Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Sep 9, 2022 • 8 tweets • 44 min read • Read on X

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation 2/3 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:

✅3 agents (pembro, atezo, cempilimab) 👍🏽PD-L1 TPS >50% in 1L
– No head to head ICI comparisons
✅OS BETTER w IO alone vs chemo
✅💰tox huge problem!
📚We captured the convo in this moment:
twitter.com/i/events/15675…

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation 2.5/3 #TumorBoardTuesday
Thurs Case🎀

Key factors to choose ICI (in absence of head to head trials):
- Pt experiences/preferences
- Dosing schedule
- $$$ toxicity

The good news: across 3 separate agents (pembrolizumab, atezolizumab, cemiplimab) OS is BETTER w IO alone vs chemo

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation @esinghimd @jacobadashek @KinhHoangMD @RenoHemonc @tanyawildes @OncBrothers 3/3
Thurs Case🎀

Thanks for joining us for #TumorBoardTuesday!

Some scheduling notes:
@jane_meisel’s #BRCA case is rescheduled for 12.20.22

➡️Please be sure to join us on 09/20/22 when @maryam_lustberg @JasmineSukumar present a case focused on PIK3CA inhibition in #mBC 😀

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation @esinghimd @jacobadashek @KinhHoangMD @RenoHemonc @tanyawildes @OncBrothers @jane_meisel @maryam_lustberg @JasmineSukumar ...and before we close out this #TumorBoardTuesday case wrap up, we have to acknowledge @ShrutiPatelMD's meme game:

https://twitter.com/ShrutiPatelMD/status/1567303589936373761

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation @esinghimd @jacobadashek @KinhHoangMD @RenoHemonc @tanyawildes @OncBrothers @jane_meisel @maryam_lustberg @JasmineSukumar Remember #TumorBoardTuesday continues to offer AMA & MOC credit for FREE!
Don’t forget to answer the polls👇🏽
Click this link to quickly request your credit!
CME eval🔗: integrityce.com/tbteval
ALL CME 🔗: integrityce.com/tbt

https://twitter.com/ShrutiPatelMD/status/1567321501149569024?s=20&t=cAwSg1Hxyy9YorMtlBxL_w

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation @esinghimd @jacobadashek @KinhHoangMD @RenoHemonc @tanyawildes @OncBrothers @jane_meisel @maryam_lustberg @JasmineSukumar @dawood_findakly @ALKpositiveINT @HannahAlison20 @JineshGheeya @LatinasInMed @FawziAbuRous @LatinxOncology @FernandoDiazMD1 @KellyMezaMD @MomaVelez11 @SarahGhosh20 @MNagasaka @KanKParmar @CaThompsonMD @s_brond @GallodeMoraesMD @esinghimd @OMETinyHeartsMD @KinhHoangMD @AnaVManana

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation @esinghimd @jacobadashek @KinhHoangMD @RenoHemonc @tanyawildes @OncBrothers @jane_meisel @maryam_lustberg @JasmineSukumar @ALKpositiveINT @HannahAlison20 @JineshGheeya @LatinasInMed @FawziAbuRous @FernandoDiazMD1 @KellyMezaMD @MomaVelez11 @SarahGhosh20 @MNagasaka @KanKParmar @CaThompsonMD @s_brond @GallodeMoraesMD @OMETinyHeartsMD @AnaVManana @anguspratt @OPENoncology @jennifermarksmd @drkevinknopf @drpushkal1 @GiulyPalumbo @Harshadod @ADesaiMD @OncBrothers @Angela_Ai_ @JFreemanDaily @paulalv @acmoorephd @jillfeldman4 @tanyawildes @Gr8Engineering @RenoHemonc @ChrisJ_Shepherd

