Discover and read the best of Twitter Threads about #lcsm
Most recents (24)
In May 2019, Dr. @rschilsky & I co-chaired the #AAADV19 Workshop Plenary Session "Decentralized #ClinicalTrials: The Future is Now." An incredible group of panelists from academia, industry, govt, & patient #advocacy 👇discussed the rationale, challenges, & opportunities of DCTs. 
No one knew yet that the #COVID19 #pandemic was just around the corner. In Mar 2020, FDA released a guidance on conduct of #clinicaltrials during the pandemic: fda.gov/media/136238/d…, & colleagues wrote about the impact on #OncTwitter trials: ncbi.nlm.nih.gov/pmc/articles/P…. /2
FDA has now released a draft guidance on decentralized #clinicaltrials for drugs, biological products, & devices covering #telehealth, remote assessments, consent, shipping of IP, & more: fda.gov/media/167696/d…. #MedTwitter #regulatory #drugdevelopment
@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?
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 nejm.org/doi/full/10.10…
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 nejm.org/doi/full/10.10…
@TumorBoardTues @LealTiciana @FordePatrick @DrMarkAwad @JulieBrahmer @TonyMok9 @FordePatrick @RamalingamMD @RachelSanbornMD @KarenReckampMD @DrMarkAwad @JulieBrahmer @AnaVManana @DevikaDasMD @JSabari @Exon20Group @CharuAggarwalMD @tehfem @ElizSMcKenna @JineshGheeya @ShrutiPatelMD @NarjustFlorezMD @HosseinBorghaei @ThanksCancer @IASLC @IbiayiMD
Dr. Shun Lu presents interim results from the perioperative NEOTORCH study at the #ASCOPlenarySeries. Randomized pts with resectable stage II/III NSCLC to perioperative chemotherapy with toripalimab (anti-PD1) vs placebo. Another entry in the perioperative space? #LCSM
Includes resectable stage II/III (AJCC v8), EGFR/ALK wild type NSCLC. Pts receive 3 cycles of neoadjuvant chemotherapy + toripalimab vs placebo then surgery then 1 more cycle of adjuvant chemo (+tori/pbo) then 13 doses of maintenance toripalimab vs placebo. #ASCOPlenarySeries
First interim EFS analysis only for stage III. Includes 404 pts - but 926 screened. Would be interesting to see specific eligibility criteria not met in screening process. Reminder of how selected trial populations are and value of future real-world analyses. #ASCOPlenarySeries
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?
⛹🏻♀️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 🙌🏽
🩸🧬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
📚@IASLC jto.org/article/S1556-…
👨🏻🏫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
📚@IASLC jto.org/article/S1556-…
@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 2/5 #TumorBoardTuesday
Thurs Case🎀
✅Biomarker - sq cell #LC, chemoIO is the SOC
✅Pembro, cemi, ipi/nivo approved in 1L squamous cell lung cancer—must be paired with chemo if PD-L1 TPS < 50%
✅ irAEs can be very serious- early, multi-D mgmt is 🗝️
Thurs Case🎀
✅Biomarker - sq cell #LC, chemoIO is the SOC
✅Pembro, cemi, ipi/nivo approved in 1L squamous cell lung cancer—must be paired with chemo if PD-L1 TPS < 50%
✅ irAEs can be very serious- early, multi-D mgmt is 🗝️
@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 3/5 #TumorBoardTuesday
Thurs Case🎀
📽️TBT video wrap up:
IO has fundamentally changed 🫁 cancer tx.
Choosing the right strategy in squamous cell lung ca largely based on PD-L1 status; we’re hoping for more, & better, biomarkers in the future.
Thurs Case🎀
📽️TBT video wrap up:
IO has fundamentally changed 🫁 cancer tx.
Choosing the right strategy in squamous cell lung ca largely based on PD-L1 status; we’re hoping for more, & better, biomarkers in the future.
@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 4/5 #TumorBoardTuesday
Thurs Case🎀
📷TBT in an image:
Check out this algo to help select IO vs chemoIO strat in #squamouscell #lcsm lung cancer 1L setting.
