🚀Excited to kick off ⁦OBR Oncology⁩ ‘Leading Thoughts in Lung Cancer’ Series with #lcsm friends Maya K. Khalil, MD Sandip Patel MD!

Ep.1: First-Line Treatment of EGFR+ mNSCLC

Thanks to our predecessors, H. Jack West, MD Charu Aggarwal, MD, MPH, FASCO Devika Das, MD, MSHQS! obroncology.com/leading-though…

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Useful slide for this discussion. K-RAS , B-RAF and MET ( smoking associated driver mutations) are 3 mutations in which one can use IO with some useful responses rates and PFS ESMO - Eur. Oncology

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Following Alina, Laura paradigm - either chemo xrt -> one of the ros agents or surgery -> targeted therapy +/- chemo
Very off label though..

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Santhosh Ambika History of smoking? I would hesitate to do IO here, if there is a site not too far away would consider Nautika classic.clinicaltrials.gov/ct2/show/NCT04… if that’s not feasible then some are extrapolating Alina to other rare mutational groups, not sure I am there yet so maybe induction chemo alone

Bijoy Telivala Oncology Brothers H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Agree with not doing IO here and agree with Patrick Forde if study available like Nautika would be great option clinicaltrials.gov/study/NCT04302…

Patrick Forde Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Good point .

76M T1bN2(paratracheal Ln)M0-StageIIIA adeno-Ros+ve
PDL1-0
PFT fine
neoadjuvant chemo+ I/O or surgery upfront
Maj of studies didnt report ROS but i worry about ? benefit + toxicity
Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Sir plz suggest, patient with Uterine corpus tumour with High Grade serous Histology. Figo Staging (2023) II C. Nodes negative, LVSI Focal, Serosa negative for tumour. Endo Cervical canal negative for tumour. Mymoterial invasion deep more then 50 percent. What next?

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Interesting case. I usually don't offer IO to patients with resectable tumors bearing an AGA in ROS1 or NTRK. They respond poorly to IO and it may compromise your opportunity to give TKI at PD. I prefer to give them neoadjuvant chemo followed by surgery, and close follow-up.

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Tbh chemo RT would be resonable IMO

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika After Radical open hysterectomy

Eric K. Singhi, MD OBR Oncology Maya K. Khalil, MD Sandip Patel MD H. Jack West, MD Devika Das, MD, MSHQS Fantastic group and congratulations!

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Would avoid IO here. At this age, there is a fair possibility of developing significant toxicities to neoadjuvant chemotherapy making him unfit for surgery.

Santhosh Ambika Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde PFT fine and talking to Pulm it is clealry resectable and pt also agreeable for surgery

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Neo adjuvant Ros1 inhibitors x 2-3 months and then surgery

Devika Das, MD, MSHQS OBR Oncology Maya K. Khalil, MD Sandip Patel MD H. Jack West, MD Charu Aggarwal, MD, MPH, FASCO Thanks so much! 😀

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika Thx for including me.
Pending more data in this setting, including role of ROS1 targeted therapy, I favor avoiding IO, but would consider neoadjuvant chemo (similar to what we used to do in pre-IO era) to cover possible micrometastatic Disease, and of course including the patient…

Eric K. Singhi, MD OBR Oncology Maya K. Khalil, MD Sandip Patel MD H. Jack West, MD Charu Aggarwal, MD, MPH, FASCO Devika Das, MD, MSHQS Amazing! Congratulations:))

Bijoy Telivala Oncology Brothers Sandip Patel MD H. Jack West, MD Rami Manochakian MD, FASCO 🇺🇸🇸🇾CancerEducation Devika Das, MD, MSHQS Patrick Forde Santhosh Ambika If we haven’t done molecular testing upfront then IO plus chemo would be the choice of everyone