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Featuring perspectives from Prof Nicolas Girard, Dr Jonathan Goldman, Dr Pasi A Jänne, Dr Suresh S Ramalingam, Dr Joshua K Sabari and Dr Helena Yu, moderated by Dr Yu, including the following topics: Introduction (0:00) Evolving First-Line Treatment for Metastatic EGFR Mutation-Positive Non-Small Cell Lung Cancer (NSCLC) — Dr Yu (1:47) EGFR-Targeted Approaches for Relapsed EGFR-Mutant NSCLC; Strategies to Facilitate Delivery of Recently Approved Agents — Dr Sabari (23:48) Potential Utility of TROP2-Targeted Therapy in the Management of EGFR-Mutant NSCLC — Dr Ramalingam (45:16) Contemporary Care for Patients with Nonmetastatic EGFR-Mutant NSCLC — Dr Goldman (1:03:56) Current and Future Management of EGFR Exon 20 Mutation-Positive NSCLC — Prof Girard (1:24:40) Emerging Role of HER3-Targeted Therapy in the Management of EGFR-Mutant NSCLC — Dr Jänne (1:43:46) CME information and select publications
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with CTSNet JANS Editor Dr. Mateo Marin-Cuartas, a cardiac surgeon in the University Department of Cardiac Surgery at the Leipzig Heart Center, Germany, about surgical aortic valve replacement (SAVR) vs transcatheter aortic valve replacement (TAVR). Chapters 00:00 Intro 00:57 Dr. Marin-Cuartas Feature 02:28 SHURUI Robot Feasability 05:09 Touching as Diagnostic Test 09:06 Removal of Rib Stab Hardware 13:00 Resectable EGFR-Positive NSCLC 16:12 On-Pump Beating Heart MVR 17:56 Post-Infarction Myocardial Rupture 19:52 Head-First Graft Technique 22:18 SAVR vs TAVR, Dr. Marin-Cuartas 46:44 Upcoming Events 47:52 Closing They discuss SAVR and TAVR guidelines, the suitability of SAVR vs TAVR for patients aged 65-75, and mechanical heart valves. They also explore surgery after TAVR, TAVR after TAVR, and the future of addressing aortic valve stenosis. Joel also highlights recent JANS articles on the safety and feasibility of novel single-port robotic-assisted lobectomy/segmentectomy for lung cancer, touching (proximity) as a companion diagnostic test, long-term outcomes after removal of rib stabilization hardware in patients with blunt chest trauma, and advancing the needle on the management of resectable EGFR-positive NSCLC. In addition, Joel explores an on-pump beating heart mitral valve repair through right anterior minithoracotomy, post-infarction myocardial rupture treated with surgical repair and graded mechanical support, and a head-first graft technique in aortic arch replacement. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned 1.) Safety and Feasibility of Novel Single-Port Robotic-Assisted Lobectomy/Segmentectomy for Lung Cancer 2.) Touching (Proximity) as a Companion Diagnostic Test 3.) Long-Term Outcomes After Removal of Rib Stabilization Hardware in Patients With Blunt Chest Trauma 4.) Advancing the Needle on the Management of Resectable EGFR-Positive NSCLC: Is Neoadjuvant Osimertinib the Answer? CTSNET Content Mentioned 1.) On-Pump Beating Heart Mitral Valve Repair Through Right Anterior Mini Thoracotomy 2.) Drain, Patch, Unload: Post-Infarction Myocardial Rupture Treated With Surgical Repair and Graded Mechanical Support 3.) Head-First Graft Technique in Aortic Arch Replacement Other Items Mentioned 1.) Career Center 2.) CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
BUFFALO, NY - June 11, 2025 – A new #research paper was #published in Volume 16 of Oncotarget on May 29, 2025, titled “Durable complete response in leptomeningeal disease of EGFR mutated non-small cell lung cancer to amivantamab, an EGFR-MET receptor bispecific antibody, after progressing on osimertinib.” A team led by first author Jinah Kim, from the University of Vermont Medical Center, and corresponding author Young Kwang Chae, from the Feinberg School of Medicine, reports a clinical case in which a patient with advanced non-small cell lung cancer (NSCLC) carrying rare EGFR mutations responded remarkably to amivantamab after other treatments had failed. The patient experienced a complete resolution of brain and spinal fluid metastases, suggesting that amivantamab may be a viable option for patients with uncommon genetic profiles and limited therapy options. Lung cancer remains one of the leading causes of cancer-related deaths worldwide. Patients with NSCLC who have rare mutations in the EGFR gene often face limited treatment options and poor outcomes, especially when the disease spreads to the brain or spinal fluid. This case involved a 67-year-old man diagnosed with NSCLC who had two rare EGFR mutations—G719A and A289V. After disease progression on osimertinib and other therapies, the patient began amivantamab monotherapy. Within six weeks, his lung tumor shrank by over 30 percent. By six months, imaging confirmed the disappearance of brain metastases and leptomeningeal disease, a serious condition affecting the membranes of the brain and spinal cord. Blood tests showed no detectable cancer-related mutations, and the patient, previously wheelchair-bound, regained the ability to walk and perform daily activities. This response has been sustained for more than 19 months. “Treatment produced a durable response over 19 months, including a 32.2% reduction in tumor size at six weeks, and complete resolution of brain metastases and LMD by six months.” Amivantamab is a bispecific antibody that targets EGFR and MET, two key drivers of tumor growth. While it is approved in combination regimens for common EGFR mutations, its effectiveness as a single agent in rare mutations or in treating brain metastases remains largely unproven. This case challenges the assumption that large antibody drugs cannot cross the blood-brain barrier and suggests that amivantamab may have potential in managing central nervous system involvement. Further research is needed to clarify how the drug achieves these effects and to explore its broader use in patients with rare EGFR mutations and limited treatment options. This case highlights three key findings: amivantamab may be effective against rare EGFR mutations, can be used as monotherapy, and may overcome the challenges of the blood-brain barrier. Although based on a single patient, the results provide encouraging evidence to support further investigation of amivantamab in treating difficult-to-manage forms of NSCLC. DOI - https://doi.org/10.18632/oncotarget.28730 Correspondence to - Young Kwang Chae - young.chae@northwestern.edu Video short - https://www.youtube.com/watch?v=RJX3rmtH7h8 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, amivantamab, monotherapy, rare EGFR mutation, NSCLC, leptomeningeal disease To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC information, and to apply for credit, please visit us at PeerView.com/ZAF865. CME/MOC credit will be available until June 15, 2026.Mastering the Evidence and Establishing Best Practices for Making Well-Informed Precision Decisions in EGFR-Mutated NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC information, and to apply for credit, please visit us at PeerView.com/ZAF865. CME/MOC credit will be available until June 15, 2026.Mastering the Evidence and Establishing Best Practices for Making Well-Informed Precision Decisions in EGFR-Mutated NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Johnson & Johnson.Disclosure information is available at the beginning of the video presentation.
Featuring perspectives from Dr Jessica J Lin and Dr Joel W Neal, including the following topics: Introduction: Actionable Genomic Alterations (0:00) ALK (9:49) ROS1 (22:22) HER2 (31:00) RET (38:52) NTRK (45:30) MET (46:31) Novel Targeted Strategies (49:09) BRAF (54:19) KRAS G12C (55:38) CME information and select publications
In today's episode, we spoke with Jonathan W. Goldman, MD, about the phase 2 LUMINOSITY study (NCT03539536) evaluating telisotuzumab vedotin-tllv (Teliso-V; Emrelis) in patients with c-MET protein–overexpressing, nonsquamous, EGFR wild-type advanced non–small cell lung cancer (NSCLC). Dr Goldman is a professor of medicine in the Division of Hematology/Oncology at UCLA, as well as director of Clinical Trials in Thoracic Oncology, associate director of Early Drug Development, and chair of the University of California Lung Cancer Consortium.
Dr Jessica J Lin from Massachusetts General Hospital in Boston and Dr Joel W Neal from Stanford Cancer Institute in California summarize major treatment advances over the past year and review relevant ongoing clinical trials using targeted therapies for patients with non-small cell lung cancer. CME information and select publications here.
Welcome to the Oncology Brothers podcast! In this episode, hosts Drs. Rahul and Rohit Gosain are joined by Dr. Stephen Liu from Georgetown Lombardi Comprehensive Cancer Center to discuss the latest and most impactful findings from the ASCO 2025 meeting, focusing on lung cancer. Join us as we dive into five key studies that could change clinical practice: 1. CheckMate 816: Discover the significant overall survival benefits of neoadjuvant chemotherapy combined with nivolumab in resectable non-small cell lung cancer. 2. Timing of Immunotherapy: Explore a groundbreaking study that reveals how the timing of immunotherapy infusions can dramatically affect patient outcomes. 3. NeoADAURA Trial: Learn about the use of osimertinib in the neoadjuvant setting for EGFR-mutated lung cancer and how it compares to established adjuvant therapies. 4. IMforte Study: Understand the implications of maintenance therapy in small cell lung cancer and how it can improve overall survival rates. 5. DeLLphi 304: Get insights into the efficacy of tarlatamab as a second-line treatment for small cell lung cancer and its potential to become the new standard of care. Follow us on social media: • X/Twitter: https://twitter.com/oncbrothers • Instagram: https://www.instagram.com/oncbrothers • Website: https://oncbrothers.com/ Tune in for an engaging discussion filled with expert insights, clinical pearls, and the latest advancements in lung cancer treatment. Don't forget to like, subscribe, and check out our other conference highlights! #OncologyBrothers #LungCancer #ASCO2025 #CancerResearch #Immunotherapy #EGFR #SmallCellLungCancer #NeoadjuvantTherapy #Podcast
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/CC/AAPA information, and to apply for credit, please visit us at PeerView.com/UKV865. CME/MOC/CC/AAPA credit will be available until June 13, 2026.Harnessing Precision With EGFR-Targeted Therapy in Resectable NSCLC: Evidence, Cases, and Considerations for Multidisciplinary Patient Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/CC/AAPA information, and to apply for credit, please visit us at PeerView.com/UKV865. CME/MOC/CC/AAPA credit will be available until June 13, 2026.Harnessing Precision With EGFR-Targeted Therapy in Resectable NSCLC: Evidence, Cases, and Considerations for Multidisciplinary Patient Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/CC/AAPA information, and to apply for credit, please visit us at PeerView.com/UKV865. CME/MOC/CC/AAPA credit will be available until June 13, 2026.Harnessing Precision With EGFR-Targeted Therapy in Resectable NSCLC: Evidence, Cases, and Considerations for Multidisciplinary Patient Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/CC/AAPA information, and to apply for credit, please visit us at PeerView.com/UKV865. CME/MOC/CC/AAPA credit will be available until June 13, 2026.Harnessing Precision With EGFR-Targeted Therapy in Resectable NSCLC: Evidence, Cases, and Considerations for Multidisciplinary Patient Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/CC/AAPA information, and to apply for credit, please visit us at PeerView.com/UKV865. CME/MOC/CC/AAPA credit will be available until June 13, 2026.Harnessing Precision With EGFR-Targeted Therapy in Resectable NSCLC: Evidence, Cases, and Considerations for Multidisciplinary Patient Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/CC/AAPA information, and to apply for credit, please visit us at PeerView.com/UKV865. CME/MOC/CC/AAPA credit will be available until June 13, 2026.Harnessing Precision With EGFR-Targeted Therapy in Resectable NSCLC: Evidence, Cases, and Considerations for Multidisciplinary Patient Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
Why You Should Listen: In this episode, you will learn about chronic kidney disease and how to address the Kidneydemic with Renology. About My Guest: My guest for this episode is Dr. Robin Rose. Robin Rose, MD began a journey into holistic healing in her teens in the mid-sixties beginning with nutrition and botanical medicine and yoga and meditation. Over the years her journey included time living in India and working with both village doctors and healers. She became a health food chef and inspired many to change their habits. Before long she was enrolled in an RN program and then a family nurse practitioner program. Aware that the education wasn't complete, she attended University of Arizona College of Medicine; while also serving as a medical student board member for the American Holistic Medical Association. During residency, she continued learning Chinese medicine, acupuncture, osteopathy, energy medicine, and herbal medicine. Her main practice was in Ashland, Oregon where she served a community eager to integrate many healing modalities into the conventional setting, including innovative care in the hospital. In the past decade after her own alarming health challenges with kidney cancer and advanced kidney disease, she became agile in regenerative medical approaches to kidney care. She created a new specialty called Renology; a new concept of "Kidney Success" not Kidney Failure. When she discovered peptides and especially bioregulator peptides, she led the brigade to new heights of seeing success in a field that had not embraced this kind of care. Her recent book "Renology Peptides" is a nearly 800 page text on how to achieve this renewal of health. Her current intention is to raise awareness of the role of kidney in wellbeing and how we can all celebrate this success. Key Takeaways: What is the purpose of the kidneys? What symptoms are observed in chronic kidney disease? Is kidney disease a catabolic process? Is kidney disease genetic or epigenetic? What are the stages of kidney disease? What are the best tests and lab markers? What might elevations or phosphorous or potassium suggest? What is the kidney-gut axis? What is the role of endothelial health in kidney disease? What role do the mitochondria play? How do infections and environmental toxicants contribute to kidney disease? What is the role of oxalates in kidney health? How might carbon dioxide guide treatment? Does cellular senescence play a role? What is the connection between the kidneys and the teeth? How do the limbic system and mental/emotional health impact the kidneys? What treatment intervention warrant exploration? Where do dialysis and transplantation come into the discussion? What role might peptides and peptide bioregulators play? Connect With My Guest: RenologyIsKidneySuccess.com Interview Date: May 21, 2025 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode217. Additional Information: To learn more, visit https://BetterHealthGuy.com. Follow Me on Social Media: Facebook - https://facebook.com/betterhealthguy Instagram - https://instagram.com/betterhealthguy X - https://twitter.com/betterhealthguy TikTok - https://tiktok.com/@betterhealthguy Disclaimer: The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.
