@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga #TumorBoardTuesday
Some of tonight’s conversation will be discussing of multiple treatments of stage 3 #NSCLC.
My COI: I’m a consultant with @AstraZeneca, but thoughts are my own.
Some of tonight’s conversation will be discussing of multiple treatments of stage 3 #NSCLC.
My COI: I’m a consultant with @AstraZeneca, but thoughts are my own.
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 1/13 #TumorBoardTuesday #NSCLC #OncTwitter
65yo 🧔🏽, former 🚬, pmhx🫀 MI with stents
🩻CT: 🫁 right middle lobe mass & adenopathy
EBUS confirms adenocarcinoma level 7, 4R and the mass
🔬Molecular test: KRAS G12C & STK11 mutations, TMB 10, PD-L1 40% by 22C3.
Final stage T3N2M0
65yo 🧔🏽, former 🚬, pmhx🫀 MI with stents
🩻CT: 🫁 right middle lobe mass & adenopathy
EBUS confirms adenocarcinoma level 7, 4R and the mass
🔬Molecular test: KRAS G12C & STK11 mutations, TMB 10, PD-L1 40% by 22C3.
Final stage T3N2M0
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 2/13 #TumorBoardTuesday #LCSM #NSCLC
Multi-D Tumor Board discussion about 👆🏽patient.
🧐 Is an STK11 mutation taken into consideration?
🤨 What would you recommend as a treatment option?
Multi-D Tumor Board discussion about 👆🏽patient.
🧐 Is an STK11 mutation taken into consideration?
🤨 What would you recommend as a treatment option?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 3/13 #TumorBoardTuesday #NSCLC
➡️This patient’s tumor is multi station N2 adenocarcinoma.
➡️Preferred approach is concurrent chemoradiation (cCRT) followed by durvalumab per PACIFIC trial.
➡️Long term OS data suggests sustained clinical benefit.
📚 see below @ASCO #ASCO21
➡️This patient’s tumor is multi station N2 adenocarcinoma.
➡️Preferred approach is concurrent chemoradiation (cCRT) followed by durvalumab per PACIFIC trial.
➡️Long term OS data suggests sustained clinical benefit.
📚 see below @ASCO #ASCO21
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 4/13 #TumorBoardTuesday
👨🏻🏫 Mini tweetorial 1
✨PACIFIC trial✨
🌐P3 SOC vs Durva post cCRT
713 👫 WHO 0/1
cCRT ➡️no progression
🌐Updated OS
HR=0.72
PFS HR=0.55
5 yr OS=42.9% w durva vs 33.4% for SOC
<65, adeno, PS 0,👩🏻🦱, Asian ⬆️OS
Safety manageable
📚doi.org/10.1200/JCO.21…
👨🏻🏫 Mini tweetorial 1
✨PACIFIC trial✨
🌐P3 SOC vs Durva post cCRT
713 👫 WHO 0/1
cCRT ➡️no progression
🌐Updated OS
HR=0.72
PFS HR=0.55
5 yr OS=42.9% w durva vs 33.4% for SOC
<65, adeno, PS 0,👩🏻🦱, Asian ⬆️OS
Safety manageable
📚doi.org/10.1200/JCO.21…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 5/13 #TumorBoardTuesday
👨🏻🏫 Mini tweetorial 2
✨PACIFIC trial✨
📍PFS significantly better in ITT with durvalumab
📍Clear benefit in ITT population
🫧Subsets
🫧🔹EGFR+ examined 👎🏽 clear benefit but small n
🫧🔹PD-L1 Low/- ⬇️ benefit
👀Current FDA approval in ITT
👨🏻🏫 Mini tweetorial 2
✨PACIFIC trial✨
📍PFS significantly better in ITT with durvalumab
📍Clear benefit in ITT population
🫧Subsets
🫧🔹EGFR+ examined 👎🏽 clear benefit but small n
🫧🔹PD-L1 Low/- ⬇️ benefit
👀Current FDA approval in ITT
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca 6/13 #TumorBoardTuesday
👨🏻🏫Mini tweetorial 3
✨PACIFIC trial✨
📄Metastatic setting retro data, co-mutations like KRAS with STK11 SEEM to be associated with ⬇️ response to checkpoint inhibitor monotherapy.
📚@FSkoulidis doi.org/10.1158/2159-8…
📚@BiagioMd doi.org/10.1016/j.jtho…
👨🏻🏫Mini tweetorial 3
✨PACIFIC trial✨
📄Metastatic setting retro data, co-mutations like KRAS with STK11 SEEM to be associated with ⬇️ response to checkpoint inhibitor monotherapy.
📚@FSkoulidis doi.org/10.1158/2159-8…
📚@BiagioMd doi.org/10.1016/j.jtho…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd 7/13 #TumorBoardTuesday #NSCLC
👨🏻🏫 Mini tweetorial 4
✨PACIFIC trial✨
📄No clear data to suggest similar ⬇️ lower response in the locally advanced #LungCancer 🫁 setting and post RT.
🤨 Could RT create a more immune responsive TME +/- mutations?
