With the focus of journals and conferences on clinical trials and large registries, the value of unique individual cases cannot be underestimated. These individual case stories that tell compelling presentations and outcomes can be helpful.
The opportunity to oversee these submissions to the Research Topic within gastrointestinal cancers was of interest to me since it brings to focus a diverse array of case reports. Often, these are what the National Cancer Institute (NCI) calls the “exceptional responders” (1). It brings to light these patients with unique cancers and exceptional clinical outcomes. Figure 1 illustrates how each patient from diverse backgrounds and different cancers with their treatment journey typifies an individual story, and it needs to be viewed as such.
Figure 1
Illustration showing how each patient from diverse backgrounds and different cancers with their treatment journey typifies an individual story.
If we look at the spectrum of these individual reports, some are deep, brisk, durable, and sometimes curative outcomes to different kinds of novel therapies. Some are new or off-label usage of drugs for actionable markers in histologies or cancer types or settings for which they still are not approved by regulatory agencies or guidelines. Not all are about exceptional outcomes. Some of these reports highlight unexpected or not previously known side effects of drugs or point to mechanisms and/or ways to overcome and manage these issues. These can help inform the care of future patients. Not only that, from a practical standpoint, publications in peer-reviewed journals can help provide evidence supporting a strategy that biologically makes sense but needs clinical reports of similar stories. Insurance companies and guidelines committees seek more evidence before recommending or endorsing an approach for access to off-label therapies.
Advances are coming in subsets for patients with different types of cancers. We are also seeing agnostic approvals for markers like fusions that are rare events but very actionable. Real-world evidence and publications in this regard can be clinically meaningful. We have also found these helpful as initial proof-of-principle published evidence for investigator-initiated trials that can change practice.
Lastly, from an academic standpoint, these are also opportunities for students, clinical investigators, and multidisciplinary teams to have a place or home to highlight their work. I want to laud that the journal was open to case reports and hope readers, scientists, patients, caregivers, advocacy groups, and physicians who would benefit from this endeavor. Future directions are changes in clinical trial designs proposing n-of-1 trials as an opportunity to help expedite drug development (2).
Statements
Author contributions
PK: Writing – original draft, Writing – review & editing.
Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. PI/investigator discretionary funds were used to cover the cost of the illustration and publication.
Acknowledgments
Thanks to DrawImpacts for the beautiful work on the illustration accompanying this editorial.
Conflict of interest
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1
Conley BA Staudt L Takebe N Wheeler DA Wang L Cardenas MF et al . The exceptional responders initiative: feasibility of a national cancer institute pilot study. J Natl Cancer Inst (2021) 113:27–37.
2
Gouda MA Buschhorn L Schneeweiss A Wahida A Subbiah V . N-of-1 trials in cancer drug development. Cancer Discovery (2023) 13:1301–9.
Summary
Keywords
precision oncology, precision medicine, N-of-1 clinical trials, case reports, editorial, CtDNA, exceptional responders, N-of-1 analysis
Citation
Kasi PM (2023) Editorial: Case reports in gastrointestinal cancers : 2022. Front. Oncol. 13:1333174. doi: 10.3389/fonc.2023.1333174
Received
04 November 2023
Accepted
06 November 2023
Published
16 November 2023
Volume
13 - 2023
Edited and reviewed by
Yun Dai, Peking University, China
Updates
Copyright
© 2023 Kasi.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Pashtoon Murtaza Kasi, pmk4001@med.cornell.edu
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.