Why You Should Listen: In this episode, you will learn about chronic kidney disease and how to address the Kidneydemic with Renology. About My Guest: My guest for this episode is Dr. Robin Rose. Robin Rose, MD began a journey into holistic healing in her teens in the mid-sixties beginning with nutrition and botanical medicine and yoga and meditation. Over the years her journey included time living in India and working with both village doctors and healers. She became a health food chef and inspired many to change their habits. Before long she was enrolled in an RN program and then a family nurse practitioner program. Aware that the education wasn't complete, she attended University of Arizona College of Medicine; while also serving as a medical student board member for the American Holistic Medical Association. During residency, she continued learning Chinese medicine, acupuncture, osteopathy, energy medicine, and herbal medicine. Her main practice was in Ashland, Oregon where she served a community eager to integrate many healing modalities into the conventional setting, including innovative care in the hospital. In the past decade after her own alarming health challenges with kidney cancer and advanced kidney disease, she became agile in regenerative medical approaches to kidney care. She created a new specialty called Renology; a new concept of "Kidney Success" not Kidney Failure. When she discovered peptides and especially bioregulator peptides, she led the brigade to new heights of seeing success in a field that had not embraced this kind of care. Her recent book "Renology Peptides" is a nearly 800 page text on how to achieve this renewal of health. Her current intention is to raise awareness of the role of kidney in wellbeing and how we can all celebrate this success. Key Takeaways: What is the purpose of the kidneys? What symptoms are observed in chronic kidney disease? Is kidney disease a catabolic process? Is kidney disease genetic or epigenetic? What are the stages of kidney disease? What are the best tests and lab markers? What might elevations or phosphorous or potassium suggest? What is the kidney-gut axis? What is the role of endothelial health in kidney disease? What role do the mitochondria play? How do infections and environmental toxicants contribute to kidney disease? What is the role of oxalates in kidney health? How might carbon dioxide guide treatment? Does cellular senescence play a role? What is the connection between the kidneys and the teeth? How do the limbic system and mental/emotional health impact the kidneys? What treatment intervention warrant exploration? Where do dialysis and transplantation come into the discussion? What role might peptides and peptide bioregulators play? Connect With My Guest: RenologyIsKidneySuccess.com Interview Date: May 21, 2025 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode218. Additional Information: To learn more, visit https://BetterHealthGuy.com. Follow Me on Social Media: Facebook - https://facebook.com/betterhealthguy Instagram - https://instagram.com/betterhealthguy X - https://twitter.com/betterhealthguy TikTok - https://tiktok.com/@betterhealthguy Disclaimer: The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.
JCO Editorial Fellow Dr. Ece Cali Daylan and JCO Associate Editor Dr. Thomas Stinchcombe discuss the ASCO 2025 Simultaneous Publication paper "Neoadjuvant Osimertinib for Resectable EGFR-Mutated Non-Small-Cell Lung Cancer." Transcript The guest on this podcast episode has no disclosures to declare. Dr. Ece Cali: Hello, and welcome to our 2025 ASCO Annual Meeting series, where we cover some of the top JCO papers published simultaneously with their abstract presentation at this year's meeting. I'm your host, Dr. Ece Cali, JCO Editorial Fellow, and I am joined by JCO Associate Editor, Dr. Tom Stinchcombe. In this episode, we will discuss the Journal of Clinical Oncology article and abstract presentation "Neoadjuvant Osimertinib for Resectable EGFR-Mutated Non–Small-Cell Lung Cancer.” NeoADAURA is a randomized global phase III study investigating the efficacy of neoadjuvant osimertinib-containing regimens in patients with resectable EGFR-mutated stage II to IIIB non–small-cell lung cancer. 358 patients were randomized 1:1:1 to receive osimertinib plus chemotherapy, osimertinib monotherapy, or placebo plus chemotherapy in the neoadjuvant setting. The primary endpoint was major pathological response. Osimertinib plus chemotherapy and osimertinib alone demonstrated MPR rates of 26% and 25%, respectively, compared to 2% in the chemotherapy plus placebo arm with a p-value of less than 0.001. Tom, can you please explain to our listeners how you interpret this data? Dr. Thomas Stinchcombe: Great question. Yeah, I think to give a little context, obviously, chemotherapy and immunotherapies preoperatively is becoming the standard of care. However, patients with EGFR-mutant lung cancer generally have not responded to immunotherapy, and many of the trials excluded patients with known EGFR mutation. There have been smaller phase II trials that had looked at EGFR TKIs preoperatively, but none of these were definitive. So I think that this trial is a big trial, and I think some of the strengths are that it has osimertinib alone and chemotherapy with osimertinib arms as compared to the standard of chemotherapy. I think it's going to be really interesting at the meeting to see how this is discussed by the discussant and also what the reaction is to its public presentation. And I think that's largely because there's an alternative paradigm now, surgical resection adjuvant osimertinib, that's available to patients. So I think this will be interesting to see what the reaction is to the induction therapy. For patients with known N2 disease, I've generally given some form of induction therapy prior to surgical resection. So I think that's the subgroup of patients that I'm most likely to employ this approach with based on the results. Dr. Ece Cali: So, in this trial, more than 90% of the patients on the osimertinib-containing regimens underwent curative-intent surgery. So, this speaks to the feasibility of the approach, and the higher MPR rate with osimertinib-containing regimens is encouraging. Event-free survival data is currently immature. You have already touched upon some of the strengths of the trial, but what are the weaknesses and the strengths of this trial? Dr. Thomas Stinchcombe: So, I mean, I think there are some weaknesses. A major pathological response was chosen as an endpoint, and there could be an argument that path CR is more of a prognostic marker. However, the rates of path CR are relatively low, so it would have been very hard to design a trial such as that. And then I think the trial started off as a preoperative trial but effectively became a perioperative trial with preoperative EGFR-TKI, postoperative osimertinib. And so I think it's going to be very hard to determine what the contribution of the components are. And then you've hit on another part that I think is very important when we interpret the data that the maturity on the event-free survival is only 15%, and most people are still on therapy. So the event-free survival, which is an important endpoint, is very immature right now. Dr. Ece Cali: And this trial was designed to compare the neoadjuvant approaches, hence the comparator arm here is neoadjuvant chemotherapy followed by surgery. So, considering the ADAURA trial results with upfront surgery followed by osimertinib as adjuvant, so how do you see this trial's impact on the current clinical practice? Dr. Thomas Stinchcombe: Well, very good question, I think one that we're still struggling with as we kind of look at this data. I think, for me, stage II patients will most likely go to surgery and then get adjuvant osimertinib, and then maybe the N2 patients will get an osimertinib-containing regimen as an induction therapy. I think one of the questions is does it really matter when you get the osimertinib as long as you get it at some point? And I think that's going to be the critical interpretation of some of the data at this point. Dr. Ece Cali: And how do you think this trial shapes the future research for patients with resectable EGFR-mutated lung cancer? Dr. Thomas Stinchcombe: Well, I mean, I think it shows that chemotherapy was really modestly active with an MPR rate of 2%, no pathological responses. And then I think you're going to have to look at an osimertinib plus another targeted therapy component. I think, you know, when I looked at the osimertinib versus the chemo-osimertinib arm, I also was sort of surprised that the MPR rate and the path CR rate were very, very similar. So I think that the question is would a double targeted therapy approach or some other approach matter? And I think it also sets a safety standard. And you touched on this in your comments, that there was not a disparity in terms of the rate of going to surgery or R0/R1 resections. So patients were not having progressive disease events or toxicities that prevented surgery. So I think it does give us good safety data. Dr. Ece Cali: Tom, thank you so much for sharing your insights on the JCO article, "Neoadjuvant Osimertinib for Resectable EGFR-Mutated Non–Small-Cell Lung Cancer." Join us again for the latest simultaneous publications from the 2025 ASCO Annual Meeting, and please take a moment to rate, review, and subscribe to all ASCO podcast shows at asco.org/podcasts. Until then, enjoy the rest of ASCO 2025. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Cornelia Kropf-Sanchen und Harald Müller-Huesmann diskutieren Studien zum kleinzelligen und nicht-kleinzelligen Lungenkarzinom – darunter Immun-Chemo-Kombinationen, molekulare Rebiopsien bei Resistenzen und ctDNA als Marker für Therapieentscheidungen. Und auch die Nachwuchsförderung wird beleuchtet.
