رتبها

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DAielloMD @DrRiyazShah @DrSanjayPopat @TomVargheseJr @acmoorephd @McPerego @IntegrityCE @JanssenUS @AstraZeneca 1/22 #TumorBoardTuesday #LungCancer #OncTwitter
57y 👩🏽 short of breath
PMH: GERD
🚬3pk/yr smoking hx, quit 25yrs prior
🩻CT: bilat 🫁 nodules
🔬bx: adenocarcinoma, PDL1 85%
🧲MRI brain: 5 mets, each < 3mm
Asymptomatic
Stage IV NSCLC adenocarcinoma
🔬Liquid bx: EGFR L858R
Next?

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DAielloMD @DrRiyazShah @DrSanjayPopat @TomVargheseJr @acmoorephd @McPerego @IntegrityCE @JanssenUS @AstraZeneca 2/22 #TumorBoardTuesday #LCSM @MMarmarelis @MPishvaian @JohnEbbenMDPhD @cbcbc1971 @LatinaMD @RamalingamMD @SamuelKareffMD @livinglife82 #LungCancer
👩🏽 🤝👩🏻‍⚕️#SharedDecision
🟢 Start osimertinib
🗓️ 3 week visit to check on toxicities of therapy
🧐Which is FALSE about osimertinib

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DAielloMD @NarjustFlorezMD @LeciaSequist @LauraJBook @PatelOncology @LaurenByersMD @BairdAM @DrSteveMartin @DevikaDasMD @JSabari @ADesaiMD @jillfeldman4 @DrBivas @DAielloMD @FawziAbuRous @esinghimd @ShrutiPatelMD @JineshGheeya @sands_jacob @JuliaRotow @CharuAggarwalMD @StephenVLiu

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DAielloMD @LauraJBook @PatelOncology @LaurenByersMD @BairdAM @JSabari @jillfeldman4 @DrBivas @JineshGheeya @JuliaRotow 3/22 #TumorBoardTuesday #LCSM
🎯Osimertinib - Anti-EGFR
❌No stopping PPI
✨OCEAN: CNS ORR >70%
📚jto.org
✨FLAURA: 91% CNS ORR
AEs:
👺Any Grade rash
🚽diarrhea 58%
📚@plummer_ruth @JhanelleGray @jsoriamd @reungwetwattana
ascopubs.org

ascopubs.org/doi/full/10.12…

CNS Response to Osimertinib Versus Standard Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients With Untreated EGFR-Mutated Advanced Non–Small-Cell Lung Cancer

Purpose We report CNS efficacy of osimertinib versus standard epidermal growth factor receptor (EGFR...

jto.org/article/S1556-…

A Phase II Study of Osimertinib for Radiotherapy-Naive Central Nervous System Metastasis From NSCLC: Results for the T790M Cohort of the OCEAN Study (LOGIK1603/WJOG9116L)

Osimertinib has been reported to be effective against central nervous system (CNS) metastasis from a...

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Back to the case🔎
🗓️ 2 years on osimertinib
🙏🏼 Initial partial response
🫁 Multifocal disease growth in the lung
🤨 What’s your next step?

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke @BijoyTelivala

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke 5/22 #TumorBoardTuesday
👩🏼‍🏫Mini-Tweetorial 1👩🏻‍🏫
🔬What to biopsy?
@NCCN: tissue &/or liquid
📚nccn.org
🥇Tissue gold standard
Recurrent/resistant dz:
🔬Redo tissue AND plasma
BUT
💦liquid sometimes faster
‼️Make sure enough tissue‼️
📚nature.com

nccn.org/professionals/…

Login

nature.com/articles/s4141…

Liquid biopsy and non-small cell lung cancer: are we looking at the tip of the iceberg?

British Journal of Cancer - Liquid biopsy and non-small cell lung cancer: are we looking at the tip...

