Iberdomide doubles MRD negativity in relapsed myeloma at a cost in infections, and longer scalp cooling may save more hair

The edition in brief

In EXCALIBER-RRMM, an open-label phase 3 trial in relapsed or refractory myeloma after one or two prior lines, iberdomide with daratumumab and dexamethasone produced MRD-negative complete response in 41% of the first 420 patients against 21% with daratumumab, bortezomib and dexamethasone (difference 20.1 points). Grade 3–4 adverse events were more common (92% vs 70%), including neutropenia in 84% and pneumonia as a serious event in 18%. Progression-free survival, the second primary endpoint, is still being assessed. A network meta-analysis of 12 trials (736 patients) found scalp cooling continued for more than 90 minutes after chemotherapy ranked highest for preventing alopecia, with low to very low certainty. Long-term follow-up of a Chinese phase 3 trial of entinostat plus exemestane in HR-positive, HER2-negative advanced breast cancer found median overall survival of 38.6 versus 29.2 months, but HR 0.83 (0.62–1.10) was not significant. A meta-analysis of 10 studies found PIK3CA and BRAF mutations associated with shorter progression-free and overall survival in RAS wild-type metastatic colorectal cancer treated with first-line anti-EGFR therapy. The pearl covers extended RAS and BRAF testing before anti-EGFR treatment.