Oncology Clinical Practice Research Articles

Sotorasib Treatment Could Worsen the Prognosis of Advanced KRASG12C-Mutated Non-Small Cell Lung Cancer

Sotorasib, the first RAS inhibitor FDA-approved drug for advanced, KRASG12C-mutated non-small cell lung cancer (NSCLC), was approved in May 2021 under the FDA-Accelerated Approval program. This commentary critically reviews the results on progression-free survival (PFS) and overall survival (OS) of the CodeBreaK 200 trial, a randomized, open-label, phase 3 trial published in The Lancet in 2023. The study reported increased PFS with sotorasib based on a reduced hazard ratio (HR). Despite the FDA's rejection of regular approval for sotorasib in October 2023, the accelerated approval status is maintained pending further confirmatory trials. We stress the crucial role of journal editors in ensuring the comprehensive reporting of statistical analyses in RCTs, particularly for publications in highly-ranked journals like The Lancet, which can heavily influence the clinical practice of oncology. Their role in upholding the highest scientific integrity and transparency standards is essential for informing oncologists, patients, and decision-makers of public health systems.

NIMG-03. USE OF ARTERIAL SPIN LABELING TO DIFFERENTIATE ICTAL PHENOMENON FROM TUMOR PROGRESSION IN HIGH GRADE ASTROCYTOMA

Abstract A 39-year-old female with grade-3 left parietal IDH-mutant astrocytoma following resection presented with convulsive status. EEG showed electrographic seizures arising from the left parietal region. MRI-brain showed the left temporoparietal post-treatment bed without any contrast enhancement (Fig-1A). Arterial spin labeling (ASL) – MR perfusion showed markedly increased cerebral blood flow (CBF) in the left temporoparietal lobe (Fig-1 C, D) with corresponding diffusion restriction (Fig-1B). Repeat imaging two weeks after the seizure control showed complete resolution (Fig-2) suggesting the imaging abnormalities to be a peri-ictal phenomenon.1 ASL-MR perfusion is a highly sensitive marker of increased CBF with its emerging application in distinguishing tumor progression (increased CBF) from post-treatment changes such as radiation necrosis (reduced CBF).1,2 This case highlights the utility of ASL-MR perfusion in differentiating peri/post-ictal phenomenon (increased CBF without T1-contrast enhancement) from tumor progression (increased CBF with T1-contrast enhancement) when employed routinely in clinical oncology practice.

Effects of a Revision to the Standard Admission Order Set on Laxative Prescribing for Opioid-Induced Constipation

Purpose: Opioid-induced constipation (OIC) is highly prevalent in patients with cancer-related pain on opioid analgesics and has negative consequences on physical and psychological well-being and quality of life. Oncology clinical practice guidelines recommend the use of osmotic and stimulant laxatives for the prevention and management of opioid-induced constipation, not stool softeners such as docusate sodium. Prescribing practices continue to fall behind these recommendations. Methods: This quality improvement project revised the laxative options available in the standard admission order set in the electronic medical record. Specifically, docusate sodium was removed and replaced with senna and polyethylene glycol 3350. Results: A total of 2,742 patient admissions preintervention were compared to 2,752 admissions postintervention. The number of orders for docusate (p < .001) and docusate-senna (p = .002) orders decreased significantly after the intervention, in addition to the number of OIC diagnoses (p < .001). However, the number of orders for polyethylene glycol (p = .559), senna (p = .582), other laxatives (p = .245), or functional bowel disorder medications (p = .533) did not change significantly. No significant differences were observed in the frequency of laxative orders placed within 24 hours of an opioid order, number of laxatives prescribed at discharge, admissions related to bowel-related complications, or length of stay. Conclusions: Interventions utilizing the electronic medical record can facilitate evidence-based management of OIC. Development of clinical practice guidelines and tailoring these interventions further is needed to adapt this approach at other institutions and sustain practice change.

