Somatostatin receptors (SSTRs) have played a central role in all aspects of the management of neuroendocrine/endocrine neoplasms (NENs). This includes in diagnosis of NENs with the widespread use of radiolabeled SSTR ligands to localize both the primary tumor location and extent of the tumors, as well as confirm its NEN nature. In NEN management non-radiolabeled SSTR agonists are the first line for control of the hormone-excess state for most functional NENs (F-NENs) as well as for the initial cytotoxic treatment of advanced tumor growth, and more recently, the use of radiolabeled SSTR ligands for the treatment of more aggressive advanced disease, as well as the assessment of tumor location, tumor extent and response to therapies. While somatostatin analogs (SSTA) have been successful in all of the above areas, there is increasing need for improvement, because not all patients respond to existing SSTAs therapies, others become resistant with time to existing SSTA treatment, current imaging with radiolabeled SSTAs is negative in some patients and ease of use/availability of ligand can be a problem and lastly, newer groups of patients are being considered for possible SSTA treatment with newer SSTA related compounds.

In this perspective, the authors briefly review recent advances which are resulting or may result in new and emerging SSTAs that show promise in future use in NEN patients. It includes identification of both new or promising non-radioactive SSTA (cold SSTA) and radiolabeled SSTAs which could replace existing SSTAs now currently used, as well as new protocols for the new/promising SSTAs, or for existing SSTAs. These new/promising SSTAs/ or new/promising uses of these SSTAs include both chemically completely new SSTAs; pharmacologically new in their actions such as nonpeptide in nature; antagonist rather than agonist; longer acting in duration; and oral rather than parenteral administration. For peptide receptor radionuclide therapy (PRRT)/ imaging with radiolabeled SSTAs new developments covered include new promising SSTAs coupled to beta-emitters, alpha emitters, administered with radio-sensitizing agents, and new, promising protocols for PRRT retreatment, personalized treatment, adjuvant treatment or treatment of pediatric patients. They also include combinations of new/promising/exiting SSTAs both radiolabeled for PRRT or non-radiolabeled for tumor cytotoxic /and/or inhibitory effects formed by administration of the SSTA with other cytotoxic agents such as mTor inhibitors, chemotherapeutic agents, Tyrosine Kinase Inhibitors (TKIs), angiogenesis inhibitors, nonradioactive-SSTAs with PRRT or with immune therapy.

This review of new and promising SSTR therapies involving both radiolabeled and non-radiolabeled for the future treatment of NENs strongly supports the conclusion that in the future SSTR- based drugs will continue to play prominent roles in all aspects of the management of NENs. This conclusion extends to the use of SST ligands to image these tumors to establish the location of the primary, location and extent of metastatic disease and the presence of SSTRs on the tumor for possible PRRT therapy; to the control of hormonal symptoms in F-NENs such as the carcinoid syndrome, vasoactive-intestinal-peptide- secreting (VIPomas)/ Adrenocortotropin-secreting(ACTHomas), etc. and to anti-proliferative roles for the treatment of advanced disease with both non-radioactive SSTAs, as well with PRRT with radiolabeled SSTAs and likely with novel new non-radiolabeled cytotoxic SSTAs. Numerous recent studies firmly establish these conclusions, all of which are reviewed here; and they will likely be further supported by additional studies that are in progress and also cited here.

The objective of this study is to explore and validate a novel prognostic index for patients with locally advanced or metastatic biliary tract cancer (BTC) treated with first-line therapy with cisplatin, gemcitabine, and durvalumab.

This is a retrospective, multicenter, real-world study including 712 patients in the training cohort and 646 patients in the validation cohort. Using multivariate analysis for overall survival (OS) and applying the adjustment methods of Holm-Bonferroni, Benjamini-Hochberg, and Hommel, the authors identified five baseline statistically significant variables: disease stage, neutrophils, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA 19-9) levels, and Eastern Cooperative Oncology Group performance status (ECOG PS). According to the HR of each variable, β coefficients were calculated and the following formula was applied: (0.1757 * neutrophils value) + (0.5055 * ECOG PS) + (1.4037 * disease stage) + (0.1108 * CA 19-9) + (0.2126 * CEA). According to tertiles, the authors developed a prognostic model called the SENECA index, dividing the population into three risk groups: low-risk (≤2.14), intermediate-risk (2.15-2.89), and high-risk (>2.89).

