Kuan-Wen Chen @ymouchtw

The outcomes with non-surgical treatment for stage III NSCLC pioneered by a Spanish group reported in Nature Communications. @_ShankarSiva @fcounago @SalmaJabbour1 @NitinOhri3

M.Provencio @MARIANOPROVENCI

6 months ago

nature.com/articles/s4146… PFS was 68.4% (95% CI, 51.1–80.7) at 12 months (*statistically significant* compared to null hypothesis of 55%) GECP SpanishLung Cáncer Group, Do it again for Christmas.

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2025 was a banner year for BC therapy across all subtypes. My take on the top practice changing trials: 1. DESTINY-Breast09 | ASCO 2025 1L HER2+ MBC: TDxD + P vs THP. Median PFS 40.7 vs 26.9 months; HR 0.56. Regimen FDA-approved. 2. lidERA | SABCS 2025 Adjuvant ER+ BC: Giredestrant vs standard ET. Improved iDFS, HR 0.70. 3. monarchE (OS update) | ESMO 2025 High-risk ER+ BC: Abema + ET vs ET improved OS; HR 0.84. 4. DESTINY-Breast05 | ESMO 2025 High-risk HER2+ BC with residual disease: TDxD vs T-DM1 improved iDFS. 5. NeoCARHP | ASCO 2025 Neoadjuvant HER2+ BC: Carbo-containing vs carbo-free chemo demonstrated noninferior pCR. 6. HER2CLIMB-05 | SABCS 2025 1L HER2+ MBC: Tucatinib + HP maintenance vs HP alone improved PFS 7. TROPION-Breast02 | ESMO 2025 1L PD-L1- mTNBC: Dato-DXd vs chemo improved OS (23.7 vs 18.7 mo, HR 0.79). 8. ASCENT-04 | ASCO 2025 1L PD-L1+ mTNBC: Saci + pembro vs chemo + pembro improved PFS. 9. ASCENT-03 | ESMO 2025 1L PD-L1- mTNBC: Saci vs chemo improved PFS. 10. VIKTORIA-1 | ESMO 2025 2L ER+ MBC, PIK3CA WT: Geda + palbo + fulv triplet and geda + fulv doublet vs fulv improved PFS. 11. SERENA-6 | ASCO 2025 1L ER+ MBC switch: ctDNA-detected ESR1 mut; switch to camizestrant + CDK4/6i improved PFS vs AI + CDK4/6i. 12. DESTINY-Breast11 | ESMO 2025 Neoadjuvant HER2+ BC: TDxD + THP vs ddAC/THP improved pCR. @theNCI @SusanGKomen @METAvivor @BreastCancerOrg @LivingBeyondBC @BCRF @PIK3CApathbreak @NBCCStopBC @Perlmutter_CC #bcsm

High-Dose Versus Standard-Dose Twice-Daily Thoracic Radiotherapy in SCLC: Final data: Median OS in the 60 Gy group was significantly longer (43.5 versus 22.5 mo) Same toxicity. jto.org/article/S1556-…

Among adolescents and young adults with #cancer, 9.5% of patients with earlier-stage cancer experienced metastatic recurrence within five years, with the highest rates in sarcoma (24.5%) and colorectal cancer (21.8%). ja.ma/3XjeUo8

