Direct-acting antivirals (DAAs) cure most chronic hepatitis C virus (HCV) infections, but their impact on liver functional reserve in patients with a history of hepatocellular carcinoma (HCC), particularly after non-curative HCC treatment, remains unclear. We evaluated antiviral efficacy and liver functional reserve after DAA therapy according to HCC history and timing of DAA initiation. In this retrospective single-center cohort, 716 patients initiated DAA therapy, and 690 with evaluable sustained virological response at 12 weeks after treatment (SVR12) were analysed. Patients were classified as no HCC, curative-treated HCC, or non-curative-treated HCC according to the most recent HCC treatment before DAA initiation. Liver functional reserve was assessed using the albumin-bilirubin (ALBI) score, modified ALBI grade, and Child-Pugh class. In the non-curative-treated HCC group, early (≤ 3 months) versus delayed (> 3 months) DAA initiation after the most recent HCC treatment was compared. Overall SVR12 was 96.1%, with similarly high rates across groups regardless of HCC history. The median ALBI score improved from -2.35 to -2.58 at SVR12 in the curative-treated HCC group (p < 0.001) but remained unchanged in the non-curative-treated HCC group (-2.36 to -2.38). Among 64 patients with a history of HCC, 43 (67.2%) developed recurrence; in these patients, the ALBI score improved from -2.31 at DAA initiation to -2.57 at recurrence (p < 0.001), and more than 90% remained Child-Pugh class A. Early and delayed DAA initiation showed similarly high SVR12 rates and comparable liver functional reserve. DAAs achieved high SVR12 rates and maintained liver functional reserve in patients with HCV, including those with a history of HCC after non-curative treatment.

Human papillomavirus (HPV) infection contributes to rising incidence of HPV-related oropharyngeal cancer (OPC). After the U.S. expanded HPV vaccination to adults aged 27-45 y in 2018, COVID-19 caused preventive visits and routine immunizations to plunge. We analyzed 2019 and 2022 NHIS data among adults aged 27-45 (2019 n = 8,745; 2022 n = 7,303). The primary outcome was ever HPV vaccination (≥1 dose), regardless of age at first vaccination. We estimated age-adjusted, survey-weighted coverage and used multivariable logistic regression to estimate adjusted odds of vaccination by sociodemographic characteristics; secondary 2022 analyses assessed initiation between ages 27 and 45. Ever HPV vaccine uptake increased from 15.1% in 2019 to 20.7% in 2022 (difference 5.6 percentage points; 95% CI, 4.03-7.07). In both years, lower odds were observed with increasing age, men, non-Hispanic Asian adults, individuals with lower educational attainment, and those without a usual place for care. By 2022, lower income-to-poverty ratios and lack of insurance were associated with reduced odds, whereas LGB+ and unmarried adults had higher odds, and adults in the Northeast had higher odds than those in the South. Only 1.43% (95% CI, 1.07-1.80) initiated vaccination between ages 27 and 45 in 2022. Initiation was more common among females, LGB+ and non-Hispanic Asian adults, and unmarried adults, and less common among those with lower education and no usual place for care. The increase in lifetime HPV vaccine coverage likely reflects childhood and adolescent vaccination rather than initiation at ages 27-45, which remained uncommon, and persistent inequities highlight missed opportunities for equitable OPC prevention.

This umbrella review aimed to systematically synthesize and critically appraise the available evidence from systematic reviews and meta-analyses evaluating the association between talc exposure and cancer risk in humans.

This umbrella review was conducted in accordance with the PRIOR guidelines and registered in PROSPERO. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Epistemonikos was performed up to October 2024 without language or date restrictions. Eligible studies were systematic reviews evaluating any type of talc exposure in humans. Study selection and data extraction were performed independently, and risk of bias was assessed using the AMSTAR-2 tool.

