Stage III-IV Cancer Research Articles

Quality of life and somatic physical function of patients with colorectal cancer who underwent oxaliplatin-based systemic chemotherapy: a prospective study.

This study aimed to study the potential effects of oxaliplatin-based chemotherapy on cardiorespiratory fitness, handgrip strength (HGS), body composition, and quality of life (QoL) of stages III-IV colorectal cancer (CRC) patients before the first cycle (T0) and after the last cycle of systemic adjuvant/neoadjuvant chemotherapy (T1). Cardiorespiratory fitness, HGS, body composition, and QoL were evaluated with the six-minute walk test (6MWT), hydraulic hand dynamometer, body composition analyzer, and Functional Assessment of Cancer Therapy-Colon (FACT-C) questionnaire in both T0 and T1, respectively. Twenty-eight CRC patients were included in this study. The total walked distance (TWD) was found to be decreased from T0 to T1 (499.72m vs. 488.56m); however, this change was not significant (z = -.706, p = 0.48). Type of chemotherapy whether adjuvant or neoadjuvant also showed no significant effect on TWD (z = -.1.372, p = .17 vs z = -1.180, p = .238, respectively). The QoL was significantly decreased (T0 = 118.35 vs T1 = 110.77, t = 2.176,p = 0.05). The TWD was significantly correlated with the physical well-being (PWB) subscale of FACT-C (r = .64, p = 0.001) as well as with HGS (r = .46, p = .018) in T0. After controlling for age, type of chemotherapy, and type of regimen, the HGS did not show a significant difference from T0 to T1 (F(1,23) = 1.557, p = .22, ηp2 = .06). However, the effect of time x gender showed significant difference from T0 to T1 (F(1,23) = 4.906, p = .037, ηp2 = .17). This study showed the decreased QoL and physical well-being of CRC patients who underwent oxaliplatin-based treatment. In addition, the gender effect of decreased HGS should be considered further when planning an oncological rehabilitation program.

Spillover effects of Medicaid expansion on insurance coverage among low-income older individuals newly diagnosed with cancer.

168 Background: Medicaid expansion is associated with increased insurance coverage and improved health outcomes among patients diagnosed with cancer < 65 years. Although not the target population, individuals ≥65 years may benefit from Medicaid expansion through “welcome mat” effects – the indirect increase in enrollment, particularly those with low income eligible for both Medicaid and Medicare (dual-eligible). This study aims to examine the associations of Medicaid expansion with Medicaid coverage, including both dual-eligible and Medicaid-only, among individuals diagnosed with cancer. Methods: Using the National Cancer Database, we identified patients ≥65 years newly diagnosed with cancer between 2010-2019 with income below 138% federal poverty level. We applied a quasi-experimental design, the difference-in-difference approach, with multivariable linear probability models to compare the changes in the percentage of dual-eligible or Medicaid-only coverage post (vs. pre) Medicaid expansion in expansion v. non-expansion states. Analyses were also stratified by key demographic characteristics. Results: A total of 256,997 patients with cancer were identified, with 136,373 patients from expansion states and 120,624 patients from non-expansion states. After adjusting for sociodemographic characteristics, the percentage of patients with dual or Medicaid-only coverage increased from 16.84 to 18.09 in expansion states and decreased from 14.14 to 12.62 in non-expansion states, resulting in a net increase of 2.11 percentage points (ppt, 95% confidence interval: 1.55, 2.67) associated with Medicaid expansion. Differences were more pronounced among patients diagnosed with stage III-IV cancers (DD: 2.53 ppt, 95%CI: 1.58, 3.48), racialized as non-Hispanic Black (DD: 3.71 ppt, 95%CI: 2.70, 4.73), residing in metropolitan areas (DD: 2.77 ppt, 95%CI: 2.08, 3.47), with two or more comorbidities (DD: 4.14 ppt, 95%CI: 2.47, 5.80), and treated in comprehensive (DD: 2.98 ppt, 95%CI: 2.02, 3.94) or academic cancer centers (DD: 3.31 ppt, 95%CI: 2.14, 4.49). Conclusions: Medicaid expansion was associated with an increase in Medicaid enrollment among patients diagnosed with cancer at 65 or older, suggesting spillover benefits of Medicaid expansion in supporting low-income elderly populations with cancer.

Endoscopic diagnosis of larynx pathology

Despite the large number of publications devoted to the diagnosis of laryngeal pathology, the issues of timely and early diagnosis of malignant neoplasms of this localization still remain very relevant. In 2022, the proportion of patients with laryngeal cancer in stages I-II was 40.3%, stage III - 30.3%, stage IV - 28.4%, while 13.1% were actively detected. Accordingly, stage III-IV cancer of the larynx accounts for 58.7%.

