Oncopharmpod

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

Foundations of OncoPharm episode on lenalidomide (Revlimid) and its MOA, use, dosing, & toxicity.

A Holiday Tradition returns as we review 14 new OncoPharm drugs approved this past year and ask Keep, Re-Gift, or Return.

Small bites of updates coming out of ASH's 2023 annual meeting on CLL, multiple myeloma, and lymphoma.

Our Landmarks of OncoPharm series returns to talk about 2008's VISTA study, which ushered bortezomib into the front line setting, albeit with a now outdated alkylating agent-based backbone. VISTA (VMP vs. MP): https://www.nejm.org/doi/full/10.1056/nejmoa0801479

The recent approval of nirogacestat, the first gamma secretase inhibitor on the market, provides a great opportunity to discuss desmoid tumors and Notch signaling. Review article: https://doi.org/10.1002/onco.13627 Also, a new T-cell malignancy warning for most CAR-T products. And, is belantamab mafodotin coming back based on the DREAMM-7 results?

FDA has approved two new kinase inhibitors: one for ROS1 (+) NSCLC and one for PIK3CA/AKT/PTEN altered breast cancer.

This week's Pod dives into a new VEGF-R inhibitor, fruquintinib. We also ask if FLAURA2, osimertinib + chemotherapy in combination, will become a new standard of care in EGFR-mutated metastatic NSCLC.

Aggressive hematologic malignancy publications can be challenging to interpret and translate to clinical practice. We look at two recent studies to illustrate this point. Elderly AML: 10-day decitabine vs. 7 + 3 (https://doi.org/10.1016/S2352-3026(23)00273-9) Burkitt Lymphoma: R-CODXO-M/R-IVAC vs. DA-R-EPOCH (https://doi.org/10.1016/S2352-3026(23)00279-X)

Out Landmarks of OncoPharm series returns to chronicle how treatment of stage III NSCLC has changed over time with an overview of three studies. 1. Dillman (1990) NEJM (sequential chemo --> RT): https://doi.org/10.1056/nejm199010043231403 2. Albain (1995) JCO (concurrent cisplatin/etoposide + RT): https://pubmed.ncbi.nlm.nih.gov/?term=7636530 3. Albain (2009) Lancet (concurrent cis/etposide + RT --> surgery --> consolidation chemo): https://doi.org/10.1016/s0140-6736(09)60737-6

Lots of practice changing new information came out of last week's ESMO conference. This Pod is packed with updates on NSCLC, bladder cancer, gastric cancer, medullary thyroid cancer, KRAS G12C colorectal cancer.....and even bendamustine (non-ESMO update).

This week we discuss the continued push to introduce 2nd generation androgen inhibitors earlier into treatment with the EMBARK trial. Nivolumab and pembrolizumab, pemrolizumab and nivolumab. Again and again. Their role (and approvals) for adjuvant melanoma make sense. But what to think about their use for NSCLC in the neoadjuvant setting? West commentary: https://dailynews.ascopubs.org/do/should-induction-chemoimmunotherapy-lead-us-broaden-our-definition-resectability-nsclc