Discover and read the best of Twitter Threads about #NSCLC

Most recents (24)


🔬🧬Tx of #EGFR Exon20 insertion has changed significantly. @LealTiciana @JennyCarlisleMD brought us up to speed at #TumorBoardtuesday

➡️Here’s the Thursday Case 🎀
🆓 #CME: 2 quick❓
CME eval🔗: Image
2/8 #TumorBoardTuesday
Thurs Case🎀
✅Next gen seq=ESSENTIAL. PCR misses EGFR exon20 ins!
✅CHRYSALIS: Amivantamab (EGFR/MET Bispecifc mAb) 2L
✅EXCLAIM: Mobocertinib (EGFR TKI) 2L
✅1L= Plat chemo; 2L= ami/mobo

📚 @LealTiciana @JennyCarlisleMD’s thread…
3/8 #TumorBoardTuesday
Thurs Case🎀
🎥 TBT in a video: Pt 1-
@LealTiciana takes us through importance of NGS–but not just any NGS.

🔹RNA/DNA based NGS>>> hotspot PCR, which may miss ex20 ins
🔹🩸ctDNA + tumor🧬= Make faster tx decision, ⬆️sens
🔹Identify trials, future options
Read 9 tweets
@TumorBoardTues @LealTiciana 1/21 #TumorBoardTuesday #LungCancer #OncTwitter

47yo 👨🏽‍💼🚭
No significant PMHx
Incidental 📏 2.8cm cavitary RLL nodule on coronary calcium scan in 2020
FDG 💥on PET with hilar LN 💥
🫁🎥 Mediastinoscopy shows adenocarcinoma, + subcarinal LN (stage IIIA)

🤨 How would you treat?
@TumorBoardTues @LealTiciana 2/21 #TumorBoardTuesday
Due to findings👆🏽
👨🏽‍💼Began Neoadjuvant cisplatin/pemetrexed x 4
✂️lobectomy in 2020

ChemoIO was not SOC in 2020.
✨Checkmate 816
📍patients excluded if they had EGFR and ALK alterations:
📚@FordePatrick @DrMarkAwad @JulieBrahmer… Image
Read 24 tweets
@TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 2/5 #TumorBoardTuesday
✅ 🧬test 🗝️! Biomarkers 👉 best tx
✅ OlympiA: OS & IDFS⬆️w Olaparib- gBRCAm
✅ MonarchE: IDFS⬆️ w abema +ET- HR+
✅ Fertility pres & interrupting adj tx (if desired) for pregnancy
📚@JenniferLitton @marijasullivan’s thread…
@TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 3/5 #TumorBoardTuesday
Thursday Case🎀

🎥 TBT in a video
@marijasullivan summarizes adj tx based on biomarkers. How to approach pts w gBRCA1/2m & HR+? Need more data!

🔹gBRCAm👉 Olaparib x 1y
🔹 HR+👉 Abemaciclib + ET x 2y -> ET; data expected on other CDK4/6i soon (ribociclib)
@TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 4/5 #TumorBoardTuesday
📷 TBT in an image

In pts who desire pregnancy, data that adj tx can be interrupted & later resumed safely- waiting on long-term follow up @AnnPartridgeMD.

✅Pregnancy outcomes after #BreastCancer NOT worse. Fertility pres strat BEFORE tx 🗝️ if desired. Image
Read 8 tweets
@TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 2/5 #TumorBoardTuesday
Thurs Case🎀

✅ctDNA= both tx decision making & MRD in #NSCLC
✅Identify actionable muts in dz where a bx not possible
✅Pros (serum test) & cons ($, inability to multiplex with IHC- aka PD-L1 status)

📚The thread:…
@TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 3/5 #TumorBoardTuesday
Thurs Case🎀

🎥 TBT in a video
ctDNA + tissue-based NGS= highest sensitivity (do NOT miss actionable mutations in #NSCLC).
ctDNA can be used to:
🔹Identify actionable mutations
🔹Track disease status (MRD)
🔹Adapt targeted therapies based on 2dary muts
@TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 4/5 #TumorBoardTuesday
Thurs Case🎀

