Oncology Experts Research Articles

ERS International Congress 2022: highlights from the Thoracic Oncology Assembly.

Thoracic malignancies are associated with a substantial public health burden. Lung cancer is the leading cause of cancer-related mortality worldwide, with significant impact on patients' quality of life. Following 2 years of virtual European Respiratory Society (ERS) Congresses due to the COVID-19 pandemic, the 2022 hybrid ERS Congress in Barcelona, Spain allowed peers from all over the world to meet again and present their work. Thoracic oncology experts presented best practices and latest developments in lung cancer screening, lung cancer diagnosis and management. Early lung cancer diagnosis, subsequent pros and cons of aggressive management, identification and management of systemic treatments' side-effects, and the application of artificial intelligence and biomarkers across all aspects of the thoracic oncology pathway were among the areas that triggered specific interest and will be summarised here.

Catching Cancer Early: The Importance of Dermato-Oncology Screening.

The European Society for Medical Oncology experts have identified the main components of the long-term management of oncological patients. These include early diagnosis through population screening and periodic control of already diagnosed patients to identify relapses, recurrences, and other associated neoplasms. There are no generally accepted international guidelines for the long-term monitoring of patients with skin neoplasms (nonmelanoma skin cancer, malignant melanoma, precancerous-high-risk skin lesions). Still, depending on the experience of the attending physician and based on the data from the literature, one can establish monitoring intervals to supervise these high-risk population groups, educate the patient and monitor the general population.

Enhancing Radiotherapy Workflow for Head and Neck Cancer with Artificial Intelligence: A Systematic Review.

Head and neck cancer (HNC) is characterized by complex-shaped tumors and numerous organs at risk (OARs), inducing challenging radiotherapy (RT) planning, optimization, and delivery. In this review, we provided a thorough description of the applications of artificial intelligence (AI) tools in the HNC RT process. The PubMed database was queried, and a total of 168 articles (2016-2022) were screened by a group of experts in radiation oncology. The group selected 62 articles, which were subdivided into three categories, representing the whole RT workflow: (i) target and OAR contouring, (ii) planning, and (iii) delivery. The majority of the selected studies focused on the OARs segmentation process. Overall, the performance of AI models was evaluated using standard metrics, while limited research was found on how the introduction of AI could impact clinical outcomes. Additionally, papers usually lacked information about the confidence level associated with the predictions made by the AI models. AI represents a promising tool to automate the RT workflow for the complex field of HNC treatment. To ensure that the development of AI technologies in RT is effectively aligned with clinical needs, we suggest conducting future studies within interdisciplinary groups, including clinicians and computer scientists.

The cognitive load of inpatient consults involving immune-related adverse events.

11033 Background: Immune-related adverse events (irAE) requiring hospitalization involve complex, multidisciplinary management. Expertise in oncology and/or the affected organ(s) may be required in the form of inpatient consults. Trainees (fellows and residents) often provide such consults. irAE consults may be rich learning opportunities, but it is unclear whether the cognitive load, or mental effort, required for these complex cases may overwhelm trainees and impair learning. To investigate the cognitive load of irAE consults, we surveyed trainees who had recently completed an irAE consult and compared the results to a control dataset. Methods: Between October 2021 and January 2023, we identified patients hospitalized due to irAEs at the University of California, San Francisco by reviewing patient lists (oncology consults and hospital medicine admissions) daily. We emailed the published Consult Cognitive Load (CCL) survey to any residents or fellows who had signed initial consult notes in the charts of identified patients. The CCL uses 4-point scales to measure three types of cognitive load related to one consult: intrinsic load (IL) related to the consult task itself, extraneous load (EL) related to distractions during the consult, and germane load (GL), the mental effort left over for learning after IL and EL are accounted for. IL, EL, and GL scores range from 4 to 16. Using two-tailed t tests, we compared mean IL, EL, GL, and total cognitive load (the sum of IL, EL, and GL) between the irAE group and a control group of fellows and residents who performed a variety of consults at five University of California hospitals during a 2018-2019 study (n = 142). Detecting a difference of 0.5 with a variance of 0.5 (calculated for the control group), 80% power, and 95% confidence required an irAE group sample size of 18. Results: Of 36 trainees contacted for the irAE group, 18 completed the CCL (50% response rate, 61% fellows, 39% residents). The irAE group and the control group (80% fellows, 17% residents, 3% not reported) spanned multiple specialties. Total cognitive load (p = 0.49) and IL (p = 0.95) did not differ. EL was significantly lower (8.4 vs 10.3, p = 0.002) and GL higher (11.9 vs 10.8, p = 0.04) in the irAE group. Conclusions: Trainees experienced similar cognitive load when performing irAE consults as compared to other consults, but the sources of cognitive load differed. Trainees performing irAE consults expended less mental effort on distractions (EL) and more on learning (GL) as compared to other consults. The consult task itself (IL) imposed a similar amount of cognitive load whether or not it was an irAE consult. Complex irAE cases did not overwhelm trainees or preclude learning; rather, trainees performing irAE consults exhibited a sharpened focus on the task at hand and extracted more learning than trainees performing other consults. Educators should foster trainee exposure to inpatient irAE consults to promote worthwhile learning.

