BACKGROUND:Delirium is a common and distressing complication in terminally ill patients with advanced cancer, often impairing communication and decision-making, and diminishing the quality of the remaining life. Effective symptom management is essential; however, current clinical guidelines offer limited recommendations, and supporting evidence remains insufficient. OBJECTIVES:This scoping review systematically mapped the existing literature on pharmacological and nonpharmacological interventions for delirium symptom management in terminally ill patients with cancer and identified gaps in the evidence base. METHODS:Following the framework proposed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, we conducted a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Ichushi-Web of the Japan Medical Abstract Society for studies published up to August 31, 2023. Subsequently, two updated searches were conducted using the same procedure with the first covering studies published between September 1, 2023, and September 30, 2024, and the second covering studies published between October 1, 2024, and September 30, 2025. Eligible studies evaluated interventions for delirium in adults with terminal cancer with a life expectancy of one month or less. Two reviewers independently screened the studies for inclusion. RESULTS:Of the 1640 articles identified, seven met the inclusion criteria including four randomized controlled trials on pharmacologic interventions, one randomized controlled trial on hydration, and two observational studies on opioid switching. All studies targeted terminally ill patients with advanced cancer and assessed the outcomes related to delirium symptom relief. CONCLUSIONS:This review revealed that the literature addressing delirium symptom management in terminally ill patients with cancer is limited and heterogeneous. Further research is warranted to strengthen the evidence base and to inform clinical practice guidelines for the care of this vulnerable population.
Abstract Introduction: Petosemtamab, a bispecific antibody targeting LGR5 (Leucine-rich repeat-containing G-protein coupled receptor 5) and EGFR, is under clinical development. Wnt-driven LGR5, a stem cell-associated marker, stabilizes EGFR by preventing lysosomal degradation, thereby promoting cancer cell survival. However, its role in lung squamous cell carcinoma (LUSC) remains unclear. This study evaluates the impact of LGR5 expression on clinical characteristics, genomic alterations, and therapeutic outcomes in LUSC. Methods: Using the LC-SCRUM-Asia clinico-genomic database, mRNA levels of LGR5, EGFR, and other genes were assessed via the AMOY Master Panel. High LGR5 was defined as above the median. Clinical, genomic characteristics, and treatment outcomes were compared between high and low LGR5 groups. Results: LGR5 expression was evaluated in 233 LUSC patients between June 2021 and February 2022. The median LGR5 expression was 0.02 FPKM (range: 0.00-5.44), and the median EGFR expression was 12.09 FPKM (range: 0.07-572.49). No correlation was observed between LGR5 and EGFR expression (Pearson r = -0.0387, P = 0.687). Clinical characteristics, including age, sex, smoking history, ECOG-PS, and clinical stage, did not differ significantly between high and low LGR5 groups. The prevalence of driver gene alterations (KRAS mutation: 6 vs. 3, EGFR mutation: 2 vs. 4, MET ex14 skipping: 2 vs. 4, ALK fusion: 3 vs. 1) also showed no significant differences (P = 0.816). Among 103 patients receiving first-line ICI with or without chemotherapy, the median PFS was 8.0 months in the high LGR5 group and 5.6 months in the low LGR5 group (HR = 0.91, 95% CI: 0.58-1.44, P = 0.570). In 90 patients treated with first-line platinum-based chemotherapy, the median PFS was 5.5 months in the high LGR5 group and 4.3 months in the low LGR5 group (HR = 0.99, 95% CI: 0.52-1.91, P = 0.985). Wnt (P-weighted Log2FC = 0.753), Hedgehog (P-weighted Log2FC = 0.877), and Notch (P-weighted Log2FC = 0.564) pathways, key regulators of stem cell function, were significantly upregulated in the high LGR5 group (all P < 0.05). Conclusion: High LGR5 expression does not define a clinically or genomically distinct subgroup of LUSC; however, it is associated with a transcriptionally stemness-activated phenotype characterized by upregulation of Wnt, Hedgehog, and Notch pathways. These findings suggest that LGR5-high LUSC represents a biologically distinct subtype that may inform future development of LGR5×EGFR-targeted therapies. Citation Format: Yu Tanaka, Shuji Murakami, Kazumi Nishino, Motoko Tachihara, Ichiro Nakachi, Mayu Kawakami, Satoshi Hara, hitomi Aono, Shoichi Kuyama, Gaku Yamamoto, Eri Sugiyama, Tetsuya Sakai, Hiroki Izumi, Shigeki Umemura, HIBIKI UDAGAWA, Yoshitaka Zenke, Shingo Matsumoto, Kiyotaka Yoh, Koichi Goto. Clinical, genomic, and therapeutic outcomes of lung squamous cell carcinoma with high LGR5 expression : A study from the LC-SCRUM-Asia database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 7919.
