Mike Pishvaian Profile picture
Jun 13 22 tweets 106 min read Twitter logo Read on Twitter
@TumorBoardTues @JohnEbbenMDPhD #TumorBoardTuesday
📣Welcome as we summarize some of the incredible data from #ASCO23
👉There was SO much to take in, that even focusing on GI Cancers was a challenge
🙏As always, these were the🧑‍🏫that caught OUR interest, but this is not a judgement on those we do not highlight‼️
@TumorBoardTues @JohnEbbenMDPhD 1/21
#TumorBoardTuesday
🤔Speaking for myself, @knutjla ‘s data has shaken my practice the most (including twice last week)
👉He presented the NORPACT-1 trial of peri-operative FOLFIRINOX vs. upfront🔪for resectable #PancreaticCancer Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer 2/21
#TumorBoardTuesday
@knutjla🗣️a well designed, well run trial
✅The authors even hypothesized a 20%⬆️in mOS
➡️However, pre-operative chemotherapy led to a significant⬇️in 18 month mOS😲
👉Despite a much better R0 resection rate

🤔What are your thoughts💭❓ Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao 3/21
#TumorBoardTuesday
✅The other trial that hopefully can shake things up is @BenWestphalen 's FOOTPATH trial

👉Last year, we saw the SEQUENCE data demonstrated a significant⬆️in mOS for #PancreaticCancer with alternating gem-nab and FOLFOX, compared to gem-nab alone👇 Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao 6/21
#TumorBoardTuesday
🤔Maybe the 11 mo mOS w/ NAPOLI/FOLFOX is↔️to the 11.1 mo mOS w/ NALIRIFOX (@EileenMOReilly see below)❓
👉BUT NAPOLI/FOLFOX was quite well tolerated

🤔Maybe INTEGRATED SEQUENTIAL NAPOLI/FOLFOX is just a better way to give these3⃣agents❓ Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly 7/21
#TumorBoardTuesday
🤔ORRRR.....maybe NAPOLI/FOLFOX is a way for us to finally give a FFX-like regimen in the2⃣nd line after1⃣st line gem-nab❓

Would you consider INTEGRATED SEQUENTIAL NAPOLI/FOLFOX in the2⃣nd line after1⃣st line gem-nab❓
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly 8/21
#TumorBoardTuesday
✅Some of the exciting NOVEL data🗣️at #ASCO23 in #PancreaticCancer was with KRAS🎯💊

➡️@DrShubhamPant🗣️ an update on 57 Pts (21 w/ PDAC) Txed w/ the KRASG12C⛔️adagrasib
👉ORR 35% overall
👉N/V/D in ~50% of Pts - almost all Grade ≤2
👉6% Gr 3 fatigue Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant 9/21
#TumorBoardTuesday
@EileenMOReilly gave us our first👀at a KRAS vaccine
➡️ELI-002 is a KRASG12D/R & TLR-9🎯vaccine
➡️Only MRD Pts were eligible - i.e.🚫disease on🖥️, but ct🧬/biomarker➕

➡️The vaccine showed surrogate efficacy
👉77%⬇️in the marker
👉32% clearance of ct🧬 Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant 10/21
#TumorBoardTuesday
✅KRAS⛔️can be effective
👉 But the effect may be short lived

🤔Perhaps there will be⬆️outcomes with combination therapies❓

➡️Drillon, et al showed activity of a SHP2⛔️but only in combos
👉 E.g. SHP2i + encorafenib + cetux in a BRAFV600E mutated CRC Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant 11/21
#TumorBoardTuesday
✅In #cholangiocarcinoma @DrShubhamPant & Dr. Nakamura🗣️exciting data on HER2🎯💊
👉Tx w/ tucat+trastuz➡️a 47% ORR in 30 Pts
&
👉Zanidatamab➡️a 41% ORR in 80 Pts

✅Giving us two new options for these patients that we might be able to use in sequence❓ Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant 12/21
#TumorBoardTuesday
➡️Dr. Ying🗣️that adding anti-PD1➕anti-VEGF mAbs⬆️PFS in advanced BTC
👉BUT, AEs were⬆️with 4💊Tx
👉This is consistent with the ImBrave151 trial

