Publications Update # 56
Non-Medical Article of the Week
13 Financial Tips for Physicians
WealthKeel, one of the best financial planning firms for Physicians, shares 13 of their top Financial Tips for Physicians.
Chad Chubb
I've reviewed numerous articles on financial advice and found this one to be the most comprehensive and straightforward. Be aware that the article heavily promotes its sponsoring company, so approach with caution. However, if you can look beyond the promotional content, the advice provided is reliable. It offers a complete checklist of tasks that fellows should complete before graduation, and for attending physicians, it's a useful reminder to ensure all recommended financial steps are in place.
If you hire a financial advisor, make sure you find the one that you pay for service and not the ones working on commission! Here is the website from the CFP Board of Standards to help you ask important questions
10-questions to ask your financial advisor before you hire them
Ovarian Cancer
MITO-23 Trial
Single-Agent Trabectedin Versus Physician’s Choice Chemotherapy in Patients With Recurrent Ovarian Cancer With BRCA-Mutated and/or BRCAness Phenotype: A Randomized Phase III Trial - PubMed
Trabectedin did not improve median OS and showed a worse safety profile in comparison with physician’s choice control chemotherapy.
Domenica Lorusso
Hypothesis
- Trabectedin monotherapy is more effective than physician’s choice chemotherapy for recurrent ovarian cancer in patients with BRCA mutations and/or BRCAness phenotype.
Inclusion Criteria
- Adult females with histologically confirmed invasive epithelial ovarian cancer, primary peritoneal carcinoma, or fallopian tube cancer.
- Recurrent platinum-resistant or platinum-sensitive disease with BRCA1/2 mutation or BRCAness phenotype.
- Prior response to ≥two platinum-based chemotherapy lines.
Exclusion Criteria
- Previous exposure to trabectedin.
- Less than two responses to platinum treatment lines unless BRCA mutation documented.
Primary Endpoint
- Overall survival (OS).
Experimental Arm(s)
- Trabectedin 1.3 mg/m² via a 3-hour infusion every 21 days.
Control Arm
- Physician’s choice chemotherapy (pegylated liposomal doxorubicin, topotecan, gemcitabine, once-weekly paclitaxel, or carboplatin).
Results
| Metric | Experimental Arm (Trabectedin) | Control Arm (Physician's Choice) | p-value | Hazard Ratio |
|---|---|---|---|---|
| Overall Survival | 15.8 months | 17.9 months | 0.304 | 1.15 |
| Progression-Free Survival | 4.9 months | 4.4 months | 0.897 | 1.02 |
| Objective Response Rate | 17.1% | 21.4% | NS | NS |
| Duration of Response | 5.62 months | 5.66 months | NS | NS |
*NS - Not significant
Top 5 Adverse Events (AEs) - Grade 3 or worse
| AE Category | Experimental Arm (Trabectedin) | Control Arm (Physician's Choice) |
|---|---|---|
| Neutropenia | 34.7% | 12.7% |
| Fatigue | 15.7% | 6.8% |
| Hepatic Toxicity | 14.9% | 1.7% |
| Thrombocytopenia | 5.0% | 8.5% |
| Febrile Neutropenia | 4.1% | 0.8% |
Conclusions
- Trabectedin did not improve median OS and demonstrated a worse safety profile compared to physician’s choice chemotherapy.
Limitations
- High performance of the control arm might have affected the power of the study.
💡
Even though this study was a negative trial, i.e., trabectedin did not improve survival compared to the physician's choice of chemotherapy; this drug could be used as a single agent. It's not currently listed anywhere in the NCCN guidelines! However, the following obscure drugs are on the NCCN list of viable options for platinum-resistant ovarian cancer: Melphalan, Vinorelbine, pemetrexed, and Ixabepilone.
Keep in mind that if a CT scan is performed after 3 months, even a placebo drug might show a progression-free survival (PFS) of 3 months. In this study, the population was heavily pre-treated, with 70% of patients having received three or more prior lines of chemotherapy. Under these conditions, trabectedin achieved an objective response rate (ORR) of 17.1% and a disease control rate (DCR) of 60.0%. The median progression-free survival was 4.9 months, and the median overall survival was 15.8 months.