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Anthracycline is a commonly prescribed antineoplastic agent. As a consequence of the growing number of cancer survivors, the incidence of anthracycline-induced cardiotoxicity is increasing. However, the optimal primary preventive strategy is lacking. Therefore, we conducted a meta-analysis of all randomized controlled trials to evaluate the efficacy of carvedilol for the primary prevention of anthracycline-induced cardiotoxicity. A comprehensive search of electronic databases was conducted. The primary and secondary outcomes were the occurrence of low left ventricular ejection fraction, and the absolute change in left ventricular ejection fraction (LVEF), respectively. We calculated the odds ratios for the primary outcome and the weighted mean differences for the secondary outcomes using a random-effects model. We included 8 randomized controlled trials (633 total patients). Our results showed significantly reduced rates of low LVEF favoring the carvedilol group (3.2% vs 5.8%; odds ratios: 0.42; 95% confidence interval: 0.18 to 0.99; p = 0.05). Furthermore, there were significantly smaller reductions in LVEF in carvedilol-treated patients than in placebo-treated patients (mean differences: 2.41%; 95% confidence interval: 0.01 to 4.81; p = 0.05). In conclusion, prophylactic administration of carvedilol in anthracycline-treated cancer patients may reduce the early onset of left ventricular dysfunction compared with placebo.

Introduction Immune checkpoint inhibitors (ICIs) are often the initial treatment choice for melanoma, the third most common cancer in the adolescent and young adult (AYA) male population. Although ICIs have improved survival rates, their effects on male fertility and the adequacy of related counseling remain unclear. This study aimed to both characterize the current state of fertility discussions in male AYA patients with melanoma receiving first‐line ICIs and to explore their experiences and concerns regarding reproductive health. Methods We conducted a mixed‐methods study of 38 male patients aged 18–39 with metastatic or locally advanced melanoma treated with first‐line PD‐1/PD‐L1/CTLA‐4 therapies at a single academic center between 2013 and 2024. Quantitative medical record review assessed fertility counseling and preservation actions. Semi‐structured interviews were conducted with ten living patients from this cohort to explore knowledge, concerns, and experiences surrounding fertility and reproductive health. Thematic analysis identified key patient perspectives. Results Among 38 patients (median age 32), 71% had stage IV disease and received combination immunotherapy. 74% of patients experienced at least one immune‐related adverse event (irAE). Fertility counseling was documented for 27 patients, with eight referred for fertility preservation. Of the ten interviewees, nine recalled discussing fertility, while only three pursued preservation. Qualitative themes included challenges accepting uncertainty about family planning, pressure to accelerate planning, feelings of forced maturity, difficulty processing complex information, and concerns about the reliability of information from family, providers, and social media. Conclusion Although most young males with advanced melanoma treated with first‐line ICIs had documented fertility discussions, few elected fertility preservation. Patient experiences highlight the need for collaboration among oncologists, fertility specialists, and supportive professionals to develop tailored counseling and educational materials for male AYA patients with advanced melanoma.

To the Editor, Melanoma is an aggressive malignancy that most commonly arises from the skin with an increasing annual incidence.1 Most of these cases are considered resectable, meaning they are treated with surgery with a curative intent.1 Compared to a decade ago, significant advances in drug therapies for patients with unresectable and metastatic melanoma are associated with significant improvements in survival.1 Most of these survival improvements and advancements stem from the use of various immunotherapy drugs, better known as immune checkpoint inhibitors (ICIs).1 While surgical resection is curative in many situations, higher-risk tumors carry a significant risk of recurrence.1 In order to extend the benefit of surgical resection, earlier attempts to use adjuvant therapies employed various drugs, such as interferons, but with limited oncologic benefit and significant toxicity.2 Since then, the advent of PD-1-based therapy has played an important role in establishing the role of ICIs in this setting.2–4 The principle benefit of adjuvant PD-1 therapies is improvement in recurrence-free survival and distant metastasis-free survival, despite no demonstrable benefit in overall survival.3,4 Routine use of these drugs in the adjuvant setting requires challenging discussions with our patients, especially when considering the significant risk of toxicity, some of which are lifelong, as well as their high costs and commitment. OpACIN and OpACIN-neo were two early-phase clinical trials assessing the benefit of neoadjuvant ipilimumab and nivolumab at various doses for patients with macroscopic stage III melanoma.6 These trials have shown a clinically relevant recurrence-free survival and overall survival benefit for patients with a pathological response to neoadjuvant combination ICI when compared to adjuvant therapy alone.6 Similarly, the PRADO trial showed that patients with macroscopic stage III melanoma who achieve a major pathological response (viable tumor <10 %) after undergoing neoadjuvant ipilimumab and nivolumab can potentially safely forgo additional surgical resection or adjuvant systemic therapies with a 24-month relapse-free survival rate of 93 %7; patients that did not achieve a major pathological response might still benefit from completion lymphadenectomy and adjuvant PD-1 antibody treatments.7 The PRADO and other neoadjuvant trials also pose a certain clinical complexity, as they require technical surgical techniques, for example, the need to mark certain lymph nodes with a clip for longitudinal follow-up after initiation of neoadjuvant ICI therapies, requiring earlier involvement of the surgical team, sophisticated surgical techniques and also rigorous follow-up of these patients while on treatment. [...]while the incidence of cutaneous melanoma increases, melanoma-specific survival has also improved substantially.

Key Clinical Message A 75‐year‐old man with a left adrenal mass found on CT scan showed Hodgkin disease on biopsy. Bone marrow biopsy was normal. This is the fourth case in the literature of primary adrenal Hodgkin lymphoma. Multiple chemotherapy lines were given, and the patient years later are alive and in progression of disease. A 75‐year‐old man with a left adrenal mass found on CT scan showed Hodgkin disease on biopsy. Bone marrow biopsy was normal. This is the fourth case in the literature of primary adrenal Hodgkin lymphoma. Multiple chemotherapy lines were given, and the patient years later are alive and in progression of disease.

