onc brain

About · curated by Nick Boehling, MD · @nb2276

    Palliative

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    ES-SCLC Concurrent TRT + Chemoimmunotherapy (LBA8005)

    ForES-SCLC, treatment-naïve, ECOG 0-1, measurable thoracic lesion

    TL;DRmOS 10.0 vs 11.8mo, HR 1.14, p=0.40: concurrent TRT adds no OS benefit to chemoIO in ES-SCLC.

    vs leading data
    • vs CREST (Lancet 2015): TRT 30 Gy/10 fr post-induction improved 1yr OS in pre-IO ES-SCLC; not replicated here in IO era

    Radiation Palliative Phase 3 RCT Confirmatory

    ES-SCLC Concurrent TRT + Chemoimmunotherapy (LBA8005)
    ArmMedian OS95% CIHR (95% CI)p
    ChemoIO + TRT10.0 mo8.3-11.71.14 (0.84-1.56)0.40
    ChemoIO11.8 mo10.0-13.6refn/a
    +3 more figures
    ES-SCLC Concurrent TRT + Chemoimmunotherapy (LBA8005)
    ArmMedian PFS95% CIHR (95% CI)p
    ChemoIO + TRT5.1 mo4.7-5.41.10 (0.84-1.45)0.49
    ChemoIO5.0 mo4.6-5.4refn/a
    ES-SCLC Concurrent TRT + Chemoimmunotherapy (LBA8005)
    ES-SCLC Concurrent TRT + Chemoimmunotherapy (LBA8005)
    SubgroupChemoIO+TRT median OSChemoIO median OSHR (95% CI)p
    Completed all 4 cycles11.9 mo12.1 mo1.02 (0.72-1.44)0.92
    No brain/liver mets11.9 mo13.2 mo1.10 (0.65-1.87)0.72
    6 details
    Methods
    • 🔍 Phase III RCT, N=228 (115 vs 113); TRT 30 Gy/10 fr concurrent from day 21-28 of cycle 1
    • 🔍 Eligibility: stage IV SCLC or stage III ineligible for curative CRT, ECOG 0-1, measurable thoracic lesion required
    • 🔍 PCI 25-30 Gy optional for responders per local routine; durvalumab 1500 mg Q4W maintenance until PD
    CONSORT flow
    Randomized 228
    ↓
    ChemoIO + TRT
    allocated 115
    ChemoIO
    allocated 113
    Critique
    • ⚠️ Control arm mOS (11.8mo) consistent with CASPIAN durvalumab arm (~12.9mo); TRT arm numerically inferior at 10.0mo
    • ⚠️ Pre-specified OS subgroups (completed all 4 cycles, no brain/liver mets) both null, consistent with ITT
    • ⚠️ PCI optional per local routine; differential PCI use between arms unreported, potential survival confound
    Open questions
    • Whether consolidative rather than concurrent TRT sequencing improves outcomes
    • Role of PCI in IO-era ES-SCLC given uncontrolled differential use in this trial
    • Optimal ES-SCLC subpopulation (if any) for TRT in the IO era
    📚 Sources · 🐦 1 tweet

    DeLLphi-304 (tarlatamab CNS outcomes)

    For2L ES-SCLC; brain mets subgroup ≥1 BM at baseline, >70% prior CNS treatment

    TL;DRCNS PFS HR 0.54 (ITT), HR 0.40 in brain mets; CNS CR 14.9% vs 5.4% with tarlatamab vs chemo 2L SCLC.

    vs leading data
    • DeLLphi-304 primary results: tarlatamab OS + PFS benefit in 2L SCLC; CNS data extends intracranial signal

