The approval of T-DXd for the (neo)adjuvant treatment of HER2+ breast cancer will add an invaluable tool to our arsenal. Yet, in this era of right-sizing, not all patients require T-DXd treatment to be cured. Some thoughts in my recent JCO editorial. https://t.co/tKCgzzbdiq
🧬🛡️ HER2-low tumors escape HER2 ADCs by losing the target
• True HER2 loss is uncommon in HER2-amplified disease but frequent in HER2-low, where HER2 isn’t oncogenic
• On HER2 ADC therapy, ~50% of tumors reduce HER2; among reducers, ~half become IHC 0
• Reduced HER2 → impaired ADC internalization, not payload resistance
• ERBB2 ECD variants disrupt antibody binding and phenocopy antigen loss
• Suggested strategy: multi-target payload delivery to bypass target dependence and improve durability
https://t.co/fAFUEr3V3p
Just out in @NEJM, the results of ASCENT-04, by @stolaney1 et al. Among patients with PD-L1+ mTNBC, first-line SG/pembro significantly improved PFS (11.2 vs 7.8 months, HR 0.65, p<0.001) compared with chemo/pembro. New standard of care for this population. https://t.co/cjlf6z3x4r
If you were still debating if osimertinib was better than gefitinib/Erlotinib: FLAURA OS update presented by @RamalingamMD at #ESMO19: MS OS 38.6 vs 31.8 mos, impressive 54% ⬇️ in CNS progression (HR 0.48), we still need better drugs for rare EGFR mutations and L858R. #lcsm
What after Osimertinib? Chemo?
Not always! Many targetable fusions drive osi resistance, and more and more promising TKIs are emerging
@OncoAlert#ESMO19
Brilliant presentation on role of ctDNA in detecting molecular relapse for early stage breast cancer by Nick Turner 1. Biology of breast cancer determined at initial diagnosis 2. Lead time (10mos) prior to clinical relapse 3. Consistent findings across all subtypes #ESMO19#bcsm
Very proud of @RamalingamMD for outstanding presentation of OS from FLAURA! Exciting data with over 3 yr OS for osimertinib and over 25% of patients still on at 3 years. Real hope for our patients with EGFRmut NSCLC but still much room to go.
Dr. Hoyle presents the results of STAMPEDE @Prof_Nick_James stratifying M1 patients between low/high risk (LATITUDE) and low/high volume (CHAARTED). Similar benefit across subgrups. #ESMO18
JAEVILIN Renal 101 preliminary results presented by Dr. Motzer. Double the ORR with Avelumab+Axitinib, and improved PFS. Overall population and PDL1 positive poliarquia with similar benefit. OS still premature. #ESMO18