The edition · Oncology
What comes after FOLFIRINOX in pancreatic cancer, and ctDNA as a prognostic signal in advanced breast cancer
Pooled data from 3,888 patients put median survival from second-line therapy at about 7.6 months, with performance status the strongest predictor. Raised baseline ctDNA was linked to two to two and a half times the hazard of progression and death in advanced breast cancer.
The edition in brief
A meta-analysis of 23 mostly retrospective studies (3,888 patients) of second-line therapy after first-line FOLFIRINOX or NALIRIFOX for metastatic pancreatic cancer found pooled median overall survival of 7.6 months and progression-free survival of 3.2 months; gemcitabine-based combinations did better than monotherapy in patients with ECOG 0–1, and performance status was the strongest predictor. The only phase 3 trial, GEMPAX, improved progression-free survival but not overall survival with gemcitabine plus paclitaxel. A meta-analysis of 64 studies in advanced breast cancer found raised baseline ctDNA associated with shorter progression-free (HR 2.0) and overall survival (HR 2.6), and rising ctDNA on treatment with worse outcomes; its value in changing treatment remains unproven. A new prognostic model for metastatic clear cell renal carcinoma in the checkpoint-inhibitor era, built from CheckMate-214 and validated in CheckMate-9ER, discriminated better than IMDC (C-index 0.72 v 0.61–0.65). A post hoc safety analysis of OptiTROP-Breast01 found severe haematological toxicity and stomatitis with sacituzumab tirumotecan mostly arose in the first two cycles and usually settled within 14 days with dose modification. The FDA recorded a supplement to the lenvatinib licence on 24 September; its content is not specified. The pearl covers febrile neutropenia.
Sacituzumab tirumotecan: severe toxicities cluster in the first two cycles
Concentrate toxicity monitoring on the first two cycles of sac-TMT and manage with dose modification.
FDA records a supplement to the lenvatinib licence
No change to lenvatinib prescribing until the updated label shows what this supplement altered.
Raised ctDNA was linked to double the hazard of progression in advanced breast cancer
Treat ctDNA levels in advanced breast cancer as prognostic, not yet as a trigger to change treatment.
A checkpoint-era prognostic model for metastatic clear cell RCC outperformed IMDC
Expect prognostic scoring in metastatic clear cell RCC to be updated for the checkpoint era; IMDC remains standard for now.
Febrile neutropenia: antibiotics within the hour, investigations in parallel
Treat suspected febrile neutropenia with antibiotics within the hour, before results are back.
After FOLFIRINOX, gemcitabine combinations for fit patients; performance status decides
After first-line FOLFIRINOX, offer gemcitabine-based combination therapy to fit patients and let performance status guide the rest.
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