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation @esinghimd @jacobadashek @KinhHoangMD @RenoHemonc @tanyawildes @OncBrothers @jane_meisel @maryam_lustberg @JasmineSukumar @ALKpositiveINT @HannahAlison20 @JineshGheeya @LatinasInMed @FawziAbuRous @FernandoDiazMD1 @KellyMezaMD @MomaVelez11 @SarahGhosh20 @MNagasaka @KanKParmar @CaThompsonMD @s_brond @GallodeMoraesMD @OMETinyHeartsMD @AnaVManana @anguspratt @OPENoncology @jennifermarksmd @drkevinknopf @n8pennell @drRTee @CharuAggarwalMD @CatherineShuMD @VivekSubbiah @DevikaDasMD
@letswinpc @GlopesMd @Latinamd @DrSteveMartin @manalipatelmd @FredrikThege @Aiims1742 @jacobadashek

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More from @JohnEbbenMDPhD

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Apr 20, 2023

@TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 2/5 #TumorBoardTuesday
Take🏠:
✅ 🧬test 🗝️! Biomarkers 👉 best tx
✅ OlympiA: OS & IDFS⬆️w Olaparib- gBRCAm
✅ MonarchE: IDFS⬆️ w abema +ET- HR+
✅ Fertility pres & interrupting adj tx (if desired) for pregnancy
📚@JenniferLitton @marijasullivan’s thread
threadreaderapp.com/thread/1648476…

@TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 3/5 #TumorBoardTuesday
Thursday Case🎀

🎥 TBT in a video
@marijasullivan summarizes adj tx based on biomarkers. How to approach pts w gBRCA1/2m & HR+? Need more data!

🔹gBRCAm👉 Olaparib x 1y
🔹 HR+👉 Abemaciclib + ET x 2y -> ET; data expected on other CDK4/6i soon (ribociclib)

@TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 4/5 #TumorBoardTuesday
📷 TBT in an image

In pts who desire pregnancy, data that adj tx can be interrupted & later resumed safely- waiting on long-term follow up @AnnPartridgeMD.

✅Pregnancy outcomes after #BreastCancer NOT worse. Fertility pres strat BEFORE tx 🗝️ if desired.

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Mar 24, 2023

@TumorBoardTues @shafiarahman_ @RischZack @MPishvaian @ColonCancerCoal @colontown @coloncancermike @GlobalCRC 2/6 #TumorBoardTuesday
Thurs Case🎀

#mCRC & #EGFR tx:
✅Anti-EGFR useful in RAS/RAF WT; debate re: timing vs anti-VEGF
✅Pt centered discussion including SEs 🗝️
✅Emerging data: EGFR re-tx, using ctDNA to guide

📚@shafiarahman_ @RischZack’s thread:
threadreaderapp.com/thread/1638330…

@TumorBoardTues @shafiarahman_ @RischZack @MPishvaian @ColonCancerCoal @colontown @coloncancermike @GlobalCRC 3/6 #TumorBoardTuesday
🎥 TBT in a vid- Part 1:

@shafiarahman_ 's approach: pt eligible for EGFR-directed tx in #metastatic #CRC
🔹RAS/RAF WT- more important than side
🔹Bev or pan 1L? Trend toward pan, but is 🗝️actually that pt gets anti-EGFR in tx, 🚫necessarily 1L?

@TumorBoardTues @shafiarahman_ @RischZack @MPishvaian @ColonCancerCoal @colontown @coloncancermike @GlobalCRC 4/6 #TumorBoardTuesday
🎥 TBT in a vid- Part 2:

@shafiarahman_ gives us a preview of what might be coming in #EGFR directed tx in #mCRC
🔹Re-challenge based on ctDNA clearance of resistant clones; pts w resistance to EGFRi benefit later as the tumor evolves again
🔹New combos!