Dr. John Sweetenham shares highlights from Day 3 of the 2025 ASCO Annual Meeting, including new research for the treatment of advanced renal cell carcinoma and 2 studies on novel approaches in non-small cell lung cancer. Transcript Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, the host of the ASCO Daily News Podcast, with my takeaways on selected abstracts from Day 3 of the 2025 ASCO Annual Meeting. Today's selection features studies addressing the treatment of advanced renal cell carcinoma and 2 studies exploring novel approaches in non-small cell lung cancer. My disclosures are available in the transcript of this episode. The first abstract is number 4505. This study, led by Dr. Toni Choueiri of the Dana-Farber Cancer Institute, describes the final analysis of the CheckMate 214 trial, which compared the combination of nivolumab and ipilimumab with sunitinib for the first-line treatment of advanced renal cell carcinoma. The ipi-nivo combination is approved for the frontline treatment of intermediate and poor-risk advanced renal cell carcinoma based on the primary analysis of the CheckMate 214 trial, which demonstrated a higher response rate and longer overall survival compared with sunitinib. Today's presentation provided the final safety and efficacy results for the trial with long-term follow-up of more than 9 years. The intent-to-treat (ITT) population in this trial comprised 550 patients randomized to nivo and ipi versus 546 who received sunitinib. The final analysis showed sustained long-term benefit for the combination therapy. Patients given nivolumab plus ipi had a 29% reduction in the risk for death compared with sunitinib. For patients with intermediate or poor-risk disease, there was a 31% reduction in the risk of death. The probability of remaining in response through 8 years was more than doubled with nivolumab plus ipilimumab versus sunitinib in the ITT population at 48% versus 19%, and in the intermediate and poor-risk population at 50% versus 23%. The other important observation is that patients with favorable-risk disease appeared to have a 20% reduction in the risk for death at 9 years and more durable responses. This suggests a possible delayed benefit for ipi and nivo in this group since these differences were not seen in the earlier analysis. No new safety signals emerged with longer follow-up, and the results confirm the use of ipi and nivo as a standard front-line combination therapy in this disease. Since this combination has been in widespread use for some years, the results are not surprising although the subgroup analysis suggesting benefit in favorable-risk patients is likely to inform practice in the future. Today's second abstract is number is 8506, which was presented by Dr. Tony Mok from the Chinese University of Hong Kong, describing results from the phase 3 HERTHENA-Lung02 trial. This trial compared the antibody-drug conjugate patritumab deruxtecan with platinum-based chemotherapy in patients with EGFR-mutated advanced non-small cell lung cancer following a third-generation tyrosine kinase inhibitor (TKI). Patritumab deruxtecan, also known as HER3-DXd, comprises a fully human anti-HER3 IgG3 monoclonal antibody conjugated to a topoisomerase 1 inhibitor payload, and showed activity in a previous phase 2 trial in patients relapsing after EGFR TKI and chemotherapy. In this phase 3 study, this agent was compared with platinum-based chemotherapy in eligible patients with an EGFR-activating mutation who had previously received 1 or 2 EGFR TKIs, at least one of which was a third-generation drug, with relapse or progression after this therapy. Five hundred and eighty-six patients were enrolled, with progression-free survival as the primary endpoint. The primary analysis showed a 9-month progression-free survival of 29% for the experimental arm compared with 19% for platinum-based chemotherapy, for a hazard ratio of 0.77 and a P value of 0.011. With higher progression-free survival rates at 6 months and 12 months, HER3-DXd also had a better objective response rate (35.2% versus 25.3%) compared with platinum-based chemotherapy (PBC), and HER3-DXd also extended intracranial progression-free survival compared with PBC in patients with brain metastases, with a hazard ratio of 0.75. Grade 3 or more treatment-related adverse events occurred in 73% of patients treated with HER3-DXd and 57% of patients who received PBC. HER3-DXd had a higher rate of grade or more 3 thrombocytopenia, and drug-related interstitial lung disease occurred in 5% of patients in the HER3-DXd arm. The follow-up will need more time to mature since no overall survival data are currently available, but definitely an agent to watch with interest. Moving on to today's final abstract, 8500, was presented by Dr. Pasi Jänne from the Dana-Farber Cancer Institute, describing results from the phase 2 portion of the KRYSTAL-7 study. This study is exploring the use of a potent KRAS inhibitor, adagrasib, in combination with pembrolizumab in patients with advanced or metastatic KRASG12C- mutated non-small cell lung cancer. Adagrasib has already received accelerated approval in the U.S. for previously treated locally advanced or metastatic NSCLC with a KRASG12C mutation. A previous report from the KRYSTAL-7 study demonstrated encouraging activity in combination with pembrolizumab in the frontline setting for this patient group who also had more than 50% expression of PD-L1. The presentation today described efficacy and safety data for this drug combination across all PD-L1 expression levels. One hundred and forty-nine patients with a median age of 67 years were treated with the combination, 104 of whom had PD-L1 expression level results available, representing the so-called biomarker population in this trial. The overall response rate for the entire study population was 44%. In the biomarker population, the overall response rate ranged from 36% in those with less than 1% PD-L1 expression to 61% for those with more than 50% expression. For all patients, the median response duration was just over 26 months, and the median progression-free and overall survival rates were 11 and 18.3 months respectively. For the biomarker population, the median progression-free and overall survival were highest in those patients with more than 50% PD-L1. No new safety issues emerged from this analysis; the most frequent toxicities were nausea, diarrhea, and increases in transaminases. Immune-related toxicities included pneumonitis, hypothyroidism, and hepatitis. These are important results and the results of the phase 3 portion of KRYSTAL-7, which compares first-line therapy with adagrasib plus pembro versus pembro alone in the KRASG12C mutated/PD-L1 more than 50% group, will be informative. For those patients with lower levels of PD-L1 expression, the authors suggest that the treatment escalation may be beneficial, possibly including the addition of chemotherapy. That concludes today's report. Thanks for listening and I hope you will join me again tomorrow to hear more top takeaways from ASCO25. If you value the insights that you hear on the ASCO Daily News Podcast, please remember to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Find out more about today's speaker: Dr. John Sweetenham Follow ASCO on social media: @ASCO on Twitter @ASCO on Bluesky ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. John Sweetenham: No relationships to disclose
JCO Editorial Fellow Dr. Ece Cali Daylan and JCO Associate Editor Dr. Grant McArthur discuss the ASCO 2025 Simultaneous Publication paper "A Phase II (Alliance A091802) Randomized Trial of Avelumab Plus Cetuximab vs. Avelumab Alone in Advanced Cutaneous Squamous Cell Carcinoma (cSCC)." Transcript The guest on this podcast episode has no disclosures to declare. Dr. Ece Cali: Hello, and welcome to our 2025 ASCO Annual Meeting series where we cover some of the top JCO papers published simultaneously with their abstract presentation at this year's meeting. I'm your host, Dr. Ece Cali, and I'm joined by JCO Associate Editor Dr. Grant McArthur. Today, we will discuss Journal of Clinical Oncology article and abstract presentation "A Phase II Randomized Trial of Avelumab Plus Cetuximab Versus Avelumab Alone in Advanced Cutaneous Squamous Cell Carcinoma." Let's start with a brief overview of the clinical trial. This is a randomized phase II trial that compared avelumab plus cetuximab to avelumab in PD-1/PD-L1 antibody-naive patients with advanced cutaneous squamous cell carcinoma. This is a cooperative group study conducted in the United States. Sixty patients were randomized one-to-one and stratified by PD-L1 and HIV status. The primary endpoint was progression-free survival. Patients on the cetuximab plus avelumab arm had a median PFS of 11.1 months, while patients on the avelumab arm had a median PFS of 3 months, corresponding to a hazard ratio of 0.48 with a p-value of 0.018. Grade III or higher treatment-related adverse events occurred in 48% of the patients on the combination arm versus 21% of patients on the avelumab arm. Dr. McArthur, can you please explain to our listeners how you interpret this data? Dr. Grant McArthur: These results are very important because they provide proof of concept for inhibiting PD-L1 as a target when combined with EGFR, so inhibiting PD-L1 with avelumab and inhibiting EGFR with cetuximab, in a randomized trial with a very significant impact in terms of efficacy. So, what this does is it provides proof of concept for inhibiting those targets in cutaneous squamous cell carcinoma of the skin. Avelumab is not approved for cutaneous squamous cell carcinoma of the skin, and so further studies would need to be done, particularly asking the question about combination with the approved PD-1 agents cemiplimab and pembrolizumab. Dr. Ece Cali: I still find the difference in median PFS with various PD-1/PD-L1 inhibitors striking in this context. In this trial, avelumab, as you mentioned, the PD-L1 inhibitor, demonstrated a median PFS of 3 months, whereas PD-1 inhibitors cemiplimab and pembrolizumab have demonstrated longer median PFS in other trials. So, what are some potential reasons for this, and do you think this difference impacts the interpretation of the results here? Dr. Grant McArthur: So, the obvious reason for the differences is that avelumab targets PD-L1, where pembrolizumab and cemiplimab inhibit PD-1, so there could be simply a difference in the target to explain those differences in progression-free survival. However, as you point out, cross-trial comparisons, one has to do with caution because you can, in different phase II studies, enroll different patient populations, which would impact the progression-free survival. So, we have to be cautious about that interpretation. However, given that cemiplimab and pembrolizumab are the approved agents, I think they are the logical ones for further clinical development. Nonetheless, this is still a very important proof-of-concept trial showing that there is a strong clinical signal when you combine EGFR inhibition with inhibition of PD-L1 versus PD-L1 alone. Dr. Ece Cali: I want to highlight some of the safety data presented in this trial as well. The treatment discontinuation rate due to adverse events was much higher in the combination arm, reaching 31% compared to the 14% in the single-agent avelumab arm. The most common grade III adverse events were infusion reaction, rash, and diarrhea in the combination arm. So, these adverse events may affect patients' quality of life significantly. So, what are your thoughts on this, Dr. McArthur? Dr. Grant McArthur: So, the safety data is important. What we're seeing is safety related to each individual agent. So, we have diarrhea and skin rash from the cetuximab, and the infusion reactions is a common toxicity of avelumab. I think what's important, given this is proof of concept inhibiting these targets going forward to further studies, is that agents such as cemiplimab and pembrolizumab have a very low infusion reaction rate. So, the treatment discontinuations due to infusion reaction are unlikely to be an issue with cemiplimab and pembrolizumab when further clinical trials are done. Of course, there is still the issue of diarrhea and skin rash. Now, that can be managed in many patients with EGFR inhibition, you know. However, one would have to await safety data from a significant patient cohort with a combination of cetuximab with either cemiplimab or pembrolizumab, of course, to assess the clinical impact of those safety signals. But I would expect there to be definitely rash and diarrhea as predominant toxicities with those other combinations as well. Dr. Ece Cali: And lastly, I think we touched upon this a little bit, but how do you think this trial impacts the clinical practice, and what are some outstanding questions that need to be addressed in this field in light of the data from this trial? Dr. Grant McArthur: So, the most important outstanding question is - of course, we've already alluded to in our conversation - regarding using anti-PD-1 agents such as pembrolizumab or cemiplimab. So, that needs to be undertaken. Clearly, a randomized trial would be required combining cetuximab with those agents because they are quite active as single agents with impressive response rates and PFS. So, that is the way forward. There's other important clinical questions as well, though. So, patients that get locally aggressive or metastatic cutaneous squamous cell carcinoma of the skin are often immunosuppressed. And so, we do need data in patients that are immunosuppressed, either due to treatment of immune-related disorders - and also organ transplantation. We see a lot of cutaneous squamous cell carcinoma in organ transplant patients. So, these are important patient subsets that would also need to be investigated in further clinical development. However, overall, you know, this is a strong signal, hazard ratio of less than 0.5, and very worthy of further investigation in randomized trials of inhibiting these targets. Dr. Ece Cali: This was a great discussion. Thank you so much for your insight, Dr. McArthur, for speaking about the JCO article "A Phase II Randomized Trial of Avelumab Plus Cetuximab Versus Avelumab Alone in Advanced Cutaneous Squamous Cell Carcinoma." Join us again for the latest simultaneous publications from the 2025 ASCO Annual Meeting. Please take a moment to rate, review, and subscribe to all ASCO podcast shows at asco.org/podcasts. Until then, enjoy the rest of ASCO 2025. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
How well are you managing your patients with the new intensification strategies for EGFR-mutated advanced non-small cell lung cancer (NSCLC)? Credit available for this activity expires: 5/29/2026 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1002547?ecd=bdc_podcast_libsyn_mscpedu
Host: Jacob Sands, MD Guest: Elaine Shum, MD Guest: Estelamari Rodriguez, MD, MPH There was a recent pooled analysis of the TROPION-Lung01 and TROPION-Lung05 studies, which focused on the efficacy and safety of datopotamab deruxtecan (Dato-DXd) in patients with previously treated EGFR-mutated advanced non-small cell lung cancer (NSCLC). According to the results, Dato-DXd demonstrated an overall response rate of 43 percent, with durable responses and a manageable safety profile. Joining Dr. Jacob Sands to talk more about these findings and their implications are Drs. Elaine Shum and Estelamari Rodriguez. Dr. Shum is an Assistant Professor in the Department of Medicine at NYU Grossman School of Medicine, and Dr. Rodriguez is an Associate Director of Community Outreach, Thoracic Oncology at Sylvester Comprehensive Cancer Center at the University of Miami Health System.
