@TumorBoardTues 1/23 #TumorBoardTuesday #Mesothelioma #OncTwitter @FordePatrick @MPishvaian @JohnEbbenMDPhD
65 yo ๐จ๐ฝโ๐ผ๐ญ
retired ๐ท๐ฝโโ๏ธ construction
โ PMHx
๐ฎโ๐จ SOB + cough
๐ฉป CT CAP: pleural effusion with thickening + โฌ๏ธ hilar LNs, nil other
๐ซ Thoracentesis: atypical cells
๐งช Hb, WBC & Biochem: WNL
65 yo ๐จ๐ฝโ๐ผ๐ญ
retired ๐ท๐ฝโโ๏ธ construction
โ PMHx
๐ฎโ๐จ SOB + cough
๐ฉป CT CAP: pleural effusion with thickening + โฌ๏ธ hilar LNs, nil other
๐ซ Thoracentesis: atypical cells
๐งช Hb, WBC & Biochem: WNL
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD 2/23 #TumorBoardTuesday #LCSM @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa #Mesothelioma
๐ฌVATS bx โ Path Dx: mesothelioma
๐จ๐ปโ๐ฌFurther studies pending
+ asbestos exposure
ECOG: 0
No FHx of malignancy
๐ค What would you do next to complete your work-up?
๐ฌVATS bx โ Path Dx: mesothelioma
๐จ๐ปโ๐ฌFurther studies pending
+ asbestos exposure
ECOG: 0
No FHx of malignancy
๐ค What would you do next to complete your work-up?
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 3/23 #TumorBoardTuesday #LCSM
๐จ๐ผโ๐ซMini tweetorial 1๐ฉ๐ปโ๐ซ
๐Mesothelioma
USA~3300 pts/yr
๐๏ธAnnual incidence ~1/100,000
โ๏ธ>โ๏ธ
๐ซ80-90% Pleural
#1 risk=Asbestos exposure w >15 yrs latency: ~85% of cases
๐งฌGenetics: BAP1 + DDR altsโmore later!
Pre-2021 mOS ~1yr
๐jto.org
๐จ๐ผโ๐ซMini tweetorial 1๐ฉ๐ปโ๐ซ
๐Mesothelioma
USA~3300 pts/yr
๐๏ธAnnual incidence ~1/100,000
โ๏ธ>โ๏ธ
๐ซ80-90% Pleural
#1 risk=Asbestos exposure w >15 yrs latency: ~85% of cases
๐งฌGenetics: BAP1 + DDR altsโmore later!
Pre-2021 mOS ~1yr
๐jto.org
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 4/23 #TumorBoardTuesday #LCSM
๐จ๐ผโ๐ซMini tweetorial 2๐ฉ๐ปโ๐ซ
๐Mesothelioma
๐ฌDx by morphologic & IHC features
โก๏ธExperienced path neededโผ๏ธ
3 subtypes
๐ซงepi
๐ซงsarc
๐ซงbiphas
โNo single marker has sufficiently โฌ๏ธ sensitivity & โฌ๏ธ specificity: multiple required
๐นSpecific markers for each
๐จ๐ผโ๐ซMini tweetorial 2๐ฉ๐ปโ๐ซ
๐Mesothelioma
๐ฌDx by morphologic & IHC features
โก๏ธExperienced path neededโผ๏ธ
3 subtypes
๐ซงepi
๐ซงsarc
๐ซงbiphas
โNo single marker has sufficiently โฌ๏ธ sensitivity & โฌ๏ธ specificity: multiple required
๐นSpecific markers for each
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @AndresFCardonaZ
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy 5/23 #TumorBoardTuesday
๐จ๐ผโ๐ซMini tweetorial 3๐ฉ๐ปโ๐ซ
๐Mesothelioma
๐Prognostic Factors in pleural:
#1 = Advanced stage & non-epithelioid histology
See EORTC & CALGB prognostic indices for addโl factors
๐@andrewbottom0 ascopubs.org
๐@_johnedwards thorax.bmj.com
๐จ๐ผโ๐ซMini tweetorial 3๐ฉ๐ปโ๐ซ
๐Mesothelioma
๐Prognostic Factors in pleural:
#1 = Advanced stage & non-epithelioid histology
See EORTC & CALGB prognostic indices for addโl factors
๐@andrewbottom0 ascopubs.org
๐@_johnedwards thorax.bmj.com
thorax.bmj.com/content/55/9/7โฆ
Prognostic factors for malignant mesothelioma in 142 patients: validation of CALGB and EORTC prognostic scoring systems
BACKGROUND The incidence of malignant mesothelioma is increasing. There is the perception that survi...