Cancer incidence and mortality in the Far Eastern Federal District (2013–2022)

The aim of the study was to assess the territorial patterns in cancer incidence and mortality among the population of the Far Eastern Federal District in the period 2013–2022. Material and Methods. Data from official reports of cancer services (form No 35, No. 7) processed using standard cancer statistics programs were presented. Results. In the east of the country, 31,822 new cancer cases were registered in 2022, which was 1.3 % more than in 2021. The average cancer incidence rate in males was 294.06 ± 5.05 per 100,000 (2020: 296.94 ± 4.66), with a decrease rate of 3.0 %. In females, the equivalent rate increased to 240.96 ± 5.73 per 100,000 (2020: 237.92 ± 6.26 per 100,000) with a rise of 6.3 %. Skin cancer was the most common malignancy (11.6 %) followed by trachea, bronchi, lung (11.5 %), breast (11.3 %) and colon (6.3 %) cancers. The percent of actively detected patients increased to 23.2 % (2013: 14.0 %) as did the index of accumulation of contingents – 7.3 (2013: 5.3). The number of patients with stage I–II cancer increased to 57.0 % (2013: 47.5 %), while the number of stage III-IV cancers decreased to 20.8 % (2013: 24.7 %). The number of morphologic studies (94.1 %) was lower than the average for RF (95.8 %). The proportion of patients registered for five or more years decreased to 57.2 % (RF: 58.2 %). The average cancer mortality rate in men was 174.99 ± 3.10 per 100,000 (2020: 181.76 ± 2.51 per 100,000). The average cancer mortality rate in women was lower than in men, being 91.34 ± 1.20 per 100,000 (2020: 93.71 ± 0.80о per 100,000). Cancers of trachea, bronchi and lung (20.0 %), stomach (8.9 %), colon (7.0 %) and breast (6.6 %) were the leading causes of mortality. Conclusion. The low level of active cancer detection did not significantly change the incidence rates during the study period. A greater volume of preventive measures with improvement of their quality will enable the primary health care system to detect cancer at early stages, form groups being at high risk for cancer development and, consequently, to reduce mortality rates. A prerequisite for improving medical care for cancer patients is the continuous training of professional staff and the use of modern diagnostic and treatment technologies.

Identifying the factors affecting financial toxicity status in patients with middle and advanced colorectal cancer: a cross-sectional study.

Colorectal cancer (CRC) ranks as the second most prevalent type of cancer in China. The financial implications of treatment are a significant factor to be taken into account for patients diagnosed with middle and advanced stages of colorectal cancer (III-IV CRC). The research aims to explore current financial toxicity (FT) conditions and analyze factors that may influence it in patients with middle and advanced CRC. This is a cross-sectional survey. The participants of the study were individuals diagnosed with middle and advanced colorectal cancer who were admitted to the hospital between January and June 2023. The cross-sectional survey utilized a variety of instruments, including a general information questionnaire, a cancer patient report outcome economic toxicity scale, a medical coping style questionnaire, an Anderson symptom assessment scale, a disease shame scale, and a social support scale. Multiple linear regression analysis was employed to examine the factors influencing FT. A cohort of 264 patients diagnosed with stage III-IV CRC were included in the study. The majority of patients with intermediate and advanced CRC (87.1%, n = 230) reported experiencing substantial financial strain. Multivariate analysis revealed that factors influencing FT included low family monthly income, out-of-pocket expenses, unemployment, undergoing surgical treatment, the level of stigma, and the severity of symptoms (P < 0.001). Patients with stage III-IV cancer (CRC) demonstrate increased levels of financial toxicity (FT), a common occurrence in individuals with moderate to severe CRC. In patients with stage III-IV CRC, the presence of FT is correlated with various factors including family monthly income, medical payment methods, work status, surgical treatment, stigma levels, and symptom severity. These characteristics may serve as influencing factors for subsequent treatment decisions.

Risk factorsfor preoperative frailty in older patients withgastric cancer: a systematic review and meta-analysis.

To summarize the available evidence on risk factors for preoperative frailty in older gastric cancer patients. We comprehensively searched the CNKI, Wanfang, VIP, CBM, PubMed, Embase, The Cochrane Library, Web of Science, and CINAHL databases for preoperative articles on risk factors for frailty in older gastric cancer patients. The search was conducted from the time of construction of the library to January 27, 2024, with no language restrictions. The quality of the included studies was rated by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Qualitytool. A total of 20 studies were included, including 16 cohort studies and 4 cross-sectional studies, with a total sample size of 51,717 individuals. The results of the meta-analysis showed that age, albumin, hemoglobin, cancer stage III-IV, Charlson Comorbidity Index score ≥ 3, Eastern Cooperative Oncology Group score > 2, American Society of Anesthesiologists score > 2, smoking, nutritional risk, high school degree or above, and sleep disorders are the main influencing factors for the occurrence of preoperative frailty in older gastric cancer patients. Among them, high school degree or above was aprotective factor. Our study provides valid evidence of risk factors for preoperative frailty in older patients with gastric cancer and informs clinical healthcare professionals to make targeted interventions.

