JULY 2023 ONCOLOGY CARTOONS

1. DR KANHU CHARAN PATRO
M.D, D.N.B[RT], MBA, FICRO, FAROI, PDCR,
CEPC
JULY 2023 ISSUE/88th VOLUME
www.facebook.com/oncologycartoons/photos_albums
www.slideshare.net/search/slideshow?searchfrom=header&q=oncology+cartoons

4. Vorasidenib (AG-881) is an Orally Available, Brain
Penetrant and dual mIDH1/2 Inhibitor
https://www.medchemexpress.com/ 16th JUNE 2023/BRAIN

5. INDIGO-VORASIDENIB VERSUS PLACEBO IN PATIENTS WITH RESIDUAL OR
RECURRENT GRADE 2 GLIOMA WITH AN IDH1/2 MUTATION
ascopubs.org 17th JUNE 2023/BRAIN
Condition or disease Intervention/treatment Phase
Grade 2 GliomaResidual
GliomaRecurrent Glioma
Drug: VorasidenibDrug: Matching
Placebo
Phase 3
1. Grade 2 gliomas are slowly progressive, malignant brain tumors with a poor long-term prognosis. Current
treatments (surgery followed by observation or adjuvant radiation and chemotherapy) are not curative and can
be associated with short- and long-term toxicities.
2. Mutations in isocitrate dehydrogenase (IDH) 1 or 2 occur in approximately 80% and 4% of grade 2 gliomas,
respectively, and are a disease defining characteristic in the World Health Organization (WHO) 2021
definition.
3. Vorasidenib (VOR) – an oral, brain-penetrant, dual inhibitor of mutant (m)IDH1/2 enzymes has shown a
tolerable safety profile and preliminary clinical activity in phase 1 studieThis is the first prospective,
randomized phase 3 study of a targeted therapy in grade 2 mIDH glioma. VOR significantly improved PFS by
BIRC compared with PBO with a manageable safety profile.
4. These data demonstrate the clinical benefit of VOR in this patient population for whom chemotherapy and
radiotherapy are being delayed
5. Hopefully will have a treatment (vorasidenib) approved shortly to offer patients with resected IDH-mutated
grade 2 oligodendroglioma or astrocytoma. Mellinghoff presented compelling data at the Plenary Session.
6. Patients randomized to the drug had a median PFS of 27.7 months as opposed to 11.1 months in placebo-
treated patients. Questions obviously remain regarding the duration of response and effect on OS and how to
use the drug in patients previously treated with chemotherapy and/or radiation therapy

6. Nivolumab(N)-AVD VS Brentuximab vedotin(BV)-AVD in
advanced stage classic Hodgkin lymphoma.
https://www.medchemexpress.com/ 18th JUNE 2023/LYMPHOMA
1. Patients with stage III and IV Hodgkin’s lymphoma a regimen incorporating
immunotherapy as first-line treatment.
2. It appears to be more effective and less toxic than the BV-AVD regimen,
which has become a standard of care. As reported by Herrera at the Plenary
Session (LBA4), substituting nivolumab (N-AVD) for brentuximab vedotin in
SWOG S1826 resulted in 1-year PFS improvement from 86% to 94%, with
fewer deaths and fewer long-term toxicities such as neuropathy.
3. N-AVD improved PFS vs BV-AVD in pts with AS HL. Few immune AEs were
observed and < 1% of pts received RT.
4. Longer follow-up is needed to assess OS and PROs. S1826, the largest HL
study in NCTN history, is a key step towards harmonizing the pediatric and
adult treatment of AS HL.
5. Hypo/hyperthyroidism was more frequent after N-AVD (7%/3% N vs <1%
BV) while peripheral neuropathy (any gr) was more common after BV-AVD
(sensory: 28.1% N vs 54.2% BV; motor: 4% N vs 6.8% BV).

