Oncology Medicine Research Articles

A proposed analytical framework for qualitative evaluation of access to medicines from a health systems perspective

ObjectiveDespite global recognition that access to medicines is shaped by various interacting processes within a health system, a suitable analytical framework for identifying barriers and facilitators from a system’s perspective was needed. We propose a framework specifically designed to find drivers to access to medicines from a country’s health system perspective. This framework could enable the systematic evaluation of access across countries, disease areas and populations and facilitate targeted policy development. This framework is the byproduct of a larger study on the barriers and facilitators to childhood oncology medicines in South Africa.ResultsEight core (pharmaceutical) functional processes were identified from existing frameworks: (I) medicine regulation, (II) public financing and pricing, (III) selection, (IV) reimbursement, (V) procurement and supply, (VI) healthcare delivery, (VII) dispensing and (VIII) use. National contextual components included policy and legislation and health information systems. To emphasize the interlinkage of processes, the proposed framework was structured as a pharmaceutical value chain. This framework focusses on national processes that are within a country’s control as opposed to global factors, and functional mechanisms versus a country’s performance or policy objectives. Further refinement and validation of the framework following application in other contexts is encouraged.

A Review on Integration of Precision Medicine in Oncology Practice

Oncology, the medical specialty focused on cancer study, diagnosis, and treatment, has experienced remarkable progress over the years. The introduction of chemotherapy, targeted therapy, and immunotherapy has broadened treatment possibilities, yet the field continues to face significant challenges. Precision medicine, also known as personalized medicine, has emerged as a transformative approach in this complex environment. It offers innovative strategies for disease prevention and treatment by considering individual genetic, environmental, and lifestyle differences. A leading trend in precision oncology is the formulation of personalized treatment plans based on the distinct genetic and molecular characteristics of each patient's tumor. The evolution of precision medicine in oncology has been driven by technological advancements such as genomic sequencing technologies, high-throughput screening, bioinformatics, targeted therapy, liquid biopsy, CRISPR and gene editing, and the application of artificial intelligence and machine learning. These innovations have significantly influenced cancer treatment, enabling more precise and effective interventions. This article examines the critical technological developments propelling precision medicine forward and assesses their impact on oncology. It also explores the essential steps required to integrate precision medicine into clinical practice, addressing the challenges and advantages associated with its adoption. Integrating precision medicine into oncology promises to enhance the accuracy of diagnoses, improve treatment outcomes, and reduce adverse effects by tailoring interventions to individual patient profiles. This review discusses the importance of continued research and technological innovation in realizing the full potential of precision oncology

Advancing precision medicine in cutaneous oncology through 3D high-frequency ultrasound imaging.

e13625 Background: Clinical assessment of tumor depth and shape often requires biopsy, especially when evaluating skin cancers. High Frequency Ultrasound (HFUS) is a non-invasive clinical tool that can quickly produce high resolution images ideally suited for evaluating topical tumors. In comparison to other imaging modalities, HFUS do not always provide the spatial data required to model 3-dimensional (3D) tumors. Currently, 3D-images are an amalgamation of many segmented image slices. However, in outpatient clinics it is unrealistic for HFUS devices and clinicians to gather large sets of image data. In our present original research, we aimed to overcome limited number of HFUS and dermatoscopic images by constructing a simple framework to process sparse and non-spatial data into working 3D skin tumor models. Methods: We analyzed two different skin tumors, the dermal duct tumor (DDT) and basal cell carcinoma (BCC), each with different number of HFUS images at 30Hz and 50Hz respectively. 1 set of 6 parallel images were obtained for the BCC, while 2 orthogonal sets of 6 parallel images were obtained for the DDT. For each tumor, a single dermatoscopic photo and sets of bitmap HFUS images with a resolution of 1024 x 512 were taken. Our study was IRB-approved. Mathematica and MATLAB, both with accessible documentation, were used to process images. Results: We developed a novel algorithmic approach to produce 3D tumor models with limited medical data. Both tumors appear corporally hypoechoic under HFUS. Mathematica was used to first reduce HFUS image noise and binarize the tumor region with a bilateral Gaussian filter. The user-friendly MATLAB Image Segmenter application manually filled the region of interest. Next, Mathematica was used to orient and plot tumor borders in 3D. Finally, we encompassed the borders with a 3D convex hull to conservatively predict tight margins around the tumor. Conclusions: Our simplified approach allows clinicians and scientists to produce 3D renderings of tumor margins. Margin control must always be balanced with a positive surgical outcome. By approaching our 3D-model with a convex hull around sampled border cross-sections, we chose a conservative approach that focuses skin tumor margin evaluation. Our results promote precision medicine and planning into the current standard of skin cancer treatment. Our findings can allow tracking tumor progression or treatment possible via non-invasive evaluation of tumor depth and contour. An aim of our present research is to lower the barrier of 3D construction in clinical settings. Simple algorithms, such as shown in our work, transform orthogonal and sparse data into usable data that can be implemented to train machine learning and artificial intelligent programs. Future research tailoring this approach may allow instant programming of HFUS images to non-invasively render cutaneous tumor borders and depth in real time during clinical examination.