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke @NCCN 6/22 #TumorBoardTuesday
👩🏼‍🏫Mini Tweetorial 2👩🏻‍🏫
📌Which TKI is best for EGFR mutant NSCLC?
✨FLAURA
📍1st trial comparing 2 EGFR TKIs
📍Prior trials compared TKIs to chemo
📍556 pts
📍Osimertinib (3rd gen) vs earlier gen EGFR TKIs (gefitinib/erlotinib)
📚nejm.org

nejm.org/doi/full/10.10…

Osimertinib in Untreated EGFR-Mutated Advanced Non–Small-Cell Lung Cancer | NEJM

Original Article from The New England Journal of Medicine — Osimertinib in Untreated EGFR-Mutated Ad...

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke @NCCN 7/22 #TumorboardTuesday
👩🏼‍🏫Mini Tweetorial 3👩🏻‍🏫
📌Osimertinib
🔹Irreversible
🔸blocks EGFR-activating & T790M resistance mutations
✨FLAURA: mPFS= 18.9 mos vs 10.2 mos with earlier TKIs
🔹ORR similar
🔸mDOR= 17.2 mos vs 8.5 mos with earlier TKIs
🔹CNS penetration
⬇️serious AEs

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke @NCCN 8/22 #TumorboardTuesday #LungCancer
👩🏼‍🏫Mini Tweetorial 4👩🏻‍🏫
📌Osimertinib
👎🏽resistance will occur
EGFR dependent
OR
EGFR independent:
➡️HER2 amplification
➡️MET amplification
➡️MAPK/PI3K activation
➡️Novel fusions
➡️Transformation (SCLC, SCC)
📚nature.com

nature.com/articles/s4141…

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke @NCCN 9/22 #TumorBoardTuesday
👩🏼‍🏫Mini Tweetorial 5👩🏻‍🏫
📌Osi
📍resistance & losing T790M
✨ AURA3: ctDNA/T790M mut NSCLC
🔹~50% LOST T790M mutation at time of progress
📍T790M loss
✅Early resistance
✅MET Amp, KRAS mut, fusions, & small cell transformation
📚link.springer.com

link.springer.com/article/10.100…

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke 10/22 #TumorBoardTuesday
👩🏼‍🏫Mini Tweetorial 6
📌Osi
📍resistance & EGFR muts
✨AURA3: tertiary EGFR mut in ~20%/T790M maintained
Common:
🔹C797S (Ex 20) ~10-26% resist to 2L
🔹Position re other EGFR muts
➡️Can re-try 1st + 3rd gen TKI combos
📚@elisagiovan nature.com

nature.com/articles/s4141…

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke @elisagiovan 11/22 #TumorBoardTuesday #LungCancer
👩🏼‍🏫Mini Tweetorial 7👩🏻‍🏫
📌Osimertinib
📍Combo Tx: earlier gen TKIs + Osi
🔹Common target (EGFR) method of resistance fueling a lot of drug development & trials
📚classic.clinicaltrials.gov
📚classic.clinicaltrials.gov
📚nature.com

classic.clinicaltrials.gov/ct2/show/NCT04…

(SYMPHONY) Phase 1/2 Study Targeting EGFR Resistance Mechanisms in NSCLC - Full Text View - ClinicalTrials.gov

(SYMPHONY) Phase 1/2 Study Targeting EGFR Resistance Mechanisms in NSCLC - Full Text View.

classic.clinicaltrials.gov/ct2/show/NCT05…

(HARMONY) Study of BLU-701 in EGFR-mutant NSCLC - Full Text View - ClinicalTrials.gov

(HARMONY) Study of BLU-701 in EGFR-mutant NSCLC - Full Text View.

nature.com/articles/s4141…

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AngelQinMD @SimonWambeke 12/22 #TumorBoardTuesday
👩🏼‍🏫Mini Tweetorial 8
📍New tx after resistance
💊Amivantamab – Bispecific Ab (EGFR, MET) ➡️anti-tumor effect
Initially in:
Exon 20 +, Pre-Treated
ORR ~40% #WCLC20 mDOR 11.1 mos
AEs:
💉infusion rxn
👺rash
💅paronychia
🚽diarrhea
@Jbauml #ASCO21 Ami v RWD

