Evelyn EH

MD, MSc working in God's fields.

[NEJM @NEJM]

Presented at #ASCO26:

Among patients with previously treated metastatic pancreatic ductal adenocarcinoma, the RAS(ON) inhibitor daraxonrasib led to significantly longer overall survival and progression-free survival than chemotherapy. Full phase 3 RASolute 302 trial results: https://t.co/xwLWBZYRzq

@ASCO

[Dr Rishabh Jain @DrRishabhOnco]

🚨 THE 15 MOST IMPORTANT TRIALS OF #ASCO26

May 29 - June 2 | Chicago
Which trial are you watching most closely?

🌟 PLENARY GAME-CHANGERS

1️⃣ PROTEUS
Perioperative apalutamide + ADT in high-risk localized prostate cancer

2️⃣ LIBRETTO-432
Adjuvant selpercatinib in RET+ NSCLC

3️⃣ HARMONi-6
Ivonescimab + chemo vs tislelizumab + chemo in squamous NSCLC

4️⃣ RASolute 302
Daraxonrasib (RMC-6236) in metastatic pancreatic cancer

5️⃣ SARC041
Abemaciclib in dedifferentiated liposarcoma

⚡ FRONTLINE & PERIOPERATIVE SHIFTS

6️⃣ KEYNOTE-B15 / EV-304
EV + pembrolizumab vs chemo in MIBC

7️⃣ LITESPARK-022
Pembrolizumab + belzutifan in adjuvant ccRCC

8️⃣ AMBITION
Paclitaxel/bevacizumab ± atezolizumab in HR+ breast cancer

9️⃣ NeoADAURA
Neoadjuvant osimertinib in EGFR+ NSCLC

🔟 A-DREAM
ADT interruption strategies in mCSPC

🧬 PRECISION, ADCs & NEXT-GEN IMMUNOLOGY

1️⃣1️⃣ DESTINY-Breast06
T-DXd expands into HER2-ultralow disease

1️⃣2️⃣ CROWN (7-year update)
Lorlatinib durability in ALK+ NSCLC

1️⃣3️⃣ DeLLphi-312
Tarlatamab in frontline SCLC

1️⃣4️⃣ COMMIT
Atezolizumab + FOLFOX/Bev in MSI-H mCRC

1️⃣5️⃣ IMvigor011
ctDNA-guided adjuvant atezolizumab in bladder cancer

#OncoTwitter #MedTwitter #ASCO26 #CancerResearch @OncoAlert @ASCO @JCOPO_ASCO @OncBrothers

[Dr Rishabh Jain @DrRishabhOnco]

🫀 Why do some patients crash on trastuzumab… and others don’t?

👉 Not just anthracyclines 💉
👉 Not just age 🎂
👉 Host genomics? 🧬

New JAMA Oncology data highlight CHIP as a key risk factor

Study snapshot 🧪
15,729 patients (UK Biobank) 🇬🇧
454 trastuzumab cohort 🏥
•mouse model 🐭

Key signal 📊

📈 2-year cardiotoxicity (CHIP vs no CHIP):
ESC: 15.7% vs 5.0%
Canadian: 19.9% vs 10.8%
CREC: 20.9% vs 11.3%

👉 Adjusted risk: sHR 1.91 📌
👉 CHIP + trastuzumab → ~4.5× HF risk ⚠️

Biology fits 🔬
Tet2-deficient mice 🐭 → ↓LVEF with trastuzumab 📉

Takeaway 🎯
🧬 CHIP may help identify high-risk patients
⚠️ Not practice-changing yet

💡 Toxicity = drug 💊 × host biology 🧬

📖 Full paper in comment ⬇️

#OncoTwitter #MedTwitter #BreastCancer #CardioOncology
@OncoAlert @myesmo @esmo_open @asco @JAMAOnc

[ESMO - Eur. Oncology @myESMO]

#ESMORareCancers26: Preliminary data with the DR5 agonist, ozekibart, added to chemotherapy indicate robust activity and a manageable safety profile in relapsed/refractory #EwingSarcoma.
Learn more➡️ https://t.co/0Rqz7e2Cz4

#ESMODailyReporter

[JAMA Oncology @JAMAOnc]

Among adolescents and young adults with #cancer, 9.5% of patients with earlier-stage cancer experienced metastatic recurrence within five years, with the highest rates in sarcoma (24.5%) and colorectal cancer (21.8%).

https://t.co/RS85GuKpr6

[CTOS @ctosociety]

🚨Historical presentation at #CTOS2025
ChonDRAgon - first positive randomised trial in chondrosarcoma
🔹Ozekibart vs placebo
🔹 mPFS 5.52 vs 2.66 months
🔹 HR 0.479; p<0.0001
🔹 a manageable safety profile - most common TRAE: fatigue, diarrhea, and nausea

[Yüksel Ürün @DrYukselUrun]

Men with PSA <1–2 ng/ml at 60 are very unlikely to die from prostate cancer. Screening them again may just cause harm, not help.
#ProstateCancer
@JNCI_Now @APCCC_Lugano @PCFnews
https://t.co/ky2BoM6HJz

[Dr Rishabh Jain @DrRishabhOnco]

Why 30%↓ vs 20%↑ in RECIST?