DASS Good: Explainable Data Mining of Spatial Cohort Data.

Developing applicable clinical machine learning models is a difficult task when the data includes spatial information, for example, radiation dose distributions across adjacent organs at risk. We describe the co-design of a modeling system, DASS, to support the hybrid human-machine development and validation of predictive models for estimating long-term toxicities related to radiotherapy doses in head and neck cancer patients. Developed in collaboration with domain experts in oncology and data mining, DASS incorporates human-in-the-loop visual steering, spatial data, and explainable AI to augment domain knowledge with automatic data mining. We demonstrate DASS with the development of two practical clinical stratification models and report feedback from domain experts. Finally, we describe the design lessons learned from this collaborative experience.

Examining molecular testing practices and targeted therapy use in advanced/metastatic non-small cell lung cancer (mNSCLC): A quality improvement initiative across ten community cancer centers.

e21191 Background: A growing number of targeted therapy approvals for mNSCLC have dramatically increased requirements for molecular testing. Identifying and addressing real-world challenges mNSCLC care teams face due to resulting workflow shifts is essential to optimize patient outcomes. Methods: In March–September 2022, 126 health care professionals (HCPs) who treat NSCLC at 10 US community oncology clinics completed surveys assessing practice patterns, challenges, and confidence related to biomarker testing and targeted therapy use. HCPs (N = 105) participated in interdisciplinary audit and feedback (AF) sessions to examine clinical evidence and develop clinic-specific action plans to address identified gaps. Results: Participants represented the interprofessional NSCLC care team: medical oncologists (32%), pathologists (1%), radiation oncologists (1%), pulmonologists (2%), PCP/other physicians (5%), advanced practice professionals (22%), nurses (19%), and other HCPs (e.g. patient navigator, practice manager; [19%]). At the time of the program there were 9 NCCN-recommended biomarkers for mNSCLC. Less than half of HCPs reported regular testing for 4 of these biomarkers (Table 1). The majority of HCPs were somewhat (52%) or very/extremely (23%) likely to start treatment prior to receiving molecular testing results. Top reported barriers to integrating molecular diagnostics into routine practice were biopsy tissue availability/quality (45%) and determining whether to begin treatment prior to receipt of molecular testing results (43%). Gap-oriented clinic action plans aimed to improve communication between oncologists, pulmonologists, and pathologists to increase quality and efficiency of testing. A targeted therapy toolkit was developed with a panel of oncology and pathology experts and distributed to participants to address gaps in knowledge of testing practices and guidelines. HCP confidence in biomarker testing increased from 72% to 92% following the intervention. More HCPs correctly answered knowledge (43% pre-AF vs 61% post-AF) and competence (29% pre-AF vs 54% post-AF) questions following participation in the AF sessions. Conclusions: While molecular testing is critical for mNSCLC care, HCPs report sub-optimal rates of conducting testing prior to treatment and incorporating results into treatment planning. Here, we highlight an unmet need for improved interdisciplinary communication and coordination in mNSCLC care teams and an educational intervention strategy that can be used to improve HCP biomarker and targeted therapy use in mNSCLC. [Table: see text]

Automatic Assessment of Stereotactic Radiation Therapy Outcome in Brain Metastasis Using Longitudinal Segmentation on Serial MRI.

