Created by @mpishvaian.bsky.social • @MPishvaian • FREE CME
👍Supported by ed grants from Exelixis, Ferring, Ipsen, Lilly, Janssen Scientific Affairs, Merck & Taiho Oncology 🙏
👉🏽Info about 🆓 CME: integrityce.com/tbt2025
👍Supported by ed grants from Exelixis, Ferring, Ipsen, Lilly, Janssen Scientific Affairs, Merck & Taiho Oncology 🙏
👉🏽Info about 🆓 CME: integrityce.com/tbt2025
🧠And while we finalize the case details, collect FREE #CME
👉🏽https://integrityce.com/tbt2025
🧠And while we finalize the case details, collect FREE #CME
👉🏽https://integrityce.com/tbt2025
📢Join us Tuesday, 10-21-25 at 8PM ET as @drgattimays.bsky.social &
@KennaKoehler 🗣️ Tx options after CDK4/6⛔️: What to consider in the 2nd line for HR+/HER2– mBC❓
RT and bring others into the discussion‼️
📢Join us Tuesday, 10-21-25 at 8PM ET as @drgattimays.bsky.social &
@KennaKoehler 🗣️ Tx options after CDK4/6⛔️: What to consider in the 2nd line for HR+/HER2– mBC❓
RT and bring others into the discussion‼️
🧠And while we finalize the case details, collect FREE #CME
👉🏽integrityce.com/TBT2024
🧠And while we finalize the case details, collect FREE #CME
👉🏽integrityce.com/TBT2024
🤔Can Claudin 18.2 be used for treatment💊outside of upper GI cancers❓
📢Join us Tuesday, 02-04-25 at 8PM ET as @ndevitomd.bsky.social & @katherinezhoumd.bsky.social from @dukemedschool.bsky.social 🗣️Claudin 18.2 as a🎯in #pancreaticcancer
RT and bring others into the discussion‼️
🤔Can Claudin 18.2 be used for treatment💊outside of upper GI cancers❓
📢Join us Tuesday, 02-04-25 at 8PM ET as @ndevitomd.bsky.social & @katherinezhoumd.bsky.social from @dukemedschool.bsky.social 🗣️Claudin 18.2 as a🎯in #pancreaticcancer
RT and bring others into the discussion‼️
👍Supported by ed grants from Astellas, AstraZeneca, Janssen, Lilly, Novartis, Seagen and Taiho Oncology🙏
Info about 🆓 CME: integrityce.com/TBT2024
👍Supported by ed grants from Astellas, AstraZeneca, Janssen, Lilly, Novartis, Seagen and Taiho Oncology🙏
Info about 🆓 CME: integrityce.com/TBT2024
We have not heard any updates from #SABCS24 yet!
📢So join us Tuesday, 01-14-25 at 8PM ET here & on Twitter as @dr-rshatsky.bsky.social & @zoezhang.bsky.social🗣️SERDS & novel Tx for HR+ #breastcancer
RT and bring others into the discussion‼️
We have not heard any updates from #SABCS24 yet!
📢So join us Tuesday, 01-14-25 at 8PM ET here & on Twitter as @dr-rshatsky.bsky.social & @zoezhang.bsky.social🗣️SERDS & novel Tx for HR+ #breastcancer
RT and bring others into the discussion‼️
👨⚕️Summary👩⚕️
🧑🔬Periop mangement increasingly complex👩🔬
⭐️Patient selection is key🔑
⭐️Biomarker testing necessary for early stage dz🎯
⭐️Multi-D teamwork for best decision making👫👬
👀See our suggested algorithm + consensus guidelines..
👨⚕️Summary👩⚕️
🧑🔬Periop mangement increasingly complex👩🔬
⭐️Patient selection is key🔑
⭐️Biomarker testing necessary for early stage dz🎯
⭐️Multi-D teamwork for best decision making👫👬
👀See our suggested algorithm + consensus guidelines..
👩🏫Mini tweetorial 18👨🏫
📣KN671 exploratory analyses of..
