OncoPharm

A new drug for small-cell lung cancer, a bispecific, targeting DLL3 on small-cell lung cancer and CD3 on T-cells is FDA approved. But, infigratinib's FDA approval for cholangiocarcinoma is withdrawn.

QT interval prolongation is a common hurdle to taking care of cancer patients. We dive into what QT interval prolongation is, why it matters, risk factors, and prevention/management strategies.

The non-Award Winning series of Landmarks in OncoPharm returns to discuss a Next Big Thing in NHL that wasn't any better than plain old CHOP. From April 1993, it's Pro-MACE-CytaBOM Link: https://www.nejm.org/doi/full/10.1056/NEJM199304083281404

Tisotumab vedotin garners a regular FDA approval for metastatic cervical cancer with OS benefit data. A lingering question that demands a focused RCT: What is the optimal dose of methotrexate in primary CNS lymphoma? I'm glad I'm not the only one with this question: https://doi.org/10.1177/10781552231176754 What, some BRAF mutations in colorectal cancer might respond to EGFR-mab therapy? https://doi.org/10.1200/OP.21.00160

Lots of recent updates to cover this week... 1. Adjuvant pembrolizumab of RCC demonstrates OS improvement in NEJM publication (DOI: 10.1056/NEJMoa2312695) 2. Yet adjuvant nivolumab did not demonstrate OS improvement in the adjuvant setting. There may be a few reasons for this (https://doi.org/10.1200/JCO.2024.42.4_suppl.LBA358) 3. A cytokine-fusion protein, nogapendekin alfa inbakicept, is approved for intravesicular use in BCG-unresponsive bladder cancer. This agent appears to activity in NSCLC too... 4. The Phase II APPLE trial provides some evidence than deferring osimertinib to the second-line setting in metastatic EGFR-mutated NSCLC may yield similar OS to first-line use of osimertinib. (https://doi.org/10.1200/JCO.23.01521) 5.The METALLICA study provides a nice roadmap for empiric metformin use when starting alpelisib (https://doi.org/10.1016/j.eclinm.2024.102520) 6. Does CPX-351 cause less intestinal damage than 7 + 3? And could that explain the discordance between time of neutropenia and infection rates? A mouse model suggests yes. (https://doi.org/10.1200/jco.2017.77.6112)

Dive into the intricacies of non-small cell lung cancer treatment! Discover the latest advancements in targeted therapies and immunotherapy. The discussion emphasizes the importance of personalized treatment plans tailored to individual patient histories and genetic profiles. Explore how these developments can significantly impact patient outcomes in this evolving field of oncology.

What I learned (or relearned?) at HOPA's 2024 Annual Conference: updates in Neuro Oncology, fedratinib toxicity, and bispecific antibodies in multiple myeloma. Also, fam-trastuzumab deruxtecan (T-DXd) garnered a site-agnostic approval for HER2 amplified solid tumors. Finally, the ALINA study, adjuvant alectinib in ALK+ NSCLC, was published in this week's NEJM.

Dive into the complexities of Tumor Lysis Syndrome, a crucial topic for oncology professionals. Discover the implications during chemotherapy and the importance of monitoring lab values to prevent severe complications. Explore effective prevention strategies for at-risk patients and learn about practical management techniques, including IV fluids and medications. This knowledge is vital for ensuring patient safety during treatment.

Discussing four papers that caught our eyes from the last few weeks: Pazopanib vs. placebo following metastatectomy. Always concerning when placebo has an OS advantage. ECOG-ACRIN E2810: https://doi.org/10.1200/JCO.23.01544 Gemcitabine vs. Gem + Paclitaxel (Taxol) in pancreatic cancer patients after FOLFIRINOX: https://doi.org/10.1200/JCO.23.00795 An RNA assay to predict gemcitabine sensitivity: https://doi.org/10.1200/JCO.22.02668 Management of skin cancers with ICIs in kidney transplant patients: https://doi.org/10.1200/JCO.23.02570

Two recent publications suggest more people may be choosing non-colonoscopy screening practices in the future. One is a new stool DNA test, while the other is a blood test. How do they compare to the gold standard of colonoscopy? Cell-free DNA blood test: DOI: 10.1056/NEJMoa2304714 Next generation stool DNA test: DOI: 10.1056/NEJMoa2310336