Prostate cancer management in Southeast Asian countries: a survey of clinical practice patterns

Background

Prostate cancer (PC) has a serious public health impact, and its incidence is rising due to the aging population. There is limited evidence and consensus to guide the management of PC in Southeast Asia (SEA). We present real-world data on clinical practice patterns in SEA for advanced PC care.

Method

A paper-based survey was used to identify clinical practice patterns and obtain consensus among the panelists. The survey included the demographics of the panelists, the use of clinical guidelines, and clinical practice patterns in the management of advanced PC in SEA.

Results

Most panelists (81%) voted prostate-specific antigen (PSA) as the most effective test for early PC diagnosis and risk stratification. Nearly 44% of panelists agreed that prostate-specific membrane antigen positron emission tomography-computed tomography imaging for PC diagnostic and staging information aids local and systemic therapy decisions. The majority of the panel preferred abiraterone acetate (67%) or docetaxel (44%) as first-line therapy for symptomatic mCRPC patients. Abiraterone acetate (50%) is preferred over docetaxel as a first-line treatment in metastatic castration-sensitive prostate cancer patients with high-volume disease. However, the panel did not support the use of abiraterone acetate in non-metastatic castration-resistant prostate cancer (nmCRPC) patients. Apalutamide (75%) is the preferred treatment option for patients with nmCRPC. The cost and availability of modern treatments and technologies are important factors influencing therapeutic decisions. All panelists supported the use of generic versions of approved therapies.

Conclusion

The survey results reflect real-world management of advanced PC in a SEA country. These findings could be used to guide local clinical practices and highlight the financial challenges of modern healthcare.

Relationship between PET/CT images and KRAS gene mutations in colorectal cancer in Vietnamese patients

OBJECTIVE

We conducted this study to determine the relationship among standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) indexes of Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography18 (FDG-PET/CT) imaging and Kirsten rat sarcoma (KRAS) gene mutations in colorectal cancer (CRC).

PATIENTS AND METHODS

This cross-sectional study was conducted in Bach Mai Hospital from 2020 to 2022. It included newly diagnosed CRC patients who underwent PET/CT examination prior to primary tumor resection. The maximum SUV (SUVmax - SUVmean), MTV, and TLG were considered. All pathologically confirmed CRC patients were accepted with further KRAS mutation status analysis.

RESULTS

We enrolled 63 newly diagnosed CRC patients who underwent PET/CT examination prior to primary tumor resection. Among them, 31 (49.2%) patients had KRAS gene mutation. Patients with KRAS mutation status showed significantly different and higher SUVmax (p-value = 0.025), SUVmax t/b (p-value = 0.013), SUVmax t-b (p-value = 0.014), MTV (p-value = 0.023), and TLG (p-value = 0.011) than patients with WT KRAS. Other characteristics, including age, gender, tumor location, SUVb, SUVmean, SUVmax of lymph nodes, and SUVmax of liver metastasis, were insignificantly different between the two groups of patients with KRAS mutation status. Receiver operating curve analysis showed that the area under the curve was 0.672 for SUVmax (p-value = 0.019), SUVt/b (p-value = 0.045), and SUVt-b (p-value = 0.020).

CONCLUSIONS

We observed a relationship, considering the quantitative parameters (SUVmax, SUVmax, SUVmax t-b, MTV, and TLG), between 18FDG-PET/CT images and the KRAS gene mutation in CRC by analyzing 63 patients prior to treatment.

Prognostic Significance of PD-L1 Expression and Standardized Uptake Values in the Primary Lesions of Stage IV Adenocarcinoma Lung Cancer

Background

This study evaluated the prognostic ability of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with stage IV adenocarcinoma lung cancer to detect protein death-ligand 1 (PD-L1) expression levels.

Methods

In total, 86 patients with stage IV adenocarcinoma lung cancer underwent ¹⁸F-FDG PET/CT imaging and PD-L1 expression evaluation before treatment from February 2019 to November 2020 at Bach Mai Hospital, Hanoi, Vietnam. The assessed patient characteristics in this study included sex, age, smoking status, epidermal growth factor receptor (EGFR) mutation, PD-L1 expression level, survival status, tumor, node, and metastasis (TNM) stage, and metastasis locations.

