therapy have become widely adopted as a first-line treatment approach for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC). Through a collaboration between Novartis and the US Food and Drug Administration, we integrated multimodal data from phase III MONALEESA trials to identify novel prognostic factors for HR+/HER2- ABC. Experimental Design: Baseline clinical and genomics data were collected from patients in the MONALEESA-2, -3, and -7 trials. Circulating tumor DNA (ctDNA) from plasma samples and gene expression in archival tumor biopsies were analyzed. Machine learning models were trained (n = 1,355) on progression-free survival (PFS) using multimodal features via fusion models. In a test set (n = 382), prognostic performances were evaluated using the Kaplan-Meier, Cox, and Weibull models. Results: The late fusion model achieved a prognostic performance (C-index: 0.727, 95% CI: 0.641-0.799) slightly outperforming early fusion (C-index: 0.718, 95% CI: 0.631-0.791) and single-modality models. Model-based risk stratification identified distinct low- and high-risk groups (PFS HR, 0.28; 95% CI: 0.20-0.38). Among the top 40 features for progression risk (18 clinical, 20 gene expression, and 2 ctDNA), these were associated with higher risk: liver involvement, higher histological grades, early relapse; lower STC2 and RBBP8 expressions and higher FBX05 expression; and higher tumor mutational burden and ctDNA purity. Conclusions: Integrating clinical and genomic modalities improved progression risk prediction compared with single-modality models, while highlighting salient features that inform the underlying biology and support hypothesis generation.

The FORESEE trial (NCT04450706) was a prospective study to evaluate the feasibility of integrating organoid-based drug testing with comprehensive genomic characterization to inform treatment selection in patients with HER2-negative metastatic breast cancer. The primary objective of the study was to determine the feasibility of providing personalized therapy recommendations using a combination of genomic vulnerability information with drug testing in patient-derived organoids (PDOs) in a clinically relevant time frame. Of the 15 patients enrolled, 10 cases had biopsies with adequate tumor content, and PDOs were successfully established in 4 of 10 cases. Drug profiling and genomic testing was completed in all established organoids, yielding an overall success rate of 40% in cases of biopsies with adequate tumor content. Drug sensitivity and genomic results were returned within 12 weeks and informed subsequent treatment selection in all evaluable cases. The primary endpoint - demonstrating that PDO-based drug screening combined with genomic characterization would identify clinically actionable outcomes in at least 46% of patients based on prior data - was not met. In conclusion, successful PDO establishment represents a limiting step in the implementation of FPO for metastatic breast cancer; however when PDO were successful, drug responses were always obtained and physicians chose to use the information in 100% of cases. These findings highlight the need for improved strategies optimizing use of patient biopsy material for drug testing in order to fully realize the clinical potential of FPO.

Background: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) shows higher prevalence of lymph node metastases than HPV-negative OPSCC. It remains unclear whether HPV-positive and HPV-negative OPSCC differ in occult metastasis risk, which is relevant to personalize elective nodal treatment volumes. Methods: We performed a retrospective analysis of 780 untreated OPSCC patients from four European centers. Patterns of lymph node level involvement (LNLs I, II, III, IV, V, VII) were assessed using a consensus diagnosis integrating imaging (CT, MRI, PET) and pathological findings from surgically treated patients. Occult metastases were assessed in 288 surgical patients with paired clinical and pathological information. Results: HPV-positive patients more frequently presented with ipsilateral LNL II involvement, particularly in early T-stage disease (80.6% [75.6-84.8] vs. 54.8% [47.2-62.2]). However, the probability of downstream involvement in LNLs III and IV conditioned on upstream LNL involvement was similar between HPV-positive and HPV-negative patients. Similarly, contralateral involvement conditioned on midline extension of the primary tumor was similar. The overall proportion of occult metastases, defined as clinically false-negative LNLs divided by pathologically positive LNLs, was lower in HPV-positive patients (24.7% [19.7-30.1] vs. 48.7% [39.7-57.8]). Conclusions: HPV-positive OPSCC showed higher prevalence of LNL involvement, especially in ipsilateral LNL II and early T-stage tumors. The data to directly compare occult metastasis risk has important limitations and does not allow definitive conclusions. However, the presented data suggests that higher prevalence likely does not translate into higher risk of occult metastases for the most common clinical diagnoses and therefore does not support larger elective nodal treatment volumes compared with HPV-negative tumors.

