Glioblastoma is the most common primary brain cancer in adults, with half of cases diagnosed in patients aged ≥ 65 years. However, definitions of older adults vary, resulting in treatment variation between centres. This study aimed to report on the treatment intensity and survival outcomes in older patients with glioblastoma diagnosed according to WHO CNS 5 classification. We conducted a retrospective, multicentre cohort study (Histo-Mol GBM Collaborative) of consecutive patients with pathologically confirmed glioblastoma, IDH-wildtype diagnosed in 2021, according to the 2021 WHO CNS 5 classification, across 52 centres in the UK, Ireland, New Zealand, and Australia. Demographic, molecular, treatment, and survival data were analysed. Of 1,857 patients, 863 (46.5

Small cell lung cancer (SCLC) brain metastases (BM) are common at presentation and relapse. Historically, BM were managed with whole brain radiotherapy (WBRT). However, WBRT is associated with significant toxicity, and so interest in the focal management of BM (focal radiotherapy including stereotactic radiosurgery (SRS) and surgery) is increasing. A systematic literature search of PubMed, Embase, and CENTRAL databases and clinicaltrials.gov was conducted as per the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to obtain all published articles, abstracts, and ongoing studies regarding focal management of SCLC BM. We identified 59 eligible articles, 6 related to surgical BM treatment (4 case studies, 2 retrospective case studies), and 53 regarding focal radiotherapy (4 case reports, 9 retrospective cohort studies, 32 retrospective case series, 2 prospective cohort trials, 6 ongoing trials). Several trials (n = 6) are ongoing investigating outcomes following focal radiotherapy for SCLC BM, alone and versus WBRT. Whilst limited by their retrospective design, and lack of information regarding local control, first line focal radiotherapy ± WBRT seems to be associated with better survival than WBRT alone. Additionally, salvage focal radiotherapy can achieve 14.3 months median overall survival, outperforming the 3 months median overall survival with salvage WBRT. In highly selected patients, neurosurgical resection of brain metastases may play a role in optimizing local control and/or relieving BM symptoms. Focal treatments for SCLC BM are being used more frequently. However, randomized trial evidence for their safety and effectiveness are still pending.

Abstract AIMS The 2021 World Health Organisation Classification (WHO CNS5) incorporated molecular diagnostic features for glioblastoma for the first time. The Histo-Mol GBM collaborative is conducting a retrospective cohort study evaluating the outcomes of patients prospectively diagnosed with WHO CNS5 IDH wild type glioblastoma. METHOD Biopsy confirmed glioblastoma patients diagnosed between 01/01-31/12/2021 were identified. Demographic, tumour, treatment, and survival data were collected. Descriptive statistics and Kaplan-Meier method were used to describe the cohort and for survival analysis respectively, assessed from surgery date. RESULTS So far, 363 glioblastoma patients were included from 13 centres (range: 11-61 patients/centre). Median age was 63.0, 65.8% were male, 77.4% had an ECOG performance status of 0-1 at diagnosis, and 28/333 had a molecular glioblastoma (8.4%). Biopsy was performed in 106/363 patients (29.2%), and gross total resection in 50/363 (13.8%). Adjuvant radiotherapy was performed in 290/363 (79.9%), and 71/290 (24.5%) had an additional pre-radiotherapy MRI with rapid early progression identified in 30/71 patients (42.3%). 128/269 (47.6%) patients received 2nd line treatment; most commonly systemic therapy (91/128, 71.1%) followed by re-resection (27/128, 21.1%). Second line systemic therapy was primarily lomustine (48/81, 52.7%). Median progression free survival was 7.7 months and median overall survival (OS) was 11.6 months. Median OS was 16.9 months with conventional fractionation chemoradiotherapy (n=169/363, 46.6%), 10.4 months with hypofractionated chemoradiotherapy (n=64/363, 17.6%), and 2.3 months with no oncological treatment (n=57/363, 15.7%). On univariate analysis age, gender, performance status, multifocality, MGMT promoter methylation, surgery extent, radiotherapy type (none, palliative, hypofractionated, conventional fractionation), larger planning target volume (PTV), receiving concurrent temozolomide, and receiving adjuvant temozolomide were statistically significant. On multivariate analysis age, and receiving concurrent temozolomide remained significant. CONCLUSION We describe the initial findings from a large real-world cohort of glioblastoma patients prospectively diagnosed according to WHO CNS5. Survival compares favourably with the practice changing phase 3 clinical trial outcomes.

