Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Feb 16, 2023 • 14 tweets • 89 min read • Read on X

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 2/5 #TumorBoardTuesday
Case🎀

Take🏠
✅For plat ineligible, pembro=1L option
✅4 cycles of plat tx ➡️ IO maint equally efficacious to 6 cycles
✅Early prog predicts⬇️2L IO benefit
✅💔Myocarditis irAE needs aggressive mgmt

📚@arkhaki @glovedoc’s thread
threadreaderapp.com/thread/1625661…

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 2.5/5 #TumorBoardTuesday

Bonus: @PGrivasMDPhD & @rafee_talukder recently discussed platinum eligibility & tx options- take a look here:
threadreaderapp.com/thread/1612977…

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 3/5 #TumorBoardTuesday
Thurs Case🎀

🎥 TBT in video
Pembro= 1L option for pts not eligible for plat tx.
☑️4 cycles plat doublet AS GOOD as 6 in plat eligible
💔ICI myocarditis is rare, but serious- we discuss tx

Quick video summary covering major pts in just over 2 mins!

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 4/5 #TumorBoardTuesday
Thurs Case🎀

📷 TBT in an image: Quick overview of tx options in advanced #urothelialcarcinoma.

For patients that DO receive platinum tx, initial response is predictive of IO efficacy in the 2L setting.

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly 5/5 #TumorBoardTuesday
Thursday Case🎀

🙏IO offers option to pts not able to receive platinum tx to treat #urothelialcarcinoma
🤔Awaiting data on ADC + IO combos

➡️Join us on 02/21/2023: @NarjustFlorezMD @ShrutiPatelMD present a case of
I/O + chemo #LCSM #LungCancer 😀

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD Are you a fellow? Do you enjoy #TumorBoardTuesday?

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https://twitter.com/tumorboardtues/status/1626346939267571714?s=46&t=lDEBuGMETCvxXbFrHGz9oQ

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD Remember #TumorBoardTuesday continues to offer AMA & MOC credit for FREE! Don’t forget to answer the polls👇🏽
Then click this link to quickly request your credit!
CME eval🔗: integrityce.com/tbteval
ALL CME 🔗: integrityce.com/tbt

https://twitter.com/glovedoc/status/1625677198295457792?s=46&t=lDEBuGMETCvxXbFrHGz9oQ

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD @HanZhuMD @PauloBergerot @DrChoueiri @spsutkaMD @AlbigesL @TiansterZhang @shilpaonc @montypal @PGrivasMDPhD @tompowles1 @KidneyCancerDoc @NazliDizman @ShuchiGulati @wandering_gu @DrKarineTawagi

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD @HanZhuMD @PauloBergerot @spsutkaMD @AlbigesL @TiansterZhang @shilpaonc @montypal @tompowles1 @KidneyCancerDoc @NazliDizman @ShuchiGulati @wandering_gu @DrKarineTawagi @neerajaiims @sophia_kamran @RCCadvocate @DarcyBurbage @TripNish @PBarataMD @ReneeBultijnck @helitropen @ciaraconduit @DVCastro_ @RohanGarjeMD @bev_chigarira @cdanicas @KunalDesaiMD @persandstorm @ranjithramamd @GGiannarini @DRBakaloudiMD

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD @HanZhuMD @PauloBergerot @spsutkaMD @AlbigesL @TiansterZhang @shilpaonc @montypal @tompowles1 @KidneyCancerDoc @NazliDizman @ShuchiGulati @wandering_gu @DrKarineTawagi @neerajaiims @brian_rini @crisbergerot @DrYukselUrun @KidneyCancer @HHammersMD @arihakimi @AmandaNizamMD @QingZhangLab @DrRanaMcKay @DrScottHaake @DrDavidNanus @PavlosMsaouel @OAlhalabiMD @kcCURE @motzermd @MosheOrnsteinMD @RenoHemonc @Daniel_J_George @JVentoMD @KFronhas

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD @HanZhuMD @PauloBergerot @spsutkaMD @AlbigesL @TiansterZhang @shilpaonc @montypal @tompowles1 @KidneyCancerDoc @NazliDizman @ShuchiGulati @wandering_gu @DrKarineTawagi @neerajaiims @crisbergerot @BlkBoiScientist @dawood_findakly @mtsiatas @sonpavde @nataliagandur @LauraEsfeller @DrJeffreyGraham @BourlonMaite @PBarataMD @TomJayram @drenriquegrande @YuWeiChenMD @minaseconomides @DrRosenbergMSK @FedGhali @betsykoehne @JonAnker1 @fuatbcr @MikeSerzanMD

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD @HanZhuMD @PauloBergerot @spsutkaMD @AlbigesL @TiansterZhang @shilpaonc @montypal @tompowles1 @KidneyCancerDoc @NazliDizman @ShuchiGulati @wandering_gu @DrKarineTawagi @neerajaiims @UROncDoc @koshkin85 @TomJayram @arnabguonc @UroCancerMD @vinay_onc @simon_p_kim @AlexAlvaro_PSC @AlyaShamsan @MichaelStaehler @DrOmarMian @kaydaustin @josiegarcia1 @LeeJonesMBA @mcricardoa @UroDocAsh @Uromigos @AJangMD @BenMironMD @ChrisSweens1

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD @HanZhuMD @PauloBergerot @spsutkaMD @AlbigesL @TiansterZhang @shilpaonc @montypal @tompowles1 @KidneyCancerDoc @NazliDizman @ShuchiGulati @wandering_gu @DrKarineTawagi @DRBakaloudiMD @arkhaki @DMakrakisMD @LDiamantMD @Tanjin097 @NikiTripathi27 @JessicaHawleyMD
@JLWrightMD @ZakhariaYousef @cdanicas @niklas_kluemper @BradMcG04 @ERPlimackMD @DrTylerStewart @DanielPetrylak @MarkTysonMD @EHeath4100 @ArjunBalarMD @djmcconkey @MaxKates @tbivala1

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos @ParamMD @UroOnc @vinay_onc @brian_rini @MichaelStaehler @DrChoueiri @dawood_findakly @NarjustFlorezMD @ShrutiPatelMD @HanZhuMD @PauloBergerot @spsutkaMD @AlbigesL @TiansterZhang @shilpaonc @montypal @tompowles1 @KidneyCancerDoc @NazliDizman @ShuchiGulati @wandering_gu @DrKarineTawagi @DRBakaloudiMD @drphil_urology @MichalisLiontos @ewanagibb @AndreaNecchi @GiorgioBre @MattGalsky @giannatempopatr @ewanagibb @SpiessPhilippe @maughanonc
@umangtalking @sandysrimd @sumitshahMD
@DrTylerStewart @Dr_Aggen @drenriquegrande
@DrDanielHeng @motzermd @AlbigesL @shilpaonc

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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.

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