The risk of gastrointestinal (GI) perforation associated with bevacizumab (Bev) in patients undergoing palliative radiotherapy (RT) remains unclear. This study investigated the incidence of GI perforation in colorectal cancer patients treated with Bev and palliative RT. We retrospectively reviewed colorectal cancer patients who received Bev and palliative RT involving the GI tract between January 2013 and December 2025. Bev and palliative RT were defined as treatment with Bev within 4 weeks before RT initiation or within 4 weeks after RT completion. A total of 109 patients were analyzed. Bev was administered before RT in 44 patients (40.4
Cutaneous toxicity is common during enfortumab vedotin plus pembrolizumab, but evidence for prophylaxis is limited. We evaluated whether institutional prophylactic intravenous dexamethasone before enfortumab vedotin was associated with reduced cutaneous toxicity in locally advanced or metastatic urothelial carcinoma. This multicenter prospective cohort enrolled 172 patients at 11 Japanese institutions. Before enrollment, three institutions adopted fixed dexamethasone (6.6 mg) premedication and eight did not; policies remained unchanged, and patients were not individually allocated. The primary endpoint was any-grade skin reaction. Best radiographic response was a prospectively specified exploratory analysis, and progression-free survival (PFS) was evaluated post hoc. Forty-one patients were treated under the dexamethasone-premedication policy and 131 under the no-premedication policy. Any-grade skin reactions occurred in 36.6
Chimeric Antigen Receptor T-cell (CAR-T) therapy has changed the treatment landscape for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Although its clinical effectiveness has been demonstrated, the cost of CAR-T is concerning, given its accessibility and sustainability, especially in countries with intermediate incomes such as Colombia. Assess the cost-utility of CAR-T therapy relative to conventional salvage chemotherapy from the perspective of the Colombian health system. A cost-utility analysis was performed using a state-transition (Markov) model with a 10-year horizon and monthly cycles. The costs were estimated from Colombian tariff manuals (ISS, SOAT), adjusted to 2025 values. Effectiveness was measured by quality-adjusted life-years (QALYs) from clinical trial data (ZUMA-1, JULIET) and literature-based utilities. Both costs and outcomes were discounted by 3
Maintenance Bacillus Calmette–Guérin (BCG) therapy is a key component of treatment for intermediate-risk to high-risk non-muscle-invasive bladder cancer (NMIBC) and an essential backbone for combination immunotherapy. However, its implementation remains limited by concerns regarding adverse events (AEs). We evaluated the association between AE-related discontinuation of maintenance BCG therapy and oncological outcomes. We retrospectively investigated 228 patients with NMIBC who had received adequate induction BCG and were subsequently scheduled to receive 1 year of maintenance BCG therapy between 2007 and 2020. Patients were categorized into an AE-related discontinuation group, a discontinuation for other reasons group, and a maintenance completion group. Recurrence-free survival (RFS) was assessed using Kaplan–Meier curves. Confounding and time-dependent bias were addressed by propensity score matching and landmark analyses at 3, 6, and 12 months. Overall, 108 patients discontinued maintenance BCG because of AEs, 38 discontinued for other reasons, and 82 completed therapy (completion rate, 36
Near-infrared photoimmunotherapy (NIR-PIT) is a novel local treatment for recurrent or metastatic head and neck cancer. However, the clinical significance of immune checkpoint inhibitor (ICI) timing and treatment sequencing remains unclear. This study investigated their association with clinical outcomes after NIR-PIT. This multicenter retrospective study included 44 patients with 48 lesions who underwent initial NIR-PIT between January 2021 and March 2026. The primary analysis compared outcomes according to prior ICI exposure. An exploratory analysis evaluated outcomes according to treatment sequence and timing of ICI administration. The primary endpoint was local control. Secondary endpoints were objective response rate and disease control rate, while overall survival was assessed exploratorily. Median local control duration was 253 days, but was 174 days in the prior ICI exposure group and 342 days in the non-prior ICI exposure group (log-rank P = 0.031). Local progression occurred in 69.2–37.1
