@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance 1/22 #TumorBoardTuesday #ColonCancerAwarenessMonth #OncTwitter @shafiarahman_
62 yo 👨🏼🦳 asymptomatic
🔦 Screening colonoscopy - sigmoid mass
🔬Biopsy + for pMMR/MSS adenocarcinoma
🩻Staging CT + for unresectable liver mets
🤨What first line systemic treatment would you choose?
62 yo 👨🏼🦳 asymptomatic
🔦 Screening colonoscopy - sigmoid mass
🔬Biopsy + for pMMR/MSS adenocarcinoma
🩻Staging CT + for unresectable liver mets
🤨What first line systemic treatment would you choose?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ 2/22 #TumorBoardTuesday @MPishvaian @JohnEbbenMDPhD #CRCAwarenessMonth
👨🏼🦳started on first line FOLFOX
🧪NGS testing
KRAS/BRAF WT
TMB low
ERBB2 negative
ATM mutation
👨🏼🦳started on first line FOLFOX
🧪NGS testing
KRAS/BRAF WT
TMB low
ERBB2 negative
ATM mutation
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ 3/22 #TumorBoardTuesday #GI23 #CRCAwareness
👩🏻🏫Mini tweetorial 1👨🏻🏫
↩️Left side tumors more common:
BRAF WT
KRAS WT
HER2 amp
↪️Right side tumors enriched for
BRAF V600E mutation
KRAS Mut
MSI-H
📚@ASCO
👩🏻🏫Mini tweetorial 1👨🏻🏫
↩️Left side tumors more common:
BRAF WT
KRAS WT
HER2 amp
↪️Right side tumors enriched for
BRAF V600E mutation
KRAS Mut
MSI-H
📚@ASCO
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO 4/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 2👨🏻🏫
📌RAS Mutation = resistance to anti-EGFR therapy
📌KRAS muts:🕵🏻 detected by NGS- tissue or liquid bx #ctDNA
≈49% of #CRC= KRAS/NRAS muts
KRAS codons 12 (30%) & 13 (~8%) of exon 2. NRAS (exons 2, 3, 4)
📚pubmed.ncbi.nlm.nih.gov/26189770/
👩🏻🏫Mini tweetorial 2👨🏻🏫
📌RAS Mutation = resistance to anti-EGFR therapy
📌KRAS muts:🕵🏻 detected by NGS- tissue or liquid bx #ctDNA
≈49% of #CRC= KRAS/NRAS muts
KRAS codons 12 (30%) & 13 (~8%) of exon 2. NRAS (exons 2, 3, 4)
📚pubmed.ncbi.nlm.nih.gov/26189770/
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO 5/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 3
🥇Tissue test “gold standard” but liquid bx⬆️concordance (80-93%)
⚡Fast
💁Concordance highest with liver mets> peritoneal >🫁in mCRC
📚Corcoran, RB @NatureMedicine doi.org/10.1038/s41591…
📚@YoshinoriKagawa aacrjournals.org/clincancerres/…
👩🏻🏫Mini tweetorial 3
🥇Tissue test “gold standard” but liquid bx⬆️concordance (80-93%)
⚡Fast
💁Concordance highest with liver mets> peritoneal >🫁in mCRC
📚Corcoran, RB @NatureMedicine doi.org/10.1038/s41591…
📚@YoshinoriKagawa aacrjournals.org/clincancerres/…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa 6/22 #TumorBoardTuesday
#ColonCancer
Back to case🔎
👨🏼Pmab added to FOLFOX after 1 cycle
📌Data for 1L Anti-EGFR inhibitor
👍🏽Several prior trials signal OS benefit of anti-EGFR tx in L side KRAS WT
❓Is frontline anti-EGFR essential in fit unresectable👨🏾 given clinical➕💰tox
#ColonCancer
Back to case🔎
👨🏼Pmab added to FOLFOX after 1 cycle
📌Data for 1L Anti-EGFR inhibitor
👍🏽Several prior trials signal OS benefit of anti-EGFR tx in L side KRAS WT
❓Is frontline anti-EGFR essential in fit unresectable👨🏾 given clinical➕💰tox
