Frontiers in Oncology

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. Progression of prostate cancer under androgen receptor (AR) pathway-targeted therapy spans a phenotypic spectrum, from tumors that sustain AR pathway output to tumors that become independent of AR signaling. Experimental models that occupy the intermediate portion of this spectrum, in which AR is still expressed but pathway output is reduced, are comparatively scarce. Methods. LNCaP cells expressing a triple-modality reporter (LNCaP-TR) were injected into nude mice by the intracardiac route, and a bone lesion that arose in the middle spine of one animal was recovered and propagated as LNCaP-TR-BoM. The subline and its parental line were compared by two-dimensional and three-dimensional culture assays, RNA-seq, qRT-PCR, and immunoblotting. AR pathway output was assessed using KLK3 expression under AR antagonist treatment. Public prostate cancer datasets provided clinical context. A CRISPR-Cas9 EPHA3-edited derivative was evaluated in aggregation and spheroid assays. Results. Relative to parental LNCaP-TR, LNCaP-TR-BoM formed more numerous and larger cell aggregates in monolayer culture and larger, less circular spheroids in both suspension and Matrigel three-dimensional culture. AR mRNA was modestly reduced and AR protein remained readily detectable, whereas KLK3 mRNA and protein were reduced disproportionately more than those of AR. Residual KLK3 expression remained suppressible by AR inhibitors enzalutamide and darolutamide. Transcriptome-based pseudotime placed LNCaP-TR-BoM between the parental line and the androgen-refractory LNCaP-RF variant. Subsequent differential gene expression (DGE) and pathway enrichment analysis revealed that LNCaP-TR-BoM exhibits transcriptomic rewiring concordant with that of clinical mCRPC, thus evidencing LNCaP-TR-BoM as a potentially clinically relevant model cell line. Finally, EPHA3 showed the largest fold change among the most significant differentially expressed genes in LNCaP-TR-BoM compared with the parental line. Therefore, EPHA3 was explored to demonstrate the utility of the LNCaP-TR-BoM cell line as a discovery system for genes that potentially drive the malignancy of bone-metastatic prostate cancer at the intermediate AR-attenuated progression stage. An EPHA3-silenced derivative of LNCaP-TR-BoM lacking detectable EPHA3 protein formed smaller aggregates and smaller, more circular spheroids, suggesting EPHA3 may play a role in driving the malignancy of AR-intermediate bone-metastatic prostate cancer. This finding provides support for the potential utility of the LNCaP-TR-BoM cell line as a discovery system for genes relevant to driving AR-intermediate bone-metastatic prostate cancer. Conclusions. LNCaP-TR-BoM is a bone lesion-derived prostate cancer cell line in which AR expression is retained but AR pathway output is attenuated, accompanied by an mCRPC-concordant transcriptomic shift and altered multicellular organization. It provides a paired discovery system for candidate genes such as EPHA3.

Background: Prostate cancer (PCa) is the most common urological malignancy globally and remains a major cause of cancer mortality among men. In Hong Kong, a comprehensive evaluation of disease burden, real-world treatment patterns, and outcomes across clinically relevant PCa subgroups is essential for identifying unmet needs and optimising care delivery. Objectives: This study aims to characterise the burden of PCa and patterns of care in Hong Kong by (1) estimating annual patient load (2) describing treatment patterns, and (3) evaluating real-world outcomes among patients receiving systemic therapy (chemotherapy or novel hormonal agents [NHA]) and novel agents (immunotherapy, poly ADP-ribose polymerase [PARP] inhibitors, radiation therapy). Methods: We conducted a population-based retrospective cohort study using electronic medical records from the Hong Kong Hospital Authority (HA). The cohort included patients diagnosed with PCa between January 1, 2012 and December 31, 2024. Subgroup analyses included patients with metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC) and were further stratified by the treatment received. Descriptive analyses summarised annual patient load and treatment patterns over 2018 to 2022. We evaluated treatment outcomes from 2012 to 2024, including overall survival, progression-free survival, number of hospitalisations, and main adverse events. Results: From 2018 to 2022, prevalence increased for prostate cancer (12,014 to15,610), mHSPC (1,188 to 1,779), and mCRPC (167 to 290), while annual mCRPC incidence rose from 125 to 274. There was an increasing number of prevalent and new users of the investigated novel treatment, including first-/second-/third-line therapy for mCRPC. Compared with patients treated with NHAs, chemotherapy showed a numerically higher rate of hospitalisations, bone treatment initiation and higher hematologic toxicity. Conclusions: This population-based retrospective study provides Hong Kong-specific evidence on PCa burden, real-world management, and outcomes across key subgroups, thereby supporting policy planning, formulary evaluation, and targeted strategies to address unmet clinical needs. Funding: This work was supported by a grant from Novartis.

