Most rectal cancer patients avoided a stoma with CRP-guided diversion

The edition in brief

A randomised trial of 200 patients undergoing laparoscopic low anterior resection for stage II or III rectal cancer compared routine diverting ileostomy with a selective strategy: daily CRP from day 1, contrast CT when CRP exceeded 114 mg/L on day 3 or rose by more than 15 mg/L a day, and a stoma only if CT suggested leak. Ileostomy fell from 100% to 22%, stoma complications from 30% to 3%, and leaks did not differ, though they were rare in both arms and the trial was registered retrospectively. A pooled analysis of three trials in 685 patients with HER2-positive gastro-oesophageal adenocarcinoma found zanidatamab plus chemotherapy produced a 70% response rate and median progression-free survival of about 12.6 months, with grade 3 or worse diarrhoea in about a quarter and serious adverse events in about two-thirds. The phase 2 NANT trial of two cycles of neoadjuvant niraparib in HRD-positive advanced ovarian cancer reported a 63% response rate and 80% R0 resection among those operated on, with grade 3–4 thrombocytopenia in 48%. A Lancet Oncology analysis found essential cancer medicines that need genomic testing had about 65% lower uptake. The pearl covers cardiac monitoring on HER2 therapy.