{

"episode_title": "DREAMM-7 Updated Overall Survival: Belantamab Mafodotin with BVd in Relapsed/Refractory Multiple Myeloma",

"podcast_show": "PACUPod",

"description": "In this episode of PACUPod, we review the updated overall survival results from the DREAMM-7 phase 3 trial, testing belantamab mafodotin in combination with bortezomib and dexamethasone (BVd) versus daratumumab, bortezomib, and dexamethasone (DVd) in relapsed or refractory multiple myeloma. We discuss the significant OS improvement (hazard ratio 0.58; p=0.0002), deeper responses with higher MRD negativity, longer duration of response, and safety considerations including thrombocytopenia and ocular keratopathy, along with monitoring strategies. We also cover clinical implications, limitations (notably underrepresentation of Black patients), and future directions including DREAMM-8 and sequencing with other BCMA-targeted therapies.",

"study_title": "Belantamab mafodotin plus bortezomib and dexamethasone in RRMM: DREAMM-7 updated OS analysis",

"trial_design": "Global, randomized, open-label phase 3 trial",

"trial_details": {

"n_patients": 494,

"population": "Relapsed or refractory multiple myeloma after at least one prior line",

"exclusions": ["prior anti-BCMA therapy", "significant ocular disease"],

"primary_endpoint": "Progression-free survival",

"update_endpoints": ["Overall survival", "Minimal residual disease negativity", "Duration of response", "Safety"]

},

"interventions": {

"experimental_arm": "Belantamab mafodotin 2.5 mg/kg IV q3 weeks + bortezomib + dexamethasone",

"comparator_arm": "Daratumumab + bortezomib + dexamethasone"

},

"key_results": {

"overall_survival": {

"hazard_ratio": 0.58,

"p_value": 0.0002,

"median_OS": {

"BVd": "not reached",

"DVd": "34.5 months"

}

},

"MRD_negativity": {

"BVd": "25%",

"DVd": "10%"

},

"duration_of_response": {

"BVd": "40.8 months",

"DVd": "17.8 months"

}

},

"safety": {

"thrombocytopenia": {

"BVd": "56%",

"DVd": "35%"

},

"ocular_events": {

"keratopathy": "about 40%",

"nature": "mostly low-grade and reversible with interruptions/dose adjustments"

},

"monitoring_recommendations": "Regular ophthalmologic monitoring; manage with dose modifications and treatment interruptions"

},

"clinical_implications": [

"BVd is a promising triplet regimen for RRMM after ≥1 prior therapy, especially lenalidomide-refractory",

"Ocular toxicity requires monitoring and management",

"Safety profile compared to T-cell redirecting therapies may be favorable",

"Supports belantamab-based triplets as a new standard of care in RRMM"

],

"limitations": [

"Underrepresentation of Black patients",

"Long-term safety and cumulative toxicity unknown",

"Open-label design despite independent efficacy assessment"

],

"future_directions": [

"DREAMM-8 (belantamab with pomalidomide/dexamethasone)",

"Sequencing with other BCMA-targeted therapies (CAR-T, bispecifics)",

"Head-to-head comparisons of belantamab-based triplets"

],

"references": [

"Hungria et al. Lancet Oncology; DREAMM-7 updated OS analysis"

],

"keywords": [

"DREAMM-7",

"belantamab mafodotin",

"BVd",

"DVd",

"bortezomib",

{

"episode_title": "ECHELON-2 5-Year Follow-Up: Brentuximab Vedotin Plus CHP in Frontline sALCL",

"episode_description": "In this PACUPod episode, Britany and Seth dissect the five-year subgroup analysis of the ECHELON-2 trial focused on frontline systemic anaplastic large cell lymphoma (sALCL). They compare brentuximab vedotin plus CHP (BV+CHP) against CHOP in untreated CD30-positive PTCL, highlighting long-term efficacy and safety. Key findings include progression-free survival not reached with BV+CHP versus 29.4 months with CHOP (HR 0.71, P=0.011), five-year overall survival of 70.1% vs 60.9%, and higher complete remission rates (67% vs 50%). The discussion covers tolerability (noting higher—but generally reversible—peripheral neuropathy with BV+CHP and lower febrile neutropenia), the rationale for omitting vincristine to reduce neurotoxicity, mechanistic insights into CD30 targeting and MMAE delivery, dosing (1.8 mg/kg every 3 weeks for 6–8 cycles), and practical implications including NCCN category 1 frontline recommendation for sALCL. The hosts also address patient selection, real-world applicability, potential roles for consolidative stem cell transplant, and directions for future research.",

"keywords_json": {

"keywords": [

"ECHELON-2",

"brentuximab vedotin",

"CHP",

"CHOP",

"frontline therapy",

"systemic anaplastic large cell lymphoma",

"sALCL",

"CD30-positive",

"ALK-positive",

"ALK-negative",

"progression-free survival",

"overall survival",

"complete remission",

"hazard ratio",

"five-year follow-up",

"peripheral neuropathy",

"febrile neutropenia",

"neurotoxicity",

"dosing 1.8 mg/kg",

"every 3 weeks",

"six to eight cycles",

"vincristine omission",

"antibody-drug conjugate",

"monomethyl auristatin E",

"NCCN category 1",

"real-world data",

"Sasaki 2020",

"Horwitz meta-analysis",

"consolidative stem

In this PACULit update, Britany and Seth discuss Groninger and colleagues' pilot study on using virtual reality (VR) as a nonpharmacologic adjunct for outpatient management of chronic cancer pain. The single-arm trial enrolled 33 adult outpatients with persistent cancer pain to evaluate a phased VR dosing regimen over three weeks using the Meta Quest 2 headset. Primary outcome was pain intensity (numeric rating scale); secondary outcomes included PROMIS pain interference, patient satisfaction, and breakthrough opioid use. Results showed significant reductions in pain intensity and interference and an increase in satisfaction, with no significant change in opioid use. The episode covers dosing implications (twice-daily sessions in week two may be more effective), study strengths/limitations, and the need for larger randomized trials to confirm analgesic effects and potential opioid-sparing benefits. Contextual notes highlight the growing VR oncology literature and implications for outpatient pain management and multimodal analgesia.

In this PACUPod episode, hosts Britany and Seth dissect the INAVO120 phase III trial evaluating inavolisib, a PI3K-alpha inhibitor, combined with palbociclib and fulvestrant in hormone receptor-positive, HER2-negative, PIK3CA-mutated advanced breast cancer. They discuss the clinical context, trial design (randomized, double-blind, placebo-controlled), patient population, endpoints (overall survival as primary, with progression-free survival and objective response rate as secondary), key results (approximate hazard ratio of 0.75 indicating a 25% reduction in risk of death), and safety considerations with a focus on hyperglycemia and metabolic monitoring. The episode covers management strategies for toxicities, drug interactions via CYP pathways, comparisons to prior PI3K inhibitors such as alpelisib (SOLAR-1), real-world applicability, sequencing considerations, and future directions for precision oncology. Practical takeaways for clinicians include molecular profiling importance, multidisciplinary management, and how this trial informs treatment paradigms for patients with endocrine-resistant, PIK3CA-mutated breast cancer.