1/ #OncTwitter #NephTwitter #TumorBoardTuesday
#RenalCell #MedTweetorial🧵
w @brian_rini @shilpaonc @katy_beckermann

🦺TKI/IO safety data
🥽Tox to look 4
⛑AE mgmt

🆓#CME @BonumCe🔗bit.ly/3VDaK81
Support by edu grants from Eisai & @Merck

🟢What's your specialty?
2/ #TumorBoardTuesday #BonumCE #RenalCell #OncTwitter #NephTwitter
🆓#CME info ➕ full ref list🗒️ 👉 bit.ly/3VDaK81

✳️The critical elements👇 Image
3/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢 Which of the following TKI/IO combo regimens is 🚫NOT approved by the FDA for the frontline mgmt of #RenalCell carcinoma?
4/ #TumorBoardTuesday #BonumCE #OncTwitter #RenalCell

💎Combo txs as SOC for 1st line mRCC💎

TKI/ICI combos:
🔸#lenvatinib (TKI) + #pembrolizumab (PD-1 mAb)
🔸#axitinib (TKI) + pembro
🔸#cabozantinib (TKI) + #nivolumab (PD-1 mAb)

Dual ICI combo:
🔸#ipilimumab (CTLA-4) + nivo
5/#TumorBoardTuesday #RenalCell
🔑Ph3 trls #KEYNOTE426, #CLEAR, #CheckMate9ER, #CheckMate214

💎Each combo regimen ⬆️PFS, OS, & ORR vs sunitinib
💎Axi-avelumab approved but OS data immature
💎Benefit across IMDC risk groups
💎Axi-pembro=longest f/u among approved TKI-ICI in RCC Image
6/ #TumorBoardTuesday #BonumCE #OncTwitter #NephTwitter #MedTwitter #RenalCell

✳️Dual ICI combo (ipi + nivo) also approved tx option

💎#CheckMate214 - ipi + nivo vs sunitinib
✅Longest follow-up in frontline RCC (>5 years)
✅OS and PFS favor combo tx in int/poor risk pts Image
7/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢Which of the following is a characteristic feature of the most common toxicities associated with anti-angiogenic therapies?
8/#TumorBoardTuesday #BonumCE #RenalCell

Combo tx =possible⬆️tox➡️can lead to trtmnt🛑

✨Anti-angio inhibitors=multi🎯TKIs
✨AEs related to shared 🎯s (e.g. VEGFR)=predictable class tox
✨Some nuance due 2 diff🎯/potency
✨Typ occur 1st few wks of ▶️tx
✨Broadly dose-dependent
9/#TumorBoardTuesday #RenalCell
ICI AEs related to immunostimulatory MOA (irAEs)
✳️Most mild/mod severity & reversible
⚠️CAN become sev/fatal if not promptly Dx & Tx⚠️
👉Impact virtually any bodily system
🗓️Most occur “early” (<14wks after start tx), some can occur mos/yrs later Image of bodily systems tha...
10/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢Which of the following is an AE that is commonly observed with both ICIs and TKIs?
11/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

Some AEs attributable to either drug
These🔂overlapping tox can complicate pt mgmt Diagram of potential for in...
12/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🔬Common tox in pivotal Phase 3 trials of TKI-ICI combos🔬
#KEYNOTE426 #CLEAR #CHECKMATE9ER #JAVELINrenal101
🔹Diarrhea
🔸HTN
🔹Hypothyroidism
🔸Fatigue
🔹PPES
🔸Loss of appetite Graphs showing common tyros...
13/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🔬Common tox in pivotal P3 #CHECKMATE214 trial of dual ICI combo🔬
🔸Fatigue
🔹Pruritus
🔸Diarrhea
🔹Rash
🔸Nausea Infographic showing common ...
14/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

Effective tox mgmt ➡️optimize pt outcomes✅

🩺 Mgmt strategies include...🩺
🔹Prevention
🔸Monitor BP, urine protein, thyroid & liver function
🔹Dose modification (⏸️⬇️🛑)
🔸Supportive care Infographic showing managem...
15/ #TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🟢Pt w mRCC
🔸Initiated tx w pembro + lenva
🔹Developed G3 diarrhea
🔸Lenva withheld & anti-diarrheal treatment initiated 🔹Diarrhea now resolved.

🟢What next step is best for the pt?
16/#TumorBoardTuesday #RenalCell

If tox occurs,🔑strategy
🔸⬇️dose TKI
🔹Dose flex of TKIs>ICIs
🔸Axi fastest washout (hrs)

🔹Lenva 14mg➡️10mg ➡️8mg
🔸Axi 5mg➡️3mg➡️2mg
🔹Cabo 40mg QD➡️20mg QD➡️20mg QOD

Many pts need dose⬇️
BUT most can stay on tx if manage pt expectations
17/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🔬Research needed to ⬇️ tox while maintaining efficacy

❓Alternative dosing strategies (incl. dose breaks)
❓Effects of dose ⬇️ on pt outcomes
❓Effects of reduced ▶️ dose on pt outcomes
18/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

