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  • Artificial intelligence (AI) has the potential to dramatically change several aspects of oncology including diagnosis, early detection and treatment-related decision making. However, many of the underlying algorithms have been or are being trained on datasets that do not necessarily reflect the diversity of the target population. For this, and other reasons, many AI tools might not be suitable for application in less economically developed countries and/or in patients of certain ethnicities. In this Perspective, the authors discuss possible sources of inequity in AI development, and how to ensure the development and implementation of equitable AI tools for use in patients with cancer.

    • Vidya Sankar Viswanathan
    • Vani Parmar
    • Anant Madabhushi
  • Increasing evidence indicates that intratumoural bacteria can have crucial roles in both the pathogenesis and treatment of cancer. In this Review, the authors discuss the characteristics of intratumoural bacteria and the emerging understanding of their tumour-promoting and antitumour activities. They also describe a range of innovative strategies that are being used to engineer bacteria for use in the treatment of cancer and summarize clinical trials of various bacteria-mediated cancer immunotherapies.

    • Seong-Young Kwon
    • Hien Thi-Thu Ngo
    • Jung-Joon Min
    Review Article
  • Following the introduction of blinatumomab in 2014, the past 4 years have seen the approval of a further ten bispecific antibodies, reflecting substantial research effort and clinical interest in these agents. In this Review, the authors describe the developments leading to the approval of these novel agents and highlight important future research directions, including clinical optimization as well as innovative antibody engineering approaches.

    • Maria-Elisabeth Goebeler
    • Gernot Stuhler
    • Ralf Bargou
    Review Article
  • De-escalation of treatment for HER2+ breast cancer is a priority, given the increase in cure rates owing in part to improved HER2-targeted therapies. In this regard, the neoadjuvant approach provides the ideal platform to test less-intensive treatment regimens. Here we highlight a study that demonstrated the role of the metabolic response after dual HER2 blockade as a method of selecting patients who are most likely to benefit from chemotherapy-free neoadjuvant therapy.

    • Maria Vittoria Dieci
    • Valentina Guarneri
    News & Views
  • The majority of patients with cancers of unknown primary have unfavourable outcomes when they receive empirical chemotherapy. The shift towards using precision medicine-based treatment strategies involves two options: tissue-agnostic or site-specific approaches. Here, we reflect on how cytology-based deep learning tools can be leveraged in these approaches.

    • Elie Rassy
    • Nicholas Pavlidis
    News & Views
  • Chimeric antigen receptor (CAR) T cell therapy has revolutionized the treatment of various haematological malignancies but is associated with characteristic toxicities as well as less well-defined adverse effects, many of which can be severe and potentially fatal. The increasing clinical experience with CAR T cell products has resulted in better recognition and management of these toxicities using a range of pharmacotherapies, although this is an area of continued evolution and refinement. In this Review, Brudno and Kochenderfer discuss the current understanding and clinical management of CAR T cell-associated toxicities.

    • Jennifer N. Brudno
    • James N. Kochenderfer
    Review Article
  • Lessons from the prevention of cervical cancer, the first cancer type deemed amenable to elimination, can provide information on strategies to manage other cancers. Infection with human papillomavirus (HPV) causes virtually all cervical cancers and an important proportion of other cancer types. The authors of this Review discuss the epidemiology of HPV-associated cancers and the potential for their elimination, focusing on the cofactors that could have the greatest effect on prevention efforts and health equity.

    • Talía Malagón
    • Eduardo L. Franco
    • Salvatore Vaccarella
    Review Article
  • Following their successful implementation in the COVID-19 pandemic, the technology behind mRNA vaccines is now being applied to cancer. In this Review, the authors described the several decades of development of mRNA vaccines for patients with cancer, including initial developments in this area involving cell-based vaccines as well as more recent developments with nanoparticle-encapsulated vaccines, which are beginning to show promising clinical activity.

    • Elias J. Sayour
    • David Boczkowski
    • Smita K. Nair
    Review Article
  • The question of whether chimeric antigen receptor (CAR) T cell therapies should be used in earlier lines (after 1–2 prior lines of therapy) in patients with relapsed and/or refractory multiple myeloma remains unanswered. Herein, I argue that the use of surrogate end points that lack a robust correlation with overall survival, as well as suboptimal control arms and use of post-progression therapies, limit the ability to make definitive conclusions on the basis of the available data.

    • Vinay Prasad
  • Expansion of the utilizable spectrum of light from the visible region to the near-infrared (NIR) window has greatly facilitated the clinical application of optical technologies for cancer imaging and phototherapy. However, use of light in the first NIR region (NIR-I) has important limitations, some of which might be overcome with emerging technologies utilizing NIR-II light. In this Review, the authors describe the current clinical experience with NIR-II-based cancer imaging and phototherapy, and discuss emerging NIR-II-based approaches that might further enhance patient outcomes. They also highlight challenges that will need to be addressed to translate NIR-II-based modalities from bench to bedside.

    • Zeyu Zhang
    • Yang Du
    • Jie Tian
    Review Article
  • The FDA has approved nanoliposomal irinotecan, 5-fluorouracil, leucovorin and oxaliplatin (NALIRIFOX) for patients with metastatic pancreatic adenocarcinoma on the basis of results from the NAPOLI 3 trial, in which this four-drug regimen improved overall survival relative to a doublet regimen. Here we discuss how, in the context of prior results from the PRODIGE 4 trial testing 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (modified FOLFIRINOX), NALIRIFOX does not seem to raise the bar, but rather exposes patients and health-care systems to financial toxicities.

    • Christopher Nevala-Plagemann
    • Ignacio Garrido-Laguna
    News & Views
  • Certain subsets of patients with multiple myeloma or its precursor conditions are overtreated with current approaches to therapy. Herein, we highlight several key areas where we believe de-escalation of treatment is needed. Dedicated trials to assess these de-escalation approaches and urgent changes to current clinical practices are needed.

    • Ghulam Rehman Mohyuddin
    • Aaron M. Goodman
  • By combining multiple MRI sequences, each providing different but complementary information about the tumour microenvironment (TME), multiparametric MRI (mpMRI) enables non-invasive assessment of the heterogeneous features of the TME components. The authors of this Review describe the role of mpMRI in the non-invasive characterization of the TME, presenting examples of its utility in cancer detection, staging and assessment of response to therapy, and considering future applications for personalized integrated diagnostics.

    • Emily Hoffmann
    • Max Masthoff
    • Moritz Wildgruber
    Review Article