Martín Lázaro

Medical oncologist. Lung and genitourinary cancer. #lcsm #pcsm #kcsm

[Dr. Antonio Calles 🫁🚭 @Tony_Calles]

Phase Ib results from the phase Ib/II study of [Lu]Lu-DOTA-TATE in combination with standard of care as a first-line treatment for pts with ES-SCLC.
☢️ Feasible but challenging combination. Hard to understand the contribution of Lu-DOTA-TATE in terms of efficacy. Ongoing phase II study no longer recruiting patients.
#ASCO25 #SCLC #LCSM

[Stephen V Liu, MD @StephenVLiu]

Dr. @LuisPaz_Ares: biomarkers from phase III IMforte trial of maintenance lurbinectedin in SCLC #ASCO26. PFS & OS benefit of maintenance lurbinectedin seen across molecular subtypes and independent of SLFN11 expression. Suggestion that lurbi may overcome TAM-mediated resistance.

[OncoAlert @OncoAlert]

The #OncoAlertTopTweet 🚨Day Three #ASCO26
Post by @OncoAlert Faculty @CathyEngMD 🇺🇸

Daraxonrasib is the first RAS-targeted therapy to demonstrate a clinically meaningful survival advantage over standard chemotherapy in previously treated metastatic #PancreaticCancer

Ping: OncoAlert ❤️Pulse
@DrChoueiri 🇺🇸 @hoperugo 🇺🇸 @matteolambe 🇮🇹 @TiansterZhang 🇺🇸 @CathyEngMD 🇺🇸 @stolaney1 🇺🇸 @montypal 🇺🇸 @tompowles1 🇬🇧 @brian_rini 🇺🇸 @cdanicas 🇪🇸 @NiuSanford 🇺🇸 @amerseburger 🇩🇪 @GlopesMd 🇺🇸 @Icro_Meattini 🇮🇹 @PGrivasMDPhD 🇺🇸 @DrYukselUrun 🇹🇷 @nataliagandur 🇦🇷 @ElisaAgostinett 🇧🇪 @HHorinouchi 🇯🇵 @realbowtiedoc 🇺🇸 @to_be_elizabeth 🇮🇹 @UOzkerim 🇹🇷 @p_ciracimd 🇮🇹 @DrVilmaPBarcia 🇪🇸 @DraMartinezLago 🇪🇸 @DrMirallas 🇺🇸 @GaiaGriguolo 🇮🇹 @MarioBalsaMD 🇪🇸 @scocmem 🇬🇧 @AmandaNizamMD 🇺🇸 & @weoncologists 🇺🇸

[Adam B. Weiner, MD @Adam_Weiner535]

🚨 PROTEUS: perioperative apalutamide moves into high-risk localized #prostatecancer

Just out in @NEJM

🧬 2109 men w/ high-risk localized or locally advanced PCa randomized to ADT + apalutamide vs ADT + placebo around radical prostatectomy.

🎯 Both stated primary endpoints met.

⚠️ But the trial deserves nuance. Thread 🧵

#ASCO26 @ASCO @PCF_Science

[Eric Topol @EricTopol]

Another major advance vs cancer! @ASCO #ASCO26
Personalized neoantigen mRNA vaccine 5 year follow-up vs metastatic melanoma reduced recurrence and death by 49% (on top of Keytruda)
https://t.co/NadITTYIT2

[UroToday.com @urotoday]

Neoadjuvant sacituzumab govitecan in patients with #MIBC: Final results and biomarker analyses of the SURE-01 trial. Presentation by @BrigidaMaiorano @SanRaffaeleMI. #ASCO26 written coverage by @zklaassen_md @GACancerCenter > https://t.co/Y0U4w0Wo0i @ASCO

[UroToday.com @urotoday]

Subgroup analyses by disease volume and de novo/recurrent #mHSPC in the #PSMAddition study of [177Lu]Lu-PSMA-617. Presentation by Fred Saad, CQ, MD, FRCS, FCAHS @chumontreal. #ASCO26 written coverage by @RKSayyid @UAUrology > https://t.co/WlcyMVLacY @ASCO

[Dra. María Natalia Gandur Quiroga @nataliagandur]

#ASCO26 GU Oncology Spotlight 🚨

🔬 Abstract 4521 | CaboNivo in non–clear cell RCC
Final results of phase 2 cabozantinib + nivolumab in patients with non–clear cell renal cell carcinoma
Presented by Darren R. Feldman, MD
@ASCO
@OncoAlert
Important final dataset in a difficult RCC space.

Non–clear cell RCC represents a biologically diverse group of kidney cancers, often with fewer prospective data and historically poorer outcomes than clear cell RCC.
🔵 Study design
Investigator-initiated phase 2 study:

➡️ cabozantinib 40 mg daily
➡️ nivolumab 240 mg q2w or 480 mg q4w

Cohort 1 included:

• papillary RCC
• FH-deficient RCC
• unclassified RCC
• translocation-associated RCC

Chromophobe RCC was evaluated separately and closed early for inefficacy.

