Garth Nicholas Profile picture
A Canadian oncologist. I tweet what I read, more or less. No pharma conflicts.
Nov 30, 2021 12 tweets 4 min read
30 November: IMpower, adieu

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/12 Image I thought we’d close out the month with a trial that’s so new that its impact is not yet agreed upon, and its findings have not ossified into standard practice. It combines two strands that have run through the month: benefit of adjuvant therapy, and the advance of immunotherapy.
Nov 29, 2021 11 tweets 4 min read
29 Nov: Chemo/gefitinib, randomized phase II

For Lung Cancer Awareness Month #LCAM I’m going to review 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial.#lcsm 1/11 All of the randomized studies we’ve looked at to date have been phase III studies, meaning that they are randomized studies with sufficient statistical power to demonstrate a clinically meaningful difference. Today we’ll look at a randomized phase II study. 2/11
Nov 28, 2021 15 tweets 6 min read
28 November: ROS1, single arm trials

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/15 This month I have focused exclusively on randomized studies, because I believe strongly that they are our best tools for evaluating the benefits and harms of cancer therapies. Today will be my sole foray into non-randomized studies. I hope to illustrate some of their limitations.
Nov 27, 2021 19 tweets 5 min read
27 November:Temel, QoL outcomes

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial.#lcsm 1/19 Image Today’s trial is one of the most thought-provoking of the month, and it has been discussed widely since its publication in 2010. It is a trial looking at the timing of referral to palliative care for people with advanced, incurable lung cancer. 2/19
Nov 26, 2021 12 tweets 4 min read
26 November: Biases and negative studies

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/12 Image Today we are returning to small cell lung cancer, a disease that we previously considered on 10 November.
We discussed how limited-stage disease can be treated with curative intent chemoradiotherapy, while extensive stage disease is treated palliatively with chemotherapy. 2/12
Nov 25, 2021 12 tweets 4 min read
25 November: LACE meta-analysis

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/12 Image Throughout these summaries I have proposed that the randomized controlled trial is our most powerful form of evidence for the effectiveness of medical interventions. Today we’re going to look at a potentially stronger type of evidence: meta-analysis. 2/12
Nov 24, 2021 16 tweets 5 min read
24 November: And now a word from our sponsor

For Lung Cancer Awareness Month #LCAM I’m going to review 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/16 To date we have reviewed at a couple of trials looking at the role of surgery in multidisciplinary management (Nov 6 & 8). Today we’ll look at a proper randomized trial of two surgical procedures for staging the mediastinum (the middle of the chest, between the lungs). 2/16
Nov 23, 2021 11 tweets 4 min read
23 November: ALEX and clarity

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. 1/11 #lcsm Today we’re returning to ALK-positive lung cancer. Way back on 5 November we looked at the PROFILE study that established crizotinib rather than chemotherapy as the second-line standard of care.
Today’s study compares crizotinib to a newer generation of ALK drug, alectinib. 2/11
Nov 22, 2021 13 tweets 4 min read
22 November: PACIFIC, intention to treat

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/13 Image We previously looked at locally-advanced lung cancer on 4, 6, and 9 November. We have established standard treatment as ~60 Gy radiotherapy with concurrent chemotherapy for those that are not resectable by lobectomy. Today’s trial looked at adding immunotherapy. 2/13 Image
Nov 21, 2021 17 tweets 4 min read
21 November: Screening part 2

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/17 Image Yesterday we went over the major results of the NLST. We discussed screening in general and the concept of overdiagnosis in particular. Today we’ll look at the Dutch-Belgian NELSON study, the next largest randomized study in this field. 2/17
Nov 20, 2021 17 tweets 5 min read
20 November: Screening part 1

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/17 Image I’m going to spend the next two days on screening studies. Honestly, I have some trepidation in posting on this topic. There are advocates of screening and sceptics about screening, both vocal, and I’m probably going to disagree with most of them. Let’s look at some evidence.2/17
Nov 19, 2021 18 tweets 5 min read
19 Nov: Ipi-nivo-meso, stratified randomization

For Lung Cancer Awareness Month #LCAM I’m going to review 30 important lung cancer trials in 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial.#lcsm 1/18 Image We previously discussed a mesothelioma trial on 8 November. On 15 November I also briefly alluded to a study that established platinum/pemetrexed as the standard chemotherapy, in 2004. Today’s study expands the use of immunotherapy into this disease. 2/18
Nov 18, 2021 13 tweets 4 min read
18 November: Pemetrexed & placebo

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/13 Image Today’s trial takes us back to 2005, when standard first-line platinum doublet was given for 4-6 cycles, followed by a treatment break. People would be followed, usually for a few months, and when their cancer worsened they would get second-line chemo, often pemetrexed. 2/13
Nov 17, 2021 14 tweets 4 min read
17 Nov: Exploring exploratory analyses

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/14 Image We have previously looked at adjuvant chemotherapy (Nov 2) and osimertinib (14 November). Today we’ll look at another influential adjuvant study, and ask whether it ought to be as influential as it is. 2/14
Nov 16, 2021 14 tweets 5 min read
16 November: The right side of the curve

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/14 Image In our previous discussion of immunotherapy (13 Nov) we talked about the expression of PD-L1 on tumour cells. At the time of this study (2014) there was some evidence that tumours with more cells expressing PD-L1 were more likely to benefit from immunotherapy. 2/14 Image
Nov 15, 2021 14 tweets 4 min read
15 November: Vitamins, a note to trainees

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/14 To date we have looked at trials that compared different treatments. Today, we’re going to look at something a little different: a trial of the schedule of supportive medications that are given along with chemotherapy, in this case vitamin B12 and folic acid with pemetrexed. 2/14
Nov 14, 2021 17 tweets 4 min read
November 14: Controversy, hierarchy
For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/17 This is the most recent study we’ve looked at so far, from 2020. You may recall that adjuvant chemotherapy (after surgery) increases the chances of cure for early stage lung cancer (Nov 2), and also that we have good oral medications for lung cancer with EGFR mutation (Nov 7, 12)
Nov 13, 2021 17 tweets 5 min read
13 November: Our 1st Keynote, HR

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial.#lcsm 1/17 Image The uptake of immunotherapy in lung cancer has been rapid and widespread. In 2014 it was research only: in 2021 it is used in all types of lung malignancies, in almost all stages of disease. We will discuss at least six immunotherapy studies in the remainder of the month. 2/17
Nov 12, 2021 15 tweets 4 min read
12 November: FLAURA, intro to power

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/15 Image Today we are back to looking at EGFR-mutated lung cancer, with the FLAURA trial comparing osimertinib to either gefitinib or erlotinib in the first-line setting. Today’s discussion is from two papers, one looking at Progression Free Survival, the other at Overall Survival 2/15 Image
Nov 11, 2021 11 tweets 4 min read
11 November: Non-inferiority, pemetrexed

For Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/11 Image Today we are back to looking at a study of chemotherapy for metastatic non-small cell lung cancer (NSCLC). Our last study in this area (3 November) established the notion that all platinum doublets were more or less the same. Today’s study, from 2008, overturned that consensus.
Nov 10, 2021 16 tweets 4 min read
10 November: CONVERT and CIs

This year for Lung Cancer Awareness Month #LCAM I’m going to summarize 30 important lung cancer trials over 30 days. These posts are directed at non-medical professionals, with descriptions of the results and of what makes a good trial. #lcsm 1/15 Image To date in these tweets I have loosely used the term “lung cancer” to refer to non-small cell lung cancer (NSCLC), by far the commonest type of lung cancer. Today we’ll look at a trial in small cell lung cancer. 2/15