Median OS was 23.4 months in low-risk group,16.1 months in intermediate-risk group, and 8.3 months in high-risk group (low-risk hazard ratio [HR], 0.20; intermediate-risk HR, 0.36; high-risk HR, 1; p < .0001). Median progression-free survival was 11.0 months in low-risk group (33.1%), 8.8 months in intermediate-risk group (33.3%), and 5.5 months in high-risk group (33.5%) (low-risk HR, 0.35; intermediate-risk HR, 0.55; and high-risk HR, 1; p < .0001).

The SENECA index is a practical instrument for prognostic stratification of patients with BTC receiving chemoimmunotherapy.

Atypical teratoid/rhabdoid tumors (ATRTs) are aggressive pediatric brain tumors that are sensitive to proteasome inhibitors in preclinical models. We evaluated the feasibility of combining the proteasome inhibitor, bortezomib, with chemotherapy.

Six patients aged 0.8-13 years with newly diagnosed ATRT were enrolled from January 2022 through December 2023. Bortezomib was given intravenously at the dose of 1.3 mg/m²/day on days 1, 4, 8, and 11 of a 21-day chemotherapy cycle for 6 cycles. Radiation therapy was given before initiation of chemotherapy in 4 patients or at the end of chemotherapy in one patient. The primary endpoint was grade 3 or higher non-hematologic toxicities.

Thirty cycles of bortezomib with chemotherapy were evaluated. No grade 3 or higher toxicities were considered bortezomib-related. Four patients completed 6 cycles of bortezomib; 2 patients discontinued treatment due to progressive disease after 2 and 4 cycles, respectively. An additional 6 cycles of bortezomib were evaluated after high-dose chemotherapy in three patients without grade 4 bortezomib-related toxicity. Five patients had a near-total resection; one patient had a subtotal resection. Four patients were evaluable for response with 2 partial responses, 1 stable disease, and 1 progressive disease. Two patients without measurable tumor after surgery were not evaluable for response. Two patients remain alive without disease at 37 and 40 months, and one patient died without disease at 19 months after diagnosis. Three patients died with progressive disease.

The toxicities were no more than expected with chemotherapy alone. Adding bortezomib to treatment of ATRT is feasible.

NCT06853080.

Breast cancer-related lymphedema (BCRL) is one of main issues following treatments in patients with breast cancer (BC). The current study is aimed at evaluating epidemiological and clinical risk factors for BCRL in female patients with BC.

In a case-control study design from October 2024 to March 2025, female BC patients with and without BCRL were recruited from the Lymphedema Physiotherapy Clinic and the Cancer Therapeutic and Diagnosis Imaging Center in Hamadan, Western Iran. Patient, tumor, and treatment characteristics were gathered via interview and reviewing medical and pathology records.

Overall, 230 patients (127 cases and 103 controls) were included. The multivariable analysis revealed several potential risk factors for BCRL: older age at diagnosis (odds ratio [OR] = 1.05; 95% confidence interval [CI], 1.00, 1.10), urban residency (4.76; 1.20, 20.00), axillary lymph node dissection number of 6-9 compared to ≤ 5 (2.54; 0.99, 6.49), pathology grade of 2 (7.11; 1.47, 34.27) and 3 (6.53; 1.32, 32.32) compared to Grade 1, mastectomy versus lumpectomy (2.86; 1.23, 6.67), receiving chemotherapy (9.55; 1.23, 73.95), and positive progesterone receptor (PR) status (2.56; 1.16, 5.55).

The combination of patient, tumor, and treatment characteristics may be associated with BCRL, highlighting the close monitoring of high-risk patients (older age, high-grade tumors, mastectomy, and PR-positive) in Western Iran.

To compare differences in clinical outcomes between dual immune checkpoint blockade and immunotherapy plus tyrosine kinase inhibitors (TKIs) as first-line treatment for metastatic renal cell carcinoma in routine clinical practice.

Retrospective multicenter cohort study including 311 patients with International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) intermediate or poor-risk metastatic RCC who received first-line immune checkpoint inhibitor (ICI)-based combination therapy between 2018 and 2023. Patients were treated with either ICI + ICI or ICI + TKI. Inverse probability of treatment weighting (IPTW) was applied to reduce baseline imbalances. Progression-free survival (PFS), second progression-free survival (PFS2), overall survival (OS), objective response rate (ORR), and duration of response (DOR) were analyzed using weighted survival models.