Introduction: Tumors are known to develop genomic heterogeneity over time, particularly in metastatic disease, raising concerns that a single-site biopsy may be insufficient to accurately predict response to medications. Methods: We used our 3D microtumor functional profiling platform that preserves key features of the native tumor microenvironment. We tested (i) six split samples from primary tumors and (ii) seven samples from primary tumors (ovarian, colon, and breast cancer) matched with their locoregional or distant metastases. Fresh tissue specimens were processed within 24 hours after surgery and treated with NCCN guideline-recommended chemo or targeted therapies at concentrations over four orders of magnitude. Cytotoxicity was evaluated after three days to generate dose response curves. The response correlations between the split sample or between the two matched sites were quantified using the concordance correlation coefficient ({rho}c) for the drug efficacy metrics. Results: We compared a total of 275 drug responses. The six split samples resulted in a strong correlation between the two tumor areas ({rho}c=0.95, p<0.001), supporting high assay reproducibility across distinct regions of the same tumor. Locoregional metastases were highly correlated with their primaries (ovarian to omentum {rho}c=0.97, p<0.001; ovarian to liver capsule {rho}c=0.93, p<0.001; colon to peritoneum {rho}c=0.91, p<0.001). A lesser correlation was observed with lymphogenic metastases (breast to axilla {rho}c=0.87, p<0.001), and the correlations of hematogenic metastases were even lower (colon to lung {rho}c=0.69 p<0.001; ovarian to soft tissue/colon {rho}c=0.58, p<0.001). No correlation was observed among specimens that were resistant to all tested medications. Conclusion: Tumor drug responses were highly preserved in locoregional metastases, whereas somewhat greater divergence was observed in lymphogenic or hematogenic metastases. Single-site functional profiling may remain informative for identifying treatment resistance and might reduce the risk of ineffective therapy selection in metastatic disease.

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.

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.

Objectives Contemporary oncology has achieved remarkable advances in biomedical treatment while increasingly emphasizing patient-centered care. Nevertheless, routine oncology consultations must address multiple competing clinical priorities, potentially limiting opportunities for patients' experiences to become visible. To address this gap, we established a Dialogue-Based Outpatient Clinic, a complementary patient-directed consultation model embedded within routine oncology care. This study explored the dimensions of patients' experiences that became visible through this consultation model. Methods We conducted a qualitative study of 44 consecutive patients who attended a Dialogue-Based Outpatient Clinic embedded within routine oncology care between 2021 and 2023. Patients attended the clinic either on their own initiative or following a recommendation from a healthcare professional who recognized that they were struggling. Regardless of how they came to the clinic, patients independently determined the consultation agenda. Results Of the 44 patients, 13 (29.5%) sought biomedical information regarding diagnosis, treatment, or adverse effects, whereas 31 (70.5%) discussed concerns extending beyond biomedical issues. Reflexive thematic analysis of these 31 patients identified four interconnected themes: (1) making sense of a cancer diagnosis within one's own life; (2) negotiating treatment in relation to personal values and life priorities; (3) being treated for disease but not seen as a person; and (4) reconstructing life and identity through the cancer journey. Across all themes, patient-directed dialogue consistently revealed how patients understood cancer within the broader context of their lives rather than as an isolated biomedical condition. Conclusions Patient-directed dialogue within routine oncology care revealed dimensions of patients' experiences that may be less readily recognized in conventional consultations. A complementary consultation model that allows patients to determine the agenda may provide opportunities for these experiences to become clinically recognizable.