📷 TBT in an image

Also have to understand caveats!
1⃣ctDNA works best in higher volume dz.
2⃣Know when to suspect germline mut (variant allele fractions near 50%)
3⃣Clonal hematopoiesis of indeterminate potential muts that could mislead! Image
Read 11 tweets
1/26 #TumorBoardTuesday #LungCancer #OncTwitter @DrSteveMartin
⛹🏻‍♀️Case 1⛹️‍♂️
80 yo 👵🏼 never 🚬
🩻 Imaging shows R lung mass
🦴 New hip pain found to have R femoral lytic lesion
⚒️Undergoes ORIF R femur
🔬R femur path: metastatic squamous cell carcinoma, TPS 1%
🤔What next?
2/26 #TumorBoardTuesday #LCSM

🩸🧬Surprise, surprise - you send ctDNA!
➡️Results show MET Exon 14 skipping mutation (VAF 0.5%)
👵🏼started on MET TKI capmatinib 400mg BID
👍CTCAP 2 months later shows impressive response 🙌🏽
3/26 #TumorBoardTuesday #LCSM
👨🏻‍🏫Mini tweetorial 1👩🏻‍🏫

⭐️~10.5% of pts w SCC have actionable alterations
🕵🏻‍♀️Consider NGS in nonadeno #NSCLC pts who
1⃣🚭or light 🚬hx (1-10 pack yrs)
2⃣young age (dx age <50)
bc potentially ⬆️ prevalence driver muts
Read 33 tweets
@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 2/5 #TumorBoardTuesday

✅CDK4/6i +endocrine tx= 1L HR+ mBC
✅Ribo =⬆️OS; select based on shared decision
✅After prog on CDK4/6i, eval muts (ESR1, PIK3CA)➡️SERD vs PIK3CAi
✅Benefit in adj- monarchE

📚Here’s @drsarahsam @PTarantinoMD’s thread…
@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 3/5 #TumorBoardTuesday

🎥 TBT in a video: HR+ #mBC tx has changed significantly, esp in 2L setting.

Check out this SHORT video w algorithm to approach tx after progression on CDK4/6i:

A bigger and bigger role for 🎯 medicine to select next best therapy!
@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 4/5 #TumorBoardTuesday

📷 TBT in an image: Selecting CDK4/6i involves shared decision making! Things to keep in mind:

🔹OS benefit seen with ribociclib, but not palbo.
🔹Different toxicity profiles
🔹Medication interactions (QTc prolongation w ribo+ tamoxifen!) Image
Read 10 tweets
1) Welcome to a new #accredited #tweetorial, "Utilizing Immunohistochemistry Testing, Biomarkers, and Targeted Therapeutics to Optimize Outcomes in Patients with NSCLC," featuring the highlights of a symposium presented at the #ESMOIO22 congress.
@myESMO #LCSM #FOAMed Image
2) The faculty for this outstanding program were @peters_solange (Chair) 🇨🇭, @HosseinBorghaei 🇺🇸, Natasha Leighl MD 🇨🇦, and @dplanchard 🇫🇷. A truly international roster of experts in #oncology!
Don't miss prior accredited courses in this space at….
3) This program is supported by an educational grant from Sanofi. Statement of accreditation and author disclosures are at
Read 24 tweets
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell 4/23 #TumorBoardTuesday
👩🏽‍🏫Mini tweetorial 1👩🏽‍🏫

📚@NCCN based #NSCLC guide for biomarker neg, PDL1 <1% ⤵️

📍Pembro + carboplatin + paclitaxel
📍Pembro + carboplatin + nab-paclitaxel
📍Ipi/Nivo + carbo + paclitaxel
📍Cemiplimab + carbo + paclitaxel
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell @NCCN 5/23 #TumorBoardTuesday
👩🏽‍🏫Mini tweetorial 2👩🏽‍🏫

♦️Phase III
♦️Untreated metastatic, squamous NSCLC
♦️Pts randomized 1:1 pembro+platinum-doublet vs plat doublet alone
♦️Median OS 15.9 mos vs 11.3 mos
♦️69.8% of grade 3+ AEs in pembro-combo vs 68.2% in placebo-combo
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell @NCCN 6/23 #TumorBoardTuesday
👩🏽‍🏫Mini tweetorial 3👩🏽‍🏫

♦️ Phase III in untreated metastatic NSCLC
♦️ patients randomized 1:1 nivolumab+ipilimumab + 2 cycles chemo vs 4 cycles chemo

PFS KM Curves in Squamous Pts ⬇️
Read 22 tweets
@TumorBoardTues @NarjustFlorezMD 1/23 #TumorBoardTuesday #LungCancer #OncTwitter

