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[Comment] Reorienting frailty in clinical practice, public health, and policy: the Lancet Commission on Frailty
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01101-8/fulltext?rss=yes
WHO's policy framework for healthy ageing from the World Report on Ageing and Health recognises frailty as the foremost geriatric syndrome in older adults and a key determinant of functional ability.1 Frailty poses a major public health challenge, with a substantial impact on the people living with it, their families, health-care systems, and social support services.1,2 However, frailty is a poorly understood condition globally. Without an adequate understanding of frailty and its causal pathways, policy makers cannot develop effective preventive strategies to reduce frailty prevalence and its associated burden.
[Articles] Balancing the benefits and risks of colchicine use among patients with atherosclerotic cardiovascular disease: an umbrella review of meta-analyses of randomised controlled trials
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00209-3/fulltext?rss=yes
High-certainty evidence supported the therapeutic and secondary preventive benefits of colchicine in patients with ASCVD when dose and duration were appropriately controlled. Future studies could focus on identifying ASCVD subgroups with pharmacogenomic and ethnographic predictors of colchicine response heterogeneity to guide precision therapy.
[Articles] Adjuvant pembrolizumab therapy for completely resected stage I lung adenocarcinoma with micropapillary or solid histological subtypes: a single-center, single-arm, phase 2 trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00214-7/fulltext?rss=yes
Adjuvant pembrolizumab exhibited promising clinical efficacy in patients with stage I lung MPSOL, particularly those with EGFR-wild type, and exhibited tolerable safety.
[Comment] The Gavi Leap: radical transformation for a new global health architecture
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01177-8/fulltext?rss=yes
It has long been acknowledged that the global health system needs reform. Although this system has improved public health, saved lives, and advanced health equity,1,2 it remains fragmented, uncoordinated, at times inefficient, and in some settings even a barrier to progress.3 Now, in the harsh light of geopolitical realities in 2025 and an unprecedented squeeze on funding from traditional donor countries,4 discussions about how to reform global health have taken on an existential quality.
[Comment] The current situation of organ donation from occult hepatitis B infection (OBI) donors: a perspective from Iraq
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00216-0/fulltext?rss=yes
The Hepatitis B virus (HBV) continues to pose a major global health issue, especially in areas with high prevalence, such as Iraq.1 In organ transplantation, HBV-positive donors pose distinct challenges because of the potential for viral transmission and reactivation. In clinical practice in Iraq, HBV-infected organ donors are classified into three groups: The first group comprises donors who test positive for HBsAg and are therefore deemed unsuitable for organ donation. The second group contains donors who are negative for HBsAg, positive for HBcAb, and show negative results for HBV PCR.
[Articles] Evaluation of early donor renal function recovery after living-donor nephrectomy as a predictor of allograft failure after kidney transplantation: a longitudinal cohort and machine learning study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00210-X/fulltext?rss=yes
Early donor renal function recovery represents an alternative predictor of death-censored graft failure after living-donor kidney transplantation. This index may enhance risk prediction when integrated with established models. The predominantly young recipient population may limit generalizability to older transplant candidates.
[Articles] Efficacy and safety of HBM4003 combined with toripalimab in refractory neuroendocrine neoplasms: a multicenter, phase II study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00181-6/fulltext?rss=yes
HBM4003 combined with toripalimab demonstrated promising anti-tumor activity and manageable safety in patients with refractory NENs, supporting further investigation of this combination therapy.
[Correspondence] Authors’ reply to quality of care delivery in patients with acute heart failure
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00221-4/fulltext?rss=yes
We agree with Guglieri and colleagues that specific recommendations for how low-income countries can improve the quality of care for heart failure are needed. Indeed the REPORT-HF data strongly support the call for a focus on low-income regions in showing that (1) mortality following hospitalization for heart failure was 58% higher in patients from lower-income (vs. higher-income) countries1; (2) attainment of established quality indicators (QIs) was significantly lower in lower-income countries than in higher-income countries.
[Articles] Effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on maternal gestational weight gain in low-income and middle-income countries: a systematic review and individual participant data meta-analysis of randomised clinical trials
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00211-1/fulltext?rss=yes
Our findings suggest that monthly IPTp-SP has superior effect on GWG compared to weekly chloroquine or IPTp-DHA + PPQ in malaria-endemic areas. The result provides further evidence indicating that IPTp-SP improves maternal weight gain, an important determinant of fetal growth beyond its antimalarial effects. Due to the limited number of trials with weight and height measures available for the IPD meta-analysis we were likely underpowered to detect any significant difference between 2-dose SP and monthly IPTp-SP.
[Articles] Development and external validation of a risk prediction score (DASHI) for cardiovascular events following acute respiratory infections: derivation and validation retrospective cohort study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00205-6/fulltext?rss=yes
The DASHI score allows primary care clinicians to estimate the risk of cardiovascular complications within 28 days in patients with acute respiratory infections.