ascopubs.org/doi/10.1200/JCโฆ
Symptoms and Patient-Reported Well-Being: Do They Predict Survival in Malignant Pleural Mesothelioma? A Prognostic Factor Analysis of EORTC-NCIC 08983: Randomized Phase III Study of Cisplatin With or Without Raltitrexed in Patients With Malignant Pleural
Purpose Malignant pleural mesothelioma (MPM) is a rare disease. Unlike other advanced cancer types,...
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @andrewbottom0 @_johnedwards 6/23 #TumorBoardTuesday #LCSM
Back to our case๐
๐ฌPath: Biphasic histological subtype 80% sarcomatoid
PD-L1 โฅ1%
๐ฉปPET: ๐ฅ FDG๐ฅ with hilar & supraclavicular LNs
Stage IIIB at multidisciplinary team (MDT) discussion
ECOG: 0
๐งWhat treatment would YOU recommend?
Back to our case๐
๐ฌPath: Biphasic histological subtype 80% sarcomatoid
PD-L1 โฅ1%
๐ฉปPET: ๐ฅ FDG๐ฅ with hilar & supraclavicular LNs
Stage IIIB at multidisciplinary team (MDT) discussion
ECOG: 0
๐งWhat treatment would YOU recommend?
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @andrewbottom0 7/23 #TumorBoardTuesday #LungCancer #Mesothelioma
๐จ๐ผโ๐ซMini tweetorial 4๐ฉ๐ปโ๐ซ
๐Historical 1st Line โก๏ธ Cisplatin+Pemetrexed
๐Ph3 Doublet vs Cis mono 2003
๐๐ฝOnly FDA tx for 16yrs
โ ORR 41.7%
๐mPFS 5.7mo
๐mOS 12.1mo
๐#Vogelzang @SWOG ascopubs.org
x.com
๐จ๐ผโ๐ซMini tweetorial 4๐ฉ๐ปโ๐ซ
๐Historical 1st Line โก๏ธ Cisplatin+Pemetrexed
๐Ph3 Doublet vs Cis mono 2003
๐๐ฝOnly FDA tx for 16yrs
โ ORR 41.7%
๐mPFS 5.7mo
๐mOS 12.1mo
๐#Vogelzang @SWOG ascopubs.org
x.com
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @andrewbottom0 8/23 #TumorBoardTuesday #LCSM
๐จ๐ผโ๐ซMini tweetorial 5๐ฉ๐ปโ๐ซ
๐Cisplatin+Pemetrexed
4-6 cycles pre-2021 SOC
Common AEs
โฌ๏ธ neutrophils
๐mucositis
๐ฅฑFatigue
๐ฝ๏ธAnorexia
๐ฝDiarrhea
๐คขNausea
๐Ocular
๐นSkin rash
โฌ๏ธ Toxicity: folic acid + q 9wk B12
๐@MichaelBoyer1 ascopubs.org
๐จ๐ผโ๐ซMini tweetorial 5๐ฉ๐ปโ๐ซ
๐Cisplatin+Pemetrexed
4-6 cycles pre-2021 SOC
Common AEs
โฌ๏ธ neutrophils
๐mucositis
๐ฅฑFatigue
๐ฝ๏ธAnorexia
๐ฝDiarrhea
๐คขNausea
๐Ocular
๐นSkin rash
โฌ๏ธ Toxicity: folic acid + q 9wk B12
๐@MichaelBoyer1 ascopubs.org
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @andrewbottom0 9/23 #TumorBoardTuesday
๐จ๐ผโ๐ซMini tweetorial 5๐ฉ๐ปโ๐ซ
โจMAPS
๐ซ๐ทโ14
๐Ph3
๐คผDoublet + Beva (PCB) vs Cis+Peme
๐mPFS 9.2 vs 7.3mo
๐mOS 18.8 vs 16mo
โ โฅG3 AEs 71% vs 62%
โ๏ธNot FDA approvedโ๏ธ
*Multiple CTs: doublet+ Xโก๏ธunsuccessful
๐@gzalcman thelancet.com
๐คจIs more better?