Results

The average age was 62.23 ± 9.51 years, and men and women represented 67.4% and 32.6% of the population, respectively. The EGFR mutation rate was 36%. PD-L1 expression was negative (detected in <1% of the tumor) in 40.7% of cases and positive in 59.3% of cases (detected in 1–49% of the tumor in 32.6%; detected in ≥50% of the tumor in 26.7%). The mean maximum standardized uptake value (SUV_max) was 11.09 ± 3.94. SUV_max was significantly higher in PD-L1–positive tumors than in PD-L1–negative tumors (12.24 ± 4.01 and 9.43 ± 3.22, respectively; p = 0.001). Receiver operating characteristic curve analysis revealed an area under the curve of SUVmax was 0.681 (95% confidence interval 0.570–0.793, p = 0.004). Compared with PD-L1–negative cases, SUV_max was significantly different in all PD-L1–positive cases (p = 0.001), weakly PD-L1–positive cases (1–49%, p = 0.005), and strongly PD-L1–positive cases (≥50%, p = 0.003). PD-L1 expression levels were significantly associated with SUV_max (p = 0.001), tumor size (p = 0.022), and EGFR mutation status (p = 0.045).

Conclusions

SUV_max in the primary lesions was able to predict PD-L1 expression and may play a role in predicting PD-L1 immunotherapy efficacy in patients with stage IV lung adenocarcinoma.

Effects of nano-copper on maize yield and inflammatory response in mice

Objective(s):

Copper (Cu) is an essential dietary supplement in animal feeds, which plays an important role in maintaining the balance of all living organisms. Copper nanoparticles (nCu) participate in catalysing activities of multiple antioxidant/defensive enzymes and exerts pro-inflammatory and pro-apoptotic effects on systemic organs and tissues. The present study explored whether nCu affects maize growth and yield and grain mineral nutrients as well as physiological functions in mice.

Materials and Methods:

Maize seeds were treated with nCu (20 mg/kg and 1000 mg/kg dry weight (DW)) and their grain productions were used for mouse feed. For testing of autoimmune response, mice were treated with nCu at concentration of 2 mg/l and 1000 mg/l and ultimately serum biochemical indicators, numbers and activation of immune cells infiltrated in mouse spleens were examined.

Results:

Treatment of maize seeds with nCu at dose of 20 mg/kg DW, but not 1000 mg/kg DW enhanced germination rate, plant growth and grain yield as well as grain mineral nutrients as compared to control group. Importantly, administration of mice with 1000 mg/l nCu resulted in their morphological change due to excessive accumulation of nCu in liver and blood, leading to inflammatory responses involved in upregulated expression of serum biochemical indicators of liver and kidney as well as increased infiltration and activation of splenic immune cells.

Conclusion:

nCu concentration at 20 mg/kg DW facilitated the morphological and functional development of maize plants, whose production was safe to feed mice.

Rotating Gamma System Irradiation: A Promising Treatment for Low-grade Brainstem Gliomas

AIM

To evaluate the role of rotating gamma system (RGS) radiosurgery for low-grade brainstem gliomas.

PATIENTS AND METHODS

Thirty-seven patients undergoing RGS radiosurgery at the Bach Mai Hospital Hanoi for low-grade brainstem glioma were included in this prospective interventional study. The median RGS dose was 12 Gy (range=8-16 Gy). Endpoints included response to RGS radiosurgery given as change in glioma size (maximum diameter), survival and adverse events. Follow-up was performed for 36 months. Three dose-groups (<13, 13-14 and >14 Gy) were compared for survival.

RESULTS

Mean glioma size decreased from 1.87 cm before RGS irradiation to 1.15 cm at 36 months. Mean survival was 39.5 months. Mean survival after <13, 13-14 and >14 Gy were 22.7, 66.7 and 49 months, respectively (p<0.05). Adverse events, mainly reduced appetite, sleep disturbances, headache and edema, were not associated with RGS dose and were easily managed.

CONCLUSION

RGS radiosurgery led to promising results with acceptable toxicity in patients with low-grade brainstem gliomas.

Radiosurgery with a Rotating Gamma System: A Very Effective Treatment for Symptomatic Cerebral Cavernomas

AIM

To evaluate the value of radiosurgery with a rotating gamma-system (RGS) for cerebral cavernomas.