The number of older adults with early breast cancer is rising in aging societies. Optimal perioperative systemic therapy for this population remains challenging, owing to heterogeneity in functional status, comorbidities, and the limited representation of older patients in clinical trials. This article presents an English digest of the Japanese Clinical Practice Guidelines for Pharmacotherapy in Older Adults with Cancer (Second Edition), focusing on perioperative systematic therapy for early breast cancer. The guidelines were developed in accordance with the Minds 2020 methodology, incorporating systematic reviews, the Evidence-to-Decision framework, and multidisciplinary consensus. The guidelines address key clinical questions regarding perioperative systemic therapy for older patients with breast cancer, including human epidermal growth factor receptor 2 (HER2)-targeted therapy, immune checkpoint inhibitors, and treatment intensification strategies for hormone receptor–positive disease. Most recommendations are conditional because of limited direct evidence in older populations. Trastuzumab-based therapy remains the standard approach for HER2-positive disease, whereas alternative strategies may be considered for patients who are unable to tolerate chemotherapy. Immune checkpoint inhibitors combined with chemotherapy may improve recurrence-related outcomes in selected patients; however, evidence in older populations is limited. Additional therapies, such as abemaciclib or S-1, may reduce the risk of recurrence in high-risk patients but require careful consideration of toxicity. These guidelines provide practical, evidence-based recommendations for perioperative systemic therapy in older adults with early breast cancer. They emphasize individualized treatment strategies that integrate patient characteristics, treatment goals, and tolerability. Further research specifically targeting older populations is needed to strengthen the evidence base for geriatric oncology.
Metastatic urothelial carcinoma (mUC) is traditionally managed with systemic therapy; however, long-term disease control remains uncommon despite advances such as immune checkpoint inhibitors and antibody–drug conjugates. Interest has grown in integrating metastasis-directed therapy (MDT), including metastasectomy and stereotactic body radiotherapy (SBRT), and primary-site treatment (PST) in selected patients, aiming to reduce tumor burden, eliminate resistant clones, and enhance systemic therapy outcomes. Metastasectomy is not standard but may be considered for oligometastatic patients with good performance status and a favorable response to first-line therapy. Retrospective series have shown feasibility and durable control, especially with solitary lung or nodal metastases, although data are limited by selection bias and a lack of randomized trials. SBRT offers high local control and palliation, with a growing role in oligometastatic or oligoprogressive disease to delay progression and complement immunotherapy. PST after a favorable systemic response for metastatic bladder cancer, including conversion or consolidative cystectomy and palliative or ablative radiotherapy, provides additional disease control and symptom relief. In metastatic upper tract urothelial carcinoma, retrospective and SEER-based data studies similarly suggest a survival benefit from nephroureterectomy in selected patients. Circulating tumor DNA is emerging as a complementary biomarker for patient selection and response monitoring in advanced UC cases. Most evidence predates highly effective systemic therapies; thus, the clinical value and optimal integration of MDT and PST remain to be defined, requiring prospective validation and refined patient selection.
Posthepatectomy liver failure (PHLF) is a leading cause of mortality. We established a modified Rem-ALPlat index integrating preoperative (albumin, platelet count, future liver remnant) and intraoperative variables (blood loss and Pringle maneuver) for immediate postoperative prediction. This study aimed to externally validate the model and assess its utility for early interventions. We retrospectively analyzed 198 patients who underwent anatomical hepatectomy without vascular or biliary reconstruction between 2015 and 2024. This external validation cohort was derived from an independent institution, separate from the original model development cohort. PHLF was defined according to the International Study Group of Liver Surgery grades. Predictive performance was assessed using receiver operating characteristic (ROC) analysis. PHLF grades were as follows: none (n = 144), grade A (n = 24), B (n = 26), and C (n = 4). ALPlat index had the highest AUC among the preoperative models (the area under the curve [AUC] 0.684 for grades B/C). The modified Rem-ALPlat index achieved an AUC of 0.847 for grades B/C. Model-derived probability cutoffs stratified patients into low (0–0.047), intermediate (0.047–0.066), high (0.066–0.109), and very high (≥ 0.109). Risk stratification was significantly associated with PHLF grade distribution (No-PHLF/A/B/C; low 98/6/3/0, intermediate 13/8/3/0, high 17/8/8/0, very high 16/2/12/4, P < 0.001). Exploratory analysis of early intervention (n = 18) among 67 high/very high-risk patients showed favorable postoperative trends, although statistical significance was not reached (no/A/B/C; 12/1/5/0 vs. 21/9/15/4, P = 0.118). The modified Rem-ALPlat index enables accurate PHLF prediction and may facilitate risk-adapted postoperative management. The clinical benefit of early intervention requires prospective validation.