🤔Stay tuned for OS data Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant 13/21
#TumorBoardTuesday
➡️Dr. Agrawal🗣️that Chemo☢️for Pts w/ locally advanced GB cancer after gem-cis X 4 cycles improved mOS (10mos) vs observation (4 mos)
🤔BUT with 13% ☢️-induced liver disease, and 6% with a fatal GI bleed

✅This probably doesn’t change our paradigm yet Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant 14/21
#TumorBoardTuesday
➡️For Claudin 18.2➕G/GEJ cancers, Dr. Xu🗣️in the GLOW trial that that zolbetuximab added to CAPOX⬆️mOS (14.4mos) compared to only CAPOX (12.2mos)
➡️This is consistent with the SPOTLIGHT trial
➡️This should solidify FDA approval for zolbetuximab (IMHO) Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant @KoheiShitara @DrKelseyKlute @ILSONDavid @kspencer725 15/21
#TumorBoardTuesday
➡️Adding nivo to chemo⬆️OS in mG/GEJ Ca
➡️1y of adj nivo⬆️OS in Pts w/ E/GEJ Ca after chemo☢️
🤔What about post-op nivo for GASTRIC Ca❓

Dr. Terashima🗣️that for Pts w/resected gastric/GEJ Ca nivo added to adjuvant chemo did NOT⬆️3y relapse-free nor 3y OS Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant @KoheiShitara @DrKelseyKlute @ILSONDavid @kspencer725 @YJanjigianMD @mdmanishshah 16/21
#TumorBoardTuesday
➡️Finally, moving on to the management of advanced #colorectalcancer & rectal Ca, which is getting very complicated😲

➡️First, Dr. Antoniotti 🗣️an update of the AtezoTRIBE trial in which patients with mCRC were randomized to FOLFOXIRI-Bev +/- Atezo Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant @KoheiShitara @DrKelseyKlute @ILSONDavid @kspencer725 @YJanjigianMD @mdmanishshah 17/21
#TumorBoardTuesday
✅The authors had shown B4⃣ that atezo⬆️mPFS
➡️Now this was also true in dMMR and TMB-H Pts (as expected)
😲BUT in pMMR/Immunoscore-IC High Pts also had an⬆️mPFS & mOS w/ atezo
🤔Perhaps defining ANOTHER subgroup of Pts to benefit from IO in CRC❓ Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant @KoheiShitara @DrKelseyKlute @ILSONDavid @kspencer725 @YJanjigianMD @mdmanishshah @ChiaraCrem1 18/21
#TumorBoardTuesday
✅Dr. Jensen 🗣️the NeoCol trial in CRC, and similar to the NORPACT-1 trial above in PDAC, Pts with resectable CRC were randomized to surgery vs. neoadjuvant chemo
➡️But pre-op chemo did NOT⬆️Disease-free survival nor OS Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant @KoheiShitara @DrKelseyKlute @ILSONDavid @kspencer725 @YJanjigianMD @mdmanishshah @ChiaraCrem1 19/21
#TumorBoardTuesday
✅To put the PROSPECT trial in context, Dr. Conroy🗣️the PRODIGE 23 trial of TNT with FOLFIRINOX vs. Chemo☢️ for rectal
➡️TNT⬆️Disease-free survival compared to Chemo☢️
&
➡️TNT⬆️OS compared to Chemo☢️ Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant @KoheiShitara @DrKelseyKlute @ILSONDavid @kspencer725 @YJanjigianMD @mdmanishshah @ChiaraCrem1 20/21
#TumorBoardTuesday
🥁roll please...
✅Dr. Schrag🗣️the LONG awaited PROSPECT trial, which was designed on the premise that rectal Ca Pts could be cured WITHOUT pelvic☢️
➡️Pts were randomized to TNT (with FOLFOX) vs. Chemo☢️
➡️BUT Pts w/ a good response to chemo were SPARED☢️ Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer @CentralParkWMD @BenWestphalen @mnoel3232 @benweinbergmd @rachnatshroff @mkatzmd @aparna1024 @anup_kasi @AJacomeMD @FogacciJoao @EileenMOReilly @DrShubhamPant @KoheiShitara @DrKelseyKlute @ILSONDavid @kspencer725 @YJanjigianMD @mdmanishshah @ChiaraCrem1 21/21
#TumorBoardTuesday
✅The trial DID meet its primary endpoint‼️
➡️TNT with SELECTIVE☢️ was NON-INFERIOR to chemo☢️for DFS
➡️And for OS

