Oligometastatic nasopharyngeal cancer should be treated for cure, says an international guideline; and concurrent liposomal doxorubicin in HER2-positive disease

The edition in brief

An international consensus guideline in Lancet Oncology, from 54 experts and endorsed by 17 organisations, recommends curative-intent treatment for medically fit patients with de novo metastatic nasopharyngeal carcinoma and no more than three lesions in two or fewer organs, at baseline or after response: immunochemotherapy, locoregional radiotherapy, metastasis-directed therapy and maintenance. In the phase 2 METIS trial (156 patients with stage II–III HER2-positive breast cancer), concurrent pegylated liposomal doxorubicin-based chemotherapy with trastuzumab and pertuzumab gave a higher pCR rate than sequential epirubicin-cyclophosphamide (67.5% vs 48.7%), with similar cardiac safety; the event-free survival difference was not significant. A meta-analysis of mostly observational studies linked local ablation of oligoprogressive NSCLC during continued immunotherapy with better progression-free (HR 0.45) and overall survival (HR 0.41), low certainty. Antibiotic exposure during checkpoint inhibitor therapy for HCC was associated with shorter survival (HR 1.29). The pearl covers cardiac monitoring on trastuzumab.