@onc_ce on Twitter

1) Welcome to the next installment of our #accredited serialized #tweetorials from @onc_ce, your new (& only) home for the latest education from #experts on #cancer care. #Physicians #nurses #pharmacists #PAs and #NPs can all earn 0.5h CE/#CME by following this thread!

2) This one comes from @ASCO #GI22 and the #ASCOplenary. Our expert author is Dr. Alok Khorana (@aakonc) from @ClevelandClinic in Cleveland, OH. You'll find a prior program from him, still available for credit, at https://oncologytweetorials-ce.com/general1/.

3) This program on @onc_ce is supported by an educational grant from Bayer and content is intended for #healthcare providers. Faculty disclosures are listed at http://www.oncologytweetorials-ce.com/disclosures/. Earn credit from prior programs posted on http://www.oncologytweetorials-ce.com!

4) Now, on with the show! It’s early in 2022 but we already have significant updates for treatment of #GIcancers, thanks to new trial data from #GI22 and #ASCOplenary

5) Let's get ready to climb #HIMALAYA. We have new data on #tremelimumab, a fully human monoclonal antibody against CTLA-4. It is an immune checkpoint blocker.

6) And in this corner is #durvalulmab, another checkpoint inhibitor, is a human immunoglobulin G1 kappa monoclonal antibody that blocks the interaction of programmed cell death ligand 1 with the PD-1.

7) And then of course there's the standard #sorafenib, a tyrosine kinase inhibitor.

8) So . . . #HIMALAYA, presented by @GABOUALFA of @sloan_kettering to evaluate benefit of #tremelimumab x 1 dose + #durvalulmab q4 wks (T300+D) against the older SOC #sorafenib (and also against durva monotherapy) in hepatocellular cancer #HCC. Here’s the study design:

9) The primary objective was OS for T300+D vs sorafenib, which favored T300+D (16.4 m median OS vs 13.8 m)

10) OS was also a primary objective and showed similar improvement:

11) In addition, durva monotherapy was non-inferior to sorafenib

12) 36-month OS hit over 30%, which is really impressive in #HCC. Safety profiles were c/w usual immunotherapy toxicity. IMO this represents a competing standard of care with approved atezo/bev + maybe less risk of bleeding (but no head to head data). It's great to have options!

13) Given these data, what is your preference for first-line treatment of unresectable #HCC (average bleeding risk)?

14) New data for IO in #HCC bring up the issue of surrogate endpoints, investigated by Andrew Zhu et al @harvardmed, who found only medium correlation of ORR with OS, but high correlation of ORR with PFS

15) Young-onset colorectal cancer #CRC is getting increasing attention given rising cases and potentially worse outcomes, along with healthcare disparities as shown by @SKamath_MD et al @ClevelandClinic

16) New translational data presented by @ShimoliBarot of @ClevelandClinic at #GI22 shows microbiomic profiles are different in youngers vs older patients with #CRC. Much more work needs to be done here!


17) Treatment options for metastatic pancreatic cancer remain limited. What are some appropriate regimens for first-line treatment? Please mark your answer before you scroll⤵️!
a. EGFR inhibitor
b. FOLFIRINOX (5FU, irinotecan, oxaliplatin)
c. gemcitabine/nab-paclitaxel
d. b or c

18) d is the right answer. In patients where tolerance is questionable, single agent #gemcitabine could be considered but not single agent EGFR inhibitor (no data).

19)Targeted agents are sorely needed in this setting; post #GI22 at #ASCO22plenaries, new data➡️ efficacy of #sotorasib (a small molecule that specifically and irreversibly inhibits KRASG12C) in N=38 pretreated pts with #pancreaticcancer with KRAS G12C mutations

20) Hopefully this study will add to the otherwise meager targeted therapy options available for pts with pancreatic cancer. It's only February, so stay tuned for more exciting #GIOnc data to come out later this year!

21) And that’s it! You just earned 0.5h CE/#CME. Claim your certificate at https://oncologytweetorials-ce.com/ASCO_HCC_CRC & FOLLOW US for more #oncology #accredited #tweetorials for #physicians #pharmacists #nurses. I am @aakonc, signing out til next time!

Originally tweeted by @onc_ce (@onc_ce) on February 24, 2022.