OncoPharm

The non-Award Winning series of Landmarks in OncoPharm returns to discuss a Next Big Thing in NHL that wasn't any better than plain old CHOP.

From April 1993, it's Pro-MACE-CytaBOM

Link: https://www.nejm.org/doi/full/10.1056/NEJM199304083281404

Tisotumab vedotin garners a regular FDA approval for metastatic cervical cancer with OS benefit data.

A lingering question that demands a focused RCT: What is the optimal dose of methotrexate in primary CNS lymphoma? I'm glad I'm not the only one with this question: https://doi.org/10.1177/10781552231176754

What, some BRAF mutations in colorectal cancer might respond to EGFR-mab therapy? https://doi.org/10.1200/OP.21.00160

Lots of recent updates to cover this week...

1. Adjuvant pembrolizumab of RCC demonstrates OS improvement in NEJM publication (DOI: 10.1056/NEJMoa2312695)

2. Yet adjuvant nivolumab did not demonstrate OS improvement in the adjuvant setting. There may be a few reasons for this (https://doi.org/10.1200/JCO.2024.42.4_suppl.LBA358)

3. A cytokine-fusion protein, nogapendekin alfa inbakicept, is approved for intravesicular use in BCG-unresponsive bladder cancer. This agent appears to activity in NSCLC too...

4. The Phase II APPLE trial provides some evidence than deferring osimertinib to the second-line setting in metastatic EGFR-mutated NSCLC may yield similar OS to first-line use of osimertinib. (https://doi.org/10.1200/JCO.23.01521)

5.The METALLICA study provides a nice roadmap for empiric metformin use when starting alpelisib (https://doi.org/10.1016/j.eclinm.2024.102520)

6. Does CPX-351 cause less intestinal damage than 7 + 3? And could that explain the discordance between time of neutropenia and infection rates? A mouse model suggests yes. (https://doi.org/10.1200/jco.2017.77.6112)

Arguably, the most anticipated release of 4/19/24

What I learned (or relearned?) at HOPA's 2024 Annual Conference: updates in Neuro Oncology, fedratinib toxicity, and bispecific antibodies in multiple myeloma.

Also, fam-trastuzumab deruxtecan (T-DXd) garnered a site-agnostic approval for HER2 amplified solid tumors.

Finally, the ALINA study, adjuvant alectinib in ALK+ NSCLC, was published in this week's NEJM.

Tumor Lysis Syndrome (TLS) is a foundational topic for all oncology clinicians. We discuss the what, the why, prevention, and treatment.

Discussing four papers that caught our eyes from the last few weeks:

Pazopanib vs. placebo following metastatectomy. Always concerning when placebo has an OS advantage.

ECOG-ACRIN E2810: https://doi.org/10.1200/JCO.23.01544

Gemcitabine vs. Gem + Paclitaxel (Taxol) in pancreatic cancer patients after FOLFIRINOX: https://doi.org/10.1200/JCO.23.00795

An RNA assay to predict gemcitabine sensitivity: https://doi.org/10.1200/JCO.22.02668

Management of skin cancers with ICIs in kidney transplant patients: https://doi.org/10.1200/JCO.23.02570

Two recent publications suggest more people may be choosing non-colonoscopy screening practices in the future. One is a new stool DNA test, while the other is a blood test.

How do they compare to the gold standard of colonoscopy?

Cell-free DNA blood test: DOI: 10.1056/NEJMoa2304714

Next generation stool DNA test: DOI: 10.1056/NEJMoa2310336

EV-302 is finally published, and you have to squint to find any major critiques. Enfortumab bedouin + pembrolizumab fully arrives as a standard 1st-line regimen of advanced urothelial cancer.

Also, nivolumab gets a 1st-line FDA approval for urothelial carcinoma in conjunction with cisplatin + gemcitabine based on CHECKMATE-901.

Two nice studies have been recently published in the supportive care realm.

SPARED asks if we can omit dexamethasone on days 2-4 following cisplatin-based chemotherapy.

D-TORCH asks if topical diclofenac can prevent capecitabine-induced hand-foot syndrome.

SPARED: https://doi.org/10.1038/s41416-023-02493-7

D-TORCH: https://doi.org/10.1200/JCO.23.01730