Objective Dostarlimab+carboplatin-paclitaxel followed by dostarlimab maintenance demonstrated statistically significant and clinically meaningful benefits in progression-free and overall survival in the overall population of primary advanced/recurrent endometrial cancer versus chemotherapy alone in Part 1 of the phase 3 ENGOT-EN6-NSGO/GOG-3031/RUBY trial (NCT03981796). Part 2 evaluated the efficacy and safety of the addition of the poly(adenosine diphosphate-ribose) polymerase inhibitor niraparib to dostarlimab maintenance following dostarlimab+chemotherapy versus placebo maintenance following placebo+chemotherapy in primary advanced/recurrent endometrial cancer. Methods Patients were randomized 2:1 to dostarlimab+chemotherapy followed by niraparib+dostarlimab maintenance (niraparib+dostarlimab arm) or placebo+chemotherapy followed by placebo maintenance (control arm). Primary endpoint was progression-free survival in the overall and mismatch repair-proficient/micro-satellite stable populations. Overall survival (key secondary endpoint) and safety were assessed. Results In total, 291 patients were randomized (192 to niraparib+dostarlimab; 99 to control). With approximately 22 months of follow-up, the risk of progression or death was significantly reduced by 40% (hazard ratio 0.60, 95% confidence interval 0.43 to 0.82, p <.001) and 37% (hazard ratio 0.63, 95% confidence interval 0.44 to 0.91, p =.006) with niraparib+dostarlimab versus the control in the overall and mismatch repair-proficient/micro-satellite stable populations, respectively. At 36.2 months of follow-up, no overall survival benefit was observed with niraparib+dostarlimab versus the control (hazard ratio 1.2, 95% confidence interval 0.81 to 1.78).Grade ≥3 treatment-related adverse events occurred in 70.7% of patients in the niraparib+dostarlimab arm and 37.5% in the control arm; serious treatment-related adverse events occurred in 24.6% and 9.4%, respectively. Discontinuations due to adverse events occurred in 38.7% of patients in the niraparib+dostarlimab arm and 11.5% in the control arm. Conclusions While the addition of niraparib to dostarlimab maintenance showed a significant improvement in progression-free survival, there was no observed overall survival benefit. Dostarlimab+carboplatin-paclitaxel followed by dostarlimab maintenance remains the only regimen to demonstrate significant overall survival benefit versus carboplatin-paclitaxel alone in primary advanced/recurrent endometrial cancer.
OBJECTIVES:Intraoperative assessment of resection margins during pulmonary resection is limited by tissue compression and distortion caused by conventional staplers, which hinder direct pathological evaluation of the anatomical resection margin. We report our initial clinical experience with a novel asymmetric linear stapler (NALS) designed to provide direct access to the specimen-side anatomical resection margin for intraoperative histologic assessment. METHODS:We retrospectively reviewed patients who underwent pulmonary resection using the NALS between July 2024 and December 2025. Intraoperative frozen-section examination was performed for parenchymal and/or bronchial margins when malignancy was suspected or confirmed. Margin status, margin distance, and frozen-permanent pathological concordance were analysed descriptively. RESULTS:Among 226 patients who underwent pulmonary resection using the NALS, 206 resection margins (144 parenchymal and 62 bronchial) were evaluated. Intraoperative frozen-section examination identified margin positivity in 12 margins (5.8%). Residual tumour was confirmed on permanent pathology in 4 of 8 parenchymal frozen-positive margins, whereas all bronchial frozen-positive margins showed benign or reactive changes. No false-negative frozen-section findings were identified. Among negative margins with available measurements, 66.7% of parenchymal margins and 84.5% of bronchial margins measured at least 10 mm. CONCLUSIONS:In this initial experience, intraoperative margin assessment using the NALS was feasible and enabled structured evaluation of the anatomical resection margin during pulmonary resection. Because no control group using conventional staplers was included, these findings should be interpreted as a feasibility assessment rather than evidence of superiority over standard stapling devices. Further multicentre studies with controlled comparisons and long-term oncologic follow-up are warranted.
Radiation-associated breast angiosarcoma is a rare but highly aggressive malignancy with limited evidence to guide optimal management in elderly patients. We present the case of an 88-year-old woman with a history of stage IIIA estrogen receptor-positive invasive ductal carcinoma of the right breast treated with breast-conserving surgery, chemotherapy, radiation therapy, and endocrine therapy in 2014. Approximately 11 years after completing radiation therapy, she developed progressive right breast firmness, violaceous skin discoloration, and persistent ecchymotic changes concerning for vascular malignancy. Imaging demonstrated diffuse skin thickening without a discrete mass, and punch biopsy of skin changes confirmed high-grade angiosarcoma with MYC amplification. Staging studies showed no distant metastatic disease. Given her advanced age, frailty, and comorbidities, she underwent neoadjuvant weekly paclitaxel with initial dose reduction followed by response- and tolerance-guided dose escalation. Despite treatment interruptions related to frailty and fall-related injuries, she completed 12 cycles and subsequently underwent right simple mastectomy. Final pathology demonstrated no residual angiosarcoma, consistent with a pathologic complete response. This case highlights the potential efficacy of frailty-adjusted neoadjuvant paclitaxel in elderly patients with radiation-associated breast angiosarcoma and supports individualized neoadjuvant strategies for patients who are not candidates for standard multi-agent chemotherapy.
PurposeRecent publications have explored workload and productivity to improve oncology pharmacy practice. The Hematology/Oncology Pharmacist Association (HOPA) aimed to build upon this research by assessing task valuation.MethodsA web-based survey was fielded from 1/16/25-2/13/25. Eligible respondents were oncology pharmacists reporting experience with tasks related to 3 categories: direct patient care, non-direct patient care, and education/professional development. After validation, the final survey was estimated to take 10 min to complete and included 22 questions assessing valuation of workplace tasks separated into categories.Results676 responses were included. Most respondents completed post-graduate training and were board-certified in oncology. Median years in practice and in current role were 10 years and 4 years, respectively. Direct patient care was the highest ranked task category followed by education/professional development and non-patient care tasks. The most valued tasks by category were communicating with the interdisciplinary team, precepting learners, and creating standardized treatment plans, respectively. Ordinal logistic regression models did not identify any specific variables that significantly impacted results. Tasks associated with lower job satisfaction included facilitating medication access, ensuring compliance, and completing annual competencies.ConclusionWorkforce challenges, including burnout and inadequate metrics, threaten job satisfaction and retention of oncology pharmacists. Identification of tasks valued by oncology pharmacists, coupled with other practice factors such as workload and productivity, provides a more comprehensive picture of the pharmacy workforce landscape. These findings can guide strategic decisions to expand high value services and re-align lower valued tasks, with the ultimate goal of enhancing job satisfaction and improving retention.