❓Effects of reduced ▶️ dose on pt outcomes

Limited prospective trial data to date: lenva 14mg ▶️ dose

🔸Lenva 14mg vs 18mg + pembro in EC ➡️14mg ▶️dose⬇️AEs & maint efficacy
19/#TumorBoardTuesday #BonumCE
#OncTwitter #RenalCell

Plethora of options…❓Which combo to pick❓
Lack H2H trials or reliable biomarkers∴choice based on clin features & other factors, including:

🔸Tumor burden
🔹Comorbidities
🔸Pt age/func status
🔹Physician/pt pref
🔸QoL
20/ #TumorBoardTuesday #BonumCE #RenalCell

💡Examples for treatment selection💡
⛏️High tumor burden➡️ICI/TKI➡️short⏱to response/deep responses

⛏️Older/frail pt➡️axi-pembro➡️greatest flexibility in dosing to avoid AEs

⛏️Uncontrolled HTN/CHF➡️ ipi-nivo➡️TKIs contraindicated
21/#TumorBoardTuesday
🔮Is triplet tx the future?
#COSMIC313=nivo + ipi + cabo int/poor-risk #RenalCell

3x tx sig⬆️PFS vs pbo+nivo+ipi (mPFS: NR vs 11.3mos)
🚫⬆️OS - follow-up ongoing
Sig ⬆️in tox - G3/4 TRAEs in 73% pts vs 41% for pbo arm
TRAEs leading to tx🛑:12% vs 5%
22/#TumorBoardTuesday

🔑Points
🔸TKI/ICI combos SOC 1L met #RenalCell
🔹⬆️PFS, OS & ORRs vs sunitinib all risk groups
🔸⬆️risk tox & potential 4 o’lap tox complicates pt mgmt
🔹Addl options incl axi-ave, dual ICI combo, & TKI monotx
🔸Choice guided by pt- & diz-specific factors
23/#TumorBoardTues #BonumCE
Thanks for joining us, @brian_rini, @shilpaonc, & @katy_beckermann

🔴Answer post-polls👇
Claim🆓#CME👉bit.ly/3VDaK81

🔴POST Poll1️⃣
🔴Which of the following TKI/IO combo regimens is 🚫NOT approved by the FDA for the frontline mgmt of RCC?
24/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter
#CME➡️ bit.ly/3W0R1Pq

🔴Post Poll2️⃣
🔴Which of the following is a characteristic feature of the most common toxicities associated with anti-angiogenic therapies?
25/#TumorBoardTuesday #BonumCE #RenalCell
#OncTwitter #NephTwitter #MedTwitter

🔴Post Poll3️⃣
CME➡️ bit.ly/3W0R1Pq

🔴Which of the following is an AE that is commonly observed with both ICIs and TKIs?
26/#TumorBoardTuesday #BonumCE #RenalCell

🔴Post Poll4️⃣
#CME➡️ bit.ly/3W0R1Pq

Pt w mRCC
🔸Initiated tx w pembro + lenva
🔹Developed G3 diarrhea
🔸Lenva withheld & anti-diarrheal treatment initiated 🔹Diarrhea now resolved.

🔴What next step is best for the pt?
27/#TumorBoardTuesday #BonumCE
#OncTwitter #NephTwitter #MedTwitter

🧗Climb your next RCC Mt⛰️
w experts @brian_rini @shilpaonc @katy_beckermann

Next🆙
Tue, 12/13: Convo w @shilpaonc

Then on🗓Thu, Dec 15 @ 8pm ET/5pm PT
🔥#RenalCell Carcinoma Fireside Chat🎥🔥 Save-the-date flyer for upc...

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with #TumorBoardTuesday

#TumorBoardTuesday Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @TumorBoardTues

Dec 15
1/🛎️#TumorBoardTuesday #OncTwitter #NephTwitter
#RenalCell wk continues🔁

🗓️Thu 12.15 @ 8p ET

⚙️Mnging AEs w TKI/IO combos

#CME ℹ️🔗bit.ly/3iLN6aX
Supported by edu grants from Eisai & @Merck
🚨Be ready 4 tmrw!
✅Answer #PreTest polls👇
🔁Retweet & tag colleagues🩺 Image
2/ 🏆Claim 🆓#CME 🔛 bit.ly/3iLN6aX

Answer Pre Polls Qs 👇today
🟢Where r u in your career?
3/ #TumorBoardTuesday #RenalCell #NephTwitter #MedTwitter #BonumCE

#CME🔗bit.ly/3FbuEQx

🟢#PreTest Q 1️⃣
📊 Which of the following is a common high-grade toxicity associated with the use of TKIs in the management of metastatic RCC?
Read 6 tweets
May 30
#TumorBoardTuesday #ASCO2022

📢@ASCO is only a few days away & we really wanted to put out our top abstracts to👀for

🙏note - we viewed several thousand titles - so we definitely may have missed some‼️
👉And these are not in any particular order

