The edition · Oncology
Blinatumomab replaces two chemotherapy cycles and improves survival while halving harm, and sunvozertinib takes first line in EGFR exon 20
Four-year event-free survival in high-risk paediatric B-cell ALL rises from 70% to 83% with two cycles of blinatumomab in place of chemotherapy; KEYLYNK-001 shows the olaparib arm, not the pembrolizumab arm, carries the benefit in BRCA non-mutated ovarian cancer; AI-scored TILs work but add nothing to a pathologist; and surveillance colonoscopy at five years holds against three.
The edition in brief
In AIEOP-BFM ALL 2017, 709 children with newly diagnosed high-risk B-cell acute lymphoblastic leukaemia were randomised after consolidation to two cycles of blinatumomab or two cycles of chemotherapy. At a planned interim analysis, estimated four-year event-free survival was 83.0% versus 70.3% (HR 0.51, 95% CI 0.35-0.73), with treatment-related infection in 23.9% versus 69.4% and life-threatening adverse events in 0.5% versus 4.7%; neurotoxic events were more frequent with blinatumomab (12.0% vs 3.2%). KEYLYNK-001 randomised 1,367 patients with BRCA non-mutated stage III-IV epithelial ovarian cancer to pembrolizumab plus chemotherapy then pembrolizumab-olaparib maintenance, pembrolizumab alone, or control. Progression-free survival improved with pembrolizumab-olaparib (final analysis HR 0.66, 95% CI 0.53-0.83 in PD-L1 CPS 10 or higher; 0.71, 0.61-0.84 in the intention-to-treat population), while pembrolizumab alone did not (HR 0.95, 0.77-1.19). Grade 3 or higher treatment-related adverse events were 66% versus 51% in the control group. The CATALINA validation study of 1,356 patients with early triple-negative breast cancer found AI-derived TIL scores prognostic for invasive disease-free survival (HR 0.80, 0.73-0.89) but not incrementally informative once pathologist stromal TIL scores were in the model. EPoS II found a first surveillance colonoscopy at five years after high-risk adenoma removal noninferior to three years at interim analysis. The edition closes on WU-KONG28, in which first-line sunvozertinib extended median progression-free survival to 10.3 months against 7.5 with chemotherapy.
Two cycles of blinatumomab in place of chemotherapy: four-year event-free survival 83% against 70%
In high-risk paediatric B-cell ALL, replacing two chemotherapy cycles with blinatumomab improves four-year event-free survival by about 13 points and cuts treatment-related infection to a third.
In BRCA non-mutated ovarian cancer, the benefit sits with olaparib — pembrolizumab alone did nothing
The maintenance benefit in BRCA non-mutated ovarian cancer tracked olaparib, not pembrolizumab — adding a checkpoint inhibitor to get it is not supported.
AI-scored tumour-infiltrating lymphocytes are prognostic — and add nothing once a pathologist has scored them
Automated TIL scoring is a reasonable substitute where no pathologist scores TILs, and a redundant addition where one does.
Surveillance colonoscopy at five years after high-risk adenoma removal held against three
For high-risk adenomas as defined here, a five-year first surveillance interval is supported on interim data — and the capacity it releases belongs to symptomatic patients.
In febrile neutropenia, give the antibiotic before the blood count comes back
Fever plus recent chemotherapy is the indication for immediate broad-spectrum antibiotics — never wait for the neutrophil count.
First-line sunvozertinib beat chemotherapy in EGFR exon 20 insertion NSCLC
Test explicitly for EGFR exon 20 insertions in advanced non-squamous NSCLC, and use sunvozertinib first line where one is found and the drug can be obtained.
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