@bbcnickrobinson
As an oncologist, I know that a cancer diagnosis should be private if that is what the patient wants.
It doesn’t matter who you are.
This is unarguable.
Those who spread rumours and force the loss of that privacy should be ashamed of themselves.
👉 Things you learnt about in medical school but almost never see in practice
Here’s my offering from clinic today
No prizes for diagnosis
What’s your example?
Activity of ALK TKIs still stops me in my tracks after all these years. Astounding.
Before (L) and after (R) 3 month’s Alectinib
@ALKpositiveINT
@ALKLungCancer
[Images with patients permission]
Can’t claim responsibility for this, and thank you for person who sent it to me, but reckon this is the most useful
#ASCO23
list there is:
Free food available in Exhibition Hall:
DOACs and lung cancer TKIs:
I had no ideas that DDIs were so marked and ubiquitous.
Fantastic open-access review here from Dr Otten and colleagues:
I will be printing this out & sticking it on my clinic desk.
#LCSM
@BTOGORG
First patient on Sotorasib = first response to Sotorasib.
Seeing new drugs work in lung cancer is still the most exciting thing there is.
(3 months between scans. Images with patient’s permission)
#LCSM
And so it starts:
Acute Oncology inpatient list has gone from <1 page to 3 pages in past week.
Great majority COVID -ve.
Large number of Emergency Presentations of new cancer, as we suspected would happen.
Osimertinib use associated with nutritional deficiencies
❗️Significant deficiencies of Vit B, Vit D, Iron, Vit B12
❓May reflect GI side effects of drug
🤔 Should screen for these during Osimertinib treatment: quick and cheap to do
#ASCO24
#LCSM
Early Christmas present!
Appointed to
@IASLC
Multidisciplinary Clinical Science Committee.
Thank you IASLC.
Looking forward to working with colleagues to develop world-class education and to answer the major research questions we face.
👊👊
Who knew?
UK is best at palliative care (we knew, of course).
Palliative medicine an essential part of
#BTOG20
.
So pleased my colleagues Ruth Caulkin & Antonia Field-Smith are at their First BTOG.
‼️
Ivonescimab (PD-1/VEGF) + chemo post Osimertinib
✅ ⬆️ PFS
❓ ⬆️ OS benefit (immature)
✅ ⬆️ ORR
✅ ⬆️ DoR
✅ Minor additional tox vs. chemo
🤔 Impressive PFS benefit: same as MARIPOSA-2
🤔 None of Amivantamab toxicity issues
🤔 Big challenge to Ami 🤜🤜
#ASCO24
#LCSM
7th patient recruited to West London Genomics Medicine ctDNA pilot = first actionable 1L mutation.
👉 Report read by me this am.
👉 TKI lined up.
👉 Tissue NGS has only been requested today.
👍 This will cut 3-4 weeks off treatment timeline. 💥
One of the most intriguing findings in cancer immunotherapy.
I can’t explain why it happens, but we now have repeated studies finding the same thing, even when confounding factors (age, PS) taken into account.
Accumulative publications showing that immunotherapy is more potent when given early in the day. Time to change our practice and give our IOs in the morning? At least until evidence of a circadian biology supporting the hypothesis & availability of data from phase III trials?
Osimertinib + SABR in EGFR+
🔹 Osi x2m, SABR to all sites, cont Osi
👍 mPFS 32.3m
👍 mOS 45m
👍 mDuration on Osi 32.4m
👍 Low Gr3+ AE
❗️small numbers
❗️single arm study
❗️need details of SABR treatment
🤔 survival better than FLAURA
🤔 Pt selection key here
#ASCO24
#LCSM
Downloaded
@escardio
guidelines on cardio-oncology (great app)
✔️ Excellent flowchart on QTc intervals
❗️Keep K+ >4 and Mg >1.10 mmol/l
❗️<480msec is magic number ✅
❗️>500msec is scary number ❌
🙏 Great suggestion by Dr Alex Lyon
@RBandH
Weekly referrals to our
@ChelwestFT
Acute Diagnostic Oncology Clinic.
Very worried: referrals have stopped with COVID.
To our Primary Care friends: if you suspect cancer, please do not delay referral to appropriate clinic.
Cancer still happens, despite COVID.
@cwpluscharity
KEYNOTE-789: Pem/Carbo vs. Pembro/Pem/Carbo post-TKIs in EGFR+ve
👉 Non significant OS benefit
👉 Non significant PFS benefit
So if chemoIO preferred in this patient group, use IMPower150, not Pem/Pem/Carbo.