⭐️Residual tumor volume (RTV)⭐️
👉Med RTV 29.% in tx arm vs 52% in placebo
👉⏫RTV a/w worse EFS
👉Tx ⏫ EFS in all RTV subgroups (except RTV >60%)
🤔Can we use RTV to identify high-risk pts?
👩🏫Mini tweetorial 18👨🏫
📣KN671 exploratory analyses of..
⭐️Residual tumor volume (RTV)⭐️
👉Med RTV 29.% in tx arm vs 52% in placebo
👉⏫RTV a/w worse EFS
👉Tx ⏫ EFS in all RTV subgroups (except RTV >60%)
🤔Can we use RTV to identify high-risk pts?
👩🏫Mini tweetorial 17👨🏫
🫸But wait...
🙋♂️🙋♀️KN671 showed EFS ⏫for pCR + non-pCR pts
⭐️pCR 👉EFS HR 0.33
⭐️non-pCR 👉 EFS HR 0.69
🙄Is there a better measure of path response?
👩🏫Mini tweetorial 17👨🏫
🫸But wait...
🙋♂️🙋♀️KN671 showed EFS ⏫for pCR + non-pCR pts
⭐️pCR 👉EFS HR 0.33
⭐️non-pCR 👉 EFS HR 0.69
🙄Is there a better measure of path response?
👩🏫Mini tweetorial 16👨🏫
🤔💭Q: What is benefit of postop IO after preop IO?
⚠️Warning⚠️
😬Cross-trial comparison coming up..
👀Exploratory analysis of CM816 and CM77T...
⭐️Periop nivo vs prop nivo improved EFS for non-pCR
@FordePatrick
👩🏫Mini tweetorial 16👨🏫
🤔💭Q: What is benefit of postop IO after preop IO?
⚠️Warning⚠️
😬Cross-trial comparison coming up..
👀Exploratory analysis of CM816 and CM77T...
⭐️Periop nivo vs prop nivo improved EFS for non-pCR
@FordePatrick
👩🏫Mini tweetorial 15👨🏫
♟️Checkmate 77T
🔸Stage IA-IIIB (N2) NSCLC (AJCC 8)
🔸Periop nivo👇
ChemoIO▶️surg▶️IO vs Chemo▶️surg▶️placebo
⭐️Results⭐️
📈18 mo EFS (HR 0.58, p<0.001)
📈pCR rate (25.3% vs 4.7%)
🏆Another FDA Approval
👉Multiple options..
👩🏫Mini tweetorial 15👨🏫
♟️Checkmate 77T
🔸Stage IA-IIIB (N2) NSCLC (AJCC 8)
🔸Periop nivo👇
ChemoIO▶️surg▶️IO vs Chemo▶️surg▶️placebo
⭐️Results⭐️
📈18 mo EFS (HR 0.58, p<0.001)
📈pCR rate (25.3% vs 4.7%)
🏆Another FDA Approval
👉Multiple options..
👩🏫Mini tweetorial 14👨🏫
🔑🎵KEYNOTE-671
🔸Stage II-IIIB (N2) NSCLC
🔸Periop pembro
ChemoIO x 4▶️surg▶️IO v Chemo▶️surg▶️placebo
🤩Results🤩
📈OS (HR 0.73, p=0.02)
📈pCR rate (18.1% v 4.0%)
👏Finally an OS benefit
🏆FDA Approved
👩🏫Mini tweetorial 14👨🏫
🔑🎵KEYNOTE-671
🔸Stage II-IIIB (N2) NSCLC
🔸Periop pembro
ChemoIO x 4▶️surg▶️IO v Chemo▶️surg▶️placebo
🤩Results🤩
📈OS (HR 0.73, p=0.02)
📈pCR rate (18.1% v 4.0%)
👏Finally an OS benefit
🏆FDA Approved
👩🏫Mini tweetorial 13👨🏫
🥪The "sandwich" approach🥪
✨Aka perioperative chemoIO✨
🤨Multiple options..
🔑Key trials all a/w EFS 📈
1⃣KEYNOTE 671 👉pembrolizumab
2⃣AEGEAN 👉durvalumab
3⃣CM77T👉 nivolumab
@HwakeleeMD
👩🏫Mini tweetorial 13👨🏫
🥪The "sandwich" approach🥪
✨Aka perioperative chemoIO✨
🤨Multiple options..
