The edition · Oncology
Faecal blood screening cut colorectal cancer deaths by 11% in trials, but not deaths overall
A meta-analysis of 1.5 million adults in screening trials restates what FOBT screening does and does not do; OPTIMUM's five-year data link risk-adapted therapy to less than half the risk of death in high-risk myeloma compared with a matched external control; and AI scoring of TILs flags more HER2-positive patients who may gain from pertuzumab.
The edition in brief
In randomised trials of guaiac faecal occult blood screening (1,474,576 participants), colorectal cancer mortality fell (RR 0.89, 0.84 to 0.94; 38 fewer deaths per 100,000 screened), but all-cause mortality did not (RR 1.00); non-randomised FIT programme data suggested larger benefits at low certainty. Five-year follow-up of OPTIMUM (107 patients with newly diagnosed high-risk myeloma) showed longer progression-free survival (HR 0.32) and overall survival (HR 0.43) with daratumumab-based quintuplet induction, extended consolidation and maintenance compared with a genetically matched external control from Myeloma XI; in a post-hoc subgroup, the benefit was not seen in those with three or more high-risk abnormalities. In APHINITY tissue, higher stromal tumour-infiltrating lymphocytes predicted better invasive disease-free survival, pertuzumab's benefit was greater at higher TIL levels in exploratory analyses, and AI scoring reclassified 11.6% of node-positive tumours as immune-high. In KRAS G12C colorectal cancer, adding the FAK inhibitor ifebemtinib to garsorasib raised response from 16.7% to 38.9% in a small randomised phase 2, not statistically significant. SITC updated its guideline on immunotherapy for acute leukaemia.
Risk-adapted daratumumab quintuplet therapy was linked to less than half the progression risk of an external control in high-risk myeloma at five years
Test every new myeloma for high-risk cytogenetics, and consider intensified, extended daratumumab-based therapy for those who carry them.
Higher TILs marked who gained most from pertuzumab in HER2-positive early breast cancer
Stromal TILs add prognostic and possibly predictive information in HER2-positive breast cancer at almost no cost; include them in reports.
Adding a FAK inhibitor to KRAS G12C blockade doubled response in colorectal cancer, not significantly
An oral FAK inhibitor partner for KRAS G12C blockade showed a promising but unproven response signal; it remains investigational.
SITC updates its guideline on immunotherapy for acute leukaemia
Use the updated SITC guideline to plan immunotherapy sequencing and toxicity management in acute leukaemia.
Fever after a T-cell engager or CAR-T: treat for cytokine release and infection together
In a patient recently given a T-cell engager or CAR-T, fever or confusion needs same-day contact with the treating team.
Faecal blood screening cut colorectal cancer deaths by 11% in trials, but not all-cause mortality
Stool-based screening, preferably FIT with prompt colonoscopy for positives, reduces colorectal cancer death; present it honestly as cancer-specific benefit.
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