Diagnosis Of Metastatic Cancer Research Articles

Existing Health Inequities in the Treatment of Advanced and Metastatic Cancers.

This study aims to identify health inequities related to the medical treatment and supportive care of patients with advanced/metastatic cancer and recommend solutions to promote health equity. Despite robust strides in the development of therapeutic strategies for advanced and metastatic cancer, significant disparities in treatment access and implementation exist. Race, socioeconomic status, gender, and geography represent just a few of the individual-level factors which contribute to challenges in treatment administration, thorough evaluation of germline genetics and tumor genomics, and quality palliative and end-of-life care. Given the increasing complexity of cancer treatments and our enhanced understanding of tumor biology, efforts to uniformly provide equitable and high-level care to all patients are needed. In this review we will discuss factors that contribute to health inequities in patients with advanced and metastatic cancer diagnoses, highlighting opportunities for intervention, ongoing challenges in change implementation, and national and international society recommendations to eliminate disparities. Acknowledging existing inequities and engaging in multilevel discourse with key stakeholders is needed to optimize care practices to the benefit of all patients.

Abstract A132: Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina

Abstract INTRODUCTION American Indians (AI) have much higher incidence rates of lung cancer (LC) compared with non-Hispanic Whites (NHW) in the US. While low-dose computed tomography (LDCT) screening facilitates early detection of lung cancer, it is unknown how available LDCT screenings are to racially and geographically diverse populations in North Carolina (NC). To address this gap in knowledge, we conducted a descriptive study to characterize incident LC cases among AIs and NHWs, the distance from their location at diagnosis to the nearest LDCT screening facility and explored whether distance was associated with late-stage LC diagnoses. Methods Data were obtained from the Cancer Information and Population Health Resource (CIPHR), which comprise data from NC Central Cancer Registry (CCR) as well as public and private health insurance claims for the state. We identified ZIP codes and dates of rendered service for facilities providing LDCT by searching through claims from 2015-20. In addition, we identified incident LC cases among AIs and NHWs aged ≥18 years, from 2015-19. We assembled lists of LDCT facilities that existed in the year prior to each incident LC case. We calculated the minimum centroid to centroid distance to all facilities. Clinical attributes included age at diagnosis, sex, histology, stage at diagnosis, and rurality as measured by Rural Urban Commuting Area. Risk ratios were calculated for late-stage LC diagnoses across a range of thresholds for patient’s distance to nearest LDCT screening facility for AIs and NHWs. Results We identified 388 AI and 26,867 NHW incident LC cases in NC between 2015-20. Compared to NHWs, the median age at diagnosis for AIs was 5 years younger (AI: 65 vs. NHW: 69); more frequently male (AI: 54% vs NHW: 51%); and almost twice as likely to reside in rural areas (AI: 52% vs. NHW: 28%). There were no differences in late-stage LC diagnoses (AI: 54% vs. NHW: 52%). For distance (in miles) to the nearest LDCT screening facility, the median [Interquartile range] was twice as high for AIs (9.9 miles [0.8, 16.30]) compared to NHWs (5.3 miles [0, 12.1]). Among NHWs, there were statistically significant associations between distance and late-stage LC diagnosis at the shortest distance threshold of 5 miles (RR=1.04; 95%CL: 1.02, 1.07) through the threshold of 30 miles (RR=1.10 95%CL: 1.05, 1.15). There was no association across any distance threshold among AI lung cancer patients. Conclusions The large difference in accessibility of LDCT screening was not strongly associated with metastatic lung cancer diagnoses, possibly because so many patients were diagnosed late, reflecting poor early detection across all populations. We found that 80% of AIs with LC lived more than 10 miles away from LDCT screening facilities. This geographic distance may increase difficulty accessing cancer care geographically, and contribute to suboptimal LC screening rates. If efforts are to be made to increase early detection and improve survival, accessibility needs to be addressed on different dimensions. Citation Format: Bradford E. Jackson, Marc Emerson, Daniel Carrizosa, Chris Baggett, Lisa Spees, Joel Begay, Ana Salas, Yadurshirni Raveendran, Tomi Akinyemiju, Rachel Denlinger-Apte, Stephanie Wheeler, Ronny Bell. Missed Opportunities? Regional availability of Low Dose CT lung cancer screening facility locations in the year prior to diagnoses: A descriptive comparison of American Indian and Non-Hispanic White lung cancer patients in North Carolina [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A132.