๐จ๐ผโ๐ซMini tweetorial 5๐ฉ๐ปโ๐ซ
โจMAPS
๐ซ๐ทโ14
๐Ph3
๐คผDoublet + Beva (PCB) vs Cis+Peme
๐mPFS 9.2 vs 7.3mo
๐mOS 18.8 vs 16mo
โ โฅG3 AEs 71% vs 62%
โ๏ธNot FDA approvedโ๏ธ
*Multiple CTs: doublet+ Xโก๏ธunsuccessful
๐@gzalcman thelancet.com
๐คจIs more better?
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy 10/23 #TumorBoardTuesday #LCSM #Mesothelioma
๐จ๐ผโ๐ซMini tweetorial 6๐ฉ๐ปโ๐ซ
โจCheckMate743
๐คผ Ph3: Ipi-Nivo vs plat doublet
๐ธORR 40 vs 43%
๐mPFS 6.8 vs 7.2 mos
๐mOS 18.1 vs 14.1 mos
๐2 year OS 40.8 vs 27%
โ โฅG3 AEs 30 vs 32%
๐@peters_solange @gzalcman thelancet.com
๐จ๐ผโ๐ซMini tweetorial 6๐ฉ๐ปโ๐ซ
โจCheckMate743
๐คผ Ph3: Ipi-Nivo vs plat doublet
๐ธORR 40 vs 43%
๐mPFS 6.8 vs 7.2 mos
๐mOS 18.1 vs 14.1 mos
๐2 year OS 40.8 vs 27%
โ โฅG3 AEs 30 vs 32%
๐@peters_solange @gzalcman thelancet.com
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @peters_solange 11/23 #TumorBoardTuesday
๐จ๐ผโ๐ซMini tweetorial 7
โจCheckMate743
๐นMAJOR improvement for pts
๐๐ฝBetter in non-epithelioid histology
๐OS 18.1 v 8.8mos
HR 0.46 v 0.86
๐๐ฝBetter in PD-L1โฅ 1%
18.0 v 13.3mos
HR 0.69 v 0.94
๐๐ฝresults accelerated @US_FDA โ21 approval
โก๏ธPractice Changingโก๏ธ
๐จ๐ผโ๐ซMini tweetorial 7
โจCheckMate743
๐นMAJOR improvement for pts
๐๐ฝBetter in non-epithelioid histology
๐OS 18.1 v 8.8mos
HR 0.46 v 0.86
๐๐ฝBetter in PD-L1โฅ 1%
18.0 v 13.3mos
HR 0.69 v 0.94
๐๐ฝresults accelerated @US_FDA โ21 approval
โก๏ธPractice Changingโก๏ธ
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @peters_solange @US_FDA 12/23 #TumorBoardTuesday #LungCancer
๐จ๐ผโ๐ซMini tweetorial 8๐ฉ๐ปโ๐ซ
โcombo of chemo+ICI > doublet chemoโ
โจIND227โจ
๐ซ๐ท ๐ฎ๐น ๐จ๐ฆ
๐Ph3
๐คผPembro + plat-doublet vs doublet
โ ORR 62 vs.38%
๐mOS 17.3 mo, HR0.79 (0.64,0.98)
๐3yr OS 25 vs 17%
โ โฅG3 AE 28 vs 15%
โฌ๏ธin non-epithelioidโHR 0.57
๐จ๐ผโ๐ซMini tweetorial 8๐ฉ๐ปโ๐ซ
โcombo of chemo+ICI > doublet chemoโ
โจIND227โจ
๐ซ๐ท ๐ฎ๐น ๐จ๐ฆ
๐Ph3
๐คผPembro + plat-doublet vs doublet
โ ORR 62 vs.38%
๐mOS 17.3 mo, HR0.79 (0.64,0.98)
๐3yr OS 25 vs 17%
โ โฅG3 AE 28 vs 15%
โฌ๏ธin non-epithelioidโHR 0.57
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy 13/23 #TumorBoardTuesday #LCSM #Mesothelioma
๐จ๐ผโ๐ซMini tweetorial 9๐ฉ๐ปโ๐ซ
โจOngoing clinical trialsโจ
๐Exploring Chemo + IO combos
โจBuilding on IND227 results
๐@IFCTlung @CDNCancerTrials ascopubs.org
๐คCombine our two best treatments โก๏ธ can we do better?
