Overall survival, efficacy, and safety outcomes beyond front-line modern therapies in metastatic clear-cell renal cell carcinoma

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Background: Due to the ever-changing front-line landscape therapeutic options for m-ccRCC, the second-line (2L) treatment decision remains challenging due to limited information comparing each of the options. We present a survival, efficacy, and safety comparison of the 2L treatment regimens based on the most recent drug approvals for m-ccRCC. Methods: Inclusion criteria for our NMA included phase II/III RTCs that evaluated 2L and beyond for metastatic ccRCC. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and severe adverse events (SAE) hazard ratios (HRs), odds ratios (OR), and 95% confidence intervals (CI) of the treatment differences were abstracted. The p-scores were used to rank treatments. Data were analyzed in a fixed effects model using the netmeta package in R v.1.5-0. Results: Nine studies with 10 therapies included demonstrated some level of efficacy over placebo (Table). Pairwise comparisons using the NMA matrix revealed no differential OS benefit between axitinib (A), cabozantinib (C), lenvatinib+everolimus (LE), and nivolumab (N). Other regimens had no OS benefit when compared to placebo. Table was ordered based on p-score ranking the certainty that one treatment is better than another averaged over all competing treatments for OS. Placebo represents the reference of 1. Conclusions: LE had the lowest safety profile, although did prove to have the best OS and efficacy based on PFS/ORR. C and N, both had significant improvement in OS and efficacy over placebo with lower rates of SAEs compared to LE. Therefore, while further direct comparison studies are warranted to inform clinical practice, for now, we rely on the limitations inherent in indirect treatment comparisons of a NMA. [Table: see text]

Real-world data on outcomes using taxane, trastuzumab, and pertuzumab (THP) in patients with early stage HER2+ breast cancer

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Background: In HER2+ early breast cancer, dual HER2 targeted combination of trastuzumab and pertuzumab with chemotherapy achieved higher rates of pathologic complete response (pCR) and improved long term outcomes. However, the optimal chemotherapy backbone is still under investigation. While neoadjuvant taxane in combination with trastuzumab and pertuzumab (THP) has been investigated in NEOSPHERE, patients received anthracycline-based regimen in the adjuvant setting. We report real-world data on long-term patient outcomes after neoadjuvant THP. Methods: An IRB-approved retrospective chart review at 2 academic centers was conducted using EMR to identify women with stage I-III HER2+ breast cancer who exclusively received neoadjuvant THP between 2013-2020. Clinicopathological characteristics and follow up information were extracted from surgical pathology and medical records. Results: 71 patients met criteria (median, 55 years). At presentation, 56 (79%) patients had stage II - III disease and 45 (63%) were lymph node negative. The majority of tumors were ER+ (43 patients, 61%) and received paclitaxel (46 patients, 65%) as their taxane backbone. pCR was achieved in 40 (56%) patients (Table); 38 (95%) continued with adjuvant HER2 therapy alone; 1 received adjuvant endocrine therapy only and 1 received no further treatment. Of the 31 (44%) patients without pCR, 9 received additional adjuvant chemotherapy in addition to HER2 directed therapy while 18 continued with HER2 therapy alone. During the follow-up period (median 34.7 mo, range 6.8-98.9 mo), 3 patients with lymph node positive disease on presentation had disease relapse. Two of the patients with pCR had local recurrence and one without pCR had distant metastasis (brain, lung). The 2 patients with local recurrence were successfully treated with salvage therapy and remain in remission. The patient with metastatic disease remains alive and on treatment. Conclusions: We showed that a real world HER2+ patient population treated with neoadjuvant THP achieved pCR rates consistent with what has been previously reported. In addition, with a median follow up of ̃ 3 years, only 3 patients had relapse supporting the utility of THP as potential de-escalation treatment in the neoadjuvant setting. Ongoing prospective trials, like NCT03716180, will further confirm the efficacy of this regimen in a prospective setting.[Table: see text]

The trastuzumab era: current and upcoming targeted HER2+ breast cancer therapies

Human Epidermal Growth Factor Receptor 2-positive breast cancer (HER2+ BC) is defined by increased amplification of the ERBB2/neu oncogene and/or overexpression of its associated HER2 transmembrane receptor protein. HER2+ BC represents approximately 15-20% of breast cancer, and it is independently associated with a higher grade, more aggressive phenotype, and worse prognosis. With the advent of trastuzumab, the prognostic landscape for HER2+ BC patients has considerably improved. However, both de novo and acquired resistance to trastuzumab remain a significant obstacle for many patients, requiring novel therapies for further clinical benefit. Over the last two decades, there has been extraordinary progress in the development of HER2+ BC treatment regimens, with extensions into HER2-amplified gastroesophageal junction cancer via the NCI-MATCH precision medicine trial program (NCT02465060). Trastuzumab, pertuzumab, T-DM1, and lapatinib are commonly recommended as a single agent (along with chemotherapy) or in combinations of anti-HER2 agents in neoadjuvant, adjuvant and metastatic settings according to National Comprehensive Cancer Network (NCCN) guidelines. Currently, the combination of trastuzumab, pertuzumab, and taxane chemotherapy are first-line for HER2+/HR- metastatic breast cancer with potential breakthrough therapies such as trastuzumab-deruxtecan (DS-8201a), margetuximab and tucatinib (ONT-380) on the horizon. Furthermore, recent clinical trials have demonstrated the potential utility of hormone receptor status, PAM-50 luminal intrinsic subtype, PD-L1, and TIL as predictive biomarkers for response to HER2+ therapies. We briefly introduce the origin of HER2, the invention of trastuzumab, and the classification of HER2+ BC. Each HER2-targeted therapy is then presented by indication, mechanism of action, and relevant clinical trials with subsequent elaboration and contextualization within clinical settings with an epilogue of potential future biomarkers for clinical use in HER2+ BC. We summarize the most significant and updated research in clinical practice relevant to HER2+ BC management and highlight the clinical status of upcoming anti-HER2 agents as well as immunotherapy drugs in combination with anti-HER2 agents.

Hip fracture among the elderly in a mixed urban and rural population

Among the 27314 people aged 60 years or more living in the northern part of the county of Storstr øm, Denmark, 117 were hospitalized with hip fracture in one year (1978), making an incidence of 4.3 per 1000. All 117 patients were seen soon after their admittance to hospital, and after one year the 86 surviving patients were seen in their homes. A higher death rate was found during the first three months, but only among patients with additional disabling diseases. Among the survivors, the possibility of leading a regular life was found to be only slightly reduced as measured by their activity-level, mobility and state of independence. Thirteen per cent of the survivors were institutionalized. The mean stay in hospital was 66 days, including transfer to a geriatric department in some instances.