https://twitter.com/HadidiSamer/status/1615014494412881922

https://twitter.com/HadidiSamer/status/1615014494412881922

@RadiotherapyOn1

@vivek_naranbhai

@TempusLabs

Stephen V Liu

@StephenVLiu

@dave6408

#OncoAlert Results from phase III ABOUND.sqm trial online at Clinical Lung Cancer. Randomization of continuation maintenance nab-paclitaxel for squamous NSCLC. Nice work by @dave6408 @dr_ponce_aix @KMilehamMD @JackWestMD #LCSM

clinical-lung-cancer.com/article/S1525-…

#OncoAlert This study predates the chemoIO SOC (launched early 2014). 420 patients with squamous NSCLC received induction carboplatin + nab-paclitaxel x 4 and 202 were then randomized 2:1 to continue nab-pac maintenance vs not. Primary endpoint PFS. #LCSM

#OncoAlert Did not meet its primary endpoint. Median PFS with maintenance nab-paclitaxel was 3.12m vs 2.6m with supportive care alone (PFS HR 0.85).

Read 4 tweets

Stephen V Liu

@StephenVLiu

@JTOonline

#OncoAlert Online @JTOonline @IASLC: RWE report (post-marketing investigation) of interstitial lung disease with osimertinib in #EGFR NSCLC. In 3578 patients, ILD was reported in 6.8%, median time to onset 63 days. Of those, 42.4% were grade 3+. #LCSM

jto.org/article/S1556-…

#OncoAlert 39 patients with ILD were rechallenged with osimertinib and 7/39 had a second occurrence of ILD (onset 1-10 weeks). Prior use of nivolumab was a major risk for ILD (adjusted odds ratio 2.84). Risk notably greater if nivo given within 1m but risks extends past 6. #LCSM

@IASLC

#OncoAlert More evidence that IO cannot precede targeted therapy in driver positive NSCLC. Immunotherapy should not be given until molecular results are available - chemo can be used if waiting is not an option. If IO is given first inadvertently - monitor closely! #LCSM
@IASLC

Read 3 tweets

Stephen V Liu

@StephenVLiu

@Annals_Oncology

#OncoAlert Now online @Annals_Oncology is the phase III ETOP 9-15 trial (PROMISE-meso) of pembrolizumab vs chemotherapy for pretreated mesothelioma #MPM presented at #ESMO19 @myESMO @DrSanjayPopat @MdCurioni @GautschiOliver @NadalErnest @peters_solange

annalsofoncology.org/article/S0923-…

#OncoAlert Randomized 144 patients with relapsed #MPM to pembrolizumab vs chemo (gemcitabine or vinorelbine), no PDL1 selection. No difference in BICR PFS noted (HR 1.06) though RR favored pembro (22% vs 6%).

#OncoAlert In this trial, 63% of patients receiving chemotherapy crossed over and with 17.5m median follow up, no difference in survival noted (OS HR 1.12). No impact of PDL1 expression on the bottom line. Somewhat disappointing but fortunate to have 1L data for IO in #MPM now.

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Stephen V Liu

@StephenVLiu

@Twitter

#ESMO20 Well done discussion by Dr. Colin Lindsay who wins for most random @Twitter handle - @mylovelypinata. Helpful reminder of the journey leading to direct #KRAS inhibitors and the achievements of medicinal chemistry leading to agents like AMG 510 and MRTX849. #LCSM

@mylovelypinata

#ESMO20 Sotorasib was safe and effective in #KRAS G12C NSCLC. Safety profile will allow for combinations: what are the right partners? Can we combine with IO? Do we need a phase III vs docetaxel? @mylovelypinata says absolutely, we do. And other KRAS mutations being targeted too!

#ESMO20 Commenting on CHRYSALIS - amivantamab and lazertinib was safe and effective in osi-resistant and naive populations. Too early for cross trial comparisons but it seems as though IV drugs for #EGFR NSCLC are back. #LCSM #OncoAlert

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Stephen V Liu

@StephenVLiu

#ESMO20 Beppe Giaccone presents the phase 3 Atalante-1 trial of the vaccine OSE-2101 vs standard chemotherapy (docetaxel or pemetrexed) in patients with #NSCLC after immune checkpoint inhibitor therapy #LCSM #OncoAlert

#ESMO20 OSE2101 (tedopi) is a vaccine with HLA-A2 restricted neoepitopes that should increase tumor antigen presentation and T-cell priming and activation. #LCSM #OncoAlert

#ESMO20 OSE2101 associated with a 1y OS rate of 46%, meeting the boundary for Step 1. This was 10% higher than chemotherapy, though confidence intervals overlap. Remember this is OSE2101 versus chemotherapy, not in addition to chemotherapy. #LCSM #OncoAlert

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Stephen V Liu

@StephenVLiu

@ZerAlona

#ESMO20 Nice discussion of the #EGFR / #HER2 #NSCLC abstracts from @ZerAlona covering poziotinib, tarloxotinib, mobocertinib, and patritumab deruxtecan. #LCSM #OncoAlert

