High-risk myeloma: five-year survival gain with risk-stratified extended therapy against an external control; genomic-test drugs reach fewer patients

The edition in brief

At 5-year follow-up of the single-arm OPTIMUM phase 2 trial, 107 patients with newly diagnosed high-risk multiple myeloma or plasma cell leukaemia given daratumumab-based quadruplet induction, transplant, extended consolidation and maintenance had progression-free survival not reached against 24.4 months in 120 genetically matched external controls (HR 0.32, 95% CI 0.22 to 0.45) and overall survival hazard ratio 0.43 (0.28 to 0.65); benefit was not seen in patients with three or more high-risk cytogenetic abnormalities. The comparison is non-randomised. A retrospective analysis of 41 essential cancer medicines across 71 countries found medicines requiring complex genomic diagnostics had 65% lower uptake than those needing none, with the lowest uptake in lower-GDP countries. In 414,016 older US patients with lung cancer, higher long-term exposure to wildfire-related fine particulate matter was associated with higher mortality, with greater harm per unit than non-wildfire particles (HR 1.078 per microgram per cubic metre, 95% CI 1.064 to 1.092). A single-arm meta-analysis of 357 patients with recurrent or metastatic nasopharyngeal carcinoma found PD-1 inhibitors plus anti-angiogenic drugs gave a 48% response rate with 47% grade 3 or higher toxicity. Home-based exercise rehabilitation improved fitness and quality of life in nine randomised trials of 632 people with cancer.