Improving the understanding of integrative oncology approaches among hospitalized patients with cancer.

e23234 Background: Many integrative oncology (IO) outpatient (OP) cancer care approaches—yoga, acupuncture, massage, physical activity—have demonstrated benefit and are now part of guideline care. We report on a pilot inpatient (IP) IO consultative service aimed at introducing patients and families to IO at a time when cancer- and treatment-related symptoms can be significant. As a measure of patient-centered care, we assessed patient’s change in perceived understanding, intention to promote health, confidence in care, and plan for IO OP follow up. Methods: IO consultations that assess nutrition, activity, and stress were made available to patients in the Bone Marrow Transplant Unit at Thomas Jefferson University Hospital (TJUH) starting in July 2023 as ordered by the primary oncology team. Consultations (69) have been conducted by an Integrative Medicine Fellow and an attending Board Certified in both Medical Oncology and Integrative Medicine. The post-IO consultation survey includes 7 questions with a 5-point Likert Scale (1 = Do Not Agree, 5 = Completely Agree).The survey was initially offered as an online link. A paper format was developed at patient request. Results: A total of 34 patients (50%) completed the post-consultation survey. Conclusions: Patients expressed a greater likelihood of focusing on wellness through diet, nutrition, meditation, and stress reduction (76.4%) and of taking steps to promote their health (87.9%); as well as an improved understanding of the relationship between nutrition and health (88.2%) and stress and health (88.2%). Patients noted a more positive view of TJUH (84.4%) and greater confidence in their treatment (81.8%). In addition, only 10% of patients decided not to pursue an IO appointment after discharge. These pilot data suggest a benefit to IP IO consultation. [Table: see text]

Guideline of traditional Chinese medicine diagnosis and treatment for breast cancer patients with emotional disorders (2023)

Breast cancer has emerged as one of the most common malignancies among women globally, constituting a major cause of female cancer-related mortality. Among breast cancer patients, the incidence of emotional disorders is notably high, significantly impacting their quality of life and disease prognosis. Traditional Chinese medicine (TCM) offers numerous advantages in addressing emotional disorders. However, currently there are no standardized diagnostic or therapeutic guidelines for TCM management of emotional disturbances accompanying breast cancer. This guideline, authored by a panel of experts in the field of TCM, including specialists in breast oncology, breast surgery, and psychosomatic medicine, is based on the current best evidence and expert insights. It standardizes the terms and definitions, diagnostic criteria, etiology and pathogenesis, clinical staging, and treatment principles of breast cancer with emotional disorders. Meanwhile, the guideline establishes 6 main TCM syndrome types and their corresponding treatment strategies. Its purpose is to serve as a reference and foundation for the clinical syndrome differentiation and treatment of emotional disorders in breast cancer patients.

