The lancet oncology
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The lancet oncology · Sep 2019
ReviewCancer control in the Pacific: big challenges facing small island states.
This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs). PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations; additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. ⋯ Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region.
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The lancet oncology · Sep 2019
ReviewCancer management in the Pacific region: a report on innovation and good practice.
Pacific island countries and territories (PICTs) face the challenge of a growing cancer burden. In response to these challenges, examples of innovative practice in cancer planning, prevention, and treatment in the region are emerging, including regionalisation and coalition building in the US-affiliated Pacific nations, a point-of-care test and treat programme for cervical cancer control in Papua New Guinea, improving the management of children with cancer in the Pacific, and surgical workforce development in the region. For each innovation, key factors leading to its success have been identified that could allow the implementation of these new developments in other PICTs or regions outside of the Pacific islands. These factors include the strengthening of partnerships within and between countries, regional collaboration within the Pacific islands (eg, the US-affiliated Pacific nations) and with other regional groupings of small island nations (eg, the Caribbean islands), a local commitment to the idea of change, and the development of PICT-specific programmes.
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Evidence to date shows that immune checkpoint inhibitors have little benefit in most patients with head and neck squamous cell carcinoma (HNSCC). Intense interest is focused on identifying and developing rational combinations of immune checkpoint inhibitors and different therapeutic interventions to enhance response rates and overcome immune checkpoint inhibitor resistance. Combining radiotherapy, a primary HNSCC treatment modality, with immunotherapy has been shown to induce potent antitumour immune responses in many cancers including HNSCC. ⋯ In this Series paper, we examine how radiotherapy can be used to its maximum therapeutic potential in the setting of immunotherapy treatment for HNSCC by focusing on published clinical and preclinical data. We rely on preclinical evidence for this disease to discuss how radiotherapy can help create and maintain an immunologically permissive environment. Our hope is that such mechanistic insights will provide a foundation for maximising the use of radioimmunotherapy in disease control, designing future trials, interpreting emerging immunotherapy data, and accelerating discovery within radioimmunotherapy interventions for HNSCC.
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The lancet oncology · Aug 2019
ReviewIntegration of radiotherapy and immunotherapy for treatment of oligometastases.
Metastasis is the leading cause of cancer-related mortality and remains one of the prevailing challenges in cancer treatment. Most patients with metastatic disease are treated with systemic agents, which prolong survival and improve symptoms but are typically not curative. ⋯ Improvements in clinical and molecular staging of metastatic disease, as well as integration of effective systemic therapies with localised interventions, might achieve better outcomes for patients with diverse metastatic states. In this Series paper, we propose a rationale for the integration of immune checkpoint inhibitors with radiotherapy to advance the potential for effective treatment along the spectrum of disease, with emphasis on how immunotherapy can potentiate radiotherapy treatment in the oligometastatic setting.
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The lancet oncology · Aug 2019
ReviewRational combinations of immunotherapy with radiotherapy in ovarian cancer.
Except for its use in palliative care, radiotherapy has been largely abandoned in the management of ovarian cancer because of the recognised efficacy and lower toxicity of systemic chemotherapy compared with radiotherapy. New data have emerged that show synergy of radiotherapy with immunotherapy to control or eradicate cancer. ⋯ This Series paper discusses the past and present use of radiotherapy for ovarian cancer, and the mechanisms by which radiotherapy can mobilise anticancer immunity. We provide emerging preclinical and clinical data for combining immunotherapy with radiotherapy for ovarian cancer treatment and offer a clinical development roadmap to guide the next generation of clinical trials for this combination strategy for this disease.