OncoPharm

This week's Pod dives into a new VEGF-R inhibitor, fruquintinib. We also ask if FLAURA2, osimertinib + chemotherapy in combination, will become a new standard of care in EGFR-mutated metastatic NSCLC.

Aggressive hematologic malignancy publications can be challenging to interpret and translate to clinical practice. We look at two recent studies to illustrate this point. Elderly AML: 10-day decitabine vs. 7 + 3 (https://doi.org/10.1016/S2352-3026(23)00273-9) Burkitt Lymphoma: R-CODXO-M/R-IVAC vs. DA-R-EPOCH (https://doi.org/10.1016/S2352-3026(23)00279-X)

Out Landmarks of OncoPharm series returns to chronicle how treatment of stage III NSCLC has changed over time with an overview of three studies. 1. Dillman (1990) NEJM (sequential chemo --> RT): https://doi.org/10.1056/nejm199010043231403 2. Albain (1995) JCO (concurrent cisplatin/etoposide + RT): https://pubmed.ncbi.nlm.nih.gov/?term=7636530 3. Albain (2009) Lancet (concurrent cis/etposide + RT -...

Lots of practice changing new information came out of last week's ESMO conference. This Pod is packed with updates on NSCLC, bladder cancer, gastric cancer, medullary thyroid cancer, KRAS G12C colorectal cancer.....and even bendamustine (non-ESMO update).

This week we discuss the continued push to introduce 2nd generation androgen inhibitors earlier into treatment with the EMBARK trial. Nivolumab and pembrolizumab, pemrolizumab and nivolumab. Again and again. Their role (and approvals) for adjuvant melanoma make sense. But what to think about their use for NSCLC in the neoadjuvant setting? West commentary: https://dailynews.ascopubs.org/do/should-i...

Encorafenib + binimetinib gets FDA-approval for metastatic NSCLC, but how does it compare to dabrafenib/trametinib? Plus, a new pediatric approval for dabrafenib/trametinib means more dosage form options.

Trying to make sense of the limited information put out via Press Release the last 2 weeks for mobocertinib, pembrolizumab + enfortumab vedotin, nivolumab, and more.

From the Foundations of OncoPharm archives - the history and groundbreaking STI 571 (imatinib).

It's another Landmarks of OncoPharm episode looking at the carboplatin-paclitaxel regimen in ovarian cancer from 20 years ago. carboplatin/paclitaxel vs. cisplatin/paclitaxel: https://pubmed.ncbi.nlm.nih.gov/?term=37643542

An experimental drug for EGFRm NSCLC, patritumab deruxtecan (HER3-DXd), raises some eyebrows and a new agent is FDA-approved for hematopoietic stem cell mobilization (motixafortide).

You read it in every solid tumor paper - RECIST - criteria. This Pod discusses some of the details of the Response Evaluation in Solid Tumors (RECIST) criteria along with the pros and cons of its use - including a modification of the criteria for use with immunotherapy.

Empiric dose reductions for variant DPYD alleles isn't necessarily new, but the outcomes of patients treated with those dose reductions isn't well described. Dutch researchers provide some much needed evidence. Link: https://pubmed.ncbi.nlm.nih.gov/?term=37639651 Is there a role for ICIs in dMMR/MSI-h pancreatic cancer? This retrospective says, uh maybe probably. Link: https://pubmed.ncbi.nlm.nih....

A Foundations of OncoPharm episode on nab-paclitaxel, with a focus on the pharmaceutical differences from conventional paclitaxel.

A combination product is now available of niraparib + abiraterone for use in mCRPC. Another BCMA-CD3 agent is approved for r/r multiple myeloma and melphalan hepatic arterial infusion for metastatic uveal melanoma is approved.

Talquetamab is approved for r/r multiple myeloma and the STOP-CA trials asks if atorvastatin can prevent anthracycline cardiotoxicity. STOP-CA: https://jamanetwork.com/journals/jama/fullarticle/2807988

The Ruby trial leads to an FDA approval for dostarlimab + chemo in advanced/recurrent endometrial cancer, but only dMMR/MSI-H patients. Quizartinib's label and REMS program provide some clear, but concerning, warnings about its toxicity.

By listener request! What is BCOP, why pursue it, and some simple tips on studying for the exam.

A Landmark of OncoPharm from 2004: FOLFIRI --> FOLFOX or FOLFOX --> FOLFIRI. Some interesting dosing to discuss in this study. Link: https://pubmed.ncbi.nlm.nih.gov/?term=37379692

We welcome Dr. Donald Harvey to the podcast to discuss Phase 1 clinical trials in oncology. Topics include goals of Phase 1 trials, how these early studies are conducted, how doses are determined, and some limitations of current practices.

We welcome Jacqueline (Jackie) Saunders to the podcast to talk about investigational drug services (IDS) in oncology and how pharmacists manage the storage, preparation, & delivery of experimental drugs.

This episode... More evidence to support the use of neoadjuvant ICI/chemo in stage III NSCLC to obtain pCR published this week with NADIM II. Time to rethink giving ICI/TKI combination therapy to favorable-risk metastatic RCC patients? (Finally, I'm not the only one saying this anymore.) NADIM II: https://www.nejm.org/doi/full/10.1056/NEJMoa2215530 FDA Pooled Analysis Favorable Risk metastatic RCC...

This week's Pod looks at the 2nd CD20-CD3 bispecific T-Cell engager approved this year (or at all), glofitamab, and the TALAPRO-2 study of combining talazoparib to enzalutaimide. TALAPRO-2: https://doi.org/10.1016/S0140-6736(23)01055-3

We highlight notable data from this month's ASCO annual meeting. 1. SONIA: sequence (1st or 2nd-line) CKD 4/6i in MBC 2. ADAURA OS results and low rate of osimertinib use in control arm 3. Keynote 671: perioperative pembrolizumab in NSCLC 4. PROSPECT: Can radiation therapy be omitted in locally advanced rectal cancer? 5. Nivo-AVD vs. Bv-AVD in stage III Hodgkin's (ages 12+) 6. ZUMA-7: 2nd line Axl...

ASCO '23 Appetizers by John Bossaer

Olaparib + Abiraterone is FDA approved for mutated-BRCA prostate cancers. Olaparib has a bit of convoluted story to unpack in this patient population. Have we finally found a way to minimize the peripheral neuropathy from paclitaxel.....with cilostazol? PROpel: https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200043 Cilostazol RCT: https://doi.org/10.1002/phar.2830 Cilostazol effect on Schwann ce...