Background Chemotherapy (CT) de-escalation strategies based on dual HER2 blockade with trastuzumab and pertuzumab (HP) have shown promising efficacy in HER2-positive (HER2+) early breast cancer (EBC), but biomarkers to guide patient selection are lacking. The Ataraxis Breast platform (ATX) uses artificial intelligence (AI) models integrating hematoxylin-eosin (H&E) whole-slide images and clinical variables to predict pathological complete response (pCR) and long-term outcomes. We evaluated ATX in the phase II PHERGain (NCT03161353) and PHERGain-2 (NCT04733118) trials. Methods The ATX NEO model was assessed for pCR prediction in PHERGain (n=306 evaluable patients) and PHERGain-2 (n=383 evaluable patients). The ATX RISK model was evaluated for prognosis in PHERGain (n=309 evaluable patients). Prespecified cutoffs classified patients into low-, medium-, and high-probability groups for pCR and low- or high-risk groups for recurrence. Associations with pCR were assessed using logistic regression. Prognostic performance was evaluated using Cox proportional hazards models, Kaplan-Meier estimates, and Harrell's C-index. Results Overall pCR rates were 40.2% in PHERGain and 60.3% in PHERGain-2. Continuous NEO scores were significantly associated with pCR in both PHERGain (odds ratio [OR], 1.28; 95% CI, 1.11-1.48; P<0.001) and PHERGain-2 (OR, 1.30; 95% CI, 1.13-1.52; P<0.001). Using prespecified cutoffs, pCR rates increased across low-, medium-, and high-probability groups (19.2%, 41.3%, and 48.3% in PHERGain; 29.5%, 61.6%, and 70.1% in PHERGain-2). In PHERGain, the RISK score was significantly associated with event-free survival (hazard ratio per 1-SD increase, 1.56; 95% CI, 1.17-2.08; P=0.002; C-index, 0.66). Five-year event-free survival was 93.9% in the low-risk group and 83.1% in the high-risk group. Conclusions NEO score was consistently associated with pCR across two independent HER2+ EBC trials, while RISK score provided prognostic information for long-term outcomes in PHERGain. Prespecified score categories identified clinically distinct response and risk groups. These findings support further evaluation of AI-based biomarkers to refine patient selection for CT de-escalation strategies in HER2+ EBC.

Poly (ADP-ribose) polymerase inhibitors (PARPi) are the only targeted treatment available for early triple-negative breast cancer (TNBC), an aggressive subtype with limited treatment options. While PARPi are effective in patients with BRCA mutations, resistance to these inhibitors can arise. We previously developed BRCA-mutant cell lines, HCC1395, with acquired resistance to talazoparib and olaparib, and have now developed PARPi-resistant MX1 cell lines in an analogous manner. Ribosomal pathways were upregulated in 3/4 cell lines with acquired PARPi resistance. The resistant cell lines showed high and low basal nucleolar stress based on nucleolar morphology and nucleophosmin delocalization from nucleolus to nucleoplasm. Treatment of these cell lines with the combination of olaparib and a ribosome biogenesis inhibitor, BMH-21, demonstrated synergy in the PARPi-resistant cell lines, but not in the parental cells. Interestingly, HCC1395 cells, which had lower baseline nucleolar stress, showed greater nucleophosmin delocalization with combination treatment than MX1 cells, which had higher baseline nucleolar stress. All four cell lines demonstrated sustained DNA damage with the combination. We extended our investigation to 3 BRCA wild-type TNBC cell lines, BT549, Hs578T, and MDAMB231 and identified synergy in the context of intrinsic PARPi resistance. In MDAMB231 cells, combining olaparib with BMH-21 induced a senescence-like phenotype, increasing gH2AX-positive cells by up to 7.3-fold, senescence-associated B-galactosidase (SA-B-gal) staining by 5.6-fold, and p21 by 3.6-fold. These results were mirrored with a second ribosome biogenesis inhibitor, CX-5461. Finally, we identified distinct patterns of ribosomal pathway activity in a cohort of patients with treatment-resistant TNBC, and found correlations between ribosomal pathways with MYC, proliferation, DNA damage, and senescence. Together, these data identify ribosome biogenesis as a potential therapeutic vulnerability in PARPi-resistant TNBC and support its targeting in combination with PARPi, while demonstrating a broader for ribosome biogenesis in treatment-resistant TNBC.

