Ibrutinib for mantle cell lymphoma at first relapse: a United Kingdom real-world analysis of outcomes in 211 patients.

Funder: Janssen Pharmaceuticals; Id: http://dx.doi.org/10.13039/100008897Ibrutinib is an established treatment for relapsed/refractory (R/R) mantle cell lymphoma (MCL) and clinical trial data supports use at second line compared to later relapse. We aimed to investigate outcomes and tolerability for ibrutinib when given second line in a real-world setting. Our multicentre retrospective analysis included 211 R/R MCL patients, median age 73 years, receiving ibrutinib second-line within the United Kingdom's National Health Service. Overall response to ibrutinib was 69% (complete response 27%). The median progression-free survival (PFS) was 17·8 months (95% CI 13·1-22·2) and median overall survival (OS) 23·9 months (95% CI 15·0-32·8). Drug-related adverse event led to dose reduction in 10% of patients and discontinuation in 5%. In patients with progressive disease, accounting for 100 of 152 patients stopping ibrutinib, 43% received further systemic therapy. Post-ibrutinib rituximab, bendamustine and cytarabine (R-BAC) showed a trend toward improved survival compared to alternative systemic treatments (post-ibrutinib median OS 14·0 months, 95% CI 8·1-19·8, vs. 3·6 months, 95% CI 2·6-4·5, P = 0·06). Our study confirms the clinical benefit and good tolerability of ibrutinib at first relapse in a real-world population. Patients progressing on ibrutinib had limited survival but outcomes with R-BAC in select patients were promising

Minimising the Toxicities of First Line Hodgkin Lymphoma Treatment in the Modern Era.

Peer reviewed: TrueStriking advances in the treatment of Hodgkin lymphoma over the last 30 years have culminated in high rates of disease-free survival in younger patients with early and advanced stage disease. In this review we focus on strategies that have evolved over recent years to reduce short and long-term toxicities of treatment. These strategies include the selection of first-line chemotherapy, the stratification of patients based on initial response and subsequent adaptation of treatment, the addition of novel agents (e.g., brentuximab vedotin), the removal of specific drugs (e.g., bleomycin), the use of drug substitution, and the removal of consolidation radiotherapy based on interim and end of treatment PET assessment. While these strategies have successfully reduced toxicity of Hodgkin lymphoma therapy, the cornerstone of treatment continues to be combination chemotherapy and radiotherapy with significant short- and long-term side effects. To further reduce toxicity while maintaining or improving efficacy, we shall need to incorporate novel agents into our first-line treatment algorithms, and several such potentially practice-changing trials are underway

Evusheld Prophylaxis Improves Social Interactions, Anxiety, Depression, Agoraphobia, and Quality of Life in Blood Cancer Patients

Peer reviewed: TrueEvusheld is a combination injection of tixagevimab and cilgavimab and is indicated for the pre-exposure prophylaxis of COVID-19 in adults and adolescents aged 12 years and older. Its use has been advocated for immunosuppressed individuals, such as blood cancer patients, although uptake varies significantly between countries. Despite extensive use internationally, there has been limited analysis of potential psychological benefits that vulnerable patients might gain from receiving this prophylactic medication. In this study we have quantified four key psychological health parameters in blood cancer patients who received Evusheld (EQ5D-3L quality of life score, DSM5 Agoraphobia score, Duke’s Social Support Index and the hospital anxiety and depression score) and compared their responses with a control group of patients who did not receive Evusheld. We show that patients who opted for treatment had higher baseline markers of psychological stress and ill-health compared with non-treated individuals but that treatment with Evusheld significantly improved the psychological health of recipients and increased the level of physical social/work interactions over that of control patients. Although there are limitations with this small study, the findings strongly suggest that Evusheld prophylaxis can provide significant psychological benefits for vulnerable blood cancer patients who have significant anxiety about COVID-19 infection

Patterns of referrals to regional clinical genetics services for women potentially at above-population level risk of breast cancer

Background The National Institute for Health and Care Excellence (NICE) recommends that women in England at above-population risk be offered additional breast screening and, depending on the level of risk, risk-reducing medication or surgery. Methods We reviewed the hospital records of GP referrals made to two large genetics services in England between 01/12/2021-30/11/2022 for women aged 18-50 years and suspected to be at above-population level risk for breast cancer. We compared the women referred with the wider population and estimates of the number of women at above-population level risk using published data. Results Up to 20% of women referred did not provide sufficient information for a complete risk assessment and over 25% were considered at near-population level risk after assessment. We estimate that only a small fraction (<10%) of those above population-level risk are identified and women in areas of lower deprivation are disproportionately represented amongst referrals. Conclusions Many women are missing out on potential preventative and risk-reducing interventions for breast cancer and current pathways may be exacerbating existing health inequalities. Better systems for collecting data on family history, improved methods for risk assessment in general practice and more systematic risk assessment of women prior to population-based screening are needed.This study was supported by Cancer Research UK grant: PPRPGM-Nov20\100002. JUS is supported by an NIHR Advanced Fellowship (NIHR300861). MT is supported by the NIHR Cambridge Biomedical Research Centre (NIHR203312). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. AB was supported with Health Education England fellowship fundin

Patterns of referrals to regional clinical genetics services for women potentially at above-population level risk of breast cancer

Acknowledgements: The authors thank Clare Brady for help with extracting the data for Cambridge and Peterborough referrals.Abstract Background The National Institute for Health and Care Excellence (NICE) recommends that women in England at above-population risk be offered additional breast screening and, depending on the level of risk, risk-reducing medication or surgery. Methods We reviewed the hospital records of GP referrals made to two large genetics services in England between 01/12/2021-30/11/2022 for women aged 18–49 years and suspected to be at above-population level risk for breast cancer. We compared the women referred with the wider population and estimates of the number of women at above-population level risk using published data. Results Up to 20% of women referred did not provide sufficient information for a complete risk assessment and over 25% were considered at near-population level risk after assessment. We estimate that only a small fraction (&lt;10%) of those above population level risk are identified and women in areas of lower deprivation are disproportionately represented amongst referrals. Conclusions Many women are missing out on potential preventative and risk-reducing interventions for breast cancer and current pathways may be exacerbating existing health inequalities. Better systems for collecting data on family history, improved methods for risk assessment in general practice and more systematic risk assessment of women prior to population-based screening are needed. </jats:sec

Managing relapsed refractory lymphoma with palliative oral chemotherapy: A multicentre retrospective study.

PEP-C (prednisolone, etoposide, procarbazine and cyclophosphamide) is an orally administered daily chemotherapy regimen used with palliative intent in relapsed refractory lymphoma. To our knowledge, no data on PEP-C have been reported since the original group described the regimen. Here we present a multicentre retrospective cohort reporting our use of PEP-C in 92 patients over an 8-year period. We find that even heavily pretreated lymphoma can respond to PEP-C, particularly low-grade lymphoma (including mantle cell) and lymphoma that was sensitive to the previous line of systemic therapy (chemosensitive). These characteristics may help in the selection of patients likely to derive benefit. The median overall survival of patients with chemosensitive lymphoma treated with PEP-C is 217 days. Within the limitations of a retrospective cohort, we find that PEP-C is well tolerated: the most common toxicity leading to discontinuation is marrow suppression. We suggest that PEP-C should be considered for patients with relapsed refractory lymphoma in two settings: first, where there is no licensed alternative; and second, where the licensed alternative is an intravenous drug and the patient would prefer to choose an oral chemotherapy option