Discover and read the best of Twitter Threads about #SCLC
Most recents (13)
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell 4/23 #TumorBoardTuesday
👩🏽🏫Mini tweetorial 1👩🏽🏫
📚@NCCN based #NSCLC guide for biomarker neg, PDL1 <1% ⤵️
CATEGORY 1 RECOMMENDATIONS
📍Pembro + carboplatin + paclitaxel
📍Pembro + carboplatin + nab-paclitaxel
📍Ipi/Nivo + carbo + paclitaxel
📍Cemiplimab + carbo + paclitaxel
👩🏽🏫Mini tweetorial 1👩🏽🏫
📚@NCCN based #NSCLC guide for biomarker neg, PDL1 <1% ⤵️
CATEGORY 1 RECOMMENDATIONS
📍Pembro + carboplatin + paclitaxel
📍Pembro + carboplatin + nab-paclitaxel
📍Ipi/Nivo + carbo + paclitaxel
📍Cemiplimab + carbo + paclitaxel
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell @NCCN 5/23 #TumorBoardTuesday
👩🏽🏫Mini tweetorial 2👩🏽🏫
✨KEYNOTE-407✨
♦️Phase III
♦️Untreated metastatic, squamous NSCLC
♦️Pts randomized 1:1 pembro+platinum-doublet vs plat doublet alone
♦️Median OS 15.9 mos vs 11.3 mos
♦️69.8% of grade 3+ AEs in pembro-combo vs 68.2% in placebo-combo
👩🏽🏫Mini tweetorial 2👩🏽🏫
✨KEYNOTE-407✨
♦️Phase III
♦️Untreated metastatic, squamous NSCLC
♦️Pts randomized 1:1 pembro+platinum-doublet vs plat doublet alone
♦️Median OS 15.9 mos vs 11.3 mos
♦️69.8% of grade 3+ AEs in pembro-combo vs 68.2% in placebo-combo
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell @NCCN 6/23 #TumorBoardTuesday
👩🏽🏫Mini tweetorial 3👩🏽🏫
✨CHECKMATE 9LA ✨
♦️ Phase III in untreated metastatic NSCLC
♦️ patients randomized 1:1 nivolumab+ipilimumab + 2 cycles chemo vs 4 cycles chemo
PFS KM Curves in Squamous Pts ⬇️
👩🏽🏫Mini tweetorial 3👩🏽🏫
✨CHECKMATE 9LA ✨
♦️ Phase III in untreated metastatic NSCLC
♦️ patients randomized 1:1 nivolumab+ipilimumab + 2 cycles chemo vs 4 cycles chemo
PFS KM Curves in Squamous Pts ⬇️
@TumorBoardTues 1/17 #TumorBoardTuesday #LCSM #OncTwitter
50y 👩🏻 never 🚬 presents with cough
🩻CT: 2cm RLL 🫁 mass & pleural effusion
💧Tap of pleural fluid: adenocarcinoma TTF1+ (T1bN0M1a) Stage 4A #NSCLC
🧪NGS: exon19 deletion EGFR mutation & PDL1 70%+
🤨What’s most appropriate initial tx?
50y 👩🏻 never 🚬 presents with cough
🩻CT: 2cm RLL 🫁 mass & pleural effusion
💧Tap of pleural fluid: adenocarcinoma TTF1+ (T1bN0M1a) Stage 4A #NSCLC
🧪NGS: exon19 deletion EGFR mutation & PDL1 70%+
🤨What’s most appropriate initial tx?
@TumorBoardTues 2/17 #TumorBoardTuesday #LCSM
👩🏻 starts osimertinib with resolution of effusion
She has🧴dry skin & occasional 💩diarrhea managed with loperamide
After 18 months she develops headache
🧲MRI brain shows new 2cm 🧠 metastasis with edema
🤨What’s the most appropriate next step?
👩🏻 starts osimertinib with resolution of effusion
She has🧴dry skin & occasional 💩diarrhea managed with loperamide
After 18 months she develops headache
🧲MRI brain shows new 2cm 🧠 metastasis with edema
🤨What’s the most appropriate next step?