Polymorphic variants of the &lt;i&gt;PPP1R21&lt;/i&gt; gene associated with the level of sex hormone-binding globulin and the risk of various stages of breast cancer

Aim. To assess the relationship of polymorphic gene variants associated with the level of sex hormone-binding globulin (SHBG) according to genome-wide association studies (GWAS) with the risk of stage I–II and stage III-IV breast cancer. Materials and methods. A comparative genetic analysis was carried out on samples of patients with breast cancer: 254 patients with stages I–II and 91 with stages III–IV, and 1140 females of the control group. The paper considers 4 single nucleotide substitutions associated with the level of circulating SHBG according to GWAS: g.107546375AG PRMT6 (rs17496332), g.27519736TC GCKR (rs780093), g.48419260TC PPP1R21 (rs10454142), g.98364050TA BAIAP2L1 (rs3779195). Results. Differences in the involvement of polymorphic variants of SHBG candidate genes in the development of stages I–II and III–IV breast cancer were revealed. The rs10454142 TC polymorphic variant in the PPP1R21 gene is associated with the risk of stage I–II breast cancer: women with an allelic variant of this locus have a higher risk of early-stage disease (T/T vs. T/C vs. C/C, odds ratio 1.35, 95% confidence interval 1.05-1.75; p=0.021; ppermutat=0.027). Also, an increase in the number of C alleles in the female genotype increased the risk of stage I–II breast cancer by 17–18% per allele. There were no associations of polymorphic variants of SHBG candidate genes with the risk of severe disease (stage III–IV). The single nucleotide substitution rs10454142 TC in the PPP1R21 gene and the single nucleotide polymorphisms strongly linked to it are functionally significant (located in the regions of enhancers and promoters) in the epithelial and myoepithelial cells of the mammary gland and liver, affect the level of genome methylation, and are associated with the level of GTF2A1L gene expression.

Abstract PO2-12-02: Frailty among long-term breast cancer survivors

Abstract Background Cancer and its associated treatments may accelerate aging, resulting in increased frailty in survivors. However, the effect of breast cancer (BC) and treatment on frailty among long-term BC survivors has not been well investigated. This study aims to evaluate frailty prevalence and its association with clinical characteristics and treatment among 5-year BC survivors. Methods This study included 353 5-year BC survivors and 214 non-cancer control women aged ≥40 who were recruited to an ongoing breast health study at Vanderbilt University Medical Center between 2004 and 2017, and completed an online survey between May, 2022 and June 2023. Information collected includes demographics, lifestyle, disease history, and current health/functional status. A 26-item cumulative deficit index (CDI) was calculated as the proportion of deficits presented, including aging-related diseases, physical and mental health, activities of daily living, and social well-being, based on survey responses. CDI was categorized as robust (≤0.2), pre-frail (0.2-≤0.35), and frail ( &amp;gt;0.35). Cancer characteristics and treatment information was gathered from tumor registry. Multinomial logistic regression models were used to assess the association of CDI levels with case-control status, and BC clinical characteristics and cancer treatment among BC cases, with adjustment for age at survey (years), follow-up duration (5-≤10 and &amp;gt;10 years), and baseline Charlson comorbidity index (0, 1, and ≥2), and additional adjustment for BC stage and subtype in the analysis of treatment. Results The median time interval from BC diagnosis to survey was 12 years (range 5-34 years) for BC survivors. 90% of the participants were White. On average, BC patients were 3.8 years older at survey than controls [mean±SD (range) 64.5±9.2 (40-88) vs 60.7±10.3 (40-87), p&amp;lt; 0.001]. Among BC survivors, 41% had stage I, 39% stage II, and 8% stage III-IV cancer; 62% had a hormone receptor+/HER2- BC, followed by 22% HER2+ and 16% triple-negative BC. The majority of BC survivors underwent surgical resection (97%), and &amp;gt;50% received hormone therapy (59%), radiation therapy (53%), and chemotherapy (51%). BC survivors had a higher CDI score than controls (median 0.23 vs 0.19, p=0.01), with 34% and 18% of BC survivors being pre-frail and frail, compared with 25% and 16% in controls. After multivariable adjustment, BC survivors had a non-significantly increased prevalence of pre-frailty with odds ratio (OR) and 95% confidence interval (CI) of 1.49 (0.98-2.25), but a similar prevalence of frailty [OR (95% CI) = 1.08 (0.65-1.79)] compared to controls. BC survivors aged 40-65 had significantly elevated odds of pre-frailty [OR (95% CI) = 2.59 (1.44-4.63)]. Among BC survivors, frailty was significantly associated with stage [stage III-IV vs I: OR (95% CI) = 4.03 (1.27-12.78)] and chemotherapy [OR (95% CI) = 4.39 (1.71-11.30)], particularly among survivors aged ≥65 and 10-year survivors, but not BC subtype. Radiation therapy was associated with increased odds of pre-frailty among BC survivors aged 40-65. Conclusions This study suggests that long-term BC survivors younger than 65 are at increased odds of pre-frailty than non-cancer women. Frailty is associated with BC stage and chemotherapy among BC survivors, and radiotherapy among survivors younger than 65. More research is needed to investigate whether specific cancer treatment regimen is associated with frailty and other factors (e.g. lifestyle and genetics) that may modify the risk of frailty. The associations of frailty with cancer characteristics and treatments among breast cancer survivors Citation Format: Cong Wang, Jill De Vis, Kirsten Nguyen, Mason Alford, Brigitte Jia, Bapsi Chakravarthy, Xiao-Ou Shu. Frailty among long-term breast cancer survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-02.