Purpose: Biochemical recurrence (BCR) after radical prostatectomy (RP) presents heterogeneous recurrence patterns and variable outcomes following salvage radiotherapy (sRT). We evaluated clinicopathologic determinants of PSMA-PET/CT detection, anatomical recurrence distribution, and biochemical disease-free survival (bDFS) following PSMA-PET-guided sRT. Methods: This retrospective single-institution study included 140 patients with BCR after RP who underwent Ga-PSMA-PET/CT prior to sRT with or without androgen deprivation therapy. PSMA-PET-positive findings were categorized as prostate bed only (PBO) or pelvic nodal involvement with or without the prostate bed (PLNI). Receiver operating characteristic (ROC) analysis, logistic regression, and Cox proportional hazards models were employed. Results: PSMA-PET detected locoregional recurrence in 77/140 patients (55%). On multivariable analysis, PSA at recurrence (OR=2.07; p=0.003) and age (OR=1.07; p=0.016) were the sole independent predictors of PSMA-PET positivity. ROC analysis yielded AUC=0.74 (optimal threshold of 0.58 ng/mL). Among PSMA-positive patients, PBO was associated with a longer time to BCR (tBCR) (37.5 versus 15 months; p=0.006). Seminal vesicle invasion (SVI) and pT-stage predicted PLNI on univariable analysis. Among 124 of 140 evaluable patients (median follow-up 31 months), estimated bDFS at 24, 36, and 60 months was 89.7%, 80.2%, and 54.1%, respectively. SVI (HR=2.39; p=0.031), EPE (HR=2.82; p=0.012), pT-stage (HR=1.64; p=0.021), and pN-stage (HR=1.83; p=0.045) were associated with increased failure on univariable Cox regression, though none retained independent significance. Conclusion: PSA burden and age independently predicted PSMA-PET detection. Recurrence patterns reflected disease behavior, as PBO was associated with longer tBCR. Adverse pathologic features were associated with pelvic nodal disease and reduced biochemical control; none remained independently predictive.

Background: Cervical cancer remains a leading cause of cancer death among women in sub-Saharan Africa, with Ghana experiencing persistently high mortality linked to late diagnosis and constrained treatment access. Beyond its clinical burden, cervical cancer treatment is a socially demanding experience requiring women to mobilise financial, practical, informational, and emotional support over time. This study explored the social networks surrounding women during cervical cancer treatment and the social support exchanged within them at a tertiary referral facility in Ghana. Methods: A qualitative descriptive design, informed by an interpretivist epistemological orientation, was employed. Eight women receiving treatment at the National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, were recruited using criterion-based purposive sampling and interviewed individually using a semi-structured guide until data saturation was reached. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis, supported by Atlas.ti version 7.5.7. Results: Five themes were generated. Disclosure functioned as a gatekeeping process through which women selectively determined who entered their support network, shaped by anticipated stigma. Despite valuing the support they received, women displayed marked reluctance to request it directly, relying on indirect strategies and expressing gratitude regardless of whether support met their actual needs. Support networks consistently narrowed around a single family member, most often a daughter or sibling, who provided the bulk of financial, practical, and informational assistance, while more peripheral relationships receded. Social support functioned not merely as emotional comfort but as a precondition for accessing and continuing treatment at all, particularly given widely inadequate insurance coverage. Finally, some women experienced discomfort reconciling their need for support with a prior identity as habitual providers of care to others. Conclusion: Social networks and support during cervical cancer treatment in Ghana are actively constructed through disclosure, constrained by reluctance to seek help, and concentrated around a single caregiver, functioning as a determinant of whether treatment can be accessed and sustained rather than merely a source of comfort. Formalizing support around, rather than in place of, these informal networks could strengthen both access to and continuity of cervical cancer care in similarly resourced settings.