Chemoradiotherapy (CRT) with 5-fluorouracil plus cisplatin is commonly used as additional treatment after endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC); however, metastatic recurrence remains a concern. S-1 is an oral fluoropyrimidine that has shown efficacy in combination with cisplatin and radiotherapy. This single-center, single-arm, exploratory phase II study evaluated the efficacy and safety of ER followed by CRT using S-1 plus cisplatin for superficial ESCC (UMIN000014684). Patients with ESCC diagnosed with stage pT1a-MM or pT1b-SM disease or lymphovascular invasion after ER were enrolled. CRT consisted of two cycles of S-1 administered twice daily on days 1 to 14 and cisplatin (70 mg/m²) on day 1 every 4 weeks, in conjunction with radiotherapy (40.0–41.4 Gy). The primary endpoint was 3-year overall survival (OS). Progression-free survival and adverse events were also examined. Thirty-eight patients underwent CRT with S-1 plus cisplatin. The 3-year OS and progression-free survival rates were 94.7
Nivolumab plus ipilimumab-based therapies have shown long-term, durable clinical benefit in patients with metastatic non-small cell lung cancer (NSCLC), including those with tumor programmed death-ligand 1 (PD-L1) expression < 1
While clinical data on anti-CD19 chimeric antigen receptor (CAR) T-cell therapy in relapsed/refractory (R/R) large B-cell lymphoma (LBCL) have been established, data specifically focusing on high-grade B-cell lymphoma (HGBCL) remain limited. To evaluate the efficacy of CAR T-cell therapy for HGBCL, we conducted a single-center retrospective study of patients with R/R HGBCL who received CAR T-cell therapy at our institution between March 2022 and October 2024. This study included 15 patients with R/R HGBCL treated with CAR T-cell therapy (10 with axicabtagene ciloleucel and 5 with lisocabtagene maraleucel). The median age at CAR T-cell infusion was 62 years (range, 39–76 years). Eleven patients (73.3
To date, no review has specifically focused on palliative-intent radiotherapy (RT) for pancreatic cancer (PC)–related pain. This study aimed to evaluate the pain response after palliative-intent RT for PC–related pain. A comprehensive literature search was conducted using PubMed, Ichushi-Web, and the Cochrane Library for studies published between 1971 and 2024. Studies in which palliative-intent RT was administered for PC-related pain were included. Extracted Data were independently assessed by three reviewers. Of the 629 studies identified through the database search, 11 met the inclusion criteria. The most frequently used palliative-intent RT schedules were 30 Gy in 10 fractions for conventional RT and 25 Gy in a single fraction for stereotactic body radiotherapy (SBRT). In addition, 8 Gy once weekly (24 Gy in 3 fractions) RT has also been reported. Because the methods used for pain assessment varied across the included studies, a meta-analysis was considered inappropriate. Pain associated with PC improved following palliative-intent conventional RT (pain response rate, 69–94
Universal tumor screening (UTS) for Lynch syndrome (LS) is cost-effective in Western countries; however, cost-effectiveness varies based on the frequency of hereditary diseases and testing costs. This study aimed to clarify the clinical utility and cost-effectiveness of UTS in identifying LS in patients with stage II/III colorectal cancer (CRC) in Japan. This single-center, prospective cohort study evaluated 591 consecutive patients who underwent surgical resection for Stage II/III colorectal adenocarcinoma between 2016 and 2018. Immunohistochemistry (IHC) was used to evaluate mismatch repair (MMR) proteins. In patients with MMR deficiency, BRAF V600E mutational testing and genetic counseling/testing were performed to identify LS based on MMR deficiency patterns. Genetic counseling/testing was also conducted for blood relatives upon request. The cost-effectiveness of implementing UTS was evaluated from the perspective of healthcare payers using a Markov state-transition model, with the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained as the reference value. A total of 40 cases (6.8
