Expert Review of Anticancer Therapy最新文献

Introduction: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy have markedly improved clinical outcomes and are the preferred first-line treatment for metastatic hormone receptor - positive breast cancer. However, acquired resistance is almost universal, leading to a critical need for effective strategies in the post-CDK4/6i setting.

Areas covered: This review summarizes therapeutic approaches investigated after progression on CDK4/6i plus endocrine therapy. Key therapeutic approaches in this setting focus on overcoming resistance by inhibiting pathways such as PI3K/AKT/mTOR, altering treatment class through switching CDK4/6 inhibitors or endocrine therapy agents, and incorporating selective estrogen receptor degraders (SERDs). In addition, several novel strategies are under investigation, including targeting CDK7, utilizing antibody - drug conjugates, and exploiting DNA repair vulnerabilities with poly (ADP-ribose) polymerase (PARP) inhibitors. We conducted a literature search in PubMed/MEDLINE, Embase, and Scopus for studies published between January 2018 and June 2025 to identify evidence on efficacy, safety, and patient selection in this setting.

Expert opinion: Therapeutic development for post-CDK4/6i metastatic HR+ breast cancer is evolving rapidly. Identifying molecular drivers of resistance and matching patients to targeted therapies will be essential to optimize outcomes. Continued efforts toward biomarker-based treatment selection and rational sequencing strategies are expected to refine post-CDK4/6i management.

Introduction: Targeted therapy is an established treatment strategy for biliary tract cancer (BTC), yet its clinical efficacy remains limited when compared to promising in vitro and in vivo findings. This highlights the translational gap between preclinical research and real-world patient outcomes, emphasizing the urgent need for improved strategies to bridge laboratory insights with clinical practice.

Areas covered: This report explores the heterogeneous landscape of targeted therapy in BTC. It reviews established facts, including molecular mechanisms, signaling pathways, and clinical trial data, while addressing uncertainties such as patient- and tumor-related variables and infectious comorbidities. In addition, it discusses current demands and future challenges, with emphasis on integrating novel technologies, biomarker-driven approaches, and multidisciplinary collaborations to enhance therapeutic precision.

Expert opinion: Early and accurate diagnosis remains the cornerstone of successful BTC treatment. Noninvasive biomarkers, particularly liquid biopsy platforms, hold promise for improving detection and monitoring. Clinically, the establishment of high-volume BTC centers with integrated scientific and medical expertise is essential to translate molecular analyses into personalized therapies. Moreover, systematic incorporation of BTC-related clinical and molecular data into international multicenter trials is imperative. Such integration will refine therapeutic paradigms, accelerate drug development, and foster innovation through strategic collaborations with pharmaceutical industry consortia.

Introduction: Angiogenesis, the formation of new blood vessels from existing ones, plays a critical role in cancer development and progression. Given its significance, inhibiting angiogenesis has emerged as a key strategy in anticancer therapy.

Areas covered: This review outlines the biological process of angiogenesis and explores the clinical development of anti-angiogenic therapies across various cancer types. A comprehensive literature search was conducted focusing on approved therapies, emerging agents, combination strategies, and clinical outcomes. The review highlights current limitations, including variable efficacy, drug resistance, and associated toxicities. It also examines recent advances such as biomarker discovery, synergistic combinations with immunotherapy, and novel therapeutic targets.

Expert opinion: Although anti-angiogenic agents have transformed certain aspects of cancer therapy, their full potential remains unrealized. Future strategies should focus on personalized approaches aided by predictive biomarkers, and rational combinations to enhance efficacy and reduce resistance.

Introduction: Despite neck lymph node metastases occurring commonly in cases of papillary thyroid carcinoma (PTC), there has remained controversy regarding the thresholds that should be used for lymph node characteristics in predicting PTC recurrence risk.

