Assessing long-term trends in lung cancer (LC) patients is challenging, particularly in regions with limited data. We present findings from a real-life Moroccan cohort. This is a retrospective study that included patients diagnosed with LC as a primary malignancy between January 1st, 2013, and December 31st, 2022. Data were collected from one academic public hospital that, during this period, served as the referral centre for the middle and southern regions of Morocco. Patients’, clinic, pathologic, and therapeutic characteristics were described. Analyses assessed temporal trends and stage-specific outcomes. Over the study period, LC rates were highest among men 88% (1206/1369), aged 55–60 years 22% (297/1369), who were current smokers 90% (1075/1206), while rates among women remained stable. Additionally, a rising trend was observed among NSCLC, particularly adenocarcinoma (56% (34/61) in 2013 vs. 65% (80/124) in 2022; p < 0.001), at the metastatic stage 72% (949/1320), whereas small-cell lung cancer (SCLC) remained under-represented at 4.4% (59/1337) in the overall population and 40% (59/146) in the lung neuroendocrine tumour (LNET) population, with stable incidence at 3% (2/70) in 2013 vs. 6% (10/163) in 2018 vs. 1.6% (3/190) in 2022; p = 0.8. Molecular testing was limited to EGFR in 6% of cases, ALK in 4.4%, and PD‑L1 in 5%. Systemic treatment was dominated by chemotherapy ±platinum, and only 7 patients received second‑line erlotinib. No improvement in survival rates was observed, and early mortality remained high 3-month rate: 0% for localised, 13.2% (95% CI, 9.9–17.2) for locally advanced, and 22.2% (95% CI, 19.6–25) for metastatic stage. This is the only, largest, retrospective, real-life cohort study including LC patients in the African region. The trend showed an overall rising LC incidence, a consistent predominance of advanced-stage diagnoses, high mortality rates, and a lack of survival improvement with limited therapeutic options over the studied decade. Strengthening efforts in early detection, tobacco-control, and expanding diagnostic capacity, while ensuring equitable access to biomarker testing and targeted treatments, remains central.
BACKGROUND:Mucosal melanomas are a rare melanoma subtype with poor prognosis. This project aimed to identify the main driver mutations of the different mucosal melanomas and to evaluate the efficacy of targeted/immunotherapies in patients with metastatic disease in current practice. In addition, the baseline clinicopathological characteristics, metastatic patterns, and primary treatment strategies and survival of mucosal melanoma subtypes were studied. METHODS:The Dutch nationwide pathology databank (Palga) and the Netherlands Comprehensive Cancer Organisation (IKNL) were queried for all patients with a diagnosis of mucosal melanoma (1989-2021). RESULTS:The dataset included a total of 1481 patients. Mutation status was assessed in 397 patients and in 170 patients (43%) a driver mutation was discovered. Patients with metastatic disease who received targeted/immunotherapy did show a better survival. The liver and lung were the predominant locations of the first metastasis. CONCLUSIONS:The data in the present study implies that patients with metastatic disease mucosal melanoma might benefit from targeted/immunotherapies. Molecular analysis should be considered in these patients.
BACKGROUND:Homologous recombination deficiency (HRD) is associated with increased sensitivity to PARP inhibitor therapy in various cancer types, including high-grade serous carcinoma (HGSC). Current guidelines recommend HRD testing to guide treatment decisions in HGSG. The majority of HRD assays rely on tumour tissue analysis. The main objective of this study was to assess cytological HGSC samples for HRD testing. METHODS:Next generation sequencing using the Oncomine™ Comprehensive Assay Plus (OCAP) panel was performed on 110 matched cytological and histological samples from 55 treatment-naïve HGSC patients to determine the mutational status of 15 homologous recombination repair (HRR)-associated genes including BRCA1/2, and the HRD status based on BRCA1/2 mutational status and genomic instability metric (GIM). Concordance analysis was performed. RESULTS:Compared to matched histological samples, cytological HGSC samples revealed an overall concordance rate of 89.7% for HRR-associated gene mutations and of 100% for BRCA1/2 mutations, respectively. A moderate correlation between GIM values (Pearson correlation coefficient 0.48), but an overall concordance rate of 90.9% for the HRD status was observed. CONCLUSIONS:Our findings demonstrate that cytological HGSC samples can be employed for HRR-associated gene mutation and HRD testing using next generation sequencing with the OCAP panel.
