Articles related to Oncology, Surgical

Recently, the ALBI (albumin-bilirubin) score has been developed as an HCC-specific refinement of the Child-Pugh (C-P) score. In this commentary, the authors summarize the limitations of the C-P score, which include subjectivity and inconsistency of versions, as well as lack of sensitivity in patients with mild liver dysfunction. In comparison, the ALBI score “is entirely objective, obviating any need for subjective assessment of clinical signs, that it is derived from an entirely HCC population and is a continuous score that readily lends itself for assessment of changes in liver reserve over time.”

Sixty patients with EGFR-amplified gastroesophageal adenocarcinoma(GEA) received EGFRi, including 31 of 60 patients (52%) with concurrent chemotherapy. Across treatment lines, patients achieved a 43% objective response rate with a median PFS of 4.6 months. Typical OS with first-line initiation of non-EGFRi therapy in patients with EGFR-amplified GEA is 11.2 months, as determined by analysis of a deidentified clinicogenomic database. Despite this benefit, analysis of that database for January 2011 through December 2020 suggests that only 5% of patients with EGFR-amplified GEA received EGFRi.

Many patients have devoted time and effort to learning about their diagnosis and have engaged (or want to) in a collaborative relationship that benefits their care. This represents a shift from the more traditional health care paradigm, where the doctor is the primary content expert providing education and recommendations. To engage with expert patients, clinicians must acknowledge their existence as experts on their own diseases and that they can be a valuable resource and want to become more deeply involved.

Responses to conventional donor lymphocyte infusion for post-allogeneic hematopoietic cell transplantation relapse are typically poor. Natural killer cell-based therapy is a promising modality to treat post-HCT relapse. This ongoing phase I trial of adoptively transferred cytokine induced memory-like (CIML) NK cells in patients with myeloid malignancies relapsed after haploidentical HCT saw a dynamic evolution of the activated CIML NK cell phenotype, superimposed on the natural variation in donor NK cell repertoires.

Mirvetuximab soravtansine is an antibody-drug conjugate that consists of an FRα-binding antibody, cleavable linker, and maytansinoid DM4, which is a potent tubulin-targeting agent. It was tested in a single-arm phase 3 trial that included 106 patients with platinum-resistant, high-grade serous epithelial ovarian, fallopian tube, or primary peritoneal cancers with high FRα expression. The investigator-assessed ORR was nearly triple the benchmark set in prior studies of less heavily pretreated platinum-resistant ovarian cancer populations. The ORR was similar regardless of the number of prior lines of therapy or prior PARP inhibitor exposure. The rapid and durable response seen with mirvetuximab in patients with FRα-positive, platinum-resistant ovarian cancer may position it to become a practice-changing, biomarker-driven standard of care treatment option.

In an editorial accompanying the final results of the TOURMALINE-MM1 study, Drs. D’Souza and Lonial question whether overall survival (OS) is “still the gold standard for demonstrating the value of a novel agent in phase III trials early in the disease course given the current treatment landscape.”