Maximising the Synergy of Tumour Tissue and Liquid Biopsy Testing in Oncology Clinical Practice

The symposium took place during the 2024 European Society for Medical Oncology (ESMO) Congress in Barcelona, Spain, with the goal of highlighting the synergy between tissue and liquid biopsy testing in the diagnosis and treatment of solid tumours. Christian Rolfo, Director of the Division of Medical Oncology at The Ohio State University Comprehensive Caner Centre, Columbus, USA, set the stage with a discussion on the state-of-the-art liquid biopsy for solid tumour testing. He was followed by Guilhem Roubaud from the Bergonié Institute in Bordeaux, France, and Federico Cappuzzo from Regina Elena Institute, Rome, Italy, who delved into molecular testing challenges and applications in genitourinary and non-small cell lung cancer (NSCLC), respectively. Practical insights on next-generation sequencing (NGS) implementation was provided by Bence Sipos, TBAG of Molecular Pathology Baden-Württemberg, Germany, with real-world case studies presented by Sara Pilotto, University Hospital, Verona, Italy, and Roubaud. The faculty emphasised the importance of integrating liquid and tissue biopsies to perform tumour molecular profiling, which is crucial for accurate diagnosis and personalised treatment strategies. They also highlighted the critical role of rapid NGS in detecting a wide range of genetic alterations to enhance the precision of diagnosis and access to precision therapies.

Survey on current clinical practice in geriatric oncology: the individual experience in five European Cancer Centers.

To gather information from clinicians on how geriatric oncology models of care have emerged in different European countries and describe current practice in this clinical area. A semi-structured online interview was performed, exploring aspects related to implementation, perceived quality of care, and professional satisfaction. The centers participating in this interview showed significant differences in terms of resource allocation, team members, components of the comprehensive geriatric assessment (CGA), and CGA-driven interventions. High levels of professional satisfaction were expressed by all participants. This was deemed a consequence of a perception of increased quality in the provision of care and enhanced educational and academic opportunities. Interdisciplinary models of care in geriatric oncology, regardless of implementation details, seem to provide grounds for increased professional satisfaction and perception of better provision of quality of care. These characteristics could support promoting and further developing similar collaborations on a wider scale.

The continuous improvement of digital assistance in the radiation oncologist's work: from web-based nomograms to the adoption of large-language models (LLMs). A systematic review by the young group of the Italian association of radiotherapy and clinical oncology (AIRO).

Recently, the availability of online medical resources for radiation oncologists and trainees has significantly expanded, alongside the development of numerous artificial intelligence (AI)-based tools. This review evaluates the impact of web-based clinical decision-making tools in the clinical practice of radiation oncology. We searched databases, including PubMed, EMBASE, and Scopus, using keywords related to web-based clinical decision-making tools and radiation oncology, adhering to PRISMA guidelines. Out of 2161 identified manuscripts, 70 were ultimately included in our study. These papers all supported the evidence that web-based tools can be transversally integrated into multiple radiation oncology fields, with online applications available for dose and clinical calculations, staging and other multipurpose intents. Specifically, the possible benefit of web-based nomograms for educational purposes was investigated in 35 of the evaluated manuscripts. As regards to the applications of digital and AI-based tools to treatment planning, diagnosis, treatment strategy selection and follow-up adoption, a total of 35 articles were selected. More specifically, 19 articles investigated the role of these tools in heterogeneous cancer types, while nine and seven articles were related to breast and head & neck cancers, respectively. Our analysis suggests that employing web-based and AI tools offers promising potential to enhance the personalization of cancer treatment.