🔑Key trials all a/w EFS 📈
1⃣KEYNOTE 671 👉pembrolizumab
2⃣AEGEAN 👉durvalumab
3⃣CM77T👉 nivolumab
@HwakeleeMD
😷 W/u reveals...
😬Thyroiditis likely 2/2 IO ➡️sx tx w beta blocker
🏥Underwent RUL lobectomy
🫁🔬Pathologic review➡️pCR‼️
🧐Could irAE predict better outcomes?
👇600 pt cohort analysis
G1-2 irAEs w C1 a/w 📈survival (OS) (HR 0.61)
😷 W/u reveals...
😬Thyroiditis likely 2/2 IO ➡️sx tx w beta blocker
🏥Underwent RUL lobectomy
🫁🔬Pathologic review➡️pCR‼️
🧐Could irAE predict better outcomes?
👇600 pt cohort analysis
G1-2 irAEs w C1 a/w 📈survival (OS) (HR 0.61)
👩🏫Mini tweetorial 12 👨🏫
📜To summarize..
👊Neoadjuvant vs 👊Adjuvant ChemoIO
🔹Both approaches with ➕ and ➖
🔹No definite OS benefit with either approach 🫤
🔹BUT CM816 shows early trend toward 📈OS
🔹Selection based on pt characteristics 👩🧑🧓👴
👩🏫Mini tweetorial 12 👨🏫
📜To summarize..
👊Neoadjuvant vs 👊Adjuvant ChemoIO
🔹Both approaches with ➕ and ➖
🔹No definite OS benefit with either approach 🫤
🔹BUT CM816 shows early trend toward 📈OS
🔹Selection based on pt characteristics 👩🧑🧓👴
👨🏫 Mini tweetorial 10 👨🏫
✅Checkmate 816✅
👉Neoadj chemoIO w nivolumab vs chemo alone
🔑Results
⭐️Med EFS 31.6 vs 20.8 mo
⭐️pCR rate 24.0% vs 2.2%
⭐️pCR a/w 📈EFS of 25.6 vs 18.0 mo
⭐️In PD-L1 TPS ≥ 50%, pCR rate of 44.7%
@FordePatrick
👨🏫 Mini tweetorial 10 👨🏫
✅Checkmate 816✅
👉Neoadj chemoIO w nivolumab vs chemo alone
🔑Results
⭐️Med EFS 31.6 vs 20.8 mo
⭐️pCR rate 24.0% vs 2.2%
⭐️pCR a/w 📈EFS of 25.6 vs 18.0 mo
⭐️In PD-L1 TPS ≥ 50%, pCR rate of 44.7%
@FordePatrick
👩🏫Mini tweetorial 9 👨🏫
🤩Neoadj IO w advantages
⭐️Intact tumor🫁👉tumor-specific T cell activation
⭐️Intact lymphatics👉⏫ immune priming
⭐️Immune activation👉⬇️micrometastases
👩🏫Mini tweetorial 9 👨🏫
🤩Neoadj IO w advantages
⭐️Intact tumor🫁👉tumor-specific T cell activation
⭐️Intact lymphatics👉⏫ immune priming
⭐️Immune activation👉⬇️micrometastases
👩🏫Mini tweetorial 8 👨🏫
🏆FDA Approvals/NCCN Recs for Adjuvant IO
1⃣ Atezo (IMpower010)
2⃣ Pembro (PEARLS)
🙁But limited evidence for clinical benefit..
🤔💭Might neoadjuvant IO make a difference?
👩🏫Mini tweetorial 8 👨🏫
🏆FDA Approvals/NCCN Recs for Adjuvant IO
1⃣ Atezo (IMpower010)
2⃣ Pembro (PEARLS)
🙁But limited evidence for clinical benefit..
🤔💭Might neoadjuvant IO make a difference?
