Circadian rhythms affect immunity, which could affect the effectiveness of immune checkpoint inhibitor (ICI). Whether the time of ICI administration is associated with clinical outcomes in advanced cancers remains unclear.

To evaluate the association between time of day of ICI administration and oncologic outcomes in patients with advanced solid tumors.

MEDLINE (via PubMed), Embase, and Web of Science Core Collection were searched in February 2026 to identify eligible studies.

Randomized clinical trials and prospective or retrospective cohort studies were included that compared early vs late time-of-day ICI administration and reported overall survival (OS) and progression-free survival (PFS).

This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Two authors independently extracted data and assessed risk of bias. Random effects meta-analyses with inverse-variance method were performed.

The primary outcomes were OS and PFS. These outcomes were reported as hazard ratios (HRs) with 95% CIs for early vs late ICI administration.

Of the 7892 records screened, 29 studies with 6129 patients were included. Among these studies, 1 was a randomized clinical trial in non-small cell lung cancer (NSCLC; 210 patients), 1 was a prospective cohort study in head and neck squamous cell carcinoma (62 patients), and 27 were retrospective cohort studies (5857 patients) across NSCLC, melanoma, gastric cancer, head and neck squamous cell carcinoma, renal cell carcinoma (RCC), esophageal cancer, small cell lung cancer, urothelial carcinoma, biliary tract cancer, hepatocellular carcinoma, and other cancers. Earlier ICI administration was associated with increased OS (HR, 0.60; 95% CI, 0.51-0.70) and PFS (HR, 0.62; 95% CI, 0.54-0.71). Subset analyses by cancer type confirmed significantly increased OS and PFS in NSCLC (OS: HR, 0.58 [95% CI, 0.46-0.74]; PFS: HR, 0.60 [95% CI, 0.46-0.76]), gastric cancer (OS: HR, 0.61 [95% CI, 0.49-0.77]; PFS: HR, 0.62 [95% CI, 0.43-0.89]), RCC (OS: HR, 0.60 [95% CI, 0.40-0.90]; PFS: HR, 0.70 [95% CI, 0.50-0.98]), small cell lung cancer (OS: HR, 0.37 [95% CI, 0.26-0.53]; PFS: HR, 0.48 [95% CI, 0.36-0.65]), and biliary tract cancer (OS: HR, 0.62 [95% CI, 0.41-0.93]; PFS: HR, 0.55 [95% CI, 0.38-0.79]).

In this systematic review and meta-analysis of studies including patients with advanced cancers, early immunotherapy administration was associated with improved outcomes. These findings suggest that treatment timing may have clinical relevance and warrant prospective evaluation to establish standardized timing strategies across cancer settings.

Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor.

To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.

This cross-sectional study included adult participants (aged ≥18 years) from 3 cohorts-the ACCESS trial (2021-2024), BMT CTN 1703 trial (2019-2021), and Center for International Blood and Marrow Transplant Research (CIBMTR) PRO Protocol observational study (2020-2025)-who completed a baseline PRO survey. The ACCESS and PRO Protocol cohorts were stratified by conditioning intensity (myeloablative [MAC] vs reduced-intensity and nonmyeloablative [RIC/NMA]); all BMT CTN 1703 participants received RIC/NMA.

Hematopoietic cell transplant.

Racial and ethnic diversity, insurance type, education, and income were compared among cohorts using counts and percentages, and socioeconomic and structural disadvantage were measured using the Social Vulnerability Index and Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy.

Baseline surveys were completed by 208 participants in the ACCESS trial (median [range] age at transplant, 62.3 [20.4-78.9] years; 108 male [51.9%]), 122 participants in the PRO Protocol study (median [range] age at transplant, 63.9 [21.1-78.0] years; 67 male [54.9%]), and 342 participants in the BMT CTN 1703 trial (median [range] age at transplant, 66.9 [20.7-78.6] years; 218 male [63.7%]). Participants in ACCESS were more racially and ethnically diverse, with 15 (7.2%), 25 (12.1%), 46 (22.2%), 110 (53.1%), and 11 (5.3%) of Asian, Black or African American, Hispanic or Latino, White, and other race and ethnicity, respectively, compared with 4 (3.3%), 2 (1.6%), 8 (6.6%) 104 (85.2%), and 4 (3.3%), respectively, in the PRO Protocol and 10 (3.0%), 0, 16 (4.8%), 302 (91.0%), and 4 (1.2%), respectively, in the BMT CTN 1703 trial. Participants in ACCESS were more likely to have Medicaid (36 [18.1%]) vs PRO Protocol (8 [6.7%]) and BMT CTN 1703 (16 [5.1%]) participants and reported lower education (some college or an associate's degree: 103 [49.5%] vs 73 [59.8%] in the PRO Protocol; postcollege education: 34 [17.3%] vs 35 [29.2%] in the PRO Protocol) and household income (<$40 000 annually: 25 [24.0%] vs 8 [11.6%] in the PRO Protocol and 7 [38.9%] in the BMT CTN 1703 trial). Median Social Vulnerability Index scores were highest among participants in the ACCESS MAC group (median [range], 0.72 [0.01-0.97] vs 0.61 [0.16-0.78] in the PRO Protocol MAC group), and 16 participants [27.6%] in the ACCESS MAC group reported moderate to severe financial toxicity. The ACCESS participants lived closer to transplant centers, especially in the RIC/NMA group (median [IQR], 28 [14-75] miles vs 47 [16-96] miles for BMT CTN 1703 participants and 49 [21-104] miles for PRO Protocol participants).

