Optimizing treatment strategies for synchronous malignancies: Integrating overlapping regimens for improved outcomes.

Abstract

e23086 Background: The management of synchronous dual malignancies is a therapeutic challenge in oncology clinics due to lack of clinical research. The diagnosis is often considered as an exclusion parameter in most of the clinical trials. Existing literature primarily focuses on the incidence and etiological factors of synchronous malignancies, with few studies addressing management strategies.The management of synchronous malignancies can be complex.The most crucial aspect is to understand the priorities of treatment in a given patient. Each cancer has a distinct treatment protocol, and sequencing the treatment can be challenging. Moreover, there are possibilities of drug interactions and augmentation of adverse drug reactions (ADRs). The absence of large scale studies, results in fewer standard treatment guidelines and poor overall survival. Methods: This retrospective study aims to evaluate the clinical outcome of patients suffering with synchronous malignancies treated with drug combinations effective in both cancers. We collected the data of patients from first January 2023 to 31 December 2024 in the Department of Medical Oncology at AIIMS Jodhpur. Results: Out of 51 patients diagnosed with dual malignancies, 12 were identified with synchronous malignancies.The patients were managed with treatment protocols which are independently useful in both cancers. The treatments were well tolerated, and notable responses were observed. The table highlights some of our cases that showed significant improvement. The drawbacks with this approach were deviation from standard treatment approach and over treatment of a particular primary. Conclusions: The paucity of literature in treating synchronous malignancies is a challenge that routinely arises in oncology clinics. In this situation, it is crucial to set a patient-tailored therapeutic approach. Where both malignancies demand an immediate intervention, selecting an overlapping treatment outside the standard recommendations can be considered to optimize patient outcomes. Case Malignancy 1 Malignancy 2 Treatment Outcome of Malignancy 1 Outcome of Malignancy 2 1 Ovarian carcinoma Breast Cancer Paclitaxel+ Carboplatin (6)then Adriamycin + cyclophosphamide (4) Radiological CR PathologicalCR 2 Bladder cancer Hodgkin Lymphoma Gemcitabine+Cisplatin(6) then immunotherapy Radiological CR Radiological CR 3 Bladder cancer Breast cancer Dose dense MVAC (6) then radical cystectomy and MRM Radiological partial response Radiological partial response 4 Breast Cancer Papillary thyroid cancer THC (6) then breast conservative surgery and thyroidectomy Pathological and radiological CR Radiological CR 5 Esophageal carcinoma Synovial carcinoma Gemcitabine+Docetaxel(4 cycles) Radiological CR Radiological CR