Citing powerful long-term data from the SOFT and TEXT trials, some oncologists are leaning away from chemotherapy for premenopausal patients with intermediate Oncotype scores (e.g., <25). They argue that the substantial, proven benefits of ovarian function suppression (OFS) may be equivalent to the chemotherapy benefit seen in trials like TAILORx.
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The emergence of positive data from trials like PATINA creates a dilemma for oncologists treating patients who are already stable on an older maintenance therapy. The consensus suggests not altering a successful regimen to avoid disrupting patient stability, revealing a cautious approach to integrating new evidence into established care.
After famously retreating from oncology, GSK's re-entry is not a broad effort. Their CSO clarifies a focused strategy anchored in two key areas: hematology (blood cancers) and solid tumors that are genetically unstable (DMMR/MSI high), with a particular emphasis on women's cancers like endometrial cancer.
Despite compelling data from trials like PATINA, some patients with ER+/HER2+ breast cancer refuse maintenance endocrine therapy due to side effects. This highlights a real-world gap between clinical trial evidence and patient adherence, forcing oncologists to navigate patient preferences against optimal treatment protocols.
Lutetium faces criticism for its fixed 6-cycle regimen, which may be suboptimal as the PSMA target diminishes with ADT. However, this critique is rarely applied to other drugs like PARP inhibitors, which are given until progression. This highlights a double standard and the tension between using a fixed regimen for regulatory approval versus finding the optimal dose in practice.
The practice-changing DYNAMIC trial showed that a ctDNA-guided strategy for stage II colorectal cancer reduces adjuvant chemotherapy use by 50%. Despite this significant de-escalation of treatment, patient outcomes and survival rates were identical to the standard-of-care approach.
While the Lidera trial showed a benefit for the oral SERD giredestrant in the adjuvant setting, experts advise caution before changing practice. The trial's control arm (standard endocrine therapy) does not reflect the current standard of care for high-risk patients, which now includes CDK4/6 inhibitors, making a direct comparison difficult.
While the avutometanib/defactinib combination is newly approved for KRAS-mutated ovarian cancer, its significant toxicity profile—causing up to a third of patients to stop treatment—creates a clear clinical need for agents like specific KRAS inhibitors that may offer similar efficacy with better tolerability.
Modern breast cancer treatment has shifted from a 'one-size-fits-all' aggressive approach to a highly individualized one. By de-escalating care—doing smaller surgeries, minimizing radiation, and sometimes omitting chemotherapy or lymph node biopsies—clinicians can achieve better outcomes with fewer long-term complications for patients with favorable disease characteristics.
Dr. Radvanyi advocates for a paradigm shift: treating almost all cancers with neoadjuvant immunotherapy immediately after diagnosis. This "kickstarts" an immune response before standard treatments like surgery and chemotherapy, which are known to be immunosuppressive, can weaken the patient's natural defenses against the tumor.
The IMbark trial demonstrated that an ARPI (enzalutamide), either alone or with ADT, outperformed ADT monotherapy in high-risk patients. This pivotal finding raises the question of whether giving ADT alone in any setting, such as with radiation for localized disease, is now an outdated and inferior approach.