No head-to-head 👊data to define clear winner, but pembro, cemiplimab, and ipi/nivo approved based on OS benefit.
Thurs Case🎀
📷TBT in an image:
Check out this algo to help select IO vs chemoIO strat in #squamouscell #lcsm lung cancer 1L setting.
No head-to-head 👊data to define clear winner, but pembro, cemiplimab, and ipi/nivo approved based on OS benefit.
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
@myESMO #LCSM #FOAMed
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 oncologytweetorials-ce.com/category/lung-….
Don't miss prior accredited courses in this space at oncologytweetorials-ce.com/category/lung-….
3) This program is supported by an educational grant from Sanofi. Statement of accreditation and author disclosures are at oncologytweetorials-ce.com/disclosures/.
@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% ⤵️
CATEGORY 1 RECOMMENDATIONS
📍Pembro + carboplatin + paclitaxel
📍Pembro + carboplatin + nab-paclitaxel
📍Ipi/Nivo + carbo + paclitaxel
📍Cemiplimab + carbo + paclitaxel
👩🏽🏫Mini tweetorial 1👩🏽🏫
📚@NCCN based #NSCLC guide for biomarker neg, PDL1 <1% ⤵️
CATEGORY 1 RECOMMENDATIONS
📍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👩🏽🏫
✨KEYNOTE-407✨
♦️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
👩🏽🏫Mini tweetorial 2👩🏽🏫
✨KEYNOTE-407✨
♦️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👩🏽🏫
✨CHECKMATE 9LA ✨
♦️ 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 ⬇️
👩🏽🏫Mini tweetorial 3👩🏽🏫
✨CHECKMATE 9LA ✨
♦️ 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 ⬇️
@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 2/5 #TumorBoardTuesday
Case🎀
Take🏠
✅For plat ineligible, pembro=1L option
✅4 cycles of plat tx ➡️ IO maint equally efficacious to 6 cycles
✅Early prog predicts⬇️2L IO benefit
✅💔Myocarditis irAE needs aggressive mgmt
📚@arkhaki @glovedoc’s thread
threadreaderapp.com/thread/1625661…
Case🎀
Take🏠
✅For plat ineligible, pembro=1L option
✅4 cycles of plat tx ➡️ IO maint equally efficacious to 6 cycles
✅Early prog predicts⬇️2L IO benefit
✅💔Myocarditis irAE needs aggressive mgmt
📚@arkhaki @glovedoc’s thread
threadreaderapp.com/thread/1625661…
@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 2.5/5 #TumorBoardTuesday
Bonus: @PGrivasMDPhD & @rafee_talukder recently discussed platinum eligibility & tx options- take a look here:
threadreaderapp.com/thread/1612977…
Bonus: @PGrivasMDPhD & @rafee_talukder recently discussed platinum eligibility & tx options- take a look here:
threadreaderapp.com/thread/1612977…
@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 3/5 #TumorBoardTuesday
Thurs Case🎀
🎥 TBT in video
Pembro= 1L option for pts not eligible for plat tx.
☑️4 cycles plat doublet AS GOOD as 6 in plat eligible
💔ICI myocarditis is rare, but serious- we discuss tx
Quick video summary covering major pts in just over 2 mins!
Thurs Case🎀
🎥 TBT in video
Pembro= 1L option for pts not eligible for plat tx.
☑️4 cycles plat doublet AS GOOD as 6 in plat eligible
💔ICI myocarditis is rare, but serious- we discuss tx
Quick video summary covering major pts in just over 2 mins!
There is a lot to consider in this first-line study of the #KRAS G12C inhibitor adagrasib plus pembrolizumab from #ESMOImmuno22. Some pleasant surprises in terms of safety. Definitely encouraging but need to see a bit more to be sold on this strategy. 🤔 #LCSM
We're looking for synergy with the two agents - more than an additive effect. Reason to believe there will be based on preclinical data showing the effect on T-cell infiltration from #KRAS inhibition. Similar to what has been shown with MEK inhibition. #ESMOImmuno22
The first-line dataset includes the phase Ib KRYSTAL-1 and the phase II KRYSTAL-7. In KRYSTAL-1 (n=7), 4/7 had a response and all were durable (>9m). G3 TRAEs in 4 pts (lipase elevation, LFTs, muscular pain, pneumothorax). #ESMOImmuno22
@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
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:
🫁🎥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
🧲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
@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?