The standard clinical approach to assess the radiotherapy outcome in brain metastasis is through monitoring the changes in tumour size on longitudinal MRI. This assessment requires contouring the tumour on many volumetric images acquired before and at several follow-up scans after the treatment that is routinely done manually by oncologists with a substantial burden on the clinical workflow. In this work, we introduce a novel system for automatic assessment of stereotactic radiation therapy (SRT) outcome in brain metastasis using standard serial MRI. At the heart of the proposed system is a deep learning-based segmentation framework to delineate tumours longitudinally on serial MRI with high precision. Longitudinal changes in tumour size are then analyzed automatically to assess the local response and detect possible adverse radiation effects (ARE) after SRT. The system was trained and optimized using the data acquired from 96 patients (130 tumours) and evaluated on an independent test set of 20 patients (22 tumours; 95 MRI scans). The comparison between automatic therapy outcome evaluation and manual assessments by expert oncologists demonstrates a good agreement with an accuracy, sensitivity, and specificity of 91%, 89%, and 92%, respectively, in detecting local control/failure and 91%, 100%, and 89% in detecting ARE on the independent test set. This study is a step forward towards automatic monitoring and evaluation of radiotherapy outcome in brain tumours that can streamline the radio-oncology workflow substantially.

Providing Suggested Rules for Multiple Primary Cancer Recording, Coding and Registering in Population-based Cancer Registry.

Multiple primary cancers (MPC) present many coding difficulties, while a distinction should be made between new cases and those with metastasis and/or extension and recurrence of the primary ones. We aimed to reflect on the experiences and results of data quality control of the East Azerbaijan/Iran Population-Based Cancer Registry and present our suggested rules for reporting, recording and registering multiple primary cancer. Comparability, validity, timeliness, and completeness of data assessment were performed. As a result, we created a consulting team including expert oncologists, pathologists, and gastroenterologists to discuss for multiple primary tumors recording, identifying, coding and registering. In case of confirmed Blood malignancies with definite BMB results, Brain and/or Bone involvements are always metastatic. In most cases of multiple cancers with the same morphological types, the earlier should be registered as primary tumor. In most of the synchronous multiple cancers, familial cancer syndromes should be considered and rules out. In case of two tumors diagnosed at the same time in colon and rectum, primary site should be detected by T stage or tumor sizes. In case of multiple tumors in Recto-sigmoid, Colon , and Rectum the earlier history of tumor should be considered as primary site. This rule was applied for Female Genital tumors, as earlier site is always the Primary cancer and other tumors should be registered as metastatic sites. Conclusion: Given the complexity of coding MPCs, we suggested some additional rules for identifying, recording, coding, and registering multiple primary cancers in the context of the EA-PBCR program.

Time to initial review by oncology clinical pathways committees for new FDA approvals/label expansions.

e13523 Background: Dana-Farber Cancer Institute’s (DFCI) clinical pathways provide expert oncology decision-support. We schedule 2-4 reviews/year for each of over 40 medical oncology pathways, plus ad hoc reviews. When FDA issues new approvals or label expansions, the relevant medical director assigns it to the next scheduled review or a more urgent ad hoc meeting. Here we explore the time to initial review (TTIR) for FDA approvals. Methods: This analysis includes FDA approvals/label expansions for adult oncology patients from 01/01/2021 – 12/31/2022. We excluded CAR-T therapies as well as FDA approvals not directed at one of our existing pathways. TTIR was calculated from date of FDA approval to date of DFCI clinical pathways review. Univariate analyses examined the impact of prior in-class competitors in the specific approval setting; prior approvals for the treatment class in general; and scheduled meeting cadence. Results: From January 1, 2021 – December 31, 2022, there were 58 FDA approvals/label expansions in diseases for which a DFCI pathway exists. Eighteen represented items that had been previously addressed (e.g., conversion of accelerated approval to full, or a label expansion adopted into pathways earlier based on published data). For the remaining 40 new approvals or label expansions, the median TTIR was 3.4 months. 43% of FDA approvals were addressed prior to or within 30 days after announcement. There were 9 ad hoc reviews over this period, including review of 3 new FDA approvals. Median TTIR for items that were a first-in-class therapy for that specific indication (n= 20) was 2.1 months, compared to 3.5 months for agents with an existing in-class competitor in that setting (n=20). Median TTIR for items that represented the first approval for a novel first-in-class agent (n=13) was 1.5 months; TTIR for agents with existing in-class approvals in any setting (n=27) was 3.5 months. Median TTIR for FDA actions involving diseases/pathways that have > 3 scheduled review meetings/yr (n=28) was 2.8 months, compared to 5.2 months in pathways with 1-2 scheduled reviews/yr (n=12). Conclusions: Clinical Pathways provide a structured mechanism for reviewing whether, when, and how new treatments are best used in oncology practice, and for disseminating those recommendations to providers. The time to initial review was shorter for initial registrational approvals for novel agents, and for treatments in diseases with more frequent meetings. [Table: see text]