Areas covered: This scoping review explored the prognostic significance of lymph node characteristics in predicting risk of PTC recurrence. Following the PRISMA guidelines, the PubMed, Embase, and Web of Science databases were searched and supplemented by hand searching reference lists to identify articles published from database inception until October 2024. A total of 172 studies were included. Most studies had a retrospective cohort design and were reported from South Korea, Japan, and China. In general, an increased number of metastatic lymph nodes (commonly >5), presence of extranodal cancer extension, larger size of metastatic lymph nodes (commonly >3 cm), higher lymph node ratio (commonly ≥0.3 or ≥0.4), and presence of lateral neck compartment nodal metastases were all associated with higher recurrence rates.

Expert opinion: The lack of standardized definitions and terminology make the interpretation of findings difficult and limit generalizability. Future studies must focus on exploring long-term recurrence risk, in an exclusively PTC patient population, while also incorporating standardized definitions and terminology for lymph node characteristics and recurrence.

Background: Chemotherapy-induced neutropenia (CIN) may reflect higher pharmacodynamic exposure and relate to improved outcomes, but its clinical relevance in pancreatic cancer remains uncertain.

Methods: PROSPERO-registered, PRISMA-compliant systematic review and meta-analysis. PubMed, Embase, and CENTRAL were searched to 18 August 2025. Eligible studies compared OS in CIN ≥G3 vs 

Results: Eight observational studies met inclusion; five (all advanced disease) were meta-analyzed. CIN ≥G3 was associated with better OS (grouped HR 0.50; 95% CI 0.40-0.62; I² = 0%), with consistent direction across studies. Sensitivity analyses confirmed robustness. ROBINS-I rated four studies at serious and four at moderate risk of bias; GRADE certainty for the pooled OS effect was moderate.

Conclusions: In advanced pancreatic cancer, CIN ≥G3 is associated with improved OS, supporting its role as a cohort-level prognostic/pharmacodynamic marker. Generalizability is limited by predominantly Japanese cohorts. Prospective multicenter studies with time-dependent modeling and control of relative dose intensity.

Registration: www.crd.york.ac.uk/prospero, identifier CRD420251005347.

Background: Prostate cancer is a leading malignancy among men worldwide and an increasing challenge for emerging economies. The expanded BRICS nations represent regions undergoing rapid demographic and epidemiological transitions, yet data on their comparative disease and economic burden remain limited.

Methods: We analyzed data from the GBD 2021 study to estimate prostate cancer incidence, mortality, DALYs, and mortality-to-incidence ratios (MIRs) from 1990 to 2021 across BRICS+. Temporal patterns were assessed through EAPC. Productivity losses due to premature mortality were calculated using the Human Capital Approach.

Results: Incidence and mortality rose sharply in Russia and Egypt, while China and India showed declining mortality despite increasing incidence. MIRs decreased overall, reflecting improved survival, though Ethiopia and Egypt remained high. In 2021, productivity losses were greatest in China (US$73.1 billion) and Russia (US$19.5 billion), with comparatively lower losses in Ethiopia, Saudi Arabia, Egypt, and the UAE.

Conclusion: Prostate cancer imposes a heterogeneous but rising health and economic burden across BRICS+ nations. Effective strategies integrating prevention, early detection, equitable treatment-access, and recognition of economic impact are critical to reduce disparities and improve outcomes.

Background: Metastasis is the leading cause of cancer-related death and involves biological processes such as genomic instability and immune evasion. Although metastatic tumors generally retain major alterations present in primary tumors, the extent of additional genomic divergence across cancer types remains insufficiently characterized.

Research design and methods: A pan-cancer analysis was performed using targeted sequencing data from 2846 patients with matched primary and metastatic tumors (5692 samples) from the AACR Project GENIE-v18.0 cohort. Comparisons between primary and metastatic samples included mutation count, fraction of genome altered (FGA), gene-level mutation frequencies, copy number alterations (CNA), and structural variants (SV).

Results: Metastatic tumors showed modest but statistically significant increases in mutation count (median 6 vs. 5) and FGA (0.186 vs. 0.140), with the largest differences observed in lung, breast, colorectal, pancreatic, and prostate cancers. Eleven genes, including KDM5A, CDKN2A, MYC, ESR1, and AR, were more frequently altered in metastases. Differences in CNA and SV patterns were also observed, particularly in genes involved in cell cycle control and DNA repair.