Long-term nucleos(t)ide analog (NUC) treatment improves the outcomes of patients with chronic hepatitis B virus (HBV) infection. However, only a limited number of patients treated with NUC can achieve hepatitis B surface antigen (HBsAg) seroclearance, the so-called “functional cure.” However, it remains unclear how on-treatment viral factors affect HBsAg seroclearance during long-term NUC treatment. We aimed to investigate whether the baseline and on-treatment HBV markers can predict HBsAg seroclearance and reduction in patients treated with long-term NUC treatment. This study included two independent cohorts consisting of 843 patients in the derivation cohort and 1781 patients in the validation cohort. HBsAg seroclearance was infrequent (3.7–6.2
OBJECTIVES:To investigate the efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) for duodenal varices. METHODS:Twenty-two consecutive cases of BRTO for duodenal varices between January 2001 and September 2020 were retrospectively reviewed. Preoperative patient characteristics, anatomical features of duodenal varices, treatment outcomes and technical aspects of BRTO, long-term results (bleeding-free survival and recurrence-free survival), overall survival, and complications were evaluated. RESULTS:Technical success was achieved in 77.3% (17/22) of cases. The technical success rate was 87.5% (14/16) in prophylactic cases, and 50.0% (3/6) in emergency cases. Clinical success was achieved in all 17 technically successful cases. After 6, 12, and 24 months of successful BRTO, bleeding-free survival remained 100% at all time points, recurrence-free survival was 100%, 92.3%, and 83.1% and overall survival was 86.7%, 86.7%, and 78.0%, respectively. Overall survival was significantly lower in ruptured cases than in non-ruptured cases (P = .0002). Within 3 months of BRTO, ascites worsened in 29.4% (5/17) of patients, and other gastrointestinal varices worsened in 25.0% (4/16) of patients. Post-BRTO portal vein thrombosis was detected within 1 week in 5.9% (1/17) cases. CONCLUSION:BRTO appears to be a safe and effective primary prophylactic treatment option for duodenal varices. ADVANCES IN KNOWLEDGE:This study provides evidence of the efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in treating duodenal varices. Since duodenal variceal rupture has the possibility of worsening patient prognosis, prophylactic BRTO might be performed to prevent rupture.
AIMS:Type 2 diabetes has been reported to associated with an increased risk of malignant neoplasms; however, the factors influencing cancer development in diabetic patients have not been fully elucidated. Therefore we initiated Nishinomiya Study to investigate the association between diabetes and cancer risk. METHODS:Participants were 5,210 outpatients receiving treatment for type 2 diabetes enrolled in the Nishinomiya Study. We prospectively investigated the association of baseline clinical characteristics with cancer incidence. RESULTS:During a mean follow-up period of 4.8 years, 411 participants were newly diagnosed with cancer. Kaplan-Meier analysis demonstrated that cancer incidence was significantly higher in men than in women and in patients with hypertension than in those without hypertension (both p < 0.0001). In contrast, cancer incidence was significantly lower in patients with dyslipidemia than in those without it (p < 0.0001). Cox proportional hazards analysis identified higher age (HR 1.04), male sex (HR 1.58), greater waist circumference (HR 1.02), hypertension (HR 1.40), and absence of dyslipidemia (HR 0.75) as significant predictors of cancer risk (all p < 0.01). CONCLUSIONS:Sex, age, abdominal obesity, hypertension, and dyslipidemia may have significant influence cancer risk in Japanese patients with type 2 diabetes.
