The edition · Oncology
A second lumpectomy is now a defensible choice, not a compromise
An international Delphi consensus reaches agreement on 80% of items for local recurrence after breast conservation; a nectin-4 antibody-drug conjugate reports phase 1 safety in 395 patients; and 39 trials put early palliative care ahead on quality of life and, exploratorily, survival.
The edition in brief
The oncology desk opens with an international Delphi consensus on local management of a second ipsilateral breast cancer event after primary breast-conserving therapy — 36 panellists across surgical and radiation oncology, consensus on 78 of 97 items, with unanimous agreement that a second breast-conserving therapy is reasonable in selected patients and that HER2-positive and triple-negative subtypes are not absolute contraindications. A phase 1 trial of SHR-A2102, a nectin-4-directed antibody-drug conjugate with a topoisomerase I inhibitor payload, treated 395 Chinese patients with pretreated advanced solid tumours across 39 hospitals; grade 3-4 treatment-related adverse events occurred in 54%, dominated by neutropenia, with two treatment-related deaths and no maximum tolerated dose reached. The Global Burden of Disease 2023 analysis for Africa estimates 1.54 million incident cancers and 923,000 deaths in 2023, with childhood cancer accounting for 27.7% of global incidence but 38.0% of global deaths, and risk-attributable deaths up 216% since 1990. A review sets out where myeloproliferative neoplasm therapy is heading, towards selective targeting of mutant CALR and JAK2 V617F. A pearl covers febrile neutropenia. The edition closes with a meta-analysis of 39 randomised trials in 8,399 patients finding early palliative care improved quality of life (SMD 0.30, 95% CI 0.25-0.35) with an exploratory survival signal (HR 0.84, 0.78-0.90).
Local recurrence after conservation: the panel says conserve again
Before recommending mastectomy for an in-breast recurrence, check the interval, the profile and the previous toxicity — a second conservation may be reasonable.
A nectin-4 ADC with a topoisomerase payload: the toxicity is haematological
Note the target and the payload swap, and wait for efficacy data before forming a view.
Africa carries 28% of childhood cancers and 38% of the deaths from them
Where resources are finite, the numbers argue for early diagnosis and prevention ahead of expanding late-line treatment.
Myeloproliferative neoplasms are moving from control to clonal targeting
Tell patients plainly that current treatment controls the disease rather than modifies it — and that this is what the new agents are trying to change.
In neutropenia, one temperature is enough
One temperature of 38.3°C in a neutropenic patient means antibiotics within the hour, before any other step.
Early palliative care: 39 trials, and the survival signal is still there
Build a palliative care referral into the point of diagnosis for advanced disease, not into the point where treatment stops working.
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