✅But enjoy, RT, and reply😀
#TumorBoardTuesday #ASCO2022
"Emerging"🎯💊
✅Dr. Jones👨‍🏫the Ph2 FAKTION trial of fulv/capi vs fulv/placebo for Breast Ca
➡️Capi⬆️mOS by 6 mos
➡️This⬆️jumped to 19 ms if the tumor harbored PIK3CA or AKT1 activating OR PTEN inactivating🧬mutations
🔎Breast Ca Oral Abstract # 1005
#TumorBoardTuesday #ASCO2022
"Emerging"🎯💊
✅Dr. Rixe👨‍🏫PhI data4⃣OBT076, an ADC🎯the CD205/Ly75 Ag - a receptor⬆️on immunosuppressive dendritic cells
➡️1⃣PR & 6⃣SD out of 2⃣0⃣pts
➡️Near CR in 2⃣pts who then had pembro
🤔Why wasn't☝️more than a poster❓
🔎Abs 3028, Poster 20
Read 32 tweets
May 25
🙏🏽Thank you @Latinamd @GDutcherMD for an informational & exhilarating #TumorBoardTuesday!!

🏆Remember 🆓CME

Look for the Case Wrap Up🎀 05/26/22

📅Mark your calendar for 𝙉𝙀𝙓𝙏 𝙒𝙀𝙀𝙆 05/31/22 when our own @MPishvaian joins us for a breakdown of #ASCO22 abstracts!!
🏝#TumorBoardTuesday education is beyond Twitter - we offer🆓CME!!

🫁Before you run off exploring, pick up your🏆#CME by answering quick questions regarding a case similar to @Latinamd’s‼️

🔗ALL CME: integrityce.com/tbt

🔗CME eval: integrityce.com/TBTEval

👇🏽🎁
#PostTest Q1️⃣ #CME #TumorBoardTuesday

🔗CME eval: integrityce.com/TBTeval

🫁@Latinamd @GDutcherMD took us through a case of MET exon 14 skip mutation #NSCLC - test your 🧠with these quick❓

🧐How common are METex14-skipping mutations in NSCLC (Non-Small Cell Lung Cancer)?
Read 6 tweets
May 23
#TumorBoardTuesday

🎓We have had some highly educational🗣️on tumor biomarkers
👍This week’s conversation will NOT disappoint

📢Join us as @Latinamd & @GDutcherMD from @SylvesterCancer discuss MET Exon 14 skip mutations in #NSCLC #Miami Image
#TumorBoardTuesday

@Latinamd & @GDutcherMD @TumorBoardTues 🗣️
📅Tuesday, 05/24/22 at🕗8PM ET
📊✅the polls
⚖️in & bring citations🧾
🔁Retweet & tag your🩺colleagues
🏆Earn your🆓CME and MOC integrityce.com/tbt

And B4⃣the case:
🧐tell us where you are in your🩺journey
👇
#TumorBoardTuesday

#PreTest Q 1⃣ #CME
Free CME 🔗: integrityce.com/tbt

🤔Before @Latinamd & @GDutcherMD🚶us through a case of MET Exon 14 skip mutations in #NSCLC, test your🧠with these 4 quick❓

How common are METex14-skipping mutations in Non-Small Cell Lung Cancer❓
Read 6 tweets
May 20
1/12 #TumorBoardTuesday
2L treatment in #HER2+ breast cancer #MBC is 🤯! @PTarantinoMD led us through latest evidence👩‍⚖️

➡️Here's the Thurs Case🎀
👉Grab🆓 #CME credit by answering quick❓
ALL CME 🔗: integrityce.com/tbt
CME rationale🔗: bit.ly/3NnreMW
Here we go!
2/12 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:
⬆️ options to tx HER2+ #MBC
✅T-DXd >T-DM1 in 2L setting (DESTINY BREAST-03)
✅Beware ADC tox- think 🫁pneumonitis & GI w T-Dxd
✅ADC design is 🗝:
➡️Need to consider DAR, linker, ability to cause ADCC
✅ADC + IO= open ❓
3/12 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages (cont’d):
✅T-DXd active against brain mets (TUXEDO-1)
✅Triplet (tucatinib, cape, tras) also active in brain mets
✅Next up: T-DXd in HER2 LOW- trials ongoing

📚We captured the discussion here:
twitter.com/i/events/15226…
Read 15 tweets
May 13
1/12 #TumorBoardTuesday

🔬🧬Discussion on #ColonCancer and BRAFv600E disease w dMMR led by @FlavioRochaMD
➡️Here is this week's Thurs Case🎀

👉👉 Don’t forget to pick up🆓 #CME credit by answering 2 quick ❓
ALL CME 🔗: integrityce.com/tbt
Now…we’re off to the races!
2/11 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:
#CRC 🚫one disease!
✅Diff 🧬subtypes that define tx sensitivity
✅BRAFv600E is bad–but may be ⬆️sensitive to IO w MLH1 meth
✅Neoadj tx: 🦊FOXTROT= poss benefit, depends on subgroup
✅Keynote177: IO= way to go in dMMR!
3/12 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages (cont’d):

✅ATOMIC will help answer ❓chemo/IO combo upfront is best in dMMR and BRAFv600E
✅POLEM trial also looking at adjuv IO in dMMR @shafiarahman_

📚We captured the discussion in this moment: twitter.com/i/events/15212…
Read 18 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(