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @cathyengMD @gillsharlene @basselelrayesmd @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @madhueluri @oncbrothers @KristenCiombor @cancerassassin1 @celsomello15 @marilomediano @mgfakih
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih 7/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 4👨🏻🏫
✨FIRE-3
📌Ph 3 RCT, untreated, unresectable KRAS exon 2 WT #CRC
📍592 pt 🎲 FOLFIRI + Cetux vs FOLFIRI + Bev
1° objective: ORR not met (62% vs 52%)
2° analysis: improved OS with anti-EGFR vs anti-VEGF for RAS WT
@TheLancetOncol
👩🏻🏫Mini tweetorial 4👨🏻🏫
✨FIRE-3
📌Ph 3 RCT, untreated, unresectable KRAS exon 2 WT #CRC
📍592 pt 🎲 FOLFIRI + Cetux vs FOLFIRI + Bev
1° objective: ORR not met (62% vs 52%)
2° analysis: improved OS with anti-EGFR vs anti-VEGF for RAS WT
@TheLancetOncol
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol 8/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 5👨🏻🏫
✨CALGB/SWOG 80405
📌Phase III RCT
📍1137 patients with untreated, unresectable KRAS WT #CRC
mFOLFOX6 or FOLFIRI backbone
🎲Randomized to cetux or bev
Similar OS (32 vs 31.2 mos)
📚@HJLenz59 doi.org/10.1001/jama.2…
👩🏻🏫Mini tweetorial 5👨🏻🏫
✨CALGB/SWOG 80405
📌Phase III RCT
📍1137 patients with untreated, unresectable KRAS WT #CRC
mFOLFOX6 or FOLFIRI backbone
🎲Randomized to cetux or bev
Similar OS (32 vs 31.2 mos)
📚@HJLenz59 doi.org/10.1001/jama.2…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 9/22 #TumorBoardTuesday #ColonCancer
👩🏻🏫Mini tweetorial 6👨🏻🏫
✨PEAK
📌Phase II RCT
📍156 patients with RAS/RAS WT untreated, unresectable #CRC
mFOLFOX6 + Pmab or Bev
👍🏽Improved OS with anti-EGFR (41.3 vs 28.9 mos)
📚@OncSTATdoc link.springer.com/article/10.100…
👩🏻🏫Mini tweetorial 6👨🏻🏫
✨PEAK
📌Phase II RCT
📍156 patients with RAS/RAS WT untreated, unresectable #CRC
mFOLFOX6 + Pmab or Bev
👍🏽Improved OS with anti-EGFR (41.3 vs 28.9 mos)
📚@OncSTATdoc link.springer.com/article/10.100…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc 10/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 7👨🏻🏫
✨PARADIGM
📌Phase III, multi-center, RCT
📍604 pts with L sided RAS WT untreated, unresectable #CRC
🎲Randomized to mFOLFOX6 + Pan vs Bev
👍🏽OS improved with Pan (37.9 vs 34.3 mos)
📚doi.org/10.1200/jco.20…
👩🏻🏫Mini tweetorial 7👨🏻🏫
✨PARADIGM
📌Phase III, multi-center, RCT
📍604 pts with L sided RAS WT untreated, unresectable #CRC
🎲Randomized to mFOLFOX6 + Pan vs Bev
👍🏽OS improved with Pan (37.9 vs 34.3 mos)
📚doi.org/10.1200/jco.20…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc 11/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 8👨🏻🏫
✨STRATEGIC-1
📌Phase III, RCT
📍263 pts with untreated, unresectable, RAS/RAF WT CRC (86% left side 1°)
💪🏽A: FOLFIRI-Cetux then mFOLFOX6-Bev
💪🏽B: OPTIMOX-Bev then FOLFIRI-Bev then EGFR mab +/- irinotecan
ascopubs.org/doi/10.1200/JC…
👩🏻🏫Mini tweetorial 8👨🏻🏫
✨STRATEGIC-1
📌Phase III, RCT
📍263 pts with untreated, unresectable, RAS/RAF WT CRC (86% left side 1°)
💪🏽A: FOLFIRI-Cetux then mFOLFOX6-Bev