BACKGROUND:Bladder cancer is the 11th most common cancer in the United Kingdom, with approximately 10,500 new cases annually. Diagnosis and surveillance typically involve cystoscopy, an expensive, time-consuming, and uncomfortable procedure which has encouraged efforts to identify biomarkers, particularly in urine, given its direct contact with malignant tissue. METHODS:Urine collected from 100 participants (50 bladder cancer patients, 50 controls) was subjected to solvent extraction followed by gas chromatography-mass spectrometry (GC-MS) to determine potential volatile and semi-volatile biomarkers. The results were analysed using classical univariate statistics and machine learning methods. Five machine learning algorithms were evaluated, with recursive feature elimination (RFE) identifying optimal biomarker panels. RESULTS:Machine learning with XGBoost achieved area under the receiver operating characteristic curve (AUROC) of 0.869 (95% CI: 0.740-0.988), representing a significant improvement over the classical statistical approach (AUROC 0.752). An 8-metabolite panel achieved balanced sensitivity and specificity of 85%, or 95% sensitivity with 70% specificity when optimised for screening. CONCLUSIONS:The findings indicate that solvent extraction of urine shows promise for isolating putative biomarkers of bladder cancer. Employing machine learning achieved diagnostic accuracy potentially suitable for clinical deployment as a non-invasive bladder cancer detection tool.
BACKGROUND:Exercise is recognized for its efficacy in alleviating cancer-related fatigue (CRF). However, the effect of high-frequency exercise on CRF has not been clarified. This study aimed to elucidate the association between exercise frequency during hospitalization and CRF in patients with lymphoma. METHODS:This retrospective study included patients with lymphoma admitted for chemotherapy who were advised to engage in aerobic and resistance training once daily, six days per week. Exercise frequency was calculated as the percentage of hospitalization days during which therapy was administered. Participants were categorized into two groups based on exercise frequency. CRF was evaluated using the Cancer Fatigue Scale (CFS), comprising 15 items that assess physical, affective, and cognitive factors. RESULTS:A total of 130 patients (median age: 72 [range: 66 -78] years) were eligible to participate. The median frequency of exercise was 71.4%. Multiple regression analysis revealed that the exercise frequency significantly affected the physical CFS score at discharge. However, no statistically significant relationship was observed between exercise participation frequency and other CFS scores. CONCLUSIONS:Higher-frequency exercise was significantly associated with a reduction in CRF at discharge.
Abstract Collision tumours, defined by the coexistence of two histologically distinct neoplasms within a single organ, are rare and typically arise from different cell lineages. We report a unique case of a 64-year-old woman with a history of oestrogen receptor (ER)–positive, HER2-negative breast carcinoma who developed a renal mass later identified as a collision tumour comprising clear cell renal cell carcinoma (ccRCC) and metastatic breast carcinoma. Initial imaging and biopsy suggested ccRCC alone; however, post-nephrectomy histopathology revealed metastatic breast carcinoma foci within the ccRCC and renal sinus fat, confirmed by ER, GATA3, and mammaglobin positivity. This case highlights diagnostic challenges in distinguishing synchronous primaries from metastases, particularly where biopsy sampling may obscure dual pathology. Management required balancing treatment of localised ccRCC with systemic therapy for metastatic breast cancer. Multidisciplinary evaluation is essential to guide optimal care.