DNA methylation-based biological age and time to relapse in triple negative breast cancer.

e13126 Background: Triple negative breast cancer (TNBC) represents 15% of all breast cancer cases and is one of the most aggressive forms of breast cancer with a poorer prognosis. Due to the lack of receptors, TNBC is not amendable to hormonal or anti-HER2 therapies and current gene expression arrays have limited clinical utility in TNBC. The identification of biomarkers associated with TNBC may aid in elucidating the underlying biological mechanisms of this disease and may also have implications for risk stratification, diagnosis, and prognosis of TNBC. The purpose of this study was to investigate the association between markers of biological aging and time to relapse in TNBC. Methods: DNA methylation and clinical data from a publicly available dataset (GSE141441) were used in this analysis. Breast tissue specimens in female TNBC patients who received (n=56) and who did not receive (n=110) chemotherapy underwent DNA methylation profiling using the Illumina Infinium HumanMethylation450K BeadChip. Five DNA methylation-based biological age metrics were calculated: intrinsic epigenetic age acceleration (IEAA), extrinsic epigenetic age acceleration (EEAA), PhenoAge acceleration (PhenoAA), GrimAge acceleration (GrimAA), and DunedinPACE (Pace of Aging Calculated from the Epigenome). Multiple linear and quantile regression analyses were performed to examine the association between the aging metrics and time to TNBC relapse. Interaction and stratified analyses by Ki-67 was additionally performed. Results: After adjusting for chronological age, GrimAA ( P=0.024) and DunedinPACE ( P=0.019) were negatively associated with time to relapse among patients who did not receive chemotherapy. Specifically, a 1-year increase in GrimAA and 1 unit increase in the pace of aging were associated with a 1.77-month and a 53.62-month shorter relapse of TNBC, respectively. Additionally, Ki-67 significantly modified the association between IEAA ( P=0.023) and DunedinPACE ( P=0.035) among patients who received chemotherapy with a 2.75- and a 42.17-month shorter relapse of TNBC among those with a Ki-67 index greater than 50% per unit increase in IEAA and DunedinPACE, respectively. Conclusions: We observed DNA methylation markers of biological age were associated with time to relapse in TNBC patients and these associations were modified by Ki-67. These biomarkers may have prognostic utility in TNBC relapse and potentially, may aid in oncological precision medicine efforts for personalized treatment regimens and surveillance. [Table: see text]

A medical school curriculum to foster the physician-patient relationship through narrative medicine.

e21015 Background: Narrative Competence is the ability to acquire, interpret and act on the stories of others.[1] Developing this skill can also improve health care practitioner’s sense of empathy and satisfaction with their work.[2] This study’s purpose is to evaluate the impact of a narrative medicine curriculum on medical students’ sense of connection to their patients and humanism in medicine. Methods: During the 2023 academic year, a narrative medicine assignment was introduced to the internal medicine oncology clerkship curriculum at the Yale School of Medicine. Third year medical students attended a training session on narrative medicine skills, interviewed a patient and wrote the patient’s story, and attended a session to read their written narrative. A survey was distributed to students asking for their reflections on the doctor patient relationship and the role of humanism in improving well-being and reducing burn out. Responses were de-identified and thematic analysis of responses was conducted. Results: 58 students participated in the training sessions and 11 (19%) completed a post-workshop free text survey with 5 questions reflecting on the doctor-patient relationship, the role of humanism in medicine, and the curriculum itself. Common themes that emerged include 1) how strong doctor-patient relationships makes medicine more meaningful, uplifting and enjoyable, 2) how seeking out a patient’s story is essential to the doctor-patient relationship and to optimal quality care, and 3) importance of doctor’s exhibiting care and sensitivity and placing diseases in context of their patients’ stories. Reflecting on the role of humanism in medicine, students reported that 1) taking the time to know your patients makes medicine rewarding, meaningful and worthwhile, 2) allows you to empathize and connect with patients more through recognizing their humanity and vulnerability and putting their frustrations in context, and 3) could be healing to both patient and provider. Further directions: Students suggested making the program mandatory, expanding to include pre-clerkship students and students on other clerkships, and providing more time and structure to facilitate interviewing patients and writing up their stories. Conclusions: A curriculum incorporating narrative medicine was effectively integrated and well-received by students and fostered an awareness of the rewards of listening to patient stories.

