Discover and read the best of Twitter Threads about #asco20

American Constitution Society

@OncoAlert

#ESMO20 Key update on #ADAURA regarding CNS disease recurrence with adjuvant osimertinib vs placebo after resected stage IB-III #EGFR mutant NSCLC. #LCSM @OncoAlert @myESMO

#ESMO20 We saw at #ASCO20 the positive results from #ADAURA where adjuvant osimertinib significantly improved DFS in resected stage II/III NSCLC (DFS HR 0.17). Pre-specified analysis CNS recurrence given tropism of the disease and CNS efficacy of osimertinib. #LCSM

@OncoAlert

#ESMO20 Patients receiving osimertinib were less likely to recur overall but when there was recurrence, it was less likely to be distant. #LCSM @OncoAlert

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@acslaw

About to kick off our annual convention! Follow #ACS2020 as we and others live-tweet and watch here: acslaw.org/2020-acs-natio…

We are beginning tonight's program with 8 minutes and 46 seconds of silence to honor the life of #GeorgeFloyd and other Black individuals killed by police since our last convention in 2019. #BlackLivesMatter

The minutes of silence conclude #ACS2020 #BlackLivesMatter

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Dr Julia Lai-Kwon

@JuliaLaiKwon

Slowly digesting #ASCO20. Lots of fantastic patient-reported outcomes #PRO work incl in #phase1 #oncology.

5 presentations that caught my attention:

@DrKateAbsolom

1/5 eRAPID (#7002) @DrKateAbsolom @UniversityLeeds.
💡RCT of weekly #PRO reporting and self-mx vs usual care for pts on chemo.
❗️ ⬆️early sx control, self-efficacy and #QOL w/o increasing clinical workload.
❓adapt for IO/ targeted therapy, monitoring during #COVID19

@BiostatGirl

2/5 Creating composite PRO-CTCAE scores (#7018) @BiostatGirl @EthanBasch1
💡Developed algorithm for composite scores for PRO-CTCAE, combining frequency, severity and interference into a single metric like CTCAE.
❗️Will aid PRO-CTCAE uptake/ interpretation in trials/ routine care

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Brendon Stiles

@BrendonStilesMD

@jackWestMD

Time to weigh in with a thread on the #ADAURA trial presented at #ASCO20. I have been thinking about it carefully and listening to the chatter on #Twitter and other sites. Have also watched w/ interest the back and forth b/t @jackWestMD and @n8pennell #lcsm

@JackWestMD

(By the way, @JackWestMD and @n8pennell make @drewMoghanaki and me look like amateurs…) #lcsm

@lcsmchat

This will be insufferably long (@lcsmchat long!), so I apologize in advance. #lcsm

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Nathan A. Pennell MD, PhD, FASCO

@n8pennell

THREAD: I have heard a lot of self-righteous indignation about how we would be bankrupting the system with adjuvant targeted treatment for EGFR mutation+ NSCLC pts, so let's take a quick look at how many pts we're talking about here to put this in perspective. #ASCO20 #LCSM 1/8

There will be about 230,000 people diagnosed with lung cancer in the US in 2020, of which about 88% have NSCLC and 60% of those have adenocarcinoma (~121,000). About 15% of those have EGFR mutations, so the total # of EGFR mutation+ NSCLC cases in US in 2020 is about 18,000. 2/8

Of those 18,000 people, ~1/3 will be diagnosed at stage 4, about 1/3 will have stage 3, and about 1/3 will have resectable early stage (I or II). Stage 2 is the smallest section, at about 10% of the total, and most stage 3 is unresectable so perhaps another 10% get surgery. 3/8

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@dave6408

#ASCO20 Discussion of #ADAURA provided by @dave6408 of @SarahCannonDocs reminding us why we give adjuvant therapy after surgery for NSCLC. Are we curing or are we controlling/delaying? We view toxicity (physical and financial) differently in these two situations. #OncoAlert

#ASCO20 In the #EGFR setting, we have several trials that laid the groundwork for what we saw in #ADAURA: RADIANT (adjuvant erlotinib vs placebo but included EGFRmt and wt), SELECT (EGFR+ but single arm), and ADJUVANT (gef vs chemo). #OncoAlert #LCSM

@dave6408

#ASCO20 The DFS HR is impressive but some questions about surgery imbalances, chemo delivery (a lot of pts did not get chemo). Overall, @dave6408 was not on the fence though and declared #EGFR testing and adjuvant osimertinib our new standard. #OncoAlert #LCSM

@DrRoyHerbstYale

#ASCO20 Highly anticipated plenary presentation of #ADAURA by @DrRoyHerbstYale: 3y of adjuvant osimertinib after resection of #EGFR+ NSCLC #OncoAlert #LCSM

#ASCO20 Outcomes after potentially curable surgical resection still quite poor for #NSCLC.