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD 13/22 #TumorBoardTuesday #LungCancer
👩🏼‍🏫Mini Tweetorial 9👩🏻‍🏫
✨CHRYSALIS: Ami + Lazertinib (3rd gen TKI)
🧪NGS does NOT predict response
BUT
🧪MET IHC may predict!
📚@AlexSpiraMDPhD @oncoOuLungCA @MNagasaka #ASCO21

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 14/22 #TumorBoardTuesday #LCSM #LungCancer
👩🏼‍🏫Mini Tweetorial 10👩🏻‍🏫
✨CHRYSALIS 2
📍Osi ➡️ Chemo ➡️ Ami + Laz
📍ORR 36%, median duration of response nr at 8 months
📍Prelim CNS activity
📚ascopubs.org

ascopubs.org/doi/abs/10.120…

Amivantamab and lazertinib in patients with EGFR-mutant non–small cell lung (NSCLC) after progression on osimertinib and platinum-based chemotherapy: Updated results from CHRYSALIS-2.

9006 Background: Initial results with the amivantamab (ami) and lazertinib (laz) regimen showed enco...

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 15/22 #TumorBoardTuesday
👩🏼‍🏫Mini Tweetorial 11👩🏻‍🏫
📌Novel directions
🎯HER3 targeted Abs
🫧HER3 expressed on cell surface in NSCLC (≤ 75%)
🔹Patritumab deruxtecan (HER3-Dxd): antibody-drug conjugate (ADC)
🫧Chemo (topo II inhibitor) to cells with HER3
📚ncbi.nlm.nih.gov

ncbi.nlm.nih.gov/pmc/articles/P…

Treating disease progression with osimertinib in EGFR-mutated non-small-cell lung cancer: novel targeted agents and combination strategies

A precision medicine approach has been successfully applied in medical oncology for the treatment of...

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 16/22 #TumorBoardTuesday
👩🏼‍🏫Mini Tweetorial 12👩🏻‍🏫
📌HER3-Dxd
Ongoing trials
📍EGFR-mutated, Osi-resistant NSCLC
Prelim Data
📍RR 39% in 44 pts who received Osimertinib prior
✨U3-1402
📚clinicaltrials.gov
🤨Response across mechanisms?
🤔Active regardless of HER3 IHC express?

clinicaltrials.gov/study/NCT03260…

CTG Labs - NCBI

Hide glossary Study record managers: refer to the Data Element Definitions if submitting registratio...

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 17/22 #TumorBoardTuesday #LCSM
Back to our case🔎
💦Liquid biopsy
🧪NGS did not identify resistance mechanism
🔬Tissue bx
❌No SCLC transformation
🧪NGS neg for resistance mechanism
🐟FISH pos for MET amp
🟢Start osimertinib + capmatinib 200mg bid
**Note - Off label use**

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 18/22 #TumorBoardTuesday #LCSM #LungCancer
MET resistance = MET overexpression, amp, mut, fusion
🥇Gold Standard Dx:
🔬Tissue Bx detection: FISH🐟 (30%) > Liq bx 💦 (15%)
MET Amp a/w poor prognosis
BUT
🎯We have targeted agents now!

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 19/22 #TumorBoardTuesday
📌Level of MET Expression
📍METi (Tepotinib) + EGFR (Gefitinib) vs plat-doublet chemo
❌No gross improvement in mPFS
BUT
⬆️MET IHC & MET gene amp: ⬆️Higher ORR & mPFS, tx length
📍Low accrual > trial termination
✨INSIGHT
📚ncbi.nlm.nih.gov

ncbi.nlm.nih.gov/pmc/articles/P…

Randomized Trial of Tepotinib Plus Gefitinib versus Chemotherapy in EGFR-Mutant NSCLC with EGFR Inhibitor Resistance Due to MET Amplification: INSIGHT Final Analysis

The final analyses of the INSIGHT phase II study evaluating tepotinib (a selective MET inhibitor) pl...

