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Trastuzumab Deruxtecan in Anti–Human Epidermal Growth Factor Receptor 2 Treatment–Naive Patients With Human Epidermal Growth Factor Receptor 2–Low Gastric or Gastroesophageal Junction Adenocarcinoma: Exploratory Cohort Results in a Phase II Trial

Her2-low is here to stay.  Expect further studies on Enhertu and Trodelvy on gastroesophageal Her-2 low patients.  Response rates were modest however, so temper expectations as single agent therapy.  I look forward to trials on future combination therapy.

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Efficacy and Safety of Ibrutinib Combined with Standard First-Line Treatment or As Substitute for Autologous Stem Cell Transplantation in Younger Patients with Mantle Cell Lymphoma: Results from the Randomized Triangle Trial By the European MCL Network

Potentially practice changing trial from the EU on young, transplant eligible patients with MCL were all treated with first line chemo then randomized to Auto-HSCT +/- Ibrutinib.  The addition of Ibrutinib to Auto-HSCT improved DFS compared to Auto-HSCT alone, and more interestingly patients treated Ibrutinib was better than those who had transplant but the data on the Ibrutinib vs traplant + Ibrutinib arms are premature.  The addition of maintenance Rituximab did not seem to change any outcomes.

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Phase II Randomized Study of Salvage Radiation Therapy Plus Enzalutamide or Placebo for High-Risk Prostate-Specific Antigen Recurrent Prostate Cancer After Radical Prostatectomy: The SALV-ENZA Trial

Although not a practice changing study, this study makes a few points that may be seen in future studies.  In the setting of biochem-recurrent prostate cancer after RP, novel anti-androgen agents may replace ADT in combination with salvage XRT as they appear to be active and less toxic than traditional ADT.   Low/Intermediate risk patients are likely of benefit with median PSA at accrual of 0.3 in this study, not unlike other similar studies.   The role of combination anti-hormone therapy + salvage radiation seems to be solidifying.

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Efficacy and Safety of Intravenous Efgartigimod in Adults with Primary Immune Thrombocytopenia: Results of a Phase 3, Multicenter, Double-Blinded, Placebo-Controlled, Randomized Clinical Trial (ADVANCE IV)

Another new (potential) option for refractory ITP patients, efgartigimod is an IgG1-Fc-fragment engineered to reduce IgG autoantibody levels.  131 patients enrolled and 67% had >=3 prior lines of therapy, placebo controlled study.  The study group had a 90% sustained platelet response, with >50% having plt counts of >30k >= 7 days apart.

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Primary Retroperitoneal Lymph Node Dissection for Patients With Pathologic Stage II Nonseminomatous Germ Cell Tumor—N1, N2, and N3 Disease: Is Adjuvant Chemotherapy Necessary?

Thought provoking retrospective study regarding primary RPLND for stage II NSGCT.  Study found that after RPLND N1-3 disease had a recurrence rate of about 20%, which flattens at years 2 to 5, and in patients who recurred all were treated successfully with chemotherapy.  Adjuvant chemotherapy is preferred on the NCCN for post-RPLND patients who are pN2-N3, however this suggests close surveillance may be an option in centers with high surgical expertise.

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