Abstract BACKGROUND A multidisciplinary research group, established by NCRI, identified that research into holistic needs of patients with malignant gliomas and their caregivers remains sparse. A large proportion of patients in this cohort are considered ‘clinically vulnerable’ including older and frail patients. This UK wide survey sought to identify key areas requiring greater research and intervention with a specific focus on the clinically vulnerable subgroup. MATERIAL AND METHODS Patients who identified as clinically vulnerable by themselves or their caregiver and had received a diagnosis of glioma were invited via leaflets and social media platforms to respond to a 21 question online survey, hosted by BrainsTrust. Questions focussed on support, information and treatments offered at initial diagnosis. Quantitative and qualitative data was collected and analysed using descriptive statistics and narrative analysis. RESULTS The survey received 70 responses; 57 patients, 13 caregivers. 47 female, 23 male. The mean age of respondents was 46 (range 21-76 years). 64% of respondents felt listened to by their medical team, however only 43% of respondents felt they fully understood the information they received in the consultation. Only 29% reported remembering all the information they were given once home, fewer than half (47%) of respondents received written information to take away. 50% respondents felt that all and 33% felt that some of their questions were answered by their medical team. Only 50% of respondents reported being assigned a key worker, and 43% felt they could contact their key worker when they needed. Questions regarding specific needs gave great insight into areas where these needs are not being met; 70% wanted support with fatigue, with 36% actually receiving this, 47% wanted support with memory changes but only 19% received this. 49% of respondents wanted involvement from the neuropsychology team, with 26% receiving this. Conclusion: The results of this survey demonstrate areas where brain tumour care services are not meeting the needs of this self-identified clinically vulnerable patient group. Overall there was no category of need that was fully met which identifies the requirement for consistently structured assessment and intervention.

Abstract AIMS The management of older (>70 years old) patients with glioblastoma is challenging with significant variation in practice. Using the Histo-Mol GBM database we analysed the variation in practice across 11 UK centres. METHOD Biopsy confirmed glioblastoma patients diagnosed between 01/01-31/12/2021 were identified. Descriptive statistics were used to compare demographic, tumour and treatment characteristics, and the Kaplan-Meier method was used to analyse survival, assessed from surgery date. Differences in treatment between centres were assessed using one way ANOVA. RESULTS In 2021, 81/330 (24.5%) patients with glioblastoma were >70. Compared to younger patients, the older cohort had a greater proportion of males (79.0% vs 59.0%, p<0.001), a worse performance status (66.7% vs 79.5% ECOG PS 0-1, p<0.001), and more likely to have MGMT promoter methylation (30.9% vs 22.9%, p=0.027). Most patients received biopsy only (31/81, 38.3%), followed by subtotal resection (85-94% tumour resection) (26/81, 32.1%), whilst 8/81 (9.9%) underwent debulking, 8/81 near-total resection (95-99% tumour resection), and 8/81 gross total resection, with statistically significant variation in resection extent between centres (p=0.031). Adjuvant radiotherapy was used in 56/81 patients (69.1%) with no difference between centres (p=0.220). However, there was a statistically significant difference in radiotherapy regime between centres (p=0.041). 6/81 (7.4%) received conventional chemoradiotherapy, 28/81 (34.6%) hypofractionated chemoradiotherapy, 16/81 (19.8%) hypofractionated radiotherapy alone, 2/81 (2.5%) temozolomide alone both with MGMT promoter methylation, and 21/81 (25.9%) received no oncological treatment. Median progression free survival was 5.9 months and median overall survival (OS) was 7.1 months with no difference between centres (p=0.199 and p=0.083 respectively). Median OS was 8.4 months with conventional fractionation chemoradiotherapy, 11.2 months with hypofractionated chemoradiotherapy, 7.3 months with hypofractionated radiotherapy alone, 1.8 months with temozolomide alone, and 2.5 months with no oncological treatment. CONCLUSION We identify variations in the treatment of elderly glioblastoma patients across the UK, although these do not significantly impact survival.

