Mycosis fungoides is a chronic condition that warrants novel treatments that minimize long term side effects. Current standard of care includes radiotherapy or topical chemotherapy. This study looks at the efficacy and safety of topical hypericin ointment for early-stage mycosis fungoides in a large multicenter, placebo-controlled, double-blinded, phase 3 randomized clinical trial. This study included 169 patients. Each cycle of topical hypericin is given twice a week followed by light treatment. They found a statistically significant clinical response with the hypericin ointment, including a 49% index lesion response rate (ILRR) after 3 cycles of hypericin. They did not find any serious adverse reactions. Further research is warranted to establish this treatment as a treatment option for early-stage mycosis fungoides.

(Open Access)

Reference (Pub-Med Link): Kim, E. J., Mangold, A. R., DeSimone, J. A. et al. (2022). Efficacy and Safety of Topical Hypericin Photodynamic Therapy for Early-Stage Cutaneous T-Cell Lymphoma (Mycosis Fungoides): The FLASH Phase 3 Randomized Clinical Trial. JAMA Dermatology, 158(9), 1031–1039. https://doi.org/10.1001/jamadermatol.2022.2749

Key Institution: Perelman School of Medicine at University of Pennsylvania, Philadelphia
Keywords: FLASH, Lymphoma

A phase 2 study of neoadjuvant PD-1 immunotherapy using dostarlimab was conducted in 12 patients with stage II-III rectal adenocarcinoma patients with mismatch repair deficiency. Though the study protocol called for dostarlimab q3 weeks for 6 months followed by chemoRT and surgery, after 6 months of follow up upon completion of dostarlimab therapy, all 12 patients were found to have clinical complete response on MRI, FDG PET, DRE, biopsy, or endoscopy, and no patients at the time of this article’s publication (6-25 months of follow up) have received chemoRT or surgery. This could represent a truly groundbreaking paradigm shift in the management of colorectal cancer for patients with lynch syndrome, and warrants further follow up.

Reference (Pub-Med Link): Cercek, A., Lumish, M., Sinopoli, J., et al. (2022). PD-1 Blockade in Mismatch Repair-Deficient, Locally Advanced Rectal Cancer. The New England Journal of Medicine, 386(25), 2363–2376. https://doi.org/10.1056/NEJMoa2201445

Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer

Anal cancer is more common in people with HIV than the general population. Similar to cervical cancer, anal cancer is preceded by high-grade squamous intraepithelial lesions (HSILs). Treatment and screening for cervical HSIL has led to a decrease in cervical cancer. However, little is known about the treatment of anal HSIL to prevent anal cancer. This article is the largest prospective phase 3 trial investigating how screening and treatment of HSIL can help prevent anal cell cancer development. Patients who were at least 35, HIV+, and had biopsy proven HSIL were either enrolled into active monitoring or an ablative procedure in 1:1 ratio. Of the 4459 patients who underwent randomization 4446 were analyzed with a median follow up of 25.8 months. In the treatment group, 9 cases of anal cancer were diagnosed. In the active monitoring group, 21 cases of anal cancer were diagnosed. The rate of progression to anal cancer was significantly lower in the treatment group than in the active monitoring group (Log-rank p-value: 0.03). Thus, for patients who are found to have biopsy proven anal HSIL, they should be treated with ablative therapy.

Reference (Pub-Med Link): Palefsky, J. M., Lee, J. Y., Jay, N., et al. (2022). Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer. The New England Journal of Medicine, 386(24), 2273–2282. https://doi.org/10.1056/NEJMoa2201048

Key Institution: United States

Keywords: Anal Cancer

This is a retrospective review of 130 patients with node positive (N+) or common iliac node positive (M1a) prostate cancer treated with definitive radiotherapy. Patients were treated with long-term ADT and moderately or extremely hypofractionated RT to the prostate and pelvis, including the common iliac nodes. 75% of patients were staged with PSMA PET. At the time of biochemical failure, PSMA PET was acquired. At MFU 61 months, biochemical failure was similar (25.6% in the N+ group and 24.1% in the M1a group). Other outcomes were also similar between the 2 groups: distant metastasis (57% in N+ vs 73% in M1a, p=0.47), 5-year biochemical free survival (77.4% in N+ vs 70.4% in M1a, p=0.47), metastasis free survival (86.9% in N+ vs 79.4% in M1a, p=0.23), and overall survival (92.6% in N+ vs 90.1% in M1a, p=0.80). These findings suggest that common iliac node positive disease behaves similarly to other pelvic-node positive cases and should be treated (and perhaps staged) similarly.

Reference (Pub-Med Link): Chopade, P., Maitre, P., David, S., Panigrahi, G., Singh, P., Phurailatpam, R., & Murthy, V. (2022). Common Iliac Node-Positive Prostate Cancer Treated With Curative Radiation Therapy: N1 or M1a? International Journal of Radiation Oncology, Biology, Physics, 114(4), 711–717. https://doi.org/10.1016/j.ijrobp.2022.07.011

Key Institution: Tata Memorial Hospital, Mumbai, India
Keywords: Prostate

Managing localized prostate cancer in elderly men presents a challenge for clinicians. Current guidelines state that for patients with localized intermediate to high-risk prostate cancer, they should receive either prostatectomy or a combination of androgen deprivation therapy plus definitive radiotherapy, which may be external beam radiotherapy with or without brachytherapy boost. The purpose of this study was to analyze the oncological outcomes in elderly men after they received high-dose rate brachytherapy (HDB) boost.

They conducted an observational, retrospective, single-institution study in the country of France. 518 patients from the years 2008 to 2022 received a HDB boost and 380 were analyzed and split into two groups (≤70y:177pts [46.6%] vs. > 70y:203pts [53.4%]). With MFU of 72.6 months [67–83] for the whole cohort, 5-y bRFS, 5-y CSS and 5-y OS were 88% [85–92], 99% [97–100] and 94% [92–97] respectively; there was no statistical difference between the two age groups except for 5-y CSS (p = 0.05). There was no statistical difference between the two age-groups (Age <70 vs Age >70) in regards to late GI toxicity. The authors concluded that for intermediate and high-risk prostate cancer in the elderly, brachytherapy boost remains important to achieve optimal oncological outcomes. They felt that the toxicity profile of a brachytherapy boost appeared acceptable. Oftentimes, the elderly patients can be undertreated because their age is taken into account. They found that intermediate/high risk elderly prostate cancer patients benefits less from receiving standards of care. Brachytherapy boost remains efficient and feasible in the elderly.

(Open Access)

Reference (Pub-Med Link): Marotte, D., Gal, J., Schiappa, R., Gautier, M., Boulahssass, R., Chand-Fouche, M.-E., & Hannoun-Levi, J.-M. (2022). High-dose-rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort. Clinical and Translational Radiation Oncology, 35, 104–109. https://doi.org/10.1016/j.ctro.2022.05.001

Key Institution: Antoine Lacassagne Cancer Center
Keywords: Prostate cancer, Brachytherapy