💪🏽B: OPTIMOX-Bev then FOLFIRI-Bev then EGFR mab +/- irinotecan
ascopubs.org/doi/10.1200/JC…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc 11.5/22 #TumorBoardTuesday
STRATEGIC-1 Trial showed similar DDC and OS
Suggests EGFR therapy important but not needed first line
STRATEGIC-1 Trial showed similar DDC and OS
Suggests EGFR therapy important but not needed first line
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc 12/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 9👨🏻🏫
✨FIRE-3, CALGB/SWOG 80405, PEAK
📌 AE’s
Anti-EGFR
⬆️ acneiform rash
🧃 electrolyte disorders
🥱 fatigue
🚽 diarrhea
💰 Financial toxicity
Anti-VEGF
⬆️ thrombosis
🫀 hypertension
👩🏻🏫Mini tweetorial 9👨🏻🏫
✨FIRE-3, CALGB/SWOG 80405, PEAK
📌 AE’s
Anti-EGFR
⬆️ acneiform rash
🧃 electrolyte disorders
🥱 fatigue
🚽 diarrhea
💰 Financial toxicity
Anti-VEGF
⬆️ thrombosis
🫀 hypertension
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc 13/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 10👨🏻🏫
Is tumor side🗝️to select tx?
@KoheiShitara/✨PARADIGM
🩸🧬ctDNA alterations & relation to anti-EGFR tx resistance
🔹hyperselected pts, RAS wt via ctDNA=
⬆️OS w PAN vs BEV regardless of tumor side
HR 0.76 - 0.82 w mOS 6.6-8.0 mo
👩🏻🏫Mini tweetorial 10👨🏻🏫
Is tumor side🗝️to select tx?
@KoheiShitara/✨PARADIGM
🩸🧬ctDNA alterations & relation to anti-EGFR tx resistance
🔹hyperselected pts, RAS wt via ctDNA=
⬆️OS w PAN vs BEV regardless of tumor side
HR 0.76 - 0.82 w mOS 6.6-8.0 mo
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @felipepatologia @giuseppeingrav2 @raulsgonzalezmd @drkatepedersen @marklewismd @benweinbergmd @drlauragoff @coloncancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @thaymoro @kaopubear @karunamdphd
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 14/22 #TumorBoardTuesday #ColonCancer
Back to the case🔎
🗓️3 mos later- switched to maint chemo x 6 mo
🩻scans, 9 mo : POD in liver, new peritoneal nodules & hilar LN
🩸ctDNA no new alteration
🔀Therapy switched: FOLFIRI+Bev
🗓️4 mos later
🩻scans: PR
🤨 What next?
Back to the case🔎
🗓️3 mos later- switched to maint chemo x 6 mo
🩻scans, 9 mo : POD in liver, new peritoneal nodules & hilar LN
🩸ctDNA no new alteration
🔀Therapy switched: FOLFIRI+Bev
🗓️4 mos later
🩻scans: PR
🤨 What next?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 15/22 #TumorBoardTuesday #ColonCancer
⏰When to rechallenge EGFR treatment?
⏰Optimal time to rechallenge with anti-EGFR mAb?
Post-progression on anti-EGFR mAb, RAS & EGFR mutations decreases ⬇️ half life ≈ 4 months
📚 annalsofoncology.org/article/S0923-…
⏰When to rechallenge EGFR treatment?
⏰Optimal time to rechallenge with anti-EGFR mAb?
Post-progression on anti-EGFR mAb, RAS & EGFR mutations decreases ⬇️ half life ≈ 4 months
📚 annalsofoncology.org/article/S0923-…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 15.5/22 #TumorBoardTuesday
What would be your next line?
💉TAS - 102 +/- Bev
💉Regorafenib +/- PDL-1 ⛔
💉TAS - 102 +/- EGFR rechallenge
💉Clinical Trial
What would be your next line?
