Accurate human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) scoring is crucial to identify patients for HER2-directed therapy; however, validated HER2 scoring guidelines are lacking for non-breast/gastric solid tumors. We investigated concordance in IHC scores from independent pathologists using three different scoring algorithms in non-gastric/breast solid tumors. Whole-slide scans of HER2-stained tumor samples from DESTINY-PanTumor02 (NCT04482309) and a commercial pan-tumor sample set were scored by three independent, board-certified pathologists using American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) scoring algorithms for gastric (reference) and breast cancers, and a clinical trial-based algorithm for endometrial cancers (evaluated for endometrial tumors only). The pathologists evaluated 488 samples from multiple solid tumor types. Mean positive percentage agreement (PPA; across pathologists) between the breast and gastric algorithms was higher for samples scored as IHC 3 + or IHC 0 compared with IHC 2 + or IHC 1 + . Inter-pathologist PPA for each algorithm was greatest in samples scored as IHC 3 + and IHC 0. The majority of inter-pathologist pairwise comparisons had Cohen's κ coefficient values > 0.4 when using the gastric or breast algorithm to determine IHC scores, indicating at least moderate agreement between pathologists; Cohen's κ coefficient values were generally lower (range 0.17-0.43) for the endometrial algorithm. ASCO/CAP scoring algorithms for gastric and breast cancer were comparable for identifying HER2 IHC 3 + tumors; lower concordance was observed for IHC 2 + /1 + tumors. These findings highlight a real-world issue of inter-pathologist variability and emphasize a need for greater awareness of best scoring practices.

BackgroundA significant subset of breast cancer cases is attributable to inherited pathogenic genetic variants. Germline genetic testing (GGT), particularly for BRCA1 and BRCA2, represents a critical tool for precision oncology, enabling individualized risk stratification and the development of tailored therapeutic strategies.MethodsConsecutive newly diagnosed breast cancer patients eligible for GGT testing according to the latest American Society of Clinical Oncology (ASCO) guidelines were enrolled.ResultsDuring the study period, 1,570 patients were enrolled, median age 51 (22-96) years, majority (n = 1,352, 86.1%) were Jordanian. Based on age criteria, 1,346 (85.7%) patients were eligible for testing. Another 134 (8.5%) were found eligible for testing because of other indications including personal or family history of breast and other cancers (n = 121, 7.7%), triple-negative disease (n = 9, 0.57%) and male gender (n = 4, 0.25%). In total, 1,480 (94.3%) patients were eligible for GGT as per ASCO guidelines, leaving only 90 (5.7%) patients not candidates for testing. Pathogenic/likely pathogenic variants were identified in 23 (7.8%) patients.ConclusionApplying universal GGT for all newly diagnosed breast cancer patients, regardless of their age or risk factors, would slightly increase the pool of eligible patients, the burden of which can be justified given its impact on improving referral rate.

Addition of androgen-receptor pathway inhibitors to standard of care in metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis.

Chemotherapy-induced peripheral neuropathy (CIPN) is a major potentially dose-limiting adverse event of certain anticancer drugs. There are chronic and acute polyneuropathies depending on the clinical manifestations. They are stopped in different ways. The main factors of acute CIPN are paclitaxel and oxaliplatin, acute CIPN can turn into chronic, which depends on the dose of cytostatic and could produce cumulative effect. Often, CIPN occurs with a gradual decrease in symptoms after discontinuation of treatment, but sometimes it continues to worsen for several months and after completion of therapy, in that case it is called the «inertia movement phenomenon». Until now, the effectiveness of drugs that would significantly reduce the manifestation of CIPN symptoms has not been proven. The situation is reflected in the 2020 American Society of Clinical Oncology (ASCO) guidelines for the prevention and treatment of CIPN, as well as in the ESMO/EONS/EANO collaborative guidelines. Given that already existing CIPN cannot be treated (the only option that remains is to relieve pain with selective serotonin reuptake inhibitors), but it can be aggravated and become irreversible, so clinicians carefully evaluate the effectiveness of cytostatics that cause neuropathy, especially in patients with existing moderate polyneuropathy. In this regard, the issue of CIPN prevention has been standing for a long time and work in this direction has been ongoing since the 2000s. At the moment, it is reliably known that exercise, cryotherapy or compression of the limbs or both methods together can partially prevent development of CIPN symptoms and seem to be quite safe. From 2022 to 2025, the author conducted his own observational study using various methods for prevention of CIPN. This study has shown its effectiveness and safety, as well as ease of use on the basis of any medical and preventive institution. The introduction in Russia of this method of prevention (bandaging with elastic bandages and cryoexposure in the treatment of taxanes and only bandaging in the treatment of oxaliplatin) helps patients to avoid severe manifestations of CIPN, which allows you to maintain an acceptable quality of life, without reducing the effectiveness of chemotherapy due to optimally selected doses and full-fledged regimens and it also positively affects survival.