๐จ๐ผโ๐ซMini tweetorial 9๐ฉ๐ปโ๐ซ
โจOngoing clinical trialsโจ
๐Exploring Chemo + IO combos
โจBuilding on IND227 results
๐@IFCTlung @CDNCancerTrials ascopubs.org
๐คCombine our two best treatments โก๏ธ can we do better?
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung @CDNCancerTrials 14/23 #TumorBoardTuesday #LCSM
Back to our case๐
โUnresectable per MDT
๐4 cycles of Ipi (1mg/kg q6wk) + Nivo (3mg/kg q2wk)
๐ฉG3 colitis โก๏ธ responds to oral ๐บsteroids (taper over 6wks)
๐Nivo monotherapy after 10 wk break
๐ฉปCT: 3, 6, 9 mos = PR
๐จ๐ฝโ๐ผPatient feeling well ๐
Back to our case๐
โUnresectable per MDT
๐4 cycles of Ipi (1mg/kg q6wk) + Nivo (3mg/kg q2wk)
๐ฉG3 colitis โก๏ธ responds to oral ๐บsteroids (taper over 6wks)
๐Nivo monotherapy after 10 wk break
๐ฉปCT: 3, 6, 9 mos = PR
๐จ๐ฝโ๐ผPatient feeling well ๐
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung @CDNCancerTrials 15/23 #TumorBoardTuesday #LCSM
๐ฉปCT: 12mos โ โฌ๏ธpleural thickening, thoracic LNs with liver mets
โฌ๏ธfatigue+SOBOE
ECOG: 1
๐จ๐ฝโ๐ผPatient wishes โก๏ธ more therapy
๐Consider in #SharedDecision
๐๐ปโโ๏ธDisease burden
๐ECOG PS
๐ทPrior toxicity
๐ฐFinancial toxicity
โณFreq of treatment
๐AE
๐ฉปCT: 12mos โ โฌ๏ธpleural thickening, thoracic LNs with liver mets
โฌ๏ธfatigue+SOBOE
ECOG: 1
๐จ๐ฝโ๐ผPatient wishes โก๏ธ more therapy
๐Consider in #SharedDecision
๐๐ปโโ๏ธDisease burden
๐ECOG PS
๐ทPrior toxicity
๐ฐFinancial toxicity
โณFreq of treatment
๐AE
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung @CDNCancerTrials 16/23 #TumorBoardTuesday
๐2nd Line for meso
โ ๏ธDepends on 1st txโ ๏ธ
No FDA approved salvage
๐งClinical Trial option
If IOโก๏ธCis+Pem
Carbo โ Cis
๐better tolerated
๐jto.org
If Chemo โก๏ธ IO or if platinum-free >6/12 โก๏ธ reโchallenge
๐ascopubs.org
๐2nd Line for meso
โ ๏ธDepends on 1st txโ ๏ธ
No FDA approved salvage
๐งClinical Trial option
If IOโก๏ธCis+Pem
Carbo โ Cis
๐better tolerated
๐jto.org
If Chemo โก๏ธ IO or if platinum-free >6/12 โก๏ธ reโchallenge
๐ascopubs.org
ascopubs.org/doi/10.1200/JCโฆ
Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline
Purpose To provide evidence-based recommendations to practicing physicians and others on the managem...
jto.org/article/S1556-โฆ
Pemetrexed Plus Cisplatin or Pemetrexed Plus Carboplatin for Chemonaรฏve Patients with Malignant Pleural Mesothelioma: Results of the International Expanded Access Program
Previously published results from a randomized phase III study of pemetrexed plus cisplatin in patie...
