A mutation in the estrogen receptor alpha gene (ESR1m) following first-line treatment with endocrine therapy in hormone receptor-positive metastatic breast cancer occurs in nearly half of patients. Detection of this mutation prior to radiologic progression using circulating tumor DNA (ctDNA)-based monitoring is an emerging practice that may allow an early switch to a more effective therapy. To discuss approaches to managing ESR1m advanced breast cancer (aBC) including ctDNA-based monitoring, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in February 2026. This article provides a qualitative summary of the panel discussion along with key insights and suggested payer practices meant to support informed coverage decisions and guide future work. Key insights include that community oncologists and patients may benefit from support, for example, with treatment pathways and patient navigators. Additionally, patients care about survival outcomes when combined with sustained quality of life and want monitoring practices that take patient-specific considerations into account. A primary consideration of payers related to aBC is that the optimal biomarker testing parameters, including ctDNA-based monitoring for ESR1m aBC, are uncertain, which leads to inconsistent testing practices and the need for management that promotes consistency while mitigating delays in care. Payers acknowledge that the role of next-generation selective estrogen receptor degraders is evolving based on current data and ongoing clinical trials. Suggested payer practices involve care delivery, coverage, and system advancements including engaging in multistakeholder conversations and advocating for or participating in evidence generation.

Craniopharyngiomas (CPs) are benign tumors arising in the sellar and suprasellar regions, but they frequently recur after surgery because of their proximity to critical neurovascular and hypothalamic structures. This study aimed to develop and validate a habitat-based multimodal radiomics model for early postoperative recurrence prediction in CP. This retrospective single-center cohort included 106 patients with pathologically confirmed CP selected from 136 consecutive surgically treated cases. Preoperative magnetic resonance imaging (MRI) scans (T1-weighted imaging, contrast-enhanced T1-weighted imaging, and T2 -weighted imaging) were used for tumor habitat analysis based on unsupervised clustering of voxel-level radiomic features. Radiomic features were extracted from whole-tumor and habitat-defined subregions, followed by feature selection within the training cohort using univariate filtering, correlation pruning, minimum redundancy maximum relevance (mRMR), and least absolute shrinkage and selection operator (LASSO). Clinical, radiomics, habitat-based, and Combined models. Model performance was evaluated using Receiver Operating Characteristic (ROC), calibration, and decision curve analyses. Shapley Additive exPlanations (SHAP) analysis and representative habitat maps were used for model interpretability. Among the evaluated classifiers, the ExtraTrees model showed the most stable discrimination performance across the training and validation cohorts. The HabitatAll model achieved an AUC of 0.891 in both cohorts, while the Combined model showed the best overall predictive performance, with AUCs of 0.944 and 0.891 in the training and validation cohorts, respectively, and the lowest Brier scores. SHAP analysis identified T1C-derived and H3-related habitat features as major contributors to recurrence prediction. Representative habitat maps showed that H3 was frequently distributed in the peripheral portion of the tumor in both recurrent and non-recurrent cases. This study developed a promising habitat-based multimodal radiomics model for early postoperative recurrence prediction in craniopharyngioma. The Combined model demonstrated the most favorable overall discrimination and calibration. H3-related habitat features may capture intratumoral heterogeneity associated with recurrence risk. However, given the retrospective single-center design, these findings should be interpreted as preliminary and require further validation in larger multicenter cohorts.

This study evaluated the incidence of MRONJ and associated factors among breast cancer patients with bone metastases in Finland.

This retrospective cohort study included all adult patients with breast cancer and bone metastases who were prescribed antiresorptive therapy between 2013 and 2015. Patients were identified from national health care registers and followed through 2020. The outcome variable was MRONJ (M87.1). Covariates included age, oral diseases, dental procedures, type of antiresorptive (AR) prescribed, comorbidities, and concomitant medications.

A total of 652 patients met the inclusion criteria. The incidence of MRONJ ranged from 0% to 2.2% among bisphosphonate users, compared with 12.6% among denosumab users and 15.3% among patients receiving sequential bisphosphonate and denosumab therapy. Both denosumab monotherapy and sequential bisphosphonate-denosumab therapy were associated with substantially increased MRONJ risk compared with bisphosphonate therapy.