Cost-effectiveness of multigene sequencing test and treatment for metastatic non-small cell lung cancer: A unique setting in the initial adoption phase in Japan allowing testing only after standard treatment

ObjectiveTo clarify the cost-effectiveness of comprehensive diagnosis and treatment of metastatic non-small cell lung cancer in Japan, from initial diagnosis to post-standard treatment, using three different strategies. MethodsA decision tree was created using three diagnostic and treatment strategies, assuming that Foundation One CDx (F1CDx), a comprehensive genome panel, was introduced in Japan in June 2019. This comprehensive decision tree includes Markov models, cost-effectiveness analyses (CEA), and cost-utility analyses (CUA) of the three strategies from the perspective of Japanese payers. Specifically, Strategy1 involves single-gene testing at the initial diagnosis and F1CDx after standard treatment; Strategy2 involves only single-gene testing at the initial diagnosis; Strategy3 involves F1CDx at the initial diagnosis. The incremental cost-effectiveness ratios (ICERs) of the three strategies are estimated. Sensitivity analyses were performed to assess the uncertainty of the parameter settings. ResultsStrategy3 was dominated for both CUA and CEA. The ICER/quality-adjusted life year (QALY) for Strategy2 versus Strategy1 was USD 13,734 (JPY 2,080,923, USD 1 = JPY 151.39 on April 1st, 2024), which is less than the willingness to pay of USD 45,900 (JPY 7,500,000), and Strategy2 was more cost-effective than Strategy1. F1CDx was not cost-effective compared to multiple simultaneous single tests at the initial diagnosis, either after standard treatment or at the initial diagnosis. Sensitivity analysis also showed that the most influential factor on the ICER for both CEA and CUA was treatment cost. ConclusionsFrom both patient benefit and health economic perspectives, introducing F1CDx after standard treatment in June 2019 was not as cost-effective as multiple simultaneous single tests at the initial diagnosis but was more realistic from a health economic perspective than introducing F1CDx at the time of initial diagnosis. Therefore, the policy at the time of F1CDx introduction in Japan was appropriate from a short-term health-economic perspective.

71795 - Income is associated with survival after diagnosis of metastatic colorectal cancer

71795 - Income is associated with survival after diagnosis of metastatic colorectal cancer

Aggressive Synchronous Papillary and Likely Follicular Thyroid Carcinomas in a Patient with Graves’ Disease

We report a case of an uncommonly aggressive presentation of the rare entity of synchronous papillary (PTC) and follicular thyroid carcinomas (FTC) in a 67-year-old woman initially presenting with thyrotoxicosis from Graves’ disease. She was found to have two thyroid nodules with extensive intra-cardiac tumour thrombus, symptomatic left pelvis bony metastasis with pathological fracture, pulmonary metastases and mediastinal lymph node metastases. Further investigations suggested a diagnosis of synchronous papillary and metastatic follicular thyroid cancer. Treatment with radical surgery followed by adjuvant therapeutic radioiodine ablation was proposed, but the patient declined all forms of cancer-specific therapy and was elected solely for a palliative approach to treatment. We discuss the diagnostic considerations in arriving at the diagnosis of synchronous thyroid malignancy – in this case the clear features of PTC and the strong probability of FTC due to invasiveness and metastatic follicular lesions. This case underscores potential limitations of the ACR TI-RADS system, notably with certain ultrasonographic features suggesting malignancy that might not be adequately captured. Notably, the aggressive presentation of DTC in this case may be contributed by the concurrent presence of Graves’ Disease, suggesting heightened vigilance when assessing potential thyroid malignancies in such patients.