Serous endometrial intra-epithelial carcinoma: an observational study

BackgroundSerous endometrial intra-epithelial carcinoma is described as a malignant, superficial spreading lesion with risk of extra-uterine spread at time of diagnosis, and poor outcome.ObjectiveTo evaluate the surgical management of patients...

Abstract 4577: An innovative platform to mimic the tumoral vascular microenvironment (TME) of patients with metastatic colorectal cancer (mCRC) using bioprinted hydrogel microfluidics

Abstract Introduction: Metastasis involves a set of complex events that finally result in malignant cells from primary tumors invading distant tissues by the pass of circulant tumor cells (CTC) through the blood circulation. To authentically comprehend the complex chain of events and even enable new therapeutic approaches in mCRC patients, ex-vivo functional models are an unmet research need. Experimental Plan: PROMISE project is combining bioengineering solutions such as bioprinting biomaterials and microfluidics to mimic the tumor microenvironment (TME) of metastatic sites in mCRC. In this project, we are developing a bioprinted hydrogel-based microfluidic device that recapitulates this TME. Then, CTCs are isolated from mCRC patients, cultured, and characterized by microdroplet technology. Those CTCs are then infused on the biodegradable polymer that mimics vascular channels and surrounding stromal cells, through microfluidic connection, in order to mimic CTC-endothelial interactions, study the procedures of extravasation (the invasiveness potential of extravasated patient-derived CTCs into TME) and intravasation (the process of CTCs-derived and biopsy-derived tumor spheroids from the TME to the vascular channel). The photopolymerizable hydrogel mimics vascular structures, supporting the growth of HUVEC cells, and is printed in a cost-effective manner (30 minutes) using a semi-direct printing method with visible light. The CROSS chip is used for fast and efficient isolation of CTCs from unprocessed blood of mCRC patients. In parallel, multi-omics of mCRC are done in circulant tumor DNA (ctDNA) and tumor biopsy of mCRC, therefore correlating the phenotypic and genetic profile of the patient cohorts studied. A first pilot test has been carried out successfully obtaining blood from mCRc refractory patients, and excellent coordination between the multidisciplinary consortium has been achieved to draw blood from the patient, isolate CTCs and infuse them into the hydrogel. Extravasation and intravasation studies are ongoing. Conclusion: This multidisciplinary project, which brings together bioengineering, microfluidic, and oncology experts’ teams, is developing a successful ex-vivo, in vitro, and dynamic model that will permit a better study and understanding of the metastatic process in mCRC, from the process of intravasation to extravasation of CTCs, passing thought the better multi-omic characterization of CTCs and ctDNA. Citation Format: Nadia Saoudi González, Francesc Salvà Ballabrera, Ariadna García, Javier Gonzalo-Ruiz, Iosune Baraibar, Javier Ros, Marta Rodriguez, María García Díaz, Marta Falcó Fusté, Melika Parchehbaf Kashani, Carlos Honrado, Alar Ainla, Josep Tabernero, Lorena Diéguez, Elena Martínez Fraiz, Elena Élez. An innovative platform to mimic the tumoral vascular microenvironment (TME) of patients with metastatic colorectal cancer (mCRC) using bioprinted hydrogel microfluidics. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4577.