Primary brain tumours are rare but carry a significant morbidity and mortality burden. Malignant gliomas are the most common subtype and their incidence is increasing within our ageing population. The diagnosis and treatment of gliomas involves substantial interplay between multiple specialties, including general medical physicians, radiologists, pathologists, surgeons, oncologists and allied health professionals. At any point along this pathway, patients can present to acute medicine with complications of their cancer or anti-cancer therapy. Increasing the awareness of malignant gliomas among general physicians is paramount to delivering prompt radiological and histopathological diagnoses, facilitating access to earlier and individualised treatment options and allows for effective recognition and management of anticipated complications. This article discusses evidence-based real-world practice for malignant gliomas, encompassing patient presentation, diagnostic pathways, treatments and their complications, and prognosis to guide management outside of specialist centres.

Purpose: Clinical trials have shown improvements in local control with the addition of a high dose rate brachytherapy boost to external beam radiotherapy in the treatment of higher risk prostate cancer [1,2]. We reviewed the 5-year outcomes of a cohort of patients treated within a single UK centre to examine biochemical progression free survival, overall survival and toxicity.

1.Is a one-stop-shop workflow for palliative radiotherapy (RT) feasible? Same-day adaptive palliative radiotherapy without prior CT simulation: Early outcomes in the FAST-METS study. Nelissen et al. Radiotherapy and Oncology, 2023. [[1]Nelissen K.J. Versteijne E. Senan S. Rijksen B. Admiraal M. Visser J. et al.Same-day adaptive palliative radiotherapy without prior CT simulation: Early outcomes in the FAST-METS study.Radiother Oncol. 2023; 182109538https://doi.org/10.1016/j.radonc.2023.109538Abstract Full Text Full Text PDF Scopus (1) Google Scholar].•Prospective single-institution cohort study assessing the in-silico feasibility of using a simulation CT-free adaptive workflow, in patients referred for palliative RT (single 8Gy fraction using volumetric arc therapy [VMAT] or intensity modulated RT [IMRT]) to metastases. Forty-seven treatments, on 43 patients, were performed between December 2021 and October 2022.•Diagnostic imaging (dCT), preferably less than four weeks old, was used for pre-planning, with subsequent on-couch target and plan adaptation based on a synthetic CT obtained from cone-beam CT imaging (CBCT).•Patients were initially assessed by telephone but then physically examined on day of treatment, with the aim of RT being delivered within two hours of arrival in the department, resulting in a single hospital visit compared to the standard two visits.•Completion of an in-house developed 10-question satisfaction questionnaire was requested directly following treatment and EQ-5D-5L quality of life questionnaires at were requested at baseline, 6 weeks and 3 months post.•Mean workflow time was 85 minutes (range: 50–130), of which 30 minutes (range: 16–64) was in the RT room and most patients were satisfied. In all treatments, adapted plans showed significant improvements in target coverage compared to the original plans.•Pragmatic study highlighting how advances in radiotherapy planning technology may improve patient experience in the palliative setting. However, would the use of simple field-based planning or radiographer led planning further speed up the pathway?2.Acute radiation dermatitis (RD) is a common and unpleasant side effect of breast radiotherapy. Can Mepitel Film (MF) help prevent it in high risk patients? Mepitel Film for the Prevention of Acute Radiation Dermatitis in Breast Cancer: A Randomized Multicenter Open-Label Phase III Trial. Behroozian T. et al. J Clin Oncol. 2023 [[4]Shi J.J. Lei X. Chen Y.