This cross-sectional study of clinical trial participants and a clinical cohort found that the ACCESS trial enrolled a more racially and ethnically diverse and socioeconomically disadvantaged population. Trial designs that broaden eligibility could expand access to HCT, highlighting the need for systemic interventions to ensure equity.

Existing quality-of-life assessment tools for chemotherapy-induced alopecia may not adequately serve women of all races. Non-White patients with breast cancer receiving chemotherapy at our institution were approximately six times less likely than White patients to use scalp cooling (SC).

This study examines factors contributing to this disparity through interviews with Black women undergoing chemotherapy, focusing on alopecia's impact and attitudes toward its prevention and treatment.

Semi-structured, 1-hour Zoom interviews were conducted and transcribed. Content analysis using NVIVO software and a grounded theory approach identified themes.

Three main domains emerged: (1) alopecia's impact, (2) barriers to SC, and (3) improving alopecia management. Key barriers included limited representation of Black women in SC advertising and concerns about SC's effectiveness on textured hair. Solutions included better counseling on SC use, camouflage options, and increased awareness of other treatment options like dermatology referrals.

The study was conducted at a single institution; participation was voluntary leading to possible selection bias and the risk for recall bias in the setting of assessing patients' attitudes retrospectively.

This study highlights barriers to SC use among Black women, providing insights for developing interventions to improve access to alopecia prevention and treatment.

Heparanase uniquely cleaves heparan sulfate, the main component of the outer layer of endothelial cell plasma membranes, promoting tumour invasion and dissemination. However, it can also enhance tumour immune surveillance and clearance. heparanase's versatility extends to pro-thrombotic properties, such as the promotion of tissue factor release. Interestingly, elevated heparanase levels have been found in ovarian cancer (OC), which has a notably high incidence of venous thrombosis. Previously, single-nucleotide polymorphisms (SNPs) of HPSE were shown to modulate mRNA and protein levels, possibly predicting disease outcomes.

Given the potential role of heparanase in OC, the implications of three SNPs - rs11099592, rs4364254 and rs4693608 - were investigated in OC patients. In the discovery cohort, rs11099592 TT genotype and rs4364254 C allele carriers showed lower survival time than their counterparts (log-rank test, p = 0.025 and p = 0.001, respectively). Validation cohort analysis confirmed the worse prognosis associated with the rs11099592 T allele and the rs4364254 C allele in non-serous (log-rank test, p = 0.016) and platinum-resistant (log-rank test, p = 0.044) OC patients, respectively. The rs4364254 C allele was associated with reduced HPSE expression in peripheral blood components (χ² test, p = 0.005), suggesting a protective role for HPSE in OC patients.

HPSE rs11099592 and rs4364254 showed prognostic value, with T and C allele carriers, respectively, displaying worse clinical outcomes. These results indicate that heparanase could enable a tumour microenvironment shift towards a less aggressive cancer behaviour, facilitating leukocyte migration and anti-tumour responses. Further research should explore the dual mechanisms of this protein to improve OC management.

Neoadjuvant chemotherapy (NAC) is commonly used in early-stage breast cancer. A complete pathologic response (pCR) after NAC is associated with improved outcomes. This study investigated differences in pCR and clinical outcomes by race.

A single-institution, retrospective chart review identified patients with early-stage breast cancer who received NAC between January 1, 2010, and December 31, 2017. Associations between race and pathologic and clinical outcomes were evaluated using multivariable logistic regression and Cox proportional hazard models. Kaplan-Meier estimates and log rank tests assessed differences in recurrence-free survival (RFS) and overall survival (OS).

A total of 532 patients with breast cancer of all receptor subtypes were identified; 323 (60.7%) White, 188 (35.3%) Black and 21 (3.9%) other/unknown. The pCR rate was different between the 3 race categories; White 27.2%, Black 19.1% and other/unknown 9.5% (P = 0.03). In multivariate analysis, pCR rates were higher in White versus Black patients (P = 0.02). Patients with triple-negative disease demonstrated the largest difference in pCR (White 44.3% versus Black 27.1%; P = 0.04). Black patients had inferior OS compared to White patients (P = 0.03). There was no difference in RFS by race (P = 0.07).