@ZerAlona

#ESMO20 @ZerAlona discusses the efficacy of these EGFR/HER2 TKIs, balanced by their toxicity relative to other agents #LCSM #OncoAlert

@ZerAlona

#ESMO20 We are seeing promising activity with mobocertinib in EGFRex20, patritumab deruxtecan in sensitizing #EGFR, and tarloxotinib and poziotinib in #HER2, but some toxicity concerns with poziotinib at this dose schedule. Nice discussion @ZerAlona #LCSM #OncoAlert

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Stephen V Liu

@StephenVLiu

@RielyMD

#ESMO20 Update on TAK-788 (mobocertinib) from @RielyMD. This was a dose escalation phase I/II study establishing the dose of 160mg qday. This update is focused on patients with previously treated #EGFR exon 20 insertions #NSCLC #LCSM #OncoAlert

#ESMO20 There were 28 patients in the TAK-788/mobocertinib #EGFR cohort, fairly heavily pretreated with 54% of patients having received 3+ prior regimens. Note the rate of prior immunotherapy was 61% (compared to 24% across the entire study). #LCSM #OncoAlert

#ESMO20 Safety data with mobocertinib show 82% of patients with diarrhea, 32% of patients with grade 3+ diarrhea. Curious as to whether prior immunotherapy correlated with severity of toxicity as we know that sequence is concerning in sensitizing #EGFR NSCLC. #OncoAlert #LCSM

Read 6 tweets

Stephen V Liu

@StephenVLiu

@ASCO_pubs

#OncoAlert Online now @ASCO_pubs - results from CheckMate 153 (continuous vs 1y fixed duration nivolumab for #NSCLC). This was a phase IIIB/IV study of salvage nivo monotherapy. Those with control at 1y were randomized to continue or stop. #LCSM @IASLC

ascopubs.org/doi/full/10.12…

@dave6408

252 patients were randomized and with a minimum f/u of 13.5m, mPFS strongly favored continuous over 1 year (mPFS 24.7 vs 9.4m, HR 0.56). The 1y PFS rate at 12m post-randomization was 65% if nivo continued (44% if stopped). We saw early PFS data at #ESMO17 presented by @dave6408.

@ASCO_pubs

New to the #JCO @ASCO_pubs article are survival results. OS strongly favored continuous nivolumab over 1 year fixed dose (HR 0.62). While 1y OS rates were comparable, 2y OS rates were better with continues vs 1y fixed (70% vs 57%). #LCSM

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Ashley & Brooke Barlow PharmD

@theABofPharmaC

#OTILT #IDtwitter #oncopharm

What factors do you have to consider while treating a cancer pt with a malignant pleural effusion and concurrent infection? 🤔

1/
🚨Cancer pts are at risk for MPE➡️consequence of metastatic involvement of the primary tumor in the pleura💨

💡Lung, breast, and lymphoma are the most common causes💡

Query of the pleural fluid with the use of the Lights criteria will help to determine the etiology (transudative or exudative)

Exudative=malignant OR infection

One of the criteria is a serum protein ratio >0.5

Since both MPE & infectious effusions🦠contain↗️↗️protein

🛑Avoid highly protein bound abx (Ex: daptomycin, ceftriaxone, ertapenem)➡️can get sequestered in the pleural fluid& have↘️systemic distribution & ↘️the ability to treat a bacteremia if present 😳🤯

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Stephen V Liu

@StephenVLiu

@ASCO_pubs

#OncoAlert Useful report in #JCOPO @ASCO_pubs on CNS outcomes in patients with #METex14 NSCLC. 83 patients with baseline CNS imaging; incidence of CNS metastases was 17% and an additional 19% developed CNS metastases later (lifetime risk 36%). #LCSM

ascopubs.org/doi/abs/10.120…

#OncoAlert In the 30 patients who developed CNS metastases, 83% parenchymal and 17% leptomeningeal. Probability of developing CNS metastases at 3y was 38%. Keep this in mind during surveillance! OS between those who did vs didn't have CNS mets at baseline was 26.7m vs 27.2m #LCSM

#OncoAlert Within this 83 patient METex14 cohort, 54 received crizotinib (RR 31%, TTD 7.8m, OS 13.7m). 22% had CNS progression (10% had intracranial ONLY progression) with a time to CNS progression of 5.8m. I think there's value in periodic brain MRI for most driver+ NSCLC. #LCSM

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Stephen V Liu

@StephenVLiu

@JTOonline

#OncoAlert Online now @JTOonline is the ORIENT-11 trial of sintilimab + platinum/pemetrexed in NSCLC. Simultaneous publication with #VPS20 #WCLC20 @IASLC presentation. Randomized phase III study of chemotherapy +/- anti PD-1 antibody sintilimab. #LCSM

jto.org/article/S1556-…

Sintilimab is a PD1 antibody and the phase Ib of sintilimab with platinum/pem had RR 68.4% and mPFS 11.4m. Phase III included 397 patients in 47 hospitals in China with treatment naive advanced EGFR/ALK wild type non-squamous NSCLC, stratified by PDL1 expression (22C3).