7. KEYNOTE-716 Support Use of Pembrolizumab in Stage
IIB/IIC Melanoma
Jason J. Luke/ASCO 19th JUNE 2023/MELANOMA

8. TOPICAL DICLOFENAC IN PREVENTION OF HAND-FOOT
SYNDROME IN PATIENTS RECEIVING CAPECITABINE.
AKHIL Santhosh /ASCO ABSTRACT -2023 20th JUNE 2023/TOXICITY

9. Nonmetastatic Muscle-Invasive Bladder Cancer: Results of the
GETUG-AFU V05 VESPER Trial
Christian Pfister,ASCO ABSTRACT 2023 21st JUNE 2023/BLADDER
6 cycles of dose-dense
methotrexate, vinblastine,
doxorubicin, and cisplatin
(dd-MVAC) once every 2
weeks or four cycles of
gemcitabine and cisplatin
(GC) once every 3 weeks
before surgery (neoadjuvant
group)

10. Primary outcome analysis of the SONIA trial(HR+),
HER2-advanced breast cancer (ABC).
Gabe S. Sonke,/ASCO ABSTRACT 2023 22nd JUNE 2023/BREAST
1. Use of CDK4/6i + endocrine therapy does not provide statistically significant, nor clinically
meaningful PFS benefit compared to second-line use in women with HR+, HER2-
advanced Breast cancer
2. Use in first-line prolongs the time on CDK4/6i by 16.4 months and increases toxicity and
costs.
3. Second-line use may thus be a preferred option for the majority of patients.
4. I will not automatically add a CDK inhibitor to the therapy for all my patients with
metastatic breast cancer receiving an aromatase inhibitor as first-line therapy.

11. Ribociclib and endocrine therapy as adjuvant treatment in patients with HR+/HER2-
early breast cancer: Primary results from NATALEE trial.
Dennis J. Slamon,/ASCO ABSTRACT 2023 23rd JUNE 2023/BREAST
1. Ribociclib added to standard-of-care ET demonstrated a statistically significant,
clinically meaningful improvement in iDFS with a well-tolerated safety profile.
2. The NATALEE results support ribociclib + ET as the treatment of choice in a broad
population of pts with stage II or III HR+/HER2− EBC, including pts with N0 disease

12. KEYNOTE-671: Randomized, double-blind, phase 3 study of pembrolizumab or
placebo plus platinum-based chemotherapy followed by resection and
pembrolizumab or placebo for early stage NSCLC
Heather A. Wakelee,/ASCO ABSTRACT 2023 24th JUNE 2023/LUNG
1. Selected patients with stage II and III NSCLC both preoperative and adjuvant immunotherapy
in addition to neoadjuvant chemotherapy.
2. Wakelee reported initial results from KEYNOTE-671 at a special session, which
demonstrated improvement in DFS and trend in improvement in OS.
3. The 397 patients who received pembrolizumab along with platinum-based treatment in the
neoadjuvant setting followed by adjuvant pembrolizumab for up to 13 cycles had superior
EFS compared with the 400 placebo patients (62.4% vs 40.6%) and superior OS (80.9% v
77.6%).
4. The pathologic complete response rate was superior in the neoadjuvant pembrolizumab
group (18.1% vs 4.0 %) as well

13. SWOG 1815: gemcitabine, cisplatin, and nab-paclitaxel
versus gemcitabine and cisplatin in advanced biliary tract
cancers.
Rachna T. Shroff ASCO ABSTRACT/2023 25th JUNE 2023/GALLBLADDER
SWOG 1815 did not result in a statistically
significant improvement in median OS with
GAP vs. GC. The GAP regimen had higher
rates of AEs without a statistically significant
difference in discontinuation rates. Pts with
locally advanced disease and GBC may benefit
from the use of GAP. Further analyses are
ongoing to understand potential benefit of
GAP in subsets of BTC pts

14. FIGO ENDOMETRIAL STAGING 2023
Jonathan S. Berek/IGJO/2023 26th JUNE 2023/ENDOMETRIUM

15. Randomized trial of fixed dose capecitabine compared to
standard dose capecitabine in metastatic breast cancer:
The X-7/7 trial.
Qamar J. Khan/ ASCO ABSTRACT/2023 27th JUNE 2023/BREAST
1. In metastatic breast cancer (MBC),
oral capecitabine prescribed at the
FDA approved dose of 1250
mg/m2 twice daily, 14 days on
followed by 7 days off, is associated
with poor tolerance and high
discontinuation rates.
2. Mathematical models suggest a
fixed dose, dose dense (7 days on, 7
days off) schedule may be optimal
for capecitabine efficacy.
3. Fixed dose capecitabine (1500 mg
twice daily) on a 7/7 schedule has
less toxicity and similar survival
when compared to standard BSA-
based dosing on a 14/7 schedule in
MBC.