Denosumab use and infection-related invasive dental procedures showed the strongest associations with MRONJ in this study population.

MRONJ incidence differed by type of antiresorptive therapy, with higher occurrence among patients using denosumab or bisphoshonates followed by denosumab compared with bisphosphonates. MRONJ was more frequent among patients who underwent infection-related invasive dental procedures.

Delayed gastric conduit emptying (DGCE) affects 15%-60% of patients after esophagectomy, depending on the definition used. This study evaluated DGCE incidence using the new consensus criteria and explored its clinical and scientific relevance. It also analyzed nasogastric tube (NGT) output to estimate a safe removal threshold.

This retrospective single-center cohort study included patients who underwent elective Ivor Lewis esophagectomy (2020-2024).

A total of 160 patients were included. The majority of patients underwent robot-assisted esophagectomy (n = 65 [40.6%]), whereas open esophagectomy was performed in 38 patients (23.7%). Early DGCE was identified in 40.6% of patients, predominantly via NGT output (95.4%), with few cases diagnosed radiologically (4.6%). DGCE was associated with longer hospital stays (24 vs. 18 days, p = 0.034) and higher NGT reinsertion rates (47.0% vs. 28.7%, p = 0.02), but not with differences in surgical approach or major complications (Clavien-Dindo Classification > IIIa: 18.2% vs. 13.8%, p = 0.72). Late DGCE was diagnosed in only 8 patients (5.0%), mainly because of the low use of routine radiological imaging. In the cohort of patients who did not require NGT reinsertion, the median of the average nasogastric tube output for the 2 days before removal was 200 mL per day.

The consensus definition of DGCE is applicable and identifies a clinically relevant incidence of over 40%. An average daily NGT output of 200 mL appears to reliably predict safe tube removal.

To examine the gap between evidence-based indications for PSMA PET/CT and real-world access in prostate cancer, with a focus on European implementation and country-specific experience from Spain and France.

A focused narrative appraisal of published evidence, clinical guidelines, regulatory and reimbursement information, and real-world accessibility data was performed. European accessibility modelling and physician market research from Spain were incorporated to characterise implementation patterns and barriers.

Access to PSMA PET/CT remains heterogeneous despite its established role in higher-risk staging and biochemical recurrence. Reported barriers include reimbursement and local approval requirements, PET/CT and nuclear medicine capacity, radiopharmaceutical logistics, non-standardised referral pathways, waiting times, and institutional variation. Exploratory modelling suggested that use remains below the estimated eligible population in both staging and biochemical recurrence, with differences between countries and clinical scenarios. Spanish market research similarly indicated substantial variation. These data are exploratory implementation signals rather than population-level epidemiological estimates.

Improving access requires guideline-based eligibility criteria, harmonised reimbursement, regional referral networks, adequate imaging and reporting capacity, reliable tracer supply, and measurable access indicators. Further research should determine whether reducing implementation gaps improves diagnostic pathways and treatment allocation.

To examine the relationship between health-related quality of life (HRQoL) and time to readmission in patients undergoing bladder perfusion, to explore the association of longitudinal changes and patterns of HRQoL at readmission, and to generate hypotheses for future interventions to prolong time to readmission.

This prospective observational study included 267 patients who underwent bladder perfusion at Shanghai General Hospital from August 2021 to January 2024. The SF-36 questionnaire was used to measure patients' health-related quality of life (HRQoL) at 1 week (T0) and 8 weeks (T1) after induction of bladder perfusion and to record information on readmission within 14 months. Cox proportional hazards regression models were constructed for readmission times at T0, T1, and T0-T1 change scores to analyze the ability of each HRQoL dimension to predict time to readmission.

