Johnathan Ebben MD, PhD

Follow @JohnEbbenMDPhD

Mar 17 • 9 tweets • 56 min read

@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:

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh @FoxChaseCancer @UROncDoc @KidneyCancerDoc @KidneyCancer @JessicaHawleyMD @ArjunBalarMD @JineshGheeya 5/5 #TumorBoardTuesday
Thursday Case🎀

🙏 IO (pembro) offers new tool to be carefully used in select pts to ⬇️#RCC recurrence risk
🤔Ongoing work re why anti-PD-L1 and anti-CTLA-4 agents= no DFS advantage.

➡️Join us on 3.21.23: @RischZack @shafiarahman_ discuss #EGFR in #CRC

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh @FoxChaseCancer @UROncDoc @KidneyCancerDoc @KidneyCancer @JessicaHawleyMD @ArjunBalarMD @JineshGheeya @RischZack @shafiarahman_ 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/jventomd/status/1635808236954689536?s=46&t=-_-3tKLJVODQqAvtvK2w6g

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh @FoxChaseCancer @UROncDoc @KidneyCancerDoc @KidneyCancer @JessicaHawleyMD @ArjunBalarMD @JineshGheeya @RischZack @shafiarahman_ @morr316 @MSKCC @rmistry91 @Tucker_MatthewD @MVossMD @archie_hh @DrTanWP
@montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @KidneyCancer @HHammersMD @arihakimi @RCCadvocate @AmandaNizamMD @QingZhangLab @DrRanaMcKay @DrScottHaake @DrDavidNanus

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh @FoxChaseCancer @UROncDoc @KidneyCancerDoc @KidneyCancer @JessicaHawleyMD @ArjunBalarMD @JineshGheeya @RischZack @shafiarahman_ @morr316 @mskcc @rmistry91 @Tucker_MatthewD @MVossMD @archie_hh @DrTanWP @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @TiansterZhang @PavlosMsaouel @OAlhalabiMD @kcCURE @motzermd @MosheOrnsteinMD @neerajaiims @RenoHemonc @DrChoueiri @Daniel_J_George @ctsanhue @blkboiscientist @dawood_findakly @mtsiatas @sonpavde @nataliagandur @lauraesfeller @drjeffreygraham @bourlonmaite @PBarataMD @tomjayram

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh @FoxChaseCancer @UROncDoc @KidneyCancerDoc @KidneyCancer @JessicaHawleyMD @ArjunBalarMD @JineshGheeya @RischZack @shafiarahman_ @morr316 @mskcc @rmistry91 @Tucker_MatthewD @MVossMD @archie_hh @DrTanWP @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @DrYukselUrun @drenriquegrande @yuweichenmd @minaseconomides @drrosenbergmsk @FedGhali @betsykoehne @JonAnker1 @fuatbcr @UROncDoc @koshkin85 @tompowles1 @TomJayram @arnabguonc @KidneyCancerDoc @UroCancerMD @vinay_onc @simon_p_kim @AlexAlvaro_PSC @AlyaShamsan @MichaelStaehler @DrOmarMian

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh @FoxChaseCancer @UROncDoc @KidneyCancerDoc @KidneyCancer @JessicaHawleyMD @ArjunBalarMD @JineshGheeya @RischZack @shafiarahman_ @morr316 @mskcc @rmistry91 @Tucker_MatthewD @MVossMD @archie_hh @DrTanWP @montypal @PGrivasMDPhD @rafee_talukder @shilpaonc @kaydaustin @josiegarcia1 @LeeJonesMBA @mcricardoa @UroDocAsh @Uromigos @AJangMD @BenMironMD @ReisLO @jitenjaipuria @chriseden99 @ZSchwen @edison_marie @LoebStacy @Hoomandjaladat @Khoo_Uro @dralvaropinto @abhenilmittal @BerUrologia @garysteinbergmd @CharleneMantia @amedinacol

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More from @JohnEbbenMDPhD

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Mar 10

@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

@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

@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.

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Feb 16

@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!

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Feb 10

@TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 2/5 #TumorBoardTuesday
Take🏠msgs:
✅HER2 low= 1+ to 2+ IHC, -FISH
✅T-Dxd approved in 1L HER2 low
✅Watch tox, esp ILD (need reg CT thorax)!
✅TROP-2 ADCs an option (Sacituzumab govitecan); choose based on pt profile, agent tox

📚@drteplinsky’s thread:
threadreaderapp.com/thread/1623124…

@TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 3/5 #TumorBoardTuesday
🎥 TBT in a video
New 1L T-DXd option for patients w #mBC (HER2 low, ER/PR-).

T-DXd is an antibody drug conjugate (ADC), tethering deruxtecan payload to HER2 ab. Improvements over chemo in mOS and PFS, but watch carefully for ILD and all toxicities!

@TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 4/5 #TumorBoardTuesday
📷 TBT in an image

Check out quick proposed tx algorithm for HR+ & HR- HER2 low disease. Since HER2 low is defined as 1+ through 2+ on IHC with - FISH, up to ‼️60%‼️ of cases previously called HER2 NEGATIVE are actually HER2 LOW!

Johnathan Ebben MD, PhD

@JohnEbbenMDPhD

Oct 21, 2022

@TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc 2/4 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:
#HER2+ #BreastCancer
✅Localized, early ➡️neoadj tx w chemo + anti-HER2
✅⬆️DFS w T-DM1 for residual disease
✅Future role for T-DXd?

📚We captured @drteplinsky’s discussion in this moment: twitter.com/i/events/15831…

@TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc 3/4 #TumorBoardTuesday
Thursday Case🎀

📷 TBT in an image: Take a 👀at a (simplified) guide to treatment of early stage HER2+, localized #BreastCancer!

We review KATHERINE and use of ADCs to improve OS with residual disease. Is there an evolving role for T-DXd?

@TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc @dradityabardia @EricaMarieRomn1 @jacobadashek @esinghimd @BreastCaupdates 4/4 #TumorBoardTuesday
Thurs Case🎀

🙏 Anti-HER2+ tx in neoadj setting improves pCR. T-DM1 improves OS when residual disease is present.
🤔 Role for other ADCs or even neoadj setting?

➡️Be sure to join us 11.01.22 when @LeciaSequist presents a case of ALK+ #NSCLC #LungCancer

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