Quiet today — no notable KOL discussion in the last 48 hours.
The OPTIMA trial led the breast conversation, sparked by the Oncology Brothers asking which patients should get PAM50-based testing instead of OncotypeDx. Positions across the thread: Oncotype stays the default in node-negative and postmenopausal 1–3-node disease, with Prosigna preferred for OPTIMA-eligible premenopausal patients on ovarian suppression and selected 4–9-node cases; several oncologists are most comfortable in postmenopausal node-positive disease, and some would start with 1–3 nodes while holding back in the 4–9-node group, a small minority of the trial. The shared caution: reported follow-up is 5 years, and half of HR+ HER2− recurrences occur later. Separately, the SUPREMO trial reported no 10-year overall survival benefit from post-mastectomy radiotherapy in intermediate-risk breast cancer.
“Still trying to figure out how to adopt the data from OPTIMA trial in my practice (and how to use OncotypeDx vs. PAM50 scoring/test). Who is the right patient? Should I pivot completely from other tests and just rely on PAM50?”
— @OncBrothers · OPTIMA adoption · View post ↗
“I would continue to use Oncotype as the default assay in standard node-negative disease and in postmenopausal patients with 1–3 positive nodes. In OPTIMA-eligible premenopausal patients aged ≥40 years who will receive optimal ovarian suppression, and in selected patients with 4–9 positive nodes, I would prefer Prosigna as the de-escalation assay.”
— @dr_yakupergun · Assay selection · View post ↗📌 Amplified by @KolPulseAI
“After mastectomy in intermediate-risk breast cancer, chest-wall RT brought no 10-year OS benefit and <2% reduction in chest-wall recurrence.”
— @ChandrakanthMv · SUPREMO trial results · View post ↗
“I feel most comfortable for postmenopausal node positive.”
— @drsarahsam · Where OPTIMA applies · View post ↗A multinational study in locally advanced biliary tract cancer (BTC) found that first-line cisplatin, gemcitabine, and durvalumab (CGD) enabled conversion surgery in approximately 10.9% of patients, with this cohort showing a survival trend of 22.5 vs 19.9 months. Additionally, results from the phase II MoST-CIRCUIT trial evaluating nivolumab plus ipilimumab in advanced intrahepatic cholangiocarcinoma and gallbladder cancer have been published.
“CGD enabled conversion surgery in ~10.9% of patients, showing a survival trend of 22.5 vs 19.9 months.”
— @hongjaechon · Conversion Surgery in BTC · View post ↗Track oncology’s top KOLs in your specialty
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New IBCG consensus recommendations for bladder cancer state that ctDNA is prognostic after neoadjuvant therapy and predictive for adjuvant immunotherapy benefit, and that FGFR3 and HER2 should be assessed in locally advanced/metastatic disease. Concurrently, discussion highlights the limitations of ctDNA in renal cell carcinoma, where a negative result is not yet sufficient to rule out residual disease or guide de-escalation of adjuvant therapy.
“Key recommendations: ctDNA is prognostic after neoadjuvant therapy and radical cystectomy, and predictive for adjuvant immunotherapy benefit. FGFR3 and HER2 should be assessed in locally advanced/metastatic disease.”
— @drenriquegrande · Bladder Cancer Biomarkers · View post ↗
“In kidney cancer, 🧬ctDNA+ signals high relapse risk. But ctDNA− does not mean no MRD, no relapse risk, or no need for adjuvant therapy. Negative ctDNA is not yet enough for de-escalation.”
— @DrYukselUrun · ctDNA in RCC · View post ↗
“What is the optimal prostate-specific antigen cutoff to determine the success of prostate cancer treatment?”
— @JournalCancer · Prostate Cancer Prognosis · View post ↗In newly diagnosed AL amyloidosis, a limited duration (≤3 months) of dexamethasone with a daratumumab-based regimen resulted in higher 6-month complete response rates (66.7% vs 30.4%) and reduced toxicity. The myeloma/hematology community is also discussing updated guidance for managing incidental abnormal free light chain ratios, recommending repeat testing in 6 months if the ratio is not <0.125 or >8, and a proposal to define functional high-risk myeloma as progression within 36 months after CD38-quadruplet induction therapy.
“ask referring physicians to repeat in 6 months and if stable consider it as possible LC-MGUS with subsequent testing only if symptoms concerning for myeloma, amyloid etc develop.”
— @VincentRK · Free Light Chain Ratio Management · View post ↗
“Limited duration (≤3 months) of dexamethasone in newly diagnosed AL #amyloidosis (w/ daratumumab-based regimen) results in higher 6-month CR rates (66.7 vs 30.4%, p<0.001) and reduced toxicity, similar organ responses:”
— @Myeloma_Doc · Dexamethasone in AL Amyloidosis · View post ↗
“36 is to 4 as 18 is to 3: After CD38 quad induction in myeloma, use PD ≤36 mo to define functional high-risk (not 18 mo).”
— @RahulBanerjeeMD · Functional High-Risk Definition · View post ↗📌 Amplified by @KolPulseAI
A Phase Ib/II study of the investigational use of acalabrutinib added to R-CHOP in newly diagnosed Diffuse Large B-cell Lymphoma (DLBCL) found the combination was feasible and well-tolerated, with encouraging long-term outcomes. The hematology community noted that an ongoing randomized controlled trial is underway to define its role in the frontline setting. Other discussions centered on treatment algorithms and sequencing in Myelodysplastic Syndrome (MDS) and the clinical significance of spleen size in myelofibrosis.
“Phase Ib/II study: adding acalabrutinib to R-CHOP was feasible, well tolerated across age groups, and associated w encouraging long-term outcomes in newly diagnosed DLBCL, supporting ongoing RCT to define its role in frontline treatment”
— @crisbergerot · Acalabrutinib in DLBCL · View post ↗
“MPN - does spleen size REALLY matter?”
— @MythsFactsPod · Myelofibrosis · View post ↗“Treatment Algorithm discussion on Myelodysplastic Syndrome (MDS) with @tomleblancMD”
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