Apoptosis‐Sensitizing Tumor Nanomedicine by Regulating Pyroptosis‐Associated Inflammatory Cell Death

AbstractThe vigorous development of cancer nanomedicine has revolutionized traditional oncology medicine, but it is also limited by the continuous mutation of cunning cancer cells, leading to apoptosis insensitivity and therapeutic disappointment. Inflammatory‐regulated cell death (RCD), especially pyroptosis‐related cell death, demonstrates huge potential for apoptosis sensitization due to its unique biochemical characteristics. The aim of this research is to present a thorough synopsis of the current knowledge on pyroptosis‐associated inflammatory cell death, including pyroptosis, cuproptosis, and PANoptosis, and the synergistic function in cancer nano therapy. Paradigm studies of pyroptosis‐related cell death‐mediated apoptosis‐sensitizing tumor nanotherapeutics are introduced in detail, and the coordination mechanisms based on nanomaterials are also discussed. In addition, multi‐angle analysis of the future prospects of pyroptosis‐sensitized tumor nanomedicine based on various nanomaterials is also emphasized to further expand the application scope of inflammatory RCD. It is believed that emerging auxiliary apoptosis‐sensitizing treatments based on inflammatory RCD will greatly promote the progress of cancer nanomedicine.

Comparative analysis of the results of surgical and radiation treatment of stage I kidney cancer

Purpose of the study: To conduct a comparative assessment of the results of surgical and radiation treatment of patients with stage I renal cell carcinoma (RCC) in terms of overall survival (OS), progression-free survival (PFS), local control and changes in renal function. Material and methods: From 2011 to 2022 170 patients with stage I RCC were treated at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine. We conducted a retrospective study of their treatment results. The first group — 115 patients who underwent surgical treatment of T1N0M0 kidney cancer (mainly in the amount of kidney resection — 85 people), the second group — 55 patients with verified T1N0M0 renal cell carcinoma who underwent stereotactic radiation therapy (SBRT) up to 30–45 Gy in 3 fractions using CyberKnife. SBRT was performed mainly for the treatment of a primary kidney tumor, in 7 cases — for a recurrence of kidney cancer, including 1 patient with recurrent tumors in both kidneys. The average age of patients in the surgery group was 73 years, in the SBRT group — 69.9 years. The average tumor diameter in the operation group was 4.3 cm, in the SBRT group it was 3.5 cm. Results: The median OS in the surgery group was 121 months, but it was not achieved in the SBRT group, since most patients are alive at the time of the study. 1‑year OS in the surgery group and SBRT was comparable (98.9 % and 95.1 %, respectively), but 5‑year OS in the surgery group was significantly higher — 90.2 % vs. 70 % in the SBRT group (p < 0.05). The same trend was noted in the assessment of PFS. In the surgery group, 4 patients out of 115 (3.5 %) had a recurrence in the tumor bed, in all cases after kidney resection, after 28 months in average. In the SBRT group, 42 patients (75 %) according to RECIST 1.1 criteria 6 months after SBRT showed stabilization of the process, in 20 % of cases (11 patients) — a partial response, in 5 % (3 patients) — progressed disease. 1‑year local control was 96.4 %, 1‑year cancer‑specific survival in both groups was 100 %. Renal toxicity was recorded in 38 patients (33 %) in the surgery group and in 10 patients (18 %) in the radiotherapy group 6 months after treatment. On average, glomerular filtration rate decreased by 25 % in the surgery group and by 18 % in the radiotherapy group. We have not noted a single case of a pronounced decrease in GFR, which would require dialysis. Conclusion: Surgery remains the main treatment option for T1N0M0 kidney cancer, but if there are contraindications to surgery, SBRT may be the best option for inoperable patients.

Are Turkish pharmaceutical pricing strategies an access barrier to oncology medicines for Türkiye?