Dutch biotech Merus' EGFR x LGR5 bispecific antibody has caught investors' attention in the run-up to ASCO as a new approach to block EGFR signaling. On the latest BioCentury This Week podcast, BioCentury's analysts discuss Phase II data from Merus for petosemtamab as they preview the American Society of Clinical Oncology's upcoming annual meeting. The analysts also assess a setback in a gene therapy trial for Rocket Pharmaceuticals, renewed interest in cancer target EpCAM, and a flurry of biopharma activity on the Hong Kong stock exchange. Finally, the team previews BioCentury's second annual Grand Rounds R&D meeting, which takes place next week in Chicago. This episode was sponsored by Jeito Capital.View full story: https://www.biocentury.com/article/656038#biotech #biopharma #pharma #lifescience #RandD #DrugDevelopment00:01 - Sponsor Message: Jeito Capital24:52 - HK IPOs07:12 - ASCO16:37 - EpCAM20:16 - RocketTo submit a question to BioCentury's editors, email the BioCentury This Week team at podcasts@biocentury.com.Reach us by sending a text
Dr. Luis Raez and Michael Reff share the newest update to the medically integrated dispensing pharmacy standards from NCODA and ASCO. They review updates to domain one, on key patient-centered quality standards on health equity and social determinants of health, drug access, patient safety, education, and adherence to maximize treatment outcomes and domain two, on key operational quality standards on logistics, care coordination, and waste prevention. We also cover the impact of these updated standards for clinicians, oncology practices, and people receiving oral anti-cancer medications. Read the complete standards, “Medically Integrated Dispensing Pharmacy: ASCO-NCODA Standards.” Transcript These standards, clinical tools, and resources are available on ASCO.org. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the JCO Oncology Practice. Brittany Harvey: Hello, and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Michael Reff from the Network of Collaborative Oncology Development and Advancement and Dr. Luis Raez from Memorial Cancer Institute and Florida Atlantic University, co-chairs on "Medically Integrated Dispensing Pharmacy: American Society of Clinical Oncology – Network of Collaborative Oncology Development and Advancement Association Standards Update." Thank you for being here, Michael and Dr. Raez. Dr. Luis Raez: Thanks for inviting us. Michael Reff: Thank you for having us. Brittany Harvey: Then, before we discuss these standards, I'd like to note that ASCO takes great care in the development of its standards and ensuring that the ASCO Conflict of Interest policy is followed for each guidance product. The disclosures of potential conflicts of interest for the expert panel, including Michael and Dr. Luis Raez who have joined us here today, are available online with the publication of the standards in JCO Oncology Practice, which is linked in the show notes. So then, to dive into the content here, Michael, I'd like to start with what prompted an update to these ASCO-NCODA standards and what is the scope of this update? Michael Reff: Thank you, Brittany. What led NCODA and ASCO to endeavor in this, and it started back in 2019 as the amount of oral anticancer medications became more and more prevalent in cancer treatment, we saw the need providing a blueprint for excellence in care for patients prescribed oral anticancer medications, specifically in the outpatient setting. And the update was driven by the rapid growth of these oral oncolytics starting back in the mid to late 2015 through 2019 or so, and then continued on into the 2020s where we are today. We saw the increase in the complexity of the management of these patients with these therapies basically outside the traditional clinical settings. And we wanted to make sure that with more cancer treatments that are taken at home than just at the clinic, like in the oral setting, new challenges had emerged around patient safety, access, adherence, and overall treatment success. The updates now address patient-centered and operational interventions designed to improve access, safety, quality, accountability, and outcomes of oral anticancer and other supportive care medications prescribed for the cancer patient. Dr. Luis Raez: As Mike said, these guidelines help improve patient care tremendously, but also help us a lot as an oncologist, you know, community oncologists that- now that we have opportunity to dispense these oral oncolytics, we need help to create our medical integrated pharmacies, and NCODA is providing here a way that, how to do this safely, efficaciously, good quality, you know? So that's why I think we always do everything for the patients, but also this helps a lot to the doctors. And there are a lot of what we call specialty pharmacies or medical integrated pharmacies now nationwide. Michael Reff: I'll build on what Dr. Raez had mentioned. This is the impetus. If you looked at the innovation that was coming from the pharmaceutical companies, many of it coming in the oral form for anticancer medications, and based on that, taking a look at the infrastructure that is in place in these practices, whether it's in the community or the IDN or health system settings, this amount of innovation that was coming needed to be addressed by taking a look at the medically integrated oncology team. And these standards address not just the pharmacy component, but also the whole continuum of care, starting with a medical oncologist or the hematologist, with the pharmacists, nurses, the pharmacy technicians, others that are involved in the care of the patient. And there were no standards involved. And when we approached ASCO back in 2018 to eventually publish the first version of these standards, the need was identified, and we worked collaboratively with ASCO to create the first set and then the revisions as we talked about. One thing to note regarding the revision plus the original standards, we had a cross-section of the care team on the committee, and we did that very purposefully. So, the ASCO-NCODA team curated a committee to help develop these original standards and the revision of these standards with medical oncologists both from community and health systems, pharmacists from both community and health systems, and also nurses. And we also included a patient that currently has and currently receives oral anticancer medication. And so NCODA and ASCO are very proud of the committee that we put together because of the experts in their field, but also extended the invitation to a current patient. And we embedded everybody's expertise in the curation of these standards. Brittany Harvey: Absolutely. I appreciate that background and context and how it's critical to improve patient care. And these standards really help oncologists, and we're looking across the continuum of care to provide optimal care for our patients. So then next, Dr. Raez, I'd like to review the key points of the revised standards for our listeners. So for Domain 1, what are the key patient-centered quality standards on health equity and social determinants of health, drug access, patient safety, education, and adherence to maximize treatment outcomes? Dr. Luis Raez: Yeah, this was a great effort, you know, at the multidisciplinary team. And as you can read in the standard, there were more than 240 publications reviewed; more than 55 of them are quoted here. And the standards are in two groups, as you said. With the group one, I'll briefly mention some of them. For example, SDOH, social determinants of health, is very important because as doctors, we prescribe, and sometimes patients don't get the medication, you know? And we prescribe assuming that 100% of the patients will get the medication. But something simple like the patient doesn't have insurance, the patient is underinsured. I have a patient that we didn't have an address to send the medication because he's homeless. Something that as a doctor you say, "Oh, oh my God, this is outside my realm," but it's not outside reality. So that's why, even if we don't think that this is part of our expertise dealing with social determinants of health, the fact that the patients have food insecurity, they don't have transportation, they don't have insurance, they don't have a caregiver, impact tremendously in the outcomes of the therapy. So that's why, basically, in this standard, we want to call attention that SDOH, social determinants of health, needs to be identified. There are in the literature countless examples of why this is important. For example, in the guidelines, we quote two or three examples of prostate cancer studies that, for example, we quote a study of 27,000 people with prostate cancer that were taking oral oncolytics, and how come the fact that the elderly, seniors, the fact that they have high prescription costs, and how all of this affected the adherence to the medication. And that's why it's important to identify the SDOH. And in other sections of the guidelines, we said how to address them, no? Another important thing in this domain is the cultural, you know, we need to be culturally sensitive and to take care of all of these social factors. For example, here in South Florida, we deal with the Haitian culture, Filipino culture, Latin culture, and American culture, and it's a blend, but it's not easy to go from one to the other. Another one is the fact that we have to include new technologies. A lot of patients, for example, we use EMR, EMR Epic, and now Epic has everything in the phone. The fact that we can have now the patient can see her prescription medication over the phone, the fact that they can use the phone to request from you a refill, and from your phone, you send the refill to the pharmacy, and you notify from your phone to the patient that the refill is sent, and the patient can check in his phone that the refill is ready. These things are amazing because that's why it's important that we incorporate these technologies to the patient care, and in this specific case, of dispensation of oral therapies, no? Another crucial point is education. You cannot be sending a patient a package of 300 pills without education. So that's why in our guidelines, mainly pharmacy, clinical pharmacies, or in some centers like mine, we have advanced practice providers, it's mandatory in our centers to have like a one hour of education before you send the prescription. So the patient is aware about side effects and contraindications, all of these things. They provide them also materials and also consent. You know, in the old times, you don't give chemo without a consent. Now, a lot of people say, "Oh, it's only a pill." There is a lot of benefits or side effects that can come from the pill, so you need to consent everybody, you know? So, another aspect is adherence. I already told about that, but we need to provide patients with a baseline assessment, no? So, you cannot send again the prescription and hope, "Oh, I'll figure it out what happened next month when the patient comes back." I tell you, the patient is homeless, where are you going to send it? If the patient is telling you, "I don't have insurance," what good is it for you to send a prescription? The patient will not get it. So that's why you need to do a baseline assessment of adherence. You need to do a calendar. You need to do electronic support, I mentioned already with the EMR and the phones. For example, my MIP, my specialty pharmacist, sends me a message in the EMR, "Dr. Raez, the insurance is not covering, the patient has a high copayment, we are going to delay the dispensation of the medication." So there needs to be a communication. Or sometimes there is a confusion with the insurance, and I cannot wait for the poor patient to call three, four weeks later, "Oh, I didn't get the medication," to know what happened, no? My MIP is very good. They send the clinical pharmacist a message, "Hey, you know, the insurance doesn't believe that the pill is adequate, or you need to provide more documentation. You need to prove the mutation, the genetic aberration." So if you provide us that, the insurance may approve. So that communication with the doctor is very important to improve adherence. And one important thing that we have in this one that we didn't have in the anterior is the tracking of outside medications. A lot of times you say, "Okay, the insurance allowed us to provide the medication it's 100% responsible." But then the insurance says, "Oh, no, no, don't worry. CVS will provide the medication." So it says, "Well, it's you know, it's not my responsibility. CVS will provide the medication, they have to take care." But we know that outside our specialty pharmacies or MIPs, the care is not very good. So that's why we are taking our ownership that, "Okay, the insurance said the patient will get the medication from some outside pharmacy." But our clinical pharmacists track that. What happened? Did the patient get it? The patient didn't get it. The copayment is still high. So even if you get the medication from somewhere else, if the copayment is high, we, our clinical pharmacists, help the patient to navigate and get the foundation or the copayment or finally the maker, the industry partner, provides the drug for free, but somebody needs to do the paperwork. And that's why this is very important. We cannot abort our responsibility because, "Oh, the insurance said somebody else will give it." I work for the public healthcare system, so my patients, some of them don't have insurance, they are underinsured. So we see these problems every day. And finally, the standards talk about the importance of safety, documentation, verification, monitoring, refills, you know, you need to keep track of refills. We already mentioned how important is the technology to facilitate the refills, and the quality. Brittany Harvey: Yes, thank you for touching on those highlights for Domain 1. It's important that all patients have access to care and these oral anticancer medications, and not only just access to care, but safe and effective care. It's really important, as you mentioned, Dr. Raez, to meet patients where they're at and incorporate technology. And I also want to note the coordination with external pharmacies that you mentioned in tracking outside medications as well. It's not only important for multidisciplinary care within the oncology practice itself, but also external to the oncology practice. That's why we put together this multidisciplinary panel to develop these standards. So then, expanding on that, Dr. Raez, for Domain 2, what are the key operational quality standards? Those on logistics, care coordination, and waste prevention. Dr. Luis Raez: Yeah, we have a lot of standards here, but maybe we can summarize in five or six points, no? For example, financial toxicity in cost and waste are very important because the patients, yeah, you put them on therapy, but as you can understand, if there is disease progression, the patient don't need the medications. And sometimes you get refills even if the patient has disease progression. If you do a dose reduction, the same problem. Or you discontinue medication and the patient keeps getting the drugs. So, you're talking about drugs that are between 20 and 30 thousand dollars per month. This is a lot of money. There are studies that we're quoting in the standards that the waste could be from 1 to 3 or 4 thousand per patient, no? Another aspect is dispensing. When you dispense the medication, this is not as easy as, "I'll ship to your house a bag of medications." You know, there needs to be a diagram, a decision tree. You need to train the staff to know what we're doing. There needs to be an auditing of the process. They need to be even packaging and shipping, you know? For example, I'm in Florida today and outside in summer it's going to be 95 degrees. So, everybody leaves the package outside your house, and sometimes you go the whole day until when you come at 6:00 p.m. There are medications that cannot be left outside there, you know? I don't know, it sounds like a joke, but I have a patient that the medication used to be stolen because people thought that that was something important, you know? And of course, it's important because it's a $20,000 medication. So, the poor patient, because he lives in an area that is not safe, has to come and pick up in person. All of these things sound very trivial, but that's real life that affects adherence. Another important thing is shortage. This is something that we just suffered two or three years ago, and we have to think about what happens in the next shortage. What happens if there's going to be a shortage? What do we do or how are we going to do that? Now we know it's something that is happening probably very soon again, and something that we have to consider. Another standard is the care coordination. You need to have probably, if it's possible, a coordinator. I know that for small practices it's very hard, but for big cancer centers, you should have a coordinator of this. I already mentioned before, the communication between the physicians and the doctors to coordinate the care, no? You need to write the prescription again, you need to provide