Current status of palliative care for patients with unresectable metastatic colorectal cancer in China: a questionnaire-based survey

Objective: To analyze the current adoption of palliative care by patients with unresectable metastatic colorectal cancer (mCRC) in China. Methods: From 1 March 2023 to 30 June 2023, a questionnaire survey was conducted by random sampling. An exclusive research platform for the Blue Book on Clinical Diagnosis and Treatment of Metastatic Colorectal Cancer. An online questionnaire was sent to medical oncologists (including chief physicians, associate chief physicians, attending physicians and residents) in general hospitals and oncology hospitals in four major regions of East, Central, South and Northeast China. The questionnaire contained 28 questions requesting basic information about doctors, the number of patients with mCRC, the status of treatment from first to fourth line and beyond, points concerning treatment of pain in patients with mCRC, and expectations for the future. A medical team was responsible for the quality control of data collected, whereas statisticians performed the data cleaning and sorting and statistical analysis. Results: A total of 300 clinical questionnaires were collected, including 217 (72%) from doctors in general hospitals and 83 (28%) from doctors in oncology hospitals. Senior physicians (including associate chief physicians and chief physicians) accounted for 65% of the respondents, attending physicians 30%, and residents 5%. Within 3 months (average for each month), 46.4±26.6% patients were diagnosed with recurrent or unresectable mCRC by each physician, 51.6±26.8% of the patients being in cancer hospitals and 44.4±26.3% in general hospitals. One hundred percent of patients receiving first-line treatment received palliative care, as did 80.3% of those receiving second-line treatment, 58.2% of those receiving third-line treatment, and 35.1% of those receiving ≥fourth-line treatment. The primary factor governing selection of first-line treatment was guideline recommendations, whereas comorbidities and the patients' physical status dictated second line to fourth line treatment. Standard first-line treatment was administered to 93.8% of eligible patients, standard second-line treatment to 94.3%; and standard third-line treatment to 73.5%. First-line therapy included targeted therapy in 63.6% of patients and immunotherapy in 2.8%; second-line therapy included targeted therapy in 63.0% of patients and immunotherapy in 2.0%; third-line therapy included targeted therapy in 59.2% of patients and immunotherapy in 2.2%; and fourth-line therapy included targeted therapy in 48.7% of patients and immunotherapy in 3.1%. First-line treatment lasted an average of 9.6 months, second-line treatment 6.7 months, third-line treatment 4.9 months, and fourth-line treatment 3.7 months. More than 70% of the patients maintained a good quality of life after receiving first and second-line treatment and more than 60% of them had ECOG performance scores of 0-1. After receiving third- and fourth-line treatment, 50%-60% of patients maintained a good quality of life and 40%-50% of them maintained ECOG performance scores of 0-1. The survey also revealed that the main deficiencies in treatment were limited effectiveness of third-line treatment, insufficient availability and opportunity for clinical research, popularity of new drugs or new drug combination strategies, and limited channels for participation in multidisciplinary diagnosis and treatment. Clinicians reported looking forward to participating in more clinical research on new drugs, hearing about the experience of experts in the field, and discovery of new targets and new drugs that increased the options for posterior line treatment of colorectal cancer. Conclusions: This report objectively summarizes the current situation, treatment difficulties, and expectations of frontline physicians concerning management of mCRC, thus providing a basis for decision-making and future direction for the diagnosis and research on treatment of mCRC.

A cell targeting and sorting approach based on the magnetophoretic capturing for early prognostics of metastatic cervical cancer cells

HeLa cervical cancer cells are immortal with telomerase activity and metastatic characteristics similar to circulating tumor cells (CTCs). Here, we report aptamer-modified multilayered magnetic beads (Apt@MBs) that efficiently targeted and captured HeLa cells up to a low concentration of freshly prepared cell suspension (500 cells/mL). Apt@MBs were functionalized with fluorophore-conjugated AS1411-aptamer on an outer layer made up of molybdenum disulfide (MoS2) to target nucleolin on the cell surface of captured HeLa cells. Moreover, this outer MoS2 layer of MBs was nanoporous and could load anticancer drugs inside its porous cavities with the possibility of killing the captured and metastatic CTCs in vivo. An internal core layer of Apt@MBs consisting of Ag–Fe3O4 magnetic particles (MPs) was designed for magnetic manifestations and cell sorting with the possibility of screening CTCs (in the patient's blood samples) for early diagnosis of metastatic cancers. The Apt@MBs after cell capture gave rise to the heavier HeLa-MBs composites to get settled down under gravitational/inertial forces to the bottom of the tube quicker than the free cells (within 10 min). The gravitational settling of HeLa-MBs was further coupled with exposing a magnetic field to effectively capture and enrich the cells at the bottom of the tube (from 91 to 98 % cells). While the fluid containing dead, non-cancerous, or uncaptured cells in the supernatant layers were easily removed by pipetting. The HeLa-MBs after sorting out were resuspended into a fresh culture medium for further incubation or cellular analysis. Moreover, both cisplatin (CP) and epirubicin (EP) loaded Apt@MBs showed the killing of about 50 % of the captured cells. Therefore, we are confident that Apt@MBs can contribute to enumerating patients' blood samples for screening CTCs to timely and efficiently detect metastatic cancers along with the ability to effectively perform prognosis, and treatment of metastatic cancers.

