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Mindfulness and Tai Chi for Cancer Health (MATCH) Study: Primary Outcomes of a Preference-Based Multisite Randomized Comparative Effectiveness Trial

July 1, 2025

The MATCH study was a large, pragmatic, preference-based, multisite RCT comparing Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ) in distressed cancer survivors. Both MBCR and TCQ significantly improved mood disturbance (POMS TMD) compared to waitlist, with the largest effect size for MBCR vs waitlist (0.44) and a significant reduction for TCQ vs waitlist (estimate –5.13; 95% CI, –9.44 to –1.23; P = .01). MBCR had the greatest impact on tension, anger, and vigor, while TCQ was most effective for anger, depression, and vigor; subgroup analysis showed women benefited more from MBCR, and younger or advanced-stage patients benefited more from TCQ. In short, both MBCR and TCQ are viable, evidence-based options for improving mood in our cancer survivors, and it doesn’t seem to matter whether patients choose their intervention or are randomized—everyone does better than waitlist. These are probably underutilized in our communities and more widely available than appreciated.

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Acalabrutinib Plus Bendamustine-Rituximab in Untreated Mantle Cell Lymphoma

July 1, 2025

The phase III ECHO trial evaluated acalabrutinib + bendamustine-rituximab (A+BR) vs placebo + BR in previously untreated mantle cell lymphoma (MCL) patients ≥65 years, showing a significant improvement in progression-free survival (PFS) (66.4 vs 49.6 months) with A+BR, including in high-risk subgroups. Objective response rate (ORR)/complete response (CR) rates were higher with A+BR (91.0%/66.6% vs 88.0%/53.5%), but overall survival (OS) was not significantly different (HR 0.86). Grade ≥3 adverse events (AEs) were similar between arms (88.9% vs 88.2%), with more COVID-19–related events in the acalabrutinib group, likely reflecting longer exposure. Bottom line: adding acalabrutinib to BR gives us a real PFS advantage in older, untreated MCL, with manageable toxicity, but OS benefit remains elusive—likely due to crossover and effective salvage BTKi at relapse.

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Overall Survival with Inavolisib in PIK3CA-Mutated Advanced Breast Cancer

July 1, 2025

The INAVO120 trial evaluated inavolisib + palbociclib–fulvestrant vs placebo + palbociclib–fulvestrant in patients with PIK3CA-mutated, HR+/HER2– advanced breast cancer progressing on or shortly after adjuvant endocrine therapy (ET). Inavolisib significantly improved overall survival (OS) (34.0 vs 27.0 mo) and progression-free survival (PFS) (17.2 vs 7.3 mo), with a higher objective response rate (ORR) (62.7% vs 28.0%) and longer DoR (19.2 vs 11.1 mo). Toxicities were manageable but included more hyperglycemia (63.4%), stomatitis (55.3%), GI, and ocular AEs. Bottom line: this triplet sets a new bar for first-line PIK3CA-mutant HR+ MBC, but we’ll need to stay vigilant about metabolic and mucosal side effects as we bring it into practice.

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Neoadjuvant and Adjuvant Pembrolizumab in Locally Advanced Head and Neck Cancer

July 1, 2025

The KEYNOTE-689 trial evaluated perioperative pembrolizumab + SOC (surgery + adjuvant RT ± cisplatin) in resectable, locally advanced head and neck squamous-cell carcinoma (HNSCC) that is at least 1% PDL1 positive. The addition of pembrolizumab significantly improved 3-year event-free survival (EFS) in all PD-L1 subgroups: CPS≥10 (59.8% vs 45.9%), CPS≥1 (58.2% vs 44.9%), and the total population (57.6% vs 46.4%). Three-year overall survival (OS) also favored pembrolizumab: CPS≥10 (68.2% vs 59.2%), CPS≥1 (69.0% vs 60.2%), and total (68.4% vs 61.1%), though OS was not formally tested at this interim. Toxicities were as expected. Bottom line: perioperative pembro is now a part of the treatment paradigm for locally advanced HNCSCC with PDL1 expression.

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Perioperative Durvalumab in Gastric and Gastroesophageal Junction Cancer

July 1, 2025

The MATTERHORN trial assessed patients with resectable gastric cancer/gastroesophageal junction cancer and assigned them 1:1 to perioperative durvalumab 1500 mg Q4W + FLOT (neoadjuvant and adjuvant) vs placebo + FLOT. Durvalumab + FLOT significantly improved 2-yr EFS (67.4% vs 58.5%) and increased pathological complete response (pCR) (19.2% vs 7.2%), with a numerically higher 2-year overall survival (OS) (75.7% vs 70.4%). Safety was comparable between arms (grade 3–4 AEs 71.6% vs 71.2%) with no excess surgical delays, unexpected toxicities or adjuvant initiation delays. Bottom line: Immunotherapy (IO) benefit appears linked to the FLOT backbone—as cis/FP + IO regimens have not consistently improved event-free survival (EFS)—and mature OS plus broader representation remain needed, but this looks like a meaningful advance.

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Trastuzumab Deruxtecan or Ramucirumab plus Paclitaxel in Gastric Cancer

July 1, 2025

The phase III DESTINY-Gastric04 trial randomized HER2+ metastatic gastric/GEJ adenocarcinoma progressing on trastuzumab to T-DXd versus RAM+PTX, showing a significant overall survival (OS) benefit with T-DXd (14.7 vs 11.4 months) and improved PFS (6.7 vs 5.6 months). Objective response rate (ORR) was higher with T-DXd (44.3% vs 29.1%), and duration of response was longer (7.4 vs 5.3 months). Grade ≥3 AE rates were comparable (50.0% vs 54.1%), though adjudicated ILD/pneumonitis was more frequent with T-DXd (13.9% vs 1.3%, mostly grade 1–2), underscoring the need for vigilant monitoring. Bottom line: T-DXd looks like the new second-line standard for HER2+ disease that stays HER2-positive post-trastuzumab—meaningful survival gains. Please make sure to plan for a repeat biopsy in this setting.

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Measurable Residual Disease–Guided Therapy in Newly Diagnosed Myeloma

July 1, 2025

Quadruplet induction with isatuximab, carfilzomib, lenalidomide, and dexamethasone (Isa‑KRd) has reset expectations for transplant‑eligible NDMM and enables measurable residual disease (MRD)‑adapted strategies; MRD‑negativity at 10^-5 is strongly prognostic, and the necessity of autologous stem-cell transplantation (ASCT)—particularly tandem ASCT—amid deep responses is being re‑examined. Practically, MRD‑adapted consolidation after Isa‑KRd suggests no added depth from ASCT in MRD patients and no advantage for tandem ASCT over single ASCT + Isa‑KRd in MRD+ patients. So in day‑to‑day practice, this looks like a chance to de‑escalate transplant intensity while awaiting mature progression-free survival (PFS)/overall survival (OS) data.

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