Nine systematic reviews were included, eight combining cohort and case-control studies and one restricted to cohort studies. Cosmetic talc exposure was the most frequently investigated, with most reviews focused on ovarian cancer. Moderate overlap of study populations (9.2%) was identified, primarily related to Boon et al. Based on AMSTAR-2, confidence in the evidence was moderate in one review and critically low in seven, with frequent methodological shortcomings such as lack of protocol registration and unclear study exclusions. For occupational exposure, elevated risks were observed for overall cancer (RR 1.21; 95% CI 1.03-1.42) and colorectal cancer (SIR 1.59; 95% CI 1.07-2.26), while no increased risk was found for other cancer types. Four of five systematic reviews evaluating cosmetic talc exposure and ovarian cancer reported a statistically significant association with increased ovarian cancer risk, whereas one review found no statistically significant association. However, confidence in the results of the reviews included was predominantly low or critically low, reflecting important methodological limitations, including concerns regarding risk-of-bias assessment and reporting. Overall, the evidence supporting an association between cosmetic talc exposure and ovarian cancer was of limited confidence.

There is limited evidence from systematic reviews regarding the association of exposure to cosmetic talc with an increased risk of developing ovarian cancer. Therefore, the results of the systematic reviews should be regarded as suggestive, rather than definitive, and further studies are required to demonstrate a causal relationship.

Cervical cancer remains one of the most common and preventable cancers among women in sub-Saharan Africa. Despite established curative treatments, most women present with locally advanced disease and many fail to complete therapy. Financial toxicity encompassing, direct medical costs, non-medical expenditures, income loss, and psychological distress, is an underrecognized but potentially important contributor to this treatment gap. This narrative review examines evidence on the magnitude, structural drivers, and consequences of financial toxicity in cervical cancer care across sub-Saharan Africa, and proposes system-level mitigation strategies. Targeted searches of PubMed, Embase, and Google Scholar (January 2013-April 2026), were supplemented by gray literature and reports from international health agencies. Thematic synthesis was conducted along the cervical cancer care continuum within a universal health coverage financial risk protection framework. The reviewed evidence suggests that financial toxicity is multi-dimensional, cumulative, and largely shaped by health-system organization. Quantitative studies report substantial out-of-pocket expenditure and catastrophic health spending, while qualitative studies consistently describe severe financial hardship, although definitions and measurement approaches vary across studies. Centralized radiotherapy services, requiring repeated long-distance travel over 5 to 6 weeks, appear to be an important structural contributor through transport, accommodation, and income-related costs. Available evidence further suggests that financial toxicity may contribute to delayed treatment initiation, missed radiotherapy sessions, incomplete chemoradiation, and treatment abandonment. This review also raises the hypothesis that, in radiotherapy-constrained settings, treatment pathway adaptation such as neoadjuvant chemotherapy followed by surgery may have financial as well as oncologic implications that warrant prospective evaluation. Direct evidence linking financial toxicity to survival outcomes remains limited. Reducing financial barriers will likely require health-system reforms, including decentralized service delivery where feasible, integration of financial navigation into oncology services, universal health coverage benefit packages covering the full cervical cancer care continuum, and treatment protocols that account for patients' financial burden.