@TumorBoardTues 3/17 #TumorBoardTuesday #LCSM
👨🏼🏫Mini tweetorial 1
EGFR mutations
📍≈15% of🫁adenocarcinomas
📍More common in light or never smokers, women, & Asian ethnicity
📍90% sensitizing & either exon19 del/ins or L858R mut in exon21
@NatureRevCancer Sharma et al
nature.com/articles/nrc20…
👨🏼🏫Mini tweetorial 1
EGFR mutations
📍≈15% of🫁adenocarcinomas
📍More common in light or never smokers, women, & Asian ethnicity
📍90% sensitizing & either exon19 del/ins or L858R mut in exon21
@NatureRevCancer Sharma et al
nature.com/articles/nrc20…
Major update for small cell #lung cancer! #LCSM
With @juliensage + @FoundationATCG, our paper now on @bioRxiv:
►Genomic analysis of *3,600* pts with SCLC; largest SCLC study to date!
►Multiple interesting findings discussed in this 🧵
biorxiv.org/content/10.110…
With @juliensage + @FoundationATCG, our paper now on @bioRxiv:
►Genomic analysis of *3,600* pts with SCLC; largest SCLC study to date!
►Multiple interesting findings discussed in this 🧵
biorxiv.org/content/10.110…
🧵2
This study is unique in many ways:
> The #SCLC cohort studied came mostly from community sites --> representing a more typical “real-world” cohort of SCLC.
> The genomic data are tied to clinical data + outcomes.
#LCSM
This study is unique in many ways:
> The #SCLC cohort studied came mostly from community sites --> representing a more typical “real-world” cohort of SCLC.
> The genomic data are tied to clinical data + outcomes.
#LCSM
🧵3
To the best of our knowledge, our study analyzes the largest number of SCLC tumors from African ancestry to date:
> n=256 AFR cases
> 7.1% of the entire cohort
#Diversity in clinical studies is critical!!
See tweet 🧵9 for more details.
To the best of our knowledge, our study analyzes the largest number of SCLC tumors from African ancestry to date:
> n=256 AFR cases
> 7.1% of the entire cohort
#Diversity in clinical studies is critical!!
See tweet 🧵9 for more details.
Is there a role for Local Tx of the Primary Tumor for Patients with Metastatic Cancer?
🚫Many studies demonstrate no benefit.
📌We performed a MetaAnalysis to evaluate the average effect of Local Tx across various tumors.
A thread🧵#AMSM #PRIMETX
redjournal.org/article/S0360-…
1/25
🚫Many studies demonstrate no benefit.
📌We performed a MetaAnalysis to evaluate the average effect of Local Tx across various tumors.
A thread🧵#AMSM #PRIMETX
redjournal.org/article/S0360-…
1/25
Critics of Local Tx to the Primary Tumor
📌 Many providers think local control of the primary tumor in the setting of M1 dz is akin to “closing the barn door after the horse has bolted”
📌 Ian Tannock wrote a fantastic article on this back in 2000.
pubmed.ncbi.nlm.nih.gov/11759650/
2/
📌 Many providers think local control of the primary tumor in the setting of M1 dz is akin to “closing the barn door after the horse has bolted”
📌 Ian Tannock wrote a fantastic article on this back in 2000.
pubmed.ncbi.nlm.nih.gov/11759650/
2/
Supporters of Local Tx
📌Some support aggressive ablation of all sites due to the enhanced ability to detect occult disease with improved imaging technologies and 📉 toxicities with complete ablation.
pubmed.ncbi.nlm.nih.gov/35831494/
pubmed.ncbi.nlm.nih.gov/31182289/
pubmed.ncbi.nlm.nih.gov/34742582/
3/
📌Some support aggressive ablation of all sites due to the enhanced ability to detect occult disease with improved imaging technologies and 📉 toxicities with complete ablation.
