David Einstein

Disease Group Leader, GU Medical Oncology @BIDMChealth @DanaFarber_GU, Asst Prof @harvardmed, dad, cyclist, Far Side superfan

[Ian Davis (Bluesky @profiand) @Prof_IanD]

@realbowtiedoc @PallOncCoP @MazieTsangMD @DarcyBurbage @Chaosdyna @crisbergerot @GretchenMcnally @BbaharK @asfeen_ummul @veladconmigo @FionnualaCrowle @jillfeldman4 @IshwariaMD @SrinishantR @AjuVaniBabu @rabrazzak @TamrynGray 📢 PALLIATIVE CARE IS SIMPLY GOOD CARE AIMED TO MEET PEOPLE’S NEEDS!
It is part of routine care.
It is NOT mutually exclusive with active treatment.
There is never “nothing we can do” - there is always something we can do to help.
It’s not always “find a new shiny drug.”
#ASCO26

[David Einstein @davidjeinstein]

@PaulSargos @TylerSbrt @jryckman3 @HimanshuNagarMD @Soum_Roy_RadOnc @VedangMurthy @DrSpratticus @DrAndrewLoblaw @AmarUKishan @NicholasZaorsky @seanmmcbride TFS would quantify this tradeoff nicely! Especially if EFS or TTNT is not improved.

[Tyler Seibert MD PhD @TylerSbrt]

@jryckman3 @HimanshuNagarMD @Soum_Roy_RadOnc @VedangMurthy @DrSpratticus @DrAndrewLoblaw @AmarUKishan @NicholasZaorsky SENTRY is an IIT, phase II, for localized HR (N0 on PSMA). RT+18m ADT vs RT+6m ADT/ARPI.

RSI MRI and PSMA PET required. Focal boost required if feasible.

MDT alone encouraged for oligomet recurrence.

Primary endpoint: FFS; “failure” of initial Rx plan = salvage ADT or CRPC.

[David Einstein @davidjeinstein]

@DrChoueiri @weoncologists @ASCO @OncoAlert @OncBrothers @Uromigos @DrRanaMcKay @apolo_andrea @neerajaiims @PGrivasMDPhD @BraunMDPhD @DrYukselUrun @AlbigesL @montypal Emphasis on the “who received BOTH,” a subset of the whole sample. Clearly the big question is whether Pluvicto pre-doce decreases the ability to treat with doce later.

[David Einstein @davidjeinstein]

@Prof_Nick_James @crisbergerot A similar discussion in BCR:

https://t.co/O3Lmli4qdd

[David Einstein @davidjeinstein]

@DrSpratticus @APCCC_Lugano @US_FDA @DrMakaryFDA At the NCI BCR Working Group, PFS by PET was called a “rich person’s bPFS” for this reason. Similar for bEFS/PET-defined MFS.

One more reason not to equate PSMA+ BCR with mHSPC/APMN.

@Dr_RaviMadan @melissaabel20

[David Einstein @davidjeinstein]

@CanesDavid @DrSpratticus A similar discussion in BCR:

https://t.co/O3Lmli4qdd

[David Einstein @davidjeinstein]

@DrSpratticus @APCCC_Lugano @US_FDA @DrMakaryFDA At the NCI BCR Working Group, PFS by PET was called a “rich person’s bPFS” for this reason. Similar for bEFS/PET-defined MFS.

One more reason not to equate PSMA+ BCR with mHSPC/APMN.

@Dr_RaviMadan @melissaabel20

[David Einstein @davidjeinstein]

@seanmmcbride @dr_coops

[David Einstein @davidjeinstein]

@brookmans76 @Prof_Nick_James Treatment-Free Survival is a related endpoint that would count cumulative time spent on/off treatment, with/without T recovery, and with/without toxicity. Being developed in parallel with FFCD with @ChrisSweens1 @ANZUPtrials

[David Einstein @davidjeinstein]

@brookmans76 @Prof_Nick_James Treatment-Free Survival is a related endpoint that would count cumulative time spent on/off treatment, with/without T recovery, and with/without toxicity. Being developed in parallel with FFCD with @ChrisSweens1 @ANZUPtrials

[Toni Choueiri, MD @DrChoueiri]

@DanaFarber and @DanaFarber_GU 's very own @AtishChoudhury presents compelling de-intensification data from A-DREAM/A032101 in mHSPC: 41% of favorable responders remained treatment-free with testosterone recovery 18 months after ADT + ARPI interruption, supporting treatment holidays as a promising strategy in selected pts.