BACKGROUND:Prostate cancer is a leading cause of cancer-related morbidity and mortality in men, with a subset of patients developing aggressive, castrate-resistant disease. We describe an underrecognized pattern of thoracic metastasis - peribronchial cuffing - in patients with advanced prostate cancer, with the aim to elucidate clinical, radiographic, and pathologic features and thus facilitate early recognition and management. METHODS:This was a retrospective case series conducted at a quaternary cancer center between February 2020 and June 2025. Patients with prostate cancer and radiographic evidence of peribronchial cuffing were identified through a multidisciplinary service review. Clinical data were abstracted, radiographic cross-sectional imaging findings were independently confirmed, pathologic specimens were revisited for histochemical staining with H-scoring, and next-generation sequencing results were analyzed. RESULTS:A total of nine patients demonstrated lower lobe-predominant peribronchial thickening, with 78% exhibiting right-sided involvement. All lesions were FDG- and/or PSMA-avid on positron emission tomography studies. Mediastinal lymphadenopathy and parenchymal lung metastases were concomitantly present in 66 and 22% of patients, respectively. The median time from PSA rise from baseline to cross-sectional imaging was 12.9 months, and from imaging to biopsy was 3.8 months. Tumor TP53 gene alterations were found in 66% of cases. In 33% of patients, the diagnosis of peribranchial metastases resulted in cancer upstaging. On follow-up, 55% of patients died within a median of 5.3 months from radiographic detection. CONCLUSIONS:Peribronchial metastasis represents a rare and underrecognized pattern of advanced prostate cancer spread. Its subtle presentation may result in delays in diagnosis and treatment. Recognition of this pattern in patients with rising PSA can be facilitated by new-generation molecular PET imaging studies to guide earlier biopsy and treatment initiation. Future studies are needed to characterize the pathobiologic mechanisms underlying this form of prostate cancer metastasis.
BACKGROUND:Hematopoietic cell transplant (HCT) data are well reported, but for cohorts transplanted abroad and returning to countries without transplant services, long-term outcomes such as chronic graft versus host disease (GVHD) and overall survival remain poorly captured, underscoring the need for longitudinal follow-up. METHODS:We conducted a 14-year retrospective multi-center study of allogeneic HCT recipients followed at three tertiary hospitals in the United Arab Emirates(UAE). Transplant characteristics, conditioning, GVHD prophylaxis, and outcomes were abstracted from medical records. Crude survival was reported for all indications, Kaplan-Meier (KM) overall survival for diseases with ≥20 cases. RESULTS:A total of 363 allogeneic HCTs were analyzed. Overall, cohort characteristics differed from those reported in the literature: adults undergoing HCT were relatively young, female predominance was observed in pediatric malignancies and immune deficiencies, and matched unrelated donor (MUD) utilization was limited, while peripheral blood stem cell use was higher than typically described. In contrast, haploidentical donor utilization, conditioning intensity, and GVHD prophylaxis patterns were broadly consistent with international practice. GVHD incidence was high:69.2% in adults; 45.7% in children. In adults with acute myeloid leukemia (AML), acute GVHD was associated with an inferior 5-year OS (p = 0.036). In pediatric AML, both acute-/chronic GVHD were linked to poor survival (<50%), while survival for acute lymphoblastic leukemia (B-/T-ALL) exceeded 85%. cGVHD worsened overall survival (OS) more in pediatrics than adults. CONCLUSIONS:Although most findings aligned with established benchmarks, the high GVHD incidence and its association with adverse outcomes highlight the need for improved prevention strategies and the development of local transplant services.
BACKGROUND:Lung adenocarcinoma diagnoses have increased globally despite declining tobacco exposure, raising questions about non-tobacco-related contributors. The role of fine particulate matter (PM2.5) peaks related to biomass burning in shaping population-level lung cancer patterns remains unexplored. METHODS:An ecological analysis was conducted across the Regional Health Departments of São Paulo State, Brazil, from 2000 to 2023. Histologically confirmed lung cancer cases were obtained from the state cancer registry. Temporal trends in the adenocarcinoma-to-total lung cancer ratio (ATR) were evaluated alongside annual mean and maximum PM2.5 concentrations and wildfire counts derived from satellite data. RESULTS:Among 51,580 lung cancer cases, adenocarcinoma accounted for 36%. Regions with a significant increase in ATR demonstrated annual increases ranging from 0.39 to 0.72%. With the exception of the São Paulo metropolitan area, which showed high mean PM2.5 levels despite low wildfire activity, all other regions with increasing ATR exhibited substantially higher wildfire occurrence (311 vs. 207 annual hotspots; p = 0.049), which strongly correlated with PM2.5 peaks (ρ = 0.928, p = 0.007). Periods of elevated PM2.5 peaks consistently coincided with increased wildfire activity. CONCLUSIONS:These findings suggest that biomass-burning-related PM2.5 peaks may be relevant to population-level patterns of lung cancer epidemiology.
