Lee et al, Lancet 2021.
What if opposite is also true, i.e. "inverse abscopal effect"?
What if opposite is also true, i.e. "inverse abscopal effect"?
Maybe. This was a SOC plus trial. If you blast away the TILs with big fields you could expect that you would potentially compromise the efficacy of the IO and see equivalence between SOC and SOC + IO. In a purist sense that is what you see here. But if the trends held up and SOC + IO really were inferior to SOC that would suggest something more were going on. Exhaustion? Anergy? Toxicity? Lots of possible options.The same concerns people have about TILs and immune suppression around the tumor and inability to do that when radiating large ENI fields is the question here.
It seems hard to imagine that concurrent IO adds anything to 6-7 weeks of fractionated RT. Any activated T-cells that localize to the tumor end up getting fried.
I don't know if this is being looked at in H&N, but I think it would be more interesting to investigate a sequential model like PACIFIC: CRT -> [IO vs. obs]. Create a bunch of tumor antigens with CRT... THEN give the IO.
Hear hear!The whole thing is a dumpster fire at this point.
Is anyone confused yet? I vomited trial results on the page with little context for a reason. The whole thing is a dumpster fire at this point. So many trials. So little coordination or central messaging.
The drug companies are scrambling for indications for THEIR drugs. They know the first to publish will become the standard. Easier to beat placebo than to beat the established standard (biosimilar) IO drug in a trial.This should be the last sentence of every conclusions/discussion section of these trials. Perfectly summarized.
This should be the last sentence of every conclusions/discussion section of these trials. Perfectly summarized.
The drug companies are scrambling for indications for THEIR drugs. They know the first to publish will become the standard. Easier to beat placebo than to beat the established standard (biosimilar) IO drug in a trial.
Thus, we're seeing all kinds of **** hitting walls in hopes some sticks.
Patients and rationale be damned. We answer to the shareholders.
Im sure the medoncs will conclude RT is detrimental to this whole process. ALL HAIL IPI/NIVO!!
As far as IO goes the net effect on RT utilization will be interesting to see. A lot of us are seeing a pretty good increase in referrals for SBRT for oligo progressors and many med oncs are full in on this. Before anyone celebrates too much, they are doing a zillion trials trying to show that IO works as an adjuvant for pretty much all diseases instead of RT or chemo. Any that show equivalence will almost certainly become THE SOC in very short order. They are also trying to use them for brain Mets etc. Time will tell if that happens but swapping out 25 fraction adjuvant therapy with 3-5 fraction SBRT is not a winning formula in the long run.
Yeah that only works if they are repeat patients not replacing upfront CRT with some garbage oligo progression months afterwards just so I can give them SBRT and collect the professional equivalent of a Denny's Grandslam to one or two metastatic lesions.
hey, you laugh, but as COVID dies down and marijuana is legalized in more states there are going to some super rich Denny’s franchisees. That and IHOP.