The Rutgers Cancer Institute of New Jersey (CINJ) is a cancer treatment and research institution that is a part of Rutgers University and located in New Brunswick, New Jersey. CINJ is one of only 51 Comprehensive Cancer Centers in the nation designated by the National Cancer Institute and the only one in New Jersey located in the heart of New Brunswick.The Rutgers Cancer Institute of New Jersey is an Institute of Rutgers Biomedical and Health Sciences at Rutgers University and is located adjacent to Robert Wood Johnson University Hospital, which serves as its primary clinical affiliate. CINJ delivers comprehensive cancer care to both adults and children and conducts laboratory, clinical, prevention, and population research. Laboratory research at CINJ is supported by more than $99 million annually in cancer-related research grants. CINJ has over 850 employees and manages more than 120,000 patient visits annually.
Pediatric brain tumors, including high-grade gliomas (HHG), medulloblastomas (MB), and ependymomas (EPN), are a leading cause of death in children. They are often immunologically “cold” with low tumor mutational burden (TMB) and very few tumor-infiltrating lymphocytes (TILs), which may limit the role of immune checkpoint inhibitors (ICI). We performed a PRISMA‑guided systematic review of PubMed/MEDLINE, Embase, and Scopus from inception to September 17, 2025, for English-language studies of patients ≤ 21 years with primary CNS tumors treated with PD‑1/PD‑L1 or CTLA‑4 inhibitors. Eligible reports included prospective trials, retrospective series, and observational/case reports with extractable data on efficacy and/or toxicity. Of 479 records identified, 386 unique citations were screened, 127 underwent full‑text review, and 40 met inclusion criteria for qualitative synthesis. Prospective and institutional studies in biomarker-unselected diffuse midline glioma, high-grade glioma, medulloblastoma, and ependymoma showed low objective response rates (generally ≤ 6
We present a subset analysis on the adolescent cohort of the S1826 randomized phase three trial, comparing nivolumab, doxorubicin, vinblastine, dacarbazine (N-AVD) to brentuximab vedotin-AVD (BV-AVD) in newly diagnosed advanced-stage (AS, stages III and IV) classic Hodgkin lymphoma (cHL). Among 994 patients enrolled, 24% (n = 240) were age 12-17 years. The 3-year progression-free survival (PFS) was significantly higher in the N-AVD group (93% [95% CI, 87 to 96]) compared with the BV-AVD group (82% [95% CI, 73 to 88]; hazard ratio, 0.37 [95% CI, 0.17 to 0.80]). One N-AVD and two BV-AVD patients received protocol-specified residual site radiotherapy (RT). Rates of febrile neutropenia and sepsis were low in both groups. Severe immune-related adverse events were infrequent, although thyroid dysfunction was seen in 7% with N-AVD. Sensory neuropathy (grade ≥2) was more frequent with BV-AVD (14% v 7%) by clinician report. Although premature discontinuation of therapy was reported in 12 N-AVD patients and four BV-AVD patients, no PFS events were noted in the N-AVD group. Patient-reported outcomes indicated less toxicity with N-AVD. N-AVD demonstrated high 3-year PFS in adolescents with AS cHL, with minimal RT use. S1826 exemplifies the benefits of harmonized clinical trial protocols, resulting in timely access to novel agents for adolescents.
The Phase 1/2 Intergroup study E4412 (NCT01896999; ClinicalTrials.gov) investigated checkpoint blockade with nivolumab (Nivo) and ipilimumab (Ipi) in relapsed/refractory (R/R) classic Hodgkin lymphoma (HL) while concurrently targeting CD30+ Hodgkin Reed Sternberg cells with the antibody-drug conjugate brentuximab vedotin (BV). 147 patients ≥12 years were randomized between BV/Nivo and BV/Ipi/Nivo; 132 patients are included in primary efficacy analysis. The primary endpoint, complete response (CR) rate, was 64.7% (52.2, 75.9) for BV/Nivo and 70.3% (57.6, 81.1) for BV/Ipi/Nivo (one-sided p=0.29). The median survival follow-up is 38.0 months (interquartile range 32.6-48.1). Progression-free survival (PFS) did not significantly differ between the two arms (HR=0.78, CI 0.39-1.57, one-sided p=0.24). Treatment-related grade 3+ toxicities in the adult cohort, excluding rash, was similar between both arms (38.5% BV/Nivo and 39.3% BV/Ipi/Nivo); there was higher frequency of grade 3 rash with BV/Ipi/Nivo (24.6%) compared to BV/Nivo (9.2%). We compared PFS by stem cell transplantation (SCT) status in a planned post-hoc comparison; 58 patients received SCT; 36-month PFS (from SCT) was greater than 90% for both arms. Sixty-six patients were alive and progression free after the first scan (disease evaluation) and did not undergo SCT. The 36-month PFS (from first scan) was 73.0% (54.5, 85.0) for BV/Ipi/Nivo compared to 45.8% (26.3, 63.4) for BV/Nivo (HR=0.45, CI 0.19-1.08, one-sided p=0.03). The study did not meet its primary endpoint of superior CR rate for the triplet, but it supports the use of checkpoint-ADC induction prior to auto SCT, and there is an intriguing signal of disease control for patients wishing to defer or avoid SCT for the triplet of BV/Ipi/Nivo.