Inherited mutations in the BRCA1/BRCA2 genes significantly increase the risk of breast and ovarian cancer in women of reproductive age, posing a clinical and socioeconomic challenge due to loss of fertility during cancer treatment and preventive interventions. The expansion of genetic testing programs is shifting the focus to proactive management of reproductive potential, requiring the integration of oncology, reproductive medicine, and medical genetics. The novelty of this review lies in its comprehensive synthesis of data on the impact of treatment and prevention of BRCA-associated cancer on fertility and a critical assessment of the effectiveness of fertility preservation strategies. Purpose of the study . To summarize and analyze current advances, clinical guidelines, and unresolved issues related to preserving reproductive function in women carrying BRCA1/BRCA2 mutations. Materials and methods . A systematic search of PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science was performed, along with an analysis of international guidelines (ESHRE (European Society of Human Reproduction and Embryology), ASCO (American Society of Clinical Oncology), ASRM (American Society for Reproductive Medicine), NCCN (National Comprehensive Cancer Network), ESMO (European Society for Medical Oncology)). Keywords: “BRCA1,” “BRCA2,” “fertility preservation,” “oocyte cryopreservation,” “embryo cryopreservation,” “ovarian tissue cryopreservation,” “PGT-M,” “PARP inhibitors,” and “chemotherapy gonadotoxicity.”, in the period of 2005–2025. Studies with incomplete data, duplicates, reviews of low methodological quality, and case series with fewer than 10 observations were excluded. Priority was given to meta-analyses, RCTs, large cohorts, and consensus reports. Results. The included studies included cancer patients before and after treatment, BRCA carriers with and without prophylactic strategies, and IVF/ICSI cohorts with cryopreservation. Alkylating agents and taxanes have been shown to increase the risk of premature ovarian failure, while GnRH agonists partially reduce the risk of ovarian toxicity. The efficacy of oocyte and embryo cryopreservation in BRCA-positive women is comparable to the population-­based efficacy with optimized stimulation (GnRH antagonists, letrozole-­containing protocols). Ovarian tissue cryopreservation is applicable in urgently needed patients but requires oncoprotective assessment. PGT-M ensures the selection of mutation-free embryos. Multidisciplinary pathways improve the timelines of referrals and the completion rate of fertility preservation programs Conclusion. Early identification of BRCA-positive women and the integration of a gynecologic oncologist, reproductive specialist, and geneticist enable personalized strategy selection: gamete/embryo cryopreservation, ovarian tissue, pharmacoprotection, and PGT-M. Standardized stimulation protocols and therapy timing, long-term safety and fertility data, and economic access models are needed. Improvements in biotechnology and patient pathways improve reproductive outcomes and quality of life.

Integrative Oncology (IO) is a patient-centered, evidence-based approach that combines conventional cancer treatments with complementary therapies, including mindfulness meditation, acupuncture, yoga, nutrition and exercise. These interventions are not intended to replace standard modalities like chemotherapy or radiation, but to support holistic well-being, physically, emotionally and spiritually across the cancer continuum. Mindfulness-Based Stress Reduction (MBSR) has emerged as an effective adjunct for mitigating psychological distress and enhancing quality of life. Increasing evidence demonstrates that emotional support improves adherence, immune function and overall patient engagement. Organizations such as the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) have issued guidelines endorsing these therapies for symptoms including pain, anxiety and fatigue.

The Evolution of Clinical Practice Guidelines for the Postoperative Treatment of Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma: Comments and Controversies.

