2 Minute Medicine ® - Hematology/Oncology (Oncology Focus)

1. The hazard ratio of skeletal-related events in patients treated with radiation compared with patients who were not treated with radiation was 0.09. 2. There were no grade 3 or higher treatment-related adverse events. Evidence Rating Level : 1 (Excellent) Study Rundown: Many patients with bone metastases experience skeletal-related events (SRE). While radiation therapy is known to help with painful bone metastases, its role in asymptomatic cases is not well-established. Prior research suggested a link between radiation and a lower risk of SRE...

1. 5-year distant disease-free survival was comparable between both groups. 2. 5-year overall survival was similar between groups. Evidence Rating Level : 1 (Excellent) Study Rundown : In patients with early breast cancer, the standard of care for axillary node staging is the sentinel lymph node biopsy (SLNB). This noninferiority study examined whether omitting axillary surgery (like SLNB) resulted in worse outcomes as compared to the standard SLNB. The primary outcome of this study was 5-year distant disease-free survival (DDFS) and secondary outcomes included disease free survival (DFS) and overall survival (OS)...

1. 4-year event-free survival was significantly greater in I-SABR (77%) versus SABR alone (53%). 2. More patients in the I-SABR group experienced grade 3 immunological adverse events. Evidence Rating Level: 1 (Excellent) Study Rundown : Standard treatment for early-stage inoperable non-small-cell lung cancer (NSCLC) includes stereotactic ablative radiotherapy (SABR). However, relapses remain common. Although immunotherapy may has shown efficacy in stage III NSCLC, its efficacy in earlier stages remains unknown...

1. This phase 2 randomized clinical trial found that patients with metastatic colorectal cancer who were treated with cetuximab maintenance therapy had improved progression-free survival and median overall survival compared to those undergoing observation alone in the maintenance phase. 2. There was no statistical difference in adverse events when comparing the control to patients taking Cetuximab. Evidence Rating Level: 1 (Excellent) Metastatic colorectal cancer (mCRC), particularly in patients with RAS wild-type tumours, presents a significant clinical challenge...

1. The median OS was 13.2 months with TTFields arm vs 9.9 months with standard arm, with an HR of 0.74. This effect was more pronounced in treatment with immune checkpoint inhibitors. 2. Most frequent TTFields therapy-related adverse events were grade 1 to 2 skin related events Evidence Rating Level : 1 (Excellent) Study Rundown: Metastatic non-small-cell lung cancer (NSCLC) remains difficult to treat once there is progression on platinum-based therapy. Tumor Treating Fields (TTFields) therapy, which disrupts mitosis using electric fields, has shown promise in other cancers (glioblastoma and pleural mesothelioma) with little adverse effects...

1. Disease-free survival at 24 months was 84% in the nivolumab group compared to 73% in the observation group. 2. Grade 3-4 adverse events were more common in the nivolumab group, however, there were no reported deaths. Evidence Rating Level: 1 (Excellent) Study Rundown : Merkel cell carcinoma (MCC), an aggressive skin cancer, poses a clinical challenge even after complete resection and radiation therapy. Immune checkpoint inhibitors targeting PD-1 and PD-L1 have shown promise in advanced MCC. This randomized controlled trial aimed to assess the safety and effectiveness of adjuvant immune checkpoint inhibition using nivolumab in completely resected MCC...

1. Patients with non-erosive gastro-esophageal reflux disease (GERD) do not have an increased incidence of developing esophageal adenocarcinoma compared to the general population. Evidence Rating Level: 2 (Good) For patients with gastro-esophageal reflux disease (GERD), endoscopic findings of mucosal erosion or metaplasia are associated with increased risk of esophageal adenocarcinoma. However, there has been no study to determine whether patients with non-erosive GERD, meaning normal endoscopic mucosal findings, are at increased risk for this type of malignancy...

1. 37% of study patients had an objective response to treatment with atezolizumab. 2. Median progression-free survival was 20.8 months. Evidence Rating Level : 2 (Good) Study Rundown: Alveolar soft part sarcoma (ASPS) has no standardized therapy and is one of the rarest sarcomas with a low 5-year overall survival. Traditional chemotherapies are generally ineffective; however, recent studies have shown promising outcomes with immune checkpoint inhibitors. This study examined the outcomes of atezolizumab, which binds to programmed cell death-ligand 1 (PD-L1), on objective response and progression-free survival in adult and pediatric patients with ASPS...

1. The objective response rate was 29.8% (1% complete response, 66% partial response) with a PFS of 5.5 months and a median OS of 11.9 months. 2. 64.9% of treatment-emergent adverse events (TEAEs) of grade ≥3, in which thrombocytopenia and neutropenia were the most common. Evidence Rating Level : 2 (Good) Study Rundown: Salvage therapy is limited for patients with EGFR-mutated advanced NSCLC who have failed the typical initial treatment with EGFR TKIs and second-line platinum-based chemotherapy. However, it was found that HER3, a protein linked to resistance to EGFR TKIs, is prevalent in NSCLC tumours, and a recent experimental therapy targeting HER3, Patritumab deruxtecan (HER3-DXd), showed initial promise in a phase I study...

1. Despite the decrease in colonoscopies performed at the start of the COVID-19 pandemic, there was no difference in the percentage of colorectal cancer (CRC) presentations at a later stage or with higher acuity, when comparing patients diagnosed with rectal adenocarcinoma pre-pandemic and during the pandemic. Evidence Rating Level: 2 (Good) Colonoscopies as part of colorectal cancer (CRC) screening are instrumental in the early diagnosis of CRC, and have been associated with a 75% reduction in mortality for those diagnosed with left-sided colon cancer, likely due to earlier detection...