ABSTRACT BACKGROUND: Next-generation sequencing (NGS) and the development of targeted therapies have revolutionized cancer treatment. Molecular Tumour Boards (MTB) serve as collaborative platforms to integrate individual clinical and molecular information to make recommendations for personalized treatment. METHOD: This is a single-center, retrospective cohort study of patients presented at the Jewish General Hospital (JGH) MTB between July 2018 and Dec 2022. Clinical, molecular/pathologic data, MTB recommendations, and treatment details were collected. Treatment response was determined by radiological evaluation and physician clinical assessment. Fishers exact test and Log-rank tests were used to assess differences between groups. RESULTS: A total of 328 patients were presented to the MTB, including 23 with repeat presentations, resulting in 355 case reviews. Tumour-agnostic biomarkers were detected in 18.9% of cases, most commonly high tumour mutational burden (TMB, 9.5%) and HER2 amplification (4.3%). The most frequent actionable mutations were PIK3CA (19.8%) and PTEN (13.1%), often leading to recommendations for mTOR inhibitor therapy (26.0%). Overall, therapeutic recommendations were issued in 84.5% (300/355) of cases, and implemented in 43.3% (130/300). Patients who received MTB-recommended therapies achieved significantly higher objective response rates (ORR) (14.2% vs. 4.2%; P = 0.047), longer real-world progression-free survival (rwPFS) (5.6 vs. 3.5 months; HR 0.57; 95% CI 0.390 - 0.828; P = 0.003), and improved median overall survival (OS) (12.8 vs. 5.2 months; HR 0.60, 95% CI 0.452 - 0.793; P < 0.001) compared with those treated without MTB guidance. CONCLUSION: MTB is effective in identifying biomarker-matched therapeutic recommendations for advanced malignancies where limited standard-of-care treatment option is available.

Background Cancer incidence and mortality are rising in Africa, yet the distribution and determinants of cancer in high HIV-prevalence regions remain limited. We characterized cancer epidemiology, treatment, and survival among adults in western Kenya, where HIV prevalence ranges between 10.3% and 11.7%. Methods This retrospective cohort study included adults (18 years and older) with cancer treated at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu, Kenya, between Jan 1, 2014, and Dec 31, 2024, followed through June 30, 2025. Data were abstracted from paper records into REDCap. Negative binomial models estimated annual trends, Kaplan-Meier curves evaluated survival, and Cox proportional hazards models evaluated mortality. Findings Among 3978 patients (64% female; median age 53.9 years, IQR 42.0-65.1), annual case counts rose from 29 to 708, averaging a 38% annual increase (95% CI 29-48). Cervical (24%), esophageal (13.6%), breast (12%), prostate (8%), and colorectal (4%) cancers accounted for 62% of cases. 1305 (33%) of cancer patients were living with HIV and 802 (20%) had unknown HIV status. Among patients whose cancer was assigned a stage, 72% presented at stage III-IV. 1973 (50%) received cancer-directed treatment, and 51% had an unscheduled clinic visit lapse of at least 180 days. Cancer-directed treatment was the strongest protective factor for mortality (adjusted hazard ratio [aHR] 0.27, 95% CI 0.22-0.32); HIV-positive status (aHR 1.43, 1.19-1.71), HIV-unknown status (aHR 1.48, 1.20-1.81), and poor or missing performance status were independently associated with higher mortality, robust across sensitivity analyses. Interpretation Cancer mortality was strongly associated with treatment and HIV status at diagnosis. Closing the treatment-access gap and adopting routine opt-out HIV testing at the first oncology visit are essential for integrated cancer care in high-HIV-prevalence settings. Funding Research reported in this publication was supported by the American Cancer Society; the Washington University in St. Louis Institute of Clinical and Translational Sciences through a grant from the National Center for Advancing Translational Sciences (NCATs) of the National Institutes of Health; Just-in-Time funding, and the National Cancer Institute Center Support Grant P30CA091842.