Summary Purpose Cancer of unknown primary (CUP) in the head and neck region accounts for around 5% of malignancies, predominantly presenting as squamous cell carcinoma (SCCUP). Despite improved diagnostic modalities that have resulted in a decreasing incidence, therapeutic management of SCCUP remains challenging due to conflicting retrospective evidence. Materials and methods A comprehensive literature search was performed using the keywords “cancer,” “unknown,” “primary,” “cervical,” “head,” “neck,” “squamous,” “cell,” “carcinoma,” “treatment,” and “diagnosis” across the PubMed database and OpenEvidence platform. Current guidelines, including those from the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO), were analyzed to summarize state-of-the-art diagnostic and therapeutic strategies. Results A standardized diagnostic workup is essential and comprises medical history, comprehensive ENT examination, ultrasound-guided core needle biopsy, positron-emission tomography (PET/CT) imaging, and panendoscopy with palatine and lingual tonsillectomy. This approach enables identification of the primary tumor in up to 78% of cases. If a primary tumor is detected, treatment follows site-specific protocols. All SCCUP cases should be reviewed in a multidisciplinary tumor board, taking into account factors such as disease burden, immunohistochemistry (IHC), performance status, comorbidities, potential treatment-related toxicities, patient compliance, and expected functional recovery. Treatment strategies are neck dissection (ND) with adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) if necessary or definitive RT or CRT. Due to inconsistent retrospective studies, it is unclear which treatment modality is currently superior. Conclusion Management of SCCUP remains complex and requires individualized multidisciplinary decision-making. Prospective trials are essential to optimize treatment strategies.

A Comparative Review of Major International Guidelines for Venous Thromboembolism Prophylaxis in Gynecology.

Advances in cancer treatment and supportive care have resulted in more than 80% of pediatric cancer patients surviving into adulthood. This progress has prompted consideration of factors influencing long-term quality of life for patients, including fertility. The ability to have biological children is important to many survivors. Yet, gonadotoxic therapies, such as alkylating agents and radiation, can damage gonadal tissues and cause infertility. Since these treatments remain essential for cure, efforts have expanded to better understand fertility risks and preservation strategies. Prominent organizations, including the American Society for Reproductive Medicine, American Society of Clinical Oncology, American Academy of Pediatrics, Association of Pediatric Hematology/Oncology Nurses, and Children's Oncology Group, recommend all cancer patients receive comprehensive counseling on fertility risks and options. This review outlines current knowledge on fertility risk, preservation strategies, care barriers, and future directions to improve fertility preservation access and outcomes for pediatric cancer patients and survivors.

Cancer is still a leading world cause of death, being responsible for some ten million annual fatalities, as indicated by World Health Organization (WHO). The complex nature of oncology is a consequence of needing to inter-relate several sources of information, like genomic signatures, pathological reports, and clinical studies, to generate individualized therapy. Classical approaches to decision-making, based nearly solely on clinical expertise and labour-intensive scanning of published clinical work, are correspondingly threatened by increasing numbers of data on oncology and fluid nature of recommendations for treatment. As a result of all these constraints, a cognitive information system, called IBM Watson for Oncology, was constructed for supporting clinical decisions, based on evidence, for oncologists. With Natural Language Processing (NLP) and Machine Learning (ML) techniques, Watson analyses both structured and unstructured clinical information for recommending treatment procedures, following accepted protocols, such as those of National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO). This case study evaluates the architecture, modus operandi, and performance of IBM Watson for Oncology as a clinical decision-support system. The evaluation dwells on its capacity for delivering accurate, interpretable, and personal treatment recommendations and its capacity for concordance with decisions of oncologists for breast, lung, and colorectal cancer. Several studies report their results as having a high degree of concordance between Watson's recommendations and experts' judgment ranging between 70% and 96%. The results suggest the promise of AI-based systems like Watson for considerable improvement of consistency and efficiency of decision-making procedures across oncology. Concerns regarding data localization, interpretability, and constant learning are, however, critical areas requiring further improvement.

PROMENADE: pembrolizumab for early ER-low/HER2-negative breast cancer, real-world French cohort

Cross sectional analysis of long-term overall survival among patients taking immune checkpoint inhibitor drugs.