Enrolled in < 1y! All patients received 4 cycles of carboplatin AUC 5 with pemetrexed 500mg/m2 q21d and randomized 2:1 to sintilimab 200mg flat dose or placebo followed by sintilimab/placebo maintenance. After median f/u of 8.9m, primary endpoint met: PFS 8.9m vs 5m (HR 0.482).

Read 7 tweets

Pashtoon Kasi MD, MS

@pashtoonkasi

@WCGIC

Bird’s-eye view 👁 on what to look out for @WCGIC #WorldGI2020.
Opening remarks on important data 📺 @myESMO - by Dr. Eric Van Cutsem @UZLeuven.
🟩Good to see more #PrecisionMedicine🧬
🟥#Immunotherapy #Immuno-#oncology
🟦TNT & other chemo strategies
@Annals_Oncology #OncoAlert

@NRGonc

🆕#ctDNA #liquidbiopsies 🩸🧬
👀 👇🏾at the number of #clinicaltrials cropping up in this space‼️
🇦🇺DYNAMIC-II
🇦🇺DYNAMIC-III
🇺🇸COBRA @NRGonc
🇺🇸BESPOKE
🇺🇸@SU2C
🇯🇵 CIRCULATE
🌎COLUMBIA
🇮🇹🇪🇸PEGASYS
🇬🇧TRACC
🇩🇪CIRCULATE
🇫🇷crEATE
🇩🇰IMPROVE-IT
We have 2🇺🇸studies open. #CRCSM #WorldGI2020

@myESMO

#WORLDGI2020 This is 🆒 ☢️ 32-P EUS-guided implantation in #pancreascancer #PANCSM @myESMO @WCGIC @Annals_Oncology.

Still miles to go. OS median of 16 months pointing again to the systemic nature of disease. Need to piggyback these local approaches to better systemic. #OncoAlert

Read 55 tweets

Stephen V Liu

@StephenVLiu

#AACR20 Clinical plenary highlights the phase Ib study of RO7198457, an individualized neoantigen specific immunotherapy (iNeST) with atezolizumab. This represents a personalized immunotherapy approach that designs the agent based on likely neoantigens. #OncoAlert

#AACR20 TMB holds some value but it is likely a surrogate for neoantigen load, which may be the more important predictor. The challenge is that neoantigens are not shared between patients. iNeST is designed to expand neoantigen-specific T-cells in a specific patient. #OncoAlert

#AACR20 iNeST RO-457 is generated for an individual patient. Biopsy subject to NGS and bioinformatics used to predict neoantigens. Neoantigens encoded on two mRNA molecules (each with up to 10 neoantigens) and packaged in lipoplex nanoparticle formulation. #OncoAlert

Read 8 tweets

Stephen V Liu

@StephenVLiu

@fedcappuzzo

#AACR20 Final analysis of IMpower 150 (1L carbo, paclitaxel, bevacizumab, atezolizumab in NSCLC) presented by Dr. Mark Socinski, @fedcappuzzo @TonyMok9 @delvysra and others. Some interesting subset analyses in this trial. #LCSM #OncoAlert

#AACR20 A look at study design. Arm B was the four drug regimen which offered an OS improvement over Arm C (carbo/pac/bev, ECOG 4599). Here, we see comparison of A vs C (carbo/pac/bev vs carbo/pac/atezo). #LCSM #OncoAlert

#AACR20 In the final analysis, no significant difference between arms A and C (carbo/pac/atezo vs carbo/pac/bev), but the 4-drug regimen of carbo/pac/bev/atezo still offerering OS benefit. #LCSM #OncoAlert

Read 5 tweets

Stephen V Liu

@StephenVLiu

#AACR20 Outcomes in KEYNOTE-189 (1L carbo + pem + pembro in #NSCLC) by STK11 and KEAP1 status presented by Shirish Gadgeel. Analysis on a (sizable) subset of the ITT showed STK11mt/KEAP1wt 8.7%, STK11wt/KEAP1mt 13.5%, double STK11/KEAP1 mt 10%. #LCSM #OncoAlert

#AACR20 STK11 and KEAP1 mutations associated with lower PDL1 expression and higher #TMB. #LCSM #OncoAlert

#AACR20 Addition of pembro to chemo improved RR independent of STK11 and KEAP1 mutation status. #LCSM #OncoAlert

Read 5 tweets

Stephen V Liu

@StephenVLiu

@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

Read 3 tweets

Stephen V Liu

@StephenVLiu

@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

Read 15 tweets

Stephen V Liu

@StephenVLiu

#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

Read 7 tweets

Stephen V Liu

@StephenVLiu

@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

Read 6 tweets

Stephen V Liu

@StephenVLiu

#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

Read 3 tweets

Stephen V Liu

@StephenVLiu

@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

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