News in brief: Selinexor benefits in MM patients regardless of cytogenetic risk; Breast implant lymphoma cases predicted to surge; Gender disparity in citations a career barrier for female academics in medicine


Selinexor-based therapy benefits in MM patients regardless of cytogenetic risk

A simple triplet, non-IMiD-based regimen, which uses the oral XPO1 inhibitor selinexor, has demonstrated superior benefit across several clinical outcomes compared to standard therapy with bortezomib and dexamethasone(Vd) in patients with previously treated MM.

The once weekly XVd regimen showed superior PFS, ORR and TTNT with a trend towards improved OS compared with standard twice weekly Vd across the entire population of patients enrolled in the phase 3 BOSTON study irrespective of cytogenetic risk status

Amongst patients with high-risk MM, median PFS was 12.91 months for XVd and 8.61 months for Vd and ORRs were 78.6% and 57.7%, respectively.

Meanwhile in the standard-risk subgroup, median PFS was 16.62 months for XVd and 9.46 months for Vd, and ORRs were 75.2% and 64.7%, respectively.

The finding is particularly striking say investigators because XVd-treated patients received 40% less bortezomib and 25% less dexamethasone, with around 37% fewer clinic visits, than Vd-treated patients during the first 24 weeks of the study.

The combination was also associated with  reduced long-term toxicity, particularly peripheral neuropathy, relative to Vd.

With it’s reduced toxicity, unique mode of action and oral administration that ditches the need for intravenous or prolonged subcutaneous infusions, US investigators say the Xvd combination a viable option in the treatment of patients with MM after at least one prior regimen, whether they have high risk or standard risk disease.

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Breast implant lymphoma cases predicted to surge 

Cases of Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in textured breast implants have increased exponentially over the last decade with rates set to further ‘take off’ as the growth of cosmetic breast augmentation continues to rise, according to findings from a global review that has documented current risk estimates of developing the condition.

According to the Australian-led global research team  BIA-ALCL cases have surged from initial reports of 1 per million to current estimates, which now sit at 1/2,832.

Investigators say it’s the first time the relative risk and prevalence of the condition has been clearly reported with  previous attempts hampered by poor registry data, underreporting, lack of awareness, cosmetic tourism, and fear of litigation.

According to their review the risk of BIA-ALCL is most likely directly proportional to the surface texture and surface area of the breast implant, implicated indirectly because of a increased likelihood to harbour microorganisms eventually triggering T-cell transformation.

But a finding of ‘dramatic variation’ of incidence between regions signals ethnicity and genetic factors are also implicated the team suggests.

However with around 80% of cases usually presenting during early stages of disease investigators say the condition is ‘imminently curable’ with surgical excision alone highlighting the importance of early monitoring.

Among several recommendations off the back of review, investigators suggest that all patients undergoing the surgery provide informed educated consent that includes patient and implant-specific risk assessment and education about the signs and symptoms of BIA-ALCL.

A disease profile with established relative and absolute contraindications will be developed as more about the pathologic mechanism of the condition continues to unfold, they add.

As it stands a number of cases have recently been linked to women with JAK/STAT acquired and germline mutations and with the Li-Fraumeni syndrome, who carry the p53 oncogene mutation.

In these cases, and in women following mastectomy for breast cancer, reconstruction with textured breast implants would be inadvisable, they cautioned.

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Gender disparity in citations a career barrier for female academics in medicine

Women face an additional barrier to advancement in academic medicine because their articles published in medical journals have fewer citations than those written by men, a US study shows

An analysis of 5,554 articles published in 5 high-impact journals showed that, 36% had a female primary author, and 26% had a female senior author.

However, articles with women as primary author were cited a median of 36 times in other journals, compared to 54 citations of articles with male primary authors.

As senior authors, women were cited a median of 37 times, while male counterparts received a median of 51 citations.

The disparity is likely putting female academics at a disadvantage compared to their male peers because the number of citations of peer-reviewed articles is commonly used as a metric for academic recognition, influence, and in professional evaluations and promotion, the study authors said.

“This imbalance will not be solved through hiring and mentoring more women alone,” said senior author, Dr Rachel Werner of the University of Pennsylvania.

“We must also work to ensure that women already in academic medicine are equally valued and promoted for their contributions and their successes. From the journals publishing this work, to academic institutions promoting articles once published, everyone should be invested in bridging this gender divide.”

 

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