A total of 131 readmissions occurred, with an incidence rate of 49.1% and a median readmission time of 7.2 (IQR, 4.2-10.9) months. Physiological indicator dimensions were associated with time to readmission in the T0, T1, and T0-T1 models, and the strength of association for physiological indicators was significantly greater than that for psychological indicators (P = 0.023, < 0.001, and 0.017, respectively). In the T0 model, four of the ten SF-36 domains (Physical Component Summary [PCS], physical functioning, role-physical, and general health) showed statistically significant associations with time to readmission (all P < 0.05). In the T1 model, eight domains (all except bodily pain and mental health) were significantly associated. In the T0-T1 change model, six domains (PCS, physical functioning, role-physical, general health, role-emotional, and social functioning) were significantly associated. The number of significant domains varied across models because the strength of association between HRQoL and readmission time depends on the timing of assessment: post-treatment (T1) HRQoL showed the strongest associations, followed by change in HRQoL (T0-T1), while pre-treatment (T0) HRQoL showed the fewest significant associations. The HRQoL information collected at T1 had the strongest associations with readmission time, followed by change, and then T0 HRQoL information. Physiological indicators (PCS and its component domains) showed stronger associations than psychological indicators (MCS and its component domains).

Health-related quality of life and its longitudinal changes are associated with time to readmission, with physiological and post-treatment indicators showing stronger associations. Longitudinal HRQoL information can be used to improve patient prognosis. Collecting HRQoL data during bladder perfusion may help guide interventions that prolong the interval to readmission. In light of these limitations, our results should be considered hypothesis-generating rather than definitive. The strong associations observed between HRQoL and readmission time warrant further investigation in studies with more comprehensive clinical data.

Dietary supplement and over-the-counter product use is common among people with a history of cancer and may raise safety concerns, including treatment interactions. We assessed the frequency, patterns, temporal variation and correlates of dietary supplement and over-the-counter product use among adults with a self-reported history of cancer in Poland.

We performed a repeated cross-sectional analysis of six annual waves (2020-2025) of a nationwide quota-based web survey in Poland. Among 1,271,102 respondents overall, 79,588 reported a history of cancer. Dietary supplement and over-the-counter product use in the previous 12 months was assessed by frequency and reported product category or purpose of use. Correlates of any dietary supplement and over-the-counter product use were examined using multivariable logistic regression.

Any dietary supplement and over-the-counter product use was reported by 61.8% of respondents, including daily use in 26.9%, whereas 38.2% reported no use. The most frequently selected categories were multivitamins, digestive products, hair/skin products and sleep products. Men and older respondents had lower odds of dietary supplement and over-the-counter product use, whereas higher education and coexisting non-cancer comorbidities were associated with greater odds of use.

Dietary supplement and over-the-counter product use was frequently reported among respondents and showed distinct sociodemographic and health-related patterns. Including these products in routine medication histories may help identify potential interactions and other clinically relevant issues.

Perioperative treatment for resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma is changing rapidly as immune checkpoint inhibition enters a field historically shaped by distinct chemotherapy and surgical paradigms. This review critically appraises contemporary perioperative and adjuvant evidence and proposes a biomarker-informed, regionally adaptable framework for clinical decision-making. We conducted a structured narrative review of perioperative and adjuvant systemic therapy, surgical outcomes, treatment completion, safety, and biomarker evidence in resectable gastric and GEJ adenocarcinoma, with emphasis on randomized phase III trials, mature follow-up, prospective biomarker studies, and relevant regulatory data. MATTERHORN demonstrated significant event-free survival and subsequently overall survival benefits with perioperative durvalumab plus fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT), supporting regulatory approvals. In contrast, KEYNOTE-585 increased pathological complete response but did not meet the prespecified event-free survival statistical boundary, while ATTRACTION-5 did not establish postoperative nivolumab after D2 gastrectomy as a new standard. MSI-H/dMMR is the most clinically relevant perioperative biomarker, although chemotherapy-free strategies remain investigational. PD-L1 thresholds validated in advanced disease should not be directly transferred to the curative setting. Pathological response, ypN status, circulating tumor DNA/molecular residual disease, and emerging multimodal risk models are prognostic, but none currently provides validated treatment-effect prediction sufficient to mandate postoperative escalation or de-escalation. Perioperative treatment should integrate resectability, surgical quality, patient fitness, regional chemotherapy backbones, MSI-H/dMMR status, treatment completion, and postoperative recovery. The proposed framework is conceptual rather than a guideline and requires prospective validation.