Assessment of Chemotherapy-Induced Cardiac Dysfunction in Breast Cancer Patients: A Prospective Study.

Background Advances in cancer treatment have markedly improved survival rates but have also heightened morbidity due to treatment-related side effects. Despite this, the literature remains scarce on predicting the incidence of acute cardiac toxicity resulting from chemotherapy. We conducted a prospective evaluation to assess the incidence, timing, clinical correlates, global longitudinal strain (GLS), and response to heart failure (HF) therapy in patients experiencing cardiotoxicity. Aims and objectives Our study aimed to assess the cardiovascular complications of cancer therapy in breast cancer patients, with particular emphasis on therapy-related cardiac dysfunction. Materials and methods We conducted a prospective observational study to detect chemotherapy-related cardiac dysfunction (CTRCD) in breast cancer patients attending the outpatient department (OPD) or admitted to Dayanand Medical College and Hospital (DMCH), Ludhiana, Punjab, between March 1, 2020, and October 31, 2021. We assessed left ventricular ejection fraction (LVEF) at baseline, mid-chemotherapy, and post-chemotherapy. Patients who developed left ventricular dysfunction (LVD) had their chemotherapy regimen modified and were initiated on HF therapy. Results Ninety-seven patients (mean age: 50.74±10.30 years) were enrolled and categorized into the LVD group (n=13) and non-LVD group (n=84). CTRCD developed in 13 patients (13.4%). Patients with estrogen receptor (ER) positive, progesterone receptor (PR) positive, and human epidermal growth factor receptor 2 (HER2) positive status, as well as those in cancer stages III and IV, are at higher risk of developing LV dysfunction. Among the 13 patients, 10 (77%) experienced complete recovery, while three (23%) had partial recovery. Markers for partial recovery included cancer stages III-IV, younger age, lower body mass index (BMI), lower radiotherapy dosage, lower mean chemotherapy dosage, and left breast involvement. Conclusion Our findings suggest that acute cardiotoxicity is not linked to the cumulative dose of anthracyclines. Early detection, modification of chemotherapy regimens, and prompt initiation of CTRCD therapy can lead to substantial recovery of cardiac dysfunction.

Cancer Stage Compared With Mortality as End Points in Randomized Clinical Trials of Cancer Screening

Randomized clinical trials of cancer screening typically use cancer-specific mortality as the primary end point. The incidence of stage III-IV cancer is a potential alternative end point that may accelerate completion of randomized clinical trials of cancer screening. To compare cancer-specific mortality with stage III-IV cancer as end points in randomized clinical trials of cancer screening. This meta-analysis included 41 randomized clinical trials of cancer screening conducted in Europe, North America, and Asia published through February 19, 2024. Data extracted included numbers of participants, cancer diagnoses, and cancer deaths in the intervention and comparison groups. For each clinical trial, the effect of screening was calculated as the percentage reduction between the intervention and comparison groups in the incidence of participants with cancer-specific mortality and stage III-IV cancer. Randomization to a cancer screening test or to a comparison group in a clinical trial of cancer screening. End points of cancer-specific mortality and incidence of stage III-IV cancer were compared using Pearson correlation coefficients with 95% CIs, linear regression, and fixed-effects meta-analysis. The included randomized clinical trials tested benefits of screening for breast (n = 6), colorectal (n = 11), lung (n = 12), ovarian (n = 4), prostate (n = 4), and other cancers (n = 4). Correlation between reductions in cancer-specific mortality and stage III-IV cancer varied by cancer type (I2 = 65%; P = .02). Correlation was highest for trials that screened for ovarian (Pearson ρ = 0.99 [95% CI, 0.51-1.00]) and lung (Pearson ρ = 0.92 [95% CI, 0.72-0.98]) cancers, moderate for breast cancer (Pearson ρ = 0.70 [95% CI, -0.26 to 0.96]), and weak for colorectal (Pearson ρ = 0.39 [95% CI, -0.27 to 0.80]) and prostate (Pearson ρ = -0.69 [95% CI, -0.99 to 0.81]) cancers. Slopes from linear regression were estimated as 1.15 for ovarian cancer, 0.75 for lung cancer, 0.40 for colorectal cancer, 0.28 for breast cancer, and -3.58 for prostate cancer, suggesting that a given magnitude of reduction in incidence of stage III-IV cancer produced different magnitudes of change in incidence of cancer-specific mortality (P for heterogeneity = .004). In randomized clinical trials of cancer screening, incidence of late-stage cancer may be a suitable alternative end point to cancer-specific mortality for some cancer types, but is not suitable for others. These results have implications for clinical trials of multicancer screening tests.

