Articles related to Oncology, Radiation

Joyce A. O’Shaughnessy, MD provides updates on several key presentations from SABCS, touching on SERD therapy, ribociclib combinations, the datopotamab deruxtecan antibody-drug conjugate targeting overexpression of the calcium signal transducer TROP2, trastuzumab deruxtecan, and more. The MONALEESA phase 3 trial is looking at letrozole + ribociclib vs letrozole + placebo in postmenopausal women with ER+ HER2- advanced breast cancer. The trial arm outperformed the control arm with a median OS of 63.9 months vs 51.4 months respectively at a median follow up of just over 6.5 years. That median OS is the longest reported for any phase 3 trial in advanced breast cancer.

PIK3CA is the most mutated oncogene across many of the common solid tumor types. Consequently, targeting PIK3CA has been of major clinical interest. Initial efforts at have not been promising, however. The limiting factors have primarily been lack of isoform specificity of inhibitors and dose-limiting toxicities. This study evaluates copanlisib, an α and δ isoform–specific phosphoinositide 3-kinase (PI3K) inhibitor, in patients with PIK3CA mutations.

The CDC has released updated guidelines for prescribing opioids. The newest guidelines focus on patient-centered decisions and reduce some limitations on prescribing that were put in place back in 2016. The updated guidance recognizes the ongoing increase in opioid-related deaths, but seeks to give physicians and patients more direction in managing individual therapy.

Initial results of the PREOPANC trial — comparing the addition of neoadjuvant chemoradiation therapy of gemcitabine combined plus Gy radiotherapy to standard care — failed to demonstrate a statistically significant overall survival (OS) improvement versus standard care of upfront surgery followed by adjuvant therapy. The long-term results, however, demonstrate significant benefit with neoadjuvant chemoradiation therapy consisted of gemcitabine combined plus Gy radiotherapy. The five year OS rate was 20.5% (95% CI, 14.2 to 29.8) with neoadjuvant chemoradiotherapy and 6.5% with upfront surgery.

Interest in immune-modulating neoadjuvant therapy for melanoma is growing. It is possible that BRAF/MEK inhibition will be more effective in the neoadjuvant than in the adjuvant setting because of the effect of the tumor biomass. And the benefits neoadjuvant therapy would offer in assessing biologic response assessment to treatment are significant. In this review the authors discuss the rationale for this treatment approach, summarize completed and ongoing neoadjuvant clinical trials, and contextualize these findings within the growing body of knowledge about targeted and immune checkpoint therapy.

Extending the ELEVATE-TN to four additional years (beyond the two-year follow-up in the pivotal trial) showed ongoing efficacy with no new safety signals. Additionally, the four year ELEVATE-RR trial comparing acalabrutinib with ibrutinib as monotherapy in high-risk populations showed overall non-inferiority of acalabrutinib and a lower rate of several adverse events, including atrial fibrillation.