Confirming that RR can be an alternative to R chemotherapy as a first line therapy in advanced stage follicular lymphoma.
Oleclumab (MEDI9447) is a human IgG1λ mAb that inhibits the function of cluster of differentiation 73 (CD73).8 CD73 is an enzyme found on the surfaces of cancer and immune cells and is involved in conversion of adenosine monophosphate to extracellular adenosine, which has an immunosuppressive effect on the tumor environment.9 CD73 upregulation by tumors has been shown to increase extracellular adenosine production and result in subsequent local immunosuppression in multiple canc
Another use of genomic testing in prostate cancer, pts with high risk mutation may need systemic therapy in addition to oligometastatic stereotactic radiotherapy, well informed patients with no high risk mutation signature may elect to go under surveillance to avoid side effects of androgen deprivation therapy, this also emphasizes the importance of genomic testing in personalizing pt’s care.
Another option for HR+ /HER-2 negative pts who failed hormonal therapies, caution to toxicity though esp neutropenia and diarrhea, no OS data yet, will be interesting to know if it worth the adverse events at this stage of disease.
This article provides a sweeping historical and modern day perspective on the care delivery ecosystem beyond the four walls of a hospital. While site of care (hospital, community, home, remote, etc.), and its appropriateness / value remains a hot topic of debate, there is no questioning that ultimately the best interests of the patient should govern where care is received / delivered. For oncology/hematology patients, safe, convenient and high quality / low cost care is best received in community settings, like here at Florida Cancer Specialists & Research Institute.
This is a nice historical accounting of this sometimes-challenging paradigm. No randomized, prospective trials exist to guide practice management. The question in clinic is often, when to use prophylaxis and when not? The CNS-IPI is the best scoring system validated in the Rituximab era. This did not account for double/triple hit genetics, ABC subtypes or sites of disease (gonads, >3 sites). A high score or any of these groups are generally those that benefit the most from CNS-prophylaxis. The field has moved away from IT-MTX therapy to HD-IV-MTX since most secondary CNSL is parenchymal in nature. Most relapses occur at months 6-9 so sooner is probably better in terms of timing.
Interesting food for thought in this ethnic group regarding TTP. Large retrospective review of the TTP registry showing that among races there was no variation in mortality, however African-Americans had a reduced RFS in all metrics. Rituximab was not helpful in 1L therapy in any group. In the 2L setting, Rituximab had a significant RFS benefit in Caucasians but not in African-Americans. It did not seem that access to care was the driver in reduced RFS. African-American’s may also have shorter-lived B-cell depletion from CD20-MAb therapy.
How can you not love these nationalized country studies that make you question foundational oncologic principals; prudence of surveillance CT’s in this case? Thought provoking in the least. No OS or DFS benefit of CT+CXR vs CXR alone! However some benefit was likely present in higher stage groups, and I doubt this will change practice in the US.
Pembrolizumab remains the only adjuvant option for high risk RCC after curative surgery. The OS curves seem to be beginning to separate and hope to be positive with longer f/u. The ongoing Durvalumab + Tremilumumab will be an interesting adjuvant study for RCC when the results are available.
New 3rd gen TKI in EGFR+ patients to consider with strong efficacy, only available in China currently. Shows again that ORR is not better with the newer drug, rather its more the duration of response which is far superior.