2) @Onc_ce and its companion website https://t.co/InvUb0xwNn are supported by educational grants from Astra Zeneca and Daiichi Sankyo and content is intended for #healthcare providers. Faculty disclosures are listed at https://t.co/L3Mqp0M536.
— @onc_ce (@onc_ce) January 11, 2022
4) So let’s start with a quick knowledge check. Immunotherapy is approved for all of the following except:
— @onc_ce (@onc_ce) January 11, 2022
a. 1st line metastatic PDL1+ TNBC
b. 1st line metastatic PDL1 neg TNBC
c. neoadjuvant PDL1+ TNBC
d. neoadjuvant PDL1 neg TNBC
Vote before you scroll down!
Let’s explore.
6) Let’s start with (I): we saw the update from KEYNOTE-522 #KN522 presented by Professor Schmid.
— @onc_ce (@onc_ce) January 11, 2022
* event free survival 76.8% chemo vs. 84.5% w/ chemo + pembro
* benefit consistent across ALL groups
* benefit regardless of nodal status
Remember this from #ESMO21? pic.twitter.com/BnJVEKLj5n
8) The magnitude of benefit was certainly larger for those without pCR – EFS: 56.8% vs. 67.4%, improvement >10%!!! Here’s Dr. Schmid himself discussing the data: https://t.co/Rdrf19WXjN via @onclive
— @onc_ce (@onc_ce) January 11, 2022
10) And what about adding anti-EGFR antibody in triple-negative IBC, modulating the TME to become more favorable for responding to immunotherapy. Dr. Maggie Wang ‘s presentation suggests this may be the first step to adding anti-EGFR to the KEYNOTE-522 regimen. pic.twitter.com/yebi6arhVK
— @onc_ce (@onc_ce) January 11, 2022
12a) This came from a meta-analysis of T+/-A chemo in early breast cancer at #SABCS21 by Jeremy Braybrooke of @UniofOxford: pic.twitter.com/XDN5JdOFyw
— @onc_ce (@onc_ce) January 11, 2022
13) Again – should everyone get triplet concurrent chemotherapy? Of course not! This is an individualized decision based on individual risk factors, age, comorbidities & patient preference. Important as always to tailor therapy! pic.twitter.com/CqVXFbAYrg
— @onc_ce (@onc_ce) January 11, 2022
15) In previous retrospective findings, #ctDNA detection was highly predictive for relapse in patients w #TNBC who have completed primary treatment. This is a prospective study to assess whether ctDNA assays can guide therapy for patients with early stage TNBC.
— @onc_ce (@onc_ce) January 11, 2022
16b) pic.twitter.com/5t6NXdbmxb
— @onc_ce (@onc_ce) January 11, 2022
18) Patients who were ctDNA+ were randomized to no tx/ standard f/u or intervention with #pembrolizumab q 3wks for 1y. The groups were powered to describe rates of ctDNA clearance, not comparison.
— @onc_ce (@onc_ce) January 11, 2022
20) 7 pts relapsed w/o prior ctDNA detection. Of 45 ctDNA+ pts in the tx protion, 14 were observed and only 32 received pembrolizumab. None of these patients exhibited ctDNA clearance after 6 months on pembrolizumab.
— @onc_ce (@onc_ce) January 11, 2022
22) So what happened? Looks like >25% had subclinical metastatic disease at trial entry. For these pts, the horse was out of the barn, so to speak, so very few were able to actually go on the pembrolizumab intervention.
— @onc_ce (@onc_ce) January 11, 2022
24) Which of the following is false about PDL-1 testing in #bcsm?
— @onc_ce (@onc_ce) January 11, 2022
a. There are multiple tests (22C3, SP142, etc.)
b. Pembrolizumab approval is based on 22C3 testing
c. CPS ≥10 is the PDL1 cut-off for 1st line mTNBC
d. 22C3 and SP142 are interchangeable & yield the same results.
26) Welcome back! You are just a few🖱️clicks away from 0.5hr CE/#CME as we look at highlights from #SABCS21. I am @ErikaHamilton9 and you have found your source for #oncology education by #tweetorial! See archived programs, available for credit, at https://t.co/InvUb0xwNn!
— @onc_ce (@onc_ce) January 12, 2022
28) The answer is d: 22C3 and SP142 are interchangeable and yield the same results. They are NOT interchangeable. Per @hoperugo there is some overlap between the testing, but a meaningful percentage of patients 22C3 & SP142 do NOT yield the same result, so . . .
— @onc_ce (@onc_ce) January 12, 2022
30a) So, as promised: #SABCS21 & #mbc: an update on KEYNOTE-355. This too was pembrolizumab but in 1st line metastatic setting & only for PDL1 positive. We already saw data; analysis by PDL1 expression level again confirmed the proper cutoff is CPS≥10. No benefit for CPS1-9. pic.twitter.com/g8AwM0qg7L
— @onc_ce (@onc_ce) January 12, 2022
31a) What else? New antibody drug conjugates (#ADCs)!#datoDXd is a Trop-2 target like sacituzumab but with the payload of #TDXd. With a median of 3 priors, the overall response rate (ORR) was 34% and disease control rate was 77%. pic.twitter.com/gStoz19Ivw
— @onc_ce (@onc_ce) January 12, 2022
32) So are ADCs the new hot class? YES – there are many ADCs being looked at for what we traditionally think of as #TNBC:
— @onc_ce (@onc_ce) January 12, 2022
– saci (currently approved)
– TDXd for HER-2 low
– Dato-DXd
– LIV-1
– HER-3 DXd
And more!@JAMouabbi @hoperugo @aftimosp @stolaney1 @smreddymd @DrLisaCarey
33) And so you made it! Free CE/#CME! Please go to https://t.co/Ad2zwGP1JR to claim your credit. And please FOLLOW US for #accredited #tweetorials. I am @ErikaHamilton9. Our next set of highlights will come from #ASCO GI, so stay tuned! pic.twitter.com/GB9pOFfy8P
— @onc_ce (@onc_ce) January 12, 2022