Intensity modulated radiation therapy (IMRT) is increasingly used for total body irradiation (TBI) due to its ability to deliver myeloablative doses while sparing radiosensitive organs. To enable consistent evaluation in future National Clinical Trials Network (NCTN) studies, the NRG Hematologic Malignancies Working Group (HMWG) convened IMRT-TBI experts and NCTN leaders to develop consensus recommendations for standardized multi-institutional implementation. A 47-question survey was distributed to NRG institutions utilizing total body irradiation treated with intensity modulated radiation therapy (IMRT-TBI) to characterize current planning and delivery practices. Responses were analyzed for commonalities and variations. A multidisciplinary working group reviewed survey findings, developed consensus-based technical and clinical recommendations, and created a standardized template for IMRT-TBI integration into NCTN protocols. Topics included simulation, contouring, planning, organ-at-risk (OAR) constraints, quality assurance (QA), image guided radiation therapy, commissioning, credentialing, and safeguards for clinical trial conduct. Eight institutions with collective experience treating more than 750 patients with IMRT-TBI responded. Most centers used volumetric modulated arc therapy (VMAT) to the upper body with anteroposterior/posteroanterior fields to the lower body, 3 to 9 isocenters, lower dose rates for lung fields (100-200 MU/min), and no physical bolus. Common OAR constraints included lungs mean dose <8 Gy, kidneys mean dose <6 to 8 Gy, and lenses maximum dose <90% of prescription. All respondents used auto-segmentation; 50% used auto-planning. QA practices varied, but patient-specific QA passing rates were high (>95% with 3%/2 mm gamma). Consensus recommendations for clinical trial use were established, including standardized planning target volume definitions, OAR sparing goals, dosimetric constraints, QA requirements, and credentialing processes. IMRT-TBI offers the potential for reduced toxicity and improved dose precision compared with total body irradiation treated with a 2-dimensional technique, but its complexity requires careful standardization in multi-institutional trials. The NRG HMWG and collaborating NCTN experts developed the consensus-based technical and clinical framework for incorporating IMRT-TBI into cooperative group protocols. Adoption of these recommendations will facilitate consistent implementation and enable rigorous evaluation of outcomes.
BACKGROUND:For most cytotoxic drugs, guidelines recommend body-surface-area-based dosing, yet some patients start with reduced doses, potentially reflecting tolerability concerns. The relationship between first-cycle dose reductions and subsequent delivery is unclear. METHODS:The authors analyzed data from women with stage I-IIIA breast cancer treated with adjuvant chemotherapy. Sankey diagrams illustrated trajectories from first-cycle dose proportion (FCDP) to average relative dose intensity (ARDI, ratio of received to expected dose intensity across the regimen), and cumulative dose proportion (CDP, ratio of total received to expected dose). Poisson regression estimated adjusted prevalence ratios for reduced FCDP (<95% vs. ≥95%) and three outcomes: ARDI reduction beyond initial FCDP, receiving fewer cycles, and CDP reduction beyond initial FCDP. Analyses assessed effect modification by age, body mass index (BMI), and comorbidities. Dosing was analyzed for cytotoxic and HER2-targeted therapy. RESULTS:A total of 8772 (90.8%) patients started with FCDP ≥95%; most maintained ARDI ≥95% (65.1%) and CDP ≥95% (79.9%). In multi-variable models, FCDP <95% was not significantly associated with further ARDI or CDP reductions or receipt of fewer cycles. BMI modified these associations (p-interaction = .004 for fewer cycles; p-interaction = .03 for CDP), with positive associations among overweight but not obese or normal-weight patients. FCDP <95% was linked to a lower likelihood of further ARDI reductions for both therapy types and lower likelihood of cumulative dose reduction in HER2-targeted therapy. CONCLUSIONS:Early dosing decisions shaped subsequent chemotherapy delivery. Most patients who began at full dose maintained consistent dosing, whereas early reductions did not stave off subsequent changes, underscoring the need to balance safety with adequate dose intensity.