    Systemic Palliative Phase 3 RCT Caveats dominate

    DeLLphi-304 (tarlatamab CNS outcomes)
    ArmnMedian CNS PFS (mo)HR (95% CI)
    Tarlatamab676.5 (4.3-13.7)0.40 (0.24-0.66)
    Chemotherapy564.2 (2.9-5.5)ref
    +2 more figures
    DeLLphi-304 (tarlatamab CNS outcomes)
    ArmnMedian CNS PFS (mo)HR (95% CI)
    Tarlatamab254NE (13.7, NE)0.54 (0.39-0.75)
    Chemotherapy2557.2 (5.6, NE)ref
    DeLLphi-304 (tarlatamab CNS outcomes)
    EndpointTarlatamab (n=67)Chemo (n=56)
    CNS CR10 (14.9%)3 (5.4%)
    Non-CR/Non-PD42 (62.7%)37 (66.1%)
    CNS DCR52 (77.6%)40 (71.4%)
    Median duration CNS CR (mo)NE3.6
    Median duration CNS DC (mo)8.25.2
    5 details
    Methods
    • 🔍 Post-hoc subgroup analysis of DeLLphi-304 phase 3 RCT; ITT n=509 (254 tarlatamab / 255 chemo)
    • 🔍 Brain mets subgroup: n=67 (tarlatamab) vs n=56 (chemo); >70% had prior CNS treatment
    • 🔍 Data cutoff Jan 29 2025; median f/u 11.4 mo (tarlatamab), 11.5 mo (chemo)
    Results
    • 📊 Ongoing CNS complete response at cutoff: 5 (50%) tarlatamab vs 0 chemo
    Critique
    • ⚠️ CNS outcomes not prespecified; interpretability limited without a confirmatory prospective CNS endpoint
    Open questions
    • Does tarlatamab CNS activity change the role of PCI in ES-SCLC?
    • Confirmatory prospective CNS endpoint needed from DeLLphi-304 or successor trial
    • Durability of CNS CR beyond 11mo median f/u
    📚 Sources · 🐦 1 tweet

    RASolute 302

    ForPrev-treated metastatic PDAC, RAS G12 mutation, ≥1 prior systemic line

    TL;DRDaraxonrasib vs IC chemo in 2L RAS G12 mPDAC: mOS 13.2 vs 6.6 mo, HR 0.40 (0.30-0.54), p<0.001.

    vs leading data
    • 2L PDAC historical: IC chemo (FOLFOX, nalirinotecan-based regimens) mOS ~5-7 mo; daraxonrasib more than doubles median in RAS G12-selected pts

    Systemic Palliative Phase 3 RCT Practice-changing

    RASolute 302
    DaraxonrasibChemotherapy
    RAS G12: N228231
    RAS G12: mOS (95% CI)13.2 mo (10.0-NR)6.6 mo (5.4-8.2)
    RAS G12: HR (95% CI), p0.40 (0.30-0.54), p<0.001ref
    RAS G12: 12-mo OS53.3%8.7%
    Overall: N248252
    Overall: mOS (95% CI)13.2 mo (10.0-NR)6.7 mo (5.8-8.0)
    Overall: HR (95% CI), p0.40 (0.30-0.53), p<0.001ref
    Overall: 12-mo OS53.2%17.3%
    6 details
    Methods
    • 🔍 Phase 3 RCT; RAS G12 primary analysis N=459 (228 vs 231); overall N=500 (248 vs 252); control: investigator's choice chemotherapy
    CONSORT flow
    Randomized 500
    ↓
    Daraxonrasib
    allocated 248
    Chemotherapy
    allocated 252
    Results
    • 📊 1° EP (RAS G12 population): mOS 13.2 mo (95% CI 10.0-NR) vs 6.6 mo (5.4-8.2); HR 0.40 (0.30-0.54), p<0.001
    • 📐 12-mo OS (RAS G12): 53.3% daraxonrasib vs 8.7% chemo
    • 📊 Consistent in overall population (all RAS mutations + no-mutation pts, N=500): HR 0.40 (0.30-0.53), p<0.001; mOS 13.2 vs 6.7 mo
    Critique
    • ⚠️ Event maturity asymmetric at datacut: 32% events in daraxonrasib arm vs 55% chemo; upper OS CI not reached (NR); follow-up ongoing
    • ⚠️ G12 variant breakdown (G12D vs G12V vs G12R) not reported in source
    Open questions
    • Activity by specific G12 variant (G12D vs G12V vs G12R)
    • Durability beyond current f/u; upper OS CI not yet reached
    • Optimal sequencing and potential 1L investigation
    📚 Sources · 🐦 1 tweet

    A-DREAM (ALLIANCE mAPMS)

    FormHSPC achieving PSA<0.2 after ≥18-24mo ADT+ARPI, low-volume predominant

    TL;DRADT+ARPI interruption in mHSPC: 41% treatment-free with eugonadal T at 18mo (1° EP); 38.5% still off-tx at 26.9mo FU.

    vs leading data
    • Intermittent ADT established in earlier hormone-sensitive trials; A-DREAM is first prospective signal for ADT+ARPI interruption in mHSPC