5yr outcomes of Checkmate-9LA
(gosh, how time flies)
Confirms better activity of dual immunotherapy in PD-L1 -ve population
22% 5yr OS is impressive in this poorer prognosis subgroup
Abstract 8560
#ASCO24
#LCSM
NICE approve IMpower150 (Atezolizumab, Carboplatin, Paclitaxel, Bevacizumab) in:
• 1L, nonsquamous, PD-L1 0-49%
• EGFR or ALK mutation post TKI failure (no mention of PD-L1 cut-off)
Good news for our patients. Post-EGFR and ALK indication especially interesting.
Well, it’s been a great day 1 of
#BTOG21
Delighted so many people registered, impressed with quality of talks, enjoyed Q&A sessions
But...
Should now be heading to the bar with friends and colleagues, not sitting at home doing my emails
Alison runs our fantastic
@macmillancancer
centre
@ChelwestFT
Our patients will miss her but we know
@NightingaleLDN
needs her more.
Not surprised Alison was amongst the first to volunteer: confirms the high esteem we all hold her in.
Induction complete, currently waiting for the rosta for the family communication and support team
@NightingaleLDN
#WhatATeam
Our Macmillan centre is being looked after by my amazing centre volunteers who are answering any voicemails
#Macmillan
#Proud
Ph3 trials during COVID with teleconsultations reinforces wastefulness of study requirements every cycle:
Full neuro exam: Why, if no symptoms?
Clotting: Why, if no Ph2 concerns?
6 weekly scans: Why so often?
Hope we learn from this and have better protocols in future.
In clinic, seeing new patients and teleconsultations for all others.
Every patient lovely.
Everyone so grateful.
Everyone telling me they will be clapping at 8pm.
And then free lunch box arrives, unrequested.
😊
2nd two slides that should be in every oncology clinic room this winter.
Answer:
✅ Yes: Get a flu vaccine if your GP is offering it.
❌ No: It won’t stop immunotherapy working and is highly unlikely to cause you any problems.
@BTOGORG
#ESMOAsia19
PD-L1 high (50-89%) and very high (90%+) in 1L immunotherapy for NSCLC
✅ Better survival with both Cemiplimab and Pembrolizumab if PD-L1 90%+
❗️Make sure your pathology report states exact PD-L1 figure, not just ‘>50%’ because details matter
#WCLC23
#LCSM
@BTOGORG
All set for
@BTOGORG
‘ASCO in an Hour’ webinar:
Laptop ✅
Headphones ✅
Cup of tea ✅
Kids banished upstairs ✅
Kick off in 30 mins
>450 delegates
Note to self: don’t muck it up
Exactly 1 year after we moved out, when our chemotherapy unit was converted into a COVID ward, we are back in the Gazzard Day Unit.
Our itinerant days are over. 🤗
✅ all patients offered COVID vaccine
✅ all staff vaccinated
✅ all staff weekly PCR tested
@ChelwestFT
#BTOG22
base all set up.
Huge luxury to be able to spend 48hrs educating myself with the good and the great of lung oncology.
Only thing missing is hangover from excess Guinness in Clayton bar from night before.
More good news, folks?
🙋♂️
NICE approve Larotrectinib for advanced NTRK fusion cancer (adult & paediatric) via Cancer Drugs Fund.
Challenge is now to get national testing in place and to find the patients.
@GenomicsEngland
@BTOGORG
This is great news, and not before time.
Although it may sound trivial, in fact loss of driving license and associated independence is one of greatest quality of life issues I see for patients with CNS metastases.
Sad to read that Prof Kenneth Bagshawe has died.
A true pioneer: He set up the first medical oncology unit in 🇬🇧, cured the first patient in Europe with choriocarcinoma, amongst many other achievements.
@ACPUK
Meeting
@acmedsci
this evening. Beautiful building and a great institution.
Wandered upstairs to find a suite named after my dear dad, who sadly died 12 years ago.
He would have been SO pleased!
Great to see
@BBCNews
picking up this important good news story for lung cancer patients in England
You can hear more about the pilot phase of this work at
@BTOGORG
conference next month
@DrSanjayPopat
Delighted to be representing
@BTOGORG
at joint
@Roy_Castle_Lung
and
@MSDintheUK
reception in the House of Commons, hosted by Nicola Richards MP
Focus on improving outcomes across the UK
Great art installation from
@cwpluscharity
in outpatient corridor
@ChelwestFT
Camera tracks your movement and imposes it on the graphics
Mesmerising
Almost made me late for clinic
🚨🚨 ADRIATIC: Durvalumab after cCRT in LS-SCLC
✅⬆️ OS HR 0.73
✅⬆️ PFS HR 0.76
✅ Small ⬆️ AE, but not Gr3+
❗️Total pneumonitis 38 v 30%
👉46% PCI
🤔 Practice changing 👏 👏 👏
🤔 Rare OS improvement in SCLC
🤔 AE data reassuring
🤔 Need access now in 🇬🇧
#ASCO24
#LCSM
Landing page for virtual
#BTOG2021
is the reception of the Clayton (aka Burlington) Hotel in Dublin.