#ASCO20 In the advanced setting, #EGFR TKI therapy is our clear standard. Relatively rapid implementation and the current SOC for stage IV NSCLC is osimertinib. #LCSM #OncoAlert

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#ASCO20 Poster 9586 describes CNS outcomes with osimertinib 160mg for #EGFR NSCLC. Included patients with CNS PD on 80mg who escalated to 160mg (A), concurrent osi 160 with chemo or RT (B) and those who started at 160mg with CNS disease (C). Osi at 160mg was well tolerated. #LCSM

#ASCO20 median duration of CNS control shown below. In those who had CNS PD and escalated, median was 3.8m but different for parenchymal only (2m) vs leptomeningeal (5.8m). Curious if parenchymal disease was previously radiated pre-escalation. #OncoAler #LCSM #EGFR

@ZPiotrowskaMD

#ASCO20 Multicenter effort with valuable real-world evidence by @ZPiotrowskaMD @Jbauml @HwakeleeMD @JoelNealMD @LeciaSequist @RamalingamMD @HelenaYu923 @BeccaHeistMD @HatimHusainMD and more. Pooled RWE will be very valuable going forward, particularly as we examine resistance!

#ASCO20 A lot to think about with the data from the #SINDAS trial: a randomized phase 3 trial of early local radiation therapy for patients with metastatic #EGFR mutant #NSCLC presented by Dr. Xiao-Shan Wang. #OncoAlert #LCSM

#ASCO20 At this point, we're on board with the concept of oligometastatic NSCLC - that there is a spectrum within stage IV lung cancer and aggressive therapy for some will improve outcomes. Various definitions (would a biologic marker be better than # of radiographic lesions?)

#ASCO20 SINDAS enrolled 133pts with oligometastatic #EGFR NSCLC, defined as up to 5 metastases (max of 2 per organ), EXCLUDING brain metastases, ECOG 0-2. Used a 1:1 randomization to SBRT + TKI vs TKI alone, PFS primary endpoint. #OncoAlert #LCSM

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Mark Lewis

@marklewismd

@DavidFajgenbaum

A RARE DISEASE NARRATIVE TWEETORIAL

Today, during an #ASCO20 clinical science symposium, I'm honored to comment as a patient-physician on the meaning of drug development for rare diseases

Inspired by @DavidFajgenbaum (but not half the man he is) I am going to share my own story

It started with a call from the embassy.

We were moving to the U.S. and needed chest X-rays to exclude TB.

My father's CXR showed no concerning cavitation, but his right hemithorax was mysteriously opacified 👇

Within two weeks of arriving in Texas we had secured a cardiothoracic surgeon and my father then underwent a right pneumonectomy. It was an R2 resection and we were told he would need radiation to "lung cancer" remnant in the mediastinum. XRT was brutal and led to esophagitis.

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@benlevylungdoc

#ASCO20 Lung Cancer (metastatic NSCLC) highlights by @benlevylungdoc - 5 thought provoking trials to be discussed here. #OncoAlert #LCSM

#ASCO20 Many first line options in #NSCLC. All compared to chemotherapy alone, an old standard. Difficult to compare across studies. #OncoAlert #LCSM

#ASCO20 Review of 3y outcomes of CM227 (nivo/ipi) and first report of CM9LA (nivo/ipi/chemo) confirm these as viable options but the endpoint of most interest is long term survival - and we will have to wait a bit to see that... #OncoAlert #LCSM

#ASCO20 Abstract 9537 has results from J-ALTA, phase 2 trial of brigatinib (90mg qd x 1wk then 180mg qd) post-alectinib for #ALK NSCLC. Included 47pts who progressed on prior alectinib (+/- prior crizotinib) and RR 30%, DCR 79%, median time to response 1.9m. #OncoAlert #LCSM

#ASCO20 Median PFS with brigatinib following alectinib (+/- prior crizotinib) was 7.3m. In 8pts with measurable CNS disease, intracranial RR 25% (63% SD). Updated analysis adds 1 response for ORR 34%, median duration of response of 11.8m! #OncoAlert #LCSM

#ASCO20 Response to brigatinib (post-alectinib) noted in the presence of various #ALK resistance mutations including G1202R (1/3), L1196M (3/3), I1171N (1/2), I1171S (1/1). Well tolerated. Most common G3 tox were lipase (no pancreatitis), CK (no myalgias), HTN. #OncoAlert #LCSM

@HornLeora

#ASCO20 Excellent presentation by @HornLeora on the #TERAVOLT initiative - a global registry describing patients with thoracic malignancy and COVID19. #OncoAlert #LCSM