🔹 WHO (1981) set them differently:

• Shrinkage (PR = 50% area ↓ → ~30% 1D) → high bar to avoid false positives (be sure a drug really shrinks tumors).

• Growth (PD = 25% area ↑ → ~12% 1D) → lower bar to catch progression early.

🔹 RECIST

👉 The 30% shrinkage comes straight from math:
WHO (1981) used 50% ↓ in tumor area → when converted to 1D, that’s ~30% ↓ in diameter.

👉 The 20% growth wasn’t pure math.
WHO’s 25% ↑ in area = ~12% ↑ in 1D… but that risked calling progression too early (measurement error).
So the RECIST task force chose 20% ↑ as a safer, reproducible cutoff.

💡 In short: 30% = math, 20% = pragmatism ✅

#OncoTwitter #MedTwitter #ColorectalCancer #Immunotherapy
@OncoAlert @myesmo @asco

[César Serrano García @DrCeSarcoma]

✍️Phase 3 MOTION trial in #TGCT: Vimseltinib vs placebo

-RECIST 40% ORR
-Tumor Volume Score 67% ORR
-Clinically meaningful Improvement
-Well tolerated and manageable adverse events

➡️ Vimseltinib is a well-deserved standard of care

#ESMO24 #ESMOAmbassadors

[César Serrano García @DrCeSarcoma]

🚨 New therapy approved in #sarcoma!

@EMA_News has granted the use of 🎯CSFR1 #vimseltinib in patients with #TGCT with funtion deterioration and in whom surgical options have been exhausted or would induce unacceptable morbidity or disability

▶️https://t.co/t4ASfzJDJo

[Dr Rishabh Jain @DrRishabhOnco]

🩺 From blanket use ➡️ precision care
New 2025 ASTRO–ASCO–SSO PMRT guideline tailors radiation after mastectomy to risk, biology & therapy response 🎗️

📝 J Clin Oncol 2025 | Jimenez et al.

🔑 Key Recommendations

🔹 Upfront mastectomy
• Node+ (pN1–3) → PMRT recommended (EBCTCG meta-analysis)
• pT4 → PMRT recommended (Danish 82b/c)
• pT3N0 → PMRT conditional (EORTC 22922)
• pT1–2N0 → PMRT not recommended (except select high-risk)

🔹 After neoadjuvant systemic therapy (NAST)
• cT4 / cN2–3 → PMRT recommended (retrospective + meta-analyses)
• Residual nodes (ypN+) → PMRT recommended (NSABP B-51, Alliance A011202)
• cT1–3N1/ypN0 → PMRT conditional (SUPREMO, TAILOR-RT)
• cT1–2N0/ypN0 → PMRT not recommended

🔹 Treatment volumes
• Chest wall + regional nodes (axillary, SCV, IMN) 🌐
• IMN benefit shown in EORTC 22922 & MA.20

🔹 Dose & fractionation
• Moderate hypofractionation (15–16 fx) = preferred (UK START, Chinese PMRT RCT, RT CHARM)
• Conventional (25 fx) only in select cases

🔹 Techniques
• CT-based 3D-CRT / IMRT ✅
• Deep Inspiration Breath-Hold 💨 for heart/lung sparing
• Bolus 🎯 if skin involvement, LVI, or positive margins

💡 Takeaway:
PMRT is not “all-or-none” — decisions must be individualized by nodal status, tumor biology & systemic response.

🔖 Save this for your next MDT/tumor board!
📖 Jimenez RB et al. J Clin Oncol. 2025.
🔗DOI: https://t.co/APbRypQFtM

#OncoTwitter #MedTwitter #BreastCancer #RadiationOncology @OncoAlert @myesmo @ASCO @ASTRO_org

[Yüksel Ürün @DrYukselUrun]

The evolution of TKIs in kidney cancer!

