Bile duct tumor thrombus (BDTT) is a rare manifestation of hepatocellular carcinoma (HCC) that causes obstructive jaundice and is associated with a poor prognosis, although a treatment algorithm has yet to be established. We review the treatment landscape for HCC with BDTT, including surgical, transarterial, systemic, and radiotherapy options, and report, to our knowledge, the first case series of magnetic resonance-guided radiotherapy (MRgRT) for this condition. Four patients with unresectable HCC and BDTT were treated on a 0.35-T MR-linac with real-time cine-MRI gating (50 Gy in 5 fractions, n = 3; 40 Gy in 5 fractions, n = 1), with tumor response assessed by modified RECIST. All patients completed treatment without interruption. The best response was complete response in two patients and partial response in two, and obstructive jaundice resolved in both affected patients. The maximum radiation-attributed toxicity was a transient grade 3 bilirubin elevation that resolved without biliary intervention, and no treatment-related deaths occurred. Overall survival ranged from 5.5 to 29 months, with the two Child-Pugh class A patients without portal vein tumor thrombosis surviving 22 and 29 months. MRgRT for HCC with BDTT appears feasible with acceptable short-term safety and merits prospective evaluation.

Hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) is the most prevalent subtype of advanced breast cancer and is predominantly driven by estrogen receptor (ER) signaling. Endocrine therapy (ET) has become the backbone of first-line treatment; however, both intrinsic and acquired resistance limit long-term disease control. The introduction of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors has fundamentally reshaped the therapeutic landscape even in subsets of patients with aggressive or symptomatic visceral metastatic disease. Advances in molecular profiling have also enabled more precise, adaptive therapy. Circulating tumor DNA (ctDNA)-based liquid biopsy now allows real-time detection of emerging resistance mutations, particularly in ESR1. Additionally, patients with PIK3CA-mutated tumors who had progressed on or within 12 months of completing adjuvant ET and had no prior systemic therapy for metastatic disease had better treatment outcomes when treated with the PI3K inhibitor inavolisib in combination with palbociclib and fulvestrant. Together, these developments mark a shift from fixed treatment sequencing toward a more dynamic, biomarker-driven approach in first-line HR+/HER2- MBC. Integration of CDK4/6 inhibitors with next-generation endocrine agents and liquid biopsy-guided therapy offers the potential to delay resistance, improve survival outcomes, and individualize treatment.

Opioids are frequently prescribed for cancer pain management, yet accumulating evidence suggests that opioid exposure may be associated with inferior outcomes in patients also undergoing treatment with immune checkpoint inhibitors (ICIs). To synthesize mechanistic and clinical evidence linking opioids to the PD-1/PD-L1 axis, the literature was searched up to 18 January 2026, with study selection and data extraction focused on (i) cancer-cell and immune-cell effects of opioid agonism or antagonism on PD-1/PD-L1 biology, and (ii) clinical studies reporting ICI outcomes (progression-free survival, overall survival, or treatment duration) with concomitant opioid exposure. Preclinical studies support multiple, non-mutually exclusive mechanisms: opioids can induce PD-L1 in tumour cells, modulate innate-inflammatory pathways (including TLR4-linked cascades), promote dysfunctional T-cell phenotypes that reduce responsiveness to PD-1 blockade, and show context- and opioid-dependent effects. Clinical cohorts and meta-analytic datasets in non-small cell lung cancer and other tumour types report associations between opioid exposure (including higher morphine-equivalent dosing) and worse ICI outcomes. The intersection of opioid signaling with PD-1/PD-L1 biology likely operates across cancer cell-intrinsic and immune cell-intrinsic pathways, providing a mechanistic rationale for prospective evaluation of opioid-sparing strategies and/or peripheral opioid antagonism as adjuncts to checkpoint blockade.

Lung cancer carries a high psychosocial burden. Tobacco use, the stigma attached to the disease, and coping strategies are thought to interact and shape psychological outcomes, yet they have rarely been examined together. This review aimed to synthesise the evidence on the relationship between tobacco use, lung cancer stigma, and coping, and how these factors interact and influence patients' psychological outcomes.

Following the PRISMA 2020 guideline, PubMed/MEDLINE and Dialnet were searched (window 2014-April 2026) for empirical studies conducted in adults with lung cancer that addressed stigma, coping, or relevant psychological outcomes (e.g., anxiety, depression, distress, or quality of life). Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved by consensus and, where needed, by a third reviewer. Methodological quality was appraised with design-specific tools (JBI for cross-sectional and cohort studies, CASP for qualitative studies, and COSMIN-oriented criteria for the psychometric study). Given the clinical and methodological heterogeneity, a structured narrative synthesis was conducted following the SWiM guideline. The protocol was registered in the Open Science Framework.

