What's Hot in Hematology/Oncology

“Early (immediate) separation of curves is a sign of selection bias: the patients receiving ribo+AI and AI alone are not the same! ➡️ a causal conclusion cannot be drawn! Classical bias: ‘Detecting Selection Bias in Observational Studies—When Interventions Work Too Fast’ in JAMA Internal Medicine”

“This would be true if the intervention was ‘coffee intake.’ But in this case, the intervention is a drug, ribociclib, that works rapidly, substantially improves ORR, PFS (from the first scan) and OS. Which makes this adjusted real world analysis solid.”

“Thanks for the reply. The fact that ribociclib works rapidly in RCTs like MONALEESA-2 does not eliminate selection bias in this observational analysis. Early curve separation is exactly the pattern expected when fitter patients are preferentially given the combination. IPTW cannot correct for unmeasured confounding.”

“I explained why I believe what you said is misinformation. In an academic discussion, if you think I’m wrong, you can certainly refute my argument and point out the flaws in my reasoning.”

“Your reply is a non sequitur. My point was that perioperative ADT is not standard of care, and your post does not address that.”

“What I would say is that I’ll concede that the Proteus Trial compared two methods of systemic intensification against each other, showing Apalutamide to improve outcomes. I think you would acknowledge there is no comparator arm in this trial that is solely the current standard of care.”

“How do you propose delivering risk-adapted local therapy when perioperative ADT masks PSA, which remains our best biomarker for identifying patients who need salvage local treatment? My point is simple: PROTEUS did not test overall systemic treatment escalation against best standard-of-care management. It tested apalutamide added to perioperative ADT, not a modern local-first strategy with PSA-guided salvage therapy. That is not misinformation. It is a critique of the control arm and the clinical inference being drawn from the trial. The highlighted statement overstates what PROTEUS proves and, in my view, risks circumventing the robust data supporting local-first treatment with risk-adapted salvage therapy. In this population, I would have expected substantially higher salvage RT utilization. By shifting toward PSMA DMFS while suppressing PSA with ADT, we may be delaying recognition of salvageable local failures until distant disease is detected. So to be clear: PROTEUS supports intensification within a perioperative ADT framework. It does not establish that broad perioperative systemic escalation is superior to best standard-of-care local-first management with PSA-guided salvage therapy. At this point, I think we are talking past each other, so I’m comfortable agreeing to disagree and moving on. I would only suggest avoiding ad hominem framing and trying to steelman the opposing view rather than labeling disagreement as misinformation.”