Germ cell tumors (GCTs) are highly sensitized to cell death in response to DNA damaging agents, a property that underlies the success of current chemotherapeutic regimens. To address the molecular basis for this, known as apoptotic priming, we evaluated how different BCL2 family members modulate the heightened sensitivity of GCTs to therapy. Our analysis of human GCTs finds consistently high expression of the pro-survival factors MCL1 and BCL2L1 (BCLX) in a cohort of primary tumors and in their embryonic precursor cells, frequently accompanied by copy number gains of these loci and reciprocal losses of their pro-apoptotic interaction partners and inhibitors, PMAIP1 (NOXA) and BAD. We find that co-inhibition of MCL1 and BCLX using selective BH3 mimetics results in a potent synthetic lethality in multiple GCT embryonal carcinoma cell lines. When these cell lines were cultured with the DNA damaging agents cisplatin or etoposide, inhibition of MCL1 or BCLX potentiated their apoptotic effect in undifferentiated embryonal carcinoma cell lines, but not in retinoic acid-differentiated cells. The inhibition of MCL1 also heightened cisplatin sensitivity in p53-deficient or -mutant cell lines, which is associated with resistance to therapy. Employing an in ovo human xenograft model, we validate that the combination of cisplatin and MCL1 inhibition enhanced the therapeutic response by eliminating tumor cells. Our findings identify MCL1 and BCLX as critical factors to maintain GCT viability and as putative therapeutic targets to further augment GCT responsiveness to DNA damaging agents.

Background: Triple-negative breast cancer (TNBC) disproportionately affects women of African ancestry, yet the biological mechanisms underlying this disparity remain poorly understood. While recent genome-wide association studies (GWAS) have identified numerous TNBC risk variants, their functional consequences have not been systematically evaluated in African-ancestry populations. We hypothesized that ancestry-specific regulatory variants drive distinct transcriptomic and proteomic landscapes that contribute to TNBC aggressiveness. Methods: We extracted 2,849 unique TNBC-associated variants (p-value [&le;] 0.0001) from the GWAS Catalog. Of these, 206 were excluded due to absence in our whole-genome sequencing (WGS) dataset or low minor allele frequency ([&le;] 0.01). We prioritized the remaining 2,643 bi-allelic variants for analysis in the GENE-FORECAST cohort. We integrated WGS with whole-blood transcriptomic (n=242) and proteomic data (n=362) to perform cis-eQTL and cis-pQTL analyses in discovery and validation sets. Results: We identified 38 cis-eQTL associations and 5 cis-pQTL associations that were statistically replicated across independent discovery and validation datasets within our cohort. Both omics layers converged on a single gene, Hemoglobin Zeta (HBZ). We identified five functional variants (four SNPs and one INDEL) in strong linkage disequilibrium that consistently upregulate HBZ mRNA and the corresponding circulating embryonic zeta-globin protein. These variants were found almost exclusively in African and African-admixed populations across GENE-FORECAST, 1000 Genomes, BioVU, and All of Us datasets. Four of the five variants were also confirmed as significant HBZ eQTLs in GTEx whole blood. Conclusion: Our integrative analysis reveals variants of the embryonic HBZ gene as a novel, ancestry-specific TNBC-associated risk factor that is detectable at both transcriptomic and proteomic levels. This suggests that aberrant reactivation of this embryonic globin may provide a selective advantage in the hypoxic TNBC microenvironment. These results highlight a unique mechanism of tumorigenesis in women of African ancestry, offering a potential distinct biomarker and therapeutic target for this high-risk population.

PurposeMen with pathogenic BRCA1 and BRCA2 variants (BRCA+) have an elevated lifetime risk of male breast cancer (MBC) yet data regarding mammography in this population remain limited. MethodsWe performed a retrospective cohort study of BRCA+ assigned male at birth individuals (males) at Penn (1/1/2008-5/1/2024) and the Veterans Administration (VA, 10/1/2002-1/1/2026) for mammography uptake. Mammography results and MBC characteristics were compared between BRCA+ and BRCA-males. ResultsAmong 810 BRCA+ males, 19% had a documented mammogram for screening or symptoms. Among 562 BRCA+ males age-eligible for mammogram without prior MBC, most (63%) had documentation of a mammography-related discussion and 16% completed mammogram, of whom 25% were BRCA1+ and 75% were BRCA2+. Among mammograms obtained for screening of 97 BRCA+ males, there were few BI-RADS 4/5 (N=1, 1%) and no MBC was detected. Symptom-indicated mammograms in 59 BRCA+ compared to 228 BRCA-males yielded BI-RADS 4/5 findings in 35% versus 25%, p<0.0001, and MBC diagnoses in 29% versus 21%, p=0.219. The positive predictive value (PPV) of BI-RADS 4/5 lesions was similar in BRCA+ vs BRCA-males (71% vs 74% and 100% vs 93%, respectively). Among 22 BRCA+ and 57 BRCA-MBC, 55% and 42% were node positive and 82% and 86% were ER+Her2-, respectively. ConclusionScreening mammography utilization among BRCA+ males was low despite elevated hereditary risk. Regardless of BRCA status, nearly all MBC were diagnosed based on symptoms, and a high proportion of MBC were diagnosed at advanced stages. Our findings identify a critical need for both improved identification of males at high risk for breast cancer and improved screening practices of high-risk men.