Twenty-four studies were included. Stigma was prevalent and consistently associated with depression, anxiety, distress, and poorer quality of life, with longitudinal evidence indicating that stigma precedes and predicts distress. Internalised stigma (guilt, shame, self-blame) was the facet most strongly linked to depression and anxiety. Smoking history graded stigma intensity (current > former > never smokers) but did not determine it, since clinically significant stigma also affected never-smokers. Adaptive coping (e.g., fighting spirit, positive reappraisal) and social support were consistently associated with better psychological adjustment and quality of life, while maladaptive coping (e.g., helplessness, avoidance, anxious preoccupation) was associated with worse outcomes; cross-sectional evidence further indicated that coping modes mediated the relationship between stigma and quality of life and that social support and self-compassion attenuated the impact of stigma on distress.

Internalised stigma is a central, modifiable psychosocial stressor in lung cancer that affects smokers and never-smokers alike. Systematic screening for stigma, coping, and social support, together with non-stigmatising care, is warranted.

Melanoma remains a major global health burden, though immunotherapy and targeted therapy have markedly improved survival. Obesity has paradoxically been associated with favorable outcomes in melanoma, yet body mass index (BMI) alone fails to capture its influence on treatment response. To address this gap, we conducted a multi-site cohort study within the Canadian Melanoma Research Network, including patients with advanced melanoma treated with immunotherapy or targeted therapy. Body composition was quantified using computerized tomography (CT) imaging to assess visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle (SM) mass and intermuscular adipose tissue (IMAT), and associations with progression-free survival (PFS) and overall survival (OS) were evaluated. No overall association was seen for BMI, SAT, VAT, IMAT or SM with PFS or OS. In the targeted therapy subset, higher BMI, SAT, VAT and SM were associated with better OS (hazard ratios 0.56 to 0.65), while no effect was seen in the immunotherapy group. IMAT emerged as a novel prognostic marker, with elevated levels associated with lower OS in males and better OS in females. Our findings show that CT-based body composition is not associated with survival outcomes in patients with advanced melanoma receiving immunotherapy.

Survivors of childhood acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and non-Hodgkin lymphoma (NHL) are at risk of developing long-term adverse effects after survival. This study examined observed proportions of perceived mental distress, fatigue, and executive function (EF) impairment in adult childhood cancer survivors (CCSs) of ALL, AML, and NHL. Secondly, it examined the association between perceived EF impairment and mental distress or fatigue. Participants (n = 132; 57% female) were recruited from two major Norwegian hospitals. Self-report questionnaires included the Behavior Rating Inventory of Executive Function, Adult Version, the Hopkins Symptom Checklist-25, and the Fatigue Severity Scale. Proportions exceeding established clinical thresholds were calculated, and groups were compared using Pearson's chi-squared test and Newcombe confidence intervals. Overall, 49% and 41% of participants met the clinical thresholds for depression and anxiety; 43% for fatigue; and 28% for EF impairment. Perceived EF impairment was significantly associated with mental distress and fatigue. Mental distress, fatigue, and EF impairment are commonly reported and distressing late effects among CCSs of ALL, AML, and NHL. Follow-up care focusing on neurocognitive and psychological outcomes is important for the long-term functioning and well-being of this survivor group. Targeted neurocognitive rehabilitation may represent a key component of follow-up care.

Accurate preoperative assessment of peritoneal dissemination is essential in ovarian cancer because it influences surgical strategy and the achievement of complete gross resection. However, [¹⁸F]FDG-PET may be limited in detecting lesions with low glycolytic activity and in differentiating malignancy from inflammatory changes. This case series evaluated the clinical relevance of [¹⁸F]FAPI-74 PET/CT for preoperative assessment of peritoneal dissemination in ovarian cancer.

Four patients underwent [¹⁸F]FAPI-74 PET/CT as part of preoperative evaluation, with comparison to [¹⁸F]FDG-PET/CT when available. Imaging findings were correlated with intraoperative observations and histopathological results, including immunohistochemical assessment of fibroblast activation protein and α-smooth muscle actin.