💉TAS - 102 +/- Bev
💉Regorafenib +/- PDL-1 ⛔
💉TAS - 102 +/- EGFR rechallenge
💉Clinical Trial
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 16/22 #TumorBoardTuesday #GI23
👩🏻🏫Mini tweetorial 11👨🏻🏫
✨VELO
📌EGFR rechallenge
📍Ph II RCT
62 pts: RAS WT mCRC on 3L; prior EGFR response & ≥4 mos EGFR break
TAS-102 v TAS -102 + PAM
mPFS: 4 mos💪🏽B v 2.5 mos💪🏽A (HR): 0.48; 95% CI 0.28-0.82; P = 0.007)
📚ascopubs.org/doi/10.1200/JC…
👩🏻🏫Mini tweetorial 11👨🏻🏫
✨VELO
📌EGFR rechallenge
📍Ph II RCT
62 pts: RAS WT mCRC on 3L; prior EGFR response & ≥4 mos EGFR break
TAS-102 v TAS -102 + PAM
mPFS: 4 mos💪🏽B v 2.5 mos💪🏽A (HR): 0.48; 95% CI 0.28-0.82; P = 0.007)
📚ascopubs.org/doi/10.1200/JC…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 17/22 #TumorBoardTuesday #GI23
👩🏻🏫Mini tweetorial 12👨🏻🏫
📌EGFR rechallenge
📍Ph II single arm 1°
35 pts w RAS/RAF WT advanced, prev tx CRC: 94% L side
83%: EGFR tx
Tx w anti-PD-1, cetux & irinotecan until POD
36.4% ORR, DCR 78.8%, mPFS not reached
Xu @ASCO ascopubs.org/doi/10.1200/JC…
👩🏻🏫Mini tweetorial 12👨🏻🏫
📌EGFR rechallenge
📍Ph II single arm 1°
35 pts w RAS/RAF WT advanced, prev tx CRC: 94% L side
83%: EGFR tx
Tx w anti-PD-1, cetux & irinotecan until POD
36.4% ORR, DCR 78.8%, mPFS not reached
Xu @ASCO ascopubs.org/doi/10.1200/JC…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 18/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 13
✨REMARRY/PURSUIT
📌EGFR rechallenge
50 pts w mCRC
🔹h/o EGFR tx (prior CR/PR) ≥4 mo EGFR mAb-free ➡️PMAB+Iri
✅RAS/RAF WT by ctDNA
1° endpt 🚫 met; BUT ⬆️ORR pts >1y anti-EGFR 🆓 interval (44.4% vs 7.3%)
📚ascopubs.org/doi/10.1200/JC…
👩🏻🏫Mini tweetorial 13
✨REMARRY/PURSUIT
📌EGFR rechallenge
50 pts w mCRC
🔹h/o EGFR tx (prior CR/PR) ≥4 mo EGFR mAb-free ➡️PMAB+Iri
✅RAS/RAF WT by ctDNA
1° endpt 🚫 met; BUT ⬆️ORR pts >1y anti-EGFR 🆓 interval (44.4% vs 7.3%)
📚ascopubs.org/doi/10.1200/JC…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 18.5/22 #TumorBoardTuesday During @MPishvaian’s #GI23 preview thread, he mentioned this trial as well.
https://twitter.com/mpishvaian/status/1620591610303250433?s=46&t=jovGcLm2fbsoIiomL-WuNw
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 19/22 #TumorBoardTuesday
✨CAVE
📌EGFR re-tx +IO
📍Avelumab & cetux
Pt pop:
🔹77 pts 3L prior chemo + anti-EGFR mAb in 1L & CR/PR; rechallenge w above.
✅RAS/BRAF WT= mPFS 4.1 months & mOS of 17.3 months vs mPFS of 3.0 months & mOS of 10.4 months w muts doi.org/10.1001/jamaon…
✨CAVE
📌EGFR re-tx +IO
📍Avelumab & cetux
Pt pop:
🔹77 pts 3L prior chemo + anti-EGFR mAb in 1L & CR/PR; rechallenge w above.