Abstract 4670: True bench-to-bedside science: An international pilot study modeling hard-to-cure pediatric cancers to prioritize therapeutic intervention

Abstract There has been dramatic improvement in treatment outcomes for many pediatric cancers over the last three decades. However, for the 20% of young people with relapsed or refractory cancer, the prognosis remains grim. Canada’s PRecision Oncology For Young peopLE (PROFYLE) and Australia’s Zero Childhood Cancer (ZERO) programs, leverage nation-wide scientific and clinical oncology expertise to provide personalized precision medicine to children, adolescent and young adult (CAYA) cancer patients who lack treatment options. Beyond improving the lives of young cancer patients nationally, PROFYLE and ZERO have partnered to create an international pipeline for knowledge sharing and sample acquisition. A key component of both programs is the use of mice for patient-derived xenografts (PDXs). However, long lead times for mouse PDX generation make the timely return of preclinical drug response data challenging. PROFYLE has uniquely incorporated zebrafish larval xenografts, which have the potential to provide comparable information in a clinically actionable timeframe. In a pilot study, we compared retrospective matched ZERO patient and mouse PDX therapeutic response data with prospective zebrafish larval PDX data as a proof-of-principle that drug efficacy signals were maintained across model systems. Three ZERO avatars: high-risk neuroblastoma, Ewing’s sarcoma, and anaplastic large cell lymphoma were shipped from Australia to Canada and transplanted into 48h casper zebrafish. Following dose optimization, zebrafish PDXs were treated with targeted single and combination drug treatments by immersion therapy. Strikingly, in as little time as a week, cell proliferation rates and drug responses to single agents and combinatorial therapy in zebrafish PDXs recapitulated mouse and patient data. To expand on this pilot project, we tested additional patient samples, including multiple subtypes of sarcomas, T-cell acute lymphoblastic leukemia and an embryonal tumor with multilayered rosettes. Results further validated the practical utility of the zebrafish larval PDX model and in fact provided drug response data when mouse PDX data were unavailable. This study demonstrates the robustness and feasibility of the zebrafish larval PDX model as a preclinical tool for personalized precision therapeutic decision-making and highlights the value of international collaboration in improving outcomes of rare childhood cancers. Citation Format: Nadine Azzam, Nicole Melong, Lissandra Tuzi, Lisa Pinto, Jamie I. Fletcher, Alvin Kamili, Biljana Dumevska, Loretta Lau, Jennifer A. Chan, Donna L. Senger, Stephanie A. Grover, Michelle Haber, David Malkin, Jason N. Berman. True bench-to-bedside science: An international pilot study modeling hard-to-cure pediatric cancers to prioritize therapeutic intervention. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4670.

Supportive care for cancer-related symptoms in pediatric oncology: a qualitative study among healthcare providers

BackgroundThe aim of this study is to gain insight into the clinical experiences and perceptions that pediatric oncology experts, conventional healthcare providers, and complementary and alternative medicine (CAM) providers in Norway, Canada, Germany, the Netherlands, and the United States have with the use of supportive care, including CAM among children and adolescents with cancer.MethodsA qualitative study was conducted using semi-structured in-depth interviews (n = 22) with healthcare providers with clinical experience working with CAM and/or other supportive care among children and adolescents with cancer from five different countries. Participants were recruited through professional associations and personal networks. Systematic content analysis was used to delineate the main themes. The analysis resulted in three themes and six subthemes.ResultsMost participants had over 10 years of professional practice. They mostly treated children and adolescents with leukemia who suffered from adverse effects of cancer treatment, such as nausea and poor appetite. Their priorities were to identify the parents' treatment goals and help the children with their daily complaints. Some modalities frequently used were acupuncture, massage, music, and play therapy. Parents received information about supplements and diets in line with their treatment philosophies. They received education from the providers to mitigate symptoms and improve the well-being of the child.ConclusionsClinical experiences of pediatric oncology experts, conventional health care providers, and CAM providers give an understanding of how supportive care modalities, including CAM, are perceived in the field and how they can be implemented as adaptational tools to manage adverse effects and to improve the quality of life of children diagnosed with cancer and the families.