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Mar 17, 2023

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh 2/5 #TumorBoardTuesday
Thurs Case🎀

Take🏠msgs:
✅ Pembro ONLY approved adj IO in RCC
✅ 3 recent trials w IO failure: nivo/ipi, atezo & periop nivo
✅ Must balance risks vs benefits- shared decision-making 🗝️

📚@brian_rini @JVentoMD’s thread:
threadreaderapp.com/thread/1635792…

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh 3/5 #TumorBoardTuesday
Thurs Case🎀

🎥 TBT in a video
High risk #RCC, pembro= DFS advantage, but w cost- Grade 3 AEs= 32%. High risk #RCC defined by:
🔹Stage II w sarcomatoid features
🔹Stage III+
🔹Regional LN+/M1 disease

Quick overview of adj IO decision making:

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh 4/5 #TumorBoardTuesday
Thursday Case🎀

📷 TBT in an image
Nomograms, including ASSURE from @FoxChaseCancer can provide addtl context re: risk of recurrence–but remember:

⭐️Every patient is an individual!

Our guide to help lead discussions w pts re: risks/benefits of adj IO:

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Mar 10, 2023

@TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 2/5 #TumorBoardTuesday
Thurs Case🎀

Take🏠msg:
✅ctDNA= both tx decision making & MRD in #NSCLC
✅Identify actionable muts in dz where a bx not possible
✅Pros (serum test) & cons ($, inability to multiplex with IHC- aka PD-L1 status)

📚The thread:
threadreaderapp.com/thread/1633271…

@TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 3/5 #TumorBoardTuesday
Thurs Case🎀

🎥 TBT in a video
ctDNA + tissue-based NGS= highest sensitivity (do NOT miss actionable mutations in #NSCLC).
ctDNA can be used to:
🔹Identify actionable mutations
🔹Track disease status (MRD)
🔹Adapt targeted therapies based on 2dary muts

@TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 4/5 #TumorBoardTuesday
Thurs Case🎀

📷 TBT in an image

Also have to understand caveats!
1⃣ctDNA works best in higher volume dz.
2⃣Know when to suspect germline mut (variant allele fractions near 50%)
3⃣Clonal hematopoiesis of indeterminate potential muts that could mislead!

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Mar 3, 2023

@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 2/5 #TumorBoardTuesday
Case🎀

✅CDK4/6i +endocrine tx= 1L HR+ mBC
✅Ribo =⬆️OS; select based on shared decision
✅After prog on CDK4/6i, eval muts (ESR1, PIK3CA)➡️SERD vs PIK3CAi
✅Benefit in adj- monarchE

📚Here’s @drsarahsam @PTarantinoMD’s thread
threadreaderapp.com/thread/1630734…

@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 3/5 #TumorBoardTuesday
Case🎀

🎥 TBT in a video: HR+ #mBC tx has changed significantly, esp in 2L setting.

Check out this SHORT video w algorithm to approach tx after progression on CDK4/6i:

A bigger and bigger role for 🎯 medicine to select next best therapy!

@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 4/5 #TumorBoardTuesday
Case🎀

📷 TBT in an image: Selecting CDK4/6i involves shared decision making! Things to keep in mind:

🔹OS benefit seen with ribociclib, but not palbo.
🔹Different toxicity profiles
🔹Medication interactions (QTc prolongation w ribo+ tamoxifen!)

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Feb 24, 2023

@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 2/5 #TumorBoardTuesday
Thurs Case🎀
✅Biomarker - sq cell #LC, chemoIO is the SOC
✅Pembro, cemi, ipi/nivo approved in 1L squamous cell lung cancer—must be paired with chemo if PD-L1 TPS < 50%
✅ irAEs can be very serious- early, multi-D mgmt is 🗝️

https://twitter.com/ShrutiPatelMD/status/1628199185056153604

@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 3/5 #TumorBoardTuesday
Thurs Case🎀

📽️TBT video wrap up:

IO has fundamentally changed 🫁 cancer tx.
Choosing the right strategy in squamous cell lung ca largely based on PD-L1 status; we’re hoping for more, & better, biomarkers in the future.

@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 4/5 #TumorBoardTuesday
Thurs Case🎀

📷TBT in an image:

Check out this algo to help select IO vs chemoIO strat in #squamouscell #lcsm lung cancer 1L setting.
No head-to-head 👊data to define clear winner, but pembro, cemiplimab, and ipi/nivo approved based on OS benefit.