سامانه همایش های دانشگاه آزاد اسلامی واحد نجف آباد

صفحه اصلی / اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

Advances in Clinical and Hospital-Based Oncology Treatments: Precision Therapy, Immuno-Oncology, and Implementation Realities

نویسندگان :

Mahdi Karimi Boroujeni¹ Malihe Jahromi²

1- دانشگاه آزاد اسلامی واحد نجف آباد 2- دانشگاه آزاد اسلامی واحد نجف آباد

کلمات کلیدی :

oncology،immunotherapy،targeted therapy،hospital-based treatment،precision medicine،CAR-T،immune checkpoint inhibitors،multidisciplinary care

چکیده :

Introduction: The landscape of hospital oncology has evolved from a chemotherapy approach to precision therapy, immuno-oncology and cellular therapy.(1,2,3) While these advances have enhanced the outcomes of a select population, implementation is dependent on safe implementation, toxicity management and access to institutional expertise and infrastructure. The purpose of this review was to give a quick snapshot of the findings on key hospital-based cancer interventions and the operating conditions required for innovation to be translated into sustainable benefits. Methods: Key RCTs, phase II trials, comparative reviews and implementation-oriented literature were collected and reviewed for this narrative review. It emphasized checkpoint inhibition, CAR-T therapy, biomarker targeted therapy, supportive care, systemic factors, and challenges for implementing these therapies in the real world. Results: Pembrolizumab was proved to be superior to platinum-based chemotherapy in patients with PD-L1-high metastatic NSCLC and nivolumab combined with ipilimumab was shown to provide long-term survival benefits in patients with advanced melanoma.(2,3) High response and remission rates were achieved in refractory large B-cell lymphoma and relapsed/refractory B-ALL with CAR-T therapy, but involved specialized CAR-T workflow for leukapheresis, lymphodepletion, infusion and monitoring for CRS and neurotoxicity. Biomarker-driven therapy was illustrated by the use of osimertinib in the treatment of advanced EGFR-mutant NSCLC which showed progression-free survival and overall survival benefit.(4) Modality-related immune adverse events, overlapping toxicity within multi-modality regimens, variable response, the need for molecular, supportive care and multi-disciplinary infrastructure, and high costs, restricted implementation across modalities. Digital symptom monitoring and hybrid tele-oncology were found to be beneficial in conjunction with clear escalation pathways. Discussion: Candidate selection, immunologic toxicity management and organized supportive care are now a part of the treatment in hospital oncology and not an additional component of drug efficacy.(2,3) The review emphasizes the key question of whether hospitals can operationalize these advances in a standardized pathway, a multidisciplinary governance, and equal access in the future. While the impact of ICI's, CAR-T platforms and targeted agents has revolutionized hospital-based oncology,(2,3,4) they only truly shine when they are supported by robust systems that facilitate them to deliver clinical value that is safe and sustainable.