✅RAS/BRAF WT= mPFS 4.1 months & mOS of 17.3 months vs mPFS of 3.0 months & mOS of 10.4 months w muts doi.org/10.1001/jamaon…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD 20/22 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 16👨🏻🏫
✨CHRONOS
📌EGFR rechallenge
📍Phase 2 Multi-center single 💪
27 pts with prior anti-EGFR mAb & baseline RAS, BRAF & EGFR ECD WT by ctDNA
ORR 30%, avg response 17 wks, DCR 63%, mOS 55 wks
📚@Albert0Bardelli doi.org/10.1038/s41591…
👩🏻🏫Mini tweetorial 16👨🏻🏫
✨CHRONOS
📌EGFR rechallenge
📍Phase 2 Multi-center single 💪
27 pts with prior anti-EGFR mAb & baseline RAS, BRAF & EGFR ECD WT by ctDNA
ORR 30%, avg response 17 wks, DCR 63%, mOS 55 wks
📚@Albert0Bardelli doi.org/10.1038/s41591…
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD @Albert0Bardelli 21/22 #TumorBoardTuesday #CRCAwareness
Back to our case🔎
👨🏼🦳 Enrolled on clinical trial NCT02693535
🗓️2 months later POD
👨🏼🦳 currently Enrolled on another clinical trial NCT05328908
🤞🏼EGFR rechallenge remains the next line of option
Back to our case🔎
👨🏼🦳 Enrolled on clinical trial NCT02693535
🗓️2 months later POD
👨🏼🦳 currently Enrolled on another clinical trial NCT05328908
🤞🏼EGFR rechallenge remains the next line of option
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD @Albert0Bardelli 22/22 #TumorBoardTuesday
Thank you to @shafiarahman_ and all of @TumorBoardTues
#CRCAwareness
Thank you to @shafiarahman_ and all of @TumorBoardTues
#CRCAwareness
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD @Albert0Bardelli #PostTest Q1️⃣ #TumorBoardTuesday
👉🏽#CME Eval 🔗 integrityce.com/tbtEval
👉🏽ALL CME🔗 integrityce.com/tbt
🤔@shafiarahman_ @RischZack taught us EGFR in #CRC, test your 🧠 with quick❓
🧐What 1L would you pick for 62yo with ASx, L side met #ColonCancer unresectable liver mets?
👉🏽#CME Eval 🔗 integrityce.com/tbtEval
👉🏽ALL CME🔗 integrityce.com/tbt
🤔@shafiarahman_ @RischZack taught us EGFR in #CRC, test your 🧠 with quick❓
🧐What 1L would you pick for 62yo with ASx, L side met #ColonCancer unresectable liver mets?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ @ASCO @NatureMedicine @YoshinoriKagawa @MGHCancerCenter @CathyEngMD @GillSharlene @BasselElRayesMD @aparna1024 @gabe_a_brooks @the_danielahn @ShaalanBeg @MadhuEluri @OncBrothers @KristenCiombor @cancerassassin1 @CelsoMello15 @MariloMediano @mgfakih @TheLancetOncol @HJLenz59 @OncSTATdoc @KoheiShitara @EGFRResisters @FelipePatologia @GiuseppeIngrav2 @RaulSGonzalezMD @DrKatePedersen @marklewismd @benweinbergmd @drlauragoff @ColonCancerDoc @elena_elez @Javier_RosMD @TaberneroJosep @MassGeneralNews @ThayMoRo @kaopubear @KarunaMDPhD @Albert0Bardelli #PostTest Q2️⃣ #TumorBoardTuesday
👉🏽 Free CME (AMA & MOC)
🔗integrityce.com/tbt
🔬Path results for 62yo 👨🏾🦳 with left-sided, metastatic #ColonCancer (unresectable liver mets) who has undergone 1 cycle of FOLFOX: disease is KRAS wild type
🧐What would you add to tx regimen?
👉🏽 Free CME (AMA & MOC)
🔗integrityce.com/tbt
🔬Path results for 62yo 👨🏾🦳 with left-sided, metastatic #ColonCancer (unresectable liver mets) who has undergone 1 cycle of FOLFOX: disease is KRAS wild type
🧐What would you add to tx regimen?
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