    Systemic Palliative Phase 2 trial Early signal

    A-DREAM (ALLIANCE mAPMS)
    +2 more figures
    A-DREAM (ALLIANCE mAPMS)
    A-DREAM (ALLIANCE mAPMS)
    9 details
    Methods
    • 🔍 Single-arm phase II, N=78 enrolled 07/2022-03/2024; PSA<0.2 after ≥18-24mo ADT + ≥12mo ARPI
    • 🔍 Re-initiation triggers: PSA ≥5 ng/mL, radiographic change (PCWG3), or PrCa-related sx
    Results
    • 📐 Primary EP: 80% CI 33.1-48.9%, one-sided p=0.0249; pre-specified 80% CI threshold (not 95%)
    • 📊 Median time to eugonadal T recovery: 9.0mo (95% CI 8.4-12.4)
    • 📊 Disposition at 26.9mo: 38.5% still off-tx; 37.2% resumed ADT+ARPI per protocol; 9.0% started non-protocol tx
    • 📊 rPFS from interruption: 15/78 events, median NE (32.5-NE); 12-mo est 94.6% (89.6-99.9%)
    • 📊 OS: 4/78 events, median NE; causes: prostate cancer, MDS, influenza, MI
    Critique
    • ⚠️ Single-arm; no randomized comparator vs continuous ADT+ARPI
    • ⚠️ 64.9% low-volume CHAARTED, 84.6% White; high-volume and diverse pts underrepresented
    Open questions
    • Impact on long-term OS vs continuous ADT+ARPI: randomized trial needed
    • Optimal re-initiation criteria in high-volume vs low-volume disease
    • Biomarker predictors of durable treatment-free interval
    📚 Sources · 🐦 1 tweet

    ENZAMET + Decipher Biomarker Analysis

    FormHSPC, ADT + enzalutamide backbone, tumor tissue available for Decipher testing

    TL;DRDecipher >0.85 identifies mHSPC pts with OS benefit from docetaxel intensification; IPTW interaction p=0.04, HR 0.75 (0.43-1.33).

    vs leading data
    • Framed as Level 1B evidence; consistent with CHARTED and STAMPEDE docetaxel predictive patterns

    Systemic Palliative Phase 3 RCT Caveats dominate

    ENZAMET + Decipher Biomarker Analysis
    AnalysisDecipherDocetaxel HR (95% CI)pInteraction p
    Unweighted≤0.852.78 (1.49, 5.21)0.0010.02
    Unweighted>0.851.13 (0.71, 1.79)0.60—
    IPTW≤0.851.94 (0.95, 3.96)0.070.04
    IPTW>0.850.75 (0.43, 1.33)0.33—
    +1 more figure
    ENZAMET + Decipher Biomarker Analysis
    DecipherOS HR triplet vs doublet (95% CI)p
    ≤0.853.02 (1.50-5.76)—
    >0.851.08 (0.60-1.71)0.73
    4 details
    Methods
    • 🔍 Biomarker analysis within ENZAMET phase 3 RCT; ADT+enza+doce cohort N=320 with evaluable Decipher; DPMC 0.85 cutoff per statistical analysis plan
    Critique
    • ⚠️ Individual arm HRs non-significant in IPTW-MVA (Decipher >0.85: HR 0.75, p=0.33; Decipher ≤0.85: HR 1.94, p=0.07); signal rests on interaction term only
    • ⚠️ Tissue available in only ~427/3816 ENZAMET pts; representativeness of the analyzed subset uncertain
    • ⚠️ ENZAMET predated current ARSI-doublet SOC; Decipher model trained pre-ARPI — applicability to modern ADT+ARSI backbone unvalidated
    Open questions
    • Prospective Decipher-guided triplet selection trial in ARPI-era mHSPC needed
    • Optimal DPMC cutoff in pts receiving ADT+ARSI (not ENZA) doublets
    📚 Sources · 🐦 2 tweets

    TALAPRO-3

    ForHRR-deficient metastatic hormone-sensitive prostate cancer

    TL;DR3yr rPFS 77% vs 56% (HR 0.48, p<0.001) favoring talazoparib+enza+ADT in HRR-deficient mHSPC.

    vs leading data
    • vs TALAPRO-2 (talazoparib+enza, mCRPC, HRR+, HR ~0.46): class effect now established in hormone-sensitive setting

