Thread by @TumorBoardTues

#TumorBoardTuesday

🔬🧬Tx of #EGFR Exon20 insertion has changed significantly. @LealTiciana @JennyCarlisleMD brought us up to speed at #TumorBoardtuesday

➡️Here’s the Thursday Case 🎀
🆓 #CME: 2 quick❓
ALL CME 🔗: integrityce.com/TBT2023
CME eval🔗: integrityce.com/TBTeval23

2/8 #TumorBoardTuesday
Thurs Case🎀
✅Next gen seq=ESSENTIAL. PCR misses EGFR exon20 ins!
✅CHRYSALIS: Amivantamab (EGFR/MET Bispecifc mAb) 2L
✅EXCLAIM: Mobocertinib (EGFR TKI) 2L
✅1L= Plat chemo; 2L= ami/mobo

📚 @LealTiciana @JennyCarlisleMD’s thread
threadreaderapp.com/thread/1651013…

3/8 #TumorBoardTuesday
Thurs Case🎀
🎥 TBT in a video: Pt 1-
@LealTiciana takes us through importance of NGS–but not just any NGS.

🔹RNA/DNA based NGS>>> hotspot PCR, which may miss ex20 ins
🔹🩸ctDNA + tumor🧬= Make faster tx decision, ⬆️sens
🔹Identify trials, future options

4/8
Thurs Case🎀
🎥 TBT in a video: Pt 2-

🔹Amivantamab= EGFR/MET bispecific mAb; approved in 2L setting ex20
🔹Infusion rxn common; need to split dose, provide pre-meds (anti-histamines, steroids)--polysorbate 80 in formulation

5/8 #TumorBoardTuesday
Thurs Case🎀
🎥 TBT in a video: Part 3-

✅Mobocertinib= next gen EGFR TKI effective against ex20ins.
✅ORAL admin, but 👀for high rates of severe diarrhea 💩. Early anti-diarrheals, dose holds 🗝️
✅New agents coming w better CNS penetration!

6/8 #TumorBoardTuesday
Thurs Case🎀
📷 TBT in an image

How to choose btwn ex20 🎯? Focus on pt!
🔹Route of admin- strong pref for PO vs IV? Consider 💸copays!
🔹SE prof- ex if pt w sig GI issues, may want to try ami 1st.
🔹Ami &mobo=diff MOA- can try alt agent on progression

7/8 #TumorBoardTuesday
Thurs Case🎀

On the horizon: 1L ex20 directed tx
🦋PAPILLON= ami: clinicaltrials.gov/ct2/show/NCT04…
‼️ EXCLAIM-2=mobo:
clinicaltrials.gov/ct2/show/NCT04…

Both use plat backbone. NEED better solutions to plat chemo shortage that could limit ability to provide the best care!

8/8 #TumorBoardTuesday
Thursday Case🎀

🙏Precision approaches continue to offer better options for EGFR ex20 #NSCLC

➡️Join us on May 2, 2023 when @RachelRiechelm2 @jessrzanotti present a unique panc neuroendocrine tumor complicated by hypermutation related to tx!

Remember #TumorBoardTuesday continues to offer CME credit for FREE! Don’t forget to answer the polls👇🏽
Then click this link to quickly request your credit!
CME eval🔗: integrityce.com/TBTeval23
ALL CME 🔗: integrityce.com/TBT2023

https://twitter.com/jennycarlislemd/status/1651029559205154817?s=46&t=Dk6yTwEBK_VuZIaYI1ykHA