Molecular Targets and Therapies for Ampullary Cancer.

Ampullary carcinomas are rare but increasing in incidence. Ampullary cancers have molecular alterations that guide choice of therapy, particularly in nonresectable cases. These alterations can be more common by subtype (intestinal, pancreaticobiliary, or mixed), and next-generation sequencing is recommended for all patients who cannot undergo surgery. In this article, we review the approach to tissue acquisition and consideration for molecular testing. Common molecular targets of interest in ampullary cancer are also discussed in this review, including HER2/ERBB2, HER3, tumor mutational burden, microsatellite instability, KRAS, and germline BRCA and ATM mutations, along with emerging and rarer alterations.

Parent Penalty: Parental Leave Experiences of Trainees and Early-Career Faculty in Oncology Subspecialties.

PURPOSE: Prime childbearing years occur during medical training and early career, leaving physicians with tough choices between family planning and career growth. Restrictive workplace parental leave (PL) policies may negatively affect physician well-being. We evaluate existing PL and lactation policies, as well as return-to-work experiences, among oncology trainees and early-career faculty. METHODS: An anonymous 43-question cross-sectional survey was distributed via e-mail and social media channels between May and June 2021 to oncology trainees and physicians within 5 years of terminal training in the United States. The survey was administered through SurveyMonkey. Descriptive statistics were used to analyze data. Two hundred seventy-five participants were recruited via social media and outreach to program directors and coordinators in adult hematology/oncology and radiation oncology program directors. RESULTS: The average duration of PL was <6 weeks for most participants. Among those who used PL, 50% felt pressured to work while on PL, 60% felt guilty asking coworkers for help, and 79% were overwhelmed with demands of work and home, whereas only 27% had resources available at workplace to assist with transition back to work. Among those who breastfed at return to work, 31% did not have access to a lactation room, 56% did not have adequate pumping breaks, and 66% did not have pumping breaks mandated in contract. CONCLUSION: Our findings underline the immense magnitude of problems surrounding inadequate PL and support for lactating mothers among trainees and early-career physicians in oncology subspecialities. Policies and practices around PL and lactation should be restructured to meet the needs of the evolving oncology workforce.

Left Atrial Mechanics Associates With Paroxysmal Atrial Fibrillation in Light-Chain Amyloidosis Following Stem Cell Transplantation.

BACKGROUND: Atrial fibrillation (AF) during high-dose melphalan and autologous stem-cell transplantation (HDM/SCT) for light-chain (AL) amyloidosis confers significant morbidity. Traditional risk factors provide limited prediction for development of paroxysmal AF during this vulnerable period. OBJECTIVES: We sought to assess the association of clinical and echocardiographic parameters, including left atrial (LA) mechanics and development of AF in patients undergoing HDM/SCT therapy. METHODS: Baseline echocardiograms, electrocardiograms, and electronic medical records were retrospectively assessed among patients with AL amyloidosis before HDM/SCT (n = 91). LA function analysis was performed using speckle-tracking echocardiography. RESULTS: In this study, 42 patients (46%) had cardiac involvement; in the peri-transplant period, 12 (13%) developed AF (7 with cardiac involvement). No significant differences in age, sex, cardiac biomarkers, or cardiac risk factors were seen between patients with and without development of AF; one-third of patients with AF peri-transplant had previous AF. Although LA reservoir strain was reduced in patients with development of AF, time to peak strain rate indexed to R-R interval (TPSRI) (p = 0.001) was prolonged in patients with development of AF compared with sinus rhythm patients in the total cohort but also in subgroups with and without cardiac involvement. CONCLUSIONS: TPSRI, a parameter of mechanical dispersion in the early reservoir phase of LA function, is associated with development of AF among patients undergoing HDM/SCT for AL amyloidosis. These findings require validation in larger prospective cohorts.