more information, or to be notified, "Hey, you know, the patient is throwing up in the first week, you need to see the patient, please," no? So, this type of communication needs to exist so we can serve the patient better. It's also important, you know, we're improving quality and we're improving care. It's important to try to collect patient-reported outcomes. This is something that now we have the opportunity, if we do things well, to do it and show that we're providing a better care. The other thing is that we already mentioned SDOH in the other standard. In this standard, we mention mainly SDOH to partner. For example, we collect in my center SDOH, and I always get frustrated when the patient doesn't have transportation. But I didn't know that there are local institutions that provide free Uber rides, free Lyft rides. So that's why it's important to partner with these institutions. I have a local grocery chain that provides free food for the patients, and I didn't know that. It's important to be aware what the patient needs and what resources do you have to fulfill the SDOH. That's the part that we mention in here. So that's why, in summary, those are the six probably most important points here. I'll ask Mike for some comments. Michael Reff: Thank you, Dr. Raez. Brittany, to answer your question, and as was pointed out on logistics, care coordination, and prevention of waste, certainly that is an aspect that has changed in the revision that we're here to talk about. There's really two components to waste, and it's cost avoidance and then waste prevention. And as Dr. Raez mentioned several times, the importance of the medically integrated team and having the ability for that practice to fill that prescription internally and have robust documentation. Cost avoidance is a critical component that the medically integrated pharmacy, or the MIP, can help the total cost of care. And that is by preventing errant fills or waste that can occur by intervening in the care of the cancer patient, as we do every day. But when the practice has access to the medication and can fill that prescription in-house in the medically integrated pharmacy, that team, that care coordination that takes place, can prevent those errant fills or additional fills when there's dose reductions, there's holidays, there's things that happen in real time. And it's impossible for a mail-order pharmacy that's in another state that has lead times, when a prescription needs to be mailed 7 days or 10 days before the patient will run out of the medication, it's impossible for them to logistically coordinate that care like we can internally within the medically integrated pharmacy. So, we prevent waste and overall cost of care by cost avoidance and having that coordination or that continuity of care that we talk about. And we prevent waste from the mail-order pharmacies by taking that prescription internally and filling it, but also doing it in a way that's more sustainable and cost-effective for all stakeholders in the oncology ecosystem. Brittany Harvey: Absolutely. Thank you both for reviewing those key standards for Domain 2 and touching on the importance of distribution logistics and all the things that a medically integrated pharmacy needs to think through in getting oral anticancer agents to patients. Following that, Michael, we've touched on this a little bit earlier, but how will these updated standards impact clinicians and oncology practices? Michael Reff: Yes, and as Dr. Raez and I have discussed throughout this podcast, these additional standards are there to help support that continuity of care by educating the clinicians that are in the oral anticancer medication space to elevate their provision for these oral therapies. What I mean by that is the practice has to perform at a certain level in order for them to, as I call it, deserve the right to fill that prescription by having the processes and procedures in place. And these standards, these updated or revised standards, are the blueprint for better patient care and to help the practices execute on that journey of continuous improvement. Dr. Luis Raez: Yeah, I only want to add, we have practical examples in the guidelines. We quote a couple of studies that have been successful. And this year, for example, I am a lung cancer doctor, we are presenting in World Lung our standards of adherence to oral oncolytics for EGFR therapy, following the NCODA-ASCO standards. We're around 95% of adherence. We are a healthcare system that is public. We have people with no insurance and a lot of social determinants of health. We are trying to show that it's feasible, even in the most difficult circumstance, when you follow the standards, to be successful. Brittany Harvey: Definitely, these standards can help clinicians and oncology practices succeed in providing these medications. So then beyond that, and to wrap us up, Michael, what do these revised standards mean for patients who are receiving oral anticancer medications? Michael Reff: Yes, great point and question, Brittany, because we have covered the benefits to the clinicians and the practices themselves. But how is this going to support better patient care? And it does it in a whole host of ways. I'll cover just a few of them. What I'm about to share with you relates back to what we call at NCODA the "core claims." Like, what's the core claims of having a medically integrated pharmacy within the practice? And there are seven different core claims that we feel practices that are focused on the continuity of care can deliver better outcomes that are embedded in these standards. And it's talking about abandonment, adherence, access and affordability, speed to therapy or time to fill, as we call it, education, patient satisfaction, and cost avoidance that we covered earlier. So those are the core claims that a practice that follows these revised standards can help elevate. So, faster and more affordable access to the oral cancer medications; individualized support to address barriers like transportation, finance, language, or health literacy, and so on; clear, patient-friendly education; something that is near and dear to all clinicians' hearts, and of course, the patient that was on our panel or on our committee, to empower them to manage side effects and recognize when to seek help; and a stronger partnership with a care team, with regular follow-ups focused on their experience, challenges, and successes; and then, greater overall safety through proactive monitoring for medication errors or complications. So all of these aspects, or tenets, as I'll call them, are baked into these quality standards that are totally aligned with NCODA's core claims document that, again, talks about abandonment, adherence, access and affordability, speed to therapy, education, satisfaction for the patients, and also cost avoidance. Dr. Luis Raez: I only want to add and invite the community to adhere to these standards, to practice the standards. You will be providing the best patient care that we can nowadays. Brittany Harvey: Definitely. I think these standards are very important. And Michael, I thank you for touching on those key claims from NCODA. I think those, along with these updated standards, will improve outcomes for patients everywhere. So I want to thank you both so much for your work to update these standards and all the time you put into it. And thank you for your time today too, Michael and Dr. Raez. Michael Reff: I'd like to thank not only the committee, my esteemed committee that helped support the standards and the revision. Many of the original healthcare providers and patient that were on the first go of the standards were part of the second standards. We revised it, of course, and we got additional support from the new committee. And certainly ASCO and their partnership and collaboration with NCODA has been tremendous. And we look forward to the oncology community at large adopting these standards, again, to work together, we do become stronger, and it will improve cancer care for patients receiving oral anticancer medications. So thank you, Brittany. Dr. Luis Raez: I only want to say the same thing. Actually, there is probably more people in NCODA that is not in the publication that has helped. Same in ASCO. Also, we want to give thanks to Dr. Stephen Grubbs, our leader in quality. He's retiring. We're going to miss him, but he has been a key collaborator with Mike organizing these standards for the last five or six years. So, looking forward to these standards in practice. Brittany Harvey: Absolutely. A big thank you to the entire panel and everyone who contributed to this, and NCODA as well. And then finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the complete standards, go to www.asco.org/standards. I also encourage you to check out the companion episode on these standards on the PQI podcast by NCODA, which you can find on Apple Podcasts and Spotify. You can also find many of our standards and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Welcome to the Oncology Brothers podcast! In this episode, hosts Drs. Rahul and Rohit Gosain are joined by Dr. Gilberto Lopes, a thoracic medical oncologist from the Sylvester Cancer Center. Together, they dived into the latest updates on anti-EGFR drugs used in non-small cell lung cancer (NSCLC) with EGFR mutations. In this informative discussion, they covered: • The evolution of EGFR inhibitors, including Afatinib, Osimertinib, Amivantamab, and Lazertinib. • Common side effects associated with these treatments, such as diarrhea, skin toxicity, and infusion-related reactions. • Strategies for managing these side effects to improve patient quality of life and treatment adherence. • Insights from recent studies, including the SKIPirr trial and the MARIPOSA study, highlighting the benefits of new combinations and treatment approaches. Youtube: https://youtu.be/v6fb6nx0YY4 Follow us on social media: • X/Twitter: https://twitter.com/oncbrothers • Instagram: https://www.instagram.com/oncbrothers • Website: https://oncbrothers.com/ Join us as we explore how proactive management of side effects can maximize the effectiveness of these therapies and enhance patient outcomes. Don't forget to check out our other ToxCheck discussions, treatment algorithms, and conference highlights!
We are giving you a fresh take on celebrity health news and medical news that you can't get anywhere else! We're talking about Al B. Sure!'s wild survival story (coma, liver transplant, and those Diddy rumors), plus Nate Robinson's journey from NBA All-Star to kidney transplant survivor.I misspoke on the LIVE today. I said that it is standard of care for one to be referred to a nephrologist when the eGFR is less than 30. I meant to say that it is standard of care to refer a patient to a nephrologist when the eGFR is less than 60 and when the patient is in stage 3 CKD.This podcast is intended to be informational only. It is not a medical consultation, nor is it personalized medical advice. For medical advice, please consult your physician.Did you hear about Fox News commentator Camryn Kinsey fainting on live TV? Let's talk about why fainting happens—and why it's not just about “catching your breath.” Also, have you heard about That's So Raven, Disney Star, Rondell Sheridan's pancreatitis battle? It's a wake-up call for sure, and we'll talk about what you need to know plus so much more!#HealthHappyLifePodcast #DrFrita #MedicalMondays #MedicineInTheNewsHere are a few helpful resources to help on your journey to wellness:▶️ Subscribe so you will never miss a YouTube video.
The FiltrateJoel TopfAC GomezSophia AmbrusoNayan AroraSpecial Guest Charles Edelstein, MD, PhD Professor, Medicine-Renal Med Diseases/HypertensionExtra-Special GuestMichelle Rheault, MD Professor of Pediatrics, University of MinnesotaEditing bySimon and Joel TopfThe Kidney Connection written and performed by by Tim YauShow NotesKDIGO ADPKD Guidelines:WebsiteGuideline PDFExecutive Summary PDFNephJC coverageConsortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP)Hy's Law (Wikipedia) has three components:ALT or AST by 3-fold or greater above the upper limit of normalAnd total serum bilirubin of greater than 2× the upper limit of normal, without findings of cholestasis (defined as serum alkaline phosphatase activity less than 2× the upper limit of normal)And no other reason can be found to explain the combination of increased aminotransferase and serum total bilirubin, such as viral hepatitis, alcohol abuse, ischemia, preexisting liver disease, or another drug capable of causing the observed injuryMeeting this definition yields a very high risk of fulminant kidney failure (76% in one series)Clinical Pattern of Tolvaptan-Associated Liver Injury in Subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database (PubMed) Two of 957 patients on tolvaptan met Hy's law criteria. None had fulminant kidney failure.Effects of Hydrochlorothiazide and Metformin on Aquaresis and Nephroprotection by a Vasopressin V2 Receptor Antagonist in ADPKD: A Randomized Crossover Trial (PubMed) Patients had a baseline urine volume on tolvaptan of 6.9 L/24 h. Urine volume decreased to 5.1 L/24 h with hydrochlorothiazide and to 5.4 L/24 h on metformin.TEMPO 3:4 Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease (NEJM)Reprise Trial Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease ( NEJM | NephJC )Unified ultrasonographic diagnostic criteria for polycystic kidney disease by Edelstein in JASN (PubMed)Tolvaptan and Kidney Function Decline in Older Individuals With Autosomal Dominant Polycystic Kidney Disease: A Pooled Analysis of Randomized Clinical Trials and Observational Studies (PubMed)Charles' draft choice Recommendation 4.1.1.1: We recommend initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ‡25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease (1B).Sophia's draft choice Recommendation 1.4.2.1: We recommend employing the Mayo Imaging Classi cation (MIC) to predict future decline in kidney function and the timing of kidney failure (1B).Progression to kidney failure in ADPKD: the PROPKD score underestimates the risk assessed by the Mayo imaging classification (Frontiers of Science)AC's draft choice Recommendation 9.2.1: We recommend targeting BP to ≤ 50th percentile for age, sex, and height or ≤ 110/70 mm Hg in adolescents in the setting of ADPKD and high BP (1D).HALT-PKD Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease (NEJM)Nayan's draft choice Recommendation 6.1.2: We recommend screening for ICA in people with ADPKD and a personal history of SAH or a positive family history of ICA, SAH, or unexplained sudden death in those eligible for treatment and who have a reasonable life expectancy (1D).Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease (CJASN)Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms (PubMed) Clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms, whereas coiling is associated with lower morbidity and mortality and a better postoperative course.Joel's editorial pick Recommendation 6.1.1: We recommend informing adults with ADPKD about the increased risk for intracranial aneurysms (ICAs) and subarachnoid hemorrhage (1C).Joel's first draft pick The bring out your dead pick:Recommendation 4.3.1: We recommend not using mammalian target of rapamycin (mTOR) inhibitors to slow kidney disease progression in people with ADPKD (1C).Recommendation 4.4.1: We suggest not using statins specfiically to slow kidney disease progression in people with ADPKD (2D).Recommendation 4.5.1: We recommend not using metformin specifically to slow the rate of disease progression in people with ADPKD who do not have diabetes (1B).Recommendation 4.6.1: We suggest that somatostatin analogues should not be prescribed for the sole purpose of decreasing eGFR decline in people with ADPKD (2B).Perfect match: mTOR inhibitors and tuberous sclerosis complex (Orphanet Journal of Rare Diseases)Navitor Pharmaceuticals Announces Janssen Has Acquired Anakuria Therapeutics, Inc. (BioSpace) This is press release about acquiring the mTor1 inhibitor.Joel's second draft pick Recommendation 4.2.1.1: We suggest adapting water intake, spread throughout the day, to achieve at least 2–3 liters of water intake per day in people with ADPKD and an eGFR ≥ 30 ml/min per 1.73 m2 without contraindications to excreting a solute load (2D).Nayan's bonus draft Practice Point 4.7.1: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) should not be used to slow eGFR decline in people with ADPKD.Open-Label, Randomized, Controlled, Crossover Trial on the Effect of Dapagliflozin in Patients With ADPKD Receiving Tolvaptan (KIReports)SMART Trial of GLP-1ra in non-diabetics: Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial (PubMed)Tubular SecretionsNayan: Landman on Paramount Plus (IMDB)Sophia: PassNayan: steps in with The Pitt on HBO (Wikipedia)Charles: The White Lotus, Yellowstone 1923, Poirot (IMDB)AC: The PittMichael Crichton's Estate Sends The Pitt to the Courtroom (Vulture)Joel: I Must Betray you by Ruta Sepetys (Amazon)
Clinical investigators discuss available data guiding the management of EGFR mutation-positive non-small cell lung cancer. CME information and select publications here.