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 20/22 #TumorBoardTuesday
Prospective Trials
✨INSIGHT-2
📚tinyurl.com
🎯EGFR & MET combination
📍Osi + Tepotinib (initial results)
📍MET Amp
📍ORR > 50% at 9 mos
AEs
⬇️dose in ~20%
👍🏽No new AE
✨TATTON
📚classic.clinicaltrials.gov
✨SAVANNAH
📚classic.clinicaltrials.gov

tinyurl.com/2p8ph6zy

ESMO Congress | OncologyPRO

OncologyPRO is the home of ESMO’s educational & scientific resources, with exclusive content for ESM...

classic.clinicaltrials.gov/ct2/show/NCT02…

AZD9291 in Combination With Ascending Doses of Novel Therapeutics - Full Text View - ClinicalTrials.gov

AZD9291 in Combination With Ascending Doses of Novel Therapeutics - Full Text View.

classic.clinicaltrials.gov/ct2/show/NCT03…

Osimertinib Plus Savolitinib in EGFRm+/MET+ NSCLC Following Prior Osimertinib - Full Text View - ClinicalTrials.gov

Osimertinib Plus Savolitinib in EGFRm+/MET+ NSCLC Following Prior Osimertinib - Full Text View.

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Back to our patient
🗓️3 Month
🩻Scan
🫁Decrease size of lung nodules
Toxicities
👩🏽 Patient ⬇️ reduces dose of MET TKI due to edema
🙏🏼feels well 🎉

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD @oncoOuLungCA @MNagasaka 22/22 #TumorBoardTuesday #LCSM #LungCancer
🔥Bonus🔥
🎯If no targetable alteration then use chemotherapy +/- continue osimertinib
🧠Get brain MRI at time of disease progression for new baseline
🧲Especially if stopping osimertinib ➡️ MRI brain surveillance q6Month

@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD #PostTest Q1️⃣ #TumorBoardTuesday #LungCancer
👉🏽#CME Eval 🔗 integrityce.com
🤔@MMarmarelis @norataranto taught us Tx after progression on Osimertinib, test your 🧠
🧐What Tx?
57yo 👩🏼‍🦳
Asx Stage IV NSCLC adenocarcinoma
EGFR L858R
5 🧠 mets <3mm
PD-L1 85%

integrityce.com/TBTeval23

Tumor Board Tuesday Evaluation 2023 (ID: i854/i855/i862/i865)

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@TumorBoardTues @MMarmarelis @MPishvaian @JohnEbbenMDPhD @ADesaiMD @esinghimd @marinagarassino @n8pennell @LeciaSequist @apipervallillo @JessicaJLinMD @NarjustFlorezMD @Tony_Calles @JoelNealMD @DrSteveMartin @HosseinBorghaei @FawziAbuRous @Latinamd @CatherineShuMD @VivekSubbiah @DevikaDasMD @ShrutiPatelMD @CharuAggarwalMD @StephenVLiu @NIVokes @sands_jacob @JustinGainor @FordePatrick @DrRoyHerbstYale @DrRiyazShah @DrJNaidoo @Alfdoc2 @gbanna74 @bhsubecha @snoonanonc @debonco @bpiperdi @chase_wasson @acmoorephd @DrSanjayPopat @colinsky2k @alejos_david @jkverma2429 @steveleeyc @deeptibehl1 @SprakerMDPhD @BMuthusamyMD @AlexSpiraMDPhD #PostTest Q2️⃣ #TumorBoardTuesday
👉🏽 Free CME 🔗 integrityce.com
👉🏽#CME Eval 🔗 integrityce.com
🧐 What treatment next?
57yo 👩🏼‍🦱
EGFR L858R NSCLC adenocarcinoma
🗓️2 years osimertinib
🫁Progress in lung
🔬Tissue re-biopsy
MET amp

integrityce.com/TBT2023

Tumor Board Tuesday 2023 Conversations

Tumor Board Tuesdays is a regularly scheduled, Twitter-based case discussion forum led by expert fac...

integrityce.com/TBTeval23

Tumor Board Tuesday Evaluation 2023 (ID: i854/i855/i862/i865)

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CNS Response to Osimertinib Versus Standard Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients With Untreated EGFR-Mutated Advanced Non–Small-Cell Lung Cancer

A Phase II Study of Osimertinib for Radiotherapy-Naive Central Nervous System Metastasis From NSCLC: Results for the T790M Cohort of the OCEAN Study (LOGIK1603/WJOG9116L)