Oncopharmpod

Lots and lots of updates from the past weekend's ASCO annual meeting. 1. ADRIATIC (consolidation durvalumab in limited stage SCLC) 2. NADINA (neoadjuvant Nivo/Ipi in stage III melanoma) 3. *NICHE-2 (neoadjuvant Nivo/Ipi in dMMR colon cancer) 4. CheckMate 8HW (Nivo/Ipi in dMMR metastatic colon cancer) 5. TRANSMET (liver transplantation in colon cancer with liver mets) 6. Eposec (FLOT > CROSS in adenocarcinoma of the esophagus) 7. LAURA (forever osimertinib in stage III EGFR-mutated NSCLC post-chemoRT) 8. CROWN (5 year update of lorlatinib in ALK+ NSCLC) 9. Destiny Breast-06 (T-DXd vs. chemo in HER-2 low and "ultra" low MBC who haven't received chemo in metastatic setting) 10. ASC4FIRST (Asciminib first line in CML. Funny title, amirite?)

ASCO & ONS (along with pharmacist representation) released updated safety standards for preparing, administering, and monitoring chemotherapy. Look for a calendar invitation to review your site's policies soon. Link: https://doi.org/10.1200/OP.24.00216

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 But, infigratinib's FDA approval for cholangiocarcinoma is withdrawn.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 infec

Arguably, the most anticipated release of 4/19/24

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.

Tumor Lysis Syndrome (TLS) is a foundational topic for all oncology clinicians. We discuss the what, the why, prevention, and 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

EV-302 is finally published, and you have to squint to find any major critiques. Enfortumab bedouin + pembrolizumab fully arrives as a standard 1st-line regimen of advanced urothelial cancer. Also, nivolumab gets a 1st-line FDA approval for urothelial carcinoma in conjunction with cisplatin + gemcitabine based on CHECKMATE-901.

Two nice studies have been recently published in the supportive care realm. SPARED asks if we can omit dexamethasone on days 2-4 following cisplatin-based chemotherapy. D-TORCH asks if topical diclofenac can prevent capecitabine-induced hand-foot syndrome. SPARED: https://doi.org/10.1038/s41416-023-02493-7 D-TORCH: https://doi.org/10.1200/JCO.23.01730

An exciting new cellular therapy, lifileucel, is approved for metastatic melanoma. The FLAURA2 trial of osimertinib + chemotherapy has led to an FDA approval, but questions remain about a possible new standard of care. And a few minor updates on tepotinib.

New updates on metastatic pancreatic cancer (NAPOLI-3), upper tract urothelial cancer (POUT), and the drug-drug interaction between ivosidenib and azole antifungals. NAPOLI 3: https://doi.org/10.1016/S0140-6736(23)01366-1 POUT (final OS): https://doi.org/10.1200/JCO.23.01659 Ivosidenib Azole Antifungal DDIs: https://doi.org/10.1002/cncr.35251

You know about small cell lung cancer, but let's talk about small cell carcinoma of the prostate.

In oncology we are always asking questions about which treatment option is best. And that focus on the next best treatment may prevent us from rethinking some fundamentals of current practice. Three recent studies illustrate this and made me ask: Do we need a Port or PICC for every testicular cancer patient? Study: https://doi.org/10.1200/OP.23.00580 Editorial: https://doi.org/10.1200/OP.23.00730 Is vaginal estrogen safe if breast cancer patients? Study: https://jamanetwork.com/journals/jamaoncology/article-abstract/2811413 Does paclitaxel work differently than we always thought? Study: https://doi.org/10.1371/journal.pbio.3002339

...on FDA approvals for belzutifan for RCC, pembrolizumab + cisplatin/RT for cervical cancer, erdafitinib (FGFR3 alterations only) for bladder cancer. Plus, early morning ICIs (https://doi.org/10.1016/j.ejca.2024.113571) & FLAG-Ida-GO in AML from NCRI AML 19 (https://doi.org/10.1200/JCO.23.00943)

Special guest Ryan Beechinor joins the pod to discuss his recent paper on the obstacles in the development of generic lenalidomide. It's a fantastic read, and this episode will be a fantastic listen! Link: https://doi.org/10.1016/j.jcpo.2023.100446