Abstract 1265: Comparison of mortality- vs. stage-based endpoints in randomized trials of cancer screening: A systematic review with implications for multi-cancer screening trials

Abstract Background: Randomized controlled trials (RCTs) assessing the endpoint of late-stage cancer incidence, rather than the gold-standard of cancer-specific mortality, are proposed for evaluation of multi-cancer early detection tests. Methods: We conducted a systematic review to assess whether stage-based endpoints can provide a valid alternative for mortality-based endpoints (registration: PROSPERO CRD42023411132). We searched PubMed to identify RCTs of cancer screening interventions published in English before January 20, 2023. Inclusion required that RCTs report, by study arm, numbers of cancer-specific deaths and cancer cases distinguishable between stages I-II vs. III-IV. Data extraction was done by 2 separate reviewers and included the numbers of cancer cases, deaths, and participants by study arm. For each trial, we calculated the percentage reduction in the cumulative (a) late-stage cancer incidence and (b) cancer-specific mortality between the intervention and control arms. We compared these two endpoints based on Pearson correlation coefficients, fixed-effects meta-analysis, and binary statistical significance. Results: We analyzed 41 trials ranging in size from 2,500 to 409,000 participants. Correlation between the reduction in cancer-specific mortality vs. stage III-IV cancer was strong for lung (Pearson’s ρ=0.92, n=12), breast (ρ=0.70, n=6), and ‘other’ cancers (ρ=0.69, n=8) but weak for colorectal (ρ=0.39, n=11) and prostate cancers (ρ&amp;lt;0, n=4). The overall correlation by fixed-effects meta-analysis across cancer types was 0.71 (95%CI=0.47-0.86) (I2=0.55). In larger trials, there was a smaller deviation between the observed reduction in cancer-specific mortality and that predicted, by cancer type, based on the trial’s reduction in stage III-IV cancer (p=0.02). Of 12 trials demonstrating a statistically significant reduction in stage III-IV cancer incidence (p&amp;lt;0.05), 5 also showed reduced cancer-specific mortality (42%). Conclusions: In screening RCTs, reductions in late-stage cancer vs. cancer-specific mortality are correlated, but with important differences by cancer type. Screening interventions that reduce late-stage cancer incidence do not necessarily reduce cancer-specific mortality. Citation Format: Xiaoshuang Feng, Hana Zahed, Justina Onwuka, Mattias Johansson, Ruth Etzioni, Matthew E. Callister, Hilary A. Robbins. Comparison of mortality- vs. stage-based endpoints in randomized trials of cancer screening: A systematic review with implications for multi-cancer screening trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1265.

Abstract 2452: Clinical importance of nicotinamide nucleotide transhydrogenase in obesity-associated colorectal cancer

Abstract Background: Obesity is increasing worldwide, and many associated diseases are emerging as global health problems. There is a relationship between body mass and the risk of developing colorectal cancer (CRC). However, predictive biomarkers of survival with body mass remain elusive. Therefore, we aimed to identify novel clinically relevant biomarkers for obesity-associated CRC. Methods: We searched for biomarker candidates in The Cancer Genome Atlas CRC cohort. We divided the TCGA CRC cohort (n=268) data into 3 groups (healthy weight CRC group [HT], adjacent normal tissue from the HT group [AN]), and obesity CRC group [OT]). Candidates were validated by survival analysis after immunohistochemistry in an independent cohort of 420 patients. Results: The gene expression levels of NNT, PANK3, PPARGC1B, RTL6, FAM220A, and TMEM9 were associated with survival in overweight and obese patients with CRC from TCGA cohort. These findings were validated using protein expression data from our independent cohort. In our patient cohort, the hazard ratio (HR) of the subgroup of low NNT versus that of high NNT in terms of 5-year event-free survival (EFS) was 2.20 (adjusted for age and sex, 95% CI: 1.01-4.80, p &amp;lt; 0.05) among patients of obesity-associated CRC. When both TNM staging and NNT expression were considered, patients of obesity-associated CRC with low NNT expression and advanced stage III-IV cancer had a HR of 21.20 (adjusted for age and sex, 95% CI: 2.88-156.08, p &amp;lt; 0.01) compared to those with high NNT expression and early stage I-II cancer. However, when patients of obesity-associated CRC with high NNT expression and advanced stage III-IV cancer were compared to those with high NNT expression and early stage I-II cancer, the former subgroup had a HR of 8.39 (adjusted for age and sex, 95% CI: 1.03-68.39, p &amp;lt; 0.05) in terms of the 5-year EFS. Finally, when the 5-year disease-specific survival analysis was performed, the patients of obesity-associated CRC with low NNT expression and advanced stage III-IV cancer were found to have a HR of 14.05 (adjusted for age and sex, 95% CI: 1.89-104.38, P = 0.01) compared to those with high NNT expression and early stage I-II cancer. Furthermore, low NNT expression results in the inactivation of several metabolic pathways, including ROS-related pathways. Conclusions: NNT is a novel and promising CRC prognostic biomarker for overweight and obese patients. It can provide clinicians with early indicators of patient prognosis and aid in appropriate treatment selection. Citation Format: Soyeon Jeong, Sungjin Park, Jungsuk An, Myunghee Kang, Seungyoon Nam, Jung Ho Kim. Clinical importance of nicotinamide nucleotide transhydrogenase in obesity-associated colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2452.

