Welcome to the Hematology/Oncology Updates section of our Hospital Medicine Cheat Sheets blog! We summarize recent practice-changing research across hematologic and oncologic care from peer-reviewed journals. Each entry is concise and clinically focused with a journal link, statistical robustness, strengths and pitfalls, clinical implications, and a practical example.
The final ALPINE analysis shows zanubrutinib improves progression-free survival versus ibrutinib in relapsed/refractory CLL (HR ≈0.65) with fewer cardiac adverse events.
Statistical Robustness
Multinational phase 3 head-to-head RCT (n=652) with hierarchical testing; consistent benefit across high-risk subgroups.
Strengths
Direct comparator; clinically meaningful endpoints; safety advantage.
Pitfalls
Excludes patients intolerant to BTK inhibitors; follow-up still maturing for OS.
Clinical Implication
For R/R CLL requiring BTK inhibition, zanubrutinib may be preferred over ibrutinib due to superior PFS and fewer cardiac events.
Practical Example
A 74-year-old with R/R CLL and prior AF on beta-blocker needs BTK therapy. Choose zanubrutinib and monitor blood pressure and rhythm.
Reference: Brown JR, et al. Zanubrutinib or ibrutinib in R/R CLL. N Engl J Med. 2023;388:319-332.
2. Second-Line CAR-T for Large B-Cell Lymphoma (ZUMA-7)
In ZUMA-7, axicabtagene ciloleucel as second-line therapy improved overall survival versus standard platinum-based salvage chemo plus ASCT for primary refractory/early relapsed LBCL.
Statistical Robustness
Phase 3 RCT with OS advantage (HR ~0.73) and marked event-free survival benefit; robust stratification and intention-to-treat analysis.
3. Elacestrant for ESR1-Mutated ER+/HER2– Metastatic Breast Cancer (EMERALD)
The phase 3 EMERALD trial showed elacestrant improved PFS versus standard endocrine therapy in the overall population and especially in ESR1-mutated tumors.
Statistical Robustness
Randomized, active-controlled study with significant PFS benefit (overall HR ≈0.70; larger effect in ESR1-mutated subgroup).
Strengths
First oral SERD with positive phase 3 results; manageable safety profile.
Pitfalls
Cross-over and post-progression therapies may blur OS effects; GI adverse events.
Clinical Implication
Consider elacestrant after CDK4/6 inhibitor progression when ESR1 mutation is present (liquid biopsy compatible).
Practical Example
A 63-year-old with ER+/HER2– mBC progressing on AI+CDK4/6i has ESR1 mutation on plasma NGS. Start elacestrant with antiemetic strategy.
Reference: Bidard F-C, et al. EMERALD trial of elacestrant. J Clin Oncol. 2022.
4. Extended Anticoagulation in Cancer-Associated VTE (API-CAT)
API-CAT found reduced-dose apixaban (2.5 mg BID) was noninferior to full-dose (5 mg BID) for preventing recurrent VTE after ≥6 months of prior therapy, with less clinically relevant bleeding.
Statistical Robustness
Large double-blind noninferiority RCT (n=1,766). Recurrent VTE ~2.1% vs 2.8%; clinically relevant bleeding ~12.1% vs 15.6% favoring reduced dose.
5. First-Line Quadruplet Therapy in Multiple Myeloma (Guideline Updates)
Recent guideline updates prioritize anti-CD38–based quadruplet induction (e.g., daratumumab-VRd) as preferred first-line therapy for many newly diagnosed patients, with higher MRD-negativity and PFS improvements versus triplets.
Statistical Robustness
Recommendations reflect multiple phase 3 data (e.g., PERSEUS, CEPHEUS) and expert consensus; updates incorporated into NCCN 2024/2025 resources.
Strengths
Consistent efficacy across trials; clear practical pathways.
Pitfalls
Cost/toxicity trade-offs; regimen selection by frailty/eligibility remains nuanced.
Clinical Implication
Adopt quadruplet induction where feasible; tailor by transplant eligibility and frailty with maintenance strategies guided by MRD and tolerance.
Practical Example
A 62-year-old transplant-eligible NDMM patient: start Dara-VRd induction; plan ASCT and daratumumab+lenalidomide maintenance per center protocol.
Reference: NCCN/Expert updates on first-line myeloma therapy (2024–2025).
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