ASTRO backs trimodality therapy as an alternative to cystectomy for selected muscle-invasive bladder cancer

The edition in brief

The American Society for Radiation Oncology guideline recommends multidisciplinary evaluation for all bladder cancer patients and endorses trimodality therapy (maximal resection, radiotherapy with concurrent radiosensitising systemic therapy) as an alternative to radical cystectomy for selected cT2–4aN0M0 disease, with conditional adjuvant radiotherapy after cystectomy for pT3–4, node-positive or margin-positive disease. In EMERALD-3 (760 patients with embolisation-eligible hepatocellular carcinoma), durvalumab plus tremelimumab plus lenvatinib with TACE improved median progression-free survival to 13.0 from 9.8 months with TACE alone (HR 0.70), but overall survival was not significantly different at the second cut-off (HR 0.84, 0.65 to 1.09), serious adverse events were 64% against 23%, and 2% had treatment-related deaths. A meta-analysis of seven prospective cohorts found postoperative ctDNA positivity in colorectal cancer associated with a sevenfold recurrence risk (HR 7.60), but randomised decision evidence supports only selective stage II de-escalation, not routine stage III de-escalation or empiric escalation. ALINA quality-of-life data show adjuvant alectinib for resected ALK-positive NSCLC was well tolerated, with fewer serious treatment-related events than chemotherapy (2% vs 7%) and quality of life near population norms over two years. The FDA lists a supplemental approval for ZELBORAF (vemurafenib); the record does not state its content.