Keratin-based topical cream for radiation dermatitis during head and neck radiotherapy: a randomised, open-label pilot study.

Radiation dermatitis (RD) is a frequent toxicity during radiotherapy (RT) for head and neck cancer (HNC). We report the first use of KeraStat® Cream (KC), a topical, keratin-based wound dressing, in patients with HNC receiving RT. This pilot study randomized HNC patients treated with definitive or postoperative RT (≥60 Gy) to KC or standard of care (SOC), applied at least twice daily during and for 1-month after RT. Outcomes of interest included adherence to the assigned regimen (at least 10 applications per week of treatment), clinician- and patient-reported RD, and skin-related quality of life. 24 patients were randomized and completed the study. Most patients had stage III-IV disease and oropharynx cancer. Median RT dose was 68 Gy; the bilateral neck was treated in 19 patients, and 18 patients received concurrent chemotherapy. Complete adherence was observed in 7/12 (SOC) vs. 10/12 (KC, p = 0.65). Adherence by patient-week was 61/68 versus 64/67, respectively (p = 0.20). No differences in RD were observed between groups. A randomized trial of KC versus SOC in HNC patients treated with RT is feasible with good adherence to study agent. An adequately powered randomized study is warranted to test the efficacy of KC in reducing RD.

IMMEDIATE AND LONG-TERM OUTCOMES OF COMPREHENSIVE TREATMENT FOR PATIENTS WITH OVARIAN CANCER STAGE III-IV

Summary. Aim:to evaluate the immediate treatment outcomes and overall and relapse-free survival of patients with ovarian cancer stage III-IV depending on the treatment method. Object and methods: the study presents the overall and relapse-free survival results of 269 patients with ovarian cancer stage III-IV who received comprehensive treatment at the “Prykarpattia Clinical Oncology Center of the Ivano-Frankivsk Regional Council” between 2017 and 2023. Patients were divided into 3 groups based on the treatment method: Group I – primary cytoreductive surgery followed by 6 adjuvant cycles of polychemotherapy (PCT); Group II – three neoadjuvant cycles of PCT, interval cytoreductive surgery, and adjuvant PCT; Group III – 6 cycles of PCT. All patients received chemotherapy following the paclitaxel-carboplatin regimen. Results: in all groups, 19 (7%) cases of platinum-resistant ovarian cancer were identified, and the treatment outcomes for these patients were not included in survival calculations. The 3-year overall cumulative survival rate was 50% in group I, 58% in group II, and 36% in group III. The median overall survival in group I was 31 months, in group II – 37 months, and in group III – 17 months. The 3-year relapse-free cumulative survival was 24% in group I, 48% in group II, and 36% in group III. The median relapse-free survival in group I was 19 months, in group II – 25 months, and in group III – 17 months. Conclusions: relapse-free and overall survival rates were significantly better in patients who received comprehensive treatment compared to those who only underwent chemotherapy cycles. The use of neoadjuvant chemotherapy in patients with stage III-IV ovarian cancer improves relapse-free survival but does not affect overall survival compared to patients who underwent primary cytoreductive surgery.

The effect of digital acupressure on chemotherapy-induced nausea in Indonesian patients with stages III-IV breast cancer

Patients with breast cancer are reported to experience nausea and vomiting during neoadjuvant chemotherapy. Both remain the most troubling side effects of chemotherapy, even in the era of new antiemetic agents. Hence, our study aims to investigate the clinical outcome of acupressure in the prevention of acute chemotherapy-induced nausea (CIN) by evaluating the frequency and severity of nausea. This study was a randomized controlled trial consisting of 42 breast cancer patients, divided equally into two groups (experimental (acupressure) and control groups). Digital acupressure was performed at pericardium 6 (P6 or Neiguan) and stomach 36 (ST36 or Zusanli) points. Assessment of nausea was conducted by examining the frequency of nausea and measuring nausea-related subscores from the simulator sickness questionnaire (SSQ) and visual analog scale (VAS) within one hour after chemotherapy. Our study indicated that patients in the experimental group had significantly lower frequency and less severe nausea than those in the control group. In conclusion, acupressure effectively decreased the frequency and severity of nausea in breast cancer patients undergoing neoadjuvant chemotherapy. Acupressure could be implemented as an adjunct intervention in addition to antiemetic therapy for the prevention of CIN in breast cancer patients.

