The edition · Oncology
First colonoscopy at five years matched three years after high-risk adenoma removal at interim analysis
An interim noninferiority result in 10,799 patients, five-year follow-up of a quadruplet-based strategy in high-risk myeloma, an association between wildfire smoke and survival in older lung cancer patients, and recommendations for reporting quality of life in adjuvant trials.
The edition in brief
In the EPoS II trial, 10,799 patients with high-risk adenomas were randomised to a first surveillance colonoscopy at 5 years or 3 years after polyp removal. At an interim analysis after 5.5 years, five-year colorectal cancer incidence was 0.77% against 0.82% (difference -0.05 percentage points; upper boundary of the 99.12% confidence interval 0.68, within the 0.7 margin), meeting the interim noninferiority criterion; five patients died of colorectal cancer. The trial is ongoing to 10 years, and current guidelines recommend surveillance at 3 years. A five-year follow-up of the UK OPTIMUM phase 2 trial, compared with a matched external control from Myeloma XI, reported longer progression-free survival (hazard ratio 0.32, 95% CI 0.22 to 0.45) and overall survival (0.43, 0.28 to 0.65) with a daratumumab-based quadruplet, extended consolidation and maintenance in 107 patients with high-risk myeloma, except in those with three or more high-risk cytogenetic abnormalities. An external-control comparison is not randomised. A SEER-Medicare cohort of 414,016 older patients with lung cancer linked wildfire-related PM2.5 to shorter survival (HR 1.0782 per 1 microgram per cubic metre). Common-Sense Oncology and EORTC recommend that adjuvant trials report the proportion with a prespecified quality-of-life deterioration and its duration. The pearl covers giving absolute benefit figures.
Quadruplet induction with extended consolidation held up at five years in high-risk myeloma, against an external control
Consider risk-stratified, extended quadruplet-based therapy in transplant-eligible high-risk myeloma, recognising the evidence comes from a non-randomised comparison.
Wildfire smoke exposure was linked to shorter survival in older people with lung cancer
Consider asking about air pollution exposure and advising mitigation on high-pollution days, without expecting a large individual effect.
How adjuvant trials should report quality of life
When reading an adjuvant trial, check whether it reports the proportion with quality-of-life deterioration and its duration.
Give patients the absolute benefit, not just the relative one
Quote absolute benefit and harm, with time frames, when discussing cancer treatment.
First surveillance colonoscopy at five years was noninferior to three years at interim analysis
Keep guideline surveillance intervals for now, and watch for the 10-year results of EPoS II before shortening or lengthening them.
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