PATIENTS AND METHODS

Seventy-nine patients with symptomatic cerebral cavernomas underwent RGS radiosurgery at the Bach Mai Hospital, Hanoi, Vietnam. Median dose (single fraction) was 20 Gy (range=14-26 Gy). Endpoints included effect on headache, seizures and tumor size.

RESULTS

Of 60 patients with headache, 17% had complete response, 82% partial response and 2% stable disease (best response). Of 39 patients with seizures, 31% had complete response, 64% partial response and 5% stable disease. Four patients developed recurrent seizures after 1 year. Regarding the size of cavernoma at 15 months, complete response was observed in 6%, partial response in 75%, stable disease in 15%, progression in 1% and pseudo-progression in 3% of patients. Bleeding within 2 years after RGS radiosurgery occurred in only five patients (6%). RGS dose had no significant impact on outcomes.

CONCLUSION

RGS radiosurgery provided very high rates of symptom relief in patients with cerebral cavernomas.

A Survival Score Based on Symptoms and Performance Status for Patients with High-grade Gliomas Receiving Radiochemotherapy

AIM

To create a simple survival score for patients with high-grade gliomas based on clinical symptoms and performance status.

PATIENTS AND METHODS

Thirty-six patients received neurosurgical intervention followed by radiochemotherapy for high-grade gliomas. Six pre-treatment symptoms were included in the score depending on their impairment of quality of life, scoring each between 1 and 3. For each patient, the points from the symptoms were added and another 4 points were added for Karnofsky performance status (KPS) <80%. Based on the survival rates of these scores, two groups were formed: 1-4 (group A) and 5-12 points (group B).

RESULTS

The 1-, 2- and 3-year survival rates in group A were 100%, 33% and 24% in group A and 47%, 7% and 0% in group B (p<0.001). In addition, complete tumor resection (p<0.001) and tumor grade III (p<0.001) were associated with improved survival.

CONCLUSION

A simple survival score was developed helping physicians in decision-making for patients with high-grade gliomas.

A New Predictive Tool for Optimization of the Treatment of Brain Metastases from Colorectal Cancer After Stereotactic Radiosurgery

AIM

To develop a predictive tool for survival after stereotactic radiosurgery of brain metastases from colorectal cancer.

PATIENTS AND METHODS

Out of nine factors analyzed for survival, those showing significance (p<0.05) or a trend (p≤0.06) were included. For each factor, 0 (worse survival) or 1 (better survival) point was assigned. Total scores represented the sum of the factor scores.

RESULTS

Performance status (p=0.010) and interval from diagnosis of colorectal cancer until radiosurgery (p=0.026) achieved significance, extracranial metastases showed a trend (p=0.06). These factors were included in the tool. Total scores were 0-3 points. Six-month survival rates were 17% for patients with 0, 25% for those with 1, 67% for those with 2 and 100% for those with 3 points; 12-month rates were 0%, 0%, 33% and 67%, respectively. Two groups were created: 0-1 and 2-3 points. Six- and 12-month survival rates were 20% vs. 78% and 0% vs. 44% (p=0.002), respectively.

CONCLUSION

This tool helps optimize the treatment of patients after stereotactic radiosurgery for brain metastases from colorectal cancer.

Radiosurgery with 20 Gy provides better local contol of 1-3 brain metastases from breast cancer than with lower doses

AIM

To determine the optimal dose of radiosurgery-alone for patients with 1-3 cerebral metastases from breast cancer.

PATIENTS AND METHODS

Patients receiving 20 Gy (n=20) were compared to those receiving 16-18.5 Gy (n=10) for local control, distant brain control and overall survival. Seven other variables were also evaluated.

RESULTS

Radiosurgery dose achieved significance on univariate (p=0.002; log-rank and Wilcoxon test) and multivariate analysis (p=0.004) of local control. Twelve-month local control rates were 94% after 20 Gy and 48% after 16-18.5 Gy. On univariate analysis of distant brain control, radiosurgery dose was not a significant factor, with 12-month rates of 73% and 60%, respectively. Regarding overall survival, radiosurgery dose was of borderline significance (p=0.059; Wilcoxon test). Twelve-month overall survival rates were 75% and 40%, respectively. On Cox regression analysis, radiosurgery dose exhibited a trend for improving survival (p=0.10).

CONCLUSION

Radiosurgery with 20 Gy resulted in significantly better local control and led to a trend towards improved overall survival compared to treatment with 16-18.5 Gy.