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maandag 12 februari 2018

The Lancet: [Articles] Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER...

[Articles] Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer (EORTC 75111-10114): an open-label, randomised, phase 2 trial from the Elderly Task Force/Breast Cancer Group
Addition of metronomic oral cyclophosphamide to trastuzumab plus pertuzumab in older and frail patients with HER2-positive metastatic breast cancer increased median progression-free survival by 7 months compared with dual HER2 blockade alone, with an acceptable safety profile. Trastuzumab and pertuzumab plus metronomic oral cyclophosphamide, followed by trastuzumab emtansine after disease progression, might delay or supersede the need for taxane chemotherapy in this population.
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[Comment] Clinical trials in older, less fit populations: an unmet need?
Hans Wildiers and colleagues1 are to be congratulated on their demonstration of a framework for clinical trials in older, more frail patients with HER-positive metastatic breast cancer. Clinical trials are a global prerequisite for establishing new treatment standards, but eligibility criteria generally restrict participation to fit populations with minimal comorbidities. These criteria contribute to underrepresentation of older populations with functional limitations in most clinical trials.
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[Articles] Axitinib in combination with pembrolizumab in patients with advanced renal cell cancer: a non-randomised, open-label, dose-finding, and dose-expansion phase 1b trial
The treatment combination of axitinib plus pembrolizumab is tolerable and shows promising antitumour activity in patients with treatment-naive advanced renal cell carcinoma. Whether or not the combination works better than a sequence of VEGF pathway inhibition followed by an anti-PD-1 therapy awaits the completion of a phase 3 trial comparing axitinib plus pembrolizumab with sunitinib monotherapy (NCT02853331).
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[Comment] Combination therapies for patients with metastatic renal cell carcinoma
In the past decade, several single drugs have been approved for the treatment of metastatic renal cell carcinoma, with substantial benefits in disease control, resolution of symptoms, and survival for the patients.1 In the meantime, only two combination therapies, bevacizumab plus interferon-alfa as first-line treatment and lenvatinib plus everolimus in the second-line setting, have been approved on the basis of a better outcome and an acceptable toxicity over single drugs.2,3 The poor tolerability and absence of predictive biomarkers for treatment response represented major issues in the development of combination strategies.
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[Articles] Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial
Adjuvant chemotherapy given during and after radiotherapy for high-risk endometrial cancer did not improve 5-year overall survival, although it did increase failure-free survival. Women with high-risk endometrial cancer should be individually counselled about this combined treatment. Continued follow-up is needed to evaluate long-term survival.
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