Thread by @JohnEbbenMDPhD

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation 1/13 #TumorBoardTuesday #LCSM
➡️Here’s this week's Thursday Case🎀!

🧬@Latinamd @GDutcherMD took us through METex14 skipping in older pts with 🫁#NSCLC.

👉Get 🆓#CME credit with quick❓

CME eval 🔗: integrityce.com/tbteval

@SylvesterCancer

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 2/13 #TumorBoardTuesday
Thurs Case🎀

Take🏠points:

#LungCancer= molecular disease

✅IDEAL=wait for NGS before tx
✅Send tissue NGS & ct🧬
✅MET mut= RTK driver- rare!
🔷MET exon 14 skipping best detected w RNAseq
🔷Capmatinib/tepotinib= FDA👍🏽
✅METi side effects: 🤨EDEMA

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 3/13 #TumorBoardTuesday
Thurs Case🎀

Take🏠points (cont’d):

✅🎯tx preferred in 1L >> IO
🗝️ IO first 👉🏽TKI (osi) 👉🏽⬆️irAE
✅Older pts may need dose adjustment of TKI d/t tox
✅MET bispecifics (amivantamab) & ADCs coming!

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 4/13 #TumorBoardTuesday

Thursday Case🎀

💥 Meet your patient where they are. 💥

All 🫁#NSCLC pts require multi-d care, but extra attn to side effects for older pts.💥

📚We captured as much of this #LCSM chat as we could in this moment:
Part 1: twitter.com/i/events/15295…

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 5/13 #TumorBoardTuesday #LCSM

Thursday Case🎀

Remember pt context: pts w 🚬 history & older women more likely to have METex14 skip mut.

Part 2 of chat: twitter.com/i/events/15295…

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 6/13 #TumorBoardTuesday
Thursday Case🎀

@Latinamd @GDutcherMD presented a case:
83yo 👩🏼‍🦳with stage IV NSCLC & remote 🚬 hx.
🧪NGS not avail yet
🔹PD-L1 TPS= 90% ‼️
🫁Pt having some SOB

➡️What should be 1L treatment?
There was good convo about this! IDEAL to wait for NGS🧪

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 7/13 #TumorBoardTuesday
Thursday Case🎀

😱Liquid bx returns with METex14 skip mut
🚨METex14 muts more common in pts w
🚬 history🚨

🤔What now❓PD-L1 high, AND MET mutated
💡✅ This time–less debate; favor TKI
– TWO FDA approved options- capmatinib and tepotinib

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 8/13 #TumorBoardTuesday
Thurs Case🎀

⚖️Why TKI 1L vs IO?
🔷Oncogenically driven may have ⬇️response to IO (but still have ⬆️PD-L1)
🔷IO pre TKI (osi) assoc w⬆️pneumonitis…even 3 months later!

📚⬆️risk of transaminitis w IO pre KRAS G12Ci #ASCO22!

annalsofoncology.org/article/S0923-…

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 9/13 #TumorBoardTuesday
Thursday Case🎀

👩🏾‍🦳has nearly complete response to capmatinib 400 mg BID! 🎉🎉

But…intolerable edema & 20 lb wt gain ⏫!!
➡️Now what❓

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 10/13 #TumorBoardTuesday
Thursday Case🎀

Edema 🦵🏾is a MAJOR side effect of METi
📍52% of cases with capmatinib w any grade edema!

📍No great 🛠 to manage, other than dose reduction–
📍some success w switching agents
📍Proactively ✅ weight
📍Early edema mgmt➡️ better outcomes

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 11/13 #TumorBoardTuesday
Thurs Case🎀

Recap: METex14 skip= 3-4% of NSCLC, with ⬆️ rates in pts with 🚬 hx
🔹MET= receptor tyrosine kinase
🔹Ex14 skip DELETES an inhibitory binding domain from the protein➡️ ⬆️signaling

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 12/13 #TumorBoardTuesday
Thurs Case🎀
MET💊 are effective, but 🦵edema is common!
📍Sometimes, dose adjustments are necessary.
📍NEW data shows osimertinib at ⬇️dose is equally effective (PFS) in patients >75 yo.

‼️Need more 🔢 for other TKIs and 🎯 therapies‼️
@ClinicalLung

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer @ClinicalLung 12.5/13

...and the PFS curves from osimertinib study in patients older than 75 treated with lower doses of osimertinib.
(HOT 2020 trial) @GDutcherMD
Can we extrapolate to other targeted agents, including METi?

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer @ClinicalLung 13/13 #TumorBoardTuesday
Thursday Case🎀

🙏 Pt doing well w dose ⬇️to cap 150 mg BID, w better🦵edema control 🙌🏾
🤔 NGS is 🗝️ in #NSCLC, but 🎯tx need to match pts pharmacogenomics/needs

➡️Join us on 06/07/22 when @MPishvaian joins us to rundown #ASCO22 abstracts 😀

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer @ClinicalLung Remember #TumorBoardTuesday continues to offer AMA & now MOC credit for FREE! Don’t forget to answer the polls👇🏽
Then click this link to quickly request your credit! EASY
CME eval🔗: integrityce.com/tbteval
ALL CME🔗: integrityce.com/tbt

https://twitter.com/tumorboardtues/status/1529270446939594753?s=21&t=ymNtVM3s2RoUXT5s1D8klw

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer @ClinicalLung @HOJournalClub @DrSteveMartin @GlopesMd @NarjustDumaMD @AnaVManana @COlazagasti @StephenVLiu @chulkimMD @LudaBazhenovaMD @benlevylungdoc @luisraez1 @edgardo_ny @letswinpc @SushmaJonna @KatsuakiMaehara @ASCO @Dr_R_Kurzrock @DrMarkAwad @ChristianRolfo @GilbertodeCas13

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@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer @ClinicalLung @HOJournalClub @GlopesMd @NarjustDumaMD @AnaVManana @COlazagasti @StephenVLiu @chulkimMD @LudaBazhenovaMD @benlevylungdoc @luisraez1 @edgardo_ny @letswinpc @KatsuakiMaehara @ASCO @Dr_R_Kurzrock @DrMarkAwad @ChristianRolfo @DevikaDasMD @GRecondoMD @Anna_Minchom @DrClaudiomartin @oncologician @ShaalanBeg @drkpavithran @VivekSubbiah @esinghimd @mlazqui @RielyMD @SPSuehnholz @CDebyaniPhD @BairdAM @NReguart @geoff_oxnard @LaurenByersMD @HemOncFellows @AsaadTrabolsi ⁦@cwru

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