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medwireNews: Here we report on the optimal radiotherapy regimen for patients with small-cell lung cancer, as well as the outcomes of adding evofosfamide to doxorubicin in the first-line soft tissue sarcoma setting and continuing nivolumab after progression in advanced melanoma.
In the phase III CONVERT trial, patients with limited-stage small-cell lung cancer treated with concurrent chemoradiotherapy had comparable overall survival (OS) irrespective of whether the radiotherapy was given in 30 twice-daily fractions of 1.5 Gy up to a maximum of 45 Gy (n=273) or in 33 once-daily fractions of 2 Gy up to 66 Gy (n=270), at a median of 30 and 25 months, respectively.
As the study was powered to show superiority, and not equivalence, of the once-daily regimen, “the implication is that twice-daily radiotherapy should continue to be considered the standard of care in this setting,” say Corinne Faivre-Finn (University of Manchester, UK) and colleagues in The Lancet Oncology.
The addition of the hypoxia-activated prodrug evofosfamide to the standard of care doxorubicin does not improve OS in patients with treatment-naïve unresectable, locally advanced, or metastatic soft tissue sarcoma, with median times of 18.4 months for the 317 patients who received the combination and 19.0 months for the 323 given doxorubicin alone.
The combination was also associated with an increased incidence of hematologic, skin, and mucosal toxicities, leading William Tap (Memorial Sloan Kettering Cancer Center, New York, USA) and fellow TH CR-406/SARC021 investigators to conclude in The Lancet Oncology that the dual regimen “cannot be recommended in this setting.”
Treatment with nivolumab beyond disease progression as defined by the RECIST criteria could be an option for some advanced melanoma patients, say Georgina Long (Melanoma Institute Australia in Sydney, New South Wales) and co-researchers, who analyzed data from the nivolumab monotherapy arms of the phase III CheckMate 066 and 067 trials.
Of 526 nivolumab-treated participants, 58% experienced disease progression, and of these 306, 28% remained on the drug beyond progression as the investigator felt they were deriving a clinical benefit.
As reported in JAMA Oncology, just under half (42%) had tumor shrinkage in response to continued nivolumab, with 28% achieving a 30% or greater reduction in tumor volume relative to baseline.
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