Purpose: Uveal melanoma (UM) is a rare but aggressive intraocular malignancy originating in the uvea (choroid, iris, and ciliary body). Despite primary treatment, 50% of UM patients develop metastases to the liver, lungs, bones, and skin. Topotecan, a topoisomerase I inhibitor, and SP141, an MDM2 inhibitor, have been studied in cancers, including retinoblastoma. This study explores a combined approach with these drugs in the 92-1 UM cell line. Methods: Primary choroidal melanoma-derived 92-1 cells were treated with topotecan and SP141 individually to determine IC50 values. Cell viability and proliferation were assessed using the MTT assay and the xCELLigence real-time monitoring system. The synergistic effects were analyzed quantitatively using the Loewe Additivity and Highest Single-Agent (HSA) models. Flow cytometry was employed to analyze cell cycle distribution, while cell death and apoptosis were monitored via high-throughput, real-time quantitative analysis using the IncuCyte live-cell kinetic imaging system. Results: Both Topotecan and SP141 induced significant cell death in 92-1 cells. xCELLigence showed dose- and time-dependent inhibition of proliferation. Combining sub-IC50 concentrations of topotecan and SP141 exhibited significant synergistic effects, markedly reducing growth. Cell cycle analysis revealed that topotecan causes a dose-dependent biphasic arrest in G2 and S phases, while SP141 causes G2/M arrest, leading to cell death. Cytotoxicity assays corroborated increased cell death following combination therapy, and the Caspase 3/7 assay indicated that apoptosis is the mechanism underlying cell death. Conclusions: The multi-targeted approach combining topotecan and SP141 drugs demonstrated synergistic therapeutic effects in 92-1 cells, suggesting a potential treatment strategy for managing UM.

Abstract Background: Experimental models that retain endogenous tumor immune complexity are needed to investigate heterogeneous responses to immune checkpoint inhibitors (ICIs) in melanoma. We established patient-derived melanoma organoids (PDMOs) to examine retention of parental tumor cellular components and investigate patient-specific and context-dependent responses to checkpoint blockade. Methods: Fresh melanoma specimens (n=50), including primary tumors, neoadjuvant-treated tumors and tumor-infiltrating lymphocyte (TIL) associated samples were processed for Matrigel-embedded culture of patient-derived melanoma organoids (PDMOs). Characterization and functional studies were performed in subsets of established cultures. Immunofluorescence assessed tumor, stromal, immune, and checkpoint-marker expression in PDMOs and matched parental tissues. NGFR expression was evaluated in relation to organoid establishment and growth. Responses to anti PD1 alone or combined with anti-LAG3 or anti-CTLA4 therapies were evaluated using viability and morphological analyses, with selected models undergoing immune phenotyping and multiplex cytokine profiling. Available clinical outcomes were used for exploratory comparison. PDMOs and matched two-dimensional cultures were evaluated under 21% and 5% oxygen conditions. Results: PDMOs were established from 30 of 50 specimens (60%) and retained melanoma, stromal, lymphoid, and myeloid components identified in matched parental tissues during early culture, together with immune checkpoint expression. Higher NGFR (CD271) expression was associated with greater organoid-forming capacity in an exploratory subset. Responses to checkpoint blockade varied across patient-derived models and regimens, with combination blockade not uniformly producing lower viability than PD1 monotherapy. Ex vivo responses showed parallels with available clinical outcomes, with discordant cases also observed. In three selected PDMOs, divergent PD-1 responses were accompanied by differences in T-cell and myeloid representation, MHCII and AXL expression, and inflammatory versus immunoregulatory cytokine profiles. Under normoxic conditions, PDMOs and matched two-dimensional cultures exhibited divergent treatment sensitivities, including clinically responding cases in which sensitivity was retained in PDMOs but attenuated in monolayers. Changing oxygen tension further altered checkpoint sensitivity within individual PDMOs, with the direction and magnitude of the observed shifts varying by model and regimen. Conclusions: Early passage PDMOs retain key endogenous tumor, immune, and stromal components and support functional investigation of patient-derived melanoma biology. Their heterogenous responses across checkpoint regimens and oxygen conditions provide a platform for investigating how tumor-immune composition and environmental context influence treatment sensitivity.