🟢 Final efficacy signal
With longer follow-up of ~50 months, CaboNivo reaffirmed antitumor activity in non–clear cell RCC.

In cohort 1:

• N = 53
• PR/CR: 43%
• median PFS: 11 months
• median OS: 28 months
Responses were seen across several non–clear cell histologies, with a particularly notable signal in FH-deficient RCC:
➡️ 7/8 patients had an objective response.
🔵 Why it matters

Non–clear cell RCC is not one disease.

Histology matters.

Biology matters.

And prospective treatment data remain limited.

This final analysis supports cabozantinib + nivolumab as an active regimen for selected patients with non–clear cell RCC histologies, especially papillary, FH-deficient, unclassified, and translocation-associated disease.
🟠 Safety
Toxicity was consistent with known cabozantinib + nivolumab profiles.
Grade 3/4 treatment-emergent AEs occurred in a substantial proportion of patients, and discontinuations due to AEs occurred with cabozantinib, nivolumab, or both.

So this is active therapy — but not low-burden therapy.

🧠 My take

CaboNivo is one of the more clinically useful prospective datasets in non–clear cell RCC.

The key message is not “treat all non–clear cell RCC the same.”

It is:

➡️ use histology
➡️ recognize biologic subgroups
➡️ avoid assuming clear-cell algorithms fully apply
➡️ consider CaboNivo as a treatment option where prospective evidence supports activity
➡️ continue building trials specific to rare RCC subtypes

For non–clear cell RCC, better classification is the beginning of better treatment.

#ASCO26 #GUOnc #KidneyCancer #RCC #NonClearCellRCC #PapillaryRCC #FHdeficientRCC #Cabozantinib #Nivolumab #PrecisionOncology

@OncLive @TargetedOnc @CancerNetwrk @ASCOPost @ecancer @VJOncology @curetoday @JCO_ASCO

[Dra. María Natalia Gandur Quiroga @nataliagandur]

#ASCO26 GU Oncology Spotlight 🚨

🔬 Abstract 5017 | PROTRACT
ctDNA-guided biomarker-directed therapy vs physician/patient choice in mCRPC progressing after abiraterone/prednisone
Presented by Corinne Maurice-Dror, MD
@ASCO
@OncoAlert
This is a very relevant precision-oncology question in prostate cancer:

➡️ Can ctDNA help guide whether a patient should receive docetaxel or enzalutamide after progression on abiraterone?
PROTRACT tested a simple treatment-selection strategy:
🔵 Biomarker-directed arm

• ctDNA ≥2% → docetaxel
• ctDNA <2% → enzalutamide

vs

🟠 Physician/patient choice

• docetaxel or enzalutamide, based on clinical preference

Primary endpoint: PFS
Secondary endpoints included OS, PSA50 response, PFS2, safety, and ctDNA correlatives.
🔵 Why this matters

This trial directly addresses a common real-world problem:

After abiraterone progression in mCRPC, treatment choice is often based on clinical judgment, patient preference, fitness, access, and toxicity concerns.

But biology may matter.

A higher ctDNA fraction may reflect more aggressive disease biology and could potentially support moving toward chemotherapy rather than sequential AR pathway inhibition.
🔵 Feasibility signal

The study randomized 42 patients before early termination due to slow accrual.

Importantly:

➡️ 57% of patients had discordance between physician/patient preference and ctDNA-directed assignment.

That is the key signal.

ctDNA guidance would have changed the treatment direction for more than half of patients.

🟠 Important caveat

This was underpowered and stopped early.

So PROTRACT should not be read as a definitive efficacy trial.

But it is still highly informative because it shows how often biomarker-directed treatment selection may differ from usual clinical choice.

🔵 My take

PROTRACT is important not because it settles the sequencing question, but because it frames the next one:

➡️ Can ctDNA move from prognostic biomarker to treatment-selection tool in mCRPC?

The future algorithm may not simply ask:

“ARPI again or chemotherapy?”

It may ask:

What does the tumor biology suggest this patient needs next?

#ASCO26 #GUOnc #ProstateCancer #mCRPC #ctDNA #PrecisionOncology #Biomarkers #ClinicalTrials #TreatmentSequencing

@OncLive
@TargetedOnc
@CancerNetwork
@ASCOPost
@ecancer
@VJOncology
@curetoday

[Dra. María Natalia Gandur Quiroga @nataliagandur]

#ASCO26 GU highlight 🚨
LBA1 PROTEUS
Perioperative apalutamide + ADT in high-risk localized / locally advanced prostate cancer
@ASCO @OncoAlert @NEJM
Presented by @MaryEllenTaplin
Published in @NEJM
https://t.co/0JWZmhn0df
This is a major perioperative prostate cancer dataset.

#PROTEUS tested 6 cycles of neoadjuvant + 6 cycles of adjuvant apalutamide added to ADT around radical prostatectomy.
Key results:

• pCR / minimal residual disease: 8.9% vs 1.0%
• 5-year metastasis-free survival: 78.2% vs 73.5%
• HR for distant metastasis or death: 0.80
• Event-free survival: 57.1 vs 38.4 months
• Time to first subsequent therapy: 74.2 vs 41.5 months

Why it matters:
For years, systemic perioperative intensification around prostatectomy has been difficult to establish in high-risk localized prostate cancer.