-S. Chavez-MacGregor M. Bloom E. Schlembach P. et al.Socioeconomic Barriers to Randomized Clinical Trial Retention in Patients Treated with Adjuvant Radiation for Early-Stage Breast Cancer.Int J Radiat Oncol Biol Phys. 2023; (Article in Press)https://doi.org/10.1016/j.ijrobp.2023.01.037Abstract Full Text Full Text PDF Scopus (1) Google Scholar]•Previous studies showed conflicting results as to the efficacy of MF in preventing RD but studies had involved all breast cancer patients rather than stratifying those known to be higher risk•This trial enrolled 403 patients who were planned for post mastectomy chest wall radiotherapy, irrespective of previous bra size, or whole breast radiotherapy if bra size was 36 inches and/or a C cup or greater. Participants received standard (50Gy in 25 fractions) or hypofractionated (40–42.6Gy in 15–16 fractions) radiotherapy. Participants stratified by surgery received (58% lumpectomy, 42% mastectomy), radiotherapy schedule (93% hypofractionated) and presence or absence of boost and/or bolus (no difference in treatment arms).•Participants randomised in 2:1 ratio to having MF applied on first day of treatment and continued throughout (group 1) versus standard of care which was twice daily moisturiser (group 2). Participants were assessed weekly for 6 weeks after the completion of RT, and at 3, 6, 12, and 24 months after RT. Acute toxicity graded by both clinician and patients at each visit. Primary endpoint was CTCAE G2 or 3 RD during radiotherapy and within 3 months of completion of radiotherapy.•CTCAE G2/3 RD seen in 15.5% (95% CI, 11.3–20.6%) of group 1 and 45.6% (95% CI, 36.7–54.8%) of group 2. In multivariate analysis, this effect persisted with an OR of 0.22 (95% CI, 0.13 to 0.35, P < .0001). Patient reported outcomes were also significantly improved in group 1.•Application of MF to the breast can be difficult without shape distortion and adherence in the axilla is problematic. MF is expensive however these results are very encouraging in the reducing the rate of RD and support its use amongst high risk patients.3.10 years on from the PRIME II study. Is it safe to omit adjuvant radiotherapy in older women with breast cancer? Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. Kunkler IH et al. N Engl J Med. 2023 [[3]Kunkler I.H. Williams L.J. Jack W.J.L. Cameron D.A. Dixon J.M. Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer.N Engl J Med. 2023; 388: 585-594https://doi.org/10.1056/NEJMoa2207586Crossref Scopus (19) Google Scholar]•Phase 3 randomised trial enrolled 1326 women aged 65 years or older with T1 or T2 (<3cm) hormone receptor sensitive breast cancer. Patients had received breast conserving surgery with clear margins and were randomised to surveillance or adjuvant whole breast radiotherapy (40–50Gy). Primary endpoint of ipsilateral local recurrence. Secondary endpoints of overall survival, disease-free survival, regional recurrence, contralateral breast cancer and distant metastases. Data also collected on duration of endocrine therapy and patient compliance•Trial originally powered to detect a difference at 5 years of at least 5 percentage points but this was revised due to overestimate of recurrence rates. New estimates enabled the detection of a difference of at least 3 percentage points at 5 years with 80% power at a significance level of 5% and with a 10% allowance for loss to follow-up.•Cumulative incidence of local recurrence at 10 years was 9.5% (95% CI 6.8 to 12.3) in the no-radiotherapy group and 0.9% (95% CI, 0.1 to 1.7) in the radiotherapy group. Hazard ratio for local recurrence (no radiotherapy vs. radiotherapy) was 10.4 (95% CI 4.1 to 26.1; P < 0.001).•OS at 10 years was 80.8% (95% CI, 77.2 to 84.3) in the no-radiotherapy group and 80.7% (95% CI, 76.9 to 84.3) in the radiotherapy group. Breast cancer–specific survival at 10 years was 97.4% (95% CI, 96.0 to 98.8) in the no radiotherapy group and 97.9% (95% CI, 96.5 to 99.2) among patients assigned to radiotherapy.•In line with NICE guidance, this data supports the omission of radiotherapy in certain cohorts of older breast cancer patients. Only a small proportion of patients had G3 tumours or lymphovascular invasion and the authors do not advocate omission in these patients.