"Lancet"[JOURNAL]

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Assisted dying and the silencing of medicine's next generation.

Khan HA, Chhatwal K, Bryan M … +2 more , Merzah J, Arab S

Lancet · 2026 Jul · PMID 42398507 · Publisher ↗

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Linguistic pragmatism: a woman with progressive abdominal pain in Thailand.

Stonington S, Surinkaew P, Prachanukool T

Lancet · 2026 Jan · PMID 42397763 · Publisher ↗

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Medical compartmentalisation: a patient with chromosome 22q11.2 deletion syndrome in Japan.

Kasai K, Kumakura Y, Kitanaka J … +2 more , Kumagaya SI, Stonington SD

Lancet · 2025 Nov · PMID 42397129 · Publisher ↗

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[Lu]Lu-edotreotide versus everolimus for gastroenteropancreatic neuroendocrine tumours (COMPETE): a phase 3, multicentre, randomised, open-label, superiority trial.

Walter T, Jann H, Ansquer C … +27 more , Deshayes E, Garcia-Carbonero R, Teulé A, Baum RP, Verberne HJ, Ćwikła JB, Srirajaskanthan R, de Mestier L, Grana CM, Buck A, Hörsch D, Pavel M, Dierickx LO, Michael M, Strosberg J, Kollár A, Jimenez-Fonseca P, Rinke A, Del Olmo-García M, Flaus A, Hernando J, Kluge A, Breuninger M, Melnyk S, Zhernosekov K, Capdevila J, COMPETE Investigator Team

Lancet · 2026 Jul · PMID 42392118 · Publisher ↗

BACKGROUND: Peptide receptor radionuclide and targeted therapy are both approved treatment options for patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEP NETs), but clinical evidence for preferre... BACKGROUND: Peptide receptor radionuclide and targeted therapy are both approved treatment options for patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEP NETs), but clinical evidence for preferred sequencing is scarce. The COMPETE trial evaluated the efficacy and harms of peptide receptor radionuclide therapy ([Lu]Lu-edotreotide) versus targeted molecular therapy (everolimus) in patients with advanced, progressive, somatostatin receptor-positive GEP NETs. METHODS: This phase 3, open-label, superiority trial included patients aged 18 years or older with treatment-naive or previously treated unresectable or metastatic (or both) grade 1-2 GEP NETs. Patients were enrolled from 49 specialist neuroendocrine tumour treatment centres across 14 countries in Africa, Europe, North America, and Oceania and randomised (2:1) to intravenous [Lu]Lu-edotreotide (7·5 ± 0·7 GBq every 3 months, maximum four cycles) or oral everolimus (10 mg/day) for up to 30 months. Random assignment was via a central, web-based randomisation system (block size of 6) and stratified by primary tumour origin and previous therapy. The primary endpoint was progression-free survival, assessed via blinded independent central review in all randomly assigned patients at 30 months. Harms were assessed in all enrolled patients who received at least one dose of a study drug. This study was registered with ClinicalTrials.gov (NCT03049189) and is no longer recruiting. FINDINGS: Between April 13, 2017, and June 20, 2022, 324 patients were enrolled and 309 patients (including 168 [54%] male patients and 141 [46%] female patients) were randomly assigned to treatment: 207 to the [Lu]Lu-edotreotide group and 102 to the everolimus group. The median follow-up for progression-free survival was 27·5 months (IQR 19·6-30·4) for the [Lu]Lu-edotreotide group and 21·2 months (8·9-29·4) for the everolimus group. Median progression-free survival was significantly longer with [Lu]Lu-edotreotide versus everolimus (23·9 months [95% CI 18·7-30·0] vs 14·1 months [9·2-20·9]; stratified hazard ratio 0·67 [95% CI 0·48-0·95]; p=0·022). Treatment-related adverse events occurred in 178 (82%) of 217 patients in the [Lu]Lu-edotreotide group and 96 (97%) of 99 patients in the everolimus group. 40 (18%) patients in the [Lu]Lu-edotreotide group and 40 (40%) in the everolimus group had at least one treatment-related grade 3-4 adverse event. The most common treatment-related adverse events in the [Lu]Lu-edotreotide group were diarrhoea and nausea (both 79 [36%] patients) and asthenia (66 [33%] patients), whereas those in the everolimus group were diarrhoea (45 [45%] patients), asthenia (36 [36%] patients), and anaemia (27 [27%] patients). No treatment-related deaths occurred in either study group. INTERPRETATION: [Lu]Lu-edotreotide led to statistically significant and clinically meaningful improvements in progression-free survival. Efficacy and harms results support the use of [Lu]Lu-edotreotide in early lines of therapy in patients with advanced, progressive GEP NETs. FUNDING: ITM Solucin.