This study aimed to systematically evaluate the clinical utility of endorectal balloons (ERB) for motion management and organ-at-risk sparing in prostate cancer patients receiving external beam radiotherapy (EBRT) or stereotactic body radiotherapy (SBRT).

A systematic search was conducted in Ovid MEDLINE, Embase, the Cochrane Library, and Korean databases through May 8, 2024. Primary outcomes included safety, toxicity, prostate motion, and dosimetric parameters. The risk of bias was assessed using the Risk of Bias Assessment tool for Non-randomized Studies 2.0 tools. Meta-analysis was conducted using Review Manager 5.3.

Twenty-seven studies (3 prospective cohort studies, 24 retrospective studies) were included, covering 22 EBRT and 5 SBRT cohorts. Reported adverse events were mild and transient. One prospective study demonstrated a significant reduction in grade 1 late rectal toxicity (p = 0.003). ERB use significantly stabilized the prostate, reducing both intra- and interfractional motion, particularly minimizing displacements >5 mm. Meta-analysis revealed that ERB significantly lowered the mean radiation dose to the rectum (mean difference [MD], -3.40 Gy; 95% confidence interval [CI], -6.70 to -0.10) and anal wall (MD, -6.06 Gy; 95% CI, -9.78 to -2.35) in EBRT. Similarly, in SBRT, ERB was associated with reduced rectal wall dose (MD, -2.63 Gy; 95% CI, -4.49 to -0.77).

ERB appears to be a relatively safe and clinically useful adjunct for enhancing treatment precision in prostate cancer radiotherapy. By stabilizing prostate motion and reducing radiation exposure to the rectum and anal wall, ERB optimizes the therapeutic ratio.

Most colorectal cancers (CRCs) patients with microsatellite stability (MSS) have minimal benefit from immune checkpoint inhibitor monotherapy, and even after PD-1/PD-L1 blockade, T cell function remains inadequately restored, highlighting the importance of PD-1 downstream signaling events. SHP-2 is a critical effector of PD-1 downstream signaling and plays a key role in establishing the immunosuppressive tumor microenvironment in CRC. Gut microbial metabolites are emerging as regulators of anti-tumor immunity, but their role in modulating the PD-1/SHP-2 interaction remains unknown.

We established a split-luciferase complementation screening system based on the PD-1/SHP-2 interaction and systematically screened a library of human gut microbial metabolites (n=480). The effect of candidate metabolites on T cell function was assessed in vitro using flow cytometry, confocal microscopy, and cell viability assays. Using a mouse colon cancer model, we further investigated the role of taurocholic acid (TCA) and glycodeoxycholic acid (GDCA) in the tumorigenesis and immunotherapy of CRC. Finally, the clinical relevance of metabolite-producing bacterium was examined in tumor specimens from CRC patients (n=53) using fluorescence in situ hybridization and real-time PCR assays.

We identified the conjugated bile acids TCA and GDCA as enhancers of the PD-1/SHP-2 interaction. Mechanistically, TCA and GDCA stabilized the PD-1/SHP-2 complex through an allosteric mechanism by promoting PD-1 phosphorylation. Functionally, two metabolites suppressed CD8⁺ T cell activation, proliferation, and cytotoxicity in a PD-1/SHP-2-dependent manner, thereby accelerating tumor progression in vivo. Conversely, pharmacological depletion of TCA and GDCA using the bile acid sequestrant cholestyramine (CHO) effectively reversed their immunosuppressive effect and synergized with anti-PD-1 antibody therapy to inhibit the tumorigenesis of CRC. Clinical sample analysis revealed that the abundance of Clostridium scindens, the primary bacterial source of TCA and GDCA, was inversely correlated with CD8⁺ T cell infiltration in tumor tissues from CRC patients.

This study reveals a "Bile acid-associated metabolites-Immune checkpoint" regulatory axis that drives immunosuppression in CRC. The identification of TCA and GDCA as endogenous enhancers of PD-1 signaling provides a mechanistic rationale for targeting these metabolites to overcome immunotherapy resistance.