Unmet Needs in Geriatric Oncology.

Nikhil PathiIndia's population is aging, with the number of people aged 60 and over projected to reach 340 million by 2050. This is expected to lead to an increase in the number of older adults with cancer. Geriatric oncology is a rapidly growing field in India that is facing several challenges. Some of these include inadequate access to cancer screening and early detection programs in elderly, leading to late diagnoses and poor outcomes, lack of specialized geriatric oncology services, cancer-specific treatment guidelines and protocols in elderly, limited availability of treatment options due to accessibility, finances and other logistic issues, lack of trained healthcare professionals with expertise in geriatric oncology, lack of awareness, and access to early integrated palliative care services. There are several challenges faced by elderly in this journey like financial dependency, social isolation, difficulty in transportation to healthcare for treatments, and psychosocial aspects attributed to cancer. Awareness about availability of resources, patient assistance programs to reduce financial burdens, education campaigns, use of telemedicine and telehealth services to bypass transportation issues in remote and underserved areas, and integration of geriatric oncology into mainstream oncology services might be some solutions. Additionally, there is a need for more research on the unique characteristics and needs of older cancer patients in India, as well as the development of culturally appropriate interventions to address these needs. Development of India-specific geriatric assessment scales encompassing medical, psychosocial, and functional problems in elderly identifies areas of vulnerability. A multidisciplinary team-based decision-making is required at various levels. There is a need for increased investment in geriatric oncology research, training, and integrated palliative care services in India. Geriatric oncology is slowly being recognized as a separate subspeciality and more geriatric oncology centers and clinics are being set up in major cities in India that should be the way forward.

Preventing Central Line Bloodstream Infections: An Interdisciplinary Virtual Model for Central Line Rounding and Consultation

Background: Central line–associated bloodstream infections (CLABSI) account for many harms suffered in healthcare and are associated with increased costs and disease burden. Central line rounds, like medical rounds, are a multidisciplinary bedside assessment strategy for all active central lines on a unit. In-person line rounds in this 144-bed oncology acute care setting are challenging due to a variety of unchangeable factors. The aim was to develop a process for addressing concerning central lines in this context. Methods: The project team designed a HIPAA-protected, text-based process for assessing central lines for risk factors contributing to infection. Staff initiated a consultation via a virtual platform with an interdisciplinary team composed of oncology and infectious diseases experts. The virtual discussion included recommendations for a line-related plan of care. Results: The number of consultations averaged about five per month, with 27.4% resulting in the central line being removed, which is believed to have contributed to an overall reduction in infection rates. The CLABSI standardized infection ratio, a risk-adjusted measure which accounts for patient acuity and volumes, improved from 0.85 prior to the intervention (November 2020–October 2021) to 0.57 after the intervention (November 2021–August 2022), a 33% reduction. Conclusion: A virtual process for central line consultation and interdisciplinary planning was effective and, in this setting, perhaps optimal. This type of process could be applied to nearly any aspect of clinical care where teams are solving problems in an environment with complex geography and relationships.

Plain language summary and patient perspective of the European Society for Medical Oncology expert consensus statements on treating EGFR-positive non-small-cell lung cancer.

This article provides a plain language summary and patient perspective of a new set of recommendations made by the European Society for Medical Oncology (ESMO for short). These recommendations are also called expert consensus statements. They cover the management of people with a type of lung cancer called epidermal growth factor receptor-positive non-small-cell lung cancer (EGFR-positive NSCLC for short). The ESMO Clinical Practice Guidelines are used by healthcare professionals when treating people with cancer, but they don't necessarily have all the information healthcare professionals need to make decisions for with people with EGFR-positive NSCLC. So, in 2021, 32 healthcare professionals who are experts in treating people with EGFR-positive NSCLC worked together to produce recommendations to fill these gaps about EGFR-positive NSCLC. This was called a consensus-building process and it also included patient advocates. The experts discussed four main topics including how people with different stages of EGFR-positive NSCLC are diagnosed and treated, and how clinical studies are done. They reviewed the scientific information that exists on these subjects. They reached an agreement and developed the recommendations that are summarized here.

Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective.