FAPI-PET detected peritoneal dissemination not identified by FDG-PET in several cases, including occult metastasis confirmed histologically and additional lesions after neoadjuvant chemotherapy. FAPI-avid lesions showed stromal activation on immunohistochemistry, supporting the biological basis of FAPI uptake. In one case, additional FAPI uptake may have been partly influenced by inflammatory changes associated with bloody ascites.

FAPI-PET may provide complementary information by visualizing stromal components of ovarian cancer and may support preoperative mapping of peritoneal dissemination, although interpretation should consider inflammatory conditions.

Patients with cancer often experience intertwined symptom burden and functional decline that contribute to falls, unsafe transfers, uncontrolled symptoms, caregiver strain, and crisis-driven care. Physical medicine and rehabilitation (PM&R), also known as physiatry, and specialty PC both address suffering and quality of life through complementary clinical approaches; however, collaborative care with and between these two specialties is inconsistent in routine oncology practice. This paper presents a clinical implementation framework informed by targeted literature synthesis for bidirectional referral and co-management between PM&R and PC in oncology. The framework was informed by the PC referral criteria literature, cancer rehabilitation triage literature, trigger-based serious illness identification models, and implementation science. Four clinic-usable tools are proposed, including a scope and overlap map, a clinical-needs gradient, a referral trigger table linking common clinical signals to the reason for referral and expected clinical actions, and a primary-service triage workflow. This framework is intended to clarify which service is best positioned to be the primary supportive service according to the patient's current needs, when rehabilitation therapy alone may be sufficient, and when co-management should be the default. This concept-to-practice model is designed to facilitate early, needs-based referrals and coordinated supportive care in oncology settings.

Patients with BRAF^V600E-mutated metastatic lung cancer benefit from both BRAF plus MEK inhibitors and immune checkpoint inhibitor (ICI)-chemotherapy. This study evaluated the cost-effectiveness of first-line ICI-chemotherapy compared with BRAF plus MEK inhibitors in these patients. This economic analysis, with a 15-year time horizon and an annual 3% discount, was conducted from the perspective of the healthcare sectors in Taiwan and the US. Simulated patients were entered into partitioned survival models upon initiation of first-line therapies. The model inputs were derived from the FRONT-BRAF study (progression-free/overall survival, adverse events, and subsequent therapies), insurance payments or retail prices (costs of drugs, physician visits, monitoring, adverse events, and end-of-life care), and a hospital cohort (health utility). Deterministic and probabilistic analyses were performed. The incremental cost-effectiveness ratios (ICERs) of ICI-chemotherapy compared with BRAF plus MEK inhibitors (Taiwan: $73,561/QALY; US: $290,279/QALY) exceeded the willingness-to-pay (WTP) thresholds (Taiwan: $70,000/QALY; US: $150,000/QALY). The drug costs of subsequent therapies and the utility values of the progressive-disease state were the major determinants of ICERs. In Taiwan, ICI-chemotherapy had a 41.0% probability of being cost-effective at the WTP threshold. ICI-chemotherapy had a higher probability of being cost-effective than BRAF plus MEK inhibitors when the WTP exceeded $300,000/QALY in the US. Our analysis suggests that, despite the longer survival of first-line ICI-chemotherapy compared with BRAF plus MEK inhibitors, ICI-chemotherapy is not a cost-effective strategy for patients with BRAF^V600E-mutated metastatic lung cancer.

Membranous nephropathy (MN) and minimal change disease (MCD) are the most common causes of nephrotic syndrome following hematopoietic stem cell transplantation (HSCT), a complication conventionally attributed to chronic graft-versus-host disease (GVHD). Paraneoplastic MCD is well described in lymphoid malignancies but is rarely reported in myeloid neoplasms. We report two cases of biopsy-confirmed MCD presenting as the initial manifestation of acute myeloid leukemia (AML) relapse following allogeneic HSCT. Both patients were White men in their sixties with relapsed/refractory AML who developed nephrotic-range proteinuria and acute kidney injury after matched unrelated donor HSCT without histologic evidence of GVHD. Renal biopsies confirmed MCD in both cases. Corticosteroid therapy was ineffective in halting renal deterioration; renal function improved only after initiation of leukemia-directed therapy, with one patient achieving dialysis independence. These cases highlight a rare paraneoplastic presentation of AML relapse. Nephrotic syndrome due to MCD may signal post-HSCT leukemia recurrence, and evaluation for AML relapse warrants consideration in steroid-refractory cases or those without concurrent GVHD. In such cases, control of the underlying malignancy, rather than escalation of immunosuppression, may be central to renal recovery.