High early mortality following percutaneous nephrostomy in metastatic cancer: a national analysis of outcomes

ObjectivesTo assess the outcomes of percutaneous nephrostomy in England for renal decompression, in the context of metastatic cancer.MethodsRetrospective observational study of all patients undergoing nephrostomy with a diagnosis of metastatic...

Problems of oxaliplatin-induced neuropathy in patients with colorectal cancer

Aim. To investigate the methods of early diagnosis of oxaliplatin-induced peripheral neuropathy (PN).Materials and methods. The study included 52 patients with diagnosis of metastatic colorectal cancer receiving 1st line polychemotherapy per the mFOLFOX6 scheme ± targeted therapy who prior to each cycle filled out the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (EORTC QLQ CIPN 20) and were subject to neurological examination using the Neuropathy Disability Scale (NDS).Results. The analysis included 28 patients who completed polychemotherapy: 16 (57,2 %) men and 12 (42,8 %) women, mean age 60.0 ± 10.0 years. Fridman’s two-way analysis of variance by ranks showed significant changes in the scores (sensory, motor, autonomic) of the EORTC QLQ CIPN 20 questionnaire with the increase in the number of chemotherapy cycles (р = 0.001). Significant increase in the sensory and motor scores was observed after the 3rd cycle, in the autonomic – after the 6th cycle. Significant increase in NDS score was observed starting at the 3rd cycle, and vibration sensitivity on the medial ankle or at the base of the 1st toe significantly decreased after the 1stcycle. Median number of cycles at which oxaliplatin dose was reduced or the drug was discontinued due to clinically significant symptoms of PN irrespective of questionnaire results and neurological examination was 6.Conclusion. According to the results of the study, the following conclusions were made: 1) sensory scale of the 3-part EORTC QLQ CIPN 20 questionnaire (9 questions of 20) or motor scale (7 questions of 20), vibration sensitivity can be considered as stand-alone informative tests; 2) in a large patient cohort, NDS score increase to 5, EORTC QLQ CIPN 20 sensory scale score increase to 12 and higher or decreased vibration sensitivity on the medial ankle or at the base of the 1st toe to 4.5 arbitrary units should be considered early manifestations of PN; 3) for a routine algorithm, it is acceptable to consider a combination of 9 questions of the sensory or 7 questions of the motor scales of the EORTC QLQ CIPN 20 questionnaire and evaluation of vibration sensitivity on the medial ankle or at the base of the 1st toe to decide on oxaliplatin dose reduction or measures for prevention of peripheral neuropathy symptom worsening.

Machine learning approach to predict venous thromboembolism among patients undergoing multi-level spinal posterior instrumented fusion.

The absence of consensus for prophylaxis of venous thromboembolism (VTE) in spine surgery underscores the importance of identifying patients at risk. This study incorporated machine learning (ML) models to assess key risk factors of VTE in patients who underwent posterior spinal instrumented fusion. Data was collected from the IBM MarketScan Database [2009-2021] for patients ≥18 years old who underwent spinal posterior instrumentation (3-6 levels), excluding traumas, malignancies, and infections. VTE incidence (deep vein thrombosis and pulmonary embolism) was recorded 90-day post-surgery. Risk factors for VTE were investigated and compared through several ML models including logistic regression, linear support vector machine (LSVM), random forest, XGBoost, and neural networks. Among the 141,697 patients who underwent spinal fusion with posterior instrumentation (3-6 levels), the overall 90-day VTE rate was 3.81%. The LSVM model demonstrated the best prediction with an area under the curve (AUC) of 0.68. The most important features for prediction of VTE included remote history of VTE, diagnosis of chronic hypercoagulability, metastatic cancer, hemiplegia, and chronic renal disease. Patients who did not have these five key risk factors had a 90-day VTE rate of 2.95%. Patients who had an increasing number of key risk factors had subsequently higher risks of postoperative VTE. The analysis of the data with different ML models identified 5 key variables that are most closely associated with VTE. Using these variables, we have developed a simple risk model with additive odds ratio ranging from 2.80 (1 risk factor) to 46.92 (4 risk factors) over 90 days after posterior spinal fusion surgery. These findings can help surgeons risk-stratify their patients for VTE risk, and potentially guide subsequent chemoprophylaxis.