pubmed.ncbi.nlm.nih.gov/35831494/
pubmed.ncbi.nlm.nih.gov/31182289/
pubmed.ncbi.nlm.nih.gov/34742582/
3/
#ESMO20 Grateful for the chance to present characterization of long-term #SCLC survivors with atezolizumab and carboplatin/etoposide in IMpower 133. #LCSM @IASLC @OncoAlert
#ESMO20 IMpower 133 was a placebo controlled, double blind, randomized phase III trial for patients with treatment naive ES-SCLC that showed the addition of atezolizumab to 1L carboplatin + etoposide improved PFS and OS, leading to FDA and EMA approval in 2019. #LCSM @OncoAlert
#ASCO20 Well balanced review of the #SCLC IO oral abstracts by @teekayowo. Clear and consistent benefit with addition of PD(L)1 therapy to front line chemotherapy with 2y OS rates ~ 22% across studies (prior analyses suggest 2y OS rate ~ 7% with chemo alone). #OncoAlert #LCSM
#ASCO20 Looking at the OS curves, later separation leads some to question value of concurrent IO. @teekayowo cautions against this interpretation, as do I. See CM451 where maintenance IO did not impact OS. Concurrent chemo-IO was the only effective approach. #OncoAlert
#ASCO20 Nivolumab + chemotherapy performed well in EA5161 (@LealTiciana) but a phase II is insufficient to change practice in the current environment. Going forward, similar trials are not justified without plans for confirmatory trials. #LCSM #OncoAlert
#ASCO20 Fresh off the @US_FDA approval, abstract 9527 outlines biomarker results from the Japanese substudy of RELAY (phase III trial of first line erlotinib vs erlotinib + ramucirumab in #EGFR mutant #NSCLC). Overall, addition of ram improved PFS (HR 0.59) #OncoAlert #LCSM
#ASCO20 The Japanese biomarker substudy included 131 pts with full results. Baseline EGFR allele frequency did not seem to distinguish outcome (within a treatment arm) but clearance did - those with no detectable circulating EGFR at cycle 4 (and receiving ram) had best outcomes.
#ASCO20 Update on CASPIAN by Luis Paz-Ares with first report on the durvalumab + tremelimumab arm and update on the durva arm. This was an open label phase III comparing platinum/etoposide vs chemo with durva alone vs chemo with durva and treme in 1L #SCLC. #OncoAlert @IASLC
#ASCO20 Durva/treme arm with slightly more CNS metastases. PCI only permitted on EP arm though some on D+T arm did receive it. While cisplatin or carboplatin permitted, vast majority received carbo (as expected). #OncoAlert #LCSM
#ASCO20 Addition of durvalumab and tremelimumab to EP chemotherapy in #SCLC did not lead to a statistically significant improvement in OS. Median 10.4 vs 10.5 with chemotherapy, OS HR 0.82. There was a numeric increase in 2y OS rate (14.4% vs 23.4%). #OncoAlert #LCSM
#ASCO20 Long awaited results from KEYNOTE-604 by @charlesrudin. Randomized phase III trial for patients with treatment naive #SCLC. 453 patients randomized to 4 cycles of platinum/etoposide with either pembrolizumab or placebo. PCI optional, both arms. No TRT. #OncoAlert @IASLC
#ASCO20 Co-primary endpoints of PFS and OS. Safety as expected - primarily hematologic adverse events, common with platinum/etoposide chemotherapy. Immune mediated adverse events usually low grade (thyroid, etc). #OncoAlert
#ASCO20 Addition of pembrolizumab to EP improved PFS (HR 0.73). Numeric improvement in median OS (9.7m to 10.8m) and 1y OS rate (45% from 40%) but did not cross superiority threshold for improvement in survival (OS HR 0.80). #OncoAlert
#OncoAlert #AACR20 Results from phase II study of camrelizumab (SHR-1210, anti-PD-1) plus apatinib in #SCLC presented by Dr. Jie Wang. Camrelizumab is approved in China for Hodgkin lymphoma and has shown promise in HCC. Here, results from single arm phase II. #LCSM