This is the second episode of a two-part series on the HER2 diagnostic and treatment landscape in non-small cell lung cancer (NSCLC), hosted by the Oncology Brothers, Drs Rohit and Rahul Gosain. In this episode, Dr Isabel Preeshagul and Dr Eric Singhi provide the benefit of their experience when discussing how to approach different treatment scenarios in HER2-mutant NSCLC. The conversation unfolds to cover: • Ways to distinguish HER2 alterations from other alterations on biomarker reports • The latest efficacy and safety data of currently approved and emerging treatments for HER2-altered NSCLC • The potential CNS activity of these treatments in patients with HER2-mutated NSCLC • How the treatment pathway may look in the near future Clinical takeaways • In NSCLC, HER2-positivity includes mutations, amplifications and overexpression. It's important to distinguish HER2 alterations from EGFR mutations, particularly exon 20 insertions, when interpreting next-generation sequencing (NGS) results • Trastuzumab Deruxtecan (T-DXd) is currently the only approved targeted agent for HER2-altered NSCLC in the 2nd-line setting. It shows promising efficacy, especially in HER2-mutant cases, but has limited brain penetration and is associated with notable side effects, including pneumonitis, which requires close monitoring • Emerging TKIs, such as zongertinib, BAY 2927088 (sevabertinib), and NVL-330, target HER2-mutations and have shown high response rates and CNS activity in early studies, without ILD/pneumonitis. These treatments come with unique side effects like diarrhoea and rash, which can be managed with supportive care • CNS metastases are common, with up to 30% of HER2-altered NSCLC patients presenting with or quickly developing CNS metastases. Current large molecule therapies (like T-DXd) have limited brain penetration, making small-molecule TKIs, like zongertinib, BAY 2927088 (sevabertinib), and NVL-330, promising for their potential CNS activity • Current standard 1st-line care for HER2-mutant NSCLC remains platinum-based chemotherapy ± immunotherapy. Targeted agents (like T-DXd) are generally reserved for 2nd-line use, but ongoing trials are evaluating the move toward frontline therapy Follow us on social media: • X/Twitter: https://twitter.com/oncbrothers • Instagram: https://www.instagram.com/oncbrothers • Website: https://oncbrothers.com/ Don't forget to subscribe for the next episode
Why You Should Listen: In this episode, you will learn about Metabolic Vulnerability Index (MVX) as an indicator of mortality and longevity. About My Guest: My guest for this episode is Dr. Darren Schmidt. Darren Schmidt, DC is the Founder of The Nutritional Healing Center of Ann Arbor which is the largest non-insurance nutrition clinic in the country. His purpose is to bankrupt pharmaceutical companies by teaching doctors how to improve health rather than treat symptoms. He uses new and old clinical discoveries to solve complex chronic illness with only diet and supplements. He uses MVX Plus, the best lab test to measure longevity and health, and it also directs the treatment plan. Key Takeaways: What is MVX? What are the 6 factors and 3 indices that are explored with MVX? How might MVX be a better metric for mortality than many conventionally-used metrics today? Can MVX be extrapolated to be used as a measure of health and longevity? What is GlycA? What drives it? What tools can be used to lower GlycA? What is the connection between GlycA and hypercoagulation? Why is eGFR and kidney health often used on the context of predicting mortality? What is small HDL particle number? How can it be optimized? What is the Inflammation Vulnerability Index? What is citrate? What tools can be used to lower it when elevated? What is the connection between citrate and mitochondrial function? What is lactic acidosis? What is learned from looking at valine, leucine, and isoleucine? What steps may be taken if they are high? If they are low? What is the Metabolic Malnutrition Index? When might a keto diet be appropriate? What does the Metabolic Vulnerability Index tell us? Is MVX impacted by genetics or epigenetics? What is the 7 Step Blueprint to Optimal Health? How do the 7 steps overlap with the 6 MVX factors? Connect With My Guest: TheNutritionalHealingCenter.com Related Resources: To see the resources in the Show Notes, visit https://BetterHealthGuy.com/Episode216. Interview Date: April 21, 2025 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode216. Additional Information: To learn more, visit https://BetterHealthGuy.com. Follow Me on Social Media: Facebook - https://facebook.com/betterhealthguy Instagram - https://instagram.com/betterhealthguy X - https://twitter.com/betterhealthguy TikTok - https://tiktok.com/@betterhealthguy Disclaimer: The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.
The OncoAlertWeekly Round Up Covering the TOP of the week April 18-24, 2025 REGISTER at http://OncoAlert360.com OR https://oncoalert.m-pages.com/nhMpwe/oncoalert-newsletter-registration Discussing:UPDATE on DESTINY-Breast09https://astrazeneca.com/media-centre/press-releases/2025/enhertu-combination-improved-pfs-in-1l-her-positive-mbc.htmlUPDATE on ASCENT 04https://gilead.com/news/news-details/2025/trodelvy-plus-keytruda-demonstrates-a-statistically-significant-and-clinically-meaningful-improvement-in-progression-free-survival-in-patients-with-previously-untreated-pd-l1-metastatic-tripAnnual Report to the Nationon the Status of Cancer, featuring state-level statistics after the onset of the COVID-19 pandemichttps://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.35833Osimertinib vs. Afatinib in 1L therapy of atypical EGFR-mutated metastatic non-small cell lung cancer https://lungcancerjournal.info/article/S0169-5002(25)00443-X/fulltextTargeting Lung Cancer with Precision: The ADC Therapeutic Revolutionhttps://link.springer.com/article/10.1007/s11912-025-01655-5Prevalence by therapy line and incidence of breast cancer brain metastases in 18 075 patientshttps://academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djaf048/8101485?login=falseEuropean screening platform for EORTC clinical trials in advanced colorectal cancer ‘SPECTAcolor'https://esmogastro.org/article/S2949-8198(25)00037-8/fulltextKorea, Japan, Europe, and the United States: Why are guidelines for gastric cancer different?https://link.springer.com/article/10.1007/s10120-025-01613-xOutpatient Administration of Chimeric Antigen Receptor T-Cell Therapy Using Remote Patient Monitoringhttps://ascopubs.org/doi/10.1200/OP-25-00062Safety and Activity of Fibroblast Growth Factor Receptor Inhibitors in Advanced Malignancieshttps://ascopubs.org/doi/10.1200/PO-24-00896?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
LIVE from Transform 2025! Adria Ferrier is the founder of Elayne, an AI copilot for financial and estate management. Elayne's mission is to modernize estate planning and affairs settlements, making it more accessible, efficient, and integrated into daily life. She launched Elayne after experiencing firsthand the disjointed, frustrating challenges families face after loss, along with its impact on careers. After her mom passed away, she spent months navigating banks, insurance companies, lawyers, taxes, and doing countless administrative tasks—like canceling her mom's subscriptions and deactivating her social media—each with its own complex, manual process. The burden, on top of the impact of losing her mother, took a toll on her performance at work. Ultimately, she resigned, a decision made by nearly 50% of employees within a year of a major loss. Adria started her career in corporate M&A before transitioning to private equity at Blackstone in NYC. She later earned her MBA from Wharton and joined Permira's healthcare investing team, deploying billions in capital throughout her career. In her early 20s, she helped launch a patient advocacy group for EGFR-positive lung cancer with her mom, directing hundreds of thousands toward EGFR-related research projects. Adria grew up between Debrecen, Hungary, and Providence, RI. She has lived in nine countries and speaks four languages. We dig into: - What key flaws in estate management inspired you to launch Elayne, and how does AI solve them? - How can companies better support employees navigating loss, so they don't feel forced to resign? - From private equity to entrepreneurship, what's been the biggest mindset shift in building Elayne? - The passion and story behind her company and so much more! Visit www.Elayne.com Get.elayne.com/POZCAST https://get.elayne.com/transform/ Live from Transform 2025, we're bringing you an exclusive podcast series packed with insights from some of the brightest minds in hiring, talent strategy, and workforce transformation! In this series, we've got incredible guests from Okta, Tubi, Edelman, Greenhouse, Findem, and more, sharing how top organizations are rethinking hiring, culture, and talent acquisition in today's fast-changing world. Greenhouse combines a structured, data-driven hiring approach with AI-embedded workflows that empower recruiters to focus on strategic, high-impact work. From sourcing top talent to personalizing the candidate experience, Greenhouse streamlines and optimizes the entire hiring process. This ensures that every hire is the right hire—eliminating bias, creating fairness, and helping teams make smarter, faster decisions. Over 7,500 companies, including HubSpot, Duolingo, and J.D. Power, trust Greenhouse to build better teams and turn talent into a strategic advantage. Want to learn how today's top companies are winning the talent game? Tune in now and visit Greenhouse.com to transform the way you hire. Thanks for listening. Please follow us on Instagram @NHPTalent and X @AdamJPosner. Visit www.thePOZcast.com for all episodes.
Featuring perspectives from Dr Jonathan Goldman and Dr Natasha B Leighl, including the following topics: Introduction (0:00) Current Management of Nonmetastatic and Metastatic EGFR Mutation-Positive Non-Small Cell Lung Cancer (NSCLC) — Prof Leighl (1:42) Promising Novel Agents in Clinical Development; EGFR Exon 20 Mutation-Positive NSCLC — Dr Goldman (37:25) CME information and select publications
In this episode, host Jonathan Sackier speaks with Alexander Spira about cutting-edge advances in lung and colorectal cancer, including EGFR and KRAS-targeted therapies. They also discuss Spira's leadership in oncology research, his thoughts on the evolving ‘town-gown' dynamic in US medicine, and his hopes for the future of cancer care. Timestamps: 00:00 – Introduction 01:50 – Most memorable family travel adventure 03:30 – What inspired you to go into oncology 05:49 – Three recent publications in lung cancer 07:02 – Real-world data on colorectal cancer 08:15 – Sex/gender differences in non-small cell lung cancer 11:53 – The science of KRAS mutations and drug development 15:07 – Accelerating diagnostics and access to therapies 17:13 – The ‘town-gown' debate in American healthcare 18:09- Three Wishes
Welcome back to the Oncology Brothers podcast! In this episode, Drs. Rahul and Rohit Gosain are joined by Dr. Joshua Sabari, a thoracic medical oncologist from NYU, to discuss the latest findings from the European Lung Cancer Conference (ELCC) 2025. We dived into several key studies that are shaping the future of lung cancer treatment, including: • KEYNOTE-799: Exploring the combination of concurrent chemotherapy and radiation with the PD-1 inhibitor pembrolizumab for unresectable non-small cell lung cancer (NSCLC). • LAURA: The impact of osimertinib in patients with EGFR mutations post-chemoradiation therapy. • MARIPOSA: The promising results of amivantamab and lisertinib in the metastatic setting for EGFR-mutated NSCLC. • KRYSTAL-7: Investigating the use of KRAS G12C inhibitors in frontline therapy. Join us as we discuss the implications of these studies, the importance of next-generation sequencing (NGS), and how to manage side effects associated with these new therapies. YouTube: https://youtu.be/akoXXAUEl_8 Follow us on social media: • X/Twitter: https://twitter.com/oncbrothers • Instagram: https://www.instagram.com/oncbrothers • Website: https://oncbrothers.com/ Don't forget to like, subscribe, and hit the notification bell for more updates on the latest in oncology! #Oncology #LungCancer #ELCC2025 #EGFR #KRAS #CancerResearch #Podcast
Oncology here & nowIn this interview Dr. Biagio Ricciuti of Dana Farber Cancer Institute (USA) talks to Dr. Marcelo Corassa of beneficência Portuguesa de São Paulo (Brazil) as they discuss Treatments in EGFR mutant Non Small Cell Lung Cancer. The discussion centers around the results of FLAURA, MARIPOSA and FLAURA2, future directions and much more.Join Us
Welcome to another episode of the Oncology Brothers podcast! In this episode, hosts Drs. Rahul and Rohit Gosain continue their ToxCheck series, focusing on the management of side effects associated with treatments for pancreatic cancer. Join us as we dive deep into the use of key drugs such as 5-FU, oxaliplatin, irinotecan, liposomal irinotecan, and the combination of gemcitabine and nab-paclitaxel. We are joined by esteemed guests Dr. Rachna Shroff from the University of Arizona and Dr. Midhun Malla from the University of Alabama, who share their insights and clinical pearls on managing the challenging side effects of these therapies. Key topics discussed include: • The utility of 5-FU bolus and leucovorin in treatment regimens • Managing common side effects like diarrhea, mucositis, and neuropathy • The importance of preemptive strategies in side effect management • Insights on liposomal irinotecan and its tolerability • The impact of gemcitabine and nab-paclitaxel on quality of life Whether you're a healthcare professional or someone interested in oncology, this episode provides valuable information on optimizing treatment while maintaining patient quality of life. YouTube: https://youtu.be/KByOGRpzFMQ Follow us on social media: • X/Twitter: https://twitter.com/oncbrothers • Instagram: https://www.instagram.com/oncbrothers • Website: https://oncbrothers.com/ Don't forget to check out our other ToxCheck episodes on antibody drug conjugates, CAR-T, and anti-EGFR drugs used in colorectal cancer. Subscribe for more insights from the Oncology Brothers!