@marinagarassino

#TERAVOLT is such an impressive effort, spearheaded by @marinagarassino. Flurries of emails sent on March 15, 2020 and a protocol approved 5d later with 200 patients presented at #AACR20 and 400 patients at #ASCO20! Driven by passion and a deep collaborative spirit. #OncoAlert

#ASCO20 An interesting observation in #TERAVOLT was the association of steroid use and anticoagulation (at #COVID19 diagnosis, not as an intervention) with higher mortality in patients with lung cancer. Months ago, we would not have predicted this. #OncoAlert #LCSM

@teekayowo

#ASCO20 Well balanced review of the #SCLC IO oral abstracts by @teekayowo. Clear and consistent benefit with addition of PD(L)1 therapy to front line chemotherapy with 2y OS rates ~ 22% across studies (prior analyses suggest 2y OS rate ~ 7% with chemo alone). #OncoAlert #LCSM

@teekayowo

#ASCO20 Looking at the OS curves, later separation leads some to question value of concurrent IO. @teekayowo cautions against this interpretation, as do I. See CM451 where maintenance IO did not impact OS. Concurrent chemo-IO was the only effective approach. #OncoAlert

@LealTiciana

#ASCO20 Nivolumab + chemotherapy performed well in EA5161 (@LealTiciana) but a phase II is insufficient to change practice in the current environment. Going forward, similar trials are not justified without plans for confirmatory trials. #LCSM #OncoAlert

Matthew Katz, MD

@subatomicdoc

Another study of interest on systemic radiation in metastatic prostate cancer

meetinglibrary.asco.org/record/187000/…

TheraP: randomised phase II trial of 177Lu-PSMA-617 vs cabazitaxel in progressive metastatic castration resistant prostate cancer (mCRPC) #ASCO20 #pcsm #radonc
H1/

@Prof_IanD

ANZUP 1603 with @Prof_IanD et al evaluated radionuclide Lutetium-177 linked to prostate specific membrane antigen (177-Lu-PSMA-617) 6-8Gbq every six weeks x 6 vs. cabazitaxel 20 mg/m2 q 3 wks x 10 in men with mCRPC progressing after paclitaxel #ASCO20 #pcsm
H2/

200 men randomized to each drug stratified by prior abirateron/enzalutamide use, >20 metastases, study site. Median age 72 years old

Primary endpoint response rate, secondary PSA relapse free survival and overall survival.
#ASCO20 #pcsm #radonc
H3/

Stephanie Graff, MD, FACP

@DrSGraff

@tmprowell

I “ASCO-miss-you” ⁦@tmprowell⁩. Someday again I will find myself in your restorative light. #ASCO20

@SuzanneColeMD

I also “ASCO-miss-you” my dear @SuzanneColeMD #ASCO20 (and yes, those are floral crowns...embrace it)

@ErikaHamilton9

And I “ASCO-miss-you” @ErikaHamilton9 —and our accidental limo rides. #ASCO20

@US_FDA

#ASCO20 Fresh off the @US_FDA approval, abstract 9527 outlines biomarker results from the Japanese substudy of RELAY (phase III trial of first line erlotinib vs erlotinib + ramucirumab in #EGFR mutant #NSCLC). Overall, addition of ram improved PFS (HR 0.59) #OncoAlert #LCSM

#ASCO20 The Japanese biomarker substudy included 131 pts with full results. Baseline EGFR allele frequency did not seem to distinguish outcome (within a treatment arm) but clearance did - those with no detectable circulating EGFR at cycle 4 (and receiving ram) had best outcomes.

#ASCO20 Differences in HER2 and MET copy number also noted over time. Pharmacodynamic studies like this may help identify patients who need modifications to their treatment for better long term control. Trial could be: if ctDNA clear at 4m, continue. If not, add/modify. #LCSM

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@DrJNaidoo

#ASCO20 Abstract 9048 by @DrJNaidoo reviews non-pneumonitis immune mediated AEs in the PACIFIC trial (consolidation durvalumab post chemoradiation in stage 3 NSCLC). 24% had imAEs with durva, 15% had non-pneumonitis imAEs (71/475). No diff if < or >14d from CRT. #OncoAlert #LCSM

#ASCO20 Most common non-pneumonitis imAEs were thyroid (11.4%, 54/475), rash (1.9%), diarrhea (1.1%). Far lower than I would have guessed. Rash had earliest onset and longest time to resolution. Overall, 86% of events occur within first 6m (56% within first 3) #OncoAlert #LCSM

#ASCO20 Patients who developed a non-pneumonitis immune mediated AE were more likely to complete the 12 month durvalumab course than those who did not have an event (59% vs 47%), potentially because there were lower rates of discontinuation due to progression (19.7% vs 33.3%).