Objectives: Cancer diagnosis is increasing day by day all over the world. Deaths due to cancer are among the most common causes of death. Access to cancer drugs is a priority of health policies. The aim of this study is to evaluate access to cancer drugs through drug box sales data by modeling population growth, cancer incidence, and Fixed Euro Exchange (FEE) rate parameters used in drug pricing in Türkiye. Methods: Access to cancer drugs was evaluated by drug box sales figures obtained from IQVIA. Box sales data were classified according to diagnosis codes (ICD-10), reference, or generic status. Consumption of cancer drugs was examined over time with panel regression analysis, taking into account variables of population growth, cancer incidence, and the FEE rate in drug pricing in Türkiye. Results: The incidence of cancer in Türkiye was 215.1 in 2010 and 223.1 (per hundred thousand) in 2017. Whereas there was a 127.02% increase in the real euro exchange rate, there was an 89.6% increase in the FEE rate. With the regression approach, there is a negative relationship between the real and fixed exchange rate difference (RFED) and reference and generic drug consumption data. Medicine access is affected depending on diagnosis codes at different levels. Colorectal cancer medicine sales had negative correlations for each variable, namely, exchange rate, population growth, and cancer incidence. On the contrary, there was a positive correlation between non-small-cell lung cancer and relevant variables. Innovative medicine groups such as monoclonal antibodies and protein kinase inhibitor consumption showed a negative correlation. Conclusion: According to our results, pricing strategy may be an access barrier for oncology medicines in Türkiye. It should be reviewing the pricing policy that is beneficial for oncology medicine access in Türkiye.

Prognostic value of CDKN2A in head and neck squamous cell carcinoma via pathomics and machine learning.

This study aims to enhance the prognosis prediction of Head and Neck Squamous Cell Carcinoma (HNSCC) by employing artificial intelligence (AI) to analyse CDKN2A gene expression from pathology images, directly correlating with patient outcomes. Our approach introduces a novel AI-driven pathomics framework, delineating a more precise relationship between CDKN2A expression and survival rates compared to previous studies. Utilizing 475 HNSCC cases from the TCGA database, we stratified patients into high-risk and low-risk groups based on CDKN2A expression thresholds. Through pathomics analysis of 271 cases with available slides, we extracted 465 distinctive features to construct a Gradient Boosting Machine (GBM) model. This model was then employed to compute Pathomics scores (PS), predicting CDKN2A expression levels with validation for accuracy and pathway association analysis. Our study demonstrates a significant correlation between higher CDKN2A expression and improved median overall survival (66.73 months for high expression vs. 42.97 months for low expression, p = 0.013), establishing CDKN2A's prognostic value. The pathomic model exhibited exceptional predictive accuracy (training AUC: 0.806; validation AUC: 0.710) and identified a strong link between higher Pathomics scores and cell cycle activation pathways. Validation through tissue microarray corroborated the predictive capacity of our model. Confirming CDKN2A as a crucial prognostic marker in HNSCC, this study advances the existing literature by implementing an AI-driven pathomics analysis for gene expression evaluation. This innovative methodology offers a cost-efficient and non-invasive alternative to traditional diagnostic procedures, potentially revolutionizing personalized medicine in oncology.

Awareness and attitude of genetic testing among relatives and patients with breast cancer

Background Genetic testing is an important medical tool for assessing many inheritable diseases and cancers. It plays a vital role in diagnosing patients before symptoms, which helps decrease the severity of outcomes and promote quality of life Aim To assess the awareness and attitude of genetic testing of breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) among first-degree relatives (FDR) and patients with breast cancer. Design A descriptive exploratory research design was used. Sample A convenient sample of 100 participants were divided into 50 patients with confirmed diagnosis of breast cancer and 50 FDR of patients with breast cancer. Setting The study was conducted at the Center of Clinical Oncology and Nuclear Medicine in one of Cairo University’s affiliated hospitals. Tools Four tools were used to collect data: Tool (a): Patients’ Personal and Medical Background Form (PPMBF), Tool (b): FDR of Patients with Breast Cancer Personal and Medical Background Form (FRPBCPMBF). Tool (c) Awareness of Genetic Testing Structured Questionnaire (AGTSQ). Tool (e): Attitude toward Genetic Testing Structured Questionnaire (ATGTSQ) Results Of the patients, 86% had an unsatisfactory level of awareness of genetic testing of BRCA1 and BRCA2, 64% of patients had a neutral attitude toward genetic testing of BRCA1 and BRCA2, 32% of FDRs had a satisfactory level of awareness of genetic testing of BRCA1 and BRCA2, and 60% of FDRs had a neutral attitude toward genetic testing BRCA1 and BRCA2. Conclusion Awareness of genetic testing of BRCA1 and BRCA2 is very important to detect genetic mutation and improve prognosis. FDR and patients with breast cancer had an unsatisfactory level of awareness and a neutral attitude toward genetic testing of BRCA1 and BRCA2. Recommendations FDR and patients with breast cancer must undergo BRCA1 and BRCA2 genetic testing to exclude genetic mutation. Awareness of FDR of patients with breast cancer should be raised regarding genetic testing of BRCA1 and BRCA2.