Black patients demonstrated a lower pCR rate compared to White patients, and this was more pronounced in the triple-negative subgroup. There was no difference in RFS by race, but OS was inferior among Black patients. It is possible that the lower pCR rate in Black patients may contribute to lower OS; however, more investigation is needed to explain these differences.

Neoadjuvant chemotherapy is standard for stage IB-III triple-negative breast cancer (TNBC), with pathological complete response (pCR) strongly associated with survival. Although escalation with platinum and immune checkpoint inhibitors (ICI) improves pCR and long-term outcomes, patients with pCR in control arms of pivotal trials also show favorable outcomes. Whether the regimen leading to pCR impacts long-term survival is largely unknown.

We conducted a systematic review and meta-analysis, searching phase II and III trials including early-stage TNBC patients with pCR. A pooled analysis of Kaplan-Meier-derived individual patient data was performed for event-free survival (EFS) and overall survival (OS), with subgroup analyses by treatment regimens.

Of 2830 identified publications, 18 trials comprising 3430 patients were included. Neoadjuvant ICI with chemotherapy improved EFS (HR 0.67; 95%CI 0.50-0.89; p < 0.01) compared with chemotherapy-only regimens, with no significant OS difference (HR 0.84; 95%CI 0.50-1.41; P = 0.51). In contrast, EFS and OS were not significantly different regardless of platinum use (HR 0.55; 95%CI 0.20-1.50; P = 0.24 and HR 0.33; 95%CI 0.09-1.22; P = 0.10, respectively). Similarly, anthracycline-containing regimens showed comparable EFS to anthracycline-free regimens (HR 0.86; 95%CI 0.51-1.45; P = 0.58). For patients with pCR after ICI therapy, no benefit of adjuvant ICI for EFS or OS was observed (HR 1.16; 95%CI 0.55-2.44; P = 0.70 and HR 2.91; 95%CI 0.40-21.37; P = 0.29, respectively).

These findings suggest that the context in which a pCR is achieved may influence long-term outcomes. Neoadjuvant ICI-based regimens improve EFS in patients with early-stage TNBC and pCR. However, EFS seems not to be impacted by neoadjuvant chemotherapy type.

Patients with nasopharyngeal carcinoma often face sleep and anxiety problems during chemoradiotherapy. These two issues interact with each other, forming a vicious cycle that seriously affects the patients' quality of life and treatment outcomes. In order to address the neglect of group heterogeneity in traditional studies, this study employs latent profile analysis and network analysis methods to explore patient subgroups and reveal the association patterns between symptoms, thereby providing a basis for precise nursing interventions.

From September 2023 to March 2025, a convenience sampling method was used to select 513 patients with nasopharyngeal carcinoma who were receiving initial treatment in the Radiotherapy Department of a Grade A tertiary hospital in Nanning, Guangxi. General information questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A) were used to assess the patients' sleep quality and anxiety. Latent Profile All assessments were conducted at the mid-stage of concurrent chemoradiotherapy (2-4 weeks after the initiation of treatment), and the specific treatment phase of each participant was recorded and summarized. Latent Profile Analysis (LPA) was applied to identify potential patient subgroups with different "sleep-anxiety" characteristics. For different subgroups, symptom networks of sleep and anxiety were constructed respectively, and the core symptoms were identified and compared.

The sleep quality and anxiety symptoms of nasopharyngeal carcinoma patients undergoing chemoradiotherapy can be divided into 4 latent profiles: low distress group (43.86%), emotional distress dominant group (21.25%), sleep problem dominant group (23.59%), and high anxiety-sleep disorder group (11.31%). Network analysis shows that in the low distress group network, the association between HADS1 and PSQI2 was the strongest, and PSQI2, PSQI3, and PSQI4 had the highest centrality. In the network of the emotional distress dominant group, the association between PSQI3 and PSQI4 was the strongest, and HADS4 also had relatively high centrality. In the sleep problem dominated group network, the association between HADS1 and PSQI2 was the strongest among all subtypes, and PSQI2, HADS1, and PSQI3 were the core symptoms in this network. In the network of the high anxiety-sleep disorder group, the association between HADS3 and PSQI3 was the strongest, and PSQI3, HADS3, and HADS2 were the core symptoms with high centrality.

There is group heterogeneity in sleep-anxiety symptoms among patients with nasopharyngeal carcinoma undergoing chemoradiotherapy, which can be divided into four subgroups with different core symptom characteristics. The identified symptom associations provide hypothesis-generating insights for clinical intervention, and targeted strategies for core symptoms in each subgroup may help optimize symptom management in this population.