A 77-year-old African American female was referred to oncology for evaluation of an adrenal fossa mass detected on computed tomography scan of the abdomen and pelvis (CT-scan A/P) that was ordered as a work-up for painless hematuria. Further evaluation by positron emission tomography (PET) scan showed hypermetabolic masses in the left suprarenal and right iliac region. The biopsy of the right iliac mass was consistent with IgG4-related disease (IgG4RD). It was supported by an elevated serum IgG4 level. She was treated with prednisone with a good response.

Key Clinical Message This clinical image teaches readers that a rare finding such as intramedullary spinal metastasis could exist even in the rarest tumors. It adds to the literature how it was managed. It also might reflect the improvement of our cancer treatment allowing us to follow patients longer to find those rare findings in rare tumors. This clinical image teaches readers that a rare finding such as intramedullary spinal metastasis could exist even in the rarest tumors. It adds to the literature how it was managed. It also might reflect the improvement of our cancer treatment allowing us to follow patients longer to find those rare findings in rare tumors.

Background: In the USA cancer is the second leading cause of mortality, as such, primary prevention of cancer is a major public health concern. Vitamin D supplementation has been studied as a primary prevention method for multiple diseases including cardiovascular disease, osteoporosis, diabetes mellitus and cancer. The role of Vitamin D as primary prevention of cancer is still controversial. With fast emergence of large randomized controlled trials (RCTs) in that regards, we aimed to evaluate the efficacy of Vitamin D supplementation as primary prophylaxis for cancer. Methods: A comprehensive electronic database search was conducted for all RCTs where comparison of Vitamin D supplementation versus placebo for the prevention of any type of disease with at least 3 years of Vitamin D supplementation was used and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality and cancer incidence. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up. Results: We included 10 RCTs with 79,055 total patients, mean age of 68.07 years, a female percentage of 78.02% and a minimum follow-up of 4 years and more. Vitamin D was associated with significant reduction of cancer-related mortality compared with placebo (RR 0.87; 95% CI: 0.79-0.96; P = 0.05: I 2 = 0%). Compared with placebo, Vitamin D was not associated with significant reduction of cancer incidence (RR: 0.96; 95% CI: 0.86-1.07; P = 0.46; I 2 = 31%). Conclusion: With inclusion of studies, which did not primarily examine vitamin D for the purpose of preventing cancer or reducing cancer mortality our meta-analysis highlights that the use of vitamin D supplementation for primary prevention of cancer is encouraged as it does possibly decrease cancer-related mortality once cancer is diagnosed; however, it has no role or effect on cancer incidence.

This is the case of a 56-year-old white woman with a medical history significant for chronic obstructive pulmonary disease, migraine, hypertension, tobacco abuse and hypercholesterolaemia. Her surgical history is significant for total hysterectomy and bilateral salpingo-oophorectomy for diffuse endometriosis. The patient presented with a vaginal lesion. The biopsy was positive for primary vaginal small cell carcinoma and human papilloma virus (HPV). Initial staging positron emission tomography (PET) scan confirmed stage 1 disease. The patient was started on chemotherapy with cisplatin and etoposide for four cycles, followed by concurrent chemotherapy with cisplatin/taxol and radiation therapy.

2019 has been a landmark year in the world of electronic nicotine delivery systems (ENDS), specifically e-cigarette and vaping. Numerous state health departments across the United States have voiced their concerns in the growing number of lung injury cases from e-cigarettes and vaping. Over the past few decades, many agencies have brought into light the harmful effects of smoking cigarettes, and despite popular belief, a growing movement has started to recognize the harmful effects of ENDS. The Centers for Disease Control and Prevention have released recommendations and provided health practitioners a methodology to identify and diagnose e-cigarette, or vaping, product use-associated lung injury (EVALI). EVALI is a diagnosis of exclusion and comprises a variety of respiratory illnesses, with intubation rates nearing 32%. The most critical risk factor remains product use in the preceding 90 days, although a timeline on the development of symptoms or notable structural changes remains unknown. We present a case of acute lung injury in a traditional cigarette smoker that evolved within hours of switching to e-cigarettes.

Classic or large duct primary sclerosing cholangitis (PSC) is part of the PSC spectrum. It is diagnosed on clinical and biochemical findings of cholestasis supported by biliary tree changes on cholangiography, forgoing the need for an invasive liver biopsy. The spectrum contains various PSC variants with distinct clinical courses and outcomes. We present a case of small duct PSC, a rare variant that manifested insidiously with clinical and objective cholestasis but appeared negative on diagnostic cholangiography. Eventually, a liver biopsy was obtained that revealed chronic bilious disease of the small and microscopic ducts with simultaneous changes consistent with liver cirrhosis. Despite presenting like its classical counterpart, small duct PSC can remain undetectable on cholangiography due to the diminutive size of the bile ducts requiring histological confirmation. In contrast to classic PSC, small duct PSC portends a much better prognosis. However, it eventually progresses to the classic form or end-stage liver disease, requiring patients to receive timely surveillance and transplantation referrals. Due to the limited understanding of this disease process, patients with similar presentations often pose a diagnostic dilemma due to the clinical and cholangiographic mismatch. This case aims to reaffirm that a negative cholangiography does not rule out the PSC spectrum and that small duct disease is a rare but growing entity. The paucity in cases emphasizes the importance of isolated reports in guiding workup and management, especially since surveillance schedules and transplantation guidelines have not been formally established.