The edition · Oncology
One in five adults on R-CHOP had febrile neutropenia in routine care, and a new prognostic index outperformed IMDC in metastatic kidney cancer
Real-world cohorts put febrile neutropenia during first-line R-CHOP at the 20% threshold for primary G-CSF prophylaxis, well above trial figures. CPI2, built on checkpoint-era trial data, sorted metastatic clear cell renal cancer prognosis more accurately than IMDC.
The edition in brief
A meta-analysis of 15 studies (5,440 adults with diffuse large B-cell lymphoma on first-line R-CHOP or similar) found pooled febrile neutropenia incidence of 19.0% (17.1% to 21.1%) across ten observational cohorts, with a prediction interval of 15.3% to 23.3%, against 11.7% in heterogeneous trials. The new CPI2 prognostic model for metastatic clear cell renal cell carcinoma, built from CheckMate-214 and validated in CheckMate-9ER using 14 routine clinical and laboratory variables, achieved a C-index of 0.72 in both, against 0.65 and 0.61 for IMDC; PD-L1 added nothing. A meta-analysis of nine studies (528 people) of MEK inhibitors for symptomatic inoperable NF1 plexiform neurofibromas found a descriptive response rate of 53.7%, higher in children (62.9%) than adults (40.8%), with mostly low-grade toxicity. A Lancet Oncology policy review argues cancer susceptibility testing has outpaced evidence beyond first-wave genes such as BRCA1/2, MLH1 and MSH2, and proposes tiered, context-specific use. The FDA recorded a supplemental approval for pirtobrutinib on 2 October; the record does not state its content. Today's evidence is observational, model-based or policy; none is a new treatment trial.
FDA supplemental approval recorded for pirtobrutinib
A supplemental FDA approval for pirtobrutinib was recorded on 2 October; check the label for what changed before acting on it.
Germline cancer testing has outrun its evidence beyond the first-wave genes
Act firmly on BRCA and Lynch syndrome results, but treat findings in less-established panel genes and polygenic scores with caution and genetics input.
CPI2 predicted survival in metastatic clear cell kidney cancer better than IMDC
Keep using IMDC for now, but expect CPI2 to sort prognosis more accurately under checkpoint-based treatment once validated outside trials.
MEK inhibitors shrank about half of inoperable NF1 plexiform neurofibromas
Consider MEK inhibitor therapy for symptomatic inoperable NF1 plexiform neurofibromas, with cardiac and eye monitoring and realistic expectations of partial response.
Give antibiotics within an hour of febrile neutropenia, before results
Start empirical antibiotics within an hour for suspected febrile neutropenia, without waiting for the count.
Febrile neutropenia on first-line R-CHOP ran at about 19% in routine care, at the G-CSF threshold
Consider primary G-CSF prophylaxis for most adults with DLBCL on R-CHOP, because routine-care febrile neutropenia risk is about 20%.
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