Background: Comprehensive genomic profiling (CGP) is a tool used in precision oncology to identify genomic alterations and match them with targeted therapies across several tumor types. However, real-world data on its clinical utility and impact remains limited. The FRONTAL study (Foundation Medicine Real wOrld evideNce in porTugAL) is a multicenter academic initiative that established a national registry of Portuguese patients with solid tumors who underwent CGP with FoundationOne CDx, Liquid CDx or FoundationOne Heme assays. Methods: Eligible patients had advanced solid tumors not suitable for curative treatment at the time of recruitment. Prior CGP testing was permitted if taken within 12 months before study initiation. Genomic profiling data were extracted from FoundationOne Medicine reports, and clinical information was extracted from medical records. Actionable alterations were defined as those associated with approved treatments or with clinical evidence of benefit in other cancers, per NCCN guidelines. Variant interpretation was also reviewed according to ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) guidelines. The primary outcome was disease control at 16 weeks, defined by the absence of progression. Results: The study included 205 patients between 2020 and 2025 across 10 sites, with colorectal (40, 19.5%), sarcomas (28, 13.7%), and other gastrointestinal tumors (22, 10.7%) being the most common pathologies. Actionable alterations were identified in 104 cases (50.7%). Genomic findings guided therapy decisions in 50 patients (24.4%), of whom 30 achieved disease control at 16 weeks (14.6%). Conclusions: The FRONTAL study highlighted the clinical relevance of CGP in advanced solid tumors. Over half of the patients had actionable alterations, a quarter had therapy changes based on CGP results, and improved disease outcome was observed in approximately 15% of the cohort.
Introdução: A administração de terapêutica antineoplásica sistémica (TANP) exige dos enfermeiros conhecimentos e competências específicas que garantam uma prática segura e de qualidade. Objetivos: Avaliar os conhecimentos e práticas dos enfermeiros que administram TANP e identificar necessidades prioritárias de formação. Metodologia: Estudo quantitativo, descritivo e transversal, realizado com 31 enfermeiros de dois serviços hospitalares dedicados à administração de TANP. Utilizou-se um questionário de autoavaliação adaptado da Associação de Enfermagem Oncológica Portuguesa. Resultados: Os participantes apresentaram um nível global de conhecimentos e práticas adequado (M=1,62; DP=0,21). Foram identificados quatro domínios com necessidade de intervenção formativa prioritária: Avaliação contínua da pessoa sob TANP, Gestão de efeitos adversos, Continuidade de cuidados e Prática profissional e liderança. Conclusão: A identificação de lacunas formativas reforça a importância do desenvolvimento de programas de formação contínua ajustados às necessidades dos enfermeiros que administram TANP.
IntroductionApproximately 60% of patients with head and neck squamous cell carcinoma are diagnosed with locally advanced disease (LA-HNSCC), which is associated with a high risk of recurrence, distant metastasis, and poor prognosis. A multidisciplinary approach is recommended for comprehensive care, resulting in a substantial burden on the healthcare system. The TRACE2 study aimed to describe patients’ clinical characteristics, healthcare resource utilization (HCRU), and costs associated with LA-HNSCC management in real-world practice in Portugal.MethodsNon-interventional, retrospective cohort study conducted in four Portuguese hospitals between 30/11/2021-04/03/2024, including adult patients diagnosed between 01/06/2016-31/05/2018 who were eligible for curative treatment. Secondary data were collected from medical records from the time of diagnosis until recurrence, death, loss to follow-up, or the cut-off date (31/12/2020), whichever occurred first. The financial analysis was conducted from the perspective of the Portuguese public healthcare payer, considering only direct medical costs.ResultsThe study included 150 patients (94.7% male; 91.3% aged 50–79 years), with a high prevalence of tobacco (92.0%) and heavy alcohol (83.1%) use. Combined systemic therapy and radiotherapy (ST+RT) was the most frequent treatment (81.3%), whereas a minority underwent surgery (17.3%) or RT without ST (13.3%). During a median follow-up of 12 months, over 89% of patients required outpatient consultations and medical exams. Hospitalizations and emergency consultations were reported in 74.5% and 37.6% of patients, respectively. Overall, supportive care, including nutritional support (85.2%), psychological treatment (16.1%), and speech therapy (8.7%), were used by fewer patients. HCRU was generally higher during treatment than after its completion or discontinuation. The global median (P25; P75) annualized cost per patient was €7,706.0 (3,775.8; 20,784.8), with the primary cost drivers being ST+RT and hospitalizations, followed by outpatient consultations and imaging assessments.DiscussionThe TRACE2 study provides the first comprehensive description of LA-HNSCC management in real-world practice in Portugal, underscoring the burden on both patients and the healthcare system. Given the persistently high proportion of patients diagnosed with locally advanced disease, these findings offer supporting evidence for the implementation of measures to improve patient follow-up protocols and resource allocation, ultimately enhancing patient outcomes.
Metastatic hormone-sensitive prostate cancer (mHSPC) is a disease state characterized by the presence of distant metastases detectable on conventional imaging while the tumor remains responsive to androgen deprivation therapy (ADT). It represents an earlier, treatment-sensitive phase that precedes the development of metastatic castration-resistant prostate cancer (mCRPC), the terminal stage of the disease. The addition of therapies beyond traditional ADT to achieve more sustained tumor regression by combining different mechanisms of action and targeting different cancer fuelling pathways has spurred the concept of treatment intensification in prostate cancer. This approach may involve the addition of androgen receptor pathway inhibitors (ARPIs) to ADT—hereafter referred to as “treatment intensification”—or the addition of ARPIs plus chemotherapy to ADT—hereafter referred to as “treatment optimization.” Randomized controlled trials have consistently shown improved patient outcomes with the evolution from ADT alone to ADT plus ARPI, and more recently to ADT plus ARPI plus docetaxel, and demonstrated that treatment intensification decisions in mHSPC have clinically meaningful implications. However, in the absence of comparative efficacy data between therapy options, the treatment choice for a given patient will depend on patient- and disease-related factors, with the goal of improving outcomes while minimizing the cumulative toxicity of therapies, particularly when using combination strategies. In this article, a panel of 28 experts—8 urologists and 20 oncologists—with recognized experience and expertise in the management of advanced prostate cancer discussed the role of treatment intensification in mHSPC and which patients are more likely to benefit from each treatment strategy.
