Guidelines for post-mastectomy radiation include patients who received neoadjuvant therapy, with or without residual disease after treatment. A good topic to review.
This study reviewed the effects of using novel agents (immunotherapy and targeted therapy) in patients at the end of life (EOL), based on the perception that these therapies may be less toxic than chemotherapy. Adjusted odds of high health service utilization and hospital death were more than twofold greater among patients receiving systemic anticancer therapy (SACT) at the EOL compared to those receiving none.
Xevinapant (an inhibitor of apoptosis proteins inhibitor) added to chemoradiotherapy did not improve event-free survival (EFS) or overall survival (OS); in fact, OS was worse in the combination arm.
Interim analysis of 302 patients revealed no lymph node metastases in either study arm. No lymphadenectomy-related complications occurred in the no-LND arm.
The combination therapy demonstrated improved overall survival (a 25% reduction in mortality) but was associated with increased toxicity, including skin rash and venous thromboembolic events (VTEs). Single-agent osimertinib may lose its role as monotherapy for EGFR-mutated NSCLC, as the FLAURA2 trial showed that combining osimertinib with chemotherapy yielded better outcomes than osimertinib alone.
A 13% reduction in mortality was observed in the screening group, with an improved harm-benefit ratio. For every 456 men screened, one prostate cancer death was prevented. It is an easy and inexpensive test, though concerns remain regarding unnecessary biopsies and overtreatment.
The phase 2 trial of Moga-CHOP (CHOP + mogamulizumab) in older patients with aggressive adult T-cell leukemia/lymphoma (ATL) demonstrated a significant improvement in 1-year PFS (36.2% vs 16% historical control), with a 1-year OS of 66.0% and a CR rate of 64.6%. The overall response rate (ORR) was high at 91.7%, and the median overall survival (OS) reached 1.6 years. Notably, CCR4 mutations and Moga-associated cutaneous AEs correlated with better OS, and the regimen was generally tolerable with no unexpected toxicities. Bottom line: Moga-CHOP is now a strong first-line option for older, transplant-ineligible ATL patients, and it’s encouraging to see these survival gains in a population with historically poor outcomes.
The Alliance phase II, multi-institutional trial evaluated SRS/SRT in small cell lung cancer (SCLC) patients with 1-10 brain metastases, showing a 1-year neurologic death rate of 11.0% vs 17.5% with historical whole brain radiation therapy (WBRT) controls, and a median OS of 10.2 months. Notably, only 22% required salvage WBRT, and 78% avoided WBRT entirely, with high rates of local control and manageable toxicity. The incidence of new brain mets was high (1-year: 59%), but most were managed with salvage SRS/SRT rather than WBRT. In short, for SCLC patients with limited brain mets, SRS/SRT with close MRI surveillance looks like a real alternative to upfront WBRT, potentially preserving neurocognition without compromising intracranial control.
The S1826 phase III trial evaluated N-AVD vs BV-AVD in patients ≥60 years with advanced-stage cHL, showing a significant improvement in 2-year PFS (89% vs 64%) and OS (96% vs 85%) with N-AVD. N-AVD was better tolerated, with fewer discontinuations (14% vs 55%), lower nonrelapse mortality (6% vs 16%), and less peripheral neuropathy, despite higher rates of neutropenia. Patient-reported outcomes confirmed a more favorable toxicity profile for N-AVD, and notably, no EBV+ patients on N-AVD progressed, compared to 7/11 on BV-AVD. Bottom line: Today, N-AVD is essentially the SOC for most everyone with cHL..
The phase III NeoADAURA trial evaluated neoadjuvant osimertinib (OSI) with or without platinum-based chemotherapy (CT) versus CT alone in resectable, EGFR-mutated stage II-IIIB non-small cell lung cancer (NSCLC). Both OSI+CT and OSI monotherapy significantly improved major pathologic response (MPR: 26% and 25% vs 2%), and 12-month event-free survival (EFS) rates were higher with OSI-containing regimens (OSI+CT 93%, OSI 95%, CT 83%). Nodal downstaging was also more frequent with OSI arms (53% vs 21%). Neoadjuvant OSI—with or without CT—looks like a real step forward for our EGFR-mutant NSCLC patients, especially given the robust pathologic responses and high rates of surgical completion.