Hung Kien Do

Introduction: This single-center retrospective study aimed to assess the efficacy and safety of first-line rituximab-containing regimens in treatment-naïve patients with mantle cell lymphoma (MCL) in a resource-constrained setting. Methods: We included 73 patients diagnosed with MCL between May 2019 and June 2024 who received rituximab-based chemotherapy (RB, RBAC, RDHAP, or RCHOP) at the Vietnam National Cancer Hospital. Clinical characteristics, treatment responses, survival outcomes, and prognostic factors were analyzed. Results: The median age was 60 years, and the male-to-female ratio was 2.17. Stage IV disease was present in 47.9% of patients and stage III in 38.4%. B symptoms were observed in 27.4%, and Ki-67 >30% in 45.2% of patients. The overall response rate (ORR) was 94.5%, including a complete response rate of 64.4%. The most common grade 3/4 adverse event was neutropenia (17.8%). The 3-year progression-free survival (PFS) and overall survival (OS) rates were 72.6% and 93.2%, respectively. Mantle Cell Lymphoma International Prognostic Index (MIPI) risk classification, treatment response, and extranodal involvement were associated with PFS, whereas OS was primarily influenced by treatment response. Conclusion: Rituximab-based chemotherapy appears to provide favorable efficacy and manageable toxicity in Vietnamese patients with MCL. These findings suggest that such regimens may remain a feasible first-line option in settings with limited access to novel agents and advanced supportive care.

Background: Afatinib’s efficacy and dose-adjustment strategies have been validated in clinical trials and increasingly supported by real-world evidence. Objectives: This study aimed to provide additional real-world insights into afatinib use and to assess the impact of initial dosing and subsequent dose modifications on treatment outcomes and tolerability in patients with advanced epidermal-growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). Design: We conducted a multicenter retrospective analysis of patients with advanced EGFR-mutated NSCLC who received first-line afatinib between April 2018 and June 2022. Methods: Patients were categorized into four subgroups based on their starting and optimal afatinib doses. The primary endpoints were to analyze the association between afatinib dosing and time-to-treatment failure (TTF), overall survival (OS), and toxicity. Results: A total of 343 patients were included. The most common starting afatinib dose was 30 mg (58.6%), followed by 40 mg (39.9%). The optimal dose maintained during treatment was 30 mg in 62.1% of patients, 40 mg in 33.2%, and 20 mg in 4.7%. Dose reductions due to toxicity occurred in 23.6% of cases. Regarding four subgroups: 53.1% of patients started and remained on <40 mg, 25.4% started and maintained 40 mg, 14.6% started at 40 mg but de-escalated to <40 mg, and 7.0% started <40 mg and escalated to 40 mg. After a median follow-up of 36.8 months, the median OS for all patients was 31.3 months (95% confidence interval: 29.3–33.1). Multivariate Cox regression analysis identified smoking status, Eastern Cooperative Oncology Group performance status, and EGFR mutation subtype as independent prognostic factors for OS. Notably, patients who initiated treatment at 40 mg but de-escalated to <40 mg had the longest median TTF and OS. In terms of safety, the highest incidence of adverse events was observed in this group, followed by those who started and remained at <40 mg. Conclusion: In this real-world cohort, flexible afatinib dosing—either by initiating at 40 mg followed by dose reduction or starting at <40 mg with later escalation—was associated with favorable survival outcomes and manageable tolerability. These findings support the use of individualized afatinib dosing strategies to optimize both efficacy and safety in patients with EGFR-mutant NSCLC.

