Phosphatidylinositol 3-kinase delta (PI3Kδ) promotes tumour cell growth directly or indirectly by activating immune-suppressive cells. In contrast to previous PI3Kδ inhibitors, roginolisib is a selective, non-ATP competitive inhibitor, which locks PI3Kδ into an inactive state and causes an allosteric modulation. In a First-in-Human dose study, continuous daily dosing of roginolisib was investigated in patients with solid and haematologic malignancies. In Part A, 24 patients received escalating doses of roginolisib. In Part B, 20 mostly pre-treated metastatic uveal melanoma (mUM) patients received a dose associated with continuous PI3Kδ inhibition of >90%. The primary endpoint was safety, and secondary endpoints included pharmacokinetic (PK) and pharmacodynamic (PD) profile, clinical anti-tumour responses assessments. Exploratory endpoints included immunophenotyping, proteomics, genomics. No Dose Limiting Toxicity or drug related toxicities requiring dose modifications were observed ( ≥ Grade 3 toxicities: 3/44; 6.8%). In mUM, median Overall Survival (mOS) was 20.8 months (data-cut off December 2023) and 18.4 months (data-cut-off February 2026). mOS in mUM patients with Stable Disease at Week 16 ( = Cycle 5) was 28.5 months, while patients who progressed at Week 16 had a median OS of 12.3 months. Roginolisib was safe, had a predictable PK profile, T regulatory cell abundance was decreased while activated CD8⁺ T cells increased together with soluble plasma IL-15. ClinicalTrials.gov registration: NCT04328844.

Sexual health is a core component of long-term care for patients with prostate cancer, yet treatment-related sexual dysfunction remains common and existing interventions vary considerably in their definition and delivery. This scoping review aimed to map intervention content, delivery modalities, provider involvement, tailoring approaches, and outcome assessment of sexual health care interventions for patients with prostate cancer, and to identify priorities for future development.

A scoping review was conducted using Joanna Briggs Institute methodology. PubMed, Web of Science, Scopus, Embase, APA PsycINFO, the Cochrane Library, ProQuest, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) were searched from inception to August 30, 2025. Studies were screened against prespecified criteria, and relevant data were charted and synthesized descriptively.

Thirty-one studies published between 2003 and 2025 were included. Most were randomized controlled trials, and the largest number came from the United States and China. Intervention content mainly covered education, psychological support, sexual rehabilitation, symptom management, supportive safeguards, and relationship support. Face-to-face delivery, particularly in individual or dyadic formats, was predominant, although remote and digital approaches were also reported. Intervention delivery commonly involved mental health or psychosexual practitioners, nurses, and physicians. Tailoring was commonly based on patient problems, goals, preferences, psychological status, and clinical or behavioral characteristics. Outcome assessment focused mainly on sexual function and multidimensional prostate cancer-specific measures.

Sexual health care interventions for patients with prostate cancer have developed into multidimensional approaches, but relational support, adaptive procedures, and implementation pathways remain variably specified. Future progress should focus on earlier integration of sexual health care into prostate cancer care and on implementation-oriented evidence to support sustainable service delivery.

Small bowel tumors are less common compared to large bowel tumors despite small bowel, being the largest segment of gastrointestinal tract. There is increase in incidence of small bowel cancers compared to large bowel cancer due to improved diagnostic imaging and endoscopic methods and increase in cross sectional imaging with contrast enhanced computed tomography. Diagnosis of small bowel tumors is delayed due to nonspecific clinical presentation and initial diagnosis is at advanced stage with local spread and distant metastases. There are several genetic and acquired predisposing risk factors for adenocarcinoma and lymphoma of small bowel.

The gastroduodenal region encompasses a complex anatomic area prone to diverse pathologies, including inflammatory, vascular, and neoplastic conditions. MR imaging is emerging as a useful diagnostic tool, providing superior soft-tissue contrast and high-resolution mural depiction without radiation exposure. Advanced sequences like diffusion-weighted imaging and dynamic contrast-enhanced MR imaging, combined with motion-compensation techniques, enhance tissue characterization and the accuracy of cancer staging. MR imaging is particularly useful for evaluating neoplasms. We discuss the practical uses of MR imaging in assessing gastroduodenal pathologies in this review article.

