Tom Nolan

Before 2011, when checkpoint inhibitor treatments became available, the median survival for people with advanced melanoma was 11 months. The final results of the Checkmate 067 study, just published in the New England Journal of Medicine , confirms the dramatic improvements in survival since then. The phase 3 study randomised 945 people with stage III or IV melanoma to receive either the checkpoint inhibitors nivolumab plus ipilimumab, nivolumab with placebo, or ipilimumab with placebo. Median survival in those allocated to nivolumab plus ipilimumab was 71.9 months, and 10 year overall survival was 43% with nivolumab plus ipilimumab, 37% with nivolumab, and 19% with ipilimumab.

Prostate cancer screening may be less controversial if we could reduce overdiagnosis of low risk disease. A new study suggests that magnetic resonance imaging (MRI)-targeted biopsy could help achieve this. Over 13 000 men aged 50-60 years were invited for a prostate-specific antigen (PSA) test, and if the result was ≥3 ng/mL they were randomised to have a prostate biopsy only if suspicious lesions were found on MRI (the targeted biopsy group) or a targeted biopsy in addition to a systematic biopsy (the systematic biopsy group).

Stigma, language, and cultural barriers make it harder for women from minority ethnic groups with postnatal depression to access and benefit from mental health care. A randomised controlled trial recruited women with postnatal depression from five areas across England and Scotland with high South Asian populations. The trial delivered a 12-session group intervention that included nine culturally specific topics, including: “the challenges of being a British South Asian woman, the role of religion and spirituality in mental health, and tackling social isolation.” After four months, 138 (49%) of 281 in the culturally adapted cognitive behavioural therapy (CBT) group and 105 (37%) of 281 in the control group had recovered—but by 12 months there was no difference between the groups, when only 54% of women in each group had recovered.

Plus Paula Hawkins’s “The Blue Hour” and Alan Bradley’s “What Time the Sexton’s Spade Doth Rust.”

BMJ doi: https://doi.org/10.1136/bmj.q2378 (Published 31 October 2024) Cite this as: BMJ 2024;387:q2378 Tom Nolan

When it comes to peripherally inserted lines for outpatient parenteral antimicrobial therapy (OPAT), where should one draw the line? Midline catheters, which end in peripheral veins, are thought to offer lower risks of infection and thromboembolism than peripherally inserted central catheters (PICCs). A new cohort study supports this, finding that, for a device dwell of 14 days or less, midline catheters were associated with a lower risk of major complications (0.9% v 5.3%, adjusted hazard ratio 0.29 (95% CI 0.12 to 0.68)). However, the study design means that confounding by indication—whereby lower risk patients received a midline catheter—is hard to measure and exclude.

Many people with osteoporosis are unable to tolerate oral bisphosphonates—many others would prefer a six monthly denosumab injection to a once weekly pill that comes with orders to stay upright and not eat or drink for 30 minutes after taking it. However, denosumab carries a risk of hypocalcaemia, explored in a cohort study of women in the US with chronic kidney disease. The risk of needing emergency treatment for hypocalcaemia increased with stage of chronic kidney disease: 3% of dialysis-dependent patients and 0.57% of non-dialysis-dependent patients with chronic kidney disease stages 4 and 5 had a hospital admission or emergency department visit for hypocalcaemia within 12 weeks of starting denosumab, compared with 0.00% and 0.03% respectively in those starting oral bisphosphonates.

For obvious reasons, I spent a lot of time this past year reading and rereading and rereading some more Joan Didion and Eve Babitz. (Hang on, maybe it’s not obvious: I have a new book out called Didion & Babitz.) Reading, as well, writers in the Didion-Babitz orbit. Key husbands: John Gregory Dunne. Key brothers-in-law: Dominick Dunne. Key nephews and/or barely-legal sex partners: Griffin Dunne (Didion’s nephew; Babitz’s barely-legal sex partner). Key boyfriends: Dan Wakefield, Grover Lewis

Established surgical treatment for people with severe aortic stenosis who have obstructive coronary artery disease is surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). A new trial, published in the Lancet , suggests that transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) may be a better option. Four of the 91 patients (4%) in the TAVI group of the multicentre European study and 17 of the 77 (23%) in the SAVR group reached the composite primary endpoint of the study of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target vessel revascularisation, valve reintervention, and life threatening or disabling bleeding at one year after treatment (hazard ratio 0.17 (95% confidence interval 0.06 to 0.51)). This was in large part due to none of the TAVI group dying during the one year follow-up, compared with seven (10%) in the SAVR group.

Plus Jussi Adler-Olsen’s “Locked In” and John Straley’s “Big Breath In.”