The edition · Oncology
A B7-H3 conjugate beat topotecan on survival and on toxicity at the same time
TAISHAN-302 in relapsed small-cell lung cancer, where trastuzumab deruxtecan's advantage does and does not hold, a Commission on who actually gets precision oncology, and a proposal to report what adjuvant therapy costs patients.
The edition in brief
TAISHAN-302 randomised 451 patients with small-cell lung cancer progressing after first-line platinum to tambotatug pelitecan, an antibody-drug conjugate targeting B7-H3, or to topotecan. At the prespecified interim analysis median overall survival was 13.3 months against 9.4 (stratified hazard ratio 0.46, 95% CI 0.35-0.62), progression-free survival 7.4 against 2.8 months (hazard ratio 0.29, 0.23-0.37) and confirmed response 59.1% against 9.7%. Grade 3 or higher adverse events were less frequent with the conjugate, 55.4% against 77.9%. The trial was open-label and this is an interim analysis. A Bayesian network meta-analysis of seven randomised trial families and 3,339 patients with HER2-positive metastatic breast cancer found trastuzumab deruxtecan superior to trastuzumab emtansine for progression-free survival (hazard ratio 3.30 against it, 95% credible interval 2.06-5.28) and overall survival (1.52, 1.19-2.01), with the highest confirmed response rate. Two caveats are load-bearing: it was absent from the second-line-only and Asia-dominant survival networks, and its odds of interstitial lung disease or pneumonitis were 5.55 times those of trastuzumab emtansine (2.79-12.16). A Lancet Oncology Commission reports that access to cancer genomics remains profoundly unequal, that genomic research is concentrated in high-income settings and European-ancestry populations, and that consistent benefit is confined to a few validated biomarker-treatment pairings. Common Sense Oncology and the EORTC propose that adjuvant trials report the proportion of patients experiencing a prespecified deterioration in quality of life, and for how long.
TAISHAN-302: median survival 13.3 months against 9.4 with topotecan
A B7-H3 antibody-drug conjugate roughly halved the hazard of death against topotecan in relapsed small-cell lung cancer, with less high-grade toxicity - but it is not yet available.
Trastuzumab deruxtecan leads the network, with a fivefold pneumonitis signal attached
The efficacy hierarchy favouring trastuzumab deruxtecan holds in indirect comparison, but counsel and monitor for interstitial lung disease, whose odds were over five times those with trastuzumab emtansine.
A Commission on precision oncology says the benefit is narrower than the enthusiasm
Order genomic testing where a validated biomarker-drug pairing and an accessible drug exist, rather than defaulting to comprehensive profiling.
A baricitinib supplement, and why a JAK inhibitor label concerns oncology
Check the revised baricitinib label against the class malignancy warning, and record JAK inhibitor exposure when taking a cancer history.
Ask what the patient thinks the treatment is for
Before describing a regimen, ask the patient what they understand the treatment can do for them, and record the answer.
Adjuvant trials should report how many patients got worse, and for how long
When appraising an adjuvant trial, look for the proportion of patients with a lasting deterioration in quality of life rather than a mean score difference.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for oncology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free