Steven David

Radiation Oncologist at the Peter MacCallum Cancer Centre. Views are my own, healthy skeptic. #radonc

[Steven David @drspdavid]

🔬 AVATAR trial published(ER+/HER2– MBC on AI + CDK4/6i): In OPD, SABR delayed therapy change (mPFS 9.9 mo)
🔷 44% on same Rx at 12 mo
🔷 36% at 24 mo
Some received SABR 2–3× for new oligoprogressions—modified endpoints may better reflect its value. https://t.co/g63BysQ8xJ

[Steven David @drspdavid]

@singhv2003 This is using SABR to delay a change in therapy as a strategic partner to systemic therapy… not about cure but QOL

[Steven David @drspdavid]

Huge congrats to Dr Saad Ashraf on his @FrontOncology case report! 👏

This unique case of OPD highlights 8 courses of SABR for 17 metastases over 5 years, delaying systemic therapy changes 8x to prioritize patient QOL in a HER2+ breast cancer.

Read: https://t.co/fW225bFZe7

[Peter Mac Radiation Oncology @PeterMacRadOnc]

We are proud to offer this amazing & unique opportunity: the inaugural Joint Peter Mac and The Christie NHS Foundation Trust  Radiation Oncology #Fellowship . An incredible 2-year international experience! 🌏

Check it out ➡️ https://t.co/Ed2pBk8xYp

@PeterMacCC @TheChristieNHS

[Steven David @drspdavid]

@DineshMakuny I think QOL is a measure that can capture a lot of this as long as you chose meaningful PROMS and as long as no OS detriment SABR for OPD

[Steven David @drspdavid]

@jfcdrr @michell25854824 @_ShankarSiva @PeterMacRes @PeterMacCC @MonashPCCC @e_emma243 @gerryhanna @PeterMacRadOnc They weren't oligoprogression trials.

[Steven David @drspdavid]

Our new editorial is live! 📢
PFS & OS undervalue SABR in oligoprogression trials.
Focus on TTF, TTNT, and QoL instead—highlighting SABR as a repeatable strategic ally to systemic therapy.
👉 https://t.co/TH7FHQhYnd

[Steven David @drspdavid]

@Van_den_Begin @_ShankarSiva @PeterMacRadOnc @changjeesuk1 @PBlanchardMD @DrewMoghanaki @SarahJ_Dawson @bensolomon1 @CJTsaiMDPhD @jillfeldman4 @piet_ost @gerryhanna @lauren_henke @JulesBordet Great trial! Good luck.. I suspect will recruit well

[Shankar Siva @_ShankarSiva]

Extraordinary case at #SABR2025 by @drspdavid and De Mark Shaw @PeterMacRadOnc oligoprogressive #breastcancer without switching drug therapy. 8 years of SABR with #radonc, with preserved quality of life from the patient’s perspective!!! #bcsm

[the Radiosurgery Society @the_RSS]

Register now for the next FREE #RSSwebinar on "The Role of Metastasis-Directed Therapy for Oligometastases and Oligoprogression in Breast Cancer" on 10/9 at noon ET featuring @drspdavid, @r_glicksman and @WinstonVuong; moderated by @radicalonc. https://t.co/pPdjQRRtiX

[Steven David @drspdavid]

@gerryhanna @_ShankarSiva @fifimcdrmh @finn_corinne @drdavidpalma @nickva1 @cpeedell @CJTsaiMDPhD @aislingbarryro @Mat_Guc @crispinhiley It creates interesting challenges for trial design and endpoint selection when measuring strategic efficacy.

[Steven David @drspdavid]

@CJTsaiMDPhD This is well written. Authors should always include raw numbers of the effect size in the abstract so the reader can was easily determine the clinical importance of a positive (or negative) result l.

[Steven David @drspdavid]

@CJTsaiMDPhD @Sushilberiwal @_ShankarSiva The primary endpoint of interest in this study is time to next treatment (TTNT), a measure that will determine how long T-DXd allows patients to derive clinical benefit from the study drug.

DESTINY-Breast15

[Steven David @drspdavid]

@CJTsaiMDPhD @Sushilberiwal @_ShankarSiva Also take note of the new phase 3 pharma destiny trial - primary endpoint is TNTT…https://t.co/TTep6yVxWn so pharma are interested in measures like this

[Steven David @drspdavid]

@CJTsaiMDPhD @Sushilberiwal @jryckman3 @_ShankarSiva I agree that QOL needs to be measured in an RCT but also 2nd PFS and PFS 2 to measure what happens after the switch

[Steven David @drspdavid]

@CJTsaiMDPhD @Sushilberiwal @_ShankarSiva Avatar 2 will open soon which is randomized
But builds on this and moves away from PFS as the primary endpoint and towards time to treatment failure which reflects actual practice in OPD that oncologists and patients want: SABR and maintain current line

[Steven David @drspdavid]

@rweichselbaum @_ShankarSiva @gerryhanna @e_emma243 @michell25854824 @PeterMacRadOnc @PeterMacRes @MonashPCCC @MonashHealth @svporceddu Classical progression in a RECIST sense isn’t an accurate measure of serial SABR combined with effective systemic therapy in oligoprogression

[Steven David @drspdavid]

🔬 AVATAR trial published(ER+/HER2– MBC on AI + CDK4/6i): In OPD, SABR delayed therapy change (mPFS 9.9 mo)
🔷 44% on same Rx at 12 mo
🔷 36% at 24 mo
Some received SABR 2–3× for new oligoprogressions—modified endpoints may better reflect its value. https://t.co/g63BysQ8xJ

[Steven David @drspdavid]

@dr_alimuhammad @DrewMoghanaki @_ShankarSiva @jryckman3 I think so but between cycles, single fraction

[Steven David @drspdavid]

Congrats to Dr. Belle Sasse on this impactful study! 🎉 Collaboration between @MonashHealth & @PeterMacRadOnc shows metastatic breast MDMs changed treatment plans in 28.1% of patients, highlighting their invaluable role in care.
👉 Read: https://t.co/h7A9yAxht2