Background/Aims: Biliary tract cancer (BTC) is a rare malignancy with poor prognosis. We investigated genomic determinants of clinical benefit from gemcitabine, cisplatin, and nab-paclitaxel (GAP) versus gemcitabine and cisplatin (GC) in advanced BTC. Methods: Clinical and genomic data using TruSight Oncology 500 were analyzed from patients treated with GAP (N=198) or GC (N=89) as first-line therapy. Results: With a median follow-up of 33.0 months, GAP modestly improved progression-free survival (PFS) (hazard ratio [HR] 0.764; 95% confidence interval [CI] 0.591–0.989) without significant overall survival (OS) difference compared to GC. Genomic profiling revealed frequent alterations in TP53 (35.2%), KRAS (16.4%), SMAD4 (10.5%), and TNFRSF14 (10.5%), involving RTK/RAS (44.3%), TP53 (41.8%), and PI3K (20.2%) pathways. Single-gene mutations did not predict treatment benefit. However, pathway-level analysis identified PI3K pathway activation as significantly associated with inferior PFS (HR 2.148; 95% CI 1.478–3.124) and OS (HR 2.096; 95% CI 1.413–3.109) in patients receiving GAP, an effect not observed with GC. Importantly, GAP conferred clinical benefit only in patients without PI3K pathway activation, while no survival advantage was seen in those with such alterations (Pinteraction=0.023 for PFS, Pinteraction=0.003 for OS). Similar results were obtained in the independent validation cohort treated with GAP (N=103) or GC (N=64) for BTC. Conclusions Genomic profiling using next-generation sequencing identified PI3K pathway activation as key molecular determinant that differentiates patient outcomes between GAP and GC treatments in advanced BTC.

Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

OBJECTIVES: This study explored 11 years of malaria data from mandatory reporting in Gyeonggi Province, Korea, to provide information for prevention strategies by linkage to nationwide health claims data. METHODS: Reported malaria cases in Gyeonggi Province from 2011 to 2021 were linked to medical usage data from the National Health Insurance Database. Data about hospitalization, antibiotic prescription and duration, malarial species, and sociodemographic information of the cases were included. RESULTS: Between 2011 and 2021, a total of 3,011 malaria cases were reported, consisting of 2,828 domestic (93.9%) and 183 imported (6.1%) cases. Over 80% of the cases involved males, with the majority of patients being in their 20s. Both domestic and imported cases peaked between June and August over the years. Imported cases had a higher hospitalization rate (66.9%) compared to domestically-acquired cases (54.9%). There was a significant variation in treatment rates, with 80.7% of imported cases and 74.6% of domestic cases receiving treatment. For domestic cases, chloroquine combined with primaquine was the most commonly prescribed treatment (77.0%), while atovaquone-proguanil was frequently used for imported cases (25.9%). Plasmodium vivax was the predominant species in domestic cases (94.9%), whereas P. malariae was more common in imported cases (62.3%). The overall number of reported malaria cases declined following a sharp decrease in imported cases in 2020 and 2021. CONCLUSIONS Despite a decreasing trend in malaria cases reported in Gyeonggi Province, imported cases exhibited higher hospitalization rates and different antibiotic prescription and treatment patterns, reflecting the presence of a different malarial species.

OBJECTIVES: This study explored 11 years of malaria data from mandatory reporting in Gyeonggi Province, Korea, to provide information for prevention strategies by linkage to nationwide health claims data. METHODS: Reported malaria cases in Gyeonggi Province from 2011 to 2021 were linked to medical usage data from the National Health Insurance Database. Data about hospitalization, antibiotic prescription and duration, malarial species, and sociodemographic information of the cases were included. RESULTS: Between 2011 and 2021, a total of 3,011 malaria cases were reported, consisting of 2,828 domestic (93.9%) and 183 imported (6.1%) cases. Over 80% of the cases involved males, with the majority of patients being in their 20s. Both domestic and imported cases peaked between June and August over the years. Imported cases had a higher hospitalization rate (66.9%) compared to domestically-acquired cases (54.9%). There was a significant variation in treatment rates, with 80.7% of imported cases and 74.6% of domestic cases receiving treatment. For domestic cases, chloroquine combined with primaquine was the most commonly prescribed treatment (77.0%), while atovaquone-proguanil was frequently used for imported cases (25.9%). Plasmodium vivax was the predominant species in domestic cases (94.9%), whereas P. malariae was more common in imported cases (62.3%). The overall number of reported malaria cases declined following a sharp decrease in imported cases in 2020 and 2021. CONCLUSIONS Despite a decreasing trend in malaria cases reported in Gyeonggi Province, imported cases exhibited higher hospitalization rates and different antibiotic prescription and treatment patterns, reflecting the presence of a different malarial species.

Purpose: The partner and localizer of breast cancer 2 (PALB2) mutation is a predisposition to breast cancer development. However, limited clinical data are available for the Korean population. Therefore, this study aimed to compare the characteristics and oncological outcomes of patients with PALB2-mutated and non-mutated PALB2 in Korea. Methods: A total of 1,463 breast cancer (BRCA) 1/2 mutation-negative breast cancer underwent comprehensive multigene sequencing between 2016 and 2019 at Severance Hospital, Seoul, Korea. Clinicopathological data and oncological results of PALB2 mutated patients were prospectively collected and compared with those of the non-mutated group. Results: PALB2 mutations were identified in 1.2% (17/1,463) of the patients. The median age at diagnosis was 46 (30–73) years, and the median tumor size was 1.8 (0.05–3.5) cm. All patients with PALB2 mutations had histologic grades II–III, and a triple-negative subtype was found in 23.5% (4/17); however, there were no significant differences in clinicopathological data between the groups. During the median follow-up time of 38.5 months, locoregional recurrence occurred in 4.2% (44/1,043), distant recurrence was reported in 3.0% (31/1,043), and contralateral breast cancer was diagnosed in 0.8% (9/1,043) of patients, with no significant difference observed between the groups. All-cause mortality was observed in 1.8% (19/1,028) of the non-mutated group and none in the PALB2 mutation group. However, survival analyses demonstrated no significant differences in all-cause mortality (p = 0.524) and recurrence-free survival (p = 0.319). Conclusion Clinicopathological features and oncological outcomes of PALB2 mutated breast cancer were not significantly different from those of non-mutated breast cancer in the Korean population.

Purpose: The clinical characteristics of headaches vary by age among pediatric patients. Red flag signs are key factors in differentiating secondary headaches and should be considered in the context of the patient’s age. Methods: This study involved a retrospective chart review of pediatric patients presenting with headaches. Patients were categorized by age into three groups: pre-school age (under 6 years), school-age (6 to 12 years), and adolescence (over 12 years). Demographic data, headache characteristics, laboratory findings, and neuroimaging results were evaluated. Overall, 17 potential red flags were assessed. Results: A total of 687 patients were included, of whom 102 were of pre-school age, 314 were school-aged, and 271 were adolescents. The frequency of overweight/obesity was found to increase with age. The pre-school age group experienced a shorter period from symptom onset to presentation and a briefer duration of pain. In contrast, adolescents displayed a longer period from symptom onset, a greater frequency of headaches occurring at least three times per week, and a higher rate of headache episodes lasting over 3 days. Children under 6 years old were more commonly diagnosed with secondary headaches than older children. Across age groups, secondary headaches were suspected when systemic symptoms such as fever were present, when the headache had a sudden onset, when the patient responded poorly to medication, or when abnormal neurological signs and symptoms were observed. Conclusion The clinical features of pediatric patients vary by age group. Clinicians should consider red flag signs in the context of patient age and individual characteristics.