Guideline-recommended 4-day dexamethasone (DEX) for highly emetogenic chemotherapy (HEC) raises toxicity and immunotherapy interference concerns. We tested whether DEX reduction or omission with netupitant/palonosetron (NEPA) plus olanzapine (OLZ) is noninferior to standard DEX.
In this open-label, randomized phase III noninferiority trial across 28 Chinese centers, adults receiving HEC received NEPA (day 1) plus OLZ (days 1-4) and were randomly assigned to standard DEX (12 mg day 1, 8 mg days 2-4), DEX-sparing (6 mg day 1 only), or DEX-free (no DEX). The primary end point was complete response (CR; no emesis/no rescue medication) from 0 to 120 h. Noninferiority margin was –12% (one-sided α = .025).
Of 644 randomly assigned patients (median age 54.9 years; 66.0% female), stratified analysis showed overall CR rates of 72.4% for standard, 72.2% for DEX-sparing (stratified risk difference [RD], –0.2% [95% CI, –8.7 to 8.5]; Pnoninferiority = .005), and 70.1% for DEX-free (stratified RD, –2.2% [95% CI, –10.7 to 6.4]; Pnoninferiority = .014). Both met noninferiority, confirmed in per-protocol analysis. Steroid-related toxicities were significantly lower with DEX-sparing and DEX-free regimens versus standard.
NEPA plus OLZ with reduced (6 mg day 1 only) or no DEX is noninferior to standard 4-day DEX for chemotherapy-induced nausea and vomiting prevention in HEC, supporting steroid-sparing strategies particularly relevant in the chemo-immunotherapy era.
With the addition of intrahepatic chemotherapy, median overall survival was 22.3 months. One year overall survival reached 80.0%, exceeding the historical control rate of 47%, while three year overall survival was 31.5%. For patients who can tolerate this approach, it appears to be a reasonable and potentially worthwhile option.
Music therapy is noninferior to CBT for anxiety in survivors of cancer. Music therapy was found to be noninferior to cognitive behavioral therapy for anxiety among cancer survivors. Both telehealth interventions produced clinically meaningful and durable improvements in anxiety. Should we hire musicians?
The MATCH study was a large, pragmatic, preference-based, multisite RCT comparing Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ) in distressed cancer survivors. Both MBCR and TCQ significantly improved mood disturbance (POMS TMD) compared to waitlist, with the largest effect size for MBCR vs waitlist (0.44) and a significant reduction for TCQ vs waitlist (estimate –5.13; 95% CI, –9.44 to –1.23; P = .01). MBCR had the greatest impact on tension, anger, and vigor, while TCQ was most effective for anger, depression, and vigor; subgroup analysis showed women benefited more from MBCR, and younger or advanced-stage patients benefited more from TCQ. In short, both MBCR and TCQ are viable, evidence-based options for improving mood in our cancer survivors, and it doesn’t seem to matter whether patients choose their intervention or are randomized—everyone does better than waitlist. These are probably underutilized in our communities and more widely available than appreciated.
This new subcutaneous anticoagulant, abelacimab, binds to the inactive form of FXI and blocks its activation by FXII. This drug seems significantly safer than DOAC’s in terms of bleeding risk. So much so that the study was stopped early due to a greater-than-expected reduction in bleeding events in the study arm. I hope this drug is also going to be studied for the treatment of VTE.
This is another supportive care study that confirms the benefit of Naldemdine in preventing constipation induced by opioids.