16. FICAT CLASSIFICAION OF AVASCUALR NECROSIS
BERT PARCELLS/HIP AND KNEE
BOOK
28th JUNE 2023/TOXICITY

17. SNOW CAP SIGN IN AVASCUALR NECROSIS
https://radiopaedia.org/ 29th JUNE 2023/TOXICITY
Snowcap sign, or snow capping, is defined as the appearance of
dense sclerosis over the head of the humerus or femur in cases
of osteonecrosis as seen on plain radiographs, which resembles a
snowcapped mountain

18. HBOT IN TREATMENT OF AVASCUALR NECROSIS OF FEMUR
N. D. Reis/ J Bone Joint Surg/2003 30th JUNE 2023/TOXICITY
Follow-up
MR scan obtained 1.75 years after the
hyperbaric oxygen treatment, first MRI
showing a normal image on both sides.
A coronal T2-weighted (2200/90) image showing a
subchondral low signal intensity line in the superior
part of the left femoral head bordered by a very thin
line of high signal intensity (double line sign; short
arrow), and by diffuse intramedullary oedema of high
signal intensity (long arrow)

19. TREAT THE CONTENTS NOT THE CONTAINER
SCALP SPARING WHOLE BRAIN RADIOTHERAPY
DAICHI TORIZUKA/ IJROBP/2023 1st JULY 2023/BRAIN
1. Estimated cutoff EQD 50% of the scalp for severe
permanent alopecia of 19.9 Gy.
2. Severe permanent alopecia was significantly reduced at this
cutoff value.
3. None of the patients who received SAWB-VMAT showed
disease progression.
4. 5 years after starting radiation therapy.
Medulloblastoma CSI- 35.2Gy

20. STANDARD DOSE RT VS HIGH DOSE RT IN ESOPHAGUS
YUANHU YAO/GREEN/2023 2nd JULY 2023/ESOPHAUGUS
1. Compared with the radiation dose of 50–
50.4 Gy, the increase of radiation dose (60
Gy) did not achieve benefits in survival for
inoperable EC patients receiving CCRT.
However, in patients with
2. ESCC, high dose (60 Gy) of radiation
probably improved OS.

21. INTRATHECAL TRASTAZUMAB IN LEPTOMENINGEAL METS
OANA GABRIELA TRIFANESCU/ASCO ABSTRACT/2022 3rd JULY 2023/BREAST
1. Intrathecal administration of trastuzumab along with systemic treatment and radiotherapy, might improve
or stabilise the consequences of leptomeningeal involvement by HER2-positive breast cancer with
manageable toxicity.
2. Patients with leptomeningeal metastasis that did not receive intrathecal treatment. Radiotherapy was
administered in all patients.
3. The patients included in the study received cures of 150 mg of Trastuzumab injected intrathecal every 3
weeks
4. Median progression free survival for patients receiving trastuzumab intrathecal was 11.1 months compare
with 6.4 months in patients receiving standard treatment, p < 0.019.

22. THREE-FRACTION (APBI) - (TRIUMPH-T) TRIAL.
CATHERYN YASHAR/PRO/2023 4th JULY 2023/BREAST
1. The trial treated selected breast cancers after breast-conserving surgery with brachytherapy
applicators that delivered 22.5 Gy in 3 fractions of 7.5 Gy
2. The planning treatment volume was 1 to 2 cm beyond the surgical cavity
3. There was excellent or good cosmesis in 94% of patients. There were no grade 4 toxicities. Grade 3
fibrosis at the treatment site was present in 1.7% and 32% percent had grades 1 or 2 fibrosis at the
treatment site.
4. There was 1 rib fracture. Other late toxicities included 7.4% grade 1 hyperpigmentation, 2% grade 1
telangiectasias, 1.7% symptomatic seromas, 1.7% abscessed cavities, and 1.1% symptomatic fat
necrosis.
5. There were 2 (1.1%) ipsilateral local recurrences, 2 (1.1%) nodal recurrences and no distant
recurrences.
6. Ultra-short breast brachytherapy is feasible and has excellent toxicity and could be an alternative to
standard 5-day, 10 fraction accelerated partial breast irradiation in eligible patients. Patients from this
prospective trial will continue to be followed to evaluate long-term outcomes.