#OncoAlert #AACR20 Stage I included three different schedules of apatinib delivery (camrelizumab is given IV q2w). The apatinib 375mg qday schedule was chosen for stage 2. Included chemo-sensitive and resistant #SCLC, using a 90-day platinum-free interval cutoff. #LCSM
#OncoAlert #AACR20 Patient characteristics reveal a slightly higher proportion of never-smokers (10/47, 21%). #SCLC strongly linked to smoking but can be seen in never smokers (4.5% in IMpower 133). Spontaneous transformation from #EGFR? Different outcomes in this group? #LCSM
Here’s a closer look at TIGIT and its potential in #cancer therapy. This target is primed to gain more traction in immuno-oncology this year. (Thread below)
Key players developing anti-TIGIT therapies are $RHHBY $MRK $BMY $RCUS $ALPMY $BGNE $CGEN $SGEN $MREO $IVBXF & @iTeosTx
Key players developing anti-TIGIT therapies are $RHHBY $MRK $BMY $RCUS $ALPMY $BGNE $CGEN $SGEN $MREO $IVBXF & @iTeosTx
TIGIT is an inhibitory receptor expressed by activated T-cells, T-regs & NK cells
- Ligand for TIGIT (PVR) is expressed in multiple tumor types
- Activation suppresses T-cell activity
- Upregulated during PD-1 blockade
@Cancer_Cell paper (open access): cell.com/cancer-cell/fu…
- Ligand for TIGIT (PVR) is expressed in multiple tumor types
- Activation suppresses T-cell activity
- Upregulated during PD-1 blockade
@Cancer_Cell paper (open access): cell.com/cancer-cell/fu…
A key TIGIT question is the role of FcƔR and antibody-dependent cell-mediated cytotoxicity (ADCC).
$RHHBY & $MRK support FcƔR ADCC benefit due to T-reg depletion & myeloid cell reprogramming. $RCUS states the opposite as this ADCC activity may also deplete T-effector & NK cells.
$RHHBY & $MRK support FcƔR ADCC benefit due to T-reg depletion & myeloid cell reprogramming. $RCUS states the opposite as this ADCC activity may also deplete T-effector & NK cells.
#OncoAlert Randomized cohort from CheckMate 032 now available @JTOonline. Included 243 patients with relapsed #SCLC (1-2 prior lines), no PDL1 selection. Randomized 3:2 to nivo 3mg/kg q2w or nivo 1mg/kg with ipi 3mg/kg q3w x 4 (then nivo maint). #LCSM
jto.org/article/S1556-…
jto.org/article/S1556-…
@JTOonline #OncoAlert Primary endpoint ORR (side bar: what is the best endpoint?). Early results from @ASCO 2017 showed ORR 12% nivo and 21% with nivo/ipi with improved 3 month PFS rate but no diff in 3 month OS, presented then as bar graphs instead of KM curves (?!)
@JTOonline @ASCO #OncoAlert Now, with a median f/u of 11.9m, we see similar trends. ORR 11.6% with nivo (DOR 15.8m) and 21.9% with nivo/ipi (DOR 10m). mPFS similar (1.4 and 1.5m) but landmark PFS slightly better with nivo/ipi (3m: 32% vs 22%; 6m: 16% vs 22%, 1y: 10% vs 12%). Meaningful? #LCSM
#ESMO19 Timely review and discussion of novel therapies in #SCLC by @charlesrudin in a session chaired by @fblackhall Big challenge is unraveling the biology. Need to “subdivide and conquer” #OncoAlert #LCSM
#ESMO19 Subsets certainly exist in #SCLC and efforts to standardize nomenclature is an important first step. Think of some of these as markers, not necessarily drivers. Already implementing at @MSKPathology with sample report here to allow prospective analysis #OncoAlert
#ESMO19 need to translate these subtypes into guiding therapy and may allow us to revisit other “negative” trials which may have just lacked the right selection criteria. Key point. We need smarter studies, not necessarily larger studies. #OncoAlert