#ASCO26 #ProstateCancer
@OncoAlert @ASCO @OncBrothers

[BIDMC Hematology/Oncology Fellowship @BIDMC_HOFellows]

Congratulations to our incredible GI Medical Oncologist @BrunoBockorny on his work on KMT2C mutation in GI malignancies! @BIDMC_CancerCtr #ASCO2026

[Stephanie Berg @bergsa83]

Congrats to @AtishChoudhury and @CaPsurvivorship for their oral presentations today and how we can adapt treatment interruption and cognitive change from treatment for men with advanced prostate cancer. Huge efforts from them and the study teams @ALLIANCE_org

[Neeraj Agarwal, MD, FASCO @neerajaiims]

Congrats @AtishChoudhury 👉Can we safely de-intensify Rx in exceptional responders with mHSPC/ mAPMS #prostatecancer ? #ASCO2026 A-DREAM data👉Rx holiday after ADT + ARPI may be feasible, with 41% remaining treatment-free with testosterone recovery at 18 mos @OncoAlert @urotoday

[Ashish M. Kamat, MD, MBBS @UroDocAsh]

📐 HR 0.68 = a 32% relative risk reduction in recurrence at any given moment during follow-up.

That sounds like a large benefit.
But the absolute numbers tell a different story:

BCG alone: 81.6% disease-free at 2 years
BCG + durvalumab: 86.5% disease-free at 2 years

Absolute difference: ~5%

Since BCG already works well, a big relative reduction maps to a modest absolute gain. @MaxKates @UrogerliMD @JoshMeeks

[David Einstein @davidjeinstein]

@neerajaiims @ASCO @ggebraelmd @SWOG @OncoAlert @urotoday @montypal @DrChoueiri @Huntsman_GU @carolinemilneMD @IyerGopa @TDorffOnc @PrimoLaraMD @vincedcataldo @AarmstrongDuke A very important question that has come up frequently in clinic without a good answer! Any data from patients at the very low end of the spectrum, or with T as continuous rather than dichotomous variable?

[Neeraj Agarwal, MD, FASCO @neerajaiims]

Ab#5001 @ASCO #ASCO26 by @ChrisSweens1👉 https://t.co/u08U4HEinq👉Decipher Prostate Genomic Classifier (DGC) predicts benefit w/ triplet Rx in #prostatecancer👉DGC>0.85 is predictive of benefit from adding docetaxel to ADT+Enza👇@Prof_IanD @OncoAlert @urotoday @PCF_science

[David Einstein @davidjeinstein]

@montypal @kor_shah @cityofhope https://t.co/khjsHUZObp

[David Einstein @davidjeinstein]

Come join the @BIDMC_CancerCtr GU med onc team as we join forces with @DanaFarber_GU @DrChoueiri!

@PCF_Science @BladderCancerUS @KidneyCancer

https://t.co/ay30unlymg

[David Einstein @davidjeinstein]

Society guidelines matter. This is especially concerning for rural areas where family medicine training predominates.

[BIDMC Cancer Center @BIDMC_CancerCtr]

#AUA26 Highlight: Eric Macdonald, MD, resident @BIDMCUrology and @HeidiRayala present #prostatecancer screening (PCS) patterns among primary care physicians (PCPs) and the potential impact on patients.

💡 IM-trained PCPs were 28% more likely to receive PCS than FM-trained PCPs.

[David Einstein @davidjeinstein]

Not all prostate cancer is “cold”! And the primary TIME may have relevance for later BCR/micrometastatic states! Congrats @DYangMD and team!

[Eli Van Allen @VanAllenLab]

In our latest, a surprise - thanks to computational pathology - about immune cell clustering in prostate cancer and new ways to understand tumors, their neighborhoods, and clinical outcomes ... congrats @DYangMD et al! (link below)

[David Einstein @davidjeinstein]

@BrendonStilesMD Like @piet_ost and team, we believe novel endpoints like treatment-free survival are critical here. We use a partitioned survival approach to account for all patients from time of randomization and measure cumulative time on/off tx, with/without tox.

https://t.co/a2qXJvY0TF

[David Einstein @davidjeinstein]

A BCR/early recurrent prostate cancer double-whammy today. Out in @IJROBP in a special SBRT issue, we propose Treatment-Free Survival as a novel endpoint in trials of met-directed tx +/- systemic therapy:

https://t.co/bJESrLstl8

[David Einstein @davidjeinstein]

@ChadTangMD @GiulioFrancoli1 @ndesai2005 @AlexSherryMD @_ShankarSiva @SeanMcGuireMD Sounds like a rich data source! The primary role of RT is likely to be in keeping pts off tx rather than deepening up-front response, so endpoints capturing post-tx durability will be key.