Non-Medical Article of the Week
The journey of scientific discovery often hinges on our willingness to adapt our understanding when faced with new evidence. A sudden rise in nearsightedness among kids, which nudged experts to challenge the old belief that bad eyesight was a genetic inheritance, exemplifies that. The curiosity and subsequent investigations highlighted how our modern lifestyle, dominated by screens and lacking in outdoor adventures might be ruining our eyesight. This whole scenario underscores the essence of staying open to changing narratives in science. So, as you read these articles, think about our daily understanding of the malignancies we manage. What can you challenge and create a new narrative?
Phase II study evaluating the role of HER2-directed ADC Trastuzumab deruxtecan (T-DxD) in several cancers.
Enhertu is the trade name for this ADC.
- deruxtecan - Topoisomerase I inhibitor
- HER2 testing is done via IHC - 3+ and 2+ allowed
- Prior HER2-directed therapy allowed
- Primary endpoint - Objective response rate (ORR)
- Uterus - in 2+ IHC -->47% (n=17); in 3+ IHC --> 84.6% (n=13)
- Cervix - in 2+ IHC --> 40% (n=20); in 3+ IHC patients --> 75% (n=8)
- Ovary - in 2+ IHC --> 36.9% (n=19); in 3+ IHC patients -->64% (n=11)
- Risk of pulmonary adverse events - primarily interstitial lung disease (10%, 28 patients in the entire study), 1 grade 3 and three fatal events (1.1%) due to ILD
- 35% of patients in endometrial, 47% in cervical, and 42% in ovarian cohorts with grade 3 or more toxicity. 2 deaths in endometrial (7.55%, 3/40).
- 1/3 of patients in the gyn cohort were hospitalized during therapy due to complications
- 50% need dose modifications needed
Isolated Vaginal Recurrences
An excellent study from the combined MD Anderson and MSKCC endometrial cancer database. Can someone calculate the number need to treat our surveillance visits for endometrial cancer vaginal recurrences?
Immunotherapy in Ovarian Cancer
Two more trials in ovarian cancer showed no benefit of immunotherapy. Add these to the list of the two I sent out in Publications Update # 29
However, there is one exception - a single phase II study of 40 patients that is driving the use of Cytoxan, Avastin, and Pembro in ovarian cancer. No comparative arm. Given the cost of this regimen, I think a confirmatory trial is desperately needed with a control arm getting cytoxan and Avastin alone.
That's it for todayFollow @uppals