Prognostic Impact of Early Treatment and Oxaliplatin Discontinuation in Patients With Stage III Colon Cancer: An ACCENT/IDEA Pooled Analysis of 11 Adjuvant Trials
February 1, 2023
Stopping oxaliplatinum and cont. of 5FU is better than stopping all chemotherapy. An option for patients with worsening neuropathy or other oxaliplatinum toxicity.
NAPOLI-3: A randomized, open-label phase 3 study of liposomal irinotecan + 5-fluorouracil/leucovorin + oxaliplatin (NALIRIFOX) versus nab-paclitaxel + gemcitabine in treatment-naïve patients with metastatic pancreatic ductal adenocarcinoma (mPDAC).
January 1, 2023
The NAPOLI-3 study assessed FOLFOX+ liposomal irinotecan vs. gemcitabine + nab-paclitaxel. NALIRIFOX was superior, with an OS of 11.1 vs. 9.2 months. Criticisms of modern gem trials are often that of rigid dosing requirements that differ from modern clinical practice. Additionally, it is unclear whether NALIRIFOX provides any meaningful benefit over FOLFIRINOX, and the cost is always a consideration.
Trifluridine/tipiracil plus bevacizumab for third-line treatment of refractory metastatic colorectal cancer: The phase 3 randomized SUNLIGHT study.
January 1, 2023
In the SUNLIGHT study, Lonsurf + bevacizumab was found to be superior to bevacizumab alone in the 3L setting of mCRC, independent of mutation status. First 3L mCRC where the control group was an active compound instead of a placebo. OS was superior, with a clinically meaningful difference of 10.8 vs. 7.5 months. This is now the SOC 3L option in mCRC, in my opinion.
Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture
January 1, 2023
ASA vs. LMWH prophylaxis after an extremity fracture requiring surgery or a pelvic fracture. ASA was non-inferior to LMWH, and death rates were equivalent; however, DVT rates were higher (2.5%) in the ASA group vs. the LMWH group (1.7%), while PE and bleeding rates were similar. I think ASA has a role for some patients in various high-risk settings.
Zanubrutinib or Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia
January 1, 2023
Final PFS results of the ALPINE study of Zanubrutinib vs. Ibrutinib in patients with >=2L CLL/SLL. Zanubritinib was superior in terms of PFS with an HR of 0.49; at two years PFs were 78% vs. 66% in favor of Zanubritinib; improvement was seen across all subgroups. OS data is not mature yet, and that data will be interesting. Of note, the SEQUOIA study showed this drug was superior compared to Bendamustine + rituximab in the 1L setting.
Introduction to a How I Treat series on management of high-risk patients following allogeneic transplant
January 1, 2023
Interesting prospective study assessing outcomes in ITP in pregnant women while measuring neonatal ITP in the developing child, with a control of non-pregnant women for comparison. Pregnancy-ITP was associated with a 2.7x higher rate of recurrent disease. However, bleeding was similar in pregnant vs. non-pregnant women. NITP risk was associated with more severe ITP disease in the mother and the severity of the disease, as well as prior h/o ITP in the mother.
Neoadjuvant Chemotherapy, Excision, and Observation for Early Rectal Cancer: The Phase II NEO Trial (CCTG CO.28) Primary End Point Results
January 1, 2023
Nice study showing a non-radiation approach to node-negative, earlier stage, low-lying rectal cancer, using FOLFOX/CAPEOX x 3 months followed by local excision for those with downstaging to T0/T1 disease. 79% of patients achieved organ preservation, and 2-year locoregional RFS was 90%. A good option for those who are not good candidates for radiation yet still want to avoid an APR-type surgery.
Physical Activity in Stage III Colon Cancer: CALGB/SWOG 80702 (Alliance)
January 1, 2023
Get your patients moving, even in the adjuvant setting! Of course, a lot of bias is possible here, but there was nearly a 10% difference in cure at three years.
Treatment of Metastatic Colorectal Cancer: ASCO Guideline
January 1, 2023
Guideline of the month — ASCO guidance on mCRC. Many interesting points made.
