The edition · Oncology
Supervised exercise on androgen deprivation therapy works when it is built into the service, and adjuvant alectinib costs nothing in quality of life
A 700-man randomised trial embeds exercise and dietary support in NHS prostate cancer care and improves quality of life and fatigue, a FAK inhibitor added to a KRAS G12C inhibitor raises response rates without reaching significance, and AI-scored tumour-infiltrating lymphocytes validate but add nothing to a pathologist.
The edition in brief
STAMINA randomised 700 men on androgen deprivation therapy across 15 NHS trusts to a 12-month supervised exercise and dietary intervention or to optimised usual care. At 12 months the intervention improved cancer-specific quality of life (FACT-P adjusted mean difference 4.5, 97.2% CI 1.7-7.2) and fatigue (FACIT-F 1.9, 0.4-3.4). Three intervention-related serious adverse events occurred, all recovered. The differences are statistically clear and modest in size, and the cohort was 97% White with a median age of 71.6. A phase 1b/2 Chinese study added the focal adhesion kinase inhibitor ifebemtinib to the KRAS G12C inhibitor garsorasib in previously treated KRAS G12C-mutated metastatic colorectal cancer. In the randomised part, confirmed objective response was 38.9% with the combination against 16.7% with garsorasib alone - a 22.2 percentage-point difference whose confidence interval spans -7.7 to 49.1 and did not reach significance. Grade 3 events were similar between arms; diarrhoea was the commonest. CATALINA validated two locked artificial-intelligence pipelines for scoring tumour-infiltrating lymphocytes against pathologist scores in 1,356 patients with early triple-negative breast cancer from seven randomised trials. Computational scores were independently prognostic for invasive disease-free survival (HR 0.80, 0.73-0.89) but added nothing once pathologist scores were in the model, and correlation between the two was modest (r 0.375-0.473). The FDA acted on a supplemental application for abrocitinib (Cibinqo), a JAK1 inhibitor for atopic dermatitis; the record does not say what changed. ALINA's safety and quality-of-life data show adjuvant alectinib for 24 months in resected ALK-positive lung cancer was better tolerated than four cycles of platinum chemotherapy, with fewer discontinuations and quality of life returning to population norms.
Exercise during androgen deprivation therapy works, when somebody is paid to deliver it
A 12-month supervised exercise and dietary programme improved quality of life and fatigue in men on androgen deprivation therapy, and it beat a usual-care arm that already included clinician training and written advice.
Adding a FAK inhibitor to garsorasib doubled the response rate, on 36 patients
Adding the FAK inhibitor ifebemtinib to garsorasib roughly doubled the response rate in KRAS G12C-mutated metastatic colorectal cancer, but on 36 randomised patients the difference did not reach statistical significance.
AI-scored lymphocytes are prognostic, and add nothing a pathologist has not already given you
Computational tumour-infiltrating lymphocyte scores are independently prognostic in triple-negative breast cancer but add nothing once a pathologist's score is available, so their place is where that expertise is missing.
FDA acts on a supplemental application for the JAK inhibitor abrocitinib
The FDA acted on a supplement for the JAK1 inhibitor abrocitinib, with no published detail of what changed, so nothing follows for advising cancer survivors about JAK inhibitors today.
The safety-to-exercise check is four questions long
Clear a cancer patient for supervised exercise on four checks - bone metastases, cardiac status, neuropathy and blood counts - and write the answers into the referral so the programme can start on day one.
Two years of adjuvant alectinib was easier than four cycles of platinum
Adjuvant alectinib for 24 months in resected ALK-positive lung cancer caused fewer serious adverse events and fewer discontinuations than platinum chemotherapy, with quality of life returning to general-population levels - so length of treatment is not a reason to prefer chemotherapy.
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