In today's episode, supported by Summit Therapeutics, we had the pleasure of speaking with Xiuning Le, MD, PhD, about the use of ivonescimab (SMT112) in patients with PD-L1–positive non–small cell lung cancer (NSCLC). Dr Le is an associate professor in the Department of Thoracic/Head and Neck Medical Oncology in the Division of Internal Medicine at The University of Texas MD Anderson Cancer Center in Houston. The phase 3 HARMONi-2 trial (NCT05499390) investigated ivonescimab vs pembrolizumab (Keytruda) in patients with locally advanced or metastatic, PD-L1–positive NSCLC without sensitizing EGFR mutations or ALK translocations. At the preplanned interim analysis, at a median follow-up of 8.7 months (IQR, 7.1-10.3), the median progression-free survival was significantly longer in the ivonescimab arm (n = 198) vs the pembrolizumab arm (n = 200), at 11.1 months (95% CI, 7.3-not estimable) vs 5.8 months (95% CI, 5.0-8.2), respectively (stratified HR, 0.51; 95% CI, 0.38-0.69; 1-sided P < .0001). The objective response rates were 50% (95% CI, 43%-57%) and 39% (95% CI, 32%-46%) in these respective arms. In our exclusive interview, Dr Le discussed the rationale for the HARMONi-2 trial, key findings from the study, and where these findings position the potential role of ivonescimab in the PD-L1–positive NSCLC treatment paradigm.
LCC in Mandarin: Virtual Tumor Board - EGFR NSCLC by IASLC
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/KRC865. CME credit will be available until February 26, 2026.Modern Practice Principles in Lung Cancer—First Find the Targets, Then Treat With Precision: A Concise Guide for Biomarker Testing and EGFR-Targeted Therapy in NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC. Both are Johnson & Johnson companies.Disclosure information is available at the beginning of the video presentation.
Dr. Jyoti Patel is back on the podcast to discuss the updates to the living guideline on therapy for stage IV NSCLC with driver alterations. She shares updated recommendations in the first- and second-line settings for patients with stage IV NSCLC and classical EGFR mutations, and the impact of these updates for clinicians and patients. We also look to the future to discuss ongoing developments in the field. Read the full living guideline update “Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2024.3” at www.asco.org/living-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/living-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-24-02785 Brittany Harvey: Welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Jyoti Patel from Northwestern University, co-chair on “Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2024.3.” It's great to have you back on the show today, Dr. Patel. Dr. Jyoti Patel: Thanks so much. Happy to be here. Brittany Harvey: And then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Patel, who has joined us here today, are available online with the publication of the guideline and in the Journal of Clinical Oncology, which is linked in the show notes. So then, to dive into the content of this update, Dr. Patel, this clinical practice guideline for systemic therapy for patients with stage IV non small cell lung cancer with driver alterations is living, meaning that it's continuously reviewed and updated. So what data prompted this latest change to the recommendations? Dr. Jyoti Patel: Thanks so much. So it's really been an exciting time in the treatment of EGFR lung cancer, particularly this past year has required us to rethink approaches to front- and second-line therapy. In this particular update, we examined what patients in the front-line setting may be offered by their clinicians. And so we're talking about the population of classical EGFR mutations, so exon 19 and exon 21 L858R substitution. And so certainly for this population, osimertinib has a high level of evidence and should be offered to all patients at the time of diagnosis when they present with advanced disease. Our last update included a recommendation that patients could also get platinum doublet chemotherapy with osimertinib or osimertinib alone. This current recommendation also introduces another alternative therapy and that's the combination of amivantamab plus lazertinib. And so now, clinicians are faced with three really good options for their patients with EGFR exon19 deletion or L858R. Brittany Harvey: It's great to hear that there's this advance in the space, particularly for patients with these classical EGFR mutations that you mentioned. So what should clinicians know as they implement these new first-line recommendations? Dr. Jyoti Patel: I think it's become more complex than ever. Certainly, we know again that patients should get osimertinib in the frontline setting. But we've been kind of stuck at progression-free survival that's between a year and a half and two years. And so we've really been looking at opportunities to intensify therapy. So one could certainly be with chemotherapy or switching over to amivantamab, the bispecific antibody that targets EGFR and MET plus lazertinib, an oral TKI that's very similar in structure to osimertinib. And when you're talking to a patient, it's really a conversation about balancing efficacy with toxicity. Unfortunately, as we know, there aren't that many free lunches. And so if we think about what a patient is hoping for in their therapy and how we can further personalize treatment options, really is important to look at some of the analyses for this study. So in the study of amivantamab plus lazertinib, we know that there were increased toxicities with a combination of both therapies. In fact, up to 75% of patients had over grade 3 toxicities, versus about 43% of patients with osimertinib monotherapy. And we know if we look back at FLAURA2, almost two thirds of patients with osimertinib and chemotherapy had grade 3 toxicities, compared to 27% of patients with osimertinib alone. So we certainly see an increase in toxicities. Then we have to ask ourselves, are those paper toxicities or ones that really impact patients? And we know that amivantamab, for example, causes significant cutaneous toxicities. With both of these therapies, whether it's chemotherapy or adding amivantamab, there's the burden of infusional visits and increased time in the doctor's office. Certainly with chemotherapy, there can be an increased incidence of myelosuppression. And so when we're thinking about advising our patients, certainly we need to talk about the toxicities. But one thing that we've been able to do is to look at the patients that were included in this trial. And what we really find is that in higher risk cohorts, particularly those that we know historically have done less well with standard osimertinib, so patients, for example, with CNS metastasis, for those patients with co-mutations, it may be that that additive benefit is significant. And so one example I think would be from the MARIPOSA study, again, the study of amivantamab and lazertinib versus chemotherapy. What we can say is that patients who had co-mutations, so patients with EGFR mutations as well as TP53, lazertinib and amivantamab led to a hazard ratio of 0.65 compared to osimertinib alone. So that was 18.2 months versus 12.9 months. And so this may be really important to patients. And we also see conversely that patients with wild type TP53, so those patients who didn't have the mutation, probably had equivalent survival regardless of therapy. So certainly, we need to prospectively study some of these high-risk cohorts. We've only seen progression-free survival in these studies. And so at this juncture, we can advise our patients about toxicity, the improvements in certain categories of progression-free survival, but we really still don't know how this pans out in overall survival. In many of these studies, all patients do not necessarily cross over to the study arm and so they may have lost the benefit of subsequent therapy. Brittany Harvey: Absolutely. It's very important to talk about that balance of benefits and risks and particularly those toxicities that you discussed. So I appreciate reviewing that recommendation and the considerations for clinicians for first-line therapy. This update also included a second-line treatment update. What is that update for patients with EGFR alterations? Dr. Jyoti Patel: So this is where it gets super tricky because we have a frontline option with amivantamab and now we've had an update in the second line option. So what we said is that for patients who have progressed on an EGFR TKI, and in the United States, certainly that's predominantly osimertinib, or those in other parts of the world that may have gotten an earlier generation TKI, but do not have evidence of T790M or other targetable mutations, we can offer patients chemotherapy with or without amivantamab. And so certainly we have seen that this again leads to improved survival. There have also been a number of studies looking at incorporation of PD-L1 and anti-VEGF therapies. And what we can say, I think pretty clearly is that multiple phase 3 trials have really shown no benefit of the addition of PD-1 to platinum chemotherapy. But there are some emerging bispecific antibodies that may target PD-1 as well as VEGF, or combinations of antibodies that target both of those pathways that may improve outcome. At this juncture, I think we feel that the evidence surrounding chemotherapy plus amivantamab is strongest, but there is certainly work in this space that will be of interest. Now, what happens if your patient received amivantamab and lazertinib in the frontline setting and then has progression? And so we're trying to understand resistance mechanisms and opportunities for treatment. What the panel decided to recommend, based on the available evidence, was that certainly those patients should get platinum-based chemotherapy, but there may also be a role for antivascular endothelial growth factor targeting therapy such as bevacizumab in patients in whom it would be safe. Brittany Harvey: Great. I appreciate you detailing those recommendations when it gets complicated in the second-line setting. So what should clinicians know as they implement these second-line recommendations too? Dr. Jyoti Patel: So certainly the frontline setting matters significantly. So if a patient gets osimertinib in the frontline setting, we generally suggest that patients undergo repeat testing to see if they have another targetable mutation. If they don't, then I think preferred therapy would be chemotherapy with or without amivantamab. And amivantamab leads to a significant improvement in progression-free survival and response rate at the cost of increased risk of toxicity. For patients who get FLAURA2 in the frontline setting, chemotherapy plus osimertinib, it's a little bit of an unclear space. Those patients most likely would get docetaxel with or without ramucirumab. But there are other agents that we hope to have available to our patients in the near future. For patients who receive amivantamab and osimertinib, we recommend that those patients get chemotherapy probably with anti-VEGF as demonstrated by multiple trials that have shown the improved progression-free survival with introduction of an anti-VEGF agent. And we've seen evidence of amivantamab in the third line setting, so it is likely that this question about sequencing really takes center stage in our next set of trials. When you're talking to a patient, I think again, it's absolutely important to discuss: What are their goals? How symptomatic or how fast is their progression? Are there ways in which patients may benefit from spot treatment oligoprogression such as radiation? When is the right time for introduction of amivantamab and when do we think patients need chemotherapy? Is it up front or predominantly in the second-line setting? Brittany Harvey: Definitely. And then you've just touched on the goals of treatment for individual patients. So in your view, what does this update mean for patients with stage IV non-small cell lung cancer and an EGFR alteration? Dr. Jyoti Patel: For patients, this is a time in which shared decision making really needs to take center stage. So our best patients are those patients that are best informed not only about their disease but also have a good understanding about what is important to them and their families in terms of care. And so bringing that shared understanding to the table again helps us think about this particular cancer as more of a journey rather than just a one off treatment. Therapy will hopefully be prolonged, and so it's absolutely important that we address toxicities, make therapies more tolerable, again, with the shared goal of living long and living well. Brittany Harvey: Absolutely. Those are key points to making sure that patients are living both longer and have a good quality of life during that time as well. So then, before you mentioned the possibility of future sequencing trials and other ongoing developments. What additional studies or future directions is the panel examining for future updates to this living guideline? Dr. Jyoti Patel: So certainly we're thinking about trials that look at, for example, cfDNA clearance. So are there patients that do well and can we detect that early on without having to intensify therapy on day 1 so it may be that we add chemotherapy a little bit later. I think really exciting are some of the new bispecific. The HARMONi-A trial was a trial in China of a novel bispecific, ivonescimab. And this drug targets both PD-1 and VEGF and it was combined with chemotherapy. And this trial found almost a doubling of progression-free survival with this drug in combination chemotherapy in an EGFR patient population. That study is being planned and being run in the United States to see if we have similar outcomes with a more diverse population. So certainly that's exciting. There are a number of antibody drug conjugates that are being studied in the post-chemotherapy setting as well. And I think we'll likely soon see a better understanding of what co-mutations and burden of disease really mean when we're thinking about assigning treatment. So which patients, again, need intensification of therapy and which patients may do really well on just an oral agent that they're taking at home with more tolerable toxicity than dual treatment. Brittany Harvey: Yes, we'll look forward to continued developments in these fields and seeing some of those studies come to fruition. So with that, I want to thank you for your work to rapidly and continuously update this guideline, and thank you for your time today, Dr. Patel. Dr. Jyoti Patel: Thanks so much, Brittany. It's really an exciting time for lung cancer and we hope that these updates really help physicians decide the best treatments for their patients. Again, it's a rapidly evolving landscape which is fantastic, but it does become more cumbersome to stay ahead of the literature. Brittany Harvey: Definitely. And so we appreciate your time and the panel's time spent reviewing this literature and providing this much needed information to clinicians everywhere. So finally, thank you to all of our listeners for tuning into the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/living-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Dr. Lyudmila Bazhenova joins us again to share the newest changes to the living guideline on therapy for stage IV NSCLC without driver alterations. She discusses new evidence reviewed by the panel and