Background: Total neoadjuvant therapy (TNT) is increasingly used for treatment of locally advanced rectal cancer (LARC) to improve treatment compliance, oncological outcomes and opportunities for organ preservation. However, evidence describing its implementation and outcomes in low- and middle-income countries remains limited. This study evaluated the feasibility, treatment delivery, oncological outcomes and organ preservation outcomes of TNT in a real-world South African setting. Methods: This was a retrospective review of a prospective cohort of adults with histologically confirmed, non-metastatic LARC treated with TNT at the Wits Donald Gordon Medical Centre, Johannesburg, between March 2022 and January 2026. Treatment was individualised following multidisciplinary review and included induction and/or consolidation systemic chemotherapy with either long- or short-course radiotherapy. Following TNT, treatment response was assessed clinically, endoscopically and radiologically. Patients with a clinical complete response (cCR) were offered watch-and-wait (WW) surveillance, while those with an incomplete response were recommended for total mesorectal excision (TME). The primary outcome was organ preservation, assessed as TME-free survival. Secondary outcomes included tumour regrowth, disease-free survival (DFS), overall survival (OS), and local recurrence-free survival (LRFS) following TME. Results: Forty-six patients were included; median age was 63 years, 67.4% were male, 82.6% had T3-T4 tumours and 80.4% had node-positive disease. TNT was completed as planned in 95.7% of patients. Grade [&ge;]3 toxicity occurred in 19.5% during chemotherapy and 8.9% during radiotherapy. Twenty-one patients (45.7%) achieved a cCR and entered WW surveillance. TME-free survival was 46% (95% CI 31-60) at 1-year and 18% (95% CI 8-32) at 3-years. Three-year OS and DFS were 87% (95% CI 64-96) and 76% (95% CI 53-89), respectively. Among patients managed with WW, 3-year regrowth-free survival was 53% (95% CI 26-75). Three-year LRFS following TME was 94% (95% CI 68-99), and all patients undergoing TME or completed salvage surgery achieved an R0 resection. Conclusion: TNT was feasible and well tolerated in this real-world South African cohort, with high treatment completion and favourable medium-term oncological outcomes. Although almost half of patients initially achieved a cCR, declining TME-free and regrowth-free survival demonstrated that durable organ preservation was less frequent, highlighting the importance of structured surveillance and timely access to salvage surgery. These findings support the feasibility of delivering contemporary multimodal rectal cancer care in an appropriately resourced African setting.

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. Hematoporphyrin derivative (HpD, Hiporfin) is used for photodynamic therapy (PDT) of solid tumors but had never been evaluated for fluorescence guided resection (FGR) in glioma. We assessed Hiporfin fluorescence accuracy against histopathology in recurrent glioblastoma (rGBM) and the feasibility of adding cavity PDT to FGR. Methods. In this prospective single arm series, adults with rGBM received a single preoperative intravenous Hiporfin dose of 5 mg/kg before FGR under blue light excitation and 630 nm cavity PDT. Intraoperative fluorescence assessment was the index test and histopathology the reference standard. Specimen level diagnostic accuracy was pooled with bivariate random-effects modeling. Results. Of 63 specimens, 35 were true positive, 7 false positive, 8 false negative and 13 true negative. Pooled sensitivity was 0.751 (95% confidence interval 0.600 to 0.858) and specificity 0.606 (0.407 to 0.775); the crude positive predictive value was 0.833 (0.694 to 0.917) and the negative predictive value 0.619 (0.409 to 0.792). All seven false positive specimens were peritumoral tissue and the eight false negatives were non fluorescent tumor. FGR combined with cavity PDT was completed in all six patients without new neurological deficits. Conclusions. Hiporfin fluorescence identified rGBM with moderate accuracy: fluorescent regions were likely tumor, while non fluorescent tissue often still contained tumor. The main source of error was peritumoral tissue of the treated cavity, and not the drug or the optics. Hiporfin is a new fluorescence agent for glioma. One drug provides both fluorescence guidance during resection and immediate cavity PDT.