👨🏻🏫 Mini tweetorial 4
✨PACIFIC trial✨
📄No clear data to suggest similar ⬇️ lower response in the locally advanced #LungCancer 🫁 setting and post RT.
🤨 Could RT create a more immune responsive TME +/- mutations?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd 8/13 #TumorBoardTuesday #LungCancer
📌 Improving the results of PACIFIC is the next challenge.
🤨 What would YOU prefer to see as the next step?
📌 Improving the results of PACIFIC is the next challenge.
🤨 What would YOU prefer to see as the next step?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd 9/13 #TumorBoardTuesday #LCSM #NSCLC
MRD above
Under investigation:
🕵🏻♂️Double IO & novel drug post cCRT
🕵🏻♂️Early RT then cCRT
🕵🏻♂️Better patient choice & use of MRD
🙅🏻♂️Don’t agree with doing nothing!
📄One example is the COAST trial
📚@DrRoyHerbstYale doi.org/10.1200/JCO.22…
MRD above
Under investigation:
🕵🏻♂️Double IO & novel drug post cCRT
🕵🏻♂️Early RT then cCRT
🕵🏻♂️Better patient choice & use of MRD
🙅🏻♂️Don’t agree with doing nothing!
📄One example is the COAST trial
📚@DrRoyHerbstYale doi.org/10.1200/JCO.22…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd @DrRoyHerbstYale 11/13 #TumorBoardTuesday
👨🏻🏫 Mini tweetorial 2
✨COAST trial✨
✅Interesting results and 🤞🏽 proven in a phase 3 study.
🕵🏻♂️Moving a CPI to earlier phase is under investigation.
🕵🏻♂️Smaller studies planned to look at minimal residual disease (MRD) to decide further treatment.
👨🏻🏫 Mini tweetorial 2
✨COAST trial✨
✅Interesting results and 🤞🏽 proven in a phase 3 study.
🕵🏻♂️Moving a CPI to earlier phase is under investigation.
🕵🏻♂️Smaller studies planned to look at minimal residual disease (MRD) to decide further treatment.
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd @DrRoyHerbstYale 12/13 #TumorBoardTuesday
Back to our case🔎
🧔🏽Treated per PACIFIC
Completed 1 year of therapy with mild 😴 & some weight loss but no IRAEs.
6 months after completing durva 🩻CT shows liver met.
🔬Bx confirmed
🧠MRI shows two 5 mm lesions
😰met disease?
🤨How should we proceed?
Back to our case🔎
🧔🏽Treated per PACIFIC
Completed 1 year of therapy with mild 😴 & some weight loss but no IRAEs.
6 months after completing durva 🩻CT shows liver met.
🔬Bx confirmed
🧠MRI shows two 5 mm lesions
😰met disease?
🤨How should we proceed?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd @DrRoyHerbstYale 13/13 #TumorBoardTuesday #NSCLC #LCSM
🧔🏽Patient enrolled in INSIGNIA (EA5163/S1709)
🩻 Stable disease after 1st imaging 🎉
🔮 Lots of options for care 🙏🏽
clinicaltrials.gov/ct2/show/NCT03…
🧔🏽Patient enrolled in INSIGNIA (EA5163/S1709)
🩻 Stable disease after 1st imaging 🎉
🔮 Lots of options for care 🙏🏽
clinicaltrials.gov/ct2/show/NCT03…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd @DrRoyHerbstYale #PostTest Q1️⃣ #CME #TumorBoardTuesday
👉🏽CME Eval 🔗 integrityce.com/tbtEval
👉🏽ALL CME🔗 integrityce.com/tbt
🤔@HosseinBorghaei taught us Stage 3 unresectable #NSCLC, test your🧠with quick❓
🧐Which adj tx would you pick 4 a pt with unresectable stage 3 NSCLC 1L tx chemoRT?
👉🏽CME Eval 🔗 integrityce.com/tbtEval
👉🏽ALL CME🔗 integrityce.com/tbt
🤔@HosseinBorghaei taught us Stage 3 unresectable #NSCLC, test your🧠with quick❓
🧐Which adj tx would you pick 4 a pt with unresectable stage 3 NSCLC 1L tx chemoRT?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @ASCO @JCO_ASCO @MLJohnsonMD2 @BurrisSkip @RielyMD @JustinGainor @ChiFuJeffYang @ECarcereny @anguspratt @KRASKickers @thenasheffect @ALKpositiveINT @EgidiusLambrech @EugeneManley @ipreeshagul @JoelNealMD @HwakeleeMD @GlopesMd @jmsuga @AstraZeneca @FSkoulidis @BiagioMd @DrRoyHerbstYale #PostTest Q2️⃣ #CME #TumorBoardTuesday
Free CME🔗: integrityce.com/tbt
🧐 What treatment regimen would you select for a patient with unresectable stage 3 #NSCLC and 36% PD-L1 expression who received adjuvant durvalumab treatment?
Free CME🔗: integrityce.com/tbt
🧐 What treatment regimen would you select for a patient with unresectable stage 3 #NSCLC and 36% PD-L1 expression who received adjuvant durvalumab treatment?
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