Background: Non‐small cell lung cancer (NSCLC) represents the majority of lung cancer cases, with epidermal growth factor receptor (EGFR) mutations playing a crucial role in disease prognosis and treatment. Around half of Asian patients with NSCLC, particularly non‐smoking women, have EGFR mutations. These patients with NSCLC typically exhibit a single EGFR mutation in exon 18, 19, 20, or 21. It is extremely rare for patients with bilateral primary NSCLC to harbor two different EGFR mutations.Case: We report a case of 70‐year‐old non‐smoking Vietnamese female patient diagnosed with synchronous bilateral primary NSCLC, each harboring different EGFR mutations—G719C in exon 18 in the right lung and an exon 19 deletion in the left lung. The patient underwent surgical resection of the left lung lesion, followed by targeted therapy with afatinib for the right lung lesion, which resulted in tumor reduction and disease stability for 1 year before disease progression.Conclusion: Our study underscores the complexity of diagnosing and managing synchronous bilateral NSCLC with distinct genetic profiles. This report also highlights the importance of comprehensive molecular profiling to select an optimal treatment strategy to improve patient outcomes.

Introduction: This study aimed to evaluate the therapeutic effect of osimertinib and further to compare the results of osimertinib plus brain radiation vs. osimertinib monotherapy in advanced EGFR-mutant non-small cell lung cancer (NSCLC) patients with brain metastases (BMs). Methods: A retrospective study was conducted involving 62 advanced EGFR-mutant NSCLC patients with BMs who were treated with first-line osimertinib at the Vietnam National Cancer Hospital between April 2019 and December 2023. Patients were categorised in two treatment groups: (1) osimertinib alone (33 patients) and (2) osimertinib combined with locoregional therapy, including stereotactic radiosurgery or whole-brain radiotherapy (29 patients). Endpoints included objective response rate (ORR), central nervous system response rate (CNS-ORR), progression-free survival (PFS), overall survival (OS). Results: The systemic ORR was 91.9% and the disease-control rate (DCR) was 96.8%. The CNS-ORR was 91.9% and the CNS-DCR was 100%. The median PFS and median OS achieved were 24.5 and 35.2 months, respectively. There was no significant difference in outcomes between patients in either treatment group with respect to CNS-ORR ( P = 1.0), mean best percentage change from baseline in CNS target lesion size ( P = .376), median PFS ( P = .656), intracranial progression-free survival (iPFS) ( P = .706), or OS ( P = .734). The occurrence of any-grade adverse events (AEs) did not differ significantly between the two treatment groups ( P = .762). However, in the osimertinib plus brain radiation cohort, 3/29 (10.3%) patients experienced radiotherapy-related AEs (2 cases of brain necrosis, 1 case of leukoencephalopathy), which consisted of one case of grade 3 brain radiation necrosis. Conclusion: Osimertinib shows favorable real-world outcomes in improving PFS, OS, and CNS-ORR in advanced EGFR-mutant NSCLC Vietnamese patients with BMs, with no clear additional benefit from combining with brain radiotherapy.

Background: Our aim was to demonstrate the efficacy and safety of pembrolizumab monotherapy as second-line treatment in Vietnamese nonsmall cell lung cancer (NSCLC) patients. Methods: We performed a single-center retrospective study of patients with advanced NSCLC who received pembrolizumab as second-line therapy at the Vietnam National Cancer Hospital between January 2017 and October 2023. The primary endpoints were overall survival (OS) and tumor response. Results: A total of 52 patients were included. Adenocarcinoma was observed in 43 of 52 cases (82.7%), and 40.4% of patients had PD-L1 expression in at least 50% of tumor cells. Median body weight was 57 kg (range, 45-80), and 73.1% of patients received pembrolizumab at a dose of 100 mg/3 weeks, with a median dose of 1.9 mg/kg/3-weeks (range, 1.3-4.3). The overall response rate and disease control rate were 26.9% and 51.9%, respectively. Median PFS was 6.5 months (95% CI, 3.3-9.7), and 1-year and 2-year PFS rates were 28.5% and 15.9%, respectively. Median OS was 12.0 months (95% CI, 9.8-14.2); 1-year, 2-year, and 3-year OS rates were 53.1%, 22.3%, and 8.5%, respectively. ECOG status and number of organs metastases were significantly associated with PFS and OS in the multivariate analysis. No adverse events of grades 3 to 4 were reported during the treatment. Conclusions: Second-line pembrolizumab has a good disease control rate and prolonged survival and is a viable option for the treatment of Vietnamese NSCLC patients. Further clinical studies are necessary to determine the effectiveness of administering a low dose of pembrolizumab in this setting, particularly in Asian population.