64y 👱🏼‍♂️with no 🚬hx
Presents w/chest pain
PMH: diabetes
☢️: 8cm mass in RUL with peribronchial lymph nodes with adrenal metastasis
🧠Brain MRI: ❌mets
🔬Stage IVA (T4N1M1a) 🫁 Squamous Cell Ca

🤨What systemic tx would YOU give?
@TumorBoardTues @NarjustFlorezMD 2/23 #TumorBoardTuesday #LungCancer

⏳ You await further testing
🔪 🫁biopsy tissue tested
🦠 IHC was sent 🧬
🔬 NGS: no actionable mutations
🔬 PD-L1 10%

🤨 Of the options below, what systemic tx would YOU give now?
@TumorBoardTues @NarjustFlorezMD 3/23 #TumorBoardTuesday


🫁 20-30% of all lung Ca, with declining incidence
🫁 associated with ⬇️survival vs nonsquamous #NSCLC
🫁 treatment decision-making relies on upfront PD-L1 expression testing
Read 3 tweets
@TumorBoardTues 1/15 #TumorBoardTuesday #GastricCancer #OncTwitter
Here goes

🎬Starting out with an overall poll Q

When a new advanced GC/GEJ patient presents to your clinic, your institution reflexively tests for which of the following?
@TumorBoardTues 2/15 #TumorBoardTuesday

68y/o with poorly diff gastric cardia adeno, diffuse LAD, +peritoneal mets.

🧬Biomarkers HER2-, PD-L1-, MSS
🧪Pre-screened for trials & FGFR2b-, Claudin18.2+
🔦Enrolls in frontline SPOTLIGHT trial.

❓What is Claudin18.2?
@TumorBoardTues 3/15 #TumorBoardTuesday

✨Claudin18.2 (CLDN18.2)✨

Transmembrane protein typically present in tight junctions of gastric mucosal cells, maintains barrier function of gastric mucosa, & prevents leakage of H+ in gastric acid through paracellular pathways.
Read 21 tweets
@TumorBoardTues 1/17 #TumorBoardTuesday #LungCancer #OncTwitter

42yo 👨🏽‍💼
PMH: never smoker
persistent cough

🩻PET/CT: 3.5 cm mass LLL & bulky, coalescing LNs in L hilum & mediastinum (AP 🪟, subcarinal, bilat paratracheal, supraclav)
Axillary LNs
🦴multi bony mets
🫀small pericardial effusion
@TumorBoardTues 2/17 #TumorBoardTuesday #LungCancer #NSCLC

🫁🎥Mediastinoscopy shows adenocarcinoma with signet rings.
🔬 ALK IHC positive
🐟 FISH positive
🧬 PDL1 = 0

🤨What’s your recommended initial therapy:
@TumorBoardTues 3/17 #TumorBoardTuesday #LCSM

🧲MRI: Brain shows 4 CNS mets in frontal lobes & cerebellum
📏 = 13, 10, 8 and 4 mm
💧No edema
🧠 no neuro symptoms

🤨 Does the presence of CNS mets change your 1st line recommendation?
A = alectinib
B = brigatinib
L = lorlatinib
Read 20 tweets
@TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc 2/4 #TumorBoardTuesday
Thurs Case🎀

#HER2+ #BreastCancer
✅Localized, early ➡️neoadj tx w chemo + anti-HER2
✅⬆️DFS w T-DM1 for residual disease
✅Future role for T-DXd?

📚We captured @drteplinsky’s discussion in this moment:…
@TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc 3/4 #TumorBoardTuesday
Thursday Case🎀

📷 TBT in an image: Take a 👀at a (simplified) guide to treatment of early stage HER2+, localized #BreastCancer!

We review KATHERINE and use of ADCs to improve OS with residual disease. Is there an evolving role for T-DXd? Image
@TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc @dradityabardia @EricaMarieRomn1 @jacobadashek @esinghimd @BreastCaupdates 4/4 #TumorBoardTuesday
Thurs Case🎀

🙏 Anti-HER2+ tx in neoadj setting improves pCR. T-DM1 improves OS when residual disease is present.
🤔 Role for other ADCs or even neoadj setting?

