2 Minute Medicine ® - Surgery - Surgical Oncology

1. Overall response rate to afami-cel in both groups was 37%. 2. The majority of adverse-events were moderate in nature with no treatment-related deaths. Evidence Rating Level: 1 (Excellent) Study Rundown: Synovial sarcoma and myxoid round cell liposarcoma are rare, chemo-refractory malignancies with a poor prognosis once metastasized. Current treatment regimens are limited, and a more effective form of T-cell therapy is required. This randomized controlled trial aimed to evaluate the safety and efficacy of afamitresgene autocel (afami-cel), an autologous CD4+ and CD8+ T-cell therapy, in patients with HLA-A*02 and MAGE-A4-expressing synovial sarcoma and myxoid round cell liposarcoma...

1. The hazard ratio for recurrence or death comparing sentinel node biopsy only to completion axillary lymph node dissection was non-significant (0.89) and below the noninferiority margin. 2. The overall survival rates at 5 years were similar between both groups, 92.9% vs 92%. Evidence Rating Level : 1 (Excellent) Study Rundown : Previous studies have challenged the necessity of completion axillary lymph node dissection in breast cancer treatment in certain patients. This trial aimed to validate these findings while expanding eligibility criteria...

1. 18-month recurrence-free survival was significantly greater in the combination therapy group compared to pembrolizumab alone. 2. There were no treatment-related grade 4-5 adverse events or fatalities reported. Evidence Rating Level: 1 (Excellent) Study Rundown: Checkpoint inhibitors are now commonly used as adjuvant therapy for resected melanoma, yet recurrence remains a concern among many patients. mRNA-4157 (V940) is a novel individualized mRNA-based neoantigen therapy which may improve survival in high-risk melanoma patients, although further research is needed...

1. Children randomized to the MenA group rather than the Vi-TT group were more likely to be diagnosed with typhoid fever. 2. Overall Vi-TT vaccine efficacy was 78.3% with the highest efficacy seen for children aged 2-4 years. Evidence Rating Level: 1 (Excellent) Study Rundown: Typhoid conjugate vaccines in Africa and Asia have shown high short-term efficacy, but data on long-term protection are limited. This study presents the final analysis of a trial in Malawi, spanning over 4 years, to assess vaccine efficacy over time and by age group...

1. Invasive disease-free survival was significantly higher in patients receiving adjuvant ribociclib + NSAI when compared to patients receiving NSAI alone. 2. Distant disease-free survival and recurrence-free survival also favoured treatment with adjuvant ribociclib + NSAI, compared to NSAI alone. Evidence Rating Level: 1 (Excellent) Study Rundown: In this phase 3, randomized, international, open-label trial, 5101 patients with stage II or III HR-positive, HER2-negative breast cancer were assigned to receive either, a reduced dose ribociclib (400 mg PO OD x 21 days, followed by 7 days off x 3 years) + NSAI or to receive NSAI alone (anastrozole)...

1. There were similar rates of ipsilateral invasive recurrence among the postoperative adjuvant radiotherapy group (group 1) and non-radiotherapy group (group 2). 2. 2% of patients in the total cohort underwent mastectomy and all of them were in the non-radiotherapy group. Evidence Rating Level: 1 (Excellent) Study Rundown: Adjuvant breast radiotherapy is a common practice in early breast cancer treatment, although some suggests it may be overtreatment. This randomized controlled trial aimed to explore whether the use of preoperative MRI can identify women with localized unifocal breast cancer who can safely avoid radiotherapy...

1. In this retrospective, population-based cohort study, adherence to health surveillance guidelines among adult survivors of childhood cancer in Ontario, Canada was suboptimal.  Evidence Rating Level : 2 (Good) It is known that adherence to long-term health surveillance guidelines among adult cancer survivors is poor. In this retrospective, population-based cohort study, researchers aimed to assess the adherence to surveillance guidelines for high-yield tests among adult survivors of childhood cancer. Participants in this study included adults who were diagnosed with childhood cancer between 1986 and 2014 in Ontario, Canada...

1. In a large prospective cohort, consumption of higher quality carbohydrates was associated with a decreased risk of colorectal cancer compared to lower quality carbohydrate diets. 2. Lower carbohydrate quantity consumption was not associated with significant correlations in colorectal cancer risk or outcomes. Evidence Rating: 1 (Excellent) Colorectal cancer (CRC) confers a significant healthcare burden worldwide, and it has been well documented that individual CRC risk can be mediated through diet. In prior literature, both the quantity and quality of carbohydrate consumption has been postulated as potential mediators of CRC risk and outcomes, although this has not been well characterized...

1.  Amongst a cohort of breast cancer survivors, those that were treated with radiation had a higher risk of developing nonkeratinocyte skin cancer. Evidence Rating Level: 2 (Good)  Cancer remains the second leading cause of death in the United States (US), even though incidence rates have declined. In the US, there are over 4 million breast cancer survivors that deal with mental and physical health challenges after the end of their treatment. Of the 875 880 patients with a new diagnosis of breast cancer, 51...

1. In Ontario Canada, only 50% of home care clients received at least 1 or more palliative home care visits during their last 6 months of life. 2. The Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) served as a valuable prognostic model to provide early identification of palliative care needs.   Evidence Rating Level: 2 (Good) Palliative care is as essential service in the provision of holistic and patient-centred care for those diagnosed with life-limiting illnesses...

