Postmastectomy Radiation Therapy: An ASTRO-ASCO-SSO Clinical Practice Guideline
Guidelines for post-mastectomy radiation include patients who received neoadjuvant therapy, with or without residual disease after treatment. A good topic to review.
Association Between Systemic Anticancer Therapy Administration Near the End of Life With Health Care and Hospice Utilization in Older Adults: A SEER Medicare Analysis of End-of-Life Care Quality
Author(s): Maureen E. Canavan, PhD, MPH1; Lee Cheng, PhD2; Jenny Jing Xiang, MD2; John Kent Lin, MD2; David Hui, MD2; Hui Zhao, PhD2; Nico Nortje, PhD2; Ravin Ratan, MD2; Nathan Cherny, MD3; Trinh Pham, PhD4; Sharon H. Giordano, PhD2; Jiangong Niu, PhD2; Kerin B. Adelson, MD2;
Source: DOI: 10.1200/JCO-25-00530
Dr. Maen Hussein's Thoughts
Maybe I’m biased as chair of the VBC, but this study showed that all subtypes of SACT use were associated with markers of poorer-quality EOL care.
PURPOSE
Use of cytotoxic chemotherapy end-of-life (EOL) is associated with adverse quality of life, increased health care utilization, and lower hospice rates. Although EOL cytotoxic chemotherapy use has declined in recent years, EOL novel (immunotherapy and targeted therapy) use has increased. The association between use of novel therapies EOL and health care utilization has not been widely studied.
METHODS
We identified patients within SEER-Medicare who had part D coverage (excluding those with Medicare Advantage) age 66 years and older, and breast, colorectal, lung, prostate, bladder, cervical, kidney, liver, ovarian, pancreatic, melanoma, or uterine cancer. Patients were diagnosed between 2005 and 2019 and died between 2015 and 2020. We analyzed associations between EOL systemic anticancer therapy (SACT) use (overall and by subtype), and health care utilization in the last 30 days of life (emergency department [ED], hospitalization, intensive care unit [ICU], and inpatient death), and hospice with multivariable regression, controlling for sociodemographic and cancer covariates.
RESULTS
Of 315,089 beneficiaries, 23,970 (7.6%) received SACT within 30 days of death. The breakdown by type was cytotoxic therapy 50.6%, immunotherapy 20.8%, targeted therapy 18%, and combination therapies 10.6%. After adjusting for covariates, any SACT use EOL was associated with higher ED use (odds ratio [OR], 3.05 [95% CI, 2.95 to 3.15]), hospital admissions (OR, 2.64 [95% CI, 2.56 to 2.72]), ICU admission (OR, 1.78 [95% CI, 1.72 to 1.83]), hospital death (OR, 2.02 [95% CI, 1.96 to 2.08]), and lower hospice use (OR, 0.51 [95% CI, 0.50 to 0.53]) compared with no SACT. All subtypes of SACT were individually associated with higher health care utilization and lower hospice use (P < .001).
CONCLUSION
All subtypes of SACT use were associated with markers of worse-quality EOL care. These data can inform decisions for current care guidelines and efforts to reduce overutilization.
Author Affiliations
1Yale School of Medicine, New Haven, CT; 2MD Anderson Cancer Center, Houston, TX; 3Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel; 4Yale New Haven Hospital, New Haven, CTRelated Articles
Novel Systemic Anticancer Treatments and Health Services Use the End of Life Among Adults With Cancer
This study reviewed the effects of using novel agents (immunotherapy and targeted therapy) in patients at the end of life (EOL), based on the perception that these therapies may be less toxic than chemotherapy. Adjusted odds of high health service utilization and hospital death were more than twofold greater among patients receiving systemic anticancer therapy (SACT) at the EOL compared to those receiving none.
Prescribing Changes After Accelerated vs Regular Approval of Oncology Therapies
This study analyzed prescribing patterns for oncology drugs granted FDA Accelerated Approval (AA) versus those later converted to Regular Approval (RA) using data from over 63,000 patients with advanced solid tumors. Prescribing of AA drugs increased sharply—by an average of 23 percentage points—immediately after AA, while conversion to RA led to only a minimal further increase. Off-label use of AA drugs, either in earlier lines of therapy or in biomarker-negative patients, was rare. The findings suggest that oncologists rapidly adopt AA drugs into practice, often without waiting for confirmatory evidence required for RA. In summary, AA status drives substantial and immediate uptake of oncology drugs, highlighting the importance of timely confirmatory trials to ensure clinical benefit.
Mapping the rapid growth of multi-omics in tumor immunotherapy: Bibliometric evidence of technology convergence and paradigm shifts
The article demonstrates that multi-omics research in tumor immunotherapy has grown rapidly since 2019, with China leading in publication volume but showing limited international collaboration. Early research focused on immune checkpoint blockade, while recent trends emphasize machine learning, multi-omics integration, and lncRNA, reflecting a shift toward predictive modeling and biomarker discovery. Multi-omics approaches have enabled the development of immune infiltration-based prognostic models and identified metabolic and spatial biomarkers, such as oxidative phosphorylation in melanoma and ENPP1 in Ewing sarcoma, which may guide therapeutic strategies. Overall, the study provides a systematic framework for tracking technological convergence and emerging frontiers, highlighting the need for longitudinal omics monitoring, AI-driven integration, and enhanced international collaboration to optimize precision-driven tumor immunotherapy.
Nonoperative Management of Mismatch Repair—Deficient Tumors
Two cohorts, one for patients with colon cancer and the second for all other patients. Of the 103 patients who completed treatment across both cohorts, 84 had a clinical complete response and 82 did not undergo surgery. Among the 117 total patients, recurrence-free survival at two years was 92%. Only 20-months follow up for now. It will be interesting to see how this goes with future updates but seems promising.