➡️Be sure to join us 11.01.22 when @LeciaSequist presents a case of ALK+ #NSCLC #LungCancer
Read 8 tweets
@TumorBoardTues @n8pennell @MPishvaian @ShrutiPatelMD @NarjustFlorezMD @OncBrothers @jillfeldman4 @Joshua_Reuss @JineshGheeya @ClevelandClinic 2/4 #TumorBoardTuesday
Thurs Case🎀
✅Wait on NGS- IO +TKI=⬆️tox
✅Osimertinib= ex19, 21m
✅New ADCs, small molecules= future options
✅ Re-bx on prog EGFRm- rule out small cell transformation

📚We captured @n8pennell’s discussion:…
@TumorBoardTues @n8pennell @MPishvaian @ShrutiPatelMD @NarjustFlorezMD @OncBrothers @jillfeldman4 @Joshua_Reuss @JineshGheeya @ClevelandClinic 3/4 #TumorBoardTuesday
Thursday Case🎀

📷 #TBT in an image: we’ve summarized some key pts re: EGFRm #NSCLC & emerging data- hope to see more ADCs as 3L options for pts with EGFRm disease in the future! Image
@TumorBoardTues @n8pennell @MPishvaian @ShrutiPatelMD @NarjustFlorezMD @OncBrothers @jillfeldman4 @Joshua_Reuss @JineshGheeya @ClevelandClinic @esinghimd @nihardesai7 @NicoGagelmann @drteplinsky @jacobadashek 4/4 #TumorBoardTuesday
Thurs Case🎀

🐟Thanks to @n8pennell for an excellent discussion about the future of #EGFRm directed therapy!

➡️Please be sure to join us in 2 weeks on 10/18/22 when @drteplinsky presents a case of
Early-stage #HER2+ #BreastCancer 😀
Read 7 tweets
@TumorBoardTues 1/17 #TumorBoardTuesday #LCSM #OncTwitter
50y 👩🏻 never 🚬 presents with cough

🩻CT: 2cm RLL 🫁 mass & pleural effusion
💧Tap of pleural fluid: adenocarcinoma TTF1+ (T1bN0M1a) Stage 4A #NSCLC
🧪NGS: exon19 deletion EGFR mutation & PDL1 70%+

🤨What’s most appropriate initial tx?
@TumorBoardTues 2/17 #TumorBoardTuesday #LCSM

👩🏻 starts osimertinib with resolution of effusion

She has🧴dry skin & occasional 💩diarrhea managed with loperamide

After 18 months she develops headache
🧲MRI brain shows new 2cm 🧠 metastasis with edema

🤨What’s the most appropriate next step?
@TumorBoardTues 3/17 #TumorBoardTuesday #LCSM
👨🏼‍🏫Mini tweetorial 1

EGFR mutations

📍≈15% of🫁adenocarcinomas
📍More common in light or never smokers, women, & Asian ethnicity
📍90% sensitizing & either exon19 del/ins or L858R mut in exon21
@NatureRevCancer Sharma et al…
Read 19 tweets
@TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 2/ #TumorBoardTuesday
Thurs Case🎀

Take🏠messages :
PIK3CA mutations in ER+ #mBC
✅PIK3CA mut are common- 20-30% of all #BreastCancer & 40%+ of ER+ #mBC
✅PIK3CAm are present in founder clones!

📚We captured as much of the discussion as we could:
Pt 1…
@TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 3/5 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages (Part 2):
✅Alpelisib is a PIK3CA inhib= 5.3 mo ⬆️in PFS
✅Side effect mgmt is key- esp. 💩diarrhea,
✅Personalized medicine needs personalized side effect mgmt

Part 2 of our convo…
@TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 4/5 #TumorBoardTuesday
📷 TBT in an image: Take a look at how PIK3CA inhibitors can be clinically deployed, key side effects to watch out for, and the data that supports their use.

👀Look for more developments in this space and even more, highly specific inhibitors to come. Image
Read 13 tweets
@TumorBoardTues 1/17 #TumorBoardTuesday #LungCancer #OncTwitter
72y 👩🏻with 58 pk-yr 🚬hx
Chest pain
PMH: diabetes
CT: 3 cm LLL nodule & left pleural effusion with 5mm nodule in LUL
💉thora with cytology
🔬Stage IVA (T4N0M1a) 🫁 adenoCa

🤨What systemic tx would YOU give?
@TumorBoardTues 2/17 #TumorBoardTuesday #LungCancer