23. STATIN THERAPY DOSE INTENSITY AND RADIATION CARDIOTOXICITY IN NON-
SMALL CELL LUNG CANCER: RESULTS FROM THE NI-HEART STUDY
GERARD M WALLS/RADIOTHERAPY AND ONCOLOGY/2023 5th JULY 2023/LUNG

24. Lazertinib Vs Gefitinib as First line
EGFR-mutated Advanced(NSCLC): LASER301 study
BYOUNG CHUL CHO/JCO/2023 6th JULY 2023/LUNG
1. Patients were ≥18 years with no prior systemic anti-cancer therapy.
Neurologically stable patients with CNS metastases were allowed.
2. Patients were randomized 1:1 to lazertinib 240 mg once daily (qd) orally (po)
or gefitinib 250 mg qd po, stratified by mutation status and race.
3. The primary endpoint was investigator-assessed (PFS) by RECIST v1.1
1. Overall, 393 patients received double-blind study treatment across 96 sites in 13
countries. Median PFS was significantly longer with lazertinib than with gefitinib (20.6
vs 9.7 months; hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.34 to 0.58; P
<0.001).
2. The PFS benefit of lazertinib over gefitinib was consistent across all predefined
subgroups. The objective response rate was 76% in both groups (odds ratio, 0.99; 95%
CI, 0.62 to 1.59).
3. Median duration of response was 19.4 months (95% CI, 16.6 to 24.9) with lazertinib
versus 8.3 months (95% CI, 6.9 to 10.9) with gefitinib. Overall survival data were
immature at the interim analysis (29% maturity).
4. The 18-month survival rate was 80% with lazertinib and 72% with gefitinib (HR, 0.74;
95% CI, 0.51 to 1.08; P =0.116). Observed safety of both treatments was consistent
with their previously reported safety profiles.
5. CONCLUSION: Lazertinib demonstrated significant efficacy improvement compared
with gefitinib in the first-line treatment of EGFR -mutated advanced NSCLC, with a
manageable safety profile.
Lazertinib is a potent,
(CNS)-penetrant, third-
generation (EGFR) (TKI).

25. (ORAL vs IV) VTE PROPHYLAXIS IN CANCER
DEBORAH SCHRAG/JAMA NETWORK/2023 7th JULY 2023/GENERAL

26. HYPORT: PHASE I STUDY OF 3WK
HYPOFRACTIONATED POST-OP RADIATION HEAD
AND NECK CANCER
DOMINIC
H. MOON/IJROBP/2023
8th JULY 2023/H/N
46.5 Gy in 15 fractions delivered 5 days a week and 44.4
Gy in 12 fractions delivered 4 days a week, respectively.
1. 12 patients were enrolled with 6 each on level 0 and 1.
2. No patient experienced a dose limiting toxicity or grade 4-5 toxicity.
3. Acute grade 3 toxicity occurred in two patients on level 0 (weight loss, neck abscess) and
three patients on level 1 (all oral mucositis). One patient on level 0 experienced late grade
3 toxicity (persistent neck abscess).
4. With a median follow-up of 18.6 months, two patients on level 1 had a recurrence: a
regional recurrence in the undissected, unirradiated contralateral neck from a well-
lateralized tonsil primary, and an in-field local recurrence of oral tongue primary.
5. The MTD was determined to be 44.4 Gy in 12 fractions, but due to more favorable
tolerability in the setting of equivalent biologically effective dose, 46.5 Gy in 15 fractions
was deemed the recommended phase II dose/fractionation.
6. Moderately hypofractionated RT delivered over 3 weeks is well-tolerated in the
short term in this phase I cohort of patients with HNSCC following surgical
resection.
7. The follow-on phase II randomized trial will deliver 46.5 Gy in 15 fractions as the
experimental arm.
EQD2- 50.76 Gy
[46.5Gy/15#]
EQD2- 50.69 Gy
[44.4Gy/12#]