🚀 KRAS: From “Undruggable” to the Hottest Target in Oncology 🔥🧬 KRAS is the most mutated oncogene in cancer - yet for decades it was “undruggable.” 2025 marks a turning point. A brand-new Signal Transduction & Targeted Therapy review lays out the ENTIRE evolution: • Why KRAS drives PDAC, CRC, NSCLC • Why G12C inhibitors work but only partly • Why resistance is inevitable • What the next wave of KRAS therapies looks like 🔑 Key takeaways: 🧩 KRAS mutations = ~30% of all cancers – PDAC: 80–90% – CRC: ~40% – NSCLC: ~20% (G12C dominant) 🧬 Approved “OFF-state” inhibitors: •Sotorasib •Adagrasib ➡️ ORR ~30–40%, PFS ~6 months. ➡️ Resistance? Guaranteed. 🔥 Major resistance mechanisms: – Secondary KRAS mutations (Y96D/S, G13D, A59…) – RTK pathway upregulation – EMT & squamous transformation – KRAS amplification – KEAP1/STK11/TP53 co-mutation biology 💡 The future = multi-modal KRAS targeting: – Pan-RAS inhibitors – G12D inhibitors (MRTX1133-like) – SOS1/SHP2 inhibitors combos – KRAS degraders (PROTACs) – KRAS vaccines & cell therapies – RNA & antisense therapeutics 🧠 The review beautifully shows KRAS as a signaling “master switch” with MAPK, PI3K, Ral, RAC1, Hippo/YAP-TAZ crosstalk explaining why single-agent inhibition fails. 🎯 Bottom line: KRAS is no longer undruggable - it’s just very hard to drug. The next breakthroughs will come from combos + pan-KRAS + epigenetic modulation + TME targeting. 🔖 Save this - it’s THE 2025 roadmap for KRAS-targeted therapy. 📖 Full paper cited below. #OncoTwitter #MedTwitter #LCSM #GIOnc #TargetedTherapy @myESMO @OncoAlert @ESMO_Open

Nice summary slide here for SBRT vs surgery for lung cancer

Shankar Siva @_ShankarSiva

7 months ago

@DrewMoghanaki shows us why more patients with early stage #lungcancer will have SABR over surgery -#SABR2025

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🧬 EGFR Resistance: The Next Frontier | Nat Rev Clin Oncol 2025 Even osimertinib can’t stop evolution- resistance always finds a way. ⚙️ Resistance Mechanisms 🔹 On-target → EGFR mutations (C797S, L718Q, G724S) break drug binding 🔹 Off-target → MET amp (7–15 %), HER2 amp (2–5 %), RTK fusions (3–5 %), BRAF/KRAS/PI3K mutations 🔹 Lineage transformation → SCLC (3–10 %) via RB1 + TP53 loss 🎯 Biomarker-guided Strategies 💊 4th-gen EGFR TKIs → BLU-945, BBT-176, silevertinib – aim at C797S mutants 🧩 EGFR–MET bispecifics → amivantamab ± lazertinib (💥 MARIPOSA-2: PFS ↑ to 8.3 mo vs 4.2 mo) ⚗️ EGFR + MET TKIs → savolitinib / tepotinib + osimertinib → ORR 50–60 % 🧫 ADCs → HER2 / MET / HER3-targeted conjugates giving durable benefit 🧪 Biomarker-unselected Options 🧬 TROP2-ADCs → datopotamab deruxtecan (ORR 41 %; PFS 6.8 mo) 🧬 HER3-ADC → patritumab deruxtecan (PFS ≈ 5.5 mo post-TKI) 💉 ICI + anti-VEGF + chemo → ORIENT-31 (PFS 7.2 mo vs 4.3 mo control) 🔍 From Radiological → Molecular Resistance 🧠 New paradigm: “Molecular resistance” detected via ctDNA before scans 🩸 Enables MRD tracking & earlier switch decisions → trials like APPLE, LOCAL, APPROACH exploring ctDNA-guided therapy 🚀 Future Outlook 🤖 AI + multi-omics + ctDNA → adaptive, personalized therapy sequencing 🎯 Goal: delay resistance, extend survival, and transform EGFR-mutant NSCLC from chronic → controllable disease 📖 Full paper in comment ⬇️ #OncoTwitter #LCSM #MedTwitter #LungCancer @OncoAlert @myesmo @esmo_open @NatureRevClinOnc

ESMO-ESTRO consensus on the safety of combining radiotherapy with ICIs, VEGFi, or multi-TKIs @Annals_Oncology In GI field (thorax, abdomen, or pelvis) ✅PD-(L)1: minor/no adaptation ✅CTLA-4: major adaptations with high-dose RT ✅VEGFi: major adaptations ✅TKI: major adaptations sciencedirect.com/science/articl… @OncoAlert @oncodaily

