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woensdag 22 november 2017

The Lancet: [Comment] Complexity of intermittent letrozole adjuvant therapy

[Comment] Complexity of intermittent letrozole adjuvant therapy
To improve the outcomes of postmenopausal women with early-stage breast cancer is an important ongoing research goal. In The Lancet Oncology, Marco Colleoni and colleagues1 of the International Breast Cancer Study Group attempted to address this important research question in the Study Of Letrozole Extension (SOLE) trial in which they evaluate a novel approach to aromatase inhibitor administration—namely, extended intermittent use of adjuvant letrozole. At 5 years' follow-up, they report that disease-free survival did not differ significantly between women who received extended intermittent letrozole and those given continuous letrozole (hazard ratio 1·08, 95% CI 0·93–1·26; p=0·31).
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[Articles] Cetuximab plus carboplatin and paclitaxel with or without bevacizumab versus carboplatin and paclitaxel with or without bevacizumab in advanced NSCLC (SWOG S0819): a randomised, phase 3 study
Although this study did not meet its primary endpoints, prespecified subgroup analyses of patients with EGFR FISH-positive squamous-cell carcinoma cancers are encouraging and support continued evaluation of anti-EGFR antibodies in this subpopulation.
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[Comment] EGFR monoclonal antibody biomarkers in advanced NSCLC: from translational research to clinical implementation
Lung cancer is diagnosed in 1·8 million people worldwide each year. About 40% of these patients will present with advanced non-small-cell lung cancer (NSCLC). Therapeutic advances in advanced NSCLC include targeted therapies directed against EGFR.1 EGFR expression on the surface of tumour cells has been studied as a therapeutic target for monoclonal antibodies.2 Cetuximab treatment improved survival of patients when added to platinum-based first-line chemotherapy compared with chemotherapy alone and this benefit had a hazard ratio (HR) of 0·77 (95% CI 0·64–0·93) in patients with squamous cell NSCLC.
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[Articles] Gefitinib versus vinorelbine plus cisplatin as adjuvant treatment for stage II–IIIA (N1–N2) EGFR-mutant NSCLC (ADJUVANT/CTONG1104): a randomised, open-label, phase 3 study
Adjuvant gefitinib led to significantly longer disease-free survival compared with that for vinorelbine plus cisplatin in patients with completely resected stage II–IIIA (N1–N2) EGFR-mutant NSCLC. Based on the superior disease-free survival, reduced toxicity, and improved quality of life, adjuvant gefitinib could be a potential treatment option compared with adjuvant chemotherapy in these patients. However, the duration of benefit with gefitinib after 24 months might be limited and overall survival data are not yet mature.
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[Comment] Lung cancer's real adjuvant EGFR targeted therapy questions
In The Lancet Oncology, Wen-Zhao Zhong and colleagues report findings of the ADJUVANT study.1 222 patients with completely resected, stage II–IIIA (N1–N2), EGFR-mutant non-small-cell lung cancer (NSCLC) were randomly assigned to either four cycles of adjuvant vinorelbine plus cisplatin or 24 months of gefitinib—an EGFR tyrosine kinase inhibitor. Disease-free survival (the primary endpoint) was significantly longer for patients assigned gefitinib than for those assigned cisplatin-based chemotherapy (median 28·7 months, 95% CI 24·9–32·5 vs 18·0 months, 13·6–22·3; hazard ratio [HR] 0·60, 95% CI 0·42–0·87; p=0·0054).
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