Parathyroid neoplasms encountered in routine practice are most often diagnostically straightforward and can usually be classified on the basis of conventional histomorphology without the need for extensive biomarker work-up. This relative simplicity has contributed to the perception that pathologic assessment of parathyroid tumors is largely uncomplicated. Yet this view rapidly changes when a lesion exhibits atypical features beyond those expected in a conventional adenoma, particularly when the differential diagnosis includes parathyroid carcinoma, an exceptionally rare but potentially fatal malignancy. In these difficult cases, the endocrine pathologist carries substantial responsibility in separating misleading and overinterpreted atypical findings from lesions that truly harbor malignant potential or an increased risk of recurrence. Beyond classification, pathology also has a central role in identifying molecular abnormalities of diagnostic or therapeutic relevance in parathyroid carcinoma, as well as recognizing morphologic or immunophenotypic clues that may point to an underlying hereditary syndrome. In some cases, the pathologist may be the first to raise suspicion of a germline disorder and thereby initiate further genetic investigation. This review provides a focused analysis of the major histopathologic challenges in primary hyperparathyroidism. Particular emphasis is placed on distinguishing ordinary adenoma from normal glands, identifying atypical parathyroid tumors and parathyroid carcinoma while avoiding overdiagnosis, integrating immunohistochemical and molecular findings into diagnostic practice, and identifying features suggestive of hereditary disease. Our aim is to provide a practical framework that supports more accurate, reproducible, and clinically relevant pathologic assessment of parathyroid tumors.

Given the growing population of patients living with metastatic cancer, palliative care providers need every available tool for symptom management. We conducted a rapid review of the literature on palliative uses of ketamine for pain and depression in people with cancer.

We systematically searched for studies published since 2015 that examined palliative uses of ketamine in adults with cancer using clinical trial, experiment, quasi-experiment, or meta-analytic designs. We excluded studies focused on perioperative or post-operative sedation and/or pain, and studies lacking patient-reported outcomes.

There were 13 articles included in the final review. One open-label phase II study reported positive antidepressant effects of intranasal ketamine. Four open-label pilot studies found promising benefits for acute and chronic cancer-related pain in outpatient settings. Seven studies-pilot trials, retrospective chart reviews, and one mechanistic trial-reported improvements in refractory cancer pain near end of life. However, a cost-effectiveness analysis of the only adequately powered randomized controlled trial found no analgesic benefit and greater toxicity for ketamine among inpatients near end of life.

Ketamine may alleviate refractory pain, depression, and acute cancer‑related pain, but findings remain inconsistent, particularly considering the negative randomized trial. More rigorous, practice‑aligned research is needed to define ketamine's benefits, potential synergistic effects, and the role of supportive psychotherapy in palliative care. Palliative care clinicians should cautiously consider time-limited, individualized trials of ketamine for cancer patients with high symptom burden.

Oligometastatic disease has fundamentally altered how we approach metastatic gastrointestinal (GI) cancers, blurring the boundary between curable and incurable disease. Patients with limited metastatic burden may benefit from metastasis-directed therapy (MDT) aimed at long-term disease control or even cure. In selected settings, randomized studies have demonstrated meaningful improvements in progression-free survival, and contemporary series report 5-year overall survival rates of approximately 30-65% in carefully selected patients undergoing MDT. The concept of oligoprogression-isolated sites of progression despite otherwise stable disease-has become particularly relevant as modern systemic therapies have extended disease control in many patients. Emerging data suggest that timely local consolidation at oligoprogressive sites may allow patients to continue effective systemic regimens and delay treatment switches. Successful application of MDT with either palliative or curative intent depends on careful multidisciplinary assessment. Disease kinetics, molecular and/or genomic features, response to prior treatment, and individual patient characteristics all factor into decision-making. Critically, the strength of evidence varies considerably across GI tumor types, and not all oligometastatic disease is created equal. Radiotherapy also serves an essential palliative function, addressing common symptoms including bleeding, obstruction, and pain. This review examines the current evidence and explores unresolved questions about when and how to deploy local therapy across the spectrum of metastatic GI primary tumors.

Modern systemic therapies have transformed metastatic cancer management, yet acquired resistance remains a persistent clinical challenge. Frequently, this resistance manifests as oligoprogression, a distinct biological state in which a limited number of metastatic lesions grow or newly develop during active systemic therapy. Driven by branching clonal evolution, these rogue lesions can seed further widespread dissemination. This review examines how oligoprogression is defined and classified, which biological mechanisms underlie it, what clinical evidence supports local ablative therapy (LAT), and which endpoints and selection tools are required to validate the concept.

Relevant English-language literature was identified through a search of PubMed/MEDLINE, supplemented by ClinicalTrials.gov and backward citation screening, covering the period from database inception to June 22, 2026. Prospective and, where available, randomized trials were prioritized, while consensus documents and selected retrospective and translational studies were included according to relevance and informative value.

Historically, focal progression prompted an immediate switch to next-line systemic treatments, which are often more toxic and less effective. However, a paradigm shift is underway: rather than discarding a largely successful regimen, clinicians increasingly utilize metastasis-directed therapy (MDT), such as stereotactic body radiation therapy (SBRT), to locally ablate progressive sites. Continuing effective systemic therapy while ablating resistant sites aims to safely extend its therapeutic window. Recent prospective trials suggest that SBRT may prolong progression-free survival (PFS) in selected settings, with outcomes varying substantially according to tumor histology and disease biology.