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?
👩🏻 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
nature.com/articles/nrc20…
👨🏼🏫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
nature.com/articles/nrc20…
Dr. Koichi Goto starts the lung mini oral session with results from DESTINY-Lung02 of the recently approved trastuzumab deruxtecan in #HER2 NSCLC #ESMO22
@DrSanjayPopat @myESMO #ESMO22 @DrSanjayPopat points out that the DFS HR is on par with the original analysis but the shape of the curves is different, especially for stage II/III
This is not new - we see a rise in recurrence once TKI is stopped in multiple other adjuvant TKI studies. Is this suggestive of cure or just proper therapy of unidentified (micro)metastatic cancer? #ESMO22
@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
PET: GGO in LLL SUV 4.5
💉thora with cytology
🔬Stage IVA (T4N0M1a) 🫁 adenoCa
🤨What systemic tx would YOU give?
72y 👩🏻with 58 pk-yr 🚬hx
Chest pain
PMH: diabetes
CT: 3 cm LLL nodule & left pleural effusion with 5mm nodule in LUL
PET: GGO in LLL SUV 4.5
💉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%
🔪 🫁 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% ⤵️
CATEGORY 1 RECOMMENDATIONS:
📍 Pembro, atezo, and cemiplimab
📍 ipi/nivo considered in certain circumstances
👩🏽🏫Mini tweetorial 1👩🏽🏫
@NCCN based guideline for #NSCLC biomarker negative, PDL1 >50% ⤵️
CATEGORY 1 RECOMMENDATIONS:
📍 Pembro, atezo, and cemiplimab
📍 ipi/nivo considered in certain circumstances
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga #TumorBoardTuesday
Some of tonight’s conversation will be discussing of multiple treatments of stage 3 #NSCLC.
My COI: I’m a consultant with @AstraZeneca, but thoughts are my own.
Some of tonight’s conversation will be discussing of multiple treatments of stage 3 #NSCLC.
My COI: I’m a consultant with @AstraZeneca, but thoughts are my own.
@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
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
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 2/13 #TumorBoardTuesday #LCSM #NSCLC
Multi-D Tumor Board discussion about 👆🏽patient.
🧐 Is an STK11 mutation taken into consideration?
🤨 What would you recommend as a treatment option?
Multi-D Tumor Board discussion about 👆🏽patient.
🧐 Is an STK11 mutation taken into consideration?
🤨 What would you recommend as a treatment option?
#WCLC22 Highlights #CommunityOncology perspective:
1. #YESS Study - @RachM_UoN
2. #IMPower010 Update
3. #CALGB140503 - Sublobar resection
4. #SHAWL Study - @NarjustFlorezMD @jillfeldman4
5. #NADIM2 Trial by @MARIANOPROVENCI
1/6
#LCSM #MedTwitter @OncoAlert #OncEd @IASLC
1. #YESS Study - @RachM_UoN
2. #IMPower010 Update
3. #CALGB140503 - Sublobar resection
4. #SHAWL Study - @NarjustFlorezMD @jillfeldman4
5. #NADIM2 Trial by @MARIANOPROVENCI
1/6
#LCSM #MedTwitter @OncoAlert #OncEd @IASLC
1. #YESS Study @RachM_UoN: Lung CA screening with smoking cessation intervention concurrently:
- Smoking cessation is one of the most effective way to reduce lung CA mortality
- 33% quit at 3 months
- Women more likely to benefit
2/6
- Smoking cessation is one of the most effective way to reduce lung CA mortality
- 33% quit at 3 months
- Women more likely to benefit
2/6
2. #IMPower010 Update: Atezo has been approved for adjuvant NSCLC, Stg II - IIIA post surgery and chemo.