Predictors of recurrent venous thromboembolism and major bleeding in patients with cancer: A secondary analysis of the CANVAS trial

IntroductionPatients with cancer have an increased risk of developing venous thromboembolism (VTE) but also have an increased risk of both recurrent VTE and bleeding with anticoagulation compared to anticoagulated patients without cancer. CANVAS, a randomized pragmatic effectiveness trial, compared the direct oral anticoagulants a class to low molecular weight heparin for treatment of a new VTE in patients with cancer. The aim of this prespecified secondary analysis of the CANVAS trial is to identify predictors of both recurrent VTE and major bleeding in patients with cancer and new VTE. MethodsData from the 671 participants in the analysis population were used to identify predictors of recurrent VTE and bleeding during the 6-month treatment period. Significant predictors identified in the univariable models were carried forward in the multivariable models to identify independent predictors of both risks. ResultsIndependent predictors of recurrent VTE include ECOG performance status ≥2 (HR, 3.19 [95 % CI, 1.45–7.02]; P < .005), presence of metastatic disease (HR, 2.57 [95 % CI, 1.14–5.80]; P = .023), treatment with bevacizumab (HR, 2.50 [95 % CI, 1.04–5.99]; P = .041), and deep vein thrombosis without pulmonary embolus as index VTE (HR, 1.86 [95 % CI, 1.04–3.33]; P = .037). Independent predictors of major bleeding include serum albumin <3.5 g/dL (HR 1.97 [95 % CI, 1.02–3.79]; P = .044) and metastatic disease (HR 2.80 [95 % CI, 1.08–7.22]; P = .034). ConclusionFindings from this pre-specified analysis of the CANVAS trial identified risk factors for recurrent VTE and major bleeding in a population of participants with cancer and new VTE that reflect current oncology clinical practice. Results can be used to identify at risk patients in practice and inform new risk prediction models to improve the care of these patients.

Compassion fatigue in surgical oncologists: A scoping review.

343 Background: The practice of clinical oncology includes diverse and complex clinical, interpersonal and ethical challenges that can lead to physical and/or emotional distress, including burnout (BO), compassion fatigue (CF), secondary traumatic stress (STS) or moral distress (MDS), which potentially impacts patient care and provider well-being. Surgical oncology presents additional stressors and challenges, yet little is known about CF, STS, and MDS in this population, and the greater body of literature in oncology is heterogenous.The aim of this paper is to review current literature regarding CF, MDS, and STS in clinical oncologists, with a focus on surgical oncologists. Methods: Searches of OVID Medline and Embase databases were performed, as well as relevant bibliographies to identify articles related to CF, STS and MDS in clinical and surgical oncologists. Descriptive analysis was completed on relevant articles to address common definitions, themes, and potential aggravating/protective factors. Results: 619 articles were retrieved, of which 196 underwent data extraction. Of these, 48 articles were related to CF, MDS, or STS in oncologists and 5 included surgical oncologists. There was no data specific to surgical oncologists. Definitions of the terms were inconsistent across the literature. Potential contributing factors for CF/STS/MDS are related to the work environment, time pressures, and poor communication skills. In contrast, self-care, supportive colleagues/supervisors, and experience appear to be protective. Conclusions: This study highlights a need for standardized definitions to accurately capture and explore each of these phenomena. Further research is needed to provide insight into the challenges faced by surgical oncologists and how to support them.

Standardized treatment of oral cancer under the guidance of clinical practice guidelines of National Comprehensive Cancer Network.

Oral cancer represents a serious public health problem affecting oral and system health with a high global incidence. Treatment strategies for oral cancer vary in different disciplines and are likely to be limited to certain doctor's personal experience. While clinical practice guidelines are considered to enable doctors to determine the most appropriate and consistent treatment strategy according to the patient's situation. National Comprehensive Cancer Network (NCCN) clinical practice guidelines have become the most prevalent in global clinical oncology practice. This article mainly focuses on cases to discuss the normalized treatment strategy for oral cancer in different stages based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers, Version 3, 2024.