LAT is a reasonable option in carefully selected patients, but the benefit depends on tumor histology, the systemic treatment context, and the endpoint assessed. Before oligoprogression can be regarded as an established clinical entity, trials should report PFS after subsequent therapy, time to next systemic therapy (TTNST), toxicity, and patient-reported outcomes (PROs) as distinct measures, and should evaluate imaging- and biomarker-based patient selection prospectively.

Cancer pain affects 55-95% of patients with advanced malignancy and remains inadequately controlled in approximately two-thirds of those with metastatic disease. Management is shifting toward a multimodal, mechanism-based and personalised approach. This narrative review summarises current evidence and international guideline recommendations on cancer pain management in adults, with a clinical focus on incurable disease.

PubMed/MEDLINE, Embase and the Cochrane Database of Systematic Reviews were searched from 1 January 2000 to 30 April 2026, supplemented by handsearching of international oncology, palliative-care and pain-medicine guidelines and of the 2025 multi-society consensus on opioid conversion. Systematic reviews, meta-analyses, randomised trials and current guidelines were prioritised.

Opioids are indicated for moderate-to-severe pain caused by cancer or its treatment and in palliative care; this indication should not be extrapolated to chronic non-cancer pain, where their benefit is small and comparable to non-opioid alternatives. The distinction is mechanistic: µ-opioid receptor agonism damps transmission from intact, continuously driven nociceptors, whereas nerve injury dismantles part of that target, so that antidepressants and anticonvulsants-not opioids-are first-line for neuropathic pain; methadone, buprenorphine, tapentadol and tramadol are partial exceptions owing to their additional non-opioid mechanisms. Titration and rotation remain central, with conversion ratios used as a starting framework rather than a fixed rule. Methadone, including intravenously, is valuable in neuropathic and opioid-refractory pain under specialist oversight. Rapid-onset transmucosal fentanyl outperforms oral morphine for breakthrough pain. Evidence does not support routine use of cannabinoids. Intrathecal drug delivery benefits carefully selected refractory patients, but the limitations of the published literature highlight the risk of premature procedural escalation before systemic optimisation. Non-pharmacologic interventions, palliative radiotherapy and pharmacogenomic-guided prescribing complete the framework.

Effective cancer pain management combines mechanism-based pharmacotherapy with evidence-informed interventional strategies and psychosocial support. Methadone, intrathecal therapy and emerging biased agonists each have a defined place, but none replaces clinical judgement and prior optimisation of systemic therapy. Restrictive frameworks developed for chronic non-cancer pain should not be applied to incurable cancer, where under-treatment remains the dominant risk; conversely, opioid efficacy in cancer pain does not endorse their use in non-cancer, particularly neuropathic, pain.

Non-cancer-related pain in cancer survivors can be difficult to assess when symptoms are interpreted as cancer progression and when impaired bodily awareness limits engagement in self-care. Myofascial pain with psychosomatic features accompanied by marked alexisomia has rarely been described in gastric cancer survivors. This case report describes the clinical application of a structured, multi-stage psychosomatic approach for refractory myofascial pain with psychosomatic features in an octogenarian female gastric cancer survivor.

An octogenarian woman with recurrent gastric cancer, who had achieved complete response after pembrolizumab therapy, developed refractory episodic nocturnal pain in the bilateral upper back. The pain was unresponsive to nonsteroidal anti-inflammatory drugs and opioids. Computed tomography and clinical evaluation revealed no evidence of metastatic recurrence or structural lesions. Physical examination showed marked bilateral upper-back muscle tension and multiple trigger points, although the patient was initially unaware of this tension and attributed the pain to cancer progression. The Shitsu-Taikan-Sho Scale (STSS) score was 85, indicating marked alexisomic tendencies. A multidisciplinary home-based palliative care team implemented a four-stage psychosomatic approach: establishment of a therapeutic relationship, biopsychosocial assessment, development of insight into mind-body interactions using physical examination findings including the Armchair Sign, and introduction of self-care strategies such as progressive muscle relaxation. After the intervention, the worst Numerical Rating Scale pain score decreased from 7 to approximately 4, the STSS score improved from 85 to 62, and nighttime emergency nursing visits ceased.

This single case suggests that a structured psychosomatic approach combining physical examination, assessment of alexisomia, and facilitation of mind-body awareness may be feasible and clinically useful for supporting self-care in selected cancer survivors with refractory myofascial pain and psychosomatic features. Further studies are needed to clarify its generalizability and therapeutic contribution.