After adjustment, ICI + TKI was associated with a trend toward longer PFS compared with ICI + ICI (median 28.7 vs. 16.6 months, HR 0.69, p = 0.050). No significant differences were observed in PFS2 (median 46.6 vs. 35.5 months, HR 0.84, p = 0.436) or OS (median 57.4 vs. 57.0 months, HR 1.01, p = 0.965). ORR (56.5% vs. 52.2%, p = 0.473) and DOR (median 54.6 vs. 44.9 months, HR 0.83, p = 0.502) were comparable. Subgroup analysis suggested more noticeable PFS benefit with ICI + TKI in intermediate-risk patients and those without central nervous system or bone metastases, whereas OS was similar across all subgroups. The incidence of grade ≥ 3 adverse events was comparable between groups.

In this real-world cohort, TKI-containing combinations were associated with improved initial disease control, whereas no statistically significant difference in long-term survival was observed between treatment strategies. Given the retrospective design and potential for residual confounding despite IPTW adjustment, these findings should be interpreted with caution. Treatment selection should therefore be individualized according to therapeutic priorities, such as the need for initial tumor control versus the expectation of sustained immune-mediated benefit.

While overall survival for chronic myeloid leukemia (CML) at 5 years now exceeds 90% with modern tyrosine kinase inhibitor (TKI) therapies, disparities in management and outcomes persist among underserved populations. This study describes TKI treatment patterns and outcomes in a predominantly Hispanic, underserved CML cohort treated at Los Angeles County safety-net hospitals.

We performed a retrospective chart review of 108 adult patients with CML who presented to Los Angeles County hospitals between 2015 and 2024. Data collected included demographics, comorbidities, treatment selection per line of therapy (LOT), and major molecular response (MMR; > 3-log reduction) rates.

The majority (58.3%) of patients were Hispanic, and most (59.2%) lived in zip codes with household incomes below the national average. The median age at diagnosis was 46 years old, and 82.4% of patients had comorbid conditions at diagnosis, including elevated BMI (67.5%), hypertension (28.7%), and diabetes (20.4%). By EUTOS score, 55.6% of patients were low-risk, and 11.1% were high-risk. Imatinib was the most common first-line treatment for 64.8% of patients, followed by 31.5% with dasatinib. MMR was achieved in 44.4% of patients, while 43.5% of patients discontinued first-line LOT due to medication intolerance. Overall, 56.5% of patients progressed to second LOT and 27% required third LOT.

Despite a younger median age at diagnosis, our patients had less favorable outcomes compared to previously published cohorts including lower rates of MMR with first-line therapy, higher rates of toxicity, and needing more lines of therapy overall. These findings highlight the need for further investigation into the socioeconomic, biologic, and treatment-access factors impacting outcomes in underserved patients with CML.

The decision to create an ileostomy following anterior resection is a clinical one based on the judgement of the surgical team. However, there are few data to support decision-making. This study aimed to explore variation in, and factors associated with, ileostomy creation rates following surgery for rectal cancer in England.

This exploratory, retrospective analysis used observational data from England's Hospital Episode Statistics (HES) dataset. All patients aged ≥17 years undergoing an elective anterior resection with ileostomy creation from 1 April 2016 to 31 March 2024 were included. The primary outcome of interest was ileostomy creation at the time of index surgery.

In total, 17,540 anterior resections for rectal cancer were included, and 5,954 patients (33.9%) had a diverting ileostomy. Rates of ileostomy creation declined over time, from 38.6% in 2016/17 to 29.7% in 2023/24, while the number of anterior resections remained relatively stable, other than during the COVID-19 pandemic. There was substantial variation in ileostomy creation rates across hospital trusts from 5.8% to 62.5%. Greater odds of ileostomy creation were associated with younger age, male sex, mild/moderate frailty, living in a less deprived area, Asian ethnicity, higher surgeon and trust volume and earlier time periods.

Rates of ileostomy creation are falling, but there is huge variation in creation rates across providers and patient groups. Standardised guides on when to create an ileostomy may help reduce the extent of this variation.

Treating anal high-grade squamous intraepithelial lesions (HSIL) reduces squamous cell carcinoma (SCC) rates in high-risk groups such as men having sex with men (MSM), especially those living with HIV (LWH). Follow-up data after HSIL treatment is lacking.

A retrospective analysis was conducted of consecutive male patients with biopsy-proven HSIL undergoing high resolution anoscopy (HRA)-based ablation and subsequent surveillance at a UK specialist centre until either latest HRA or cancer diagnosis. The primary objective was the proportion becoming HSIL-free after treatment. Statistical analysis was carried out using time-to-event analysis with Cox proportional hazards and endpoints of anal cancer and HSIL recurrence.

