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medwireNews: In this roundup, we cover the roles of stereotactic radiosurgery (SRS) in patients undergoing resection for intracranial metastases and nimotuzumab in the first-line treatment of advanced pancreatic cancer, as well as the hepatotoxicity associated with inotuzumab ozogamicin.
SRS could be a new standard of care for patients with resected brain metastases, indicate two phase III trials published in The Lancet Oncology.
Researcher Ganesh Rao and team, from The University of Texas MD Anderson Cancer Center in Houston, USA, found that patients with 1–3 completely resected metastases were a significant 54% more likely to be free from local recurrences at 12 months if they received SRS within 30 days of surgery (n=63) compared with observation (n=65).
The second study, by Paul Brown (Mayo Clinic, Rochester, USA) and co-workers, showed that the 98 patients with one resected metastasis who received SRS had a significantly longer cognitive deterioration-free survival than their 96 counterparts given whole brain radiotherapy, at a median of 3.7 versus 3.0 months. And median overall survival (OS) was comparable for the groups, with corresponding times of 12.2 and 11.6 months.
In a related commentary, Simon Lo (University of Washington School of Medicine, Seattle, USA) and colleagues say that “the ability of clinicians to offer informed treatment choices to patients with postoperative brain metastases will progress” in light of these findings.
Addition of the anti-epidermal growth factor receptor antibody nimotuzumab to gemcitabine significantly improves OS in patients with previously untreated, inoperable, locally advanced or metastatic pancreatic cancer relative to placebo plus gemcitabine, at 1-year rates of 34% versus 19%.
As reported in the Annals of Oncology, Beate Schultheis (Marien Hospital Herne, Germany) and study co-authors, who included 186 participants in their phase IIb study, also noted a significant improvement in progression-free survival, with corresponding 1-year rates of 22% and 10%.
Although treatment with the antibody–drug conjugate inotuzumab ozogamicin improves remission rates relative to the standard of care (intensive chemotherapy) in patients with relapsed or refractory B-cell acute lymphoblastic leukemia, it is also associated with an increased incidence of any-grade treatment-emergent hepatotoxicity (51 vs 34%) and veno-occlusive disease (13 vs <1%).
As inotuzumab ozogamicin also improves the likelihood of proceeding to hematopoietic stem cell transplantation, patients might have “a long-term survival advantage” despite the increased hepatotoxicity risk, say Hagop Kantarjian, from the University of Texas MD Anderson Cancer Center, and fellow investigators in The Lancet Haematology.
But they add that “[c]ontinued vigilance to detect hepatotoxicity is needed so that early intervention can be implemented when necessary.”
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