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.

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.

Background Immune checkpoint blockade (ICB) has become the standard of treatment for metastatic melanoma (MM). However, patients with melanoma brain metastases (MBM) are often excluded from clinical trials. Here we analyse patients within the real-world OxCITE cohort receiving ICB treatment for metastatic melanoma, with a focus on MBM, aiming to discern outcomes, prognostic factors and peripheral biomarkers. Methods Patients eligible for ICB treatment were recruited prospectively. Demographic, clinical and radiological data were collected from electronic patient records. Plasma samples were collected prior to the first cycle of treatment for plasma proteomic analysis. Results 307 patients were included, 81 of whom had MBM on commencing ICB. No difference in overall survival between patients with and without brain metastases was noted on multivariable analysis (HR=1.1, 95% CI 0.73-1.6, p=0.68), whereas hepatic metastases were associated with increased risk of death (HR 1.7, 95% CI 1.2-2.4, p=0.0019). Within the MBM group, steroid treatment (HR=2.5, 95% CI 1.3-5.0, p=0.006) was associated with poor OS, whilst treatment with single agent ICB (HR=1.9, 95% CI 0.86-3.9, p=0.11), symptomatic first presentation of MBM (HR=1.5, 95% CI 0.76-2.8, p=0.25) and anti-seizure drug treatment (HR=1.74, 95% CI 0.89-3.4, p=0.10) were not. Amongst all patients carriage of a BRAF mutation was associated with increased risk of MBM (OR 2.49, 95% CI 1.4-4.4, p=0.0007), and increased propensity to new brain metastases on ICB treatment (OR 2.5, 95% CI 1.1-5.9, p=0.036). Analysis of blood and plasma samples demonstrated that patients with MBM have altered haematological profiles, with raised NLR and increased plasma glial fibrillary acidic protein levels, reinforcing the distinct systemic features of MBM. Conclusions In this real-world cohort of patients receiving ICB for metastatic melanoma, the presence of MBM did not associate with worse OS. Conversely, baseline corticosteroid use was adversely prognostic. Intriguingly, plasma GFAP was significantly elevated in patients with MBM and correlated with the burden of intracranial disease, highlighting a potential role for GFAP as a candidate biomarker for MBM in high-risk surveillance. Our observations indicate the adversely prognostic weight historically attached to M1d disease is no longer applicable in the ICB era.

Introduction: Perioperative systemic therapy improves outcomes in gastroesophageal adenocarcinoma, but many patients do not receive postoperative treatment. We examined whether host characteristics and perioperative inflammatory and albumin changes provided information about adjuvant initiation beyond tumour pathology, and whether initiation was associated with survival and disease control. Method: This retrospective cohort included patients undergoing curative-intent resection for gastroesophageal adenocarcinoma at the McGill University Health Centre between 2006 and 2025. Sequential logistic models evaluated pathological characteristics, pre-treatment host variables and perioperative changes in CBC-derived neutrophil-to-lymphocyte ratio (cNLR) and albumin. Postoperative measurements preceded adjuvant initiation. Nested comparisons used matched complete cases. Day-90 landmark and time-varying Cox models assessed associations between adjuvant initiation and survival. Results: Among 243 patients, 78 (32.1%) did not initiate adjuvant therapy. Adding host variables improved apparent discrimination for initiation beyond pathology (AUC 0.672 to 0.763; P=0.002). Greater perioperative cNLR increase was associated with lower odds of initiation (adjusted OR 0.67 per unit increase in {Delta}log2; cNLR, 95% CI 0.47-0.95), whereas more favourable albumin change was associated with higher odds (OR 1.07 per g/L, 95% CI 1.01-1.13). Neither marker retained a clear independent association when modelled together. Adjuvant initiation by day 90 was associated with longer overall survival (adjusted HR 0.53, 95% CI 0.36-0.78) and disease-free survival (HR 0.57, 95% CI 0.39-0.84), with similar time-varying findings. Conclusion: Host inflammatory and albumin changes added information about adjuvant initiation beyond tumour pathology, and initiation was associated with longer survival. Prospective evaluation should determine whether host-directed perioperative strategies can improve postoperative treatment delivery.