😍
All kicks off at 9am tomorrow.
If I could just turn right, I would be in the bar.
👉 BiTE (bispecific T cell engager) in SCLC and other NETs: anti-DLL3 & CD3
👉 Welcome inclusion of LCNEC pts
🔺 53% Gr3-5 tox.
🔺 Cytokine release syndrome in 47% but mainly Gr 1-2
🔺ORR 26% in SCLC population
mDoR and mPFS not reached
#LCSM
#WCLC23
Clear benefits of liquid biopsy in lung cancer in keeping with what we would expect
Prospective real world data coming from ongoing
@NHSEngland
multi-centre pilot in 🇬🇧
For anyone who spends their time waiting for NGS results, this is a no-brainer
@DrSanjayPopat
Continuing immunotherapy beyond 2 years is not without risk
🚨50% develop late IRAE, post 2yrs
🚨60% of these had no pre-2yr IRAE
🚨Female, non-causcasian = higher risk
Abstract 8551
#ASCO24
#LCSM
Alex Lyon: Cardio-oncology
Last talk of BTOG, but have saved best till last:
🔴 Many of our drugs are cardiotoxic
🔴 Range of cardiac toxicites
🔴 Osimertinib important here
🔴 5% immunotherapy patients affected
#BTOG21
TRACERx continues to deliver fascinating results
🟡 Different growth rates of metastases according to site: pleura & soft tissue worst
🟡 Seeding subclone appearing on ctDNA prior to clinical relapse, and ultimately detected at autopsy
Superb 🇬🇧 research 👏
#LCSM
#ESMO23
(Self-isolation compliant) cycle ride with daughter.
Found that one of the great minds of 20th century lived just down the road in Hampton.
Died so young.
Treated so badly.
Pembrolizumab monotherapy gets additional EMA approval for a 6-weekly regimen (400mg). Should help with pressures on chemotherapy units, and be more convenient for patients. Data comes from modelling / simulation, as opposed to clinical studies.
Pembrolizumab fails where Durvalumab and Atezolizumab succeeded: no (statistically significant) improvement in OS in 1L ES-SCLC when added to platinum doublet chemotherapy.
#LCSM
@BTOGORG
DESTINY-Lung02:
T-DXd @ 5.4 vs. 6.4mg/kg
👉 ORR = 40% vs. 56%
👉 DoR = 16.8m vs. NE
👉 mPFS = 9.4m vs. 15.4m
👉 mOS = 19.5m vs. NE
👉 AEs favour 5.4mg/kg dose
👉 ILD = 12.9% vs. 28%
5.4 is recommended dose going forward
#LCSM
#WCLC23
Excellent discussion on NADIM II:
Interesting suggestion of superiority of carboplatin over cisplatin
Given toxicity of cisplatin and long chair-time, I would be very happy to shift to carboplatin
#LCSM
#ASCO22
@BTOGORG
FLAURA: Beyond headline OS data, other important findings relevant to countries struggling to get 1L Osimertinib funded:
🔶 30% of 1L EGFR TKI patients never receive any 2L treatment
🔶 40% of 1st generation EGFR TKI patients received 2L Osimertinib
#ESMO2019
#LCSM
From
@BTOGORG
Trainee Representative to fully-fledged plenary presenter:
@AdamJanuszewski
gives a beautifully clean and clear talk on controversies in NSCLC with driver mutations
#BTOG23
1 month wait for NGS results unacceptable, but all too familiar
I encourage colleagues to take advantage of
@NHSEngland
ctDNA pilot. This is greatly reducing wait times
Just received +ve MET Ex14 result for patient I am not due to meet until next week! 👊
New research confirms genomic testing is 🔑 to understand non-smokers with
#lungcancer
. Yet 40% of UK
#EGFR
+ pts faced delays in mutation ID & only 40% were offered rebiopsy on progression. 🚨 Patients need better testing to benefit from advances & get effective treatment!
#LCSM
@StephenVLiu
@JTOonline
Being a 3rd generation TKI, can’t help thinking they should have called it Aftertertinib, not Befotertinib.
(No need to thank me)
Fabulous presentation from Michelle Rosario, our lung cancer CNS
@ChelwestFT
Beautifully clear description of benefits & challenges of running
@NHSEngland
ctDNA pilot
Michelle has single handedly run this service: awesome 👏
#BTOG24
#LCSM