ASTRO 2025 Update: Radiation Therapy in Grade 4 Diffuse Gliomas 🧠⚡️ After max safe resection, RT remains the backbone for WHO grade 4 gliomas (IDH-mutant astrocytoma & IDH-WT GBM). 🔑 What’s new: 🧩 Integrates 2021 WHO molecular classification 💊 Recommends temozolomide + RT (standard) ⚡️ Tumor Treating Fields (TTF) now conditionally endorsed 👵 Frailty-based dosing: <70 yrs, KPS ≥ 60 → 60 Gy/30 fx + TMZ ≥70 yrs/frail → shorter RT course 🔁 Re-irradiation: Conditional for fit patients after MDT review ⚖️ Adds focus on health disparities & equitable trial access 🧠 “The field is shifting toward molecular nuance + individualized RT—not just age or KPS.” 📓Yeboa et al., Pract Radiat Oncol 2025 🔗 doi.org/10.1002/cncr.7… #OncoTwitter #RadOnc #NeuroOncology @ASTRO_org @myESMO @esmo_open @OncoAlert @asco

Patients on SUPREMO had median 14 lymph nodes removed, so PMRT adds little value for pT1-2N1 after ALND. If ALND not done for SLN+, PMRT still indicated since >30% have risk of additional LN+ per AMAROS & SENOMAC. ASCO guidelines summarize nicely: ascopubs.org/doi/10.1200/JC…

Dr Rishabh Jain @DrRishabhOnco

7 months ago

🚨 NEJM SUPREMO Trial (2025): Do all mastectomy pts need chest-wall RT? 🧐 👩‍🔬 1,607 women with intermediate-risk breast cancer (pT1N1, pT2N1, or pT3NO or stage pT2NO with a histologic grade 3 or LVSI) randomized to: 🟦 Chest-wall RT (40–50 Gy) vs 🟩 No RT 📊 10-yr Results: 💀

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🚨 NEJM SUPREMO Trial (2025): Do all mastectomy pts need chest-wall RT? 🧐 👩‍🔬 1,607 women with intermediate-risk breast cancer (pT1N1, pT2N1, or pT3NO or stage pT2NO with a histologic grade 3 or LVSI) randomized to: 🟦 Chest-wall RT (40–50 Gy) vs 🟩 No RT 📊 10-yr Results: 💀 OS: 81.4 % (RT) vs 81.9 % (No RT) → HR 1.04 🟰 NS 🧭 DFS: 76.2 % vs 75.5 % → NS 🧱 Chest-wall recurrence: 1.1 % vs 2.5 % (HR 0.45 ✅ ↓LRR) ⚡ Triple-negative: worse OS with RT (HR 1.9 ⚠️) 💬 Take-home: Modern systemic therapy = ultra-low local relapse 💊 👉 Omission of PMRT in intermediate-risk pts is now safe & rational ✅ 💡 Discuss this at your next Tumor Board! 🔖 Save + 📤 Share! 📚 Kunkler IH et al. N Engl J Med 2025 🔗 nejm.org/doi/full/10.10… #OncoTwitter #BreastCancer #RadiationOncology #MedTwitter @OncoAlert @myESMO @esmo_open @JCO_ASCO

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Dr. Nina Niu Sanford @NiuSanford

7 months ago

Great to see the updated BCLC guidelines include RT! RT now incorporated into most major guidelines for HCC (BCLC, AASLD, EASL, NCCN, others) & should be a standard of care option. Full link here: sciencedirect.com/science/articl… @OncoAlert

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The first results from the Phase III #RADCOMP trial @ASTRO_org — the first randomized trial of proton vs photon therapy for breast cancer. 📌 Focus: Health-related quality of life outcomes. 📍 Monday Sept 29| 1:30 PM PT | San Francisco Ballroom #BreastCancer #ProtonTherapy #RadOnc #ASTRO25

