The edition · Oncology
A chemo-free TKI-plus-radiotherapy strategy stopped early for a PFS gap of 26 months
ADVANCE randomised only 43 patients before the interim analysis halted it, a new prognostic index outperforms IMDC in metastatic renal cell carcinoma, and French paediatric oncologists set out when not to screen for thrombophilia in childhood leukaemia.
The edition in brief
Today's oncology edition opens with the CPI2 model, developed on CheckMate-214 and externally validated on CheckMate-9ER, which uses 14 routinely available clinical and laboratory parameters and achieved a 36-month discriminative accuracy of 0.72 in both cohorts against 0.65 and 0.61 for the IMDC classification. PD-L1 expression added nothing. A secondary analysis of a randomised salvage radiotherapy trial in post-prostatectomy men found African American men had higher failure-free survival than men of other races (72.8% vs 58.7%) despite lower socioeconomic status and higher allostatic load — a result from a setting where access to care was equalised by trial protocol. The French Society for Childhood Cancer has published harmonised recommendations on venous thromboembolism in paediatric acute lymphoblastic leukaemia: no routine thrombophilia screening, no routine primary prophylaxis, low-molecular-weight heparin first line where prophylaxis is indicated, and thrombophilia testing performed away from asparaginase exposure. A Lancet Oncology review from the International Immuno-Oncology Biomarker Working Group sets out how little is known about tumour-infiltrating lymphocytes and radiotherapy response in breast cancer. The edition closes on ADVANCE, a phase 3 trial of aumolertinib plus definitive radiotherapy against chemoradiotherapy in unresectable stage III EGFR-mutant non-small-cell lung cancer, stopped early after 43 patients with a median progression-free survival of 34.0 against 7.4 months.
A new renal cell prognostic index outperforms IMDC, and PD-L1 adds nothing
A better prognostic classification for trial stratification, not yet a reason to change how you counsel a patient.
French paediatric oncologists say do not screen for thrombophilia, and do not prophylax routinely
No routine thrombophilia screen and no routine prophylaxis — reserve both for children whose risk factors actually justify them.
When access was equalised by trial protocol, the racial outcome gap reversed
Where access to care was equalised, the expected outcome disparity did not appear — which locates the problem outside the tumour.
Nobody knows whether tumour-infiltrating lymphocytes predict radiotherapy response in breast cancer
Nothing to change in clinic; if you contribute to radiotherapy trials, make sure TILs are being recorded.
Confirm the EGFR result before the radiotherapy plan is signed off
No stage III lung plan should be signed off without knowing whether the molecular result is back, pending or never sent.
Dropping chemotherapy in EGFR-mutant stage III lung cancer: a large signal from a tiny trial
Put a chemotherapy-free TKI-plus-radiotherapy option on the table for stage III EGFR-mutant disease, while being clear the effect size will shrink with more data.
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