Jose Luis Tisaire Sanchez’s Post

Is there a role for neoadjuvant therapy in colon cancer?  In general, if a patient is a candidate for surgical resection, there has to be some sort of benefit for us to delay the surgery and give neoadjuvant chemotherapy.  In this recently published trial (OPTICAL), patients with locally advanced colon cancer (T3 with extramural spread into the mesocolic fat ≥5 mm or T4) were randomized to a perioperative approach or an adjuvant approach, using either mFOLFOX6 or CAPEOX.  These would generally be the highest risk patients and the ones we would expect to see a benefit in, if neoadjuvant therapy had a benefit.  There was no significant difference in 3-year disease free survival between the two arms, and the R0 resection rates were similar.  However, patients who received perioperative therapy had more pathological downstaging, and there was a signal towards an OS benefit.  This is somewhat different from the results of the FOxTROT trial, which did show a significant benefit in "residual or recurrent disease within 2 years" and more R0 resections in the perioperative arm.  There have been some concerns with the FOxTROT trial because of its primary endpoint and the duration of chemotherapy, which is why its strategy has not been adopted.  Overall, both these trials signal that there probably is no detriment to neoadjuvant therapy, but we probably need better biomarkers/patient selection to determine who would have significant benefit from this strategy. #coloncancer

A perioperative regimen of PD-L1 blocker Imfinzi yielded “clinically meaningful” survival benefits for patients with muscle-invasive bladder cancer, AstraZeneca announced Sunday. The readout comes from the Phase III NIAGARA study, which tested an investigational perioperative regimen of Imfinzi (durvalumab) with chemotherapy before cystectomy, followed by Imfinzi after surgery. As a comparator, AstraZeneca used Imfinzi before surgery followed by no further treatment after the operation. NIAGARA’s primary endpoint is event-free survival (EFS) and a key secondary endpoint is overall survival (OS). Results, which were presented at ESMO 2024, showed that the perioperative schedule resulted in a 32% drop in the risk of disease progression, recurrence, not undergoing surgery or death. This effect was statistically significant, with a p-value less than 0.0001. At the time of the analysis, estimated EFS was not yet reached in patients on the Imfinzi regimen versus 46.1 months in comparators. #biotech #biopharma #pharma #bladdercancer #ESMO

Great news for bladder cancer patients! A new study shows that Keytruda, an immunotherapy drug, nearly doubles the time people with high-risk, muscle-invasive bladder cancer remain cancer-free after surgery. This breakthrough offers hope and an alternative for those unable to undergo standard chemotherapy. Find out how this treatment could make a life-changing difference. Read more at https://lnkd.in/gAyQWQMq

The first time an immunotherapy-based regimen has demonstrated a statistically significant overall survival benefit compared to chemotherapy alone in patients with high-risk early-stage triple-negative breast cancer. The study evaluated Pembrolizumab in combination with chemotherapy as a pre-operative (neoadjuvant) treatment and then continuing as a single agent after surgery (adjuvant). The study met its overall survival (OS) endpoint. #Milestone #BreastCancer #TNBC #Immunotherapy #Oncology #CancertreatmentUpdate https://lnkd.in/d7GQKKw2.

Immunovia completes development of its pancreatic cancer detection test after substantially increasing test accuracy

A-BRAVE: Adjuvant Immunotherapy Prolongs Overall Survival in Patients With High-Risk Early-Stage TNBC Key Points: A-BRAVE is a randomized phase 3 trial that compared 1 year of adjuvant avelumab to observation in patients with triple-negative breast cancer (TNBC) with residual disease after neoadjuvant chemotherapy or patients at high risk of relapse after primary surgery and adjuvant chemotherapy. Adjuvant avelumab significantly improved overall survival (OS) but not disease-free survival (DFS)—the study’s primary endpoint. Despite recent changes in practice, adjuvant avelumab could benefit patients found to have higher-risk disease than anticipated at the time of surgery, as well as patients who decline neoadjuvant therapy.