Conclusions: Compared with primary tumors, metastatic tumors demonstrated small but consistent genomic differences. These findings varied across cancer types and may reflect changes associated with the evolutionary transition from primary to metastatic disease.

Background: This study aimed to evaluate the impact of HPV vaccination at the time of treatment of cervical intraepithelial neoplasia (CIN) 2 or 3 on recurrence/persistence.

Research design and methods: Unvaccinated women with genital high-grade lesion(s) were offered vaccination (Gardasil 9®) at the time of treatment. Those with CIN2 or 3 were compared with a historical control group of unvaccinated women.

Results: Vaccination was accepted by 99.6% of women (267/268); 170 satisfied the inclusion criteria. CIN2+ recurrence/persistence rate up to 24 months in the vaccine group was 3.0% (5/164) vs. 7.1% (21/295) in the control group, p = 0.091. There were no differences in the time until diagnosis.Positive margins (HR [hazard ratio] 8.28; 95% CI 4.08 to 16.77, p < 0.001) and age > 45 years (HR 2.99; 95% IC 1.56 to 5.74, p < 0.001) were associated with increased risk of persistence/recurrence.There was no reduction in HPV detection at 6 months, but vaccinated women were more likely to become HPV negative (HR 0.689; CI 95% 0.54 to 0.89; p = 0.003) and earlier.

Conclusion: There was a non-significant trend toward lower risk of recurrence/persistence of CIN2+ after treatment in vaccinated women; vaccination did not impact the short-term HPV detection but increased the likelihood of becoming undetectable.

Introduction: Antibody-drug conjugates (ADCs) are an expanding class of targeted cancer therapies that combine monoclonal antibody specificity with potent cytotoxic agents, offering improved precision and efficacy across multiple malignancies. As their clinical use increases, there is a growing need to address the critical role of oncology nursing in ensuring safe administration, toxicity management, and patient education.

Areas covered: This narrative review examines the current landscape of approved ADCs with a focus on nursing practice. It explores ADC mechanisms of action, administration considerations, and characteristic toxicity profiles, including hematologic, pulmonary, dermatologic, neurologic, and ocular adverse events. A literature search was conducted using PubMed, CINAHL, regulatory agency publications, clinical guidelines, and prescribing information, prioritizing sources published within the past decade and those relevant to clinical nursing care and patient safety.

Expert opinion: Oncology nurses are central to the successful delivery of ADC therapy through comprehensive assessment, vigilant monitoring, proactive toxicity management, and patient education. As ADC technologies evolve and indications expand, continued development of nursing-specific protocols and education is essential to optimize patient outcomes and maintain treatment safety.

Introduction: Chronic hepatitis B (CHB) can cause liver cirrhosis and hepatocellular carcinoma (HCC). HCC surveillance with an abdominal ultrasound and serum alpha-fetoprotein every six months is recommended for patients with cirrhosis and in a subset of patients with non-cirrhotic CHB. However, it can be difficult to determine which patients are at high- vs. low-risk for HCC.

Areas covered: We review the key factors that contribute to HCC risk in CHB, the concept of risk-based HCC surveillance, and some of the existing clinical tools that can be used to estimate HCC risk in CHB.

Expert opinion: Individualized HCC risk estimates can help clinicians stratify patients into high- and low-risk groups, enabling tailored surveillance strategies. However, the practical use of existing tools remains limited by the lack of wide validation, variability in access to laboratory testing, and the inability to accurately predict dynamic changes in HCC risk over time. For most patients with CHB, HCC risk remains sufficiently high enough to justify ongoing HCC surveillance. However, in select low-risk patients, surveillance may be delayed or stopped with regular reassessment of HCC risk and shared decision-making, given the limitations of existing tools and the likelihood of changes in HCC risk over time.