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung 17/23 #TumorBoardTuesday
๐จ๐ผโ๐ซMini tweetorial 10๐ฉ๐ปโ๐ซ
๐Role for surgery in pleural Meso๐ช
Recently at #WCLC23
โจMARS2
๐Ph3
Chemo โก๏ธ Surgery โก๏ธ Chemo vs Chemo solo
โNo PFS / OS benefit
โฌ๏ธTox
โฌ๏ธQoL after ๐ช
๐ธexpensive
๐๐ฝWorse in non-epithelioid
๐@ekslim papers.ssrn.com
๐จ๐ผโ๐ซMini tweetorial 10๐ฉ๐ปโ๐ซ
๐Role for surgery in pleural Meso๐ช
Recently at #WCLC23
โจMARS2
๐Ph3
Chemo โก๏ธ Surgery โก๏ธ Chemo vs Chemo solo
โNo PFS / OS benefit
โฌ๏ธTox
โฌ๏ธQoL after ๐ช
๐ธexpensive
๐๐ฝWorse in non-epithelioid
๐@ekslim papers.ssrn.com
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung @ekslim 18/23 #TumorBoardTuesday
๐จ๐ผโ๐ซMini tweetorial 11๐ฉ๐ปโ๐ซ
โจMARS2
Lots to debate๐คผ
๐คPractice changingโ
โฌ๏ธLess chemo + subseq line IO received in ๐ช arm
๐คจD/t impact of ๐ช on fitness for rx
โ๏ธAppropriate ptsโ๏ธ
โInclusion of non epithelioid
๐ชongoing neoadj IO trialsโ role for surgery?
๐จ๐ผโ๐ซMini tweetorial 11๐ฉ๐ปโ๐ซ
โจMARS2
Lots to debate๐คผ
๐คPractice changingโ
โฌ๏ธLess chemo + subseq line IO received in ๐ช arm
๐คจD/t impact of ๐ช on fitness for rx
โ๏ธAppropriate ptsโ๏ธ
โInclusion of non epithelioid
๐ชongoing neoadj IO trialsโ role for surgery?
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung @ekslim 19/23 #TumorBoardTuesday
๐จ๐ผโ๐ซMini tweetorial 12
๐งฌGermline susceptibility for meso
โ12% carry germ mutation
๐นFHx with low/minimal asbestos exposure
๐ธLow threshold for germ test
๐นBAP-1 + DDR muts most common
๐ฎFuture Target?
๐jto.org
๐ascopubs.org
๐จ๐ผโ๐ซMini tweetorial 12
๐งฌGermline susceptibility for meso
โ12% carry germ mutation
๐นFHx with low/minimal asbestos exposure
๐ธLow threshold for germ test
๐นBAP-1 + DDR muts most common
๐ฎFuture Target?
๐jto.org
๐ascopubs.org
jto.org/article/S1556-โฆ
Medical and Surgical Care of Patients With Mesothelioma and Their Relatives Carrying Germline BAP1 Mutations
The most common malignancies that develop in carriers of BAP1 germline mutations include diffuse mal...
ascopubs.org/doi/10.1200/JCโฆ
Frequency of Germline Mutations in Cancer Susceptibility Genes in Malignant Mesothelioma
Purpose The aim of the current study was to determine the prevalence and clinical predictors of germ...
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung @ekslim 20/23 #TumorBoardTuesday #LCSM #Mesothelioma #LungCancer
๐จ๐ผโ๐ซMini tweetorial 13๐ฉ๐ปโ๐ซ
๐ฏTargeted Therapies & Future Directions
๐ฎThe future is bright ๐
๐Thank you to all patients & caregivers involved
๐โจPEMMELA x.com
๐จ๐ผโ๐ซMini tweetorial 13๐ฉ๐ปโ๐ซ
๐ฏTargeted Therapies & Future Directions
๐ฎThe future is bright ๐
๐Thank you to all patients & caregivers involved
๐โจPEMMELA x.com
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung @ekslim 21/23 #TumorBoardTuesday #LCSM #Mesothelioma
Back to our case๐
๐จ๐ฝโ๐ผPt commences Carbo + Pemetrexed as 2L
s/p 4 cycles
๐ฉปCT: Stable disease
๐จ๐ฝโ๐ผFatigue, G2 rash, G1 diarrhea, no change in SOBOE
๐จ๐ฝโ๐ผrequests treatment break
โ๏ธConsult with & refer to supportive care
Back to our case๐
๐จ๐ฝโ๐ผPt commences Carbo + Pemetrexed as 2L
s/p 4 cycles
๐ฉปCT: Stable disease
๐จ๐ฝโ๐ผFatigue, G2 rash, G1 diarrhea, no change in SOBOE