Olaparib is widely used as maintenance therapy in advanced ovarian cancer following response to platinum-based chemotherapy, but the magnitude of benefit across molecular subgroups and its safety profile remain uncertain. This updated meta-analysis evaluated the efficacy and safety of olaparib maintenance therapy across biomarker-defined subgroups and treatment settings. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials. Two reviewers independently screened studies evaluating olaparib as maintenance therapy in patients with advanced ovarian cancer who achieved a response to platinum-based chemotherapy in either first-line or recurrent disease settings. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included time to first subsequent therapy (TFST), time to second subsequent therapy (TSST), and adverse events (AEs). Hazard ratios (HRs) and risk ratios (RRs) with 95
Non-clear cell renal cell carcinoma (nccRCC) is a rare and heterogeneous group of tumors, and data regarding its prognosis remain limited. This study primarily aimed to compare survival outcomes between clear cell RCC (ccRCC) and nccRCC, limited to papillary and chromophobe RCC, using propensity score matching (PSM). A secondary analysis evaluated prognostic differences among histological subtypes of nccRCC. We retrospectively reviewed patients who underwent curative surgery for non-metastatic RCC between 2001 and 2023. Patients with cT1N0M0 ccRCC and nccRCC (papillary and chromophobe RCC) were matched at a 2:1 ratio using PSM. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared overall and according to surgical procedure. A secondary analysis compared survival outcomes among histological subtypes of nccRCC. The matched cohort included 100 patients with ccRCC and 50 with nccRCC. Five-year RFS, CSS, and OS were comparable between the groups (94.2
Reduced physiological reserve and overall systemic state are important determinants of prognosis in non-small cell lung cancer (NSCLC). The predicted skeletal muscle index (pSMI), calculated from serum creatinine to cystatin C ratio, age, body weight, and hemoglobin, has been proposed as a laboratory-based surrogate of skeletal muscle mass; however, its prognostic value in surgically treated NSCLC remains unclear. We retrospectively analyzed 199 patients who underwent curative-intent resection for NSCLC between 2019 and 2023. Patients were classified into low and high pSMI groups using previously reported sex-specific cutoff values. Overall survival (OS) and relapse-free survival (RFS) were evaluated using Kaplan–Meier methods and multivariable Cox proportional hazards models. The prognostic performance of pSMI was compared with body mass index (BMI), prognostic nutritional index (PNI), and CT-derived SMI. pSMI correlated with CT-derived SMI and BMI, and low pSMI was more frequent in patients with larger tumors and vascular invasion. Sixty-four patients (32.2
The combination of encorafenib plus binimetinib (ENC + BIN) is approved for the treatment of BRAF V600-mutated thyroid cancer in Japan, based on a phase 2 trial. We update the efficacy and safety data for ENC + BIN of this phase 2 trial after prolonged follow-up. This multicenter, open-label, uncontrolled phase 2 trial evaluated the efficacy and safety of ENC + BIN in patients with unresectable locally advanced or metastatic BRAF V600-mutated thyroid cancer that was not amenable to curative treatment, who were refractory/intolerant to ≥ 1 previous vascular endothelial growth factor receptor-targeted regimens, or were considered ineligible for these. The primary endpoint was the objective response rate (ORR). The secondary endpoints included progression-free survival (PFS) and overall survival (OS). We enrolled 22 patients: 17 with differentiated thyroid carcinoma (DTC) and 5 with anaplastic thyroid carcinoma (ATC). During a prolonged period with a median follow-up of 28.7 months (range: 3.4–40.6), 3 additional patients with DTC achieved partial responses, increasing the ORR to 68.2