1. Chinese patients with advanced cancer identified themes such as being treated as normal and independent individuals, receiving and giving love, seeking inner peace, connecting with spiritual sources, finding meaning and purpose, and preparing for death as important spiritual needs. 2. Within the theme of connecting with spiritual sources, the subthemes of important needs include seeking folk beliefs and seeking inner faith. Evidence Rating Level: 3 (Fair) Patients facing serious illnesses, such as cancer, often require attention to their physical and psychosocial needs...

1. In a Korean cohort of breast cancer survivors, younger survivors had an increased risk of incident atrial fibrillation compared to older breast cancer survivors, regardless of length of follow-up. Evidence Rating Level: 2 (Good) Individuals previously treated with breast cancer may be at increased risk of developing atrial fibrillation (AF). Several mechanisms, such as the sharing of common risk factors between AF and cancer, cardiotoxicity of treatments, and health effects of cancer itself have been proposed to explain this association...

1. Among United States veterans of the Iraq and Afghanistan wars, the experience of a moderate, severe, or penetrating traumatic brain injury was associated with a greater risk of developing brain cancer.  Evidence Rating Level: 2 (Good) Primary brain cancer is uncommon, affecting 7.02 per 100,000 persons in the United States. Little is known about the risk factors for primary brain cancer. In this retrospective cohort study, researchers aimed to determine whether traumatic brain injury (TBI) is associated with the development of primary brain cancer...

1. Having a greater number of unmet social needs was associated with lower utilization of screening mammography services, as well as a later stage of breast cancer at the time of diagnosis.  Evidence Rating Level: 1 (Excellent) Social determinants of health (SDOH) are important drivers of health inequities. Unmet social needs, such as housing and food insecurity, are known to be associated with worse health outcomes. In this study, researchers aimed to determine whether unmet social needs are associated with the use of screening mammography programs and the stage of breast cancer diagnosis...

1. The clinical benefit rate was 32% in the 9 mg group and 29% in the 18 mg group. 2. Grade 3 or higher treatment-related adverse events occurred in 8% of the 9 mg group and 16% in the 18 mg group. Evidence Rating Level : 1 (Excellent) Study Rundown: Androgen receptors (AR) have been shown to act as a tumour suppressor in estrogen receptor (ER)-positive, HER2-negative breast cancer, however, their use was limited due to virilizing side effects. Recent developments in selective AR modulators (SARMs), such as enobosarm, have prompted a reevaluation of AR agonism in ER-positive breast cancer...

1. Median progression-free survival was greater in the SBRT group than in the standard-of-care group. 2. Patients with NSCLC displayed a significant survival benefit with SBRT in comparison to patients with breast cancer. Evidence Rating Level: 1 (Excellent) Study Rundown: Most patients with metastatic breast cancer develop resistance to systemic therapy. Stereotactic body radiotherapy (SBRT) is a relatively novel technique that may limit disease progression, although its evidence in non-small-cell lung cancer and metastatic breast cancer patients has been limited...

1. In patients diagnosed with stage III or IV non-small cell lung cancer (NSCLC), immune checkpoint inhibitors were associated with a greater risk of atherosclerotic cardiovascular disease. Evidence Rating Level: 2 (Good) Tumor treatment has become significantly better, specifically with the start of immune checkpoint inhibitors (ICIs). ICIs can be used to target programmed cell death 1 (PD-1), programmed cell death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). An important biomarker is coronary artery calcium (CAC) as it can show direct proof of coronary atherosclerosis which has a high association with atherosclerotic cardiovascular disease (ASCVD)...

1. Women with non-screen detected ductal carcinoma in situ had worse outcomes for the 25 years following their diagnosis. 2. When compared with surgery, mastectomies had better results at lowering the risks of invasive breast cancer. Evidence Rating Level: 2 (Good) A breast screening program developed by the National Health Service has contributed to the increased incidence of ductal carcinoma in situ. However, not all women with this type of cancer have been diagnosed through the screening program. A study examining outcomes of a population of 27543 women in England who had been diagnosed with non-screen detected ductal carcinoma in situ as their first cancer diagnosis...

1. Patients in the pembrolizumab plus chemotherapy group reported a significantly greater overall survival compared to those in the chemotherapy alone group (17.3 months vs. 16.1 months). 2. Grade 5 adverse events were comparable in both groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Pleural mesothelioma often presents at an advanced stage, and platinum–pemetrexed chemotherapy is a standard treatment. Pembrolizumab, a programmed cell death protein-1 (PD-1) inhibitor, has been used to treat non-small-cell lung cancer; however, little is known about its use in patients with mesothelioma...

1. This prospective study found that the Systematic Inflammatory Response Index (SIRI) and Systemic Immune-Inflammation Index (SII), as well as high platelet and low lymphocyte counts, were independent predictors of metastasis in patients with renal cell cancer (RCC).  Evidence Rating Level: 2 (Good) Cancer is a major contributing cause of mortality and morbidity worldwide, and survival rates vary greatly based on the type of cancer as well as the rate of spread. Renal cell cancer (RCC) in particular has varying survival rates which are drastically impacted in the case of distant metastases...