Purpose: There is an unmet need in the treatment of triple-negative breast cancer (TNBC), as recurrence rates remain high; thus, novel treatment strategies are warranted to improve outcomes for patients. Smac mimetics (SMs) are small molecules that inhibit the inhibitors of apoptosis. In this study, we investigated the properties of the SM Xevinapant (AT406) as a radiosensitizer in TNBC. Methods: TNBC cell lines were treated with Xevinapant (AT406) in the presence or absence of ionizing RT and cell viability and apoptosis measured in vitro. Clonogenic assays were performed to confirm radiosensitization. We also assessed xevinapant radiosensitization in the presence of the Tumor Necrosis Factor (TNF) cytokine, which has been shown to enhance SM-induced apoptosis. Radiosensitization mechanisms were further validated by western blotting, flow cytometry and cell cycle analysis. Results: We show that Xevinapant increased cell death in a panel of irradiated TNBC cell lines. In clonogenic assays, Xevinapant sensitized MDA-MB-231 cells to RT-induced cell death, and this was significantly enhanced in the presence of TNF, with a dose-enhancing factor (DEF) of 1.57. We also show that Xevinapant radiosensitization is mediated by TNF-dependent apoptosis. Conclusions: Xevinapant is a radiosensitizer that enhances RT-induced cell death in TNBC cells, and TNF is central to this process through activation of apoptosis. These results are promising for combining RT with Xevinapant to improve local control in TNBC.

New prognostic biomarkers for oesophageal adenocarcinoma (OAC) may help treatment planning as current staging does not accurately predict survival for many patients. We used a 451 cancer-associated gene panel to assess genomic alterations associated with survival for a cohort of 65 OAC patients who underwent surgical resection without perioperative treatment, reflecting institutional practice at the time. Median age at operation was 72 years, 88% were male, median 32 lymph nodes were removed per patient, and minimum follow-up exceeded 11 years. TNM stages (pTNM, 8th ed.) were 14% stage 1, 14% stage 2, 45% stage 3, and 6% stage 4 (non-locoregional nodal metastases). Copy number changes were common, and somatic mutations were similar to those reported previously. Genetic associations with worse survival included amplification of CCND1 (HR=3.08, p=0.02), EGFR (HR=2.98, p=0.01), loss of ARID2 (HR=2.12, p=0.05), KMT2D (HR=1.99, p=0.07) and missense mutation within RYR1 (HR=2.68, p=0.01). This study identifies candidate genomic prognostic biomarkers in OAC using a cohort treated by surgery alone, enabling assessment of tumour biology independent of the confounding effects of peri-operative systemic therapy and radiotherapy. Several of the identified alterations are potentially targetable, supporting further investigation of genomic profiling to refine prognostication and guide treatment selection.

Background: This study compared functional and cognitive trajectories in older women treated for early breast cancer with matched women without cancer. Methods: Data were derived from two Dutch cohorts: the CLIMB study (women aged 75 years and older with operable breast cancer) and the ISCOPE study (community-dwelling women aged 75 years and older without cancer). Breast cancer patients were matched 1:2 to controls on age and baseline functional or cognitive status. Functional status was assessed using the Groningen Activity Restriction Scale (GARS), and cognitive function using the Mini-Mental State Examination (MMSE). Longitudinal changes over 12 months were analyzed using both unadjusted and confounder-adjusted linear mixed models. Results: 168 breast cancer patients and 336 matched breast cancer-free controls were included with a mean age of 80 years. Most breast cancer patients had stage 0-I or II disease and received surgery and/or radiotherapy; 48% received adjuvant endocrine therapy, chemotherapy was rare (<1%). At baseline, both cohorts were comparable in age and functional or cognitive status, although there was a higher comorbidity burden in the control cohort. No significant differences in functional or cognitive decline were observed between the cohorts over 12 months. Conclusions: In older women, early breast cancer and its treatment did not lead to accelerated decline in functional status or cognitive function within the first year compared to matched older women without cancer. These findings suggest that, for relatively fit older patients, breast cancer treatment may not accelerate functional decline in the short term.