Construction of a prediction model for prognosis of bladder cancer based on the expression of ion channel-related genes.

To construct a prediction model for the prognosis of bladder cancer patients based on the expression of ion channel-related genes (ICRG). The clinical information and the expression of ICRG mRNA in breast cancer patients were obtained from the Cancer Genome Atlas database. Cox regression analysis, minimum absolute shrinkage and selection operator regression analysis were used to screen breast cancer prognosis related genes, which were verified by immunohistochemistry and real-time fluorescence quantitative PCR. The risk scoring equation for predicting the prognosis of patients with bladder cancer was constructed, and the patients were divided into high-risk group and low-risk group according to the median of risk score. The immune cell infiltration abundance was compared between the two groups. Kaplan-Meier survival curve and receiver operating characteristic curve (ROC curve) were used to evaluate the accuracy and clinical application value of the risk scoring equation. The factors related to the prognosis of bladder cancer patients were analyzed by univariate and multivariate Cox regression, and a nomogram for predicting the prognosis of bladder cancer patients was constructed. By comparing the expression levels of ICRG in bladder cancer tissues and normal bladder tissues, 73 differentially expressed ICRGs were screened out, of which 11 were related to the prognosis of bladder cancer patients. Kaplan-Meier survival curve suggested that the risk score based on these 11 genes was negatively correlated with the prognosis of patients. The area under the ROC curve (AUC) of the risk score for predicting the prognosis of patients at 1, 3 and 5 year was 0.634, 0.665 and 0.712, respectively. Stratified analysis showed that the ICRG-based risk score performed well in predicting the prognosis of patients with American Joint Committee on Cancer (AJCC) stage Ⅲ-Ⅳ bladder cancer (P<0.05), while it had a poor value in predicting the prognosis of patients with AJCC stage Ⅰ-Ⅱ (P>0.05). There were significant differences in the infiltration levels of plasma cells, activated natural killer cells, resting mast cells and M2 macrophages between the high-risk group and the low-risk group. Cox regression analysis showed that risk score, smoking, age and AJCC stage were independently associated with the prognosis of patients with bladder cancer (P<0.05). The nomogram constructed by combining risk score and clinical parameters has high accuracy in predicting the 1-, 3-and 5-year overall survival rate of bladder cancer patients. The study shows the potential value of ICRG in the prognostic risk assessment of bladder cancer patients. The constructed prognostic nomogram based on ICRG risk score has high accuracy in predicting the prognosis of bladder cancer patients.

Prognostic value of insulin-like growth factor receptor 1 (IGF1R) expression in high-grade serous ovarian cancer (HGSOC) treated with first line platinum derivative based chemotherapy.

e17577 Background: Insulin-like growth factor receptor 1 (IGF1R) expression is frequently observed in ovarian cancer patients. Based on data from the literature, the IGF1(IGF2)/IGF1R pathway may be associated with resistance to platinum derivative based chemotherapy. Methods: The study group included 64 Caucasian women with serous high-grade ovarian cancer (HSOC) stage III-IV TNM/FIGO classification, treated 1st line platinum derivative based chemotherapy between 2004-2014. The analysis of clinical data was carried out based on data from medical records. IGF1R expression was assessed by immunohistochemistry using the monoclonal antibody Roche Rabbit Monoclonal (G11) in tissues from paraffin-embedded blocks. Progression free survival (PFS) was analyzed as the time from the start of chemotherapy to progression. Overall survival (OS) was defined as the time from diagnosis to the patient's death, regardless of cause, or to the last contact with the patient. In all analyses, the significance level was p = 0.05. Statistical analysis was performed using the 3.4.3 version of R statistical environment. Results: The median follow-up was 1023 days (range 157 to 3420 days). The median PFS was 14.0 (95%CI: 11.9-18.0) months. Median OS was not reached. The average patients age was 62 years (range 37-83). Platinum-sensitivity, partial platinum-sensitivity, platinum resistance and platinum-insensitivity were found in 23 (37.1%), 17 (27.4%), 21 (33.9%) and 1 (1.6%) patients, respectively. Any IGF1R expression was noted in 57 patients with the median H-score of 220 (range: 0-300; IQR: 100-207). Median PFS for IGF1R H-score 220 and IGF1R &gt; 220 was 15.4 (95% CI: 13.1-23.3) and 10.8 (95% CI: 9.6-NA) months, respectively. In multivariate analysis PFS was associated with the extent of surgery: cytoreduction secondary vs. primary (WR = 1.94; p = 0.03), suboptimal vs. optimal (WR = 2.16; p = 0.01), body mass index (WR = 0.44; p = 0.05) and IGF1R expression ( &gt; 220) (WR = 2.84; p = 0.04). Conclusions: High expression of IGF1R (H-score &gt; 220) in stage III/IV HGSOC patients treated in 1st line platinum derivative-based chemotherapy is a negative prognostic factor.