Comparison of 68 Ga-FAPI-04 PET/CT with 18 F-FDG PET/CT for diagnosis and staging of gastric and colorectal cancer.

The objective of this study is to evaluate the effectiveness of 68 Ga-FAPI-04 PET/computed tomography (CT) for the diagnosis of primary and metastatic gastric cancer and colorectal cancer lesions as compared with 18 F-FDG PET/CT. Fifty-nine patients who underwent both 18 F-FDG and 68 Ga-FAPI-04 for initial staging or restaging were enrolled. Histopathological findings and clinical imaging follow-up were used as the reference standard. The diagnostic performance and TNM staging of the two tracers were calculated and compared. The maximum standardized uptake value (SUV max ), tumour-to-mediastinal blood pool ratio (TBR) (lesions SUV max /ascending aorta SUV mean ), and tumour-to-normal liver parenchyma ratio (TLR) (lesions SUV max /liver SUV mean ) of primary and metastatic lesions between two imaging modalities were measured and compared using the Wilcoxon signed-rank test and paired t -test. The two imaging agents are comparable for the detection of primary tumors. The sensitivity of 68 Ga-FAPI-04 PET/CT was higher than that of 18 F-FDG PET/CT for detecting lymph node metastases, peritoneal metastases, liver metastases, and bone metastases. In the patient-based analysis, the TLR for all lesions was significantly higher with 68 Ga-FAPI-04 PET/CT than with 18 F-FDG PET/CT (all P < 0.05). The accuracy (92.2 vs. 70.3%, P = 0.002) and sensitivity of 68 Ga-FAPI-04 were significantly higher than that of 18 F-FDG (78.6 vs. 71.4%, P = 0.011) in determining the lymph node status. 68 Ga-FAPI-04 has a higher accuracy in staging ( P = 0.041), which is mainly due to the ability of distant metastases detection. 68 Ga-FAPI-04 PET/CT may be superior in evaluating the diagnostic efficiency and staging accuracy of gastric and colorectal cancer.

An underrecognized association: immune checkpoint inhibitor-related aortitis, a case report with the review of the literature.

Immune-checkpoint inhibitors (ICIs) are considered as the novel treatment modality in certain cancers. They may soon be used widely even as the first-line option for cancer treatment due to their remarkable efficacies and impacts on survival rates, particularly in cases of advanced metastatic cancer. Of note, these agents might unveil new autoimmune diseases as well as causing flare-ups of a pre-existing autoimmune disease. Data in this field have been accumulated during recent years. Early detection and a collaborative approach are, therefore, crucial in the management of a patient who presents with any of these conditions. Herein, we report a patient with a diagnosis of metastatic renal cell cancer presented with vasculitis involvement in the aorta during nivolumab treatment. Our aim with this case is to increase the awareness of ICI-related vasculitis involvement among rheumatologists in the light of literature.

Abstract 5132: Multi-omics analysis uncovers predictive biomarkers for the efficacy and outcomes of immune checkpoint inhibitor in combination with chemotherapy in advanced unresectable biliary tract cancers