PROTEUS gives phase 3 evidence that deeper androgen-receptor pathway inhibition can improve pathologic response and delay clinically relevant recurrence events.
Important caveats:
This was not surgery alone vs systemic therapy.
The control arm received perioperative ADT + placebo.
MFS by conventional imaging alone was not significantly different.
Grade 3/4 AEs were higher with apalutamide, largely driven by rash.
My take:
This is practice-informing and potentially paradigm-shaping, but implementation will require careful patient selection, toxicity counseling, imaging context, and multidisciplinary discussion.
@EAntonarakis @DanaFarber_GU
@DrChoueiri @montypal @tompowles1 @brian_rini @PGrivasMDPhD @DrRanaMcKay @AliciaMorgans @amerseburger @NealShoreMD @DrYukselUrun @BraunMDPhD @DrSpratticus @EAntonarakis @KOSJ12 @LoebStacy @apolo_andrea @AndreaNecchi @DrDanielHeng @neerajaiims
@OncLive @TargetedOnc @CancerNetwrk @ASCOPost @VJOncology @ecancer
#ProstateCancer #GUonc #Oncology

[QianJanieQin @QianJanieQin]

Phase III MAIN-CAV: Maintenance #avelumab + #cabozantinib did not improve OS (23 v 24.8)/PFS vs avelumab alone in #mUC after 1L platinum chemo, though very small numbers/early closure amid changing 1L landscape. Great efforts f/ investigators&amp; research team! #ASCO26

[MJosé Juan @mjuanfi81]

Duravelo-2 reports encouraging activity of the Bicycle Drug Conjugate zelenectide pevedotin (BT8009)+pembrolizumab in 1L mUC: ORR 55–58%,CR ~27%, low discontinuation rate (3%),no severe skin reactions and no hyperglycemia. A Future alternative?? @OncoAlert

[Toni Choueiri, MD @DrChoueiri]

POTOMAC 5-year OS update presented by Dr Maria De Santis: Durvalumab + BCG (I+M) continues to show no detriment to OS vs BCG alone in BCG-naive high-risk NMIBC (5-yr OS 87.6% vs 86.3%), with no major impact on quality of life. #ASCO26 #BladderCancer @OncoAlert @ASCO @OncBrothers

[Alfredo Addeo MD @Alfdoc2]

One of the most awaited presentations( at least by me) #ASCO26:
HARMONi-6 shows that ivonescimab + chemo significantly improves OS
Vs tislelizumab + chemo in first-line advanced Sq #NSCLC (HR 0.66).
A positive phase III study with a clinically meaningful OS benefit and simultaneous publication in @TheLancet:
https://t.co/2JR3fy4cL1
Caveat: this was a study conducted entirely in China. How these data will translate globally remains an important question? Let’s see what HARMONI 3 will show

[Toni Choueiri, MD @DrChoueiri]

Dr. Jun Gao presented a phase 1b/2 of Bulumtatug fuvedotin (BFv) + toripalimab in la/mUC: ORR 83%, DCR 89.4%, mPFS 12.9 mo, and 18-mo OS rate 68.1%. All CRs remained on treatment. Impressive efficacy signal for this novel Nectin-4 ADC + anti-PD-1 combo. #ASCO26 #BladderCancer @OncoAlert @ASCO @OncBrothers

[Martín Lázaro @mlazqui]

When is NGS useful in the diagnosis of castration-resistant metastatic prostate cancer?
@fizazi_karim #ASCO26
#mCRPC

[Uromigos @Uromigos]

Our #ASCO26 podcasts are now available in Spanish! Thanks to the magic of AI translation, @tompowles1 and @brian_rini speak fluent (sort of) Spanish. Listen to our podcast on PROTEUS here and all ASCO podcasts on all major podcast platforms. @_SEOM @OncoAlert

https://t.co/7IUeZAU7Bb

[UroToday.com @urotoday]

Adjuvant nivolumab in high-risk muscle-invasive #UrothelialCarcinoma: Real-world evidence from the SOGUG-NIADY study of the Spanish Oncology Genitourinary Group (SOGUG). Presentation by Aurea Molina Diaz, MD. #ASCO26 written coverage by @RKSayyid > https://t.co/T0V3pBN1kJ @sogug1 @ASCO

[Toni Choueiri, MD @DrChoueiri]

CaboNivo final results in non-clear cell RCC presented by Dr Darren Feldman: ORR 43% in Cohort 1 (papillary, unclassified, tRCC), with a striking 88% ORR in FH-deficient RCC. mPFS 11 mo, mOS 28 mo. No responses in chromophobe RCC. CaboNivo confirmed as a standard 1L option for these rare subtypes. #ASCO26 #RCC @OncoAlert @ASCO @OncBrothers

[Uromigos @Uromigos]

Unsung hero poster award for RCC. @OncHahn discusses muscle and fat changes in patient receiving either Len/Ev or Cabo with some interesting findings that complement standard toxicity data.