The edition · Oncology
Multicancer screening falls short, a win in ovarian cancer, and less chemo in child ALL
The NHS-Galleri trial finds a multicancer blood test did not cut late-stage diagnoses, KEYLYNK-001 shows a pembrolizumab-olaparib maintenance benefit in BRCA non-mutated ovarian cancer, supervised exercise eases ADT effects, and blinatumomab replacing chemotherapy improves survival in high-risk childhood ALL.
The edition in brief
Five findings for medical and haemato-oncologists. In the 142,250-participant NHS-Galleri randomised trial, three rounds of a multicancer early-detection blood test did not reduce the incidence of stage III or IV cancer across 12 cancer types (incidence rate ratio 1.03), with only a borderline signal for stage IV disease (0.86); it is not yet a proven screening tool. KEYLYNK-001 found that adding pembrolizumab to chemotherapy followed by pembrolizumab-olaparib maintenance improved progression-free survival in BRCA non-mutated advanced ovarian cancer (intention-to-treat hazard ratio 0.71), with more toxicity, while pembrolizumab alone did not help. The STAMINA trial showed a supervised exercise and dietary intervention improved quality of life and fatigue in men on androgen deprivation therapy. A pearl covers recognising immune-related adverse events on checkpoint inhibitors. The practice-changer is a randomised trial in high-risk childhood B-cell ALL: replacing two cycles of intensive chemotherapy with blinatumomab raised four-year event-free survival from 70.3% to 83.0% and cut serious infections from 69% to 24%.
A multicancer blood test did not cut late-stage diagnoses
Do not offer multicancer early-detection blood testing as screening yet; the first large randomised trial showed no reduction in late-stage cancer on its primary endpoint.
KEYLYNK-001: a maintenance benefit in BRCA non-mutated ovarian cancer
Consider pembrolizumab plus chemotherapy with pembrolizumab-olaparib maintenance for BRCA non-mutated advanced ovarian cancer, weighing the added toxicity; pembrolizumab alone is not the active component.
STAMINA: supervised exercise eases the toll of androgen deprivation
Refer men on androgen deprivation therapy to a structured, supervised exercise and dietary programme rather than relying on advice alone.
Recognising immune-related adverse events on checkpoint inhibitors
In any patient on or recently on a checkpoint inhibitor, consider an immune-related adverse event before blaming infection or progression, and treat significant events with prompt steroids and drug hold.
Blinatumomab replaces chemotherapy cycles in high-risk childhood ALL
In high-risk childhood B-cell ALL, replacing two cycles of intensive chemotherapy with blinatumomab improves event-free survival and markedly reduces infection and life-threatening toxicity.
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