Timeliness of Health Technology Assessments and Price Negotiations for Oncology Drugs in Canada.

To evaluate whether time targets for Canadian Agency for Drugs and Technologies in Health (CADTH) reimbursement reviews and pan-Canadian Pharmaceutical Alliance (pCPA) price negotiations are being achieved for oncology drugs. Recommendations, dates of submission and publication, and indications for oncology medicines issued between January 2014 and December 2023 were recorded from CADTH's reimbursement reports webpage. The date any negotiation began and the date it was completed (successfully or not), or when a decision was made not to pursue negotiation was extracted from the pCPA's webpage. The duration of each CADTH review and pCPA negotiation was calculated, together with time between CADTH's recommendation and start of the pCPA negotiation or a decision not to negotiate. Percentages of reviews completed within CADTH's target and of times taken by the pCPA to decide whether to negotiate and by its price negotiations completed within the relevant targets were calculated. CADTH achieved its 270-days target in 88.2% to 100% of reviews issued between 2015 and 2019 but only in 65.9% to 73.1% of reviews issued in the last three years of the decade. CADTH's "typical timeline" of 180 days was achieved in under 40% of reviews issued in 2015 and not attained in any review in 2021, 2022 or 2023. The pCPA's target of 60 days for deciding whether to negotiate was achieved for all recommendations issued in 2014 but dropped below 40% for the last seven years of the decade; its target of 130 days for negotiations was achieved for over 85% of the recommendations in 2014 but decreased to only 14.3% in 2016 and then gradually increased to 61.5% in 2023. CADTH's "typical timeline" and the pCPA's targets were not met sufficiently to be meaningful. Their processes take too long for cancer drugs.

Unification of Efforts to Improve Global Access to Cancer Therapeutics: Report From the 2022/2023 Access to Essential Cancer Medicines Stakeholder Summit.

There is an urgent need to improve access to cancer therapy globally. Several independent initiatives have been undertaken to improve access to cancer medicines, and additional new initiatives are in development. Improved sharing of experiences and increased collaboration are needed to achieve substantial improvements in global access to essential oncology medicines. The inaugural Access to Essential Cancer Medicines Stakeholder Meeting was organized by ASCO and convened at the June 2022 ASCO Annual Meeting in Chicago, IL, with two subsequent meetings, Union for International Cancer Control World Cancer Congress held in Geneva, Switzerland, in October 2022 and at the ASCO Annual Meeting in June of 2023. Invited stakeholders included representatives from cancer institutes, physicians, researchers, professional societies, the pharmaceutical industry, patient advocacy organizations, funders, cancer organizations and foundations, policy makers, and regulatory bodies. The session was moderated by ASCO. Past efforts and current and upcoming initiatives were initially discussed (2022), updates on progress were provided (2023), and broad agreement on resulting action steps was achieved with participants. Summit participants recognized that while much work was ongoing to enhance access to cancer therapeutics globally, communication and synergy across projects and organizations could be enhanced by providing a platform for collaboration and shared expertise. The summit resulted in new cross-stakeholder insights and planned collaboration addressing barriers to accessing cancer medications. Specific actions and timelines for implementation and reporting were established.