Background: The management of resected stage III colorectal cancer (CRC) has long been reliant on fluoropyrimidine-based adjuvant chemotherapy. However, the 10–15% of patients with mismatch repair-deficient (dMMR) tumors derive limited benefit from this approach. While immunotherapy has revolutionized the treatment of metastatic dMMR CRC, its role in the early-stage setting is rapidly evolving, creating a paradigm shift. Methods: A systematic literature review was conducted to identify pivotal clinical trials evaluating therapeutic strategies for non-metastatic dMMR CRC. Databases including PubMed/MEDLINE and conference proceedings from the American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) were searched up to June 2025. The review focused on phase II and III trials reporting on disease-free survival (DFS), pathological complete response (pCR), and safety. Study selection followed PRISMA guidelines. Results: The systematic review identified 14 key studies that were included for narrative synthesis. The evidence base encompassed three areas: (1) Foundational adjuvant chemotherapy trials (e.g., MOSAIC, IDEA); (2) Pivotal metastatic trials (e.g., KEYNOTE-177) validating immunotherapy efficacy in dMMR CRC; and (3) Modern trials in non-metastatic disease. The phase III ATOMIC trial demonstrated that adding atezolizumab to mFOLFOX significantly improved 3-year DFS versus chemotherapy alone (86.4% vs. 76.6%; Hazard Ratio [HR] 0.50, 95% Confidence Interval [CI] 0.34–0.72; p < 0.001). Concurrently, phase II neoadjuvant immunotherapy trials (e.g., NICHE-2) reported remarkable pCR rates of 68% and a 3-year DFS of 100%, with a more favorable safety profile compared to chemoimmunotherapy. Conclusions: The landscape for non-metastatic dMMR CRC is shifting from a chemotherapy-based model to an immunotherapy paradigm. The ATOMIC trial establishes adjuvant chemoimmunotherapy as a new standard, while robust neoadjuvant data suggest a potential future where short-course, chemotherapy-free immunotherapy could become a preferred strategy. Ongoing trials directly comparing these approaches are awaited.

Penile cancer is arare urological malignancy with approximately 36,000 new cases worldwide each year. In the first-line setting of locally advanced or metastatic disease, platinum-based chemotherapy is recommended, but it yields only moderate response rates, short remission durations, and considerable toxicity. Effective second-line treatment options are largely lacking, underscoring the urgent need for innovative therapeutic approaches. This article aims to summarize current evidence on immunotherapeutic and targeted treatment strategies in advanced penile cancer. Asystematic literature search was conducted in PubMed, complemented by recent abstracts and presentations from major congresses (American Society of Clinical Oncology, ASCO; ASCO Genitourinary, ASCOGU; European Society for Medical Oncology, ESMO) and clinical trial registries (clinicaltrials.gov). Immune checkpoint inhibitor monotherapy demonstrates response rates of 13-17% in unselected cohorts, with improved outcomes in patients with high tumor mutational burden or exclusively nodal metastases. In combination with chemotherapy, response rates increased to around 40%. Epidermal growth factor receptor (EGFR)-targeted antibodies achieved remissions in approximately one third of patients, albeit generally of short duration. Based on expression patterns of various surface proteins (EGFR, HER2, Nectin‑4, Trop-2), several antibody-drug conjugates are currently being evaluated in phaseII trials. Moreover, poly ADP ribose polymerase (PARP) inhibition may represent arational option in tumors harboring alterations in homologous recombination repair genes. Immuno- and targeted therapies open new perspectives for the management of advanced penile cancer. Because of the rarity of this malignancy, international collaborations are crucial to ensure adequate trial recruitment. Such efforts are essential to render innovative approaches accessible to abroader patient population and to strengthen the evidence base for future treatment strategies.

Updated American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) antiemetic guidelines recommend olanzapine for the prophylactic treatment of chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC). Inadequate treatment of CINV can result in compounding physical sequelae, ultimately affecting patients' tolerance and recovery throughout chemotherapy treatment. Regional Michigan Oncology Quality Consortium (MOQC) data have identified a wide range of compliance rates in the appropriate prescribing of olanzapine. Literature has shown that olanzapine is safe and effective for the treatment of acute and delayed CINV. The purpose of this quality improvement (QI) project was to improve the compliance rate of appropriate prescribing of olanzapine for CINV for adult patients receiving HEC within the project site's outpatient oncology clinic. The project was based on the Plan-Do-Study-Act (PDSA) model and implemented in an outpatient oncology clinic in a Midwestern urban area over a 6-month time period. A multidisciplinary and interactive education program was delivered to providers. Pre- and post-intervention data were collected by impartial, independent auditors. At monthly provider staff meetings, a presentation was provided to prescribers supplying information on the updated antiemetic guideline recommendations and the pharmacodynamics of olanzapine. An olanzapine frequently asked questions (FAQ) sheet was also provided to reinforce the reviewed material. Data collected following implementation showed an increase in appropriate prescribing of olanzapine from 82.05% to 94.74% (n = 76). A standard deviation Z-test for two population proportions showed the positive change in compliance rate was statistically significant at p < .05 where p was calculated at .02852. A sustainability audit 1 year after completion showed the rate of appropriate prescribing of olanzapine at 92.59% (n = 27), representing a decrease of 2.15 percentage points. A standard deviation Z-test demonstrated the decrease in comparative compliance rates was not statistically significant at p < .05. Audit data obtained following the implementation of the QI project revealed a statistically significant improvement, which supported the hypothesis that providing education based on the PDSA model is an effective method to improve the compliance rate of appropriate olanzapine prescribing for CINV in patients receiving HEC. The result reflects the growing body of evidence confirming the validity of the PDSA model.