changes to second-line recommendations for patients with good performance status and HER2 overexpression, and what these updates mean in practice. We discuss ongoing evidence generation as we await further updates to these living guidelines. Read the full living guideline update “Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2024.3” at www.asco.org/living-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/living-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-24-02786 Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Lyudmila Bazhenova from University of California San Diego Moores Cancer Center, co-chair on “Therapy for Stage IV Non–Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2024.3.” It's great to have you back on the show today, Dr. Bazhenova. Dr. Lyudmila Bazhenova: It's my pleasure to be here as always. Brittany Harvey: Great. Then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the entire guideline panel, including Dr. Bazhenova, who has joined us here today, are available online with the publication of the guide in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into the content here, first, this living clinical practice guideline for systemic therapy for patients with stage IV non-small cell lung cancer without driver alterations has frequent updates to the recommendations. What prompted this latest update? Dr. Lyudmila Bazhenova: Living ASCO guidelines are created to keep up with rapidly changing evidence which affect treatment of our patients with lung cancer. As a committee, we review published literature on a specific topic at the regular intervals and determine if it alters any recommendations. This time, upon our literature review, we felt that there are new data that requires an update in the guidelines and therefore the guidelines were updated. Brittany Harvey: Great. Thank you for that updated information. So then it looks like the panel updated recommendations for second line and subsequent treatment options for patients with good performance status and HER2 overexpression. What is that updated recommendation from the panel? Dr. Lyudmila Bazhenova: Yes, this is correct. We now added an extra recommendation for patients with stage IV non-small cell lung cancer who have overexpression of the protein called HER2. HER2 overexpression with 2+/3+ level via immunohistochemistry is seen in approximately 8% to 20% of patients with lung cancer. And the data behind our recommendation comes from the DESTINY-Lung01 trial where patients with HER2 overexpression were treated with trastuzumab deruxtecan. And we saw that if patients with stage IV non-small cell lung cancer had a HER2 IHC score of 3+, overall response rate was seen at 53% and median duration of response was 6.9 months and, therefore, that in our opinion qualified for updated recommendation. We are still waiting for additional results that will be released later on another clinical trial where we see preliminary data presented at the World Conference of Lung Cancer in 2024. They looked at 36 patients also with HER2 overexpression and saw the overall response rate of almost 45%. It is important to highlight in this smaller study that a majority of the patients in the study were actually having EGFR mutation and the response rate in those patients who had an EGFR mutation was higher than the response rate in patients without EGFR mutations who just had a HER2 overexpression. So for now this is updated in the guidelines, but we will wait for additional data or formal publication of a World Lung Conference presentation and see if those recommendations need to be changed. Brittany Harvey: Understood, and I appreciate you providing the context of some of those ongoing developments as well. So then what should clinicians know as they implement this updated recommendation? Dr. Lyudmila Bazhenova: Number one, we should all start from remembering to test for HER2 via immunohistochemistry. There is a slight difference in what considers HER2 positive in lung versus breast. In lung, we use what's called the gastric scoring and the difference is the circumferential versus non circumferential staining of the membrane. And number two, immunohistochemistry is not always included in next generation sequencing panels. So when you order your next generation sequencing, I think it's important to know if your company that you're using is testing for HER2 via immunohistochemistry. And if it's not, make sure that you find a company that does or work with your local pathology department to make sure that this testing is offered. It is also important to know the difference between HER2 overexpression and HER2 exon 20 insertion mutation even though the treatment for those two abnormalities is the same, which is trastuzumab deruxtecan. But the benefit that you can cite your patients and the rigor of the literature supporting the usage of trastuzumab deruxtecan in mutation versus overexpression is different. Brittany Harvey: Yes. And as you mentioned, it's essential that, in the first place, patients are actually receiving the testing so that we know if they're eligible for these treatment options. So what additionally does this change mean for patients with stage IV non-small cell lung cancer and HER2 overexpression? Dr. Lyudmila Bazhenova: So for patients, it adds another treatment modality which is now FDA approved. So if there are patients listening to me, make sure that your physician has tested your tumor for HER2 overexpression. So I think proactive asking of your physician would be very appropriate in this situation. Brittany Harvey: Absolutely. And then earlier you mentioned an ongoing trial that the panel was looking to for the future. But what other additional trials did the panel review during this guideline update and what is the panel examining for future updates to this living guideline? Dr. Lyudmila Bazhenova: So at this point we reviewed three additional studies. The results of those studies did not make it into a change in guidelines. So we reviewed the HARMONi-2 trial. HARMONi-2 trial so far does not have an official publication and, as per our strategy on how we come up with ASCO guidelines, we need to wait for an official publication. So this is one thing we're going to be expecting in the future. Once this is published, we will review it and decide if we need to make an additional change in recommendations. For those of you who are not aware, HARMONi-2 trial used bispecific monoclonal antibody against VEGF and PD-1 and was a phase III randomized trial comparing their investigational product which is called ivonescimab over pembrolizumab for patients with PD-L1 more than 50. And again, we are waiting for the final publication to make our recommendation. The second trial we reviewed was a LUNAR trial and the LUNAR trial looked at addition of tumor treating fields to chemotherapy or immunotherapy in patients whose cancer progressed with platinum doublet. The key point about this study is that immunotherapy was not required to be administered in a first line setting which is a current standard of care in the United States. And even though the study met their primary endpoint of overall survival, there were more benefits in patients who were immunotherapy naive in the second line. And we felt that given the potential lifestyle implication of wearing a device for 18 hours per day, and the lack of evidence in immunotherapy-pretreated population, and the absence of data in the first-line setting where we currently using immunotherapy in the United States, we felt that there is insufficient data to definitely recommend addition of tumor treating fields to systemic chemotherapy for most patients. And we are waiting for additional trials that are ongoing in this setting to formalize or change our recommendations. And we also reviewed- the final study that we reviewed was TROPION-Lung01. TROPION-Lung01 study was a phase III study in post platinum doublet setting which compared efficacy of Dato-DXd and docetaxel and trials showed improvement in progression free survival but not in overall survival. And progression free survival benefit was more pronounced in non-squamous carcinoma histology subgroup and we felt that the results do appear promising, but the strength of evidence which was based on unplanned subgroup analysis was not sufficient enough to make a change in treatment recommendation at this time. Brittany Harvey: I appreciate your transparency on why some of that data did not prompt a change to recommendations at this time. And additionally, we'll look forward to those future published results and potential incorporation of new data into future versions of this living guideline. So, I want to thank you so much for your work to rapidly and continuously update this guideline and for your time today, Dr. Bazhenova. Dr. Lyudmila Bazhenova: It is my pleasure. Thank you so much. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast. To read the full guideline, go to www.asco.org/living-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
Featuring perspectives from Dr Enriqueta Felip and Dr Helena Yu, including the following topics: Introduction (0:00) First-Line Treatment of Metastatic Disease (2:34) Adjuvant and Neoadjuvant Therapy (22:31) EGFR Exon 20 Insertion Mutations (34:21) Antibody-Drug Conjugates (42:45) CME information and select publications
Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks… Anne: Listen to your podcast everyday and I learned so many helpful health tips. Thank you. I have recently developed dry mouth at night while I'm sleeping. I drink a lot of water during the day and I have not started any new medication. What is the cause of dry mouth and what natural remedies would you suggest. Thank you Fred: Hi Dr Cabral My name is fred and have been listening to you for the last year I truly believe your are in this t help . I have recently purchased the vitamin. And heavy metal detox tests for my wife and myself I am 63 years old and unfortunately had h pylori and was on antibiotics for 2 weeks about 2 months ago I not sure the impact but it has seemed to have worked My concern is that I have a eGFR of 46 I have an enlarged liver I am a non drinker and starting to eat better I went off my statin and am on blood pressure medication I do not sleep well at all Hoping to afford to do the big 5 one day I am Canadian and our dollar is very bad What can I do to save my kidneys naturally Kristin: I've heard that Ashwaganda supplements are not good for those with Hashimotos. Is this accurate? I've also read and experienced so many benefits from it. Mandy: High creatinine level question. Hi, I greatly appreciate all the wonderful info that you and your team provide to those of us that want to live our best and healthy life!m Is there a causal relationship between menopause and an increase in creatinine? Recently had my labs done and my creatinine was 1.24, BUN 19, and GFR 54. Any advice and recommendations to bring my level down would be greatly appreciated. I'm an active 49 yr old. Thank you for your help. Mandy Mandy: Hi! Do you recommend mattress vacuums (specifically Jigoo, Jimmy, or Ranvoo)?Also, we just heard about the Apollo 2nd Generation Do you recommend it? Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes and Resources: StephenCabral.com/3292 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!
Pierre was born and lived in the UK until 1970, when he moved to Rio de Janeiro, Brazil, where he stayed for 15 years. He returned to the UK from 1985 to 1992, then moved back to São Paulo, Brazil, until 1998. In 1998, he relocated to Fort Lauderdale, USA, and became a US citizen in 2006. He is now retired and lives near Fort Lauderdale, Florida. Pierre's wife is Brazilian. They married in Rio in January 1972 and recently celebrated their 53rd anniversary. They have three sons: the oldest are identical twins (45), and the youngest is 41. His youngest son served in the US Army Reserve and later in the US Airborne. They have five grandchildren so far. Pierre developed psoriasis in his early twenties, which worsened over time. He also experienced minor intestinal issues that gradually became more severe, leading to serious inflammation and infections. In 1993, he was diagnosed with diverticulitis, which he assumes is linked to autoimmune disorders. In 1999, Pierre underwent a successful sigmoid colon resection in the USA for diverticulitis. Post-surgery, he was diagnosed with Type 2 Diabetes (T2D). For 19 years, he followed ADA guidelines under the care of an endocrinologist, but his T2D progressed to the point where he required insulin. At his peak, he was taking 240 units of insulin daily, which contributed to his weight reaching 280 lbs (he is 5'7”). In November 2018, after watching videos by Dr. Jason Fung, Pierre adopted a low-carb, healthy fats diet, primarily keto, with intermittent fasting (16:8). Last year, he transitioned to a 98% carnivore diet, eliminating most plants. The results have been remarkable. Over the years, Pierre has lost approximately 98 lbs (with about 20 lbs left to lose), improved his eGFR, stabilized his psoriasis, and reduced his medications from 7-9 to just two: 10 mg Lisinopril and insulin as needed. His Triglyceride/HDL ratio improved from 4.78 to under 1, with triglycerides dropping from 220 to under 75 and HDL rising from 46 to the high 90s. Recently, Pierre struggled to keep his A1c below 6% without 50 units of insulin daily, which caused weight gain. Determined to reduce his insulin dependency, he joined Revero and is now under the care of Dr. Jarrouge, who has been incredibly supportive. While he has successfully reversed some weight gain, it's clear that his pancreas has suffered over the years and can no longer produce sufficient insulin. As a result, he needs a baseline insulin dose to maintain an A1c of 6% or below. Timestamps: 00:00 Trailer and introduction 05:03 Keto and psoriasis 07:46 Keto after health scare 12:23 Health improvements post-hospital recovery 13:01 Stopping statins 16:08 Health issues and nutrition 22:20 Influenced by Ivor Cummins 22:54 Unexpectedly high calcium score concerns 26:38 Scan results 29:19 Improved mobility for life quality 33:28 Keto journey without doctor's guidance 38:07 Optimizing triglyceride-HDL ratio 42:00 Navigating healthcare with online support 43:01 Low carb-savvy physicians 47:42 Low carb for marathon stamina 49:21 Where to find Pierre Join Revero now to regain your health: https://revero.com/YT Revero.com is an online medical clinic for treating chronic diseases with this root-cause approach of nutrition therapy. You can get access to medical providers, personalized nutrition therapy, biomarker tracking, lab testing, ongoing clinical care, and daily coaching. You will also learn everything you need with educational videos, hundreds of recipes, and articles to make this easy for you. Join the Revero team (medical providers, etc): https://revero.com/jobs #Revero #ReveroHealth #shawnbaker #Carnivorediet #MeatHeals #AnimalBased #ZeroCarb #DietCoach #FatAdapted #Carnivore #sugarfree Disclaimer: The content on this channel is not medical advice. Please consult your healthcare provider.
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode998. In this episode, I’ll discuss why the NKF says its OK to use race-free eGFR to make renal dose adjustments. The post 998: Why the NKF Says Its OK to Use Race-Free eGFR to Make Renal Dose Adjustments appeared first on Pharmacy Joe.
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