Breast-cancer specific comprehensive archive of Patient-Reported Outcome Measures (PROMs) for clinical research and clinical practice in oncology: Results from the PRO4All project

BackgroundInclusion of patient-reported outcomes (PROs) in oncology clinical trials is strongly recommended. However, selecting the most appropriate patient-reported outcome measures (PROMs) is not easy. This study aimed to develop a breast cancer (BC) specific comprehensive archive of PROMs. MethodsAs part of the PRO4All project, we identified available PROMs in oncology by searching facit.org, eortc.org, eprovide.mapi-trust.org, PubMed, ema.europa.eu (European Public Assessment Reports) and published reviews. For this analysis, only BC tools were extracted. We described information about PROM name, type of questionnaire, questionnaire variant(s), recall period, number of items, and presence of minimum clinically important difference (MCID) reference in literature. Then, we assigned each item to a specific domain according to a predefined taxonomy of 38 items for outcome classification. ResultsWe identified and analyzed 383 PROMs. Of these, 29 were BC specific, but 2 were excluded because the questionnaires description was not available. 6 (22.2 %) were variants of another questionnaire. All questionnaires were self-reported. In 6 cases (22.2 %) the recall period to consider was the “last week”. The mean number of items per questionnaire was 25.81 (range 6–71). 602 items were assigned to an outcome domain: emotional functioning/wellbeing in 26.6 % of cases, physical functioning in 14.1 %, delivery of care in 10.8 %, and general outcomes in 10.5 %. MCID reference was found only in 4 (14.8 %) cases. ConclusionsThe newly developed archive represents a useful tool to optimize the use of PROMs in the evaluation of treatments in BC patients, promoting a patient-centered approach both in clinical research and practice.

Recommendations to improve use and dissemination of patient versions of oncological clinical practice guidelines in Germany: results of a multi-stakeholder workshop

BackgroundOncological patients have high information needs that are often unmet. Patient versions of oncological clinical practice guidelines (PVG) translate clinical practice guidelines into laypersons’ language and might help to address patients’ information needs. Currently, 30 oncological PVG have been published in Germany and more are being developed. Following a large multi-phase project on oncological PVGs in Germany, recommendations to improve use and dissemination of PVG were adopted in a multi-stakeholder workshop.MethodsOrganisations representing users of PVGs (patients, medical personnel, and multipliers), creators, initiators/funding organisations of PVGs, and organisations with methodological expertise in the development of clinical practice guidelines or in patient health information were invited to participate. The workshop included a World Café for discussion of pre-selected recommendations and structured consensus procedure for of all recommendations. Recommendations with agreement of > 75% were approved, and in case of ≤ 75% agreement, recommendations were rejected.ResultsThe workshop took place on 24th April 2023 in Cologne, Germany. Overall, 23 people from 24 organisations participated in the discussion. Of 35 suggested recommendations 28 recommendations reached consensus and were approved. The recommendations referred to the topics dissemination (N = 13), design and format (N = 7), (digital) links (N = 5), digitalisation (N = 4), up-to-dateness (N = 3), and use of the PVG in collaboration between healthcare providers and patients (N = 3).ConclusionThe practical recommendations consider various perspectives and can help to improve use and dissemination of oncological PVG in Germany. The inclusion of different stakeholders could facilitate the transfer of the results into practice.

Shaping the future of cancer treatment: The commitment of medical physicists

The incorporation of medical physics into the field of oncology has profoundly changed the ways in which cancer is diagnosed and treated. This article highlights the essential roles that medical physicists play in cancer care, demonstrating how principles from physics improve various aspects of oncology practices. Our analysis reveals that medical physics plays a fundamental role in optimizing various oncological procedures, thereby revolutionizing the management of cancer. Specifically, medical physicists are integral to critical areas such as radiation therapy planning, surgical navigation, and quality assurance, which collectively facilitate personalized and effective treatment strategies for patients. By working closely with healthcare professionals, medical physicists help ensure patients receive top-notch care while minimizing side effects associated with treatments. Their dedication to innovation and research is essential for improving both patient outcomes and quality of life throughout the cancer journey. The ongoing partnership between medical physicists and clinicians is instrumental in propelling advancements in oncology research and clinical practices, leveraging physics principles alongside state-of-the-art technologies to enhance cancer management. As medical physicists commit to excellence and patient-centered practices, they are at the forefront of transforming oncology care, promising improved hope and outcomes for those battling cancer. This collaborative effort ensures a bright future for cancer treatment, where the integration of physics not only optimizes therapeutic approaches but also fosters a comprehensive understanding of cancer care.