👩🏫Mini tweetorial 7 👨🏫
🚨Adjuvant trials
✨PEARLS ✨
Adj pembro
👍Significant DFS 📈 (HR 0.76, p=0.0014)
🤨But not in PD-L1 ≥ 50% (HR 0.82, p=0.14)
⏳No OS benefit yet
🏆FDA Approved
✨BR.31✨
Adj durva
👎No DFS benefit, even in PD-L1 TPS ≥ 25%
👩🏫Mini tweetorial 7 👨🏫
🚨Adjuvant trials
✨PEARLS ✨
Adj pembro
👍Significant DFS 📈 (HR 0.76, p=0.0014)
🤨But not in PD-L1 ≥ 50% (HR 0.82, p=0.14)
⏳No OS benefit yet
🏆FDA Approved
✨BR.31✨
Adj durva
👎No DFS benefit, even in PD-L1 TPS ≥ 25%
👩🏫Mini tweetorial 6 👨🏫
🚨Adjuvant IO trials
🌟Impower010🌟
Adj atezo vs placebo
👍Primary endpoint reached➡️DFS benefit (HR 0.66)
👎No OS improvement (79.3% vs 81.1%)
👏But📈OS for PD-L1 ≥50% (89.1% vs 77.8%)
🏆FDA Approved Option
@EnriquetaFelip
👩🏫Mini tweetorial 6 👨🏫
🚨Adjuvant IO trials
🌟Impower010🌟
Adj atezo vs placebo
👍Primary endpoint reached➡️DFS benefit (HR 0.66)
👎No OS improvement (79.3% vs 81.1%)
👏But📈OS for PD-L1 ≥50% (89.1% vs 77.8%)
🏆FDA Approved Option
@EnriquetaFelip
✨Case 2✨
55👨heavy 🚬p/w R shoulder pain
Imaging shows 👇
😱Large (T4) RUL mass
🫣R paratracheal adenopathy
✨Case 2✨
55👨heavy 🚬p/w R shoulder pain
Imaging shows 👇
😱Large (T4) RUL mass
🫣R paratracheal adenopathy
👉Back to our case..
🫁T4N2 disease..."borderline resectable" 🫤
💊Pt tx with neoadjuvant osi x 10 wks
🩻Repeat imaging shows major clinical response 🙌
👉Back to our case..
🫁T4N2 disease..."borderline resectable" 🫤
💊Pt tx with neoadjuvant osi x 10 wks
🩻Repeat imaging shows major clinical response 🙌
👩🏫Mini tweetorial 4 👨🏫
👉PACIFIC regimen = SOC for Stage IIIB NSCLC
🧐No OS benefit for EGFRm subset..
💁♀️LAURA
⭐️Phase III - osi after chemoRT
⭐️Unresectable stage III EGFRm NSCLC
👏Osi vs placebo➡️med PFS 39.1 vs 5.6 mo
🏆Osi after chemoRT = new SOC
👩🏫Mini tweetorial 4 👨🏫
👉PACIFIC regimen = SOC for Stage IIIB NSCLC
🧐No OS benefit for EGFRm subset..
💁♀️LAURA
⭐️Phase III - osi after chemoRT
⭐️Unresectable stage III EGFRm NSCLC
👏Osi vs placebo➡️med PFS 39.1 vs 5.6 mo
🏆Osi after chemoRT = new SOC
👩🏫Mini tweetorial 3👨🏫
🤚Resectable ALKr NSCLC?
🎯ALINA ⬇️
⭐️Phase III Trial of Adjuvant Alectinib
⭐️Stage IB-IIIA (AJCC 7th ed) ALKr NSCLC
💊Adjuvant alectinib 600mg BID x 2 yrs vs chemo
👀Med DFS NR vs 41.3 mo
🏆Adjuvant alectinib FDA approved/SOC
👩🏫Mini tweetorial 3👨🏫
🤚Resectable ALKr NSCLC?
🎯ALINA ⬇️
⭐️Phase III Trial of Adjuvant Alectinib
⭐️Stage IB-IIIA (AJCC 7th ed) ALKr NSCLC
💊Adjuvant alectinib 600mg BID x 2 yrs vs chemo
👀Med DFS NR vs 41.3 mo
🏆Adjuvant alectinib FDA approved/SOC