Paediatric palliative care (PPC) in oncology plays a crucial role in enhancing the quality of life for children with cancer and their families. However, outcome measurement in this context remains fragmented, with tools often lacking validation, paediatric specificity, or contextual relevance, especially in low- and middle-income countries (LMICs). This scoping review maps the outcome measurement tools used in paediatric oncology palliative care, examining their assessed domains, psychometric properties and cultural, linguistic and health-system contextual relevance, particularly in LMICs. We systematically searched six databases from 2006 to 2025 and identified 27 eligible studies reporting on 28 unique tools across six key domains: symptom burden, quality of life, psychological well-being, spiritual health, caregiver burden and end-of-life care. While tools like Paediatric Quality of Life Inventory (PedsQL) and Symptom Screening in Pediatrics Tool (SSPedi) showed strong psychometric performance, only a few had been adapted for LMIC contexts. The psychological and spiritual domains were underrepresented, and most tools relied on proxy reporting, which limited child-centred assessments. The findings suggest the need for validated, culturally sensitive and inclusive tools co-developed with children and caregivers. Establishing such outcome measures is essential to ensuring equitable, high-quality palliative care across diverse settings. This review lays the groundwork for developing tools and advancing policies that support comprehensive and compassionate care for children with cancer. Review registration: The review is registered on Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/G8BN3 .
BACKGROUND:Pleomorphic carcinoma (PC) of the lung is a rare, aggressive non-small cell lung cancer. Neutrophil extracellular traps (NETs) are linked to tumour progression, but their relevance in pulmonary PC is unknown. We evaluated the prognostic impact of intratumoral NETs and CD66b+ neutrophil infiltration in PC versus adenocarcinoma. METHODS:Among 1148 patients who underwent pulmonary resection for primary lung cancer, 813 patients with adenocarcinoma and 17 with PC were analysed. Clinicopathological factors and survival were compared and propensity score matching was applied. NETs and neutrophils were quantified by CD66b immunohistochemistry and citrullinated histone H3/myeloperoxidase immunofluorescence. RESULTS:PC was associated with heavier smoking, more vascular invasion, and more advanced stage than adenocarcinoma (all p < 0.001). The patient characteristics were comparable after matching. Overall and recurrence-free survival were both worse in the PC group (both p < 0.001) and remained poorer after matching. Cox analysis identified NET-positive area (% per high-power field) as an independent predictor of worse overall survival (hazard ratio 1.14, 95% confidence interval 1.01-1.30; p = 0.033). CONCLUSIONS:Pulmonary PC shows intense neutrophil infiltration and abundant intratumoral NETs, both associated with poor survival. Quantitative assessment of NETs may serve as a biomarker and therapeutic target in PC.
BACKGROUND:The environmental impact of cancer care is an emerging concern, yet therapeutic strategies that may incidentally reduce greenhouse gas (GHG) emissions remain poorly described. The 2025 ESMO Congress, where nearly 3000 abstracts were presented, offered an opportunity to identify clinically validated approaches that could lower the carbon footprint of oncology. METHODS:All abstracts from the 2025 ESMO Congress were reviewed. Studies suggesting meaningful downstream reductions in drug use, visit frequency, treatment duration, or overall care intensity were selected. For each, GHG emissions were estimated using the ECOVAMED drug carbon-footprint database and standard emission factors. RESULTS:Ten abstracts were identified. They spanned primary prevention, therapeutic de-escalation, reduced dose or duration of systemic therapy, biomarker-guided treatment selection, and non-pharmacological interventions. Several strategies demonstrated non-inferior or improved clinical outcomes while substantially lowering treatment-related emissions. Notably, none of the selected studies had explicitly assessed environmental impact. CONCLUSIONS:Multiple strategies presented at ESMO 2025 appear capable of improving patient outcomes while reducing the environmental burden of cancer care. Systematically integrating environmental endpoints into clinical research would help identify such win-win approaches and advance a more sustainable oncology practice.