Quantifying the Financial Impact of Treatment Intolerance in Chronic Myeloid Leukemia on Oncology Clinical Practices: A Mixed-Methods Study

Quantifying the Financial Impact of Treatment Intolerance in Chronic Myeloid Leukemia on Oncology Clinical Practices: A Mixed-Methods Study

Principles of artificial intelligence in radiooncology.

In the rapidly expanding field of artificial intelligence (AI) there is awealth of literature detailing the myriad applications of AI, particularly in the realm of deep learning. However, areview that elucidates the technical principles of deep learning as relevant to radiation oncology in an easily understandable manner is still notably lacking. This paper aims to fill this gap by providing acomprehensive guide to the principles of deep learning that is specifically tailored toward radiation oncology. In light of the extensive variety of AI methodologies, this review selectively concentrates on the specific domain of deep learning. It emphasizes the principal categories of deep learning models and delineates the methodologies for training these models effectively. This review initially delineates the distinctions between AI and deep learning as well as between supervised and unsupervised learning. Subsequently, it elucidates the fundamental principles of major deep learning models, encompassing multilayer perceptrons (MLPs), convolutional neural networks (CNNs), recurrent neural networks (RNNs), transformers, generative adversarial networks (GANs), diffusion-based generative models, and reinforcement learning. For each category, it presents representative networks alongside their specific applications in radiation oncology. Moreover, the review outlines critical factors essential for training deep learning models, such as data preprocessing, loss functions, optimizers, and other pivotal training parameters including learning rate and batch size. This review provides acomprehensive overview of deep learning principles tailored toward radiation oncology. It aims to enhance the understanding of AI-based research and software applications, thereby bridging the gap between complex technological concepts and clinical practice in radiation oncology.

Measuring single-cell immune clonality to track haematological cancers.

While paediatric blood cancers are deadly, modern medical advances have enabled clinicians to measure levels of residual cancer cells to manage therapeutic strategies for patients. However, blood cancers, including leukaemias and lymphomas, are highly heterogeneous and is comprised of complex clonal populations that can hinder efforts in detecting the cancer cells as well as managing treatments. Furthermore, the tumour microenvironment is comprised of heterogenous immune dynamics that may be different between patients. High-throughput sequencing has constributed to new discoveries in genetic and transcriptomic alterations underpinning cancer, including blood cancers, and has changed how patients are monitored and managed. Here we discuss the recent efforts using single-cell approach, particularly on efforts to track clonal heterogenity of paediatric blood cancer and the underlying immune response, highlighting avenues for novel biomarker discovery that may have significant impact on clinical oncology practice.

Examining the Effectiveness of Electronic Patient-Reported Outcomes in People With Cancer: Systematic Review and Meta-Analysis.

