A prospective randomized trial demonstrates that a surgeon-developed mobile app where patients can submit photos, drain volumes, etc with a message center to connect with their healthcare team significantly improved quality of recovery per questionnaire at 2 and 6 weeks post-oncologic breast or gyn surgery. (https://jamanetwork.com/journals/jamasurgery/article-abstract/2802992)
Stereotactic radiosurgery for limited brain mets is currently widely employed across virtually all histologies, including small cell lung cancer (SCLC). This is largely borne of common sense decisions to use today’s technology to avoid the potentially devastating neurocognitive side effects of whole brain radiation. Despite patients with SCLC being excluded from most prospective trials of SRS, available data indicates intracranial disease control is comparable between SCLC and other histologies. Here is another retrospective review looking at outcomes following SRS for 337 SCLC brain mets across 70 patients. Find the article here (https://www.advancesradonc.org/article/S2452-1094(23)00066-0/fulltext).
This editorial is here to once again remind us all that objective response rates and progression-free survival, while often endpoints of choice to expect potential drug approvals, are far from demonstrating a history of any reliable correlation with overall survival and such investigations should always include follow-up with reported overall survival outcomes when available. Find the article here (https://ascopubs.org/doi/10.1200/JCO.23.00225).
Nausea and loss of appetite can be difficult to manage during cancer treatment and often limit tolerance of optimal therapy. In this randomized, double-blind, placebo controlled trial, 112 patients newly diagnosed, advanced lung, gastric, and hepatobiliary cancer were randomized to receive either olanzapine or placebo along with standard systemic therapy. Olanzapine was given at a dose of 2.5mg for 12 weeks. Olanzapine significantly increased the proportion of patients who had >5% weight gain during treatment from just 9% to 60%. Far more patients also reported increased appetite (48% v 13%) as well as better quality of life and less toxicity from systemic therapy. Find the article here (https://ascopubs.org/doi/full/10.1200/JCO.22.01997).
This study found that RANO, mRANO, and iRANO have about the same correlation with OS in patients with new and recurrent GBM. Post-radiation scans appear to perform the best as baseline scans, confirmatory scans can be useful in the first 12 weeks after treatment, and T2 FLAIR changes add little to response assessment. Find the article here (https://ascopubs.org/doi/abs/10.1200/JCO.22.01579).
The 2023 version of Trump’s Operation Warp Speed has been allocated $5 billion of federal funding in partnership with the private sector to usher in the next generation of adaptive COVID vaccines and therapies as rapidly as possible with a focus on pan-coverage of myriad existing and potential variants as well as inducing highly effective mucosal immunity via nasal spray. Find the article here (https://www.washingtonpost.com/health/2023/04/10/operation-warp-speed-successor-project-nextgen/).
Trabectedin is a chemotherapeutic agent that interferes with translation in tumor cells. It is active in liposarcoma and is currently approved for patients with advanced disease. Does it also enhance the response to neoadjuvant radiation for early stage disease? In the single arm phase 2 TRASTS trial, 46 patients with myxoid liposarcoma of the extremity or trunk received neoadjuvant RT (45 Gy in 25 fractions) and 3 cycles of trabectedin. The trial was designed to show a 70% response rate by RECIST criteria, which unfortunately was not met as the actual rate was 22%. Pathologic response was more encouraging. The pathologic complete response rate was 13%, and over half of patients (51%) had <10% viable tumor remaining tumor after neoadjuvant therapy. Find the article here https://jamanetwork.com/journals/jamaoncology/article-abstract/2803096?resultClick=1.
Lymphedema is an unfortunate consequence following surgery for breast cancer patients. This article attempted to answer if the technique of immediate breast reconstruction after mastectomy impact the risk of lymphedema? In this retrospective study, immediate reconstruction with a latissimus flap was associated with a lower risk of lymphedema than expander/implant or abdominal flap reconstruction. https://www.ejso.com/article/S0748-7983(23)00092-6/pdf
SB3 (aka Ontruzant) is a trastuzumab biosimilar that turned the Herceptin market on its head with FDA approval in early 2019 after its similarity simply couldn’t be denied on several large prospective trials. Emerging data in this article demonstrates that SB3 appears equally (very) safe and effective as appropriately manufactured trastuzumab, and it’s never a bad idea in terms of economics and quality assurance to have multiple producers of any critical pharmaceutical product. Find the article here (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803254).
In this retrospective review, 46 patients with MF had 242 lesions treated with 8Gy x 1. Most lesions were treated with 6MeV or 9MeV typically with 0.5cm bolus. The majority (85.1%) had an immediate complete response. The rest (14.9%) received repeat 8Gy x 1 at a median of 8 weeks after initial treatment and 50% of those lesions had a complete response. So, after a median follow up of 24.6 months, the overall complete response rate to 8Gy x 1 with an additional 8Gy x 1 8 weeks later for nonresponders was 92.6%. Over that follow up time period, no patients experienced local recurrence. Depending on the overall treatment goals, 8Gy x 1 is an effective and durable palliative option with a minority of patients requiring retreatment. This is a very neat finding for patients afflicted with this debilitating lymphomatous disease. Find the article here (https://linkinghub.elsevier.com/retrieve/pii/S1879850023001030).
Yet more data suggests restricted mean survival time may be the better endpoint than your standard median survival as it is more likely to result in a tighter confidence interval meaning more precise results with fewer required enrollees. Find the article here (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802989).
This article of JAMA tackles the painstaking reality in the rising incidence of All-Cause Mortality in US Children and Adolescents. Find the article here (https://jamanetwork.com/journals/jama/fullarticle/2802602).
Off the heels of their 200 year anniversary series Lancet has launched a podcast/video of experts from around the world speaking on the importance of improving the Availability, Accessibility, Acceptability and Quality of healthcare for all, and share insights into their own efforts and experiences. Find the link here (https://www.thelancet.com/lancet-200/universal-health-coverage?section=global-voices-audio).
This article recently published in NEJM highlights the importance of diversity in clinical trial design (https://www.nejm.org/doi/full/10.1056/NEJMp2215609?query=featured_home).
A randomized trial demonstrates that a 4-week preoperative program of supervised high-intensity exercise 3 times weekly with a nutritional and psychological support prior to colorectal cancer surgery successfully slashed the primary endpoint of severe post-op complications from a rate of 30% to 17%. Find the article here (https://jamanetwork.com/journals/jamasurgery/article-abstract/2803109).
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