Abstract Background: Biliary tract cancer, typically diagnosed at advanced stages with a poor prognosis, has witnessed a glimmer of hope in the progress of immune checkpoint inhibitors (ICIs). Yet, their limited response rates necessitate the search for effective biomarkers to refine patient selection. Methods: A total of 125 patients with a confirmed histological diagnosis of unresectable advanced or metastatic biliary tract cancers (BTC) who received first-line ICIs in combination with chemotherapy (chemoimmunotherapy) were prospectively enrolled. All baseline samples from 125 patients underwent targeted DNA sequencing, with an additional 62 patients undergoing RNA sequencing, and 85 patients had accessible mIHC data. The associations between molecular characteristics and the response to chemoimmunotherapy, progression-free survival (PFS) and overall survival (OS) were evaluated. Results: The cohort had a median age of 63 years (range from 34 to 82) and 52.8% (66/125) were male, including 54 with gallbladder cancer, 57 with intrahepatic cholangiocarcinoma, and 14 with extrahepatic cholangiocarcinoma. The median duration of follow-up was 14.8 months for the entire cohort, with the median PFS and OS of 6.9 months (95%CI: 6.2-7.9) and 11.8 months (95%CI: 10.3-14.8), respectively. The most mutated genes were TP53 (64/125, 51.2%), KRAS (34/125, 27.2%), ERBB2 (18/125, 14.4%), and ARID1A (17/125, 13.6%). Mutations of TP53 (51.2%, p = 0.042), BRCA2 (4.8%, p = 0.002), cytokine genes (6.4%, p = 0.004), and high tumor mutation burden (p = 0.072) demonstrated significant correlation with chemoimmunotherapy response. KRAS G12D mutations (PFS: P &amp;lt; 0.001; OS: P = 0.034) and ARID1A loss-of-function mutations (PFS: P = 0.009; OS: P = 0.012) were adverse survival factors, while high CXCL9 or CTLA4 expression was associated with response (CXCL9, P = 0.014; CTLA4, P = 0.067), improved PFS (CXCL9, P = 0.018; CTLA4, P = 0.008), and longer OS (CXCL9, P = 0.010; CTLA4, P = 0.008) under chemoimmunotherapy. Patients were classified into three subtypes using the identified survival biomarkers. Among them, Type I patients, characterized by the absence of KRAS G12D or ARID1A mutations but expressing high levels of CTLA4 or CXCL9, demonstrated the best outcomes under chemoimmunotherapy. Interestingly, further RNA analysis suggested that elevated CXCL9 expression correlated with heightened immune checkpoint expressions, including CTLA4, PD-L1, and PD-1 (all P &amp;lt; 0.001), as well as increased tumor microenvironment immune activity, findings validated in two additional independent patient cohorts both internal and external. Conclusions: Our study revealed predictive biomarkers relevant to the response and efficacy of immune checkpoint inhibitors in combination with chemotherapy in advanced biliary tract cancer. Citation Format: Jieer Ying, Qi Xu, Jiaojiao Ni, Hanlin Chen, Chaoqun Li, Yanru Xie, Qinhong Zheng, Jianying Jin, Junrong Yan, Xiaoying Wu, Qiuxiang Ou, Li Yuan, Wei Zhuo, Haimeng Tang. Multi-omics analysis uncovers predictive biomarkers for the efficacy and outcomes of immune checkpoint inhibitor in combination with chemotherapy in advanced unresectable biliary tract cancers [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 5132.

Diagnosis of Metastatic Non-Small Cell Lung Cancer during Hospitalization: Missed Opportunity for Optimal Supportive Care?

The usual workup for patients newly diagnosed with advanced non-small cell lung cancer (NSCLC) occurs in the ambulatory setting. A subset of patients present with acute care needs and receive the diagnosis while hospitalized. Palliative therapies are typically initiated when patients are outpatients, even when diagnoses are made when they are inpatients. Lengthy admission, rehabilitation needs after discharge, and readmissions are possible barriers to timely and adequate outpatient follow-up. The outcomes for these patients diagnosed in the hospital are not well characterized. We hypothesized that patients have been ill-served by current treatment patterns, as reflected by low rates of cancer-directed treatment and poor survival. We performed a retrospective study of new inpatient diagnoses of metastatic NSCLC at our institution between 1 January 2012 and 1 January 2022. The primary outcome was the proportion of patients ultimately receiving cancer-directed therapy. Other outcomes included time to treatment, use of targeted therapy, palliative care/hospice utilization, and overall survival (OS). Seventy-three patients were included, with a median age of 57 years. Twenty-seven patients (37%) ultimately received systemic therapy with a median time from diagnosis to treatment of 37.5 days. Overall, 5.4% patients died while admitted, 6.8% were discharged to a hospice, 21.9% were discharged to a facility, and 61.6% were discharged home. Only 20 patients (27%) received palliative care consultation. The median OS for our entire population was 2.3 months, with estimated 6-month and 1-year OS rates of 32% and 22%, respectively. Patients with new inpatient diagnoses of metastatic NSCLC have extremely poor outcomes. Current management strategies resulted in few patients starting systemic therapy, yet most of the patients did not receive palliative care or hospice involvement. These findings demonstrate that there is a high unmet need to optimally support and palliate these patients.