    Systemic Palliative Phase 3 RCT Practice-changing

    TALAPRO-3
    Subgroupn (exp/ctrl)Median rPFS expMedian rPFS ctrlHR (95% CI)
    ITT300/299NC (NC-NC)45.8 (37.7-NC) mo0.48 (0.36-0.65), p<0.001
    BRCA104/103NC (NC-NC)35.1 (18.6-NC) mo0.37 (0.22-0.61)
    Non-BRCA196/196NC (NC-NC)NC (40.5-NC) mo0.57 (0.39-0.82)
    3 details
    Methods
    • 🔍 Phase 3 RCT; N=599; HRR-deficient mHSPC; talazoparib+enza+ADT vs placebo+enza+ADT
    CONSORT flow
    Randomized 599
    ↓
    Talazoparib+enzalutamide
    allocated 300
    analyzed 300
    Placebo+enzalutamide
    allocated 299
    analyzed 299
    Critique
    • ⚠️ Primary endpoint imaging-based rPFS, not OS; OS maturity not reported in source
    • ⚠️ Non-BRCA HRR effect attenuated (HR 0.57 vs BRCA HR 0.37); non-BRCA HRR subset heterogeneous
    Open questions
    • OS benefit magnitude and maturity
    • Which non-BRCA HRR alterations drive clinically meaningful rPFS benefit
    • Post-progression sequencing in PARP-pretreated pts transitioning to mCRPC
    📚 Sources · 🐦 1 tweet

    CHRYSALIS-2 (1L Ami+Laz, Atypical EGFR+)

    ForAdvanced NSCLC, atypical EGFR mutation, treatment-naive

    TL;DRMedian OS 41.0 mo (95% CI 27.7-NE) with ami+laz in 1L atypical EGFR+ advanced NSCLC; single-arm, n=49.

    vs leading data
    • Yang JCH NEJM 2025 (ami+laz 1L common EGFR): durable OS now reported in both common and atypical EGFR-mutated NSCLC populations

    Systemic Palliative Phase 2 trial Early signal

    OS: median 41.0 mo (95% CI 27.7-NE); landmark rates 85%, 72%, 55%; median f/u 31.3 mo; n at risk 49 → 10 → 0.
    OS: median 41.0 mo (95% CI 27.7-NE); landmark rates 85%, 72%, 55%; median f/u 31.3 mo; n at risk 49 → 10 → 0.
    +1 more figure
    Median treatment duration 13.3 mo (range <0.1-53.2); 39% on treatment >2 years.
    Median treatment duration 13.3 mo (range <0.1-53.2); 39% on treatment >2 years.
    7 details
    Methods
    • 🔍 Single-arm, n=49; 1L atypical EGFR-mutated advanced NSCLC
    • 💊 Median treatment duration 13.3 mo (range <0.1-53.2)
    • 💊 39% remained on treatment >2 years
    Results
    • 📊 Median OS 41.0 mo (95% CI 27.7-NE); median follow-up 31.3 mo
    Critique
    • ⚠️ Single-arm; no randomized comparator vs osimertinib or chemotherapy
    • ⚠️ Small N (49) limits any subgroup analysis by EGFR variant subtype
    • ⚠️ No clear EGFR variant subtype-outcome association found; underpowered to confirm or exclude
    Open questions
    • Randomized trial vs osimertinib in atypical EGFR needed to confirm benefit
    • CNS penetration and activity across atypical EGFR variant subtypes
    • SC amivantamab formulation (COPERNICUS) applicability in this population
    📚 Sources · 🐦 1 tweet

    ESAONA

    For1L EGFR-mutated NSCLC with active brain metastases

    TL;DRIntracranial ORR 95.5% vs 79.6% (p=0.0004), iPFS HR 0.46 favoring asandeutertinib over osimertinib in 1L EGFR+ NSCLC with brain mets.

    vs leading data
    • Osimertinib established 1L SOC via FLAURA; ESAONA is first randomized head-to-head with a next-gen EGFR TKI in the brain-met-enriched setting