The management of unresectable stage III non-small cell lung cancer (NSCLC) continues to evolve with the integration of immunotherapy and targeted agents into treatment paradigms. The PACIFIC trial established consolidation durvalumab following concurrent chemoradiotherapy (CRT) as the standard of care in many settings. However, emerging evidence challenges the one-size-fits-all approach, particularly for molecularly defined subsets and specific patient populations. This debate article examines the evolving landscape of non-surgical stage III NSCLC management, presenting evidence-based arguments for refining treatment strategies based on molecular biomarkers, novel immunotherapy combinations, and alternative sequencing approaches.
BACKGROUND:All breast cancer (BC) patients have a risk of developing contralateral BC (CBC). This will be higher in women carrying a BC susceptibility gene pathogenic variant (PV), but specific risk estimates are lacking. We addressed this in a study-level meta-analysis of two large, recent cohort studies that used Breast Cancer Risk after Diagnostic Gene Sequencing (BRIDGES) project and Cancer Risk Estimates Related to Susceptibility (CARRIERS) consortium data. METHODS:We used population risks from the Netherlands to estimate 10-year cumulative CBC risks for BRCA1, BRCA2, PALB2, CHEK2, and ATM PV carriers. We estimated pooled hazard ratios (HRs) in meta-analyses using the generic inverse-variance method and assuming random effects. We stratified by first BC estrogen receptor (ER) status. RESULTS:Among 462 BRCA1, 590 BRCA2, 796 CHEK2, 297 PALB2, and 345 ATM PV carriers, we estimated 10-year cumulative CBC risks of 10.1% (95% confidence interval (CI):7.5-13.6%) for BRCA1, 10.2% (95%CI:7.4-13.9%) for BRCA2, 7.1% (95%CI:3.4-14.3%) for PALB2, 8.0% (95%CI:5.7-11.1%) for CHEK2 (any PV), 8.5% (95%CI:5.9-12.3%) for CHEK2 del.1100 C, and 4.5% (95%CI:2.5-8.0%) for ATM PV carriers. We found elevated HRs in BRCA1 (HR:2.8, 95%CI:2.1-3.6), BRCA2 (HR:2.8, 95%CI:2.1-3.7), and CHEK2 PV carriers (all PVs: HR:2.1, 95%CI:1.6-2.9. del.1100 C PVs only: HR:2.3, 95%CI:1.6-3.3). We found no significantly elevated risks in PALB2 (HR:1.9, 95%CI:0.9-3.8) or ATM (HR:1.2, 95%CI:0.7-2.1) PV carriers. We saw increased risks in BRCA1/2 and CHEK2 PV carriers following ER-positive BC, and in BRCA1/2 and PALB2 PV carriers following ER- negative BC. CONCLUSION:BC survivors carrying BRCA1, BRCA2, and CHEK2 PVs and ER-negative BC survivors carrying PALB2 PVs are at two-fold or higher CBC risks. These estimates may assist clinical decision making for management of the contralateral breast.
Stage III non-small cell lung cancer (NSCLC) comprises a broadly heterogeneous disease with historically poor survival, and treatment decisions must account for both pathophysiology and resectability. Despite conclusions from older trials that questioned the role of surgery, modern evidence supports surgical resection as an indispensable component of treatment when performed by experienced thoracic surgeons. Advances in neoadjuvant systemic therapy, particularly chemo-immunotherapy, have significantly improved outcomes and reinforced the added value of surgery in appropriately selected Stage III NSCLC patients. In PACIFIC, consolidation durvalumab after concurrent chemoradiation improved progression-free (16.9 vs 5.6 months) and overall survival (47.5 vs 29.1 months). Also, perioperative pembrolizumab reduced progression or death by 42% (*P* < 0.0001) and improved pCR and major pathologic response. Additional trials (NEOTORCH, NADIM 2) showed large reductions in events and higher pCR rates with checkpoint inhibitors plus chemotherapy. Collectively, these data underscore that Stage III NSCLC requires both systemic therapy and durable local control, and neoadjuvant chemo-immunotherapy followed by surgery can significantly improve oncologic outcomes without increasing perioperative mortality in carefully selected patients.