1. Pooled overall survival and progression-free survival HR were found to be 0.95 and 0.88 for nivolumab/ipilimumab vs. nivolumab. 2. Pooled OR for grade 3-4 adverse events was found to be 1.84 for the combination compared to monotherapy Evidence Rating Level : 1 (Excellent) Study Rundown: Nivolumab/ipilimumab combination therapy has demonstrated improved progression-free survival (PFS) and overall survival (OS) vs. nivolumab alone in metastatic melanoma. However, this comparison has not been well established in other forms of advanced cancers, and limited direct comparisons exist...

1. In Brasil, Russia, India, China, and South Africa, the availability of breast cancer screening programs was associated with a significant reduction in breast cancer mortality.  Evidence rating level: 3 (Average) Breast cancer is the greatest contributor to cancer-related morbidity and mortality for females across the world. Breast cancer screening (BCS) is an effective strategy for detecting asymptomatic people with breast cancer, allowing for early intervention. In Brazil, Russa, India, China, and South Africa (BRICS countries), which collectively account for approximately half of the global population, the association between BCS and breast cancer-related morbidity and mortality has not been well established...

1. This post-hoc analysis of the AMATERASU randomized clinical trial found that, for digestive tract cancer patients with positive p53-immunoreactivity, 2000 IU/day vitamin D3 supplementation resulted in significantly improved relapse-free survival at 5 years.  Evidence Rating Level: 1 (Excellent) Recent meta-analyses of randomized clinical trials have found that daily vitamin D3 supplementation benefited cancer mortality. In this posthoc subgroup analysis of the AMATERASU randomized, double-blind, placebo-controlled clinical trial, patients with digestive cancers were followed up for a median of 3...

1. In a cross-sectional study, adolescent survivors of childhood cancers were more sedentary than age-matched controls. 2. Age, gender, BMI, cancer relapse, and central nervous system tumors were all associated with less physical activity and more sedentary time. Evidence rating: 2 (Good) Study Rundown: Childhood cancer survivors are at increased risk for chronic medical conditions such as cardiovascular disease and diabetes mellitus.  Higher levels of physical activity are associated with a variety of long-term health benefits and an improved quality of life in the general population...

1. Complete response or remission was reported in 18% of patients who received a single liso-cel infusion. 2. Nearly 10% of fatalities were thought to be due to liso-cel related complications. Evidence Rating Level: 1 (Excellent) Study Rundown: There exist limited options for patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) who have failed treatment with both Bruton tyrosine kinase (BTK) inhibitor and venetoclax. This randomized controlled trial aimed to evaluate the use of lisocabtagene maraleucel (liso-cel), an autologous CD19-directed T-cell inhibitor, in patients with relapsed or refractory CLL or SLL...

1. The risk of mortality from solid cancer, lagged by 10 years, is estimated to be increased by 52% per Gy of radiation exposure, an association that is doubled when limiting to the low cumulative dose range of 0-100 mGy. 2. There is an approximate relationship between cumulative dose radiation exposure and mortality from solid cancer. 3. Excluding cancers commonly associated with smoking and asbestos exposure did not alter the association between radiation exposure and solid cancer mortality substantially...

1. 5-year recurrence incidence was 2.5% at follow-up. 2. Overall survival at 5 years without radiotherapy was 97.2%, with a disease-free survival rate of 89.9%. Evidence Rating Level : 1 (Excellent) Study Rundown: After breast-conserving surgical management of breast cancer, radiotherapy is often provided to help prevent recurrence, but not without inconvenience, increased risk of side effects, and considerable cost financially. Low-risk subtypes of breast cancer include the luminal A-subtype, described as having negative human epidermal growth factor receptor 2, estrogen receptor positivity of ≥1%, progesterone receptor positivity of >20%, and Ki67 index of 13...

1. Median progression-free survival was shown to be 27.7 months in the vorasidenib group vs 11.1 months in the placebo group, with HR 0.39. 2. Adverse events (grade 3 and above) that were more common with vorasidenib than with placebo were an elevated alanine aminotransferase level, an elevated aspartate aminotransferase level, and an increased γ-glutamyltransferase level. Evidence Rating Level : 1 (Excellent) Study Rundown: Gliomas are common malignant brain tumours in adults, with mutations in IDH1 or IDH2 genes present in most grade 2 gliomas...

1. This phase 2, single-arm, multicenter trial found that in HER2-positive breast cancer patients demonstrating resistance to trastuzumab, the combination of pyrotinib and capecitabine improved progression-free survival and objective response rates while maintaining an adequate safety profile.  2. Results also indicate that different underlying mechanisms of trastuzumab resistance may impact disease progression and the response to treatment. Evidence Rating Level: 1 (Excellent) Approximately one-fifth of patients diagnosed with breast cancer are HER2-positive...

1. Median overall survival in the atezolizumab group was 10.3 months versus 9.2 months in the chemotherapy group. 2. Patients assigned to atezolizumab had fewer treatment-related adverse events and treatment-related deaths. Evidence Rating Level: 1 (Excellent) Study Rundown: Prior first-line trials in advanced non-small-cell lung cancer (NSCLC) lacked representation for older or patients with reduced fitness. Data surrounding treatment safety and efficacy for advanced NSCLC remains scarce. This randomized controlled trial aimed to compare the safety and efficacy of atezolizumab monotherapy with single-agent chemotherapy for patients with NSCLC who were ineligible for platinum-based chemotherapy...