Nurse-led skin cancer screening extends specialist reach but depends on the nurse selecting which lesions to forward for diagnosis, and performance varies with experience. We evaluated whether real-time decision support using artificial intelligence (AI) improves malignancy detection in routine nurse-led teledermoscopy screening across MoleMap clinics in New Zealand and Australia (January 2024-July 2025). In this real-world study, clinics using AI decision support were compared with standard clinics. Nurses examined patients, captured dermoscopic images, and forwarded selected lesions to teledermatologists, who provided the reference diagnosis. The analytic cohort comprised 1,102,382 lesions from 98,422 patients across 577 sites. AI-assisted screening was associated with a higher malignancy detection rate than standard screening (25.5 vs 15.7 malignancies per 1,000 lesions; odds ratio adjusted for nurse experience 1.73, 95% CI 1.68-1.77), a finding consistent across all nurse-experience tiers and the three major malignant subtypes. AI assistance was also associated with a shift in recommended management: 21 additional intervention recommendations and 13 additional safety-netting recommendations (self-monitoring, short-term follow-up, or specialist referral) per 1,000 lesions, approximately balanced by 34 fewer no-action recommendations. The reference standard was teledermatologist diagnosis and allocation was not randomised; findings are therefore associational and require prospective, outcome-based confirmation.

Purpose: Metastatic pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine malignancies with limited systemic treatment options. Although inhibition of vascular endothelial growth factor (VEGF) signaling has demonstrated clinical benefit in metastatic PPGL, prospective data evaluating selective VEGF receptor inhibition remain limited. Axitinib is a potent and selective inhibitor of VEGFR-1, -2, and -3 with established activity in several solid tumors. We evaluated the efficacy and safety of axitinib in patients with progressive metastatic PPGL. Methods: Patients with progressive metastatic or unresectable PPGL were enrolled in a prospective, open-label, single-arm, phase II study (NCT03839498). Eligible patients had measurable disease according to RECIST version 1.1 and no prior treatment with a tyrosine kinase inhibitor. Axitinib was administered orally at an initial dose of 5 mg twice daily with protocol-defined dose modifications based on tolerability. The primary endpoints were objective response rate (ORR) and progression-free survival (PFS). Safety was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). Results: Nineteen patients were enrolled, and 17 received study treatment. A confirmed partial response was achieved in 35.3% of treated patients. Median progression-free survival was 7.9 months (95% CI, 6.1-16.8 months), median duration of response was 7.4 months, median duration of treatment was 9.5 months, and median overall survival was 29 months. Hypertension, the most common treatment-related adverse event, occurring in 79% of patients, was effectively managed with antihypertensive therapy and dose modification. Other common treatment-related adverse events included fatigue, diarrhea, oral mucositis, and palmar-plantar erythrodysesthesia. No patient permanently discontinued treatment because of treatment-related toxicity. Conclusions: In patients with progressive metastatic PPGL, single-agent axitinib demonstrated clinically meaningful antitumor activity with a manageable safety profile. The observed efficacy compares favorably with sunitinib in this rare disease. The ability to maintain treatment despite predictable VEGF-associated toxicities suggests that axitinib represents a viable therapeutic option for patients with metastatic PPGL.

Background: The organization of pancreatic cancer care may be associated with survival. Using health administrative claims data, we reconstructed the pathway from diagnosis to first-line therapy and examined associations of multidisciplinary team review and treatment at specialized centers with overall survival. Methods: Longitudinal historical cohort study using anonymized health administrative claims data from six Czech health insurance funds, covering approximately 17% of patients diagnosed with pancreatic cancer nationally between 2018 and 2020. Adults with an incident ICD-10 C25 record confirmed by imaging and histopathology were followed from the index date (the date of the first qualifying imaging or histopathological examination) until death, censoring, or 31 December 2021. Overall survival was analyzed using Kaplan-Meier methods and Cox regression adjusted for age and first-line therapy type. Results: Of 1,255 patients, 920 (73.3%) received first-line therapy and 266 (21.2%) died untreated. Among treated patients, 436 (47.4%) underwent multidisciplinary team review, 335 (36.4%) underwent surgery, and 667 (72.5%) were treated at a complex oncological center. Surgery was associated with longer overall survival than chemotherapy (age-adjusted hazard ratio [HR] 0.32, P < 0.001). Treatment at a complex oncological center was associated with longer overall survival (adjusted HR 0.77, 95% confidence interval [CI] 0.64-0.92, P = 0.004; crude median 532 versus 394 days). Multidisciplinary team review was not significantly associated with overall survival (adjusted HR 0.86, 95% CI 0.73-1.01, P = 0.073). Conclusions: Treatment at a complex oncological center was associated with longer survival, while fewer than half of patients had a recorded multidisciplinary team review. How care is organized, not only which therapy is delivered, is associated with outcome. The observational design and absence of key clinical covariates limit causal interpretation.