Pretreatment fibrinogen levels are associated with survival outcome in patients with cancer using immunotherapy as a second‑line treatment.

The present study aimed to investigate the predictive value of pretreatment fibrinogen (FIB) levels in patients with cancer who received immunotherapy as a second-line treatment. A total of 61 patients with stage III-IV cancer were included. The cut-off value of FIB for predicting overall survival (OS) was determined by receiver operating characteristic curve analysis. The prognostic value of pretreatment FIB on progression-free survival (PFS) and OS was determined by univariate and multivariate analyses. Based on a cut-off point of 3.47 g/l, patients were divided into low pretreatment FIB (<3.47 g/l) and high pretreatment FIB (≥3.47 g/l) groups. A high pretreatment FIB level was more common in older patients (P=0.03). Kaplan-Meier analysis showed that patients with high pretreatment FIB levels had shorter PFS and OS times than patients with low FIB levels (P<0.05). In multivariate analysis, pretreatment FIB was an independent prognostic factor for OS [hazard ratio (HR), 6.06; 95% CI, 2.01-18.28; P<0.01] and OS from the initiation of second-line treatment (HR, 3.69; 95% CI, 1.28-10.63; P=0.02). Overall, FIB is associated with survival outcome in patients with cancer who are administered immunotherapy as a second-line treatment.

Impact of Oral Metronomic Chemotherapy in Locally Advanced Carcinoma of the Laryngopharynx: A Case Report

Oral cancer continues to be a significant health concern in Southeast Asia. The primary treatment involves surgical resection with or without reconstruction, along with adjuvant therapy. However, the survival rates for patients with stage I-II oral cancer range from 70% to 80%, whereas in more advanced stage III-IV cancers, these rates drop significantly to 40%-50%. Unresectable oral cancers are primarily managed with palliative intent, utilising systemic therapy and/or radiotherapy. Unfortunately, a substantial portion of these cases (around 60%-80%) are diagnosed at an advanced stage due to delayed diagnosis, limited access to definitive treatment, and financial constraints. These challenges underscore the critical need for therapies that can effectively halt cancer progression, promote regression, and maintain the disease in an operable state while awaiting definitive treatment, typically involving surgery. In this context, Oral Metronomic Chemotherapy (OMCT) emerges as a promising alternative. OMCT offers costeffectiveness and involves the regular administration of chemotherapeutic drugs at low doses without interruption. The concept of “metronomic” chemotherapy draws inspiration from a metronome, which produces regular ticks representing a constant pulse. Herein, the authors presented case report of a 55-year-old male patient to compile evidence-based data on the use of OMCT in treating locally advanced carcinoma of the laryngopharynx. It explores the mechanism of action, utility, and potential future directions of OMCT. By analysing a real-world case, it seeks to highlight the effectiveness and advantages of OMCT as a treatment option for oral squamous cell carcinoma.

Association of diabetes and breast cancer characteristics at diagnosis.

This study aims to examine the association of diabetes and breast cancer characteristics at diagnosis in Aotearoa/New Zealand. Patients diagnosed with invasive breast cancer between 2005 and 2020 were identified from the National Breast Cancer Register. Logistic regression modeling was used to estimate the adjusted odds ratio (OR) of having stage III-IV cancer and the OR of having stage IV cancer for women with diabetes compared to those without diabetes. The adjusted OR of having screen-detected breast cancers for patients aged 45-69years with diabetes compared to patients without diabetes was estimated. 26,968 women were diagnosed with breast cancer, with 3,137 (11.6%) patients having diabetes at the time of cancer diagnosis. The probability of co-occurrence of diabetes and breast cancer increased with time. Māori, Pacific and Asian women were more likely to have diabetes than European/Others. The probability of having diabetes also increased with age. For patients with diabetes, the probability of being diagnosed with stage III-IV cancer and stage IV cancer was higher than for patients without diabetes (OR 1.14, 95% CI 1.03-1.27; and 1.17, 95% CI 1.00-1.38). Women aged 45-69years with diabetes were more likely to have screen-detected cancer than those without diabetes (OR 1.13, 95% CI 1.02-1.26). The co-occurrence of diabetes and breast cancer is becoming more common. Overall there is a small but significant adverse impact of having advanced disease for women with diabetes that is found at the time of breast cancer diagnosis, and this may contribute to other inequities that occur in the treatment pathway that may impact on patient outcomes.