The recent introduction of the right to oncological oblivion in some European states raises critical issues. While designed to protect cancer survivors from discrimination, this right may compromise occupational health surveillance for workers exposed to carcinogenic hazards. This commentary raises questions for future policy and research.

Giant ovarian cysts are becoming less prevalent as a result of breakthroughs in imaging, routine gynecological surveillance, and early intervention in wealthy countries. However, in resource-constrained nations, delayed access to treatment, a lack of regular prenatal and gynecological follow-up, and socioeconomic constraints all contribute to late presentation and management difficulties.

We discuss the case of a 35-year-old Somali multiparous woman (G9P7) with a five-year history of increasing abdominal distension caused by a large mucinous cystadenoma. Abdominal ultrasound, contrast-enhanced CT scans, and tumor marker assessments all contributed to the diagnosis. She was assessed at our tertiary care center after a delay in seeking to a surgical care. A massive uniloculated cystic mass was found and entirely removed with unilateral salpingo-oophorectomy. A multidisciplinary team performed definitive surgical care, which was finished successfully without major complications, and the patient made a good postoperative recovery. Histopathological investigation confirmed the diagnosis of mucinous cystadenoma, with no signs of malignancy.

This case demonstrates the significance of earlier detection and interdisciplinary surgical care in achieving favorable outcomes for large ovarian tumors in resource-limited settings. The effective treatment of a long-standing huge mucinous cystadenoma in a young Somali woman demonstrates the importance of imaging, tumor markers, and coordinated surgical expertise in lowering morbidity and improving prognosis, Raising physician awareness and enhancing access to diagnostic and surgical procedures are critical to avoiding delayed presentations and related consequences.

Early detection of pancreatic cancer is crucial for survival, but detecting smalllesions remains challenging. Intraductal Ultrasound (IDUS) using intracardiac echocardiography (ICE) catheters for B-mode and Shear-Wave Elastography (SWE) potentially offers improved visualization and characterization of small tumors. This study assesses the feasibility of IDUS using ICE catheters to detect and visualize periampullary tumors in surgically resected specimens.

In this two-phase ex-vivo feasibility study, 25 pancreatic specimens were included, of which the first 10 were used to establish and standardize the imaging protocol, followed by technical feasibility evaluation in the remaining 15 specimens. Catheters were introduced into the pancreatic duct, common bile duct, or positioned extraductally to enable tumor visualization with B-mode imaging and shear-wave elastography (SWE). Tumor visualization rates, catheter insertion success, SWE measurements in normal and tumor tissue, and image quality were assessed.

ICE catheter insertion was successful in 12 of 15 specimens; unsuccessful access was primarily related to large tumor size (>4 cm) or unidentifiable ductal anatomy following surgical resection. However, extraluminal imaging successfully visualized tumors in one of these cases. Median shear-wave speed and elastic modulus for normal pancreatic parenchyma were 1.58 m/s and 7.6 kPa, respectively. SWE measurements in tumor tissue were suboptimal, likely due to ex-vivo tissue variability and catheter strain during repeated use.

IDUS with ICE is feasible for qualitative B-mode visualization of periampullary tumors and enables SWE assessment of pancreatic parenchyma in an ex-vivo setting. Reliable elastography of tumor tissue remained challenging, indicating the need for further technical refinement and in-vivo validation.

Transthoracic CT-guided biopsy performed with the coaxial technique is a minimally invasive procedure that facilitates the diagnosis of lung lesions (nodules or masses) and/or mediastinopulmonary lesions suspected of malignancy. This procedure is the source of several complications, the most frequent of which is pneumothorax.

To describe the epidemiological, diagnostic, and therapeutic aspects of iatrogenic pneumothorax after CT-guided biopsy performed using the coaxial technique.

Prospective longitudinal study, conducted over a period of 2 years and 10 months, from April 1, 2023, to February 1, 2026, at the Mohammed V Military Teaching Hospital in Rabat, including all patients who presented with a pneumothorax following a transthoracic CT-guided biopsy, according to the coaxial technique, confirmed clinically and/or radiologically.

The study included 30 cases of pneumothorax following CT-guided biopsy according to the coaxial technique. Biopsies were performed in 217 patients, and the incidence of pneumothorax was 13.8%. The median age was 68 years [58.8-71.5], with a predominance of males (90%). The most frequent characteristics observed among patients with pneumothorax were pulmonary emphysema (73.3%), lower-lobe lesions (33.3%), and central lesions with a median depth of 3.6 cm [2.9-4.2]. Procedure-related characteristics included practitioner status and biopsy needle diameter (18-gauge). Most patients were asymptomatic (60%). Diagnosis was established by chest CT during the procedure in 26.7% of cases and by chest X-ray after the procedure in 73.3% of cases. Small pneumothorax was the most common presentation (40%). Treatment was conservative in 53.3% of cases, and intervention was required in 46.7% (7 cases drained and 7 cases exsufflated). A complication was observed in 5 cases, after initial treatment. Only one patient underwent thoracoscopic pleurodesis after 14 days of chest drainage. The median length of hospital stay was 4 days [2-5.75].