Electronic patient-reported outcomes (ePROs) are commonly used in oncology clinical practice and have shown benefits for patients and health resource use. The aim of this study was to compare the isolated effect of administering ePROs to patients with cancer versus a control condition. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Randomized controlled trials evaluating ePRO interventions that aimed to improve health-related outcomes among patients with cancer were included. The primary outcome was health-related quality of life (HRQOL), and the secondary outcomes were symptoms, hospital admissions, unplanned visits, chemotherapy completion, survival, and satisfaction with care. The effect sizes of ePROs on health-related outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs using a random effects model. The search identified 10,965 papers, of which 19 (0.17%) from 15 studies were included. The meta-analysis showed an improvement in HRQOL at 3 months, measured by the Functional Assessment of Cancer Therapy-General (SMD 0.28, 95% CI -1.22 to 1.78), and at 6 months, assessed using various HRQOL measures (SMD 0.07, 95% CI -1.24 to 1.39). The results should be interpreted with caution, given the wide 95% CIs. Of the 15 studies, 9 (60%) reported a positive signal on HRQOL, with two-thirds of the studies (n=6, 67%) including tailored patient advice and two-thirds (n=6, 67%) using clinician alert systems. The meta-analysis showed a potential improvement in HRQOL at 6 months and in Functional Assessment of Cancer Therapy-General scores at 3 months for studies that included tailored advice and clinician alerts, suggesting that these elements may improve ePRO effectiveness. The findings will provide guidance for future use and help health care professionals choose the most suitable ePRO features for their patients. PROSPERO CRD42020175007; https://tinyurl.com/5cwmy3j6.

Systematic Review of Economic Evaluations of Systemic Treatments for Advanced and Metastatic Gastric Cancer.

Recent advances in the development of biomarker-directed therapy and immunotherapy, for advanced and metastatic gastric cancers, have the potential to improve survival and quality of life.Much attention has been directed towards second- and later-line treatments, and the landscape here is evolving rapidly. However, uncertainty in relative effectiveness, high costs and uncertainty in cost effectiveness represent challenges for decision makers. To identify economic evaluations for the second-line or later-line treatment of advanced and metastatic gastric cancer. Also, to assess key criteria (including model assumptions, inputs and outcomes), reporting completeness andmethodological quality to inform future cost-effectiveness evaluations. A systematic literature search (from database inception to 5 March 2023) of EconLit via EBSCOhost, Cochrane Library (restricted to National Health Service [NHS] Economic Evaluation Database and Health Technology Assessment [HTA] Database), Embase, MEDLINE and of grey literature was conducted. This aimed to identify systemic treatments that align with National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) Clinical Practice Guidelines. Data were collected on key criteria and on reporting completeness and methodological quality. A narrative synthesis focussed on cost-effectiveness and cost-of-illness studies. Outcomes of interest included total and incremental costs and outcomes (life-years and quality-adjusted life-years), ratios of incremental costs per unit outcome and other summary cost and outcome measures. Also, for cost-effectiveness studies, reporting completeness and the methodological quality were assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and the Philips Checklist, respectively. A total of 19 eligible economic evaluations were identified (cost-effectiveness studies [n = 15] and cost-of-illness studies [n = 4]). There was a general lack of consistency in the methodological approaches taken across studies. In the main, the cost-effectiveness studies indicated that the intervention under consideration was more effective and more costly than the comparator(s). However, most interventions were not cost effective. No studies were fully compliant with reporting-completeness and methodological-quality requirements. Given the lack of consistency in the approaches taken across cost-of-illness studies, outcomes could not be directly compared. To our knowledge, this is the first published systematic literature review that has qualitatively synthesised economic evaluations for advanced and metastatic gastric cancer. There were differences in the approaches taken across the cost-effectiveness studies and the cost-of-illness studies. The conclusions of most of the cost-effectiveness studies were consistent despite identified differences in approaches. In the main, the interventions under consideration were not cost effective, presenting challenges to sustainability and affordability. We highlight a requirement for cost-effectiveness evaluations and for second-line or later-line treatments of advanced and metastatic gastric cancer that consider all relevant comparators and that are compliant with reporting-completeness and methodological-quality requirements. By addressing the methodological gaps identified here, future healthcare decision-making, within the context of this rapidly changing treatment landscape, would be better informed. CRD42023405951.

Trauma-Informed Care Addressing the Mental and Emotional Needs of Patients With Cancer.