Abstract Pancreatic ductal adenocarcinoma (PDAC) presents as a cancer with an especially poor prognosis, largely due to the challenges surrounding its early diagnosis. Liquid biopsy has emerged as a promising, noninvasive method for screening across a variety of cancers. This approach is limited, however, by the extensive heterogeneity of biological samples, a challenge that teams are looking to address using artificial intelligence (AI) and machine learning (ML) strategies. By harnessing the ability of ML algorithms to extract the most salient features from complex datasets, researchers can identify biomarkers with high predictive value for PDAC. This review explores the current landscape of AI-powered liquid biopsy for early PDAC diagnosis, focusing on specific techniques and their respective degrees of success. Following PRISMA-ScR guidelines, 85 studies were extracted from PubMed and Scopus with a final 18 studies included. The majority of papers utilized blood (n = 15) as the source of liquid biopsy, with the remainder analyzing urine, bile, or cyst fluid. Random forests (n = 9) and support vector machines (n = 7) were the most frequently implemented ML models, while two papers focused on deep learning methods. Limitations include the lack of standardized reporting for model performance metrics and small cohort sizes with non-granular labels.
Background We address the therapeutic relevance of glioblastoma (GBM)'s molecular characterization, focusing on whether a proneural-vs-mesenchymal classification may describe GBM heterogeneity, correlate to stemness and CD44 (a marker often, but conflictingly, used in GBM), and have a prognostic value in terms of temozolomide (TMZ) resistance. Methods We molecularly profiled 4 patient-derived GBM cells (PD-GBM) and a reference cell line (U87), validating the results in public datasets (PD-GBM, TCGA-GBM), then studying the subtype-specific response to TMZ in vitro, both under normoxia and simulated hypoxia. Results Firstly, the proneural subtype transcriptionally and phenotypically correlates with higher stemness. Secondly, CD44 inversely correlates to stemness, acting as a mesenchymal marker both intra-tumorally (FACS-sorted CD44(LOW) cells had higher stemness than CD44(HIGH)) and inter-tumorally (also in larger datasets). Further, mesenchymal PD-GBM cells are also enriched in other hyaluronic acid (HA) surface receptors, proneural in matrix HA receptors. Finally, although TMZ stimulates a general mesenchymal shift in all cells, there are proneural-specific responses: this subtype resists TMZ better under hypoxia (vs. normoxia) in a first treatment, and in a second treatment (vs. single) under normoxia. Conclusion PD-GBM show clear proneural/stemness and mesenchymal/CD44 correlations, which may bear prognostic significance, as more proneural/stem GBMs appeared more capable to develop TMZ resistance.
Abstract Background 800 mg avelumab, given every 2 weeks, in combination with axitinib, is an approved first-line treatment option for patients with metastatic renal cell carcinoma (mRCC). Less frequent administration of avelumab would be preferable to patients and service providers but has not been previously explored. Methods We retrospectively analysed the clinical outcomes of patients from two academic centres who received 4-weekly avelumab plus axitinib between Oct 2019 and Oct 2023. Patients in cohort 1 (C1) were treated with 4-weekly avelumab from the start of therapy. Patients in cohort 2 (C2) initially received standard 2-weekly avelumab and were later switched to 4-weekly infusions. Overall response rate (ORR), progression-free survival (PFS), overall survival (OS) and toxicities leading to dose reductions or cessation were evaluated. Results We identified 94 patients in total, 46 patients in C1 and 48 patients in C2. The majority (56%) of patients in both cohorts had IMDC favourable-risk disease. The ORR in C1 was 53% and the median PFS was 22.1 months. In C2, the median time to switch was 4.9 months (range 1.8–35.6) and median time on 4-weekly avelumab was 16.7 months (range 0.9–39.1). Toxicity was consistent with prior reports. Limitations include retrospective design. Conclusions These preliminary data support prospective evaluation of modified avelumab scheduling in patients with mRCC. Reducing treatment burden stands to improve patient quality of life and lower associated costs.
