@myESMO #ESMO20 as a #trainee can be #overwhelming! So many good studies, some more #practicechanging then others, if you missed some and want to understand (albeit at a simplistic #trainee level), sit back, relax and enjoy as we go through some great data #ESMO20 @OncoAlert
1. #NSCLC: 2 major studies #ADAURA #CROWN for adjuvant #EGFRmNSCLC, and advanced #ALK+ experts can provide better perspective @JackWestMD @n8pennell @StephenVLiu @AMansfieldMD @CharuAggarwalMD @NarjustDumaMD @GlopesMd @DevikaDasMD @OncoAlert
1. A) #ADAURA: Stage IB-IIIA #resected #NSCLC with #EGFRm treated with #Osimertinib vs #placebo [SOC prior to this was adjuvant chemotherapy [cisplatin-based doublet based on #LACE metanalysis- pubmed.ncbi.nlm.nih.gov/18506026/] showed improvement in #DFS @NEJM nejm.org/doi/full/10.10…
@myESMO #ADAURA previously presented at @ASCO #ASCO20: ascopubs.org/doi/abs/10.120… demonstrated #Osi adjuvant reduced #CNS recurrence over the improvement in 2 yr-#DFS @DrRoyHerbstYale
1. B) Advanced #ALK+ #NSCLC currently 1st line: a) #Alectinib (pubmed.ncbi.nlm.nih.gov/28586279/) or #Brigatinib (pubmed.ncbi.nlm.nih.gov/30280657/), now #CROWN tests #Lorlatinib (currently 2/3 line) in 1st line v/s #crizotinib? and shows #improved #mPFS and #intracranial activity-
My ? is #crizotinib an appropriate #control since we no longer recommend 1st line use of this drug? @VPrasadMDMPH @GlopesMd @DevikaDasMD @n8pennell @oncology_bg,I may be missing something here, need clarity for #HOTrainees!
2. #UrothelialCancer 2 studies #DANUBE #JavelinBladder100 in #adv/#metastatic #UC calling experts for help for #trainees @PGrivasMDPhD @DrChoueiri @TiansterZhang @shilpaonc @montypal

2. A) #DANUBE assesses #Durva/#Durva+ Tremelimumab in 1st line
Current #algorithm courtesy @UpToDate
#DANUBE tested whether #immunotherapy can overturn #chemo as 1st line:
Short answer: Not really, even in high #PDL1 population as presented by the brilliant presenter @tompowles1!
Based on this #amazing work by @PGrivasMDPhD et al. #FDA approved the use of maintenance #avelumab for patients who have not progressed on initial treatment with chemotherapy fda.gov/drugs/drug-app…
3. #RCC: #CheckMate9ER presented by superstar Dr. @DrChoueiri studied #Nivolumab + #Cabozantinib vs #Sunitinib as 1st line for advanced #RCC, current #SOC options are listed per @NCCN:
#CheckMate9ER showed #impressive mPFS 16.6 vs 8.3 HR (0.51), mOS (HR 0.6) with most #importantly (IMHO!) better #QoL, so this adds to #KEYNOTE426 (nejm.org/doi/full/10.10…) and #CheckMate214 (nejm.org/doi/full/10.10…) and #JAVELIN Renal 101 (pubmed.ncbi.nlm.nih.gov/30779531/)
In this #very #crowded space, we must determine which combination is better if at all. But the improvement in #QoL with #OS is very encouraging!
4. #BreastCA: we have #ASCENT, and #IMPassion130 and which are in #metastatic #TNBC, calling experts for perspective @jesusanampa @NicoleKuderer @ErikaHamilton9 @rleonferre @maryam_lustberg
4. A) #ASCENT describes results of anti-TROP2 #sacituzumab-govitecan v.s. TPC #chemo in pretreated #metastatic #TNBC with atleast 2 prior chemo @ABhealer108, previously pubmed.ncbi.nlm.nih.gov/30786188/ phase 1/2
#mPFS 1.7 to 5.6 mo, HR 0.41
#mOS improves 6.7 to 12.1 mo, HR 0.48
4. B) #IMPassion130- in #PDL1+ #TNBC, current #SOC was confirmed with final OS analysis from the pivotal Phase III #IMpassion130 study of #atezolizumab + #nab-paclitaxel vs #placebo + #nab-paclitaxel in advanced or metastatic TNBC

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More from @ADesaiMD

Jul 12, 2022
@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 @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 @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
Sep 20, 2020
Folks! We return for #HOTrainees with the exciting #Day2 @myESMO #ESMO20 and some more #practice relevant studies in #breastcancer #ProstateCancer #lungcancer #GI, so sit back, relax and lets go through some data (#HO #trainee-style!) Shout out to @peters_solange @OncoAlert
1. #BreastCancer: We have #monarchE and #IMPassion031 hoping to hear from experts @ErikaHamilton9 @NicoleKuderer @DrSGraff @matteolambe @tmprowell @GeorgeSledge51 @VukovicPetra for more insights- please link to your discussions here for #trainees:
1. A) #monarchE: use of #abemiciclib in HR+, HER2-,high risk #EBC in addition to endocrine therapy.
Current #SOC: adjuvant ET (5-10 years)
#monarchE: #Abemaciclib + ET iDFS HR 0.747, here's a great summary by @ErikaHamilton9 for @OncoAlert :
Read 11 tweets
Apr 28, 2020
Missed #COVID19nCancer plenary in #AACR20 @AACR?
Here’s a thread to catch up on all the fascinating global research presented by:
@AACR @AACRPres #AntoniRibas #LiZhang @marinagarassino @barlesi #CarlosGomez #LouisVoigt #HongbingCai cc:@OncoAlert @COVID19nCCC @ASCO @ASH_hematology
#1: Chinese Experience by #LiZhang and #HongbingCai

More evidence of increased prevalence of #Cancer among #COVID19, ~2% similar to what we found in our #metanalysis @ASCO_pubs #JCOGO here: ascopubs.org/doi/10.1200/GO…
#LiZhang described 35.7% required mechanical ventilation and significant risk factors for severe outcomes on #multivariate analysis was recent #cancertreatment and #consolidation on CT
Read 12 tweets
Feb 2, 2020
"Fall in US cancer death rates: Time to pop the champagne?": the amazing @oncology_bg and myself comment on the big debate about who deserves credit for the progress in our @EClinicalMed commentary: thelancet.com/journals/eclin…. Read along for a brief tweetorial!
Researchers found that since 1991 the cancer death rate has dropped 29%, but the 2.2% decline in mortality rates from 2016 to 2017 was the largest single-year decline in cancer mortality ever reported. Image
Since this fall was primarily driven by lung cancer, many experts speculated that this was the success story of treatment advances which has dramatically changed over the decade with the introduction of genomic and immunotherapy-based drugs. Image
Read 11 tweets

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