Immunotherapy with perioperative chemo in locally advanced, resectable GE cancers
2 phase III RCTs, MATTERHORN & KEYNOTE-585 with FLOT4
No significant difference in EFS was between the FLOT-durvalumab and FLOT-pembrolizumab arms
FLOT-IO superior to Cis/5Fu-IO
Matterhorn OS ?
Adjuvant Anti-Inflammatory Rx in Postop Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
5 trials
NSAIDs improve DFS in resected CRC
Aspirin=Best
PI3K mutations predict best risk reduction with NSAIDs
No impact on OS
No ↑ in Major AE
Liquid Biopsy
- ctDNA
-Circulating cell-free DNA
Approach= Tumour informed Vs Tumour agnostic
Various potential applications for circulating tumor DNA (ctDNA) detection during a disease course of cancer patients. ctD
2 main methods for detecting ctDNA:
-Digital PCR
-NGS
SABR: Uncommon Primary RCC
ccRCC (n=167) or nccRCC (n=44)
2007-2021 from 16 institutions in Australia,Canda,Germany, Japan,USA
nccRCC were more likely to be treated with multifractuonnand Higher BED (94.8Gy) Vs 87.5Gy for ccRCC.
5y LF=1.5%(ccRCC) vs 2.4%(nccRCC)
5yDF=6% Vs 2.9%
Secondary Cancers = Bladder and Rectal following Sx Vs RT in Prostate Cancer pts
SEER Database (2004–2020)
N=251,838
110,239 (44%)=EBRT versus
141,599 (56%) = Surgery
10y incidence of secondary BCa (0.9 vs 1.9%)
10y incidence of secondary RCa (0.8 vs 1.5%)
Evolution of Adjuvant RT: Pancreatic Cancer
Even Ro Pancreatic resection= Recurrence Rate =70-80% with dismal 5y results =20-30%
1/3rd= Local relapse
Adj RT Vs Adj Chemo favouring mFOLFIRINIX:2025
Question:
Integrate RT in Neoadjuvant or Adjuvant
SBRT
Dose escalation
ctDNA
Occupational Exposure to Ionizing Radiation in Female Physicians & Breast Cancer Risk
6 observational studies were included, with 34744 participants: 8103 exposed to ionizing radiation and 26641 controls, with min 10y FU
There is ↑ risk of breast cancer, with an OR of 1.84
Rebiopsy in mNSCLC in Oncogenic Driver Progression After Optimal Targeted Therapy. Whats Clinical Impact ? See OS
30-40% Literature
50%=Good
Challenges
Pt refusal,difficult access, deteriorating ECOG PS,poor motivation of Oncologist,Cost
Insufficient material
Inconclusive Result