Identification of Pancreatic Metastasis Cells and Cell Spheroids by the Organelle-Targeting Sensor Array.

Pancreatic cancer is a highly malignant and metastatic cancer. Pancreatic cancer can lead to liver metastases, gallbladder metastases, and duodenum metastases. The identification of pancreatic cancer cells is essential for the diagnosis of metastatic cancer and exploration of carcinoma in situ. Organelles play an important role in maintaining the function of cells, the various cells show significant differences in organelle microenvironment. Herein, six probes are synthesized for targeting mitochondria, lysosomes, cell membranes, endoplasmic reticulum, Golgi apparatus, and lipid droplets. The six fluorescent probes form an organelles-targeted sensor array (OT-SA) to image pancreatic metastatic cancer cells and cell spheroids. The homology of metastatic cancer cells brings the challenge for identification of these cells. The residual network (ResNet) model has been proven to automatically extract and select image features, which can figure out a subtle difference among similar samples. Hence, OT-SA is developed to identify pancreatic metastasis cells and cell spheroids in combination with ResNet analysis. The identification accuracy for the pancreatic metastasis cells (> 99%) and pancreatic metastasis cell spheroids (> 99%) in the test set is successfully achieved respectively. The organelles-targeting sensor array provides a method for the identification of pancreatic cancer metastasis in cells and cell spheroids.

Palliative Care as a Component of High-Value and Cost-Saving Care During Hospitalization for Metastatic Cancer.

Randomized controlled trials have demonstrated that palliative care (PC) can improve quality of life and survival for outpatients with advanced cancer, but there are limited population-based data on the value of inpatient PC. We assessed PC as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer and identified hospitalization characteristics significantly associated with high costs. Hospitalizations of patients 18 years and older with a primary diagnosis of metastatic cancer from the National Inpatient Sample from 2010 to 2019 were analyzed. We used multivariable mixed-effects logistic regression to assess medical services, patient demographics, and hospital characteristics associated with higher charges billed to insurance and hospital costs. Generalized linear mixed-effects models were used to determine cost savings associated with provision of PC. Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in US dollars (USD) to $56,098 USD, whereas the median hospital cost remained stable at $14,300 USD. Receipt of inpatient PC was associated with significantly lower charges (odds ratio [OR], 0.62 [95% CI, 0.61 to 0.64]; P < .001) and costs (OR, 0.59 [95% CI, 0.58 to 0.61]; P < .001). Factors associated with high charges were receipt of invasive medical ventilation (P < .001) or systemic therapy (P < .001), Hispanic patients (P < .001), young age (18-49 years, P < .001), and for-profit hospitals (P < .001). PC provision was associated with a $1,310 USD (-13.6%, P < .001) reduction in costs per hospitalization compared with no PC, independent of the receipt of invasive care and age. Inpatient PC is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Integration of inpatient PC may de-escalate costs incurred through low-value inpatient interventions.

Single-cell low-pass whole genome sequencing accurately detects circulating tumor cells for liquid biopsy-based multi-cancer diagnosis

Accurate detection of circulating tumor cells (CTCs) in blood and non-blood body fluids enables generation of deterministic cancer diagnosis and represent a less invasive and safer liquid biopsy approach. Although genomic alternations have been widely used in circulating tumor DNA (ctDNA) analysis, studies on cell-based genomic alternations profiling for CTC detection are rare due to major technical limitations in single-cell whole genome sequencing (WGS) including low throughput, low accuracy and high cost. We report a single-cell low-pass WGS-based protocol (scMet-Seq) for sensitive and accurate CTC detection by combining a metabolic function-associated marker Hexokinase 2 (HK2) and a Tn5 transposome-based WGS method with improved cell fixation strategy. To explore the clinical use, scMet-Seq has been investigated with blood and non-blood body fluids in diagnosing metastatic diseases, including ascites-based diagnosis of malignant ascites (MA) and blood-based diagnosis of metastatic small-cell lung cancer (SCLC). ScMet-Seq shows high diagnostic sensitivity (MA: 79% in >10 cancer types; metastatic SCLC: 90%) and ~100% of diagnostic specificity and positive predictive value, superior to clinical cytology that exhibits diagnostic sensitivity of 52% in MA diagnosis and could not generate blood-based diagnosis. ScMet-Seq represents a liquid biopsy approach for deterministic cancer diagnosis in different types of cancers and body fluids.

