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Stephen V Liu, MD

@StephenVLiu

Sep 18, 2020 • 7 tweets • 9 min read • Read on X

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@GautschiOliver

#ESMO20 With some of the technical limitations, grateful for this discussion of the mesothelioma #MPM oral abstracts by @GautschiOliver @OncoAlert

@GautschiOliver

#ESMO20 @GautschiOliver reviews the history of immunotherapy in #MPM, with early single arm trials showing efficacy but disappointing randomized trials of tremelimumab and of pembro vs chemo. Still, responses were seen, including his own patient with a 3y response. @OncoAlert

@IASLC

#ESMO20 That finally changed with #WCLC20 @IASLC with CheckMate 743 when first-line nivo/ipi improved OS compared to chemotherapy (OS HR 0.74), particularly in the non-epithelioid subtype (OS HR 0.46). @OncoAlert

@OncoAlert

#ESMO20 Here, we saw 3y follow up of nivolumab monotherapy from the phase 2 MERIT trial. Median OS of 17.3m very encouraging. Higher in PDL1 positive (19.1 vs 11.6) and in biphasic/sarc subtype (OS 26.6) vs epithelial (OS 15.7), though small numbers (n=34). @OncoAlert

@OncoAlert

#ESMO20 Relevant to these studies is this abstract on volumetric PET response in #MPM. As anyone who has treated this disease on trial, disease assessment is very challenging. This volumetric approach could be an alternate tool to gauge response. @OncoAlert

@OncoAlert

#ESMO20 Relatively small study (n=27) but found that RR was higher with PET, suggesting CT could underestimate activity. MTV held better prognostic value than SULpeak suggesting the total metabolic activity held more value than a single lesion. @OncoAlert

@sarahcpr

#ESMO20 I think that PET as a tool for #MPM is very appealing but will be challenging to implement at multiple centers. The key question: "is it scalable?" @sarahcpr @OncoAlert

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More from @StephenVLiu

Stephen V Liu, MD

@StephenVLiu

Sep 8

Dr. @marinagarassino at #WCLC24 Presidential Plenary presents Normalized Membrane Ratio of TROP2 as a biomarker for datopotamab deruxtecan in TROPION-Lung01 (Dato-DXd vs docetaxel in previously treated NSCLC which previously showed PFS benefit with Dato-DXd.

#WCLC24 TROP2 IHC has been a poor predictive marker. Normalized Membrane Ratio (NMR) factors in receptor internalization. Ratio is membrane expression over membrane plus cytoplasmic expression (using optical density from digitized slide) and lower would be more favorable.

#WCLC24 TROP2 QCS-NMR seems to be a much better predictor of benefit with datopotamab deruxtecan in BEP and in non-sq non-AGA subset: in NMR+, PFS HR 0.57 and KM shows clear separation.

Read 4 tweets

Stephen V Liu, MD

@StephenVLiu

Apr 23, 2023

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

Stephen V Liu, MD

@StephenVLiu

Apr 16, 2023

Impressive data from #AEGEAN at #AACR23 from Dr. John Heymach and colleagues. This is the first of several phase III peri-operative IO studies in resectable NSCLC combining neoadjuvant chemo-immunotherapy followed by adjuvant immunotherapy.

Included stage IIA-IIIB (AJCC v8) with no EGFR/ALK & excluded pts who would require pneumonectomy. Large study with n=801 (CM816 was n=358). Pts received 4 cycles (not 3) of platinum-based chemo with durvalumab (anti-PDL1) or placebo, then surgery, then durvalumab / placebo x 1y.

Almost 75% received carboplatin over cisplatin. Global study; fairly even PDL1 distribution. 80% of pts went to surgery, 78% completed resection (90-95% of those were R0). Overall, 66% of pts began adjuvant phase (but 90% of those who had an R0 resection had adjuvant therapy).

Read 9 tweets

Stephen V Liu, MD

@StephenVLiu

Dec 8, 2022

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

Stephen V Liu, MD

@StephenVLiu

Sep 19, 2022

@ZPiotrowskaMD

Dr. @ZPiotrowskaMD presents initial results from the ELIOS trial at #ESMO22 - molecular profiling of #EGFR mutant NSCLC after progression on 1L osimertinib.

In this study of highly motivated pts at esteemed sites, evaluable paired biopsy at PD only available in 46/115 pts (40%). Interestingly, 75 pts (65%) had paired biopsy but 27 failed NGS (23%). Speaks somewhat to the real world feasibility of a repeat biopsy approach. #ESMO22

Common co-mutations at baseline included TP53, EGFR amp, and CDKN2A loss. Acquired alterations included MET amp, EGFR C797S, ALK fusion, NKX2-1 amp. Mostly mutually exclusive. #ESMO22

Read 5 tweets

Stephen V Liu, MD

@StephenVLiu

Sep 11, 2022

Dr. Silvia Novello presents 5y update on KEYNOTE 407 (platinum plus tax and +/- pembrolizumab for 1L squamous NSCLC #ESMO22

With longer follow up, OS favors pembrolizumab arm with mOS 17.2 vs 11.6m (OS HR 0.71) in squamous NSCLC. 5y OS rate 18.4% vs 9.7%. PFS benefit (HR 0.62) and higher RR across PDL1 strata. #ESMO22

For patients who complete 2y of pembrolizumab, 3y OS rate (after completing 2y pembro) was 70% - though not all of those patients are cured (44% were alive without PD or subsequent therapy). #ESMO22

Read 4 tweets

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