🔪 🫁 tissue tested
🦠 Tissue NGS and IHC was sent 🧬
🔬 NGS: no actionable mutations
🔬 PD-L1 62%
@TumorBoardTues 3/17 #TumorBoardTuesday #LungCancer
👩🏽‍🏫Mini tweetorial 1👩🏽‍🏫

@NCCN based guideline for #NSCLC biomarker negative, PDL1 >50% ⤵️

📍 Pembro, atezo, and cemiplimab
📍 ipi/nivo considered in certain circumstances Image
Read 19 tweets
@TumorBoardTues @HosseinBorghaei @ShrutiPatelMD @KevinCalsina @DrRoyHerbstYale @NarjustFlorezMD @MPishvaian @EricaMarieRomn1 @Latinamd @KinhHoang_MD 1/3 #TumorBoardTuesday

In unresectable stage III #NSCLC:
✅ChemoXRT -> IO is SOC
✅STK11 = ⬇️response to IO, but IO still👍🏼after chemoXRT
✅New IO combos- COAST trial ongoing

📚We captured @HosseinBorghaei’s discussion:…
@TumorBoardTues @HosseinBorghaei @ShrutiPatelMD @KevinCalsina @DrRoyHerbstYale @NarjustFlorezMD @MPishvaian @EricaMarieRomn1 @Latinamd @KinhHoang_MD 2/3 #TumorBoardTuesday

📷 TBT in an image:

We summed it up in a graphic- check out management of unresectable stage III #NSCLC, with updated data from PACIFIC, + exciting data from ongoing COAST trial (evaluating anti-CD73 w ICI; anti-NKG2A w ICI).
@TumorBoardTues @HosseinBorghaei @ShrutiPatelMD @KevinCalsina @DrRoyHerbstYale @NarjustFlorezMD @MPishvaian @EricaMarieRomn1 @Latinamd @KinhHoang_MD @esinghimd @LaurenBzak @jacobadashek @VivekSubbiah @BiagioMd @FSkoulidis 3/3 #TumorBoardTuesday

Next: we’ll delve into choosing a checkpoint inhibitor (which one??) in the 1L setting in PD-L1 high #NSCLC, with experts @NarjustFlorezMD & @ShrutiPatelMD taking us through their clinical approach.

Have a great and safe holiday weekend!
Read 6 tweets
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 1/13 #TumorBoardTuesday #NSCLC #OncTwitter

65yo 🧔🏽, former 🚬, pmhx🫀 MI with stents
🩻CT: 🫁 right middle lobe mass & adenopathy
EBUS confirms adenocarcinoma level 7, 4R and the mass
🔬Molecular test: KRAS G12C & STK11 mutations, TMB 10, PD-L1 40% by 22C3.
Final stage T3N2M0
Read 15 tweets
@TumorBoardTues @hoperugo @laura_huppert @ErikaHamilton9 @MPishvaian @PTarantinoMD @stolaney1 @drteplinsky @JaniceTNBCmets @UCSFCancer 2/3 #TumorBoardTuesday
Thurs Case🎀

✅HER2 LOW= IHC1+ OR IHC2+ w - ISH (67% HR+!)
✅T-DXd= after 1L chemo in HER2 low
✅Careful monitoring for ILD!

📚We captured @hoperugo & @LauraHuppert’s discussion in below:……
@TumorBoardTues @hoperugo @laura_huppert @ErikaHamilton9 @MPishvaian @PTarantinoMD @stolaney1 @drteplinsky @JaniceTNBCmets @UCSFCancer @LauraHuppert 2.75/3 #TumorBoardTuesday

Check out this graphic outlining the key role for ADCs in the tx of HER2 low #MBC after prior 1L chemo and endocrine therapy.

Hoping for even more changes in the near future w
DB-06! Image
Read 7 tweets
Is there a role for Local Tx of the Primary Tumor for Patients with Metastatic Cancer?

🚫Many studies demonstrate no benefit.
📌We performed a MetaAnalysis to evaluate the average effect of Local Tx across various tumors.

A thread🧵#AMSM #PRIMETX…

Critics of Local Tx to the Primary Tumor

📌 Many providers think local control of the primary tumor in the setting of M1 dz is akin to “closing the barn door after the horse has bolted”
📌 Ian Tannock wrote a fantastic article on this back in 2000.

Supporters of Local Tx

📌Some support aggressive ablation of all sites due to the enhanced ability to detect occult disease with improved imaging technologies and 📉 toxicities with complete ablation.