- mFU: 46mos
- OS trend for stage II-IIIA PDL1≥1% (HR 0.71)
- BUT, meaningful OS with PDL1≥50% (HR 0.42)
3/6
- mFU: 46mos
- OS trend for stage II-IIIA PDL1≥1% (HR 0.71)
- BUT, meaningful OS with PDL1≥50% (HR 0.42)
3/6
Major update for small cell #lung cancer! #LCSM
With @juliensage + @FoundationATCG, our paper now on @bioRxiv:
►Genomic analysis of *3,600* pts with SCLC; largest SCLC study to date!
►Multiple interesting findings discussed in this 🧵
biorxiv.org/content/10.110…
With @juliensage + @FoundationATCG, our paper now on @bioRxiv:
►Genomic analysis of *3,600* pts with SCLC; largest SCLC study to date!
►Multiple interesting findings discussed in this 🧵
biorxiv.org/content/10.110…
🧵2
This study is unique in many ways:
> The #SCLC cohort studied came mostly from community sites --> representing a more typical “real-world” cohort of SCLC.
> The genomic data are tied to clinical data + outcomes.
#LCSM
This study is unique in many ways:
> The #SCLC cohort studied came mostly from community sites --> representing a more typical “real-world” cohort of SCLC.
> The genomic data are tied to clinical data + outcomes.
#LCSM
🧵3
To the best of our knowledge, our study analyzes the largest number of SCLC tumors from African ancestry to date:
> n=256 AFR cases
> 7.1% of the entire cohort
#Diversity in clinical studies is critical!!
See tweet 🧵9 for more details.
To the best of our knowledge, our study analyzes the largest number of SCLC tumors from African ancestry to date:
> n=256 AFR cases
> 7.1% of the entire cohort
#Diversity in clinical studies is critical!!
See tweet 🧵9 for more details.
@TumorBoardTues @HwakeleeMD @manalipatelmd @jillfeldman4 @JackWestMD Alright lets go!
1/18 #TumorBoardTuesday #LCSM #OncTwitter
63 yo 👩🏻
🚭 never smoker
C/O: shortness of breath presents in 2017
PMH: None
🫁 PET: shows a RLL mass and pleural effusion
ECOG PS: 0
🔬cT2, cN2, pM1a (Stage IVA) lung adenoCA
🤨What is the next step?
1/18 #TumorBoardTuesday #LCSM #OncTwitter
63 yo 👩🏻
🚭 never smoker
C/O: shortness of breath presents in 2017
PMH: None
🫁 PET: shows a RLL mass and pleural effusion
ECOG PS: 0
🔬cT2, cN2, pM1a (Stage IVA) lung adenoCA
🤨What is the next step?
@TumorBoardTues @HwakeleeMD @manalipatelmd @jillfeldman4 @JackWestMD 2/18 #TumorBoardTuesday #LCSM
Case continued..
🦠 Tissue NGS and IHC was sent 🧬
🔬 NGS: EGFR p.A767_V769dup; c.2300_2308dupCCAGCGTGG (exon 20 ins)
🔬 PD-L1 negative
🤨 What treatment plan do you initiate next? @HemOncFellows @OncBrothers @OncoAlert @lcsmchat
Case continued..
