The Five Under 5 highlights five brief videos for busy oncologists, offering expert insights on breaking news, regulatory updates, practice-changing data from medical meetings, and other key oncology topics.
Real-World Outcomes Following Treatment With Obe-Cel and Brexu-Cel in R/R ALL: Yannis K. Valtis, MD
Yannis K. Valtis of Memorial Sloan Kettering Cancer Center reviews ROCCA registry data comparing obecabtagene autoleucel (obe-cel) and brexucabtagene autoleucel (brexu-cel) in relapsed/refractory acute lymphoblastic leukemia. Early efficacy was comparable, with MRD-negative complete response/CR with incomplete hematologic recovery rates of 81% for obe-cel and 80% for brexu-cel at day 28. The findings support both CAR T-cell products as highly active in heavily pretreated patients, but limited follow-up leaves questions about durability of remission and curative potential.
Challenges in the Diagnosis and Management of LEMS in SCLC: Jacob Sands, MD
Jacob Sands of Dana-Farber Cancer Institute and Harvard Medical School outlines the difficulty of recognizing Lambert-Eaton myasthenic syndrome in small cell lung cancer, noting that proximal muscle weakness and autonomic dysfunction often overlap with treatment-related toxicities and cancer-associated fatigue. He urges clinicians to maintain a low threshold for paraneoplastic antibody testing and early neurology consultation when patients present with unexplained neurologic symptoms.
Where CELMoDs Could Fit in the Myeloma Treatment Paradigm: Joshua Richter, MD
Joshua Richter of Mount Sinai discusses evolving roles for CELMoDs, highlighting iberdomide and mezigdomide. In the phase 2 EMN 26 trial, iberdomide achieved MRD-negativity conversion rates of 30% to 50% post–autologous stem cell transplant, surpassing historical lenalidomide benchmarks, and has shown strong activity in combinations, including with elranatamab. Mezigdomide is positioned as a more potent option for high-risk disease such as extramedullary myeloma, with early studies reporting deep remissions.
Updated Efficacy Data for Avapritinib in Indolent Systemic Mastocytosis: Tsewang Tashi, MD
Tsewang Tashi of the University of Utah presents three-year follow-up data from part 3 of the phase 2 PIONEER trial showing that avapritinib produced deep, sustained improvements in total symptom score and durable quality-of-life benefits at both two and three years. No new safety signals were observed with longer-term treatment at the 25-mg or 50-mg doses.
Factors Informing Frontline Chemotherapy Selection in Pancreatic Cancer: Dong Kim, MD
Dong Kim reviews key considerations for choosing frontline chemotherapy in pancreatic cancer, including performance status, comorbidities, tumor stage and biology, and patient goals of care. He emphasizes the importance of biomarker testing (including germline and somatic assessments for BRCA, MSI, and other actionable alterations), weighing regimen efficacy against toxicity profiles such as FOLFIRINOX versus gemcitabine-based approaches, and incorporating multidisciplinary input and clinical trial options into treatment planning.
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