Melanoma represents an increasing public health burden with extensive unmet needs in Latin America (LA). A mutation in the BRAF gene is present in approximately 50% of all melanomas in White populations and is a target of precision medicine, with the potential to dramatically improve patient outcomes. Thus, increased access to BRAF testing and therapy is LA must be explored. At a multi-day conference, a panel of Latin American experts in oncology and dermatology were provided with questions to address the barriers limiting access to testing for BRAF mutation in patients with melanoma in LA, who may be eligible for targeted therapy to improve their prognosis. During the conference, responses were discussed and edited until a consensus on addressing the barriers was achieved. Identified challenges included ignorance of BRAF-status implications, limited human and infrastructural resources, affordability and reimbursement, fragmented care delivery, pitfalls in the sample journey, and lack of local data. Despite the clear benefits of targeted therapies for BRAF-mutated melanoma in other regions, there is no clear path to prepare LA for a sustainable personalized medicine approach to this disease. Due to melanoma's time-sensitive nature, LA must aim to provide early access to BRAF testing and consider mutational status within treatment decision making. To this end, recommendations are provided and include establishing multidisciplinary teams and melanoma referral centers and improving access to diagnosis and treatment.

RAPID framework for improved access to precision oncology for lethal disease: Results from a modified multi-round delphi study.

Predictive oncology, germline technologies, and adaptive seamless trials are promising advances in the treatment of lethal cancers. Yet, access to these therapies is stymied by costly research, regulatory barriers, and structural inequalities worsened by the COVID-19 pandemic. To address the need for a comprehensive strategy for rapid and more equitable access to breakthrough therapies for lethal cancers, we conducted a modified multi-round Delphi study with 70 experts in oncology, clinical trials, legal and regulatory processes, patient advocacy, ethics, drug development, and health policy in Canada, Europe, and the US. Semi-structured ethnographic interviews (n = 33) were used to identify issues and solutions that participants subsequently evaluated in a survey (n = 47). Survey and interview data were co-analyzed to refine topics for an in-person roundtable where recommendations for system change were deliberated and drafted by 26 participants. Participants emphasized major issues in patient access to novel therapeutics including burdens of time, cost, and transportation required to complete eligibility requirements or to participate in trials. Only 12% of respondents reported satisfaction with current research systems, with "patient access to trials" and "delays in study approval" the topmost concerns. Experts agree that an equity-centered precision oncology communication model should be developed to improve access to adaptive seamless trials, eligibility reforms, and just-in-time trial activation. International advocacy groups are a key mobilizer of patient trust and should be involved at every stage of research and therapy approval. Our results also show that governments can promote better and faster access to life-saving therapeutics by engaging researchers and payors in an ecosystem approach that responds to the unique clinical, structural, temporal, and risk-benefit situations that patients with life-threatening cancers confront.

PET-MRI for evaluation of response to radiochemotherapy in patients with locally advanced cervical cancer

ObjectiveWe aimed to analyze the diagnostic test accuracy of positron emission tomography and a magnetic resonance imaging scan (PET-MRI) fusion in evaluating tumor response after radiochemotherapy in patients with locally...

Global Oncology Medical Diplomacy Working Group Inaugural Meeting: Defining Worldwide Barriers to Germline Genomics in Cancer Prevention and Management.

We convened an international working group to examine the issues that challenge equity and inclusion in genetic medicine. Specifically, 72 internationally known experts in oncology and cancer genetics from 34 countries (the Global Oncology Medical Diplomacy Working Group), gathered virtually on January 4-5, 2022, for the "Humanity Cancer Germline Convergence and Divergence Cancer Predispositions" conference hosted by Memorial Sloan Kettering Cancer Center, in collaboration with the United Arab Emirates Ministry of Health and the Al Jalila Foundation. The goal of the conference was to broaden transnational understanding of the current state of genetics in preventive and therapeutic cancer medicine, and to define barriers to increased uptake of germline genomics to decrease the international burden of cancer. Here, we highlight the overarching barriers that were defined through this effort. These global barriers to incorporating germline genomics into optimal cancer care can inform ongoing research, collaboration, and advocacy for equitable, cost-effective genomic medicine for populations worldwide.