Chris Estes

Radiation oncologist in MO | @RadoncTables | Tweets = my own

[Chris Estes @EstesRadonc]

The INSEMA authors write that omission of SLNB was must be weighed against potential benefit of RNI.

If RNI was a requirement in those with 1-3 nodes, and the trial was properly powered, EBCTCG 2023 suggests the results may have been different.

[Chris Estes @EstesRadonc]

From one perspective, INSEMA and SOUND are poorly designed and underpowered clinical trials for RNI.

SOUND authors themselves write in the discussion that the trial was not powered to detect differences from adjuvant treatments.

[Chris Estes @EstesRadonc]

@AppleHelix @JackWestMD Is the pad thai standard of care for treating cancer? Then yes the chef is supposed to change it

Your tweet suggests that those who failed observation should be withheld osi so that the trial is powered

[Chris Estes @EstesRadonc]

@JackWestMD @AppleHelix I'm rad onc so not totally familiar with the practice patterns at the time, but:

The trial started 10/21/2015
Osi was approved by FDA 4/18/2018
Trial closed to enrollment 1/17/2020

39% in control arm with progression had osi

Seems not too bad given the timeline?

[Chris Estes @EstesRadonc]

@SyedMAhmedMDPhD @jryckman3 @SprakerMDPhD @RadoncTables @d_golden @emmacfields @radoncreview Not the first time I've been accused of being a machine

Thanks for your comments. Edits have been made

[Chris Estes @EstesRadonc]

@BijoyTelivala There is no such thing as a “surrogate” endpoint.

Not only that, PFS is a heterogeneous endpoint. “Surrogates” do not take into account toxicity or QOL either

Correlation doesn’t equal causation, as much as pharmaceutical companies trying to save money would like it to.

[Chris Estes @EstesRadonc]

@gammaemitter @RadoncTables Where is this in the paper? I see that it says TBI was not related, and this post is meant for people to consider ISRT, not TBI

[Chris Estes @EstesRadonc]

@Sushilberiwal @ParikhSimul

[Chris Estes @EstesRadonc]

@Sushilberiwal @ParikhSimul Teamlabs in Tokyo is an absolute must

[Chris Estes @EstesRadonc]

@gillies_mckenna The dopest hammers, ones that don’t cause gastric ulcers or kidney failure

[Chris Estes @EstesRadonc]

@NRGonc wishlist

1) hyperfx RT with concurrent chemo vs conventional chemoRT for newly dx H&N

2) IMRT vs conventional for breast w or w/out RNI

3) low dose RT for osteoarthritis and other benign things

4) bolus vs no bolus subanalysis on post mastectomy protocols

[Terry Williams @TeWilliamsMD]

This exciting paper was just published showing proof-of-principle of a core belief in radiobiology we’ve had for a long time: that hyperfractionation can reduce long-term side effects of radiation, in this case translating to OS improvement! #radbio https://t.co/Ixu96EqFoU

[Chris Estes @EstesRadonc]

@safaviaa @RadoncTables It's difficult to believe that these could be the final DFS outcomes with the length of f/u and that OS hasn't even been reported yet. Data cutoff too early

There are differences between the settings of the trial and SINDAS for sure

[Chris Estes @EstesRadonc]

@ParikhSimul I like the scope. You can see things that don’t show up on imaging.

If ENT gives you their video that’s fine but photos only are often not adequate

The prostate exam though can go away for rad onc

[Chris Estes @EstesRadonc]

STRIDE (tremelimumab + durvalumab)
Median OS 16.4 vs. 13.8 mos
3-yr OS 31% vs. 20%
Median PFS not different
Grade 3-4 events similar

Checkmate 459 (nivolumab)
Median OS 16.4 vs. 14.7 mos
2-yr OS 37% vs. 33%
Median PFS 3.7 vs. 3.8 mos

3/3

[Chris Estes @EstesRadonc]

RTOG 1112
Median OS 15.8 vs. 12.3 mos
Median PFS 9.2 vs. 5.5 mos
TTP also improved
Grade 3+ toxicity not different

KEYNOTE-240 (pembro)
Median OS 13.9 vs. 10.6 mos
Median PFS 3.0 vs. 2.8 mos
Grade 3 events 53% vs. 46%

2/3

[Chris Estes @EstesRadonc]

@tjroycemd I believe that there is a rule that when the title of an article is a question, the answer is always No

[Chris Estes @EstesRadonc]

@VidalRadOnc @subatomicdoc @bvbal79 @ParikhSimul @Ozradonc @KoneruMd Yes next time! I’m gonna try to make it to the next ACRO

[Chris Estes @EstesRadonc]

@subatomicdoc @bvbal79 @ParikhSimul @Ozradonc @KoneruMd Also there are lots of cancer patients we already see that just happen to also have arthritis pain. Might try this out!

[Chris Estes @EstesRadonc]

@subatomicdoc @ParikhSimul @SprakerMDPhD @drbeckta Susan G Komen? I found it very interesting that they sponsored TAILORX