Discover and read the best of Twitter Threads about #lcsm

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

Read 11 tweets

Angelica D'Aiello, MD

@DAielloMD

@DrSteveMartin

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 🙌🏽

@IASLC

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-…

Read 33 tweets

@TumorBoardTues

@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 🗝️

https://twitter.com/ShrutiPatelMD/status/1628199185056153604

@TumorBoardTues

@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.

@TumorBoardTues

@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.

Read 18 tweets

@onc_ce

@myESMO

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

@peters_solange

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-….

3) This program is supported by an educational grant from Sanofi. Statement of accreditation and author disclosures are at oncologytweetorials-ce.com/disclosures/.

Read 24 tweets

Shruti Patel, MD

@ShrutiPatelMD

@NarjustFlorezMD

@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

@NarjustFlorezMD

@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

@NarjustFlorezMD

@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 ⬇️

Read 22 tweets

@TumorBoardTues

@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…

@TumorBoardTues

@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…

@TumorBoardTues

@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!

Read 14 tweets

Nathan A. Pennell MD, PhD, FASCO

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

Read 10 tweets

Lecia Sequist, MD, MPH

@LeciaSequist

@TumorBoardTues

@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

@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

@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

@n8pennell

@TumorBoardTues

@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

@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

@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…

Read 19 tweets

Dr. Koichi Goto starts the lung mini oral session with results from DESTINY-Lung02 of the recently approved trastuzumab deruxtecan in #HER2 NSCLC #ESMO22

DESTINY-Lung02 compared two doses of trastuzumab deruxtecan (T-DXd) in #HER2 previously treated NSCLC (5.4 mg/kg vs 6.4 mg/kg): RR 58% and DoR 8.7m at the lower dose compared to 43% at 6.4 mg/kg. #ESMO22

Importantly- interstitial lung disease much less frequent at the 5.4 mg/kg dose (5.9%, only 1 case of G3). This is the FDA approved dose of trastuzumab deruxtecan in #HER2 NSCLC #ESMO22

Read 4 tweets

@DrSanjayPopat

Dr. @DrSanjayPopat expertly discussing the ADAURA update #ESMO22

@DrSanjayPopat

@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

Read 5 tweets

Shruti Patel, MD

@ShrutiPatelMD

@TumorBoardTues

@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?

@TumorBoardTues

@TumorBoardTues 2/17 #TumorBoardTuesday #LungCancer

🔪 🫁 tissue tested
🦠 Tissue NGS and IHC was sent 🧬
🔬 NGS: no actionable mutations
🔬 PD-L1 62%

@TumorBoardTues

@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

Read 19 tweets

Hossein Borghaei, DO

@HosseinBorghaei

@TumorBoardTues

@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.

@TumorBoardTues

@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

@TumorBoardTues

@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?

Read 15 tweets

Oncology Brothers

@OncBrothers

@RachM_UoN

#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

@RachM_UoN

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

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

Read 6 tweets

Christine Lovly

@christine_lovly

@juliensage

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…

🧵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

🧵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.

Read 15 tweets

Aakash Desai, MD, MPH

@ADesaiMD

@TumorBoardTues

@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?

@TumorBoardTues

@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

@TumorBoardTues

@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

Read 16 tweets

@TumorBoardTues

@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…

@TumorBoardTues

@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…

@TumorBoardTues

@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 🩺

Read 16 tweets

@NarjustFlorezMD

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

twitter.com/i/events/15369…

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…

twitter.com/i/events/15372…

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…

Read 15 tweets

Shruti Patel, MD

@ShrutiPatelMD

@TumorBoardTues

@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?

@TumorBoardTues

@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

@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