[Articles] Efficacy and safety of first-line maintenance therapy with lurbinectedin plus atezolizumab in extensive-stage small-cell lung cancer (IMforte): a randomised, multicentre, open-label, phase 3 trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01011-6/fulltext?rss=yes
IRF progression-free survival and overall survival were longer in the lurbinectedin plus atezolizumab group than the atezolizumab group for patients with ES-SCLC, albeit with a higher incidence of adverse events. Lurbinectedin plus atezolizumab represents a novel therapeutic option for first-line maintenance treatment in this setting.
[Articles] Efficacy and safety of selumetinib in adults with neurofibromatosis type 1 and symptomatic, inoperable plexiform neurofibromas (KOMET): a multicentre, international, randomised, placebo-controlled, parallel, double-blind, phase 3 study
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00986-9/fulltext?rss=yes
In the first international, randomised, placebo-controlled trial in adults with NF1-plexiform neurofibromas, selumetinib achieved a significant objective response rate versus placebo. No new safety concerns were identified. The observations of reduction in tumour volume by cycle 16, reduction in chronic and spike pain, reduction in analgesia, and decrease in pain interference over placebo show that selumetinib is effective at treating plexiform neurofibromas in adults with NF1.
[Articles] Claudin-18 isoform 2-specific CAR T-cell therapy (satri-cel) versus treatment of physician's choice for previously treated advanced gastric or gastro-oesophageal junction cancer (CT041-ST-01): a randomised, open-label, phase 2 trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00860-8/fulltext?rss=yes
This is the first randomised controlled trial of CAR T-cell therapy in solid tumours globally. Satri-cel treatment resulted in a significant improvement in progression-free survival, with a manageable safety profile. These results support satri-cel as a new third-line treatment for advanced gastric or gastro-oesophageal junction cancer patients.
[Comment] Seeking an inclusive and just way to simplify the global health architecture
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01100-6/fulltext?rss=yes
The 25-year-old joint commitment among established providers of official development assistance (ODA) to invest in efforts that respond to AIDS/HIV, tuberculosis, and malaria, eradicate polio, and achieve near universal global vaccine coverage for a host of diseases and conditions has collapsed in 2025. Although several European governments have reduced ODA spending,1,2 the suddenness and brutality of the US Government's withdrawal from global health efforts3 have turned a shift in ambitions into a full-fledged redefinition of what global health efforts can be, what they can achieve, and how they should be organised.
[Seminar] Acute rheumatic fever
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00185-0/fulltext?rss=yes
Acute rheumatic fever (ARF) is an autoimmune disorder resulting from Group A Streptococcus (GAS) pharyngitis or impetigo in children and adolescents, which may evolve to rheumatic heart disease (RHD) with persistent cardiac valve damage. RHD causes substantial mortality and morbidity globally, predominantly among socioeconomically disadvantaged populations, with an interplay of social determinants of health and genetic factors determining overall risk. ARF diagnosis is based on a constellation of clinical and laboratory features as defined by the 2015 Jones Criteria, although advances in molecular point-of-care testing and the ongoing search for ARF biomarkers offer the potential to revolutionise diagnostics.
[Perspectives] Vaccination: a changing political, scientific, and personal landscape
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01193-6/fulltext?rss=yes
I have read many books on the changing tide of the public's relationship with vaccines, particularly around childhood vaccines. However, Adam Ratner's book Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children's Health brings a fresh mix of medical and historical insights that are more important than ever to consider in the rapidly changing political, scientific, and personal landscape on which vaccines depend for their success.
[Articles] Risk of cardiovascular disease among cancer survivors: systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00206-8/fulltext?rss=yes
This meta-analysis provides an up-to-date comprehensive global overview that cancer survivors had increased risk of CVD and 17 CVD subtypes than non-cancer controls. CVD risk evaluation and management need to be prioritized in cancer survivors, particularly among male, younger, and specific cancer survivors (brain, hematological, respiratory, male genital, and breast). This study provides supporting evidence that may inform future updates to guidelines for CVD prevention in cancer survivors, highlighting its public health relevance.
[Articles] Incident cytopenia and risk of subsequent myeloid neoplasm in age-related clonal hematopoiesis: a multi-biobank case-control study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00215-9/fulltext?rss=yes
Longitudinal analysis across three large cohorts found that it is rare for patients with CHIP to develop MN without first developing cytopenia. The risk for MN among patients with CHIP resides almost entirely among those with cytopenia. These findings suggest that cytopenia is a critical step in progression from CHIP to MN, underscoring its utility as an endpoint in cancer prevention trials for CHIP patients.
[Perspectives] To be a distant witness
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01183-3/fulltext?rss=yes
A couple of weeks after 5-year-old Hind Rajab called for help while trapped in a car under Israeli military fire in Gaza City, her decomposing body was found in February, 2024 alongside those of her family and the burned-out ambulance and remains of the paramedics who had been sent to rescue her. Since the Government of Israel began its military campaign in Gaza after the deadly attack and hostage-taking by Hamas on Oct 7, 2023, hospitals have been destroyed, health workers detained or killed, and humanitarian aid and essential supplies denied passage.