The purpose of this retrospective study was to investigate the incidence of MRONJ and its related risk factors in multiple myeloma (MM) patients undergoing dental extractions prior to autologous stem cell transplantation (ASCT).

This retrospective study evaluated patients treated January 1, 2011, to January 1, 2022. Medical and dental records of 1547 patients referred to the Dental Oncology Clinic at Princess Margaret Cancer Centre were reviewed, with 320 patients meeting the eligibility criteria and included in the analysis.

Among 320 patients, patients had on average 3 teeth removed prior to ASCT and 13 (4.1%) developed MRONJ. Periodontal disease was the most common reason for dental extraction among MRONJ cases. Patients prescribed zoledronic acid alone were nearly 5 times more likely to develop MRONJ than patients treated with pamidronate alone, with the highest risk observed in patients who were prescribed pamidronate and later changed to zoledronic acid. Even a single dose of bisphosphonate was sufficient to cause MRONJ following dental extraction and in some cases, onset to MRONJ following extraction was in the span of years.

The decision to recommend extractions in patients previously exposed to intravenous bisphosphonates should take into account the severity of dental disease versus risk of MRONJ. In particular, the type and duration of bisphosphonate therapy should be considered. When extractions are performed in patients at-risk of MRONJ, they should be warned of the risk (around 4% in this study) and followed for a period appropriate to detect complications.

Breast cancer is the most prevalent malignancy among women and frequently causes significant psychological distress, such as anxiety and depression. The perception and impact of social support in addressing these mental health challenges differ depending on cultural and societal factors, highlighting its crucial role.

This study aimed to evaluate the association between anxiety and depression in Palestinian women with breast cancer and perceived social support (PSS).

A descriptive, cross-sectional design was employed. The study included 257 patients with breast cancer. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. PSS was measured using the Medical Outcomes Study Social Support Survey.

Most participants (95%) were married. The mean age was 51 ± 9.8 years. The total PSS was relatively mild to moderate (M = 69.7 ± 9.5). The scores for anxiety and depression were in the borderline range(M = 7.8 ± 3.3 and M = 8.3 ± 3.6, respectively). All subclasses of PSS were negatively correlated with anxiety and depression ( P < .05).

Every individual has a unique perception of social support. Depression and anxiety affect a sizable percentage of patients with breast cancer. Higher levels of social support may also assist in reducing depression and anxiety, as seen by the strong negative association found between these psychological states and PSS.

Background Complete pathologic necrosis (CPN) at liver transplant is a positive predictor of freedom from recurrence and overall survival for patients with hepatocellular carcinoma (HCC). Comprehensive authorized user parameters for yttrium 90 radiation segmentectomy CPN rates at explant remain undefined. Purpose To evaluate established outcomes for radiation segmentectomy before liver transplant and determine optimal parameters to achieve CPN among patients with treatment-naive HCC. Materials and Methods This multicenter retrospective study included patients with treatment-naive HCC who underwent glass microsphere radiation segmentectomy before liver transplant from January 2016 to December 2024. Treatment parameters were compared for patients that achieved CPN versus those without CPN using Mann-Whitney U or χ² tests. Receiver operating characteristic analysis was performed to determine treatment parameter thresholds and subsequently predict CPN. Results A total of 303 patients with 364 tumors were included in the study. Tumors had a median size of 2.4 cm (IQR, 2.0-3.1 cm) and demonstrated a CPN rate of 68% (246 of 364). Compared with tumors without CPN, those with CPN had a higher microsphere activity (median, 1242 Bq vs 1203 Bq; P < .03), microspheres per milliliter (median, 9000 per mL vs 7600 per mL; P = .02), single-compartment dose (median, 544 Gy vs 379 Gy; P < .001), and angiosome-to-tumor volume ratio (median, 25.2 vs 15.6; P = .02). Multivariable logistic regression showed that a microsphere activity of 1087 Bq or greater (P = .03), a dose of 440 Gy or greater (P < .001), and an angiosome-to-tumor volume ratio of 16 or greater (P < .001) were independent predictors of CPN. There was a positive association between the number of optimized parameters and CPN at liver transplant, with a positive predictive value of 74% (198 of 269) with one threshold met and 91% (57 of 63) with all thresholds met (P < .001). Conclusion Among patients with treatment-naive HCC, glass microsphere radiation segmentectomy before liver transplant achieved high rates of CPN, which was associated with optimized parameter thresholds determined for microsphere activity, microspheres per milliliter, dose, and angiosome-to-tumor volume ratio. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Gordon and Lewandowski in this issue.