Pneumothorax is a major complication of CT-guided transthoracic biopsy, whether performed coaxially or non-coaxially. In our descriptive series, pulmonary emphysema, lower-lobe location, and lesion depth were frequent characteristics among patients who developed pneumothorax. We believe that the radiologist's experience is a determining factor in preventing a very high incidence of pneumothorax cases.

Autosomal dominant acute porphyrias are rare inherited disorders of haem biosynthesis characterised by accumulation of potentially neurotoxic porphyrin precursors and attacks of severe abdominal pain with autonomic and neuropsychiatric features. Disease severity ranges from asymptomatic individuals to those with recurrent, life-threatening attacks. The International Porphyria Network invited 34 acute porphyria specialists from 17 countries to form an expert panel. The invited group included clinicians from diverse specialities (ie, internal medicine, haematology, endocrinology, gastroenterology, hepatology, neurology, and biochemistry), together with laboratory scientists and patient representatives. The panel met online (in 2023-25) to develop 15 evidence-based recommendations with the use of the Grading of Recommendations, Assessment, Development, and Evaluations framework addressing attack prevention, management of sporadic and recurrent attacks, long-term follow-up, surveillance for primary liver cancer, and family screening. The guidelines support safe, consistent clinical care and improved outcomes, recognising global variation in resources and access to high-cost drugs, and highlighting priorities for future research.

Second generation tyrosine kinase inhibitors (TKIs) have improved response rates in patients with chronic phase chronic myeloid leukaemia (CP-CML). Phase 2 trials demonstrated increased deep molecular response rates when combining second generation TKIs with pegylated interferon alfa (Peg-IFN). This trial aimed to evaluate the efficacy and the safety of combining nilotinib with Peg-IFN alfa-2a in patients with newly diagnosed CP-CML.

In PETALs, this open-label, randomised, multicentre phase 3 trial, we enrolled patients with newly diagnosed CP-CML from 27 French academic institutions via a centrally-generated electronic system in a 1:1 ratio to two groups: 300 mg oral nilotinib alone twice a day (the nilotinib only group) or 300 mg nilotinib twice a day combined with subcutaneous Peg-IFN (30 μg per week for the first month of treatment and 45 μg per week thereafter) for a maximum of 2 years. The randomly allocated patients were stratified by their Sokal index and European Treatment and Outcome Study long-term survival index. Eligible patients had major BCR::ABL1 transcripts, an Eastern Cooperative Oncology Group performance score of two or lower, who had never received TKIs, and were aged between 18 and 65 years. The primary endpoint was the cumulative rate of molecular response 4·5 (MR4·5; defined as BCR::ABL1 international scale [IS] of 0·0032% and lower), analysed in the intention-to-treat population (n=200). This trial is registered at ClinicalTrials.gov, NCT02201459, and is completed.

205 patients were enrolled between Aug 6, 2014, and Sept 29, 2016, after which five patients were declared ineligible and excluded, resulting in 200 patients being randomly allocated (99 to the nilotinib group and 101 to the combination group). The median age at diagnosis was 45 years (IQR 36-55); 130 patients (65%) were male and 70 (35%) were female. Median follow-up in this cohort was 67 months (IQR 32·6-70·6). The primary objective was met, with higher rates of MR4·5 in the combination group (24% [95% CI 16·0-34·1] vs 15% [8·6-24·2], p=0·048) at month 12. There were equivalent grade 3-4 haematological side effects in the both groups (14 vs 14) with a predominance for grade 3-4 thrombocytopenia without haemorrhages (six in the combination group vs five in the nilotinib group). Psychiatric grade 3-4 events occurred in six (6%) patients in the combination group (including three unsuccessful suicide attempts) compared with five (5%) in the nilotinib group (including one unsuccessful suicide attempt). Six vascular events also occurred in six patients in the combination group and seven vascular events in five patients in the nilotinib group (all grades 3-4).

In this setting, Peg-IFN combined with nilotinib induced higher initial rates of MR4·5 compared to TKI monotherapy, despite additional side effects. The onset of psychiatric events might promote immediate cease of Peg-IFN and psychiatrist advice Whether this early molecular response translates into sustained treatment-free survival should be studied in a randomised trial sufficiently powered for this outcome.