Background: Afatinib is indicated for patients with advanced-stage non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, including uncommon mutations. However, the differences in survival benefits between patients with different types of EGFR mutations remain unclear. Objectives: This study aimed to compare the effectiveness of afatinib treatment in patients harboring the EGFR-G719X mutation with that in patients carrying other uncommon EGFR mutations. Design: This was a retrospective study. Methods: Ninety-two patients with locally advanced and metastatic NSCLC, of whom 49 patients with EGFR-G719X mutations that were both single and compound, and 43 patients harbored other uncommon EGFR mutations, who were treated with afatinib as first-line treatment. The patients were followed up and evaluated every 3 months or when there were symptoms of progressive disease. The endpoints were the objective response rate (ORR), time-to-treatment failure (TTF), and overall survival (OS). Results: The average ages of patients with the EGFR-G719X and uncommon EGFR mutations were 62.7 years and 63.1 years, respectively. There were no significant differences in sex or smoking history between the two groups. In total, 28.6% of patients with the G719X mutation and 23.3% of patients with other mutations had brain metastases. The ORR of patients with the G719X mutation was 79.6%, which was 10% higher than that of patients with other EGFR mutations. Patients harboring the EGFR-G719X mutation had median TTF and median OS periods of 19.3 months and 31.4 months, respectively, which were significantly higher than those of patients carrying other mutations at 11.2 months. Subgroup analysis showed that TTF and OS benefits were observed in female patients, patients without brain metastasis, and patients with good performance status who harbored the G719X mutation. Conclusion: Patients with the EGFR-G719X mutation achieve significantly better TTF and OS benefits than those with other uncommon EGFR mutations.

Background: The standard treatment for localized osteosarcoma is neoadjuvant chemotherapy before surgery, followed by adjuvant chemotherapy. Our aim was to report the rate of histopathological response to neoadjuvant chemotherapy for the treatment of extremity osteosarcoma in Vietnam. Methods: We performed a retrospective study of stage II conventional osteosarcoma patients under 40 years-old who received MAP regimen as neoadjuvant chemotherapy at the Vietnam National Cancer Hospital between June 2019 and June 2022. Histopathological response was evaluated using the Huvos grading system, in which a good histopathological response was defined as a necrotic rate of 90% or more. Results: Thirty-five eligible patients were included in the study. Male patients accounted for 65.7%, with a median age of 16 years (range, 8-38 years). Of the 35 cases, 31 were reported as stage IIB (88.6%). The femur and tibia were the most common sites in our study, accounting for 51.4% and 34.3%, respectively. The most common pathologic subtype was osteoblastic osteosarcoma (68.6%), followed by chondroblastic subtype (20%). After two cycles of MAP-regimen neoadjuvant chemotherapy, 28 of 35 patients (80%) underwent limb-sparing surgery. A good histopathological response was observed in 18 of 35 patients (51.4%). There were significant correlations between the duration of symptoms ( P = 0.016), LDH ( P = 0.001) serum levels at initial presentation, and ALP ( P = 0.043) serum levels at initial presentation with histopathological response. Conclusion: This retrospective study suggests a possible association between symptom duration, pre-treatment LDH levels, and pre-treatment ALP levels with histopathological response rates. Additional clinical investigations with long-term follow-up are needed to investigate survival outcomes in the Asian population.