[Dr Amol Akhade @SuyogCancer]

Nice slides to show
How to treat advanced mesothelioma in 2025 . Money 💰 slides from #WCLC2025 @OncoAlert @OncBrothers

[Dr Rishabh Jain @DrRishabhOnco]

⚡ PROpel → VISION: ASCO 2025 mCRPC guideline redefines treatment 🩺

🔑 Highlights:

🧬 HRR testing = mandatory
20–30% of mCRPC have HRR mutations → guides PARPi use

🔹 BRCA1/2+
• Olaparib+Abi (PROpel)
• Niraparib+Abi (MAGNITUDE)
• Talazoparib+Enza (TALAPRO-2)

🔹 Non-BRCA HRR+
• Olaparib (PROfound)
• Talazoparib+Enza (ARPI-naïve)

🧲 PSMA+ post-ARPI+Docetaxel
• ¹⁷⁷Lu-PSMA-617 (VISION)
➡️ Used after ARPI + chemo; sequencing with PARPi still unclear

🛡️ MSI-H/dMMR/TMB-high
• Pembrolizumab (KEYNOTE-158)
• Dostarlimab
➡️ Only a small subset of prostate cancers qualify

💊🦴 Special situations
• Sipuleucel-T (IMPACT) → indolent disease
• Radium-223 (ALSYMPCA) → bone-only symptomatic

📖 Garje R, Riaz IB, Naqvi SAA, et al. JCO Oncol Pract. 2025.
DOI: https://t.co/meQfIqk6kB

#OncoTwitter #MedTwitter #ProstateCancer #Immunotherapy
@OncoAlert @myesmo @asco @JCOOP_Journal

[Rami Manochakian MD, FASCO Cancer Education @RManochakian]

🔥🚨@OncoAlert Hot off the press.

Just published @NEJM

#OverallSurvival Results of:

⭐️#MARIPOSA Study of:

#Amivantamab plus #Lazertinib vs #Osimertinib in 1st line #Treatment of #EGFR+ Advanced Non-Small Cell #LungCancer.

Reminder that we have now two excellent (but different) combination regimens:
✅ #Amivantamab + #Lazertinib (#MARIPOSA)
✅ #Osimertinib + #Chemotherapy
(#FLAURA2) with #OS data just presented @IASLC #WCLC25

👇🏻
https://t.co/bcWXooSYix

[Chul Kim @chulkimMD]

Long-awaited OS results from #FLAURA2 (1L chemo + osimertinib vs osi):

-mOS: 47.5 vs 37.6 mo (HR 0.77)
-Benefit consistent across subgroups
-Longer osimertinib exposure with combo

Strong evidence supporting osi+chemo for newly diagnosed EGFR+ NSCLC.

#WCLC2025

[Evelyn EH @Heleve1]

De-escalated adjuvant radiotherapy versus standard adjuvant treatment for human papillomavirus-associated oropharyngeal squamous cell carcinoma (MC1675): a phase 3, open-label, randomised controlled trial - The Lancet Oncology https://t.co/RBAraRkmW4

[Dr Rishabh Jain @DrRishabhOnco]

🤔 Do we always need chemo in mCRC maintenance? 🧩

📊 Pooled IPD – PanaMa + Valentino (n=607, phase II)

👥 Population
• RAS WT mCRC
• 80% left-sided
• 64% “negative hyperselected” (no BRAF V600E, HER2, PIK3CA, PTEN, etc.)

��� Treatment
Induction: FOLFOX + Panitumumab
Maintenance arms:
• 5-FU/LV + Panitumumab
• Panitumumab alone
• 5-FU/LV alone

🔑 Key insights

• 🎯 Left-sided + negative hyperselected = best outcomes

– OS 30.6 vs 17.4 mo (left vs right)
– OS 31.5 vs 19.1 mo (neg. hyperselected vs altered)

• 💊 Panitumumab (±5-FU/LV) > 5-FU/LV alone for PFS

PFS 9.4 mo (pani) vs 8.8 mo (pani+5-FU) vs ~6 mo (5-FU)

• ⚖️ Adding 5-FU/LV ➝ no extra PFS/OS benefit

• 🛡️ Panitumumab monotherapy = efficacy preserved + ↓ toxicity

✨ Take-home:
For RAS WT, left-sided, negative hyperselected mCRC, panitumumab alone may be the optimal maintenance.

📖 Reference: Ballhausen A, et al. Br J Cancer. 2025.
🔗 https://t.co/yuentzR5QN

#ColorectalCancer #GIOnc #OncoTwitter
@OncoAlert @OncoDailyNet

[PDBrown @PDBrownOnc]

Is Re-RT beneficial for recurrent pontine glioma?
YES, Re-RT only factor benefit OS on MVA
Re-RT 75% have neuro symptom improvement

[PDBrown @PDBrownOnc]

IS MGMT methylation prog in IDHM Gr4?
Yes, methylation predictive OS Tx’d w/ TMZ https://t.co/Kt7HpAdL4Y