The edition · Oncology
Signet ring gastric cancer: pooled data found no survival gain from neoadjuvant chemotherapy
Six studies and 5,388 patients leave the question open, and guidelines have not changed. Plus five-year OPTIMUM results in high-risk myeloma, a quicker way to deliver photobiomodulation in children on high-dose methotrexate, and the methotrexate safety checklist.
The edition in brief
A meta-analysis of six studies (5,388 patients) with signet ring cell-containing gastric cancer found no significant overall survival difference between neoadjuvant chemotherapy and upfront surgery (HR 0.96, 95% CI 0.68–1.34), with very high heterogeneity (I² 83%) and consistent results across Western, Eastern, randomised and observational subsets. Perioperative chemotherapy remains the guideline standard, and older regimens dominate the evidence. In the externally controlled phase 2 OPTIMUM trial, intensified daratumumab-based induction, extended consolidation and maintenance in 107 patients with high-risk myeloma gave longer progression-free survival (not reached vs 24.4 months; HR 0.32) and overall survival (not reached vs 57.4 months; HR 0.43) than matched Myeloma XI controls at about six years, except in patients with three or more high-risk abnormalities. In 155 children receiving high-dose methotrexate, extraoral photobiomodulation prevented oral mucositis about as well as intraoral (30.5% vs 41.1%, not significant) and took 30 seconds rather than six minutes per session. The pearl covers the checks that keep high-dose methotrexate safe.
High-risk myeloma: OPTIMUM's extended daratumumab-based therapy held its survival lead at five years
Test for high-risk cytogenetics in every new myeloma diagnosis, and consider risk-adapted intensified therapy for high-risk patients where available.
Photobiomodulation for mucositis: extraoral performed comparably in 30 seconds
Where photobiomodulation is used for children on high-dose methotrexate, consider the extraoral route; it performed comparably in a fraction of the time.
High-dose methotrexate: the checks before and after
Before high-dose methotrexate, check kidney function, remove interacting drugs and third-space fluid, and time folinic acid rescue to levels.
Signet ring gastric cancer: neoadjuvant chemotherapy showed no survival edge, but guidelines stand
Continue perioperative chemotherapy for locally advanced signet ring gastric cancer as guidelines advise, and discuss these patients specifically at the tumour board.
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