Thread by @ADesaiMD

@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!

2. B) #JAVELINBladder100 presented again by @tompowles1 @ASCO #ASCO20 meetinglibrary.asco.org/record/186872/… and published in @NEJM recently nejm.org/doi/full/10.10… by @tompowles1 @PGrivasMDPhD et al. ! presented #subgroup analysis @myESMO

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

Hoping this will summarize some #key #studies for fellow #HOTrainees @MayoHemeOnc @AllyHigginsMD @arkhaki @ArielleElkrief @guptaarjun90 @ChrisWeeMD @HOJournalClub @hfuentesbayne @AnaVManana @RahulBanerjeeMD @OncoAlert