➡️Interestingly, the PathCR rate was similar with TNT with SELECTIVE☢️ as with chemo☢️
👉 But ONLY 9% of Pts in the TNT arm received ☢️ Image

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More from @MPishvaian

Jan 16
😀I am so excited to be at my 1⃣st IN PERSON ASCO GI in 3y

✅To prepare, I have gone through the abstract titles, and here are my Top GI ASCO 2023 abstracts

📣Disclaimer: There is no bias or exclusion intended.
These are just the ones I personally want to see👀
#GI23
➡️Starting with #Cholangiocarcinoma because it is a big year - especially because of:
✅SWOG 1815: A phase III trial of gem-cis-nab-pac vs. gem-cis as 1⃣st line💊for advanced BTC
👁️Rachna Shroff, Abs LBA490
@rachnatshroff
#GI23
➡️Two impt ImmunoTx trials:
✅IMbrave151: Phase 2 trial of gem-cis-atezo + /- bev as 1⃣st line💊for advanced BTC
👁️A El-Khoueiry, Abs 491

✅Also a TOPAZ-1 report on the long-term survivors Txed with gem-cis-durva 1⃣st line for advanced BTC
👁️M Bouattour, Abs 531, Pos C1
Read 21 tweets
Jun 22, 2022
@TumorBoardTues @ASCO @JohnEbbenMDPhD @SushmaJonna @HeekeMd #TumorBoardTuesday
#ASCO22 Biomarker Recap

😀Don't know about you all - but I had a great time at the meeting this year!

👉I will🔦a few biomarker based studies that caught my👁️

😉Did you notice that TWO of the plenary abstracts were for biomarker based trials‼️ Image
@TumorBoardTues @ASCO @JohnEbbenMDPhD @SushmaJonna @HeekeMd @pashtoonkasi @KReissMD @DrR_DUNNE @FogacciJoao @AJacomeMD @OncBrothers @oncologician @DrSteveMartin @stolaney1 #TumorBoardTuesday
#1⃣
✅Dr. Yoshino🧑‍🏫the results of the Ph 3 PARADIGM trial
➡️FOLFOX-Pani vs. FOLFOX-Bev for RAS WT left CRC
👉823 Pts

👏OS>with Pani 36.2 vs. 31.3 months
👏ORR also > with Pani 75% vs. 67%

🤔BUT the curves don't separate until 26 months❓

🔎Abstract #LBA1 Image
@TumorBoardTues @ASCO @JohnEbbenMDPhD @SushmaJonna @HeekeMd @pashtoonkasi @KReissMD @DrR_DUNNE @FogacciJoao @AJacomeMD @OncBrothers @oncologician @DrSteveMartin @stolaney1 #TumorBoardTuesday
#2⃣

✅Dr. Modi🧑‍🏫the results of the Ph 3 DESTINY-Breast04 trial
➡️T-DXd vs. SOC for HER-2 low metBreast Ca
👉557 Pts

👏PFS>with T-DXd 10.1 vs. 5.4 months
👏OS also > with T-DXd 23.9 vs. 17.5 months

🔎Abstract #LBA3 Image
Read 17 tweets
Jun 1, 2022
📢In preparation for #ASCO22, I wanted to present my list for the #PancreaticCancer abstracts to👀for @ASCO

Again,🙏note - I went through a LOT of abstracts, and I definitely may have missed some‼️
👉And these are not in any particular order