Novartis Pharma.

The treatment landscape for relapsed or refractory diffuse large B-cell lymphoma has changed profoundly with the introduction of novel drug classes, some approved solely on the basis of single-arm early-phase trials. We aimed to evaluate antitumour activity and safety outcomes across drug classes in early-phase trials in relapsed or refractory diffuse large B-cell lymphoma since 2000.

We did a systematic review and meta-analysis of phase 1-2 trials. We searched PubMed, Embase.com, Web of Science and Wiley/Cochrane Library from database inception to May 9, 2025. We included English-language studies published between Jan 1, 2000, and May 9, 2025, enrolling adults aged 18 years or older with relapsed or refractory diffuse large B-cell lymphoma treated with experimental agents alone or combined with CD20-antibodies; trials including other B-cell malignancies were eligible if diffuse large B-cell lymphoma-specific responses could be extracted. Trials restricted to highly-selected subgroups, supportive-care, administration-routes, country-specific approvals, and conference abstracts were excluded. Two investigators independently extracted summary data. The primary outcomes were objective response rate and complete response rate, and were pooled using random-effects generalised linear mixed models. Adverse events were secondary outcomes. Prespecified subgroup analyses evaluated drug class and publication period. The study was registered with PROSPERO, CRD42023394451.

We identified 2797 citations, of which 1824 unique records remained after removal of duplicates. 132 trials including 7786 patients were eligible for analysis. 3375 (43%) of 7786 patients were female and 4411 (57%) were male. Objective response rate was 30·5% (95% CI 26·0-35·5, I²=84·7%) and complete response rate 14·3% (11·5-17·7, I²=82·2%). Response rates varied across drug classes, with the highest objective response rate or complete response rate for cellular therapies (70·0%, 95% CI 61·0-77·0 and 51·0%, 95% CI 43·0-59·0), followed by bispecific antibodies (46·0%, 38·0-53·0 and 30·0%, 24·0-36·0) and antibody-drug conjugates (40·0%, 32·0-47·0 and 18·0%, 13·0-24·0). Objective response rate increased over time, from 16·6% (95% CI 9·0-29·0) in 2000-08 to 36·8% (30·0-45·0) in 2018-25. The overall rate of dose-limiting-toxicities or discontinuations was 6·0% (95% CI 4·7-7·6). The rate of grade 3-4 adverse events was 61·5% (95% CI 54·2-68·3), treatment-related-mortality was 0·6% (0·4-1·0), and non-relapse-mortality was 3·6% (2·9-4·5). Treatment-related mortality remained below 1% over time.

Since the year 2000, early-phase trials in relapsed or refractory diffuse large B-cell lymphoma have shown more than a doubling of response rates, driven primarily by cellular and bispecific antibody therapies, while maintaining low treatment-related mortality. These results provide risk-benefit trends in early-phase trials and define contemporary benchmarks for clinicians, investigators and regulators.

None.

Covalent Bruton tyrosine kinase (BTK) inhibitors have advanced the treatment of Waldenström macroglobulinaemia; however, the occurrence of progression, intolerance, and acquired resistance are not fully understood. We aim to report on the safety and activity of pirtobrutinib (a highly selective, non-covalent BTK inhibitor) in patients with relapsed or refractory Waldenström macroglobulinaemia, including those who received previous covalent BTK inhibitors as part of the phase 1/2 BRUIN trial.

The BRUIN study was an open-label, multicentre, phase 1/2 trial that enrolled patients with relapsed or refractory B-cell malignancies from 29 sites across eight countries. Patients aged 18 years or older who previously received BTK inhibitor-containing regimens, had an Eastern Cooperative Oncology Group performance status of 0-2, and histologically confirmed Waldenström macroglobulinaemia were eligible. In phase 1, patients received 100-300 mg oral pirtobrutinib once a day in 28-day cycles and the recommended phase 2 dose (RP2D) of 200 mg pirtobrutinib once a day was determined. The phase 2 primary endpoint was antitumour activity of pirtobrutinib based on objective response rate as assessed by an investigator in patients with chronic lymphocytic leukaemia, small lymphocytic leukaemia, or mantle cell lymphoma. In patients with Waldenström macroglobulinaemia, response was evaluated using the Sixth International Workshop on Waldenström Macroglobulinemia (IWWM-6) criteria. BRUIN is registered with ClinicalTrials.gov, NCT03740529 (completed).