๐จ๐ฝโ๐ผrequests treatment break
โ๏ธConsult with & refer to supportive care
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung 22/23 #TumorBoardTuesday #LCSM
๐Maintenance pemetrexed vs break
RCT
๐Ph2
๐นn=49
โNo PFS benefit
๐OS not statistically significant (16.3 vs 11.8)
๐Multi retrospectives - no clear benefit
๐ธphysical, time, financial toxicities
๐@HosseinBorghaei
clinical-lung-cancer.com
๐Maintenance pemetrexed vs break
RCT
๐Ph2
๐นn=49
โNo PFS benefit
๐OS not statistically significant (16.3 vs 11.8)
๐Multi retrospectives - no clear benefit
๐ธphysical, time, financial toxicities
๐@HosseinBorghaei
clinical-lung-cancer.com
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy @IFCTlung 23/23 #TumorBoardTuesday
๐ซRecap๐ซ
๐Pleural mesothelioma is rare
๐๐ฝSignificant advances in last 3yrs
๐Full staging + path rv essential to optimize tx
๐ชSurgical role limited & evolving
๐Ipi + Nivo: 1st choice, especially in non-epithelioid histology
๐ฎNeed MORE research!!
๐ซRecap๐ซ
๐Pleural mesothelioma is rare
๐๐ฝSignificant advances in last 3yrs
๐Full staging + path rv essential to optimize tx
๐ชSurgical role limited & evolving
๐Ipi + Nivo: 1st choice, especially in non-epithelioid histology
๐ฎNeed MORE research!!
@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy #PostTest Q1๏ธโฃ #TumorBoardTuesday
๐๐ฝ#CME Eval ๐ integrityce.com
๐๐ฝALL CME๐ integrityce.com
๐ค@FordePatrick @LochrinSarah taught us updates in #Mesothelioma, test yourself
๐งWhatโs 1st?
66yo ๐จ๐พโ๐ฆณ
new dx
stage 3B pleural meso (biphasic, 80% sarcomatoid)
ECOG PS: 0
๐๐ฝ#CME Eval ๐ integrityce.com
๐๐ฝALL CME๐ integrityce.com
๐ค@FordePatrick @LochrinSarah taught us updates in #Mesothelioma, test yourself
๐งWhatโs 1st?
66yo ๐จ๐พโ๐ฆณ
new dx
stage 3B pleural meso (biphasic, 80% sarcomatoid)
ECOG PS: 0
integrityce.com/TBT2023
Tumor Board Tuesday 2023 Conversations
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integrityce.com/TBTeval23
Tumor Board Tuesday Evaluation 2023 (ID: i854/i855/i862/i865)
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@TumorBoardTues @FordePatrick @MPishvaian @JohnEbbenMDPhD @NarjustFlorezMD @DipeshUpretyMD @christine_lovly @esinghimd @safaviaa @DrJNaidoo @emer_hanrahan @DrJFriedberg @gzalcman @SamuelKareffMD @n8pennell @LeciaSequist @CharuAggarwalMD @AnaVManana @BrendonStilesMD @RManochakian @geoff_oxnard @DevikaDasMD @benlevylungdoc @harpreet_md @LaurenByersMD @HopkinsThoracic @AMansfieldMD @HwakeleeMD @bjork5 @Joshua_Reuss @Yvonne_Diaz_ @bensolomon1 @acmoorephd @sands_jacob @jacobadashek @jillfeldman4 @TerriConneran @LUNGevity @AmandaNerstad @Sunonmyhip @vincentlamMD @meenathakur_ @nijuoti @DrRoyHerbstYale @HosseinBorghaei @JackWestMD @PathologyPat @smlungpathguy #PostTest Q2๏ธโฃ #TumorBoardTuesday
๐๐ฝ Free CME ๐ integrityce.com
๐งIn combo with platinum-doublet chemo, which ICI significantly improved OS in patients who have pleural #mesothelioma and chemotherapy-naive
๐๐ฝ Free CME ๐ integrityce.com
๐งIn combo with platinum-doublet chemo, which ICI significantly improved OS in patients who have pleural #mesothelioma and chemotherapy-naive
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