A total of 136 men, 88% MSM, 78% LWH, underwent surveillance for a median of 5.5 (interquartile range (IQR) 4.0-6.8) years after laser ablation of 188 HSILs of the perianus (26%) or anal canal (74%). After median 1 (IQR 1-2) ablations, 122/136 (90%) patients became HSIL-free (definition: ≥ one HRA with cytology, free of HSIL), median 7 (IQR 5-14) months from index treatment. Fourteen of 136 (10%) patients never became HSIL-free, of whom 5/14 (36%) developed SCC compared to 1/122 (0.8%) who were HSIL-free at least once (p < 0.01). All six patients developing SCC were MSMLWH. Never being HSIL-free was associated with larger index lesions (p < 0.001) and a CD4 nadir of <200 (p < 0.001). At study end, 98/130 without cancer had been HSIL recurrence free (75%) for median 31 (IQR 8-58) months, after total median two ablations (IQR 2-4).

HRA-based treatment of anal HSIL with ablation allows the majority to become HSIL-free. Closer surveillance is needed for those with persisting lesions.

Opioids are commonly used for postoperative analgesia, but concerns about their potential link to cancer progression and metastasis have led to interest in opioid-free regimens. Intravenous lignocaine, with its analgesic and potential anticancer properties, is emerging as an alternative. We aimed to compare the incidence of inadequate postoperative analgesia and the need for rescue medications between intravenous lignocaine and morphine following major head and neck surgeries.

This retrospective observational study included 40 adult patients who had undergone major head and neck surgeries with reconstruction, divided into two groups. Group M received morphine 0.02 mg/kg/h infusion, and Group L received lignocaine 0.5 mg/kg/h infusion for postoperative analgesia. Data on hemodynamic responses, rescue analgesic use, and ventilation duration were extracted from electronic medical records and intensive care unit nurses' charts. Inadequate analgesia was defined as a >20% increase in heart rate or mean arterial pressure (MAP) from baseline.

Group L showed a significantly lower incidence of inadequate analgesia (20%) compared to Group M (20% vs. 80%, P = 0.0002). Patients in Group L required significantly less rescue clonidine (P < 0.001) and had significantly lower total dexmedetomidine consumption and duration of infusion. Mean heart rate and MAP were significantly higher in Group M at various postoperative time points. Postoperative ventilation duration was comparable between the groups.

Intravenous lignocaine significantly reduced inadequate analgesia and need for rescue medications with optimal hemodynamics in the immediate postoperative period following major head and neck surgeries. Further large-scale, prospective, randomized controlled trials are warranted.

Breast surgeries are commonly performed under general anesthesia. The aim of the study was to compare postoperative pain following modified radical mastectomy under thoracic epidural anesthesia versus general anesthesia with the use of laryngeal mask airway.

This randomized controlled study was performed on hundred patients undergoing unilateral modified radical mastectomy. The patients were assigned into two equal groups, E and G. Group E patients received thoracic epidural anaesthesia, and group G received general anesthesia. The primary objective was to compare postoperative pain scores between the two groups. Secondary objectives included incidence of postoperative sore throat, hoarseness of voice, cough, nausea and vomiting, perioperative analgesic requirement, patient and surgeon satisfaction, duration of hospital and intensive care unit (ICU) stay, and any associated anesthesia complications.

Both groups were similar with respect to demographics. Postoperative pain score was significantly lower in Group E at all time points. The perioperative analgesic requirement was significantly higher in Group G than in Group E, and this was statistically significant with P < 0.001. Duration of hospital stay and intraoperative hemodynamics were comparable between the two groups. Patient satisfaction was significantly higher in Group G; however, surgeons were satisfied with both methods. Sore throat, cough, hoarseness of voice, nausea and vomiting, and duration of ICU stay were significantly higher in group G. Infiltration of local anesthetic in the axilla was required in 10% of the patients in the epidural group.

Although patients found general anesthesia more satisfying, thoracic epidural anesthesia provided significantly better postoperative analgesia compared with general anesthesia with laryngeal mask airway inpatients undergoing modified radical mastectomy and was associated with significantly lower ICU stay, comparable surgeon satisfaction with lower incidence of postoperative sore throat, nausea and vomiting, hoarseness of voice, and cough.