A Feasibility Study Investigating an Exercise Program in Metastatic Cancer Based on the Patient-Preferred Delivery Mode.

Feasibility of exercise in patients with metastatic cancer is still a challenge. This study aimed to determine the feasibility and preliminary efficacy of an exercise intervention based on a patient-preferred delivery mode in patients affected by metastatic cancer. Forty-four patients with a confirmed diagnosis of metastatic cancer were recruited in a 3-month exercise program. Whereas the exercise program consisted of aerobic and resistance activities performed twice a week, the participants may choose the mode of delivery: home based, personal training, or group based. The primary endpoint was the feasibility, defined by recruitment rate, attendance, adherence, dropout rate, tolerability (comparing the session RPE with the target RPE), and safety (using the Common Terminology Criteria for Adverse Events, version 5.0). Secondary endpoints included cardiorespiratory fitness (six minutes walking test), muscle strength (handgrip strength test and isometric leg press test), flexibility (the back scratch and chair sit and reach tests), anthropometric parameters (body mass index and waist-hip ratio), quality of life (EORTC QLQ C-30 questionnaire), and amount of physical exercise (Godin's Shepard Leisure Time Exercise Questionnaire). Descriptive statistics, Student t test, and Wilcoxon signed rank test were used to analyze data. The study recruitment rate was 81%. Out of 44 recruited patients, 28 chose the personal training program, 16 chose the home-based program, and none chose the group-based program. Nine dropouts occurred (20%), 6 in the personal training program, and 3 in the home-based intervention. The median attendance rate was 92%, adherence was 88%, tolerability was 100%, and 9 nonsevere adverse events were registered during the exercise sessions. An increase in cardiorespiratory fitness (P < .001) and flexibility (P = .011 for chair sit and reach; P = .040 for back scratch) was observed at the end of the intervention, while no changes in anthropometric values and muscle strength were detected. Different quality-of-life domains were improved following the intervention, including physical (P = .002), emotional (P < .001), and role functioning (P = .018), fatigue (P = .030), and appetite loss (P = .005). A 3-month exercise program based on a patient-preferred delivery mode is feasible in patients with metastatic cancer and may improve physical function and quality of life. NCT04226508.

Hemangioendothelioma: A Rare Entity at an Unusual Location

Abstract Epithelioid hemangioendothelioma (EHE) is a rare type of vascular tumor that behaves in a manner halfway between benign hemangiomas and malignant angiosarcomas. It is histologically distinguished by angiocentricity and solid, cord-like arrangements of epithelioid cells with intracytoplasmic lumina containing red blood cells. Although uncommon in childhood, it can develop at any age and affects both sexes equally. Accurate diagnosis may require further evaluation with tru-cut biopsy due to its potential for false-positive metastatic cancer diagnoses. Treatment approaches vary based on symptomatology, ranging from regular follow-ups for asymptomatic patients to surgical resection with embolization for symptomatic cases. With the help of this case, we want to discuss the importance of considering EHE in the differential diagnosis of vascular lesions and the significance of tailored treatment strategies based on individual patient characteristics.

New ESMO guidelines for clinical practice in metastatic colorectal cancer - commentary on changes in systemic therapy.

Commentary on the newly released European Society for Medical Oncology (ESMO) guidelines for the diagnosis and treatment of metastatic colorectal cancer (mCRC). After 6 years, individual chapters have been updated, from molecular tumor testing to diagnostic and treatment procedures to the implementation of newly registered medicinal products. The authors highlight the most important changes in the guidelines. Awareness of possible new treatments for mCRC is important to determine the treatment strategy for patients with mCRC. In this commentary, we focus primarily on the status of systemic treatment in unresectable disease.