27. ANNA-KATHARINA MEIßNER/JOUR. OF NEURO-ONCOLOGY/2023 9th JULY 2023/BRAIN
Radiogenomics of PD-L1+ve and PD-L1 –ve brain mets

28. ARCHITA BISWAS/JOUR. OF NEURO-ONCOLOGY/2023 10th JULY 2023/BRAIN
Glioblastoma- Molecular differences between(≤9 mo, Short
term survivors, STS) and (≥36 mo, Long term survivors, LTS).

29. JOHANNA JOST/JOUR. OF NEURO-ONCOLOGY/2023 11th JULY 2023/BRAIN
Conceptual development of an intensive exercise program
for glioma patients (ActiNO) (Active in Neuro-Oncology).
1. This supervised training program with
submaximal exertion was feasible and
safe in glioma regardless of WHO grading.
2. Based on these experiences, we initiated
a prospective multicenter study to
objectify improvements in physical
performance and quality of life in
patients with glioblastoma

30. HIROYUKI ARAI/CANCER TREAT REV/2019 12th JULY 2023/CHEMO
REGORAFENIB- A ORAL MULTIKINASE INHIBITOR
Regorafenib simultaneously targets several hallmarks through broad kinase inhibition with anti-
angiogenesis (by inhibiting VEGFR1, −2, −3, TIE2, PDGFR, and FGFR1 and −2), anti-proliferation (by
inhibiting c-KIT, RAF1, BRAF, and RET), anti-metastasis (by inhibiting VEGFR2 and −3, and PDGFR),
and anti-immunosuppression (by inhibiting CSF1R) effects

31. GIUSEPPE LOMBARDI/LANCET ONCOLOGY/2023 13th JULY 2023/BRAIN
Regorafenib compared with Lomustine in patients with
relapsed glioblastoma (REGOMA) trial:
1. REGOMA showed an encouraging overall
survival benefit of regorafenib in recurrent
glioblastoma.
2. This drug might be a new potential
treatment for these patients and should
be investigated in an adequately powered
phase 3 study

32. PATRICK G MCALEAVEY/CNS ONCOL/2022 14th JULY 2023/BRAIN
SUMMARY OF KEY DRUG-RT COMBINATION STUDIES IN GLIOBLASTOMA

33. SHELLY SHINEBARGER MOM TO EWINGS SARCOMA
FIGHTER
15th JULY 2023/PUBLIC
SUGGESTIONS FROM A MOTHER OF CANCER PATIENT TO CANCER PATIENTS
1. Initially cancer is a wake-up call —it forces you to take stock of your life,and what is important.
2. Cancer doesn’t discriminate — it crosses all ages, races and backgrounds.
3. Always get a second opinion. It could save your life.
4. Take notes and document all of your appointments.
5. Our friends and family will all react differently. Some may disappear, others may say the
wrong thing but mean well. New friends will come into your life. Accept the differences.
Accept the help. It not only helps you but helps your family and friends when they can help in
anyway.
6. We are all stronger than we think. Take it one day at a time and sometimes one hour at a
time.
7. Get to know your medical team. They are working more hours than you know and often
sacrificing their own family time to help you gain more.
8. Focus on nutrition but don’t let it run your life. Walk, spend time in nature and live
intentionally. Say no to anything you don’t feel you want to do. Focus on what's important.
9. Find humor in the little things and laugh. Watch comedies. Read inspirational stories and
10.Have fun. Tomorrow is never promised. Life is short. If you reach remission or not, carve out
adventure and fun. It is essential to your healing and soul to have things to look forward to.
11.We do not fight alone… We have our medical teams, true friends and family supporting us
each step of the way.