2 Minute Medicine ® - Medical Oncology

1. Mitoxantrone enhances five-year event-free survival over liposomal daunorubicin in MRD-guided pediatric AML treatment. 2. High-risk patients identified by MRD guidance benefited from hematopoietic stem-cell transplantation. Evidence Rating Level: 1(Excellent) Study Rundown: The study was a phase 3 trial investigating the efficacy of mitoxantrone versus liposomal daunorubicin as induction therapy for pediatric acute myeloid leukemia (AML). Treatment allocation was determined by overall disease risk, assessed through MRD analysis using flow cytometry...

1. The overall survival at 48 months was 91.2% in the pembrolizumab group vs 86.0% in the placebo group, with an HR 0.62 (significant). 2. Adverse events grade 3 or higher occurred in 18.6% of the pembrolizumab group vs 1.2% in the placebo group. Evidence Rating Level : 1 (Excellent) Study Rundown: Adjuvant therapy for localized renal-cell carcinoma has historically seen limited success. However recently, Pembrolizumab, an anti-PD-1 antibody, was shown to have some benefit in the adjuvant setting. This paper is a third prespecified interim analysis of the previous trial...

The Latest A recent multicenter phase 1b/2a clinical trial funded by the National Institute of Health and the Humanetics Corporation investigated the utility of BIO 300, an oral synthetic genistein nanosuspension, as a radioprotectant for patients undergoing chemoradiotherapy for non-small cell lung cancer (NSCLC). Researchers found BIO 300 led to a reduction in Transformation Growth Factor β1 (TGF-β1), a proinflammatory/profibrotic cytokine implicated in lung injury.  BIO 300 did not change the pharmacokinetics of the cancer therapy, and a 65% tumor response rate was achieved...

1. When compared to upfront surgery, neoadjuvant chemotherapy using mFOLFOX or CAPOX did not appear to significantly improve 3-year disease-free survival. 2. When compared to upfront surgery, neoadjuvant chemotherapy using mFOLFOX or CAPOX did appear to be associated with significant pathological downstaging. Evidence Rating Level: 1 (Excellent) Study Rundown : In this phase 3, randomized, multicenter trial, 744 patients, with radiologically staged, locally advanced colon adenocarcinoma were randomly assigned to either the experimental, or standard of care group...

1. The hazard ratio for recurrence or death comparing sentinel node biopsy only to completion axillary lymph node dissection was non-significant (0.89) and below the noninferiority margin. 2. The overall survival rates at 5 years were similar between both groups, 92.9% vs 92%. Evidence Rating Level : 1 (Excellent) Study Rundown : Previous studies have challenged the necessity of completion axillary lymph node dissection in breast cancer treatment in certain patients. This trial aimed to validate these findings while expanding eligibility criteria...

1. Roughly 65% of the cancer medication budget is allocated to treatments that provide improvement in survival 2. Immune checkpoint inhibitors represent 17% of the cancer medication budget Evidence Rating Level : 2 (Good) Study Rundown: The incidence of cancer is increasing yearly, and many cancer medications are publicly funded in the most populous province of Canada, Ontario. The cost of these medications is roughly half of the total government spending on cancer care in this province. Many of these therapeutics have been shown to have marked improvement in progression-free survival or quality of life, but some covered medicines have a more modest effect...

1. The pathological response rate had an OR of 3.16 when comparing neoadjuvant dual vs single checkpoint inhibitors. 2. The grade 3-4 immune-related adverse event rate had an OR 3.75 when comparing neoadjuvant dual vs single checkpoint inhibitors. Evidence Rating Level : 1 (Excellent) Study Rundown: Adjuvant therapy in resected advanced melanoma with immune checkpoint inhibitors (ICIs) aims to target micrometastases post-surgery, but relapse rates remain high, especially in stage III melanoma patients. Neoadjuvant therapy (NAT) with ICIs, initiated pre-surgery, is gaining traction for potentially enhancing immune response and improving treatment outcomes...

1. 18-month recurrence-free survival was significantly greater in the combination therapy group compared to pembrolizumab alone. 2. There were no treatment-related grade 4-5 adverse events or fatalities reported. Evidence Rating Level: 1 (Excellent) Study Rundown: Checkpoint inhibitors are now commonly used as adjuvant therapy for resected melanoma, yet recurrence remains a concern among many patients. mRNA-4157 (V940) is a novel individualized mRNA-based neoantigen therapy which may improve survival in high-risk melanoma patients, although further research is needed...

1. Pazopanib did not improve disease-free survival in post-metastasectomy renal cell carcinoma patients 2. There was a concerning trend favouring placebo when assessing overall survival, suggesting a negative impact of pazopanib. Evidence Rating Level: 1(Excellent) Study Rundown: The E2810 trial was a randomized, double-blind phase III trial assessing the impact of pazopanib on patients with metastatic renal cell carcinoma (mRCC) who are post-metastasectomy. The study included patients with mRCC who had undergone surgery to remove the metastases and were classified with no evidence of disease...

1. The overall survival had a significant hazard ratio (0.65) when comparing neoadjuvant chemoimmunotherapy to neoadjuvant chemotherapy. 2. Both groups had similar rates of treatment (and surgical) related adverse events. Evidence Rating Level : 1 (Excellent) Study Rundown: Recent studies have shown evidence for neoadjuvant immunotherapy combined with chemotherapy in resectable NSCLC, though conflicting approvals between regions underscore the need for comprehensive meta-analyses to assess efficacy across different patient subgroups and treatment regimens...