🦠 Tissue NGS and IHC was sent 🧬
🔬 NGS: EGFR p.A767_V769dup; c.2300_2308dupCCAGCGTGG (exon 20 ins)
🔬 PD-L1 negative
🤨 What treatment plan do you initiate next? @HemOncFellows @OncBrothers @OncoAlert @lcsmchat
@TumorBoardTues @HwakeleeMD @manalipatelmd @jillfeldman4 @JackWestMD @HemOncFellows @OncBrothers @OncoAlert @lcsmchat 3/15.. #TumorBoardTuesday #LCSM
👩🏽🏫Mini tweetorial 1 👨🏽🏫
🚩🚩 for EGFR mutations
Types of EGFR mutations
🚩Classic Activating EGFR Mut
▫️L858R, del19-Outside US
🚩Uncommon EGFR Muts
▫️G719X, L861Q, S768I
🚩EGFR Exon 20 Ins: bit.ly/3nGc8Yp
@NatRevClinOncol
👩🏽🏫Mini tweetorial 1 👨🏽🏫
🚩🚩 for EGFR mutations
Types of EGFR mutations
🚩Classic Activating EGFR Mut
▫️L858R, del19-Outside US
🚩Uncommon EGFR Muts
▫️G719X, L861Q, S768I
🚩EGFR Exon 20 Ins: bit.ly/3nGc8Yp
@NatRevClinOncol
@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 2/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠:
#TNBC &neoadjuvant tx
✅KEYNOTE-522= new standard of care
– Pembro+chemo in neoadj= BEST pCR so far
– Caveat: only for T2+ TNBC
✅Adding pembro may have ⬆️benefit in RCB II
📚We captured much of chat:
p1: twitter.com/i/events/15423…
Thurs Case🎀
Take🏠:
#TNBC &neoadjuvant tx
✅KEYNOTE-522= new standard of care
– Pembro+chemo in neoadj= BEST pCR so far
– Caveat: only for T2+ TNBC
✅Adding pembro may have ⬆️benefit in RCB II
📚We captured much of chat:
p1: twitter.com/i/events/15423…
@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 3/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠msgs (cont’d):
✅IO NOT shown to add benefit in metastatic dz
– Atezolizumab approval in mTNBC withdrawn
✅Standard of care – multi-d team
✅No current evidence to hold IO pre-op
P2: twitter.com/i/events/15425…
Thurs Case🎀
Take🏠msgs (cont’d):
✅IO NOT shown to add benefit in metastatic dz
– Atezolizumab approval in mTNBC withdrawn
✅Standard of care – multi-d team
✅No current evidence to hold IO pre-op
P2: twitter.com/i/events/15425…
@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 4/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠messages (cont’d):
✅THINK about side FX, including fertility
— Ovarian suppression may preserve fertility while undergoing neoadj tx
✅Patient voice is MOST important- pts define “acceptable tox,” not 🩺
Thurs Case🎀
Take🏠messages (cont’d):
✅THINK about side FX, including fertility
— Ovarian suppression may preserve fertility while undergoing neoadj tx
✅Patient voice is MOST important- pts define “acceptable tox,” not 🩺
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🔗: integrityce.com/tbteval
🫁@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🔗: integrityce.com/tbteval
2/8 #TumorBoardTuesday
Thurs Case🎀
Take🏠-pt 1
We discussed #NSCLC & EGFRm
✅EGFR mutations:
🔹Female>Male;
🔹Never smoker >> smoker
✅NEED‼️NGS data‼️BEFORE systemic tx. Order panel of common EGFR muts if limited time.
We captured much of chat:
P1: twitter.com/i/events/15369…
Thurs Case🎀
Take🏠-pt 1
We discussed #NSCLC & EGFRm
✅EGFR mutations:
🔹Female>Male;
🔹Never smoker >> smoker
✅NEED‼️NGS data‼️BEFORE systemic tx. Order panel of common EGFR muts if limited time.
We captured much of chat:
P1: twitter.com/i/events/15369…
2.33 #TumorBoardTuesday
Thurs Case🎀
Take🏠msgs:
✅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
P2: twitter.com/i/events/15372…
Thurs Case🎀
Take🏠msgs:
✅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
P2: twitter.com/i/events/15372…
@TumorBoardTues 1/16 #TumorBoardTuesday #LungCancer #OncTwitter
38yo 👩🏻with remote 8 pk-yr 🚬hx
CP & diarrhea
PMH: None
🩻: 2 cm focal consolidations in the LLL
PET: GGO in LLL SUV 4.5
🔪+ mediastinal staging
🔬pT2a, pN1 (Stage IIB) lung adenoCa
🤨What adjuvant systemic tx would YOU give next?
38yo 👩🏻with remote 8 pk-yr 🚬hx
CP & diarrhea
PMH: None
🩻: 2 cm focal consolidations in the LLL
PET: GGO in LLL SUV 4.5
🔪+ 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?