BRAF V600E-mutant metastatic colorectal cancer (mCRC) is characterized by aggressive disease behavior and limited responsiveness to conventional systemic therapy. Although BRAF/EGFR-targeted therapies have improved clinical outcomes, durable complete remission remains uncommon, particularly in microsatellite-stable (MSS) disease. We report the case of a 26-year-old woman with MSS, BRAF V600E-mutant sigmoid colon adenocarcinoma and synchronous liver and omental metastases (cT4aN2M1c, stage IVC). Pretreatment biopsy demonstrated high programmed death-ligand 1 (PD-L1) expression (combined positive score = 20) and a high density of intratumoral CD8+ T cells (350 cells/mm2). Because the patient declined cytotoxic chemotherapy, first-line treatment consisted of tislelizumab combined with cetuximab and dabrafenib. After approximately 4 months of systemic therapy, radiological assessment showed a partial response, accompanied by normalization of serum marker levels, enabling conversion surgery. Histopathological examination confirmed a pathological complete response in the primary tumor and all resected metastatic lesions. A personalized tumor-informed circulating tumor DNA assay performed 3 months after surgery was negative. At the latest follow-up (35 months after treatment initiation), the patient remained free of clinical and radiological evidence of disease recurrence. This case highlights the possibility that selected patients with MSS, BRAF V600E-mutant mCRC may achieve durable remission with combined programmed cell death protein 1 blockade and dual-targeted therapy. The observed association between high intratumoral CD8+ T-cell infiltration, elevated PD-L1 expression, and favorable treatment response should be considered hypothesis-generating and requires validation in prospective biomarker-driven studies.

Prostate cancer (PCa) remains one of the most prevalent malignancies and a major cause of cancer-related deaths among men worldwide. Current pre-biopsy evaluation relies primarily on serum prostate-specific antigen (PSA) testing and multiparametric MRI (mpMRI), but both approaches have limited specificity, particularly in the diagnostic gray zone (PSA 4-10 ng/mL and/or equivocal MRI findings such as Prostate Imaging Reporting and Data System (PI-RADS) category 3 lesions). In this setting, overlap between PCa and benign prostatic diseases frequently leads to unnecessary biopsies. This unmet clinical need has driven the development of novel diagnostic strategies designed to better discriminate PCa from benign prostatic diseases before biopsy. In this review, we provide a comprehensive overview of recent advances in non-invasive diagnostic strategies, including liquid-based molecular biomarkers, advanced imaging modalities, and multimodal integrative frameworks. These advances may improve diagnostic accuracy, reduce unnecessary biopsies, and support personalized risk stratification and biopsy decision-making. Moreover, we highlight the paradigm shift from single-parameter screening to multimodal integration, including artificial intelligence-based approaches in early PCa screening. Overall, these non-invasive strategies may help reduce diagnostic uncertainty in the gray zone and support more precise and personalized biopsy decision-making.

The current classification of pulmonary neuroendocrine neoplasms (NENs) is primarily based on histomorphological criteria, which do not fully capture their underlying biological heterogeneity. This limitation is particularly evident among pulmonary carcinoids, a subgroup characterized by highly variable clinical behaviour and prognostic outcomes despite similar morphological features.Angiogenesis is a hallmark of NENs, yet the role of the vascular endothelial growth factor (VEGF) pathway in pulmonary NENs remains incompletely defined.In this multicentre retrospective study, 109 pulmonary NENs (67 typical carcinoids, 22 atypical carcinoids, and 20 high-grade NENs) were analysed. VEGF, VEGFR1, VEGFR2, and VEGFR3 expression was assessed by immunohistochemistry and correlated with clinicopathological features and outcome.VEGF pathway components showed subtype-specific expression patterns. VEGFR1 was reduced in high-grade tumours and displayed a bimodal distribution, while VEGFR2 and VEGFR3 were higher in atypical carcinoids and high-grade tumours. Survival and recurrence were driven by histological subtype, whereas VEGF pathway expression lacked independent prognostic significance.The higher expression of VEGFR2 and VEGFR3 observed in atypical carcinoids and high-grade neuroendocrine carcinomas suggests a possible involvement of the VEGF signalling pathway in tumour biology. These findings contribute to the biological characterization of pulmonary NENs and provide a rationale for future studies investigating whether VEGF pathway markers may have predictive relevance for anti-angiogenic therapies.

Tumor-associated neutrophils (TANs) display functional plasticity in lung adenocarcinoma (LUAD), but subsets linked to immune exclusion are poorly defined.