Sham-controlled RCT on LDRT for OA! That 42% reported pain improvement in sham arm emphasizes importance of conducting sham-controlled RCTs for interventions w symptom/pain endpoints – an uncontrolled RCT would have dramatically overstated efficacy (70% w 3Gy). #ASTRO25

Chemo or Not? RT Alone Holds Strong After Hysterectomy 🚨 @OncoAlert 🎯 316 pts, stage IB–IIA, randomized RT vs CRT (NRG/GOG-263) 📊 3y RFS: 88.5% (CRT) vs 85.4% (RT) → NS 📊 OS trend favoring CRT, but no significance ⚠️ Toxicity: 43% vs 15% (CRT ↑) ✅ RT alone highly effective, esp. with IMRT. 👉 Take-home: More toxicity, no clear survival gain. Precision selection needed See more in open.substack.com/pub/gusviani/p…

🤔 Is IMRT making cisplatin obsolete in early cervical cancer? 📖 Ann Oncol 2025 | Phase III | NRG/GOG-263 + KGOG1008 | n=340 (316 eligible) 👩‍🦰 Stage I–IIA, post radical hysterectomy + pelvic LND (Sedlis intermediate-risk) 🆚 Trial arms: 🔵 RT alone → 50.4 Gy/28 fx (3D-CRT/IMRT) 🟣 CRT → RT ➕ 💉 cisplatin 40 mg/m² weekly ×6 📊 Key results (median FU 76.5 mo): 📌 3-yr RFS: 85.4% (RT) vs 88.5% (CRT) → HR 0.70 (NS) 📌 OS: HR 0.59 (NS) ⚠️ Grade ≥3 AEs: 15.3% (RT) vs 🚨 42.9% (CRT) — neutropenia/leukopenia ❤️‍🩹 QoL: dip with CRT ➡️ recovery by ~36 wks 🔍 Exploratory: CRT favored with 3D-CRT, not with IMRT ✨ Takeaway: Cisplatin did not significantly improve RFS/OS ❌ but caused more toxicity 🚑. 👉 With modern IMRT, RT alone may be enough for many intermediate-risk pts. 🔖 Ryu SY, Deng W, Albuquerque K, et al. Ann Oncol. 2025. 🔗DOI: doi.org/10.1016/j.anno… #OncoTwitter #MedTwitter #CervicalCancer #GynOnc @OncoAlert @myesmo @asco @AnnOncology

Interested in learning about the application of RT in benign conditions? A new webinar will occur on Sept 17th, 4:30-5:30PM ET as a part of the ongoing RadOnc Educational Webinar Series. *CME event. Register here: ow.ly/lHk950WG4kZ Program info: ow.ly/psY950WG4kV

Who benefits most from chemoradiotherapy? PORTEC-3 delivers the decade-long answer 🔍 Adjuvant CRT vs RT in high-risk endometrial cancer 🦾 Arms • RT alone (48.6 Gy pelvic RT) • CRT = RT + Cisplatin → Carboplatin-Paclitaxel 📊 10-year Results • OS: 74.4% vs 67.3% → HR 0.73, p=0.032 • RFS: 72.8% vs 67.4% → HR 0.74, p=0.034 Biggest gain: p53-abn 🧬 (52.7% vs 36.6%) ⚠️ No CRT benefit in MMRd or POLEmut ✅ (~98% OS regardless) 🧬 NSMP (ER status matters) • ER+ → modest CRT benefit (better baseline prognosis) • ER– → poor prognosis ❌, CRT helps significantly 🔑 Takeaway CRT improves survival, strongest in p53-abn & stage III. Molecular classification is essential for tailoring adjuvant therapy. 📖 Post CCB, de Boer SM, Powell ME, et al. Lancet Oncol. 2025. 👉 doi.org/10.1016/S1470-… #OncoTwitter #MedTwitter #GynOnc #RadiationOncology @OncoAlert @myesmo @esmo_open @asco @TheLancetOncol

@ymouch Fake hacked ID; Don't be fooled

@ymouch This account has been hacked. Don't be fooled.