BackgroundAlthough the number of clinical trials on lung cancer is rapidly increasing, the clinical benefits have not received sufficient attention. This study aims to assess the clinical benefits and estimate the minimal clinically important differences (MCIDs) for overall survival (OS) and progression-free survival (PFS) to provide quantitative guidance for treatment decisions and study design in lung cancer trials.MethodsThis study systematically searched lung cancer randomized controlled trials (RCTs) from PubMed, Embase, and the Cochrane Library. The clinical benefits were estimated using the frameworks of the European Society for Medical Oncology – Magnitude of Clinical Benefit Scale (ESMO-MCBS) and the American Society of Clinical Oncology – Value Framework (ASCO-VF). The MCIDs for OS and PFS were calculated using the distribution-based method. The differences in clinical benefits of lung cancer trials between the MCIDs and the two frameworks were compared.ResultsA total of 319 lung cancer RCTs were included. The mean improved OS and PFS were 2.28 and 1.76 months between the interventional and control groups, respectively. Around 15.79% of trials with OS as the primary endpoint were rated as grades 4 or above, and only 6.02% of trials with PFS as the primary endpoint reached grade 4 by ESMO-MCBS. The overall MCIDs for OS and PFS in non-small cell lung cancer (NSCLC) were 7.66 and 3.11 months, while 2.29 and 1.13 months in small cell lung cancer (SCLC), respectively. A total of 79.61% of RCTs evaluating OS (5.92% with clinical benefits and 73.68% without clinical benefits) and 68.26% evaluating PFS (3.59% with clinical benefits and 64.67% without clinical benefits) were consistently identified as reaching clinical benefits by the MCIDs and two frameworks.ConclusionsAlthough lung cancer RCTs showed statistically significant improvement in OS and PFS, most trials did not show clinical benefits, with a limited increase in survival months. A fair-to-moderate consistency of clinical benefits classification was observed between the MCIDs and the two frameworks. Further explorations into MCID are anticipated to deepen our understanding and promote its application in the future.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-15169-7.

Background: Transthoracic echocardiographic (TTE) surveillance for left ventricular dysfunction following cardiotoxic chemotherapy, particularly anthracyclines, is a key component of cardio-oncology care. The 2017 American Society of Clinical Oncology (ASCO) guidelines recommend routine TTE screening in older adults after anthracycline-based chemotherapy, but it remains uncertain if these guidelines had an effect on physician TTE ordering frequency. Methods: The Surveillance, Epidemiology, and End Results (SEER) Medicare dataset was used to identify older adults (&gt;65 years) with HER2-negative breast cancer, lymphoma, or soft tissue sarcoma who received anthracyclines for a first cancer diagnosis from 2010-2020. Monthly TTE surveillance rates (TTEs per eligible patient-month) in the first year following chemotherapy initiation were compared before and after the ASCO guideline release in January 2017 using an interrupted time series approach. Results: Of 15,045 individuals included (mean age 74.1 ± 5.9 years, 64.9% female, 84.9% White), 9,611 (63.9%) had lymphoma, 5,106 (33.9%) breast cancer, and 328 (2.2%) sarcoma. An average of 43.6% ± 1.3% of individuals received a surveillance TTE during the first year after chemotherapy (mean 7.2 ± 0.9% per month). The monthly TTE surveillance frequency remained constant prior to 2017 (-0.003%/month, 95% CI -0.01% to +0.007%, p = 0.58) and after 2017 (+0.18%/month, 95% CI -0.57% to +0.92%, p = 0.65), with no significant change following the ASCO guideline release (+0.03%/month, 95% CI -0.005% to +0.06, p = 0.11) ( Figure ). Conclusion: TTE surveillance rates did not significantly change following the release of the 2017 ASCO guidelines among older Medicare beneficiaries receiving anthracycline chemotherapy for non-HER2+ malignancies. More than half of older anthracycline treated patients did not receive a post-anthracycline TTE in the year after their cancer treatment.

Enhancing anticoagulation stewardship: A resident-focused quality improvement project

From deficiency to competency: Strategies to strengthen classical hematology training across the United States