An audit of adherence to National Cancer Care Programme chemotherapy regimens and prescribing standards in systemic anti-cancer therapy prescriptions in an Irish hospital

Abstract Introduction The availability and usage of systemic anticancer therapy (SACT) has increased significantly over recent years. Whilst SACT has undeniably benefited patients, it also poses a challenge to patient safety as the number of cytotoxic drugs increases. The National Cancer Care Programme (NCCP) has set out to design and implement national policies and practices for oncology medicine in Ireland in order to maintain high levels of patient safety. Aim This study aims to evaluate adherence to NCCP national SACT regimens and prescribing standards at an Irish hospital. Methods This study was a prospective analysis involving an audit of SACT prescriptions for adherence to NCCP regimens and prescribing standards. The study was conducted from June 6th to June 30th 2023; the cohort was defined as patients who were receiving cancer services’ treatment from the medical oncology and haematology department at the hospital. The data collection tool was developed using template in the NCCP Oncology Medication Safety Review Report 2014. A report was run to identify outpatient patients who received SACT on each working day. For inpatients, a daily scheduling Excel file was consulted. Prescriptions were evaluated to complete the data collection tool. Anonymised data was captured and the results were collated to show any trends in adherence to NCCP regimens and prescribing standards. Descriptive analysis of patient and clinical characteristics was performed. Results Pharmacy prescription records of all patients who received SACT during the four-week study period were analysed. A total of 410 SACT prescriptions were reviewed. The median patient age in the study cohort was 59 years (range 23-93 years). Overall, 86.3% of the audited prescriptions adhered to NCCP regimens. The oncology department exhibited a higher adherence rate of adherence to NCCP regimens compared to the haematology department (89.2% versus 82.3%). Melanoma, non-small cell lung cancer, small cell lung cancer, renal cell, prostate, sarcoma, and bladder cancer all had 100% adherence. The lowest adherence rates occurred for CNS (25%), mesothelioma (50%), leukaemia (76.5%), and metastatic colorectal cancer (77.3%). Only 7% of prescriptions were written on pre-printed forms. In this audit, over 98% compliance was observed for eleven of the twenty-four NCCP prescribing standards in the 410 prescriptions: including patient name, patient date of birth, diagnosis, name of supervising consultant, protocol/regimen name, name of drug(s), dose in mg or mg/m2, route of administration, signature of the prescriber and date prescribed. Areas for improvement identified include information about ward/clinic, renal/hepatic function, start date, cycle numbers and medical council numbers. Conclusion This is the first audit of adherence to NCCP regimens using prescription data in Ireland, and the inclusion of 410 samples is a strength; however, the data are from a single site. This study has highlighted areas for improvement in prescribing practices. It emphasises the need for further multidisciplinary team education on adherence to NCCP regimens and prescribing standards. Healthcare professionals should ensure that pre-printed SACT prescription forms are used where available. Additionally, the use of regimen-specific pre-printed forms should be expanded.

Transforming oral cancer care: The promise of deep learning in diagnosis

The diagnosis and treatment of oral cancer present significant challenges, including delayed diagnosis at advanced stages and limited access to healthcare. Deep learning (DL), a subset of artificial intelligence, holds promise for transforming medical image analysis and predictive analytics. In this perspective, we examine the applications of DL in oral cancer. Specifically, we explore the efficacy of convolutional neural networks (CNNs) and recurrent neural networks (RNNs) in diagnosing and predicting the prognosis of oral cancer in the last five years. Additionally, we underscore the importance of oral cancer databases in advancing research and clinical practice. However, DL methods face constraints related to input variability and model interpretability. Addressing these issues is crucial to harnessing the full potential of DL in oral cancer treatment. In summary, this article underscores the innovative contributions of DL in revolutionizing oral cancer management and advocating for precision medicine in oncology.

Medical students’ knowledge on palliative care – a survey of teaching in Finland

Background Most studies on palliative medicine (PM) undergraduate education have focused on contents and organizational issues but not the outcome. Students’ learning outcomes should be studied to improve teaching in medical schools. Methods A questionnaire about perceived PM education and attitudes on palliative care (PC) was sent to 543 last year students in all five Finnish medical schools in 2018–2019. In total, 175 (32 %) responses were received from four universities. The students evaluated both the quantity and quality of their PM teaching, implementation of European Association for Palliative Care (EAPC) guidelines and their satisfaction to the training. There were two palliative case scenarios, and the students were asked to find the best treatment option. Results In the Finnish universities, PM education was available mainly integrated with oncology, geriatrics, and general medicine. A total of two universities also offered a specific PM course. In average, 50–70% of the EAPC curriculum was covered by lectures, small-group teaching, seminars, and bedside teaching with significant differences between faculties. Only 30–60 % of students were satisfied with the education received. The highest rankings were given in the universities with a special PM course. Conclusions In Finland, the coverage of EAPC curriculum is satisfactory, but the PM education is mainly given integrated with other specialties. The dedicated course on PM was associated with increased perceived knowledge and satisfaction of PM education. However, PM training was not associated with students’ attitudes on PC.