ASCO 2024 : GI abstracts that got my attention as a radiation oncologist. (If there are more, please add in the comment section) Esophagus Prospective randomized multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (ESOPEC trial). (Plenary Session) https://lnkd.in/dcxJmepJ A phase III trial comparing 5-FU plus cisplatin (CF) versus CF plus docetaxel or radiotherapy as neoadjuvant treatment for locally advanced esophageal cancer: 5-year follow-up from JCOG1109. (Poster Session) https://lnkd.in/dC-Sdpyw Pancreas Randomized phase II/III trial of gemcitabine plus nab-paclitaxel versus concurrent chemoradiotherapy with S-1 as neoadjuvant treatment for borderline resectable pancreatic cancer: GABARNANCE study. (Rapid Oral Abstract Session) https://lnkd.in/dMcTkHuR Liver REPLACE: A phase III, randomized, open-label trial to evaluate the safety and efficacy of regorafenib and pembrolizumab versus locoregional therapy (LRT) with transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), for the first-line treatment of intermediate-stage hepatocellular carcinoma (HCC) with beyond up-to-7 criteria. (Poster Session) https://lnkd.in/dpCEPFk8 Rectum Longitudinal circulating tumor DNA monitoring in predicting response to short-course neoadjuvant radiotherapy in locally advanced rectal cancer: Data from a phase III clinical trial (UNION). (Poster Session) https://lnkd.in/dDRm9cWk Oligometastasis Alliance A022101/NRG-GI009: A pragmatic randomized phase III trial evaluating total ablative therapy for patients with limited metastatic colorectal cancer—Evaluating radiation, ablation, and surgery (ERASur). (Poster Session) https://lnkd.in/dNPkp8gK

📃Scientific paper: Combined surgical and chemotherapy treatment for invasive primary urethral cancer: a case presentation Ref.: Springer, 2024 Abstract: Background The European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management. Case presentation In this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team. Conclusions Based on our outcome in this case, we believe that chemotherapy combined with surgery increases the cha... Continued on ES/IODE ➡️ https://etcse.fr/Sco ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

18F-FDG PET/CT for early prediction of pathological complete response in breast cancer neoadjuvant therapy: a retrospective analysis Background: Neoadjuvant treatment has been developed as a systematic approach for patients with early breast cancer and has resulted in improved breast-conserving rate and survival. However, identifying treatment-sensitive patients at the early phase of therapy remains a problem, hampering disease management and raising the possibility of disease progression during treatment. Methods: In this retrospective analysis, we collected 2-deoxy-2-[F-18] fluoro-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) images of primary tumor sites and axillary areas and reciprocal clinical pathological data from 121 patients who underwent neoadjuvant treatment and surgery in our center. The univariate and multivariate logistic regression analyses were performed to investigate features associated with pathological complete response (pCR). An 18F-FDG PET/CT-based prediction model was trained, and the performance was evaluated by receiver operating characteristic curves (ROC). Results: The maximum standard uptake values (SUVmax) of 18F-FDG PET/CT were a powerful indicator of tumor status. The SUVmax values of axillary areas were closely related to metastatic lymph node counts (R = 0.62). Moreover, the early SUVmax reduction rates (between baseline and second cycle of neoadjuvant treatment) were statistically different between pCR and non-pCR patients. The early SUVmax reduction rates-based model showed great ability to predict pCR (AUC = 0.89), with all molecular subtypes (HR+HER2-, HR+HER2+, HR-HER2+, and HR-HER2-) considered. Conclusion: Our research proved that the SUVmax reduction rate of 18F-FDG PET/CT contributed to the early prediction of pCR, providing rationales for utilizing PET/CT in NAT in the future. https://lnkd.in/d4NwTmbn

Merck Announces Phase 3 KEYNOTE-522 Trial Met its Overall Survival (OS) Endpoint in Patients With High-Risk Early-Stage Triple Negative Breast Cancer (TNBC) KEYTRUDA® (pembrolizumab) is the first and only immunotherapy-based regimen to show a statistically significant improvement in OS as pre-operative (neoadjuvant) treatment with chemotherapy and then as a single agent after surgery (adjuvant) compared to pre-operative chemotherapy in patients with high-risk early-stage TNBC New OS results build on the pathological complete response and event-free survival data previously reported from the KEYNOTE-522 trial RAHWAY, N.J.--(BUSINESS WIRE)-- Merck (NYSE: MRK), known as MSD outside of the United States and Canada, today announced that the Phase 3 KEYNOTE-522 trial evaluating KEYTRUDA, Merck’s anti-PD-1 therapy, met its overall survival (OS) endpoint, in combination with chemotherapy as pre-operative (neoadjuvant) treatment and then continuing as a single agent after surgery (adjuvant) for the treatment of patients with high-risk early-stage triple-negative breast cancer (TNBC).