•The decision to omit radiotherapy must be approached on an individual patient level, evaluating predicted life expectancy, expected radiotherapy toxicities, cardiac risk factors and likelihood of endocrine therapy compliance.4.Can we identify the socioeconomic barriers to randomised clinical trial (RCT) participation and thereby improve participant diversity? Socioeconomic Barriers to Randomized Clinical Trial Retention in Patients Treated With Adjuvant Radiation for Early-Stage Breast Cancer. Shi, J. et al. Int J Radiat Oncol, Biol, Phys. 2023. [[2]Behroozian T. Milton L. Karam I. et al.Mepitel Film for the Prevention of Acute Radiation Dermatitis in Breast Cancer: A Randomized Multicenter Open-Label Phase III Trial.J Clin Oncol. 2023; 41: 1250-1264https://doi.org/10.1200/JCO.22.01873Crossref Scopus (5) Google Scholar].•The parent RCT enrolled women aged ≥40 years with early-stage breast cancer who had breast conserving surgery with negative margins. Participants were randomised to receive either conventionally fractionated or hypo fractioned adjuvant radiotherapy.•This study analysed 253 of the trial participants with a primary endpoint of trial retention status at 3 years, defined as completion of the breast cosmesis outcomes assessment at that time. Secondary endpoint assessed this at 5 years.•The Kruskal Wallis test and multivariate logistic regression were used to test associations of retention with severity of socioeconomic disadvantage, quantified by patients' home neighbourhood area deprivation index (ADI) rank. Associations of retention with patients' use of social resource assistance were also analysed using the χ2 test.•Fifty-five (21.7%) patients dropped out by 3 years and 92 (36.7%) by 5 years. Median ADI was lower for retained patients (36.5 [IQR 22–57) vs. 46.0 [IQR 29–60]).•Dropout was associated with more severe socioeconomic deprivation (ADI ≥45 vs. <45) at both 3- (OR 3.63 [95% CI 1.62–8.15], p = 0.002) and 5 years (OR 2.55 [95% CI 1.37–4.76], p = 0.003). Practical, logistic, and financial barriers appeared to be key underlying contributors to trial dropout.•Interesting study highlighting the ongoing need for additional social determinant screening beyond routine to improve RCT inconclusiveness but also ultimately improve their validity.

Abstract AIMS Dexamethasone is an effective and commonly used treatment in patients with gliomas. However, it can also cause several metabolic side effects, including steroid-induced diabetes mellitus (SIDM), of which prevalence is estimated at 11-56%. We aimed to assess prevalence of SIDM in our local brain tumour population and audited adherence to recently published national guidance for monitoring and management of SIDM. METHOD Retrospective data review of all new primary malignant brain tumour patients seen in clinic over 12 months to assess local prevalence. Patients’ notes audited for 2 months pre- and post-adoption within the department of national guidelines focussing on how to screen and monitor for diabetes when initiating high dose steroids. RESULTS 71 new patients seen over 12 months. 66 patients with high grade and 5 with low grade gliomas. 82% were on steroids at first oncological visit. 14% known diabetic or pre-diabetic. 7% subsequently developed SIDM. 19 patient notes audited over 2 months prior to intervention (Group 1) and 11 post intervention (Group 2). All patients were taking dexamethasone. 40% of Group 1 and 36% of Group 2 had neither HbA1c nor lab glucose checked at baseline. 1 patient in Group 1 developed SIDM. CONCLUSIONS Diabetes mellitus in cancer patients increases risk of infections, cardiovascular comorbidities, and can reduce effcacy of treatment, leading to preventable admissions and decreased survival rates. Prevalence of SIDM in our local population is comparable to published data. Adoption of published guidance improved baseline monitoring but needs to be embedded within acute oncology pathways across the Trust.

18F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial. Cooke, S.A. et al.Radiotherapy and Oncology, 2023 [1].