BRUIN recruited patients from Aug 12, 2019, to March 14, 2022, and 778 patients received pirtobrutinib. 80 patients had relapsed or refractory Waldenström macroglobulinaemia (n=18 in phase 1 and n=62 in phase 2), with a median age of 68·5 years (IQR 61·0-75·0). 52 (65%) patients were male and 28 (35%) were female. The median number of previous lines of systemic therapy was 3·0 (2·0-5·0). 63 (79%) patients received previous covalent BTK inhibitors. 73 (91%) received 200 mg pirtobrutinib once per day (the RP2D). Using IWWM-6 criteria, the objective response rate was 82·5% (95% CI 72·4-90·1), with one (1·3%) patient reaching complete response, eight (10·0%) reaching very good partial response, 49 (61·3%) reaching partial response, and eight (10·0%) reaching minor response. The median study follow-up was 35·0 months (17·7-47·7). The objective response rate was 81·0% (69·1-89·8) for those who received previous covalent BTK inhibitors and 88·2% (63·6-98·5) for covalent BTK inhibitor-naive patients. Grade 3 or higher treatment-emergent adverse events occurred in 57 (71%) patients, with the most common being neutropenia or neutrophil count decreased (15 [19%]) and anaemia (19 [24%]). Treatment-emergent deaths were reported in five (6%) patients (bacterial sepsis, intracranial haemorrhage, COVID-19 pneumonia, hypertensive cardiomegaly and pneumonia [n=1 each unrelated to treatment], and treatment-related necrotising pneumonia [n=1]). Treatment-emergent adverse events leading to dose reductions occurred in four (5%) patients and pirtobrutinib discontinuation in 12 (15%).

Pirtobrutinib was highly active and well tolerated, regardless of previous exposure to covalent BTK inhibitors, and might be a promising new therapeutic option for patients with relapsed or refractory Waldenström macroglobulinaemia, particularly in those previously exposed to covalent BTK inhibitors, for whom durable and effective treatments are needed.

Eli Lilly and Company.

This study aimed to identify a subset of patients with pN1 oral squamous cell carcinoma (OSCC) and no adverse pathological features who derive significant benefit from adjuvant radiotherapy (RT).

In this multicenter retrospective study, 232 eligible pN1 OSCC patients were analyzed. Patients were stratified by T-stage (T1-2 vs. T3-4) and lymph node yield (LNY; high: ≥20; low: <20). The impact of adjuvant RT on survival outcomes was evaluated.

A significant survival benefit from adjuvant RT was observed exclusively in the subgroup with advanced T-stage (T3-4) and low LNY (< 20), with improved disease-free survival (69.2% vs. 23.1%, p = 0.003), overall survival (76.9% vs. 38.5%, p = 0.012), and disease-specific survival (80.8% vs. 46.2%, p = 0.014). In contrast, no significant survival differences were found in the other T-stage/LNY subgroups. Furthermore, LNY alone did not independently predict prognosis or RT benefit in the overall cohort.

This retrospective study suggests that pN1 OSCC patients with T3-4a stage disease and a low LNY (LNY < 20, levels I-III) may represent a subgroup that derives benefit from adjuvant RT. These exploratory findings suggest a practical model that warrants prospective validation to guide personalized therapy.

This study provides clinical evidence to help refine the postoperative management of pN1 OSCC patients without high-risk features. It provides a practical stratification tool to guide personalized treatment decisions, aiming to optimize survival outcomes while reducing unnecessary radiotherapy.

This study investigates how Chinese breast cancer survivors reconstruct damaged identities and negotiate cultural norms to build resilience within a specific socio-cultural context.

Using narrative inquiry and a life-course perspective, in-depth interviews were conducted with 15 female breast cancer survivors in Beijing. The study employed thematic narrative analysis to identify cross-cutting patterns while preserving individual story integrity. Rigor was ensured through data saturation and member checking.

Resilience is manifested as a transformative narrative practice across three dimensions: (1) body narrative, survivors transition from chaos narratives to quest narratives, reclaiming identities by ascribing meaning to physical scars; (2) relational narrative, survivors negotiate the tension between Confucian gender expectations and self-care, shifting from stoic endurance to accepting vulnerability; and (3) social narrative, survivors bridge the gap between "silent island" of isolation and collective empowerment by establishing narrative communities that challenge social stigma.

These findings reveal a duality of resilience-constrained by cultural structures yet empowered with agency. This study proposes a tripartite social work interventions framework, recommending that social workers act as narrative witnesses, cultural mediators, and community architects. By integrating local cultural wisdom with narrative techniques, social workers can effectively facilitate identity reconstruction and the social integration of breast cancer survivors.