Thread by @JohnEbbenMDPhD

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

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…

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…

2.66/9 #TumorBoardTuesday #LungCancer

✅ 🚨Patient voice is MOST important- pts define “acceptable tox,” not 🩺 🚨
✅THINK about side effects, including fertility‼️
✅Patient voice is MOST important- patients define “acceptable tox,” not 🩺

3/9 #TumorBoardTuesday
Thurs Case🎀

@ShrutiPatel @NarjustFlorezMD presented the case of a 38yo 👩🏽 w limited🚬hx, now w chest pain, diarrhea.
😥🫁mass + mediastinal nodes;
Staging= pT2apN1 (Stage IIB).

🤨What now?
⚖️Crowd was split-do standard adj tx, or need more🧾?

4/9 #TumorBoardTuesday #LungCancer
Thursday Case🎀

🧪NGS and PD-L1 IHC come back…
PD-L1 is high w TPS>50%, but–

😱EGFRex19 deletion

🤔Now what❓

The tumor board was split again, but-
💡✅ Good evidence for adj osimertinib

5/9 #TumorBoardTuesday
Thurs Case🎀

Before continuing–patient is only 38yo!
👉🏽Younger dx⬆️common

Why? Unclear–
👉🏽trends hold when adjusting for 🚬
👉🏽Radon
👉🏽environmental factors?

Some #NSCLC is familial (EGFR T790M), & there may be increasing recognition of🧬predispositions.

6/9 #TumorBoardTuesday
Thursday Case🎀

👩🏽‍🏫@ShrutiPatel @NarjustFlorezMD presented a Tweetorial on EGFRm & adj tx.

🔑takeaways:
📍EGFRm more common in females
📍🚭
📍Asian ancestry

Several classes of mutation
most susceptible to TKIs, but
👉🏽Ex20del= amivantamab, mobocertinib

7/9 #TumorBoardTuesday #LCSM
Thursday Case🎀

Good data for osimertinib as adjuvant therapy—but
🔹we only have DFS
🔹no OS data yet
🔹@NarjustFlorezMD says ⚠️BE CAREFUL⚠️

Many choosing to do 4 doses of chemo first, followed by osi (good OS data for chemo)

7.5/9 #TumorBoardTuesday #LungCancer #LCSM

🎤In summary, Drake agrees with expert consensus that osimertinib is the better choice vs gefitinib/erlotinib (1st gen tyrosine kinase inhibitors) in the adj setting

Thanks for the memorable image @ShrutiPatelMD

8/9 #TumorBoardTuesday
Thursday Case🎀

Consider toxicities.
PATIENT VOICES MATTER MOST!
🔑Key osi side FX:

👺Rash, Acne, Dry Skin
💩Diarrhea
🖐🏽Paronychia
🥃Hepatic
🫁Pneumonitis
🫀LVEF, QTc
Fertility impact for ♂️ & ♀️
+ 💵tox- costs⬆️- good point by @Latinamd @ADesaiMD

9/9 #TumorBoardTuesday
Thurs Case🎀

🙏NED, still on osi 80 mg qDay. It’s been 15 mo! ADURA (osi trial)= 3y of tx.
🤔Many q- chemo first, then osi? Does it have to be 3y? Stay tuned!

➡️Be sure to join us on 06.21.22 when @MPishvaian presents roundup of #ASCO22 abstracts!😀

Remember #TumorBoardTuesday continues to offer AMA & MOC credit for FREE!
Don’t forget to answer the polls👇🏽
Then click this link to quickly request your credit!
ALL CME eval🔗: integrityce.com/tbteval
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