Mục tiêu: Mô tả một số đặc điểm lâm sàng, cận lâm sàng ung thư phổi không tế bào nhỏ di căn não có đột biến EGFR bằng thuốc ức chế tyrosin kinase thế hệ 1 và 2. Đánh giá kết quả điều trị của nhóm bệnh nhân nghiên cứu. Đối tượng và phương pháp nghiên cứu: nghiên cứu mô tả hồi cứu trên 89 bệnh nhân ung thư phổi không tế bào nhỏ di căn não có đột biến EGFR điều trị bước 1 bằng TKIs thế hệ 1 và 2 tại bệnh viện K từ tháng 04/2019 đến 04/2023. Kết quả: Trong nghiên cứu số bệnh nhân được điều trị bước 1 với Erlotinib, Gefitinib và Afatinib lần lượt là 33, 34, 22. Độ tuổi trung bình tham gia nghiên cứu là 59,6 ± 9,50 tuổi, trong đó nam chiếm chiếm 48,3%, nữ chiếm 51,7%. Các bệnh nhân đều có đột biến gen loại thường gặp trong đó, 60,7% bệnh nhân có đột biến Del19 và 39,3% có đột biến L858R. 53,9% bệnh nhân trong nghiên cứu được điều trị kết hợp với xạ phẫu khối u não, 20,2% được điều trị với tia xạ toàn não. Tỷ lệ kiểm soát bệnh là 94,4%, trung vị thời gian sống thêm bệnh không tiến triển mPFS là 12,6 tháng; thời gian sống thêm bệnh không tiến triển tại thời điểm 12 tháng là 54,7%. Tỷ lệ đáp ứng nội sọ là 96,6%, trung vị mPFS tại não là 14,7 tháng. Tác dụng phụ hay gặp trên lâm sàng và cận lâm sàng là nổi ban gặp ở 49,4%, tiêu chảy 22,5%, viêm kẽ móng 19,1%, tăng men gan gặp ở 37,1%, giảm hemoglobin gặp ở 30,3% số bệnh nhân điều trị, chủ yếu là độ 1,2. Kết luận: điều trị TKIs bước 1 trên nhóm đối tượng UTPKTBN di căn não có đột biến EGFR đạt tỷ lệ đáp ứng cao, cải thiện PFS, các độc tính ở mức độ nhẹ nhàng có thể dung nạp được.

Objectives: To characterize the clinical features, treatment, and outcome of children diagnosed with retinoblastoma (RB) at Vietnam National Cancer Hospital.Methods: The study enrolled all RB patients newly diagnosed at Vietnam National Cancer Hospital from January 2018 to December 2022. The primary endpoint was overall survival (OS) and the eye salvage rate.Results: In total, 139 patients were enrolled, 51.8% patients were male. Median age was 18.9 months. Most patients presented with leukocoria (63.3%), followed by strabismus (14.4%), and 43.9% had bilateral disease. Of 200 eyes, 129 (64.5%) were classified as group E. Extraocular extension was noted in 10 of 139 patients (7.2%). About one‐third of the patients lived more than 300 kilometers (km) away from these hospitals, and 17.3% of the patients belonged to minority groups, both of which were dominated by group E and extraocular or high‐risk eyes at the time of consultation. Primary enucleation was done for 57 eyes (28.5%), and 51 of 61 patients (83.6%) received eye salvage therapy in bilateral RB group. At study closure, 127 children were alive at the last follow‐up, 12 cases were confirmed dead. The 5‐year OS and progression‐free survival (PFS) rates were 90.3% and 85.9%, respectively. In particular, ethnic minority, distance to hospital more than 150 km, and extraocular disease were significantly associated with higher mortality among children with RB treated in Vietnam National Cancer Hospital.Conclusions: There is a need to support for screening RB with early symptoms in grassroots medical facilities and raise awareness among patients' families through health education programs. Besides, caring and supporting treatment for patients from the ethnic minority and who live far from hospitals are also extremely necessary.

T263P mutation is one of the rare EGFR mutations located on chromosome 7p11.2, which is a change in amino acid residue at position 263 of the epidermal growth factor receptor protein, where L‐threonine has been replaced by L‐proline. This missense mutation in the extracellular EGFR domain is not well‐known in lung cancer. In this study, we first report a patient with advanced lung adenocarcinoma harbouring only a rare T263P EGFR mutation who benefited from first‐line afatinib therapy in Vietnam. The patient achieved a partial response with a time‐to‐treatment failure of 5 months. The patient subsequently received several chemotherapy regimens as the disease progressed, with overall survival of 17 months. Non‐small cell lung cancer with a rare T263P EGFR mutation responds to afatinib but has a poor prognosis. Further studies are needed to determine the efficacy of targeted therapies in this specific population.