Background: Short-course partial brain radiotherapy +/- chemotherapy for older patients with GBM extends survival but there is no validated evidence for prediction of individual risk of acute radiotherapy-related side effects. Methods: This prospective multicentre observational trial recruited patients with newly diagnosed GBM aged >= 65 planned for cranial radiotherapy. Baseline MRI scans were analyzed for markers of brain resilience including relative total brain volume (ratio of cerebrospinal fluid (CSF) volume to total intracranial volume (TIV)) and their relationship to change in quality of life (QoL). Results: 126 patients enrolled: mean age 72 years (range 65-83). 77% had debulking surgery. 79% received radiotherapy with concurrent TMZ, and 21% received palliative radiotherapy alone. The median OS was 10.7 months. After accounting for age, sex, treatment, and baseline MoCA score, there was a relationship between baseline CSF:TIV and change in QoL score at 8 weeks post treatment. For each unit point of increase in CSF:TIV, there was a corresponding decrease in QoL score of 1.72 (95% CI -3.24 to -0.19 P = .027). 35 participants were too unwell to complete questionnaires or had died by the 8 week follow-up visit. In this subgroup, post hoc logistic regression showed baseline CSF:TIV was related to the risk of non-attendance (OR 1.35, 95% CI 1.01 to 1.80, P = .042). Cox regression models showed baseline CSF:TIV was associated with worsened OS (HR 1.41, 95% CI 1.19 to 1.66, P < .001). Conclusions: This study provides evidence to support the use of an imaging biomarker to help assess the risk:benefit ratio for radiotherapy.

Aims: Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer with a median survival of 4 months. Recent advances in molecular profiling have shown that up to half of ATCs harbour the BRAF-V600E mutation. The aim of this study was to provide real-world data and experience on the use of combination therapy dabrafenib and trametinib in patients with BRAF-V60 0E-mutated advanced ATC.Materials and methods: We retrospectively evaluated patients with confirmed BRAF-V60 0E-mutated ATC, defined as patients with locally advanced or met-astatic ATC with no locoregional, radical treatment options. Outcomes measured were overall survival, progression-free survival, response rate, discontinuation rate, dose reduction rate and toxicity data.Results: Seventeen patients were evaluated and the mean age was 68 years. Ten patients died by the time of censoring. The median duration of follow-up was 12 months (3-43 months). The estimated median overall survival was 6.9 months (95% confidence interval 2.46 months -upper confidence interval not reached) and the median progression-free survival was 4.7 months (95% confidence interval 1.4-7.8 months). Dose interruptions and/or reductions were common, but none of the patients had to permanently discontinue treatment because of toxicities. Severe toxicities (grades 3 and 4) were uncommon.Conclusions: This study supports the indication of dabrafenib and trametinib in BRAF-V60 0E-mutated ATC as an effective and well-tolerated treatment in an historically difficult to treat cancer.(c) 2022 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

MC1675, a Phase III Evaluation of De-Escalated Adjuvant Radiation Therapy (DART) vs. Standard Adjuvant Treatment for Human Papillomavirus Associated Oropharyngeal Squamous Cell Carcinoma. Ma, D.M. et al. Int J Radiat Oncol Biol Phys 2021. [[1]Ma D.M. Price K. Moore E.J. Patel S.H. Hinni M.L. Fruth B. et al.MC1675, a Phase III Evaluation of De-Escalated Adjuvant Radiation Therapy (DART) vs. Standard Adjuvant Treatment for Human Papillomavirus Associated Oropharyngeal Squamous Cell Carcinoma.Int J Radiat Oncol Biol Phys. 2021; 111: 1324https://doi.org/10.1016/J.IJROBP.2021.09.012Abstract Full Text Full Text PDF Google Scholar].-Standard 60Gy in 2Gy per fraction delivered once daily over six weeks versus (vs.) DART 30-36Gy in 1.5–1.8Gy per fraction delivered bidaily over two weeks, alongside concurrent Cisplatin or Docetaxel chemotherapy, respectively.