The oncology care environment includes a wide range of traumatic physical and emotional experiences that can be challenging for patients and healthcare providers. This article aims to establish a knowledge base about the trauma-informed care (TIC) approach in oncology care. This article provides a literature-based overview of TIC as a model of care for patients with cancer, informed by definitions of trauma, post-traumatic stress disorder, and adverse childhood experiences. This review is based on clinical studies, expertise, and evidence-based guidelines. Based on a foundation of care for patients with cancer, nurses can apply TIC to clinical oncology practice. To illustrate TIC in practice, this article includes a case study, nursing approaches, implications, the TIC model of care, and resources. When applied to care, TIC benefits patients, staff, and organizations.

The potential neuroprotective effects of cannabinoids against paclitaxel-induced peripheral neuropathy: in vitro study on neurite outgrowth.

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a shared burden for 68.1% of oncological patients undergoing chemotherapy with Paclitaxel (PTX). The symptoms are intense and troublesome, patients reporting paresthesia, loss of sensation, and dysesthetic pain. While current medications focus on decreasing the symptom intensity, often ineffective, no medication is yet recommended by the guidelines for the prevention of CIPN. Cannabinoids are an attractive option, as their neuroprotective features have already been demonstrated in neuropathies with other etiologies, by offering the peripheral neurons protection against toxic effects, which promotes analgesia. Methods: We aim to screen several new cannabinoids for their potential use as neuroprotective agents for CIPN by investigating the cellular toxicity profile and by assessing the potential neuroprotective features against PTX using a primary dorsal root ganglion neuronal culture. Results: Our study showed that synthetic cannabinoids JWH-007, AM-694 and MAB-CHMINACA and phytocannabinoids Cannabixir® Medium dried flowers (NC1) and Cannabixir® THC full extract (NC2) preserve the viability of fibroblasts and primary cultured neurons, in most of the tested dosages and time-points. The combination between the cannabinoids and PTX conducted to a cell viability of 70%-89% compared to 40% when PTX was administered alone for 48h. When assessing the efficacy for neuroprotection, the combination between cannabinoids and PTX led to better preservation of neurite length at all tested time-points compared to controls, highly drug and exposure-time dependent. By comparison, the combination of the cannabinoids and PTX administered for 24h conducted to axonal shortening between 23% and 44%, as opposed to PTX only, which shortened the axons by 63% compared to their baseline values. Discussion and Conclusion: Cannabinoids could be potential new candidates for the treatment of paclitaxel-induced peripheral neuropathy; however, our findings need to be followed by additional tests to understand the exact mechanism of action, which would support the translation of the cannabinoids in the oncological clinical practice.

Extracellular vesicles as novel uro-oncology biomarkers: insights toward clinical applications.

We discussed the challenges associated with the clinical application of extracellular vesicles and summarized their potential impact on oncological clinical practice in urology. Despite extensive research on extracellular vesicles, their clinical applications remain limited; this is likely to be because of small study cohorts, a lack of large-scale analyses, and the impact of variable extraction and storage methods on analysis outcomes. However, promising results have emerged from clinical trials targeting urinary extracellular vesicles in prostate cancer using ExoDx Prostate Test. The ExoDx Prostate Test has demonstrated its efficacy in diagnosing prostate cancer in previous studies and is the only FDA-approved kit for this purpose. Moreover, recent trials have investigated the use of the ExoDx Prostate Test to determine the optimal timing for biopsies in prostate cancer patients undergoing active surveillance. We summarized recent studies on the potential of extracellular vesicles in the management of urological cancers. Particularly, the diagnosis of prostate cancer using the ExoDx Prostate Test has yielded positive results in several clinical trials. Additionally, while there are other studies suggesting its efficacy, most of these are based on retrospective analyses. These findings warrant further large-scale studies to optimize extracellular vesicle-based diagnostic and monitoring strategies. Although further research is required, extracellular vesicles would be attractive for early detection and surveillance.