    Systemic Palliative Phase 2 trial Challenges SOC

    ESAONA
    EndpointAsandeutertinibOsimertinibHR / p
    iORR (BICR)95.5% (89.8-98.5%)79.6% (71.0-86.6%)p=0.0004
    Intracranial PFSNR17.5 mo (15.18-NA)HR 0.46, p=0.0020
    Overall PFSNR17.2 mo (15.18-19.55)HR 0.64, p=0.0473
    5 details
    Methods
    • 🔍 Phase II, randomized, N=224; 1L EGFR-mutated NSCLC with brain mets, asandeutertinib (n=111) vs osimertinib (n=113)
    • 💊 Asandeutertinib: next-generation EGFR TKI evaluated head-to-head vs established osimertinib SOC
    CONSORT flow
    Randomized 224
    ↓
    Asandeutertinib
    allocated 111
    Osimertinib
    allocated 113
    Critique
    • ⚠️ Safety (TRAEs)
      • Any TRAEs: 99.1% (asandeutertinib) vs 95.6% (osimertinib)
      • Serious TRAEs: 10.8% vs 7.1% — slightly higher in experimental arm
    • ⚠️ Phase 2 only, N=224; PFS medians not reached in experimental arm (immature); OS data not reported in source
    • ⚠️ Primary EP was iORR (response endpoint), not PFS or OS; longer follow-up required for survival readout
    Open questions
    • Phase 3 OS confirmatory data needed before practice adoption
    • Activity after progression on prior osimertinib unknown
    • Optimal sequencing vs osimertinib + chemo (FLAURA2) in brain-met population
    📚 Sources · 🐦 1 tweet

    OptiTROP-Lung05 NCT06448312

    ForStage IIIB-IV NSCLC, PD-L1 TPS ≥1%, no EGFR/ALK, treatment-naive, ECOG 0-1

    TL;DRmPFS NR vs 5.7mo, HR 0.35 (0.26-0.47), p<0.0001 favoring sac-TMT + pembro in 1L PD-L1+ NSCLC.

    vs leading data
    • Converges with TROPION-Lung08 (Dato-DXd+durvalumab vs pembro, TPS≥50%): ADC+IO > IO-mono signal emerging in 1L NSCLC

    Systemic Palliative Phase 3 RCT Confirmatory

    OptiTROP-Lung05
    ArmEvents n (%)Median PFS (95%CI)HR (95%CI)p
    Sac-TMT+Pembro (n=208)66 (31.7%)NR (13.6, NE)0.35 (0.26, 0.47)<0.0001
    Pembro (n=205)128 (62.4%)5.7mo (4.3, 7.0)ref—
    +3 more figures
    Descriptive OS (immature): HR 0.55 (95%CI 0.36-0.85). Events 33 (15.9%) vs 54 (26.3%). Median f/u 10.5 months.
    Descriptive OS (immature): HR 0.55 (95%CI 0.36-0.85). Events 33 (15.9%) vs 54 (26.3%). Median f/u 10.5 months.
    OptiTROP-Lung05
    PD-L1 TPSSac-TMT+Pembro median PFSPembro median PFSHR (95%CI)
    ≥50%NR (NE, NE)9.5mo (6.9, 13.8)0.47 (0.29, 0.77)
    1-49%NR (11.1, NE)4.3mo (2.9, 5.5)0.28 (0.19, 0.41)
    OptiTROP-Lung05
    8 details
    Methods
    • 🔍 Phase 3 open-label RCT; N=413; stage IIIB/IIIC/IV NSCLC; PD-L1 TPS ≥1%; no EGFR/ALK; ECOG 0-1
    • 💊 Sac-TMT 4mg/kg Q2W + pembro 400mg Q6W vs pembro 400mg Q6W; max 18 pembro cycles
    CONSORT flow
    Randomized 413
    ↓
    Sac-TMT + Pembro
    allocated 208
    Pembro
    allocated 205
    Results
    • 📊 1° EP PFS by BICR: median NR (13.6, NE) vs 5.7mo (4.3, 7.0), HR 0.35 (95%CI 0.26-0.47), p<0.0001
    • 📊 ORR 70.2% vs 42.0%
    • 📊 Descriptive OS (immature): HR 0.55 (95%CI 0.36-0.85); events 33 (15.9%) vs 54 (26.3%); median f/u 10.5mo
    • 📊 PFS benefit consistent across both PD-L1 TPS subgroups (≥50% and 1-49%)
    Critique
    • ⚠️ OS immature at primary PFS analysis (10.5mo median f/u); definitive OS benefit not yet established
    • ⚠️ Control is pembro mono; for TPS 1-49%, pembro+platinum chemo is also SOC — no head-to-head vs chemo-IO doublet
    Open questions
    • Will PFS benefit translate to OS with longer follow-up?
    • Superiority vs. pembro + platinum chemo for TPS 1-49%?
    • Predictive biomarker beyond PD-L1 TPS for TROP2 ADC benefit?
    📚 Sources · 🐦 2 tweets

    Wait or Treat — NCT05236946 (Upfront vs Delayed Brain RT in Oncogene-mutated NSCLC) NCT05236946