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Research priorities for characterising Bundibugyo virus.

Geoffroy A, Jeang D, Baidjoe AY … +5 more , Casera M, Coulborn RM, Kyobe Bosa H, Mercy K, Katoto PDMC

Lancet · 2026 Jul · PMID 42392117 · Publisher ↗

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Rethinking treatment sequence in advanced gastroenteropancreatic neuroendocrine tumours.

Andreasi V, Falconi M

Lancet · 2026 Jul · PMID 42392116 · Publisher ↗

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Dual mobility total hip replacement in fractures: stability promotes patient confidence.

Nelissen RGHH

Lancet · 2026 Jul · PMID 42392115 · Publisher ↗

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Dual mobility versus standard cups in total hip replacement for displaced femoral neck fractures (Duality): an international, multicentre, randomised, controlled, superiority trial.

Hailer NP, Griffin XL, Mukka S … +7 more , Lakic TG, Appelbe D, Sköldenberg O, Lamb SE, Östlund O, Wolf O, DUALITY Investigators

Lancet · 2026 Jul · PMID 42392114 · Publisher ↗

BACKGROUND: Dislocation is the most common early surgical complication in patients with hip fractures treated with total hip replacement (THR). Dual mobility total hip replacement (THR) was developed to increase joint st... BACKGROUND: Dislocation is the most common early surgical complication in patients with hip fractures treated with total hip replacement (THR). Dual mobility total hip replacement (THR) was developed to increase joint stability, but no randomised trial has investigated its efficacy and safety. We aimed to compare the risk of dislocation in patients receiving DM-THR versus conventional THR. METHODS: We included people aged 65 years or older with a displaced femoral neck fracture attending 20 Swedish and 24 UK hospitals in this pragmatic, registry-based, randomised superiority trial. Participants eligible for THR were randomly allocated in a 1:1 ratio to either DM-THR or standard THR with the use of remote, web-based, country-specific sequences. Neither participants nor members of the direct clinical care teams were masked, but research investigators and statisticians were masked until the trial analysis was completed. The primary outcome was dislocation of the index joint, treated with closed reduction or open surgery within 1 year, analysed in the modified intention-to-treat population including all consenting participants receiving any type of hip replacement and excluding those with major protocol deviations. This trial is registered with ClinicalTrials.gov (NCT03909815) and ISRCTN11895196. FINDINGS: Between Jan 9, 2020, and April 2, 2024, 2934 eligible patients were screened, of whom 1334 were not enrolled, mainly due to surgeon's preference (n=560), because they had already been treated at the time of screening (n=257), or because informed consent was not obtained (n=213). 1600 participants (64% female, 36% male) were thus randomly assigned to either DM-THR (n=798) or THR (n=802). After exclusion of 34 participants due to prespecified protocol deviations, 1566 participants (97·9%) contributed to the modified intention-to-treat analysis. A dislocation, the primary outcome, occurred in ten (1·3%) of 779 participants in the DM-THR group and in 33 (4·2%) of 787 in the THR group (adjusted hazard ratio 0·27, 95% CI 0·13-0·56; p<0·0001). INTERPRETATION: The use of DM-THR substantially reduced the risk of dislocation and of any surgical complication among people treated with THR after a displaced femoral neck fracture. DM-THR can thus be recommended for this group of patients. FUNDING: The Swedish Research Council and the National Institute for Health and Care Research.

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