✅But enjoy, RT, and reply😀
#ASCO22 #PancreaticCancer
🤔Is more better❓
✅Dr. Carrato🧑‍🏫a Rand trial
👉Gem-nab-pac➡️FOLFOX (sequenced Q6 wks)
vs.
👉Standard Gem-nab-pac
➡️mOS was 3.5mos⬆️with sequenced Tx
➡️Even though more standard pts got 2nd line Tx
🤯Really❓
🤔Interesting
🔎GI Can Oral Abst 4022
#ASCO22 #PancreaticCancer
🤔Is more better❓
✅Similarly, Dr. Portalesa🧑‍🏫a Rand Ph2 "Trial in Progress" comparing:
👉Sequential gem-nab-pac➡️FFX
vs.
👉Standard FFX alone
➡️Primary objective is OS
🤔But really, what will be critical will be the OS
🔎Abst TPS4190, Poster 160a
Read 11 tweets
Aug 4, 2021
@ShimaghavimiMD @TumorBoardTues #TumorBoardTuesday
Case 08/03/21

74 yo♂️presents with RUQ pain and fatigue, 30# weight loss, PS=2

CT scan demonstrates a large panc mass and diffuse liver metastases

Liver core biopsy confirms an acinar cell #PancreaticCancer

➡️What would be your treatment recommendation❓
@ShimaghavimiMD @TumorBoardTues #TumorBoardTuesday
08/03/21

He was treated with every other week Gem-nab-pac
🙏@GIcancerDoc
➡️Had rapid symptomatic improvement
➡️Now essentially normal PS
➡️Nice response to treatment for 9 months🙂

But then disease progression❗️

What would be your 2nd line therapy choice❓
@ShimaghavimiMD @TumorBoardTues @GIcancerDoc #TumorBoardTuesday
08/03/21

Germline NGS🧬testing did not reveal any inherited alterations

☝️Somatic (tumor) NGS🧬testing revealed a
💥BRAFV600E mutation💥

✅And no KRAS mutation

➡️Done while on 1st line therapy

Would the results alter your treatment choice now?
Read 9 tweets
Jun 1, 2021
#ASCO21

🙏Thank you all for the positive feedback on the PDAC Abstracts

➡️Here now is my 2nd list
✅My Top NON-Pancreatic abstracts to watch for...in no particular order.....

📝Again, I tagged who I could (whose hashtag I could find)
#ASCO21

There were several potential practice changing studies including the one Late Breaking Abstract teaser:

➡️I Chau, et al (LBA 4001)
✅Nivo + ipi or Nivo + chemo vs. chemo alone as 1st-line Tx for esophageal SCC: CheckMate 648

🧐Will dual IO be the winner❓
#ASCO21

➡️R-H Xu, et al (abstr 4000)
✅Ph 3 trial of camrelizumab plus chemo vs. chemo in patients with advanced esophageal SCC
👉Paclitaxel + cis +/- camrelizumab
👉596 patients randomized

🎉Camrelizumab plus chemotherapy⬆️mOS (15.3 vs. 12.0 mos) and ⬆️ORR (72.1% vs. 62.1%)
Read 13 tweets
Jun 1, 2021
#ASCO21 #PancreaticCancer

📢ASCO is a few days away, and I decided to put together my list of
✅Top Abstracts to watch for

📝I tagged who I could

Starting with my Top Pancreatic Cancer Abstracts...in no particular order.....

(A common theme: NGS and fusion testing is🗝️)
#ASCO21 #PancreaticCancer

@VivekSubbiah, et al (Abstr 3079)
➡️RET inhibitor pralsetinib in patients with RET fusion-positive solid tumors

I know - he has presented this before🙄

🥳but now 3/3 patients with pancreatic cancer responded - one with a CR ongoing at 20.8 months‼️
#ASCO21 #PancreaticCancer

Alison M. Schram, @EileenMOReilly @graokane @benweinbergmd (abstr 3003)
➡️Zenocutuzumab (MCLA-128) in pancreas cancer and other solid tumors harboring NRG1 fusions

✅INV-assessed ORR = 40% (4/10)
✅Tumor regression in 7/10 pts
✅DCR = 90%
✅DOR TBD
Read 9 tweets

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