    ForMetastatic NSCLC, EGFR or ALK mutant, completely asymptomatic BM, ECOG 0-2

    TL;DRUpfront brain RT halves icPD (HR 0.35, p<0.001) but OS numerically favors delayed (HR 1.45, 2yr 60% vs 48%) in EGFR/ALK+ mNSCLC.

    vs leading data
    • First RCT on this question; supports emerging TKI-first approach (osimertinib/alectinib CNS penetration)

    Radiation Palliative Phase 3 RCT Challenges SOC

    Wait or Treat — NCT05236946 (Upfront vs Delayed Brain RT in Oncogene-mutated NSCLC)
    Upfront RT (n=105)Delayed RT (n=103)
    Events2047
    1-yr cumulative icPD8.7% (2.9%, 14.5%)25.7% (16.8%, 34.7%)
    2-yr cumulative icPD21.7% (12.6%, 30.8%)50% (39.2%, 60.9%)
    Sub-HR (95% CI)0.35 (0.21, 0.59)ref
    p-value<0.001—
    +1 more figure
    Wait or Treat — NCT05236946 (Upfront vs Delayed Brain RT in Oncogene-mutated NSCLC)
    7 details
    Methods
    • 🔍 Phase III open-label RCT, N=208; EGFR/ALK+ mNSCLC, completely asymptomatic BM, ECOG 0-2
    • 🔍 Both arms: TKIs + chemotherapy; delayed arm: RT at intracranial PD or patient request
    • 🔍 Stratification: GPA score (0-2 vs >2); synchronous vs metachronous BM
    CONSORT flow
    Randomized 208
    ↓
    Upfront Cranial RT
    allocated 105
    Delayed Cranial RT
    allocated 103
    Results
    • 📊 OS HR 1.45 favoring delayed; 2yr OS 48% upfront vs 60% delayed (secondary endpoint)
    Critique
    • ⚠️ Radiation necrosis: 6% upfront vs 0% delayed
    • ⚠️ OS HR p-value not reported in source; trial takeaway: 'timing of RT does not affect survival'
    • ⚠️ TKI + chemo backbone may not reflect current osimertinib or alectinib monotherapy practice
    Open questions
    • Does icPD reduction with upfront RT translate to QoL or neurocognitive benefit?
    • SRS vs WBRT in upfront arm: impact on radiation necrosis rate?
    • Which pts (high GPA, many lesions) benefit most from upfront cranial RT?
    📚 Sources · 🐦 3 tweets

    OLIGOMA NCT04495309

    ForMetastatic breast, ≤5 mets, any systemic therapy line

    TL;DRmPFS 35.8 vs 20.4 mo, HR 0.48; first RCT positive for MDT in oligometastatic breast cancer.

    vs leading data
    • Claimed first RCT positive for MDT PFS specifically in oligomet breast; confirmatory trials ongoing (TAORMINA, STEREO-SEIN, LARA, CLEAR)

    Radiation Palliative Phase 2 trial Early signal

    OLIGOMA
    +2 more figures
    QoL 12 wk: QLQ-C30 mean 72.2 vs 74.3; diff -2.1 (95% CI -9.2 to 5.1); NI margin -10 pts, met
    QoL 12 wk: QLQ-C30 mean 72.2 vs 74.3; diff -2.1 (95% CI -9.2 to 5.1); NI margin -10 pts, met
    OLIGOMA
    5 details
    Methods
    • 🔍 Randomised; metastatic breast any line, ≤5 lesions; systemic ± ablative RT to all mets
    • 🔍 >80% had 1-3 mets; 2/3 of lesions bone mets; majority ER/PR+, HER2- in 1st-line
    CONSORT flow
    Randomized 87
    ↓
    Systemic + ablative RT
    allocated 43
    Systemic alone
    allocated 44
    Results
    • 📊 QoL 12-wk co-primary met: QLQ-C30 diff -2.1 (-9.2 to 5.1), NI margin -10 pts (n=64)
    Critique
    • ⚠️ Stopped early: enrolled <20% of initial, <40% of amended target; N=87 total
    • ⚠️ HR CI very wide (0.25-0.91); no OS data reported
    Open questions
    • Which subgroups benefit most (therapy line, met burden, histology subtype)?
    • OS benefit not yet demonstrated; durability of PFS gain uncertain
    • Will confirmatory data from ongoing breast-specific MDT RCTs align?
    📚 Sources · 🐦 3 tweets