🧪 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)
👩🏽🏫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)
@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 🔗: integrityce.com/tbteval
@SylvesterCancer
➡️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 🔗: integrityce.com/tbteval
@SylvesterCancer
@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 2/13 #TumorBoardTuesday
Thurs Case🎀
Take🏠points:
#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
Thurs Case🎀
Take🏠points:
#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!
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!
🙏🏽Thank you @Latinamd @GDutcherMD for an informational & exhilarating #TumorBoardTuesday!!
🏆Remember 🆓CME
Look for the Case Wrap Up🎀 05/26/22
📅Mark your calendar for 𝙉𝙀𝙓𝙏 𝙒𝙀𝙀𝙆 05/31/22 when our own @MPishvaian joins us for a breakdown of #ASCO22 abstracts!!
🏆Remember 🆓CME
Look for the Case Wrap Up🎀 05/26/22
📅Mark your calendar for 𝙉𝙀𝙓𝙏 𝙒𝙀𝙀𝙆 05/31/22 when our own @MPishvaian joins us for a breakdown of #ASCO22 abstracts!!
🏝#TumorBoardTuesday education is beyond Twitter - we offer🆓CME!!
🫁Before you run off exploring, pick up your🏆#CME by answering quick questions regarding a case similar to @Latinamd’s‼️
🔗ALL CME: integrityce.com/tbt
🔗CME eval: integrityce.com/TBTEval
👇🏽🎁
🫁Before you run off exploring, pick up your🏆#CME by answering quick questions regarding a case similar to @Latinamd’s‼️
🔗ALL CME: integrityce.com/tbt
🔗CME eval: integrityce.com/TBTEval
👇🏽🎁
#PostTest Q1️⃣ #CME #TumorBoardTuesday
🔗CME eval: integrityce.com/TBTeval
🫁@Latinamd @GDutcherMD took us through a case of MET exon 14 skip mutation #NSCLC - test your 🧠with these quick❓
🧐How common are METex14-skipping mutations in NSCLC (Non-Small Cell Lung Cancer)?
🔗CME eval: integrityce.com/TBTeval
🫁@Latinamd @GDutcherMD took us through a case of MET exon 14 skip mutation #NSCLC - test your 🧠with these quick❓
🧐How common are METex14-skipping mutations in NSCLC (Non-Small Cell Lung Cancer)?
1/15 #TumorBoardTuesday #LungCancer #OncTwitter
83 yo👩🏽 remote 🚬 with good PS presents with SOB
PMhx: Afib, mild cognitive dysfunction
🩻: RML 6x3cm mass & pleural effusion
🫁: Stage IV lung adenocarcinoma
PDL1 90%
🎂Does age impact tx decision?
📊How would you Tx this pt?
83 yo👩🏽 remote 🚬 with good PS presents with SOB
PMhx: Afib, mild cognitive dysfunction
🩻: RML 6x3cm mass & pleural effusion
🫁: Stage IV lung adenocarcinoma
PDL1 90%
🎂Does age impact tx decision?
📊How would you Tx this pt?
@DrSteveMartin @glopesmd @NarjustDumaMD
@AnaVManana @COlazagasti @StephenVLiu @chulkimMD @LudaBazhenovaMD @benlevylungdoc @luisraez1 @edgardo_ny @GlopesMd
@AnaVManana @COlazagasti @StephenVLiu @chulkimMD @LudaBazhenovaMD @benlevylungdoc @luisraez1 @edgardo_ny @GlopesMd
2/15 #TumorBoardTuesday
✅ Tissue NGS and💧liquid biopsy ordered
🔬Liquid biopsy comes with MET Ex 14 skip mutation
✅Confirmed with tissue NGS based assay (🧬RNA and 🧬DNA sequencing)
👉🏽Do you start 1L immunotherapy or 🎯therapy?
✅ Tissue NGS and💧liquid biopsy ordered
🔬Liquid biopsy comes with MET Ex 14 skip mutation
✅Confirmed with tissue NGS based assay (🧬RNA and 🧬DNA sequencing)
👉🏽Do you start 1L immunotherapy or 🎯therapy?