-Two-year results of 194 patients have reported reduced grade ≥3 toxicity at three months (1.6% DART vs. 7.1% standard of care [p = 0.058]), alongside significantly reduced swallow function change compared to baseline and better quality of life (QoL).-Similar excellent rates of loco-regional control, progression-free survival (PFS) and overall survival (OS) were also reported.-Caution advised regarding the use of DART for patients with both extranodal extension and N2 disease. Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial. Fennel, D.A. et al. Lancet Oncol 2021 [[2]Fennell D.A. Ewings S. Ottensmeier C. Califano R. Hanna G.G. Hill K. et al.CONFIRM trial investigators. Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial.Lancet Oncol. 2021 Nov; 22 (Epub 2021 Oct 14. PMID: 34656227; PMCID: PMC8560642): 1530-1540https://doi.org/10.1016/S1470-2045(21)00471-XAbstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar]-Median PFS 1·8 months (95% CI 1·4–2·6) in the placebo arm versus 3.0 months (2·8–4·1) in the Nivolumab group (adjusted HR 0·67 [95% CI 0·53–0·85; p = 0·0012).-Median OS was 6·9 months (95% CI 5·0–8·0) in the placebo arm versus 10·2 months (8·5–12·1) in the Nivolumab arm (adjusted HR 0·69 [95% CI 0·52–0·91]; p = 0·0090).-No evidence to support the use of PDL-1 status as a predictive biomarker.-Nivolumab is currently funded in the second line setting in the UK as an alternative to chemotherapy under the NHS England Covid interim guidance. Quality of Life in Men With Prostate Cancer Randomly Allocated to Receive Docetaxel or Abiraterone in the STAMPEDE Trial. Rush H. et al. J Clin Oncol. 2021. [[3]Rush H.L. Murphy L. Morgans A.K. Clarke N.W. Cook A.D. Attard G. et al.Quality of Life in Men With Prostate Cancer Randomly Allocated to Receive Docetaxel or Abiraterone in the STAMPEDE Trial.J Clin Oncol. 2021 Nov 10; (Epub ahead of print. PMID: 34757812): JCO2100728https://doi.org/10.1200/JCO.21.00728Crossref PubMed Scopus (2) Google Scholar].-Androgen deprivation therapy (ADT) plus either Docetaxel chemotherapy for up to six cycles with prednisolone, or Abiraterone with prednisolone in the locally advanced or metastatic setting. Abiraterone was continued for two years in patients with non-metastatic disease.-Prospective data collection; the mean modelled global-QoL score +3.9 points (95% CI, +0.5 to +7.2; p = 0.022) higher in patients allocated to Abiraterone and ADT.-Global-QoL was also higher for patients allocated to Abiraterone and ADT over the first year (+5.7 points, 95% CI, +3.0 to +8.5; p < 0.001).-Data did not meet the predefined value for clinical significance. Consolidative Use of Radiotherapy to Block (CURB) Oligoprogression – Interim Analysis of the First Randomized Study of Stereotactic Body Radiotherapy (SBRT) in Patients With Oligoprogressive Metastatic Cancers of the Lung and Breast. Tsai, C.J. et al. Int J Radiat Oncol Biol Phys 2021. [[4]Tsai C.J. Yang J.T. Guttmann D.M. Shaverdian N. Shepherd A.F. Eng J. et al.Consolidative Use of Radiotherapy to Block (CURB) Oligoprogression – Interim Analysis of the First Randomized Study of Stereotactic Body Radiotherapy in Patients With Oligoprogressive Metastatic Cancers of the Lung and Breast.Int J Radiat Oncol Biol Phys. 2021; 111: 1325-1326https://doi.org/10.1016/J.IJROBP.2021.09.014Abstract Full Text Full Text PDF Google Scholar].-Pre-planned interim analysis of 102 patients within the PROMISE-005 phase II trial comparing the addition of SBRT to ≤5 oligoprogressive metastases plus standard of care (SOC) treatment to SOC treatment alone.-Overall, the addition of SBRT significantly increased median PFS (22 weeks [SBRT] vs. 10 weeks [SOC], p = 0.005). This was exclusively driven by the NSCLC cohort (44 weeks [SBRT] vs. 9 weeks [SOC], p = 0.004).-There was no significant difference for patients with breast cancer (18 weeks [SBRT] vs. 17 weeks [SOC], p = 0.5). The authors declare no conflict of interest.