We integrated single-cell RNA-seq, spatial transcriptomics, and bulk multi-omics data to characterize neutrophil heterogeneity in LUAD. Key findings were validated by immunofluorescence co-localization and qPCR on clinical blood and isolated neutrophils.

Neutrophils exhibited the highest scores for an EMT-associated transcriptional program and immune exclusion among all immune cell types. A distinct JUNB+ neutrophil subpopulation was spatially enriched in immune-excluded tumor regions and correlated with unfavorable prognosis. Spatial transcriptomic analysis revealed a significant positive correlation between JUNB expression and neutrophil marker module scores across tissue spots (Pearson r = 0.216 and 0.205, P = 1.84 × 10^-10 and 9.06 × 10^-11). Immunofluorescence confirmed JUNB protein co-localization with CD66b+ neutrophils in LUAD tissues (54.3% ± 8.2% of CD66b+ cells JUNB +). qPCR revealed specific upregulation of JUNB mRNA in circulating neutrophils from LUAD patients, whereas no difference was observed in whole blood.

This study identifies JUNB as a marker of a neutrophil state associated with immune exclusion and poor prognosis in LUAD. The neutrophil-specific upregulation of JUNB highlights its potential as a circulating biomarker for TAN-mediated immunosuppression, which warrants validation in prospective cohorts.

UBTF tandem duplications (UBTF-TD) define a recently recognized high-risk subtype of pediatric myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). UBTF-TD myeloid neoplasms are driven by a HOX/MEIS1 transcriptional program that depends on the interaction between menin and KMT2A. Preclinical studies have shown sensitivity to menin inhibition, but clinical experience in children with MDS remains scarce.

We report a ten-year-old girl with MDS with excess blasts harboring UBTF-TD together with NRAS and WT1 mutations. During the first cycle of azacitidine and venetoclax, blood counts did not improve, and the patient remained dependent on platelet and red blood cell transfusions. Revumenib was added to the ongoing treatment. Within two weeks, platelet counts and hemoglobin increased markedly, the patient became transfusion independent, and bone marrow blasts cleared. UBTF-TD also became undetectable by molecular testing. The patient subsequently underwent allogeneic hematopoietic stem cell transplantation and remains in complete remission with full donor chimerism one year after transplantation.

The rapid hematologic recovery and clearance of both bone marrow blasts and detectable UBTF-TD after initiation of revumenib provide clinical evidence that the menin dependency of UBTF-TD myeloid neoplasms can be therapeutically exploited. The timing and depth of the clinical and molecular response were remarkable.

Ataxia-Telangiectasia (A-T) is a rare, autosomal recessive disorder caused by biallelic pathogenic variants in the ATM gene. Loss of ataxia-telangiectasia mutated (ATM) protein function impairs DNA damage responses, leading to progressive neurodegeneration, genomic instability, immunodeficiency, and an increased risk of malignancy. Some A-T patients develop cancers at a young age and display extreme sensitivity to ionizing radiation and certain chemotherapeutics. Therefore, standard treatments often cause severe, life-threatening toxicities in these patients. This review discusses the dual role of ATM as a tumor suppressor and key DNA repair kinase, the mechanisms by which ATM deficiency promotes oncogenesis, and the unique challenges of treating malignancies in the context of A-T. We highlight emerging, less genotoxic therapies for ATM-deficient cancers including cancer vaccines, immune checkpoint inhibitors, CAR T-cell therapy, and synthetic lethal approaches such as Poly(ADP-ribose) polymerase (PARP) and Ataxia Telangiectasia and Rad3-related (ATR) inhibitors. These novel strategies may improve outcomes for A-T patients while minimizing treatment toxicity. We also outline future directions and clinical implications, emphasizing the need for tailored therapeutic approaches and multidisciplinary care for this high-risk population. Because prospective, A-T-specific therapeutic data are scarce, we draw extensively on the broader literature on somatic ATM-mutant cancers to inform management, while highlighting the additional constraints imposed by germline ATM loss.