Background: Cancer patients face a significantly elevated risk of severe COVID-19 outcomes. Although vaccination is a cornerstone of prevention, data on vaccination coverage and association with survival among Russian cancer patients remain scarce. We assessed COVID-19 vaccination coverage and its association with overall survival in a population-based cohort of cancer patients in Northwest Russia. Methods: This retrospective registry-based cohort study integrated data from the Population-Based Cancer Registry (PBCR) of the Arkhangelsk Region and the Nenets Autonomous Okrug, regional vaccination records, and an artificial intelligence (AI)-based analysis of chest computed tomography (CT) scans. The cohort consisted of 1,144 cancer patients who underwent CT between August 2020 and April 2021. Vaccination status was ascertained via data linkage. Overall survival (OS) was compared between vaccinated and unvaccinated patients using Kaplan-Meier analysis and multivariable Cox proportional hazards regression, adjusted for demographic, clinical, and AI-derived CT biomarkers. To mitigate immortal time bias, the primary analysis used a landmark approach restricted to patients alive on March1, 2021 (N=1,136). A sensitivity analysis used a November1, 2021 landmark (N=894). Vaccination status was defined as receipt of at least one dose before the landmark date. Results: Only 6.6% (n=76) of patients received at least one dose of a COVID-19 vaccine (Sputnik V or Sputnik Light). Vaccinated patients were more likely to have earlier-stage cancer and were less likely to be receiving active treatment. In the primary landmark analysis, vaccination was associated with a significantly higher 3-year OS (80.3% vs. 45.7%, p<0.001). In multivariable analysis, vaccination was independently associated with a 60% lower hazard of all-cause mortality (adjusted HR 0.40, 95% CI 0.25-0.64). AI-detected COVID-19 pneumonia on baseline CT was also an independent predictor of poorer survival (adjusted HR 1.32, 95% CI 1.09-1.59). In the sensitivity analysis (November1, 2021 landmark), the adjusted HR for vaccination was 0.56 (95% CI 0.34-0.92), showing a consistent but attenuated association. Conclusion: This study reveals critically low COVID-19 vaccination coverage among cancer patients in Northwest Russia. Nevertheless, vaccination was strongly associated with a substantial survival benefit, underscoring its importance as a potentially lifesaving intervention for this vulnerable population.

Background: Although perioperative fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) is the standard neoadjuvant regimen for resectable gastric and gastro-oesophageal junction adenocarcinoma, evidence describing treatment delivery in routine clinical practice remains limited, particularly regarding relative dose intensity (RDI) and treatment completion. Objectives: To evaluate real-world delivery of preoperative FLOT chemotherapy, including treatment completion, progression to surgery, RDI, toxicity and exploratory changes in estimated lean body mass (LBM). Methods: A retrospective single-centre service evaluation included consecutive patients receiving neoadjuvant FLOT during 2024. Outcomes included treatment completion, surgery, RDI, toxicity, pathological response and estimated LBM. Descriptive statistics were used. Results: Twelve patients were included (median age 68.6 years; 91.7% male). Eleven (91.6%) completed all four preoperative cycles and proceeded to surgery. Mean RDI was 76.7%. Pre-emptive dose capping was the predominant dose modification strategy, with only one reactive dose reduction. Two grade 3 adverse events occurred. Major pathological response (Mandard grade 1-2) was observed in 2/12 patients (16.7%). Mean estimated LBM declined from 54.3 to 53.4 kg. Greater LBM loss appeared to coincide with poorer clinical outcomes. Conclusions: High treatment completion and progression to surgery were achieved despite reduced RDI. These findings support prospective evaluation of strategies to optimise chemotherapy delivery while maintaining tolerability in routine clinical practice.