1. Children randomized to the MenA group rather than the Vi-TT group were more likely to be diagnosed with typhoid fever. 2. Overall Vi-TT vaccine efficacy was 78.3% with the highest efficacy seen for children aged 2-4 years. Evidence Rating Level: 1 (Excellent) Study Rundown: Typhoid conjugate vaccines in Africa and Asia have shown high short-term efficacy, but data on long-term protection are limited. This study presents the final analysis of a trial in Malawi, spanning over 4 years, to assess vaccine efficacy over time and by age group...

1. Invasive disease-free survival was significantly higher in patients receiving adjuvant ribociclib + NSAI when compared to patients receiving NSAI alone. 2. Distant disease-free survival and recurrence-free survival also favoured treatment with adjuvant ribociclib + NSAI, compared to NSAI alone. Evidence Rating Level: 1 (Excellent) Study Rundown: In this phase 3, randomized, international, open-label trial, 5101 patients with stage II or III HR-positive, HER2-negative breast cancer were assigned to receive either, a reduced dose ribociclib (400 mg PO OD x 21 days, followed by 7 days off x 3 years) + NSAI or to receive NSAI alone (anastrozole)...

1. VENICE-1 observed high response rates (complete or partial remission) in both BCRi-naïve and BCRi-pretreated patients with refractory or relapsed CLL. 2. Neutropenia was a common treatment-related adverse effect in those treated with venetoclax. Evidence Rating Level: 1 (Excellent) Study Rundown: VENICE-1 was an open-label multicentered trial that assessed the efficacy of venetoclax in the treatment of relapsed or refractory chronic lymphocytic leukemia (CLL). Patients included either previously treated relapsed, or refractory CLL...

1. 83.1% of patients with confirmed colorectal cancer had a positive cfDNA test meeting the accepted standard as outlined by the Food and Drug Administration. 2. Of patients without colorectal cancer, the majority (89.6%) tested negative in the screening blood test, meeting acceptable cut-offs for specificity. Evidence Rating Level : 2 (Good) Study Rundown: Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the USA and over 30% of those eligible are not up to date in their screening. Of those who die from CRC, most are not up to date with screening, emphasizing the importance of this preventative measure...

1. Adding chemotherapy to immunotherapy did not prolong OS or PFS, with non-significant differences in HR. 2. Grade 3 or higher immune-related adverse events occurred in 24.3% and 17.9% in the ICI-chemotherapy and ICI-alone groups. Evidence Rating Level : 2 (Good) Study Rundown : Immune checkpoint inhibitors (ICIs) have significantly improved outcomes in non-small cell lung cancer (NSCLC), with pembrolizumab showing promise in older adult populations based on pooled analyses and cohort studies. However, the efficacy and safety of combining ICIs with chemotherapy in older NSCLC patients remain uncertain, with previous analyses failing to demonstrate an overall survival benefit in patients aged 75 and older...

1. There were similar rates of ipsilateral invasive recurrence among the postoperative adjuvant radiotherapy group (group 1) and non-radiotherapy group (group 2). 2. 2% of patients in the total cohort underwent mastectomy and all of them were in the non-radiotherapy group. Evidence Rating Level: 1 (Excellent) Study Rundown: Adjuvant breast radiotherapy is a common practice in early breast cancer treatment, although some suggests it may be overtreatment. This randomized controlled trial aimed to explore whether the use of preoperative MRI can identify women with localized unifocal breast cancer who can safely avoid radiotherapy...

1. In this retrospective, population-based cohort study, adherence to health surveillance guidelines among adult survivors of childhood cancer in Ontario, Canada was suboptimal.  Evidence Rating Level : 2 (Good) It is known that adherence to long-term health surveillance guidelines among adult cancer survivors is poor. In this retrospective, population-based cohort study, researchers aimed to assess the adherence to surveillance guidelines for high-yield tests among adult survivors of childhood cancer. Participants in this study included adults who were diagnosed with childhood cancer between 1986 and 2014 in Ontario, Canada...

1. In a large prospective cohort, consumption of higher quality carbohydrates was associated with a decreased risk of colorectal cancer compared to lower quality carbohydrate diets. 2. Lower carbohydrate quantity consumption was not associated with significant correlations in colorectal cancer risk or outcomes. Evidence Rating: 1 (Excellent) Colorectal cancer (CRC) confers a significant healthcare burden worldwide, and it has been well documented that individual CRC risk can be mediated through diet. In prior literature, both the quantity and quality of carbohydrate consumption has been postulated as potential mediators of CRC risk and outcomes, although this has not been well characterized...

1. Significantly more patients in the imetelstat group achieved RBC transfusion independence at 8 weeks after treatment compared to placebo. 2. Grade 3-4 treatment-related adverse events were greater in the imetelstat group. Evidence Rating Level: 1 (Excellent) Study Rundown: Patients with red blood cell transfusion-dependent lower-risk myelodysplastic syndromes (LR-MDS) face unmet medical needs when unresponsive to erythropoiesis-stimulating agents (ESAs). Imetelstat, a telomerase inhibitor, showed promise in a phase 2 trial; however, limited evidence exists surrounding its therapeutic efficacy...

1.  Amongst a cohort of breast cancer survivors, those that were treated with radiation had a higher risk of developing nonkeratinocyte skin cancer. Evidence Rating Level: 2 (Good)  Cancer remains the second leading cause of death in the United States (US), even though incidence rates have declined. In the US, there are over 4 million breast cancer survivors that deal with mental and physical health challenges after the end of their treatment. Of the 875 880 patients with a new diagnosis of breast cancer, 51...