Read 28 tweets
@TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 1/8 #TumorBoardTuesday
🔬🧬@CharuAggrawalMD @ADesaiMD taught us about EGFR mutations in #LungCancer–specifically, new 2L strategies for EGFRexon20m.

➡️Here's this week's Thursday Case🎀
Pick up your 🆓#CME
CME eval🔗:
@TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 2/8 #TumorBoardTuesday
Thurs Case🎀

We discussed #EGFR mutations in #LungCancer
✅Not all EGFR mutations are the same!
✅Osimertinib=tx for most activating EGFR mutations
✅…but exon20insmut more resistant to TKIs
✅Amivantamab, mobocertinib= 2L strategies
@TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 2.5 / 8 #TumorBoardTuesday

📚We captured as much of @CharuAggrawalMD @ADesaiMD’s discussion as we could in this moment:…

CRITICAL point: if you don’t look, you won’t know! RNA based NGS recommended for 🫁cancer cases to identify actionable mut
Read 17 tweets
1/8 IT’S #TumorBoardTuesday CASE WRAP UP TIME!

🫁@NarjustFlorezMD @ShrutiPatelMD taught us about EGFR mutated #NSCLC & adjuvant therapy–rapidly changing field. Summary below!

👉Don’t forget to grab🆓#CME (AMA/MOC) w 2 quick❓ CME eval & rationale🔗: Image
2/8 #TumorBoardTuesday
Thurs Case🎀

Take🏠-pt 1
We discussed #NSCLC & EGFRm
✅EGFR mutations:
🔹Never smoker >> smoker
✅NEED‼️NGS data‼️BEFORE systemic tx. Order panel of common EGFR muts if limited time.

We captured much of chat:
2.33 #TumorBoardTuesday
Thurs Case🎀
✅Osimertinib= EGFRi w demonstrated DFS⬆️in adj setting; waiting on OS data
✅Osi best TKI (Drake says so), diff strategies for diff mutations (i.e. ex20)
✅THINK about side FX, including fertility

Read 15 tweets
@TumorBoardTues 1/16 #TumorBoardTuesday #LungCancer #OncTwitter

38yo 👩🏻with remote 8 pk-yr 🚬hx
CP & diarrhea
PMH: None
🩻: 2 cm focal consolidations in the LLL
🔪+ mediastinal staging
🔬pT2a, pN1 (Stage IIB) lung adenoCa
🤨What adjuvant systemic tx would YOU give next?
@TumorBoardTues 2/16 #TumorBoardTuesday #LCSM #LungCancer

🧪 Resected 🫁 tissue tested
🦠 Tissue NGS and IHC was sent 🧬
🔬 NGS: EGFR exon 19 deleted
🔬 PD-L1 52%

🤨 What adjuvant treatment plan do you initiate next?
@TumorBoardTues 3/16 #TumorBoardTuesday #LungCancer
👩🏽‍🏫Mini tweetorial 1 👩🏽‍🏫

🚩🚩🚩 for EGFR mutations

🚩 Asian >> Western - 47.9% vs 19.2% according to metaA
🚩 Higher in NEVER smoker 🚭
🚩 More prevalent in females
🚩 Pathologic Subtype (adeno>>SCC)
Read 18 tweets
@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation 1/13 #TumorBoardTuesday #LCSM
➡️Here’s this week's Thursday Case🎀!

🧬@Latinamd @GDutcherMD took us through METex14 skipping in older pts with 🫁#NSCLC.

👉Get 🆓#CME credit with quick❓

CME eval 🔗:

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 2/13 #TumorBoardTuesday
Thurs Case🎀


#LungCancer= molecular disease

✅IDEAL=wait for NGS before tx
✅Send tissue NGS & ct🧬
✅MET mut= RTK driver- rare!
🔷MET exon 14 skipping best detected w RNAseq
🔷Capmatinib/tepotinib= FDA👍🏽
✅METi side effects: 🤨EDEMA
@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 3/13 #TumorBoardTuesday
Thurs Case🎀

Take🏠points (cont’d):

✅🎯tx preferred in 1L >> IO
🗝️ IO first 👉🏽TKI (osi) 👉🏽⬆️irAE
✅Older pts may need dose adjustment of TKI d/t tox
✅MET bispecifics (amivantamab) & ADCs coming!
Read 20 tweets

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