Artificial Extracellular Vesicles Generated from T Cells Using Different Induction Techniques.

Cell therapy is at the forefront of biomedicine in oncology and regenerative medicine. However, there are still significant challenges to their wider clinical application such as limited efficacy, side effects, and logistical difficulties. One of the potential approaches that could overcome these problems is based on extracellular vesicles (EVs) as a cell-free therapy modality. One of the major obstacles in the translation of EVs into practice is their low yield of production, which is insufficient to achieve therapeutic amounts. Here, we evaluated two primary approaches of artificial vesicle induction in primary T cells and the SupT1 cell line-cytochalasin B as a chemical inducer and ultrasonication as a physical inducer. We found that both methods are capable of producing artificial vesicles, but cytochalasin B induction leads to vesicle yield compared to natural secretion, while ultrasonication leads to a three-fold increase in particle yield. Cytochalasin B induces the formation of vesicles full of cytoplasmic compartments without nuclear fraction, while ultrasonication induces the formation of particles rich in membranes and membrane-related components such as CD3 or HLAII proteins. The most effective approach for T-cell induction in terms of the number of vesicles seems to be the combination of anti-CD3/CD28 antibody activation with ultrasonication, which leads to a seven-fold yield increase in particles with a high content of functionally important proteins (CD3, granzyme B, and HLA II).

Evolving assessment pathways for precision oncology medicines to improve patient access: a tumor-agnostic lens.

Genomic and molecular alterations are increasingly important in cancer diagnosis, and scientific advances are opening new treatment avenues. Precision oncology (PO) uses a patient's genomic profile to determine optimal treatment, promising fewer side effects and higher success rates. Within PO, tumor-agnostic (TA) therapies target genomic alterations irrespective of tumor location. However, traditional value frameworks and approval pathways pose challenges which may limit patient access to PO therapies. This study describes challenges in assessing PO and TA medicines, explores possible solutions, and provides actionable recommendations to facilitate an iterative life-cycle assessment of these medicines. After reviewing the published literature, we obtained insights from key stakeholders and European experts across a range of disciplines, through individual interviews and an industry workshop. The research was guided and refined by an international expert committee through 2 sounding board meetings. The current challenges faced by PO and TA medicines are multiple and can be demonstrated through real-world examples of the current barriers and opportunities. A life-cycle approach to assessment should be taken, including key actions at the early stages of evidence generation, regulatory and reimbursement stage, as well as payment and adoption solutions that make use of the evolving evidence base. Working toward these solutions to maximize PO medicine value is a shared responsibility and stands to benefit all stakeholders. Our call to action is to expand access to comprehensive genomic testing, foster a learning health care system, enable fast and equitable access to cost-effective treatments, and ultimately improve health outcomes.

Targeting KRAS Diversity: Covalent Modulation of G12X and Beyond in Cancer Therapy.

The GTPase KRAS acts as a switch in cellular signaling, transitioning between inactive GDP-bound and active GTP-bound states. In about 20% of human cancers, oncogenic RAS mutations disrupt this balance, favoring the active form and promoting proliferative signaling, thus rendering KRAS an appealing target for precision medicine in oncology. In 2013, Shokat and co-workers achieved a groundbreaking feat by covalently targeting a previously undiscovered allosteric pocket (switch II pocket (SWIIP)) of KRASG12C. This breakthrough led to the development and approval of sotorasib (AMG510) and adagrasib (MRTX849), revolutionizing the treatment of KRASG12C-dependent lung cancer. Recent achievements in targeting various KRASG12X mutants, using SWIIP as a key binding pocket, are discussed. Insights from successful KRASG12C targeting informed the design of molecules addressing other mutations, often in a covalent manner. These findings offer promise for innovative approaches in addressing commonly occurring KRAS mutations such as G12D, G12V, G12A, G12S, and G12R in various cancers.