Radioresistance remains a major barrier to effective radiotherapy, yet its molecular determinants remain incompletely understood. Most radiogenomic studies infer radioresistance using surrogate endpoints rather than from clinically annotated treatment response data. Here, we analysed genomic, transcriptomic, immune and clinical features of 1,445 radiotherapy-treated patients across 15 cancer types represented in The Cancer Genome Atlas with documented radiotherapy outcomes. Cancer-type-specific somatic association analyses identified 132 significant candidate variant associations across six cancer types, including three previously unannotated coding variants in TCF20, PTPN14, and CADM1. Functional annotation showed that radioresistant tumours were enriched for cytoplasmic, protein-associated, and metabolic functions, whereas radiosensitive tumours were enriched for nuclear regulatory programs. Through transcriptomic analysis, we identified 107 differentially expressed genes across 8 cancer types, enriched for extracellular signalling, secretory programs, and tumour microenvironment interactions. The genomic and transcriptomic analyses revealed a limited gene overlap but converged on cellular adaptation and survival. Together, our findings suggest that radioresistance is characterised by complementary adaptive processes, whereby intracellular protein-regulatory and metabolic processes are coupled with extracellular signalling and tumour microenvironment interactions. Clinically, radioresistance was associated with significantly poorer overall survival, whereas the radiosensitivity index and inferred tumour immune composition showed limited concordance with observed treatment response. To our knowledge, this study provides the first pan-cancer characterisation of clinically defined radiotherapy response and identifies potential candidate biomarkers for functional validation.

Patients with majority variant subtype histology including sarcomatoid urothelial carcinoma (SUC) have poor outcomes and limited treatment options, and there are few preclinical resources to investigate rare histologic subtypes. We developed three novel variant subtype histology bladder cancer (BC) cell lines by finding that basal BC tumor cells derived from mice treated with N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) were initially not competent to grow in immune competent mice, but then acquired tumorigenicity following passaging (recycling) in mice lacking mature B and T cells. Three genitourinary oncology pathologists identified BBN966 as SUC, BBN964 as a hybrid between SUC and squamous, and BBN975 as squamous, and each had unique growth characteristics. Using a publicly available dataset and our spatial transcriptomics analysis of a cohort of human tumors with mixed SUC and UC as comparators, we found that consistent with human SUC, BBN966 lack expression of basal and luminal genes. Consistent with human SUC and spatial transcriptomics analysis of canine SUC, BBN966 had the highest epithelial to mesenchymal transition (EMT) upregulation, and all three recycled tumor cells had increased EMT pathway expression in recycled tumor cells. Moreover, increased expression of genes upregulated in all three recycled tumor cells associated with worse overall survival in patients with muscle invasive UC. Similar to human SUC, BBN966 tumors had higher proportion of M2 macrophage gene expression. Finally, we found in the largest cohort of PD-L1 IHC to date that 20 of 38 (52.6%) human SUC had CPS > 50, which was driven mostly by tumor proportion score. Consistent with this, we found anti-PD1 immune checkpoint inhibitor (ICI) significantly inhibited BBN966 tumor growth, while the hybrid BBN964 tumors had mixed response to ICI. Thus, the murine BBN966 tumors exhibited similarities to human SUC, and can be used to examine novel therapies for translation into future SUC clinical studies.