The edition · Oncology
CAR T-cells beat chemoimmunotherapy for transplant-ineligible relapsed lymphoma in a randomised trial
A tandem CD20-CD19 CAR T-cell product more than doubled event-free survival against R-GemOx in patients with a median age of 74; iberdomide doubled MRD-negative responses in relapsed myeloma, with more infections.
The edition in brief
Today's oncology edition opens with the primary analysis of EXCALIBER-RRMM (Lancet Oncology, 25 September), a phase 3 trial in relapsed myeloma after one or two prior lines. Iberdomide with daratumumab and dexamethasone doubled MRD-negative complete response against daratumumab, bortezomib and dexamethasone (41% vs 21%), but grade 3–4 neutropenia (84% vs 11%), infection and pneumonia were all higher, and progression-free survival is not yet reported. MASTERPLAN, a phase 2 trial in high-risk localised pancreatic cancer, found adding five-fraction stereotactic radiotherapy to perioperative chemotherapy cut 12-month locoregional recurrence from 52% to 20%, without a significant rise in severe toxicity; it closed early with 74 patients. In older adults with AML, the EPAG-2015 phase 2 trial found eltrombopag after induction did not improve survival but reduced platelet transfusions by about a fifth. The pearl is the one-hour rule for antibiotics in febrile neutropenia. The practice changer is DALY 2-EU (Lancet Oncology, 1 November): in 160 transplant-ineligible patients with relapsed or refractory large B-cell lymphoma, median age 74, a single infusion of fresh tandem CD20-CD19 CAR T-cells (zamtocabtagene autoleucel) gave event-free survival of 6.2 months against 2.5 with R-GemOx (HR 0.39). Cytokine release syndrome and neurotoxicity occurred, and two treatment-related deaths were recorded. It is the first randomised evidence for CAR T-cell therapy in this older, transplant-ineligible group. Access in India is limited, although locally manufactured CAR T-cell products are emerging.
Iberdomide doubled MRD-negative responses in relapsed myeloma, at a cost in infections
Iberdomide-daratumumab doubled MRD-negative responses but with much more neutropenia and infection; wait for progression-free survival before changing practice.
Stereotactic radiotherapy more than halved local recurrence in high-risk pancreatic cancer
Adding stereotactic radiotherapy to chemotherapy cut local recurrence in high-risk pancreatic cancer in a small phase 2 trial; it needs phase 3 confirmation.
Eltrombopag after AML induction cut transfusions but not deaths in older adults
Eltrombopag after induction reduced platelet transfusions modestly in older AML patients without a survival benefit.
Febrile neutropenia: antibiotics within the hour
Treat fever on chemotherapy as neutropenic sepsis and give antibiotics within an hour.
Tandem CAR T-cells more than doubled event-free survival in transplant-ineligible lymphoma
For transplant-ineligible relapsed large B-cell lymphoma, CAR T-cell therapy now has randomised support; refer early for assessment.
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