[Comment] The Pandemic Agreement is a milestone: now it is time for action in national capitals
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01178-X/fulltext?rss=yes
Surprised murmurs transformed into a prolonged standing ovation among delegates at the World Health Assembly on the evening of May 19, 2025, when they realised that no member state would oppose the Pandemic Agreement.1 After more than 3 challenging years of negotiation, the adoption of the Pandemic Agreement is worth celebrating. It is the first legally binding global agreement that sets rules around how countries should act and collaborate to prevent, prepare for, and respond to pandemic threats, and does so through a One Health approach.
[Articles] Defining benchmark values for outcomes of comprehensive resection of primary retroperitoneal liposarcoma: a retrospective multicenter study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00212-3/fulltext?rss=yes
These novel benchmark values can act as reference values to which sarcoma centers or individual surgeons can compare, which may help to identify performance gaps and improve the quality of care.
[Articles] The EORTC QLQ-F17 as a shortened version of the EORTC QLQ-C30 to assess self-reported functioning in cancer patients: investigating equivalence and psychometric properties in a randomized cross-over trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00194-4/fulltext?rss=yes
The QLQ-F17 yielded score values that are equivalent to the functional part of the QLQ-C30. Consequently, future clinical studies can employ the QLQ-F17 as a generic tool without losing comparability to studies using the QLQ-C30. Supplementing the QLQ-F17 with relevant symptom items from the EORTC Item Library allows for a time-efficient and flexible measurement strategy.
[Articles] Real-world uptake of nirsevimab, RSV maternal vaccine, and RSV vaccines for older adults: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00213-5/fulltext?rss=yes
Uptake of nirsevimab varied substantially between the countries that have implemented infant RSV immunisation programmes. Despite the limited number of studies and the lack of more accurate data at national level the low uptake estimates for RSV maternal vaccine and RSV vaccines for older adults are concerning. National, clinical, and public health initiatives are needed to increase uptake of RSV immunisation products and ensure maximum benefit to people currently at risk of severe RSV outcomes.
[Correspondence] Quality of care delivery in patients with acute heart failure
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00220-2/fulltext?rss=yes
The REPORT-HF registry evaluated the quality of care (QoC) in acute heart failure and its association with outcomes across 44 countries.1 The authors conclude that improving QoC could reduce mortality in acute heart failure. While this is a reasonable assertion, specific recommendations for how low-income countries can achieve this improvement are needed.2,3 Among targeted strategies for quality improvement that may increase the practical impact, it is suggested that NYHA classification (despite its limitations) and its routine assessment in HF with minimal cost should be promoted.
[Correspondence] Sudan's tuberculosis response needs global support amid conflict
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01119-5/fulltext?rss=yes
As Sudan enters its third year of war, tuberculosis continues to pose a serious threat to public health amid systemic health-care collapse.1 In 2024 alone, the Federal Ministry of Health in Sudan officially reported 14 310 new tuberculosis cases, reflecting the persistence of the disease despite widespread insecurity and disruption of services.2 Actual case numbers could be even higher, given the under-reporting in conflict and inaccessible areas. Currently, tuberculosis services are operational in 148 diagnostic and treatment centres across areas not directly affected by violence.
[Articles] Relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): an open-label, randomised, controlled, phase 3 trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01040-2/fulltext?rss=yes
The addition of relacorilant to nab-paclitaxel prolonged progression-free survival and interim results also showed an improvement in overall survival. Together, the results position the combination of relacorilant and nab-paclitaxel as a potential new standard treatment for patients with platinum-resistant ovarian cancer.
[Articles] No evidence of leukaemia (NEL) as a response criteria in paediatric AML: a multicentre analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00204-4/fulltext?rss=yes
By simplifying the response criteria for morphological assessment of blast persistence (NEL/EL), we provide an improved and more precise definition of response for paediatric AML, which presents a new milestone with a high prognostic impact in daily clinical practice and in interpreting clinical trials.
[Articles] Diagnostic accuracy of point-of-care triage tests for pulmonary tuberculosis using host blood protein biomarkers: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00189-0/fulltext?rss=yes
None of the POC-TTT met the WHO target product profile minimum requirements for a TB triage test of 90% sensitivity and 70% specificity when a POC device was used for screening in a typical setting studied. Further research, specifically focusing on head-to-head comparisons and combination tests are recommended.
[Department of Error] Department of Error
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01146-8/fulltext?rss=yes
Paris L, Al-Jadba G, Zeidan W, et al. Deterioration of health outcomes in Gaza: 19 months of protracted conflict. Lancet 2025; published online May 22. https://doi.org/10.1016/S0140-6736(25)00812-8—In this Correspondence, the European Centre for Disease Prevention and Control affiliation should have read “ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden”. The following disclaimer should also have been included: “LP is a fellow of the ECDC Fellowship Programme, supported financially by the European Centre for Disease Prevention and Control (ECDC).