Clark Henegan

@DongNguyeb @DrSpratticus Agree that increasing sample size preserves statistical power, & it's a common strategy. However, my concern is clinical, not statistical. This is localized disease, not metastatic. We aren't preserving power in a Stage IV setting - some of these localized pts may never progress

No, that’s not enough evidence to make that question. In survival analysis, statistical power is driven primarily by the number of events accrued, not simply by the sample size alone. So what you are pointing out , that is they increase in sample size and longer follow-up , mainly suggests that the event rate was lower than what was planned, which is not unusual in cancer trials. The more relevant focus is how many MFS events were planned to preserve the study’s statistical power and detect the prespecified treatment effect, rather than focusing only on the larger sample size or extended study duration.

Will be curious to see how thorough your assessment is Declan or if it will be the generic cheerleading talk…hoping you bring your spicy side 😂: 1. What was original primary endpoint and did it change? 2. What is relevance of PET detected MFS as it is not a surrogate endpoint? Did the confidence intervals cross the surrogate threshold effect? 3. What were rates of adjuvant and salvage RT? 4. What were Erectile function rates at 1-2 years? (In earlier neoadj trials by that group 90% were impotent even after T recovery) 5. What is relevance in the now PET staged era for PET N0M0 patients. 6. With Enzarad being negative that means that if Proteus positive surgeons will need to give ADT+ ARPI + RP and likely high rates of SRT (quadruple therapy) as compared to to just RT and ADT… Looking forward to a great discussion. @declangmurphy @ASCO @ASCOPres @US_FDA

Behind every step forward in cancer care is a team working together with purpose. CCRI leaders met for a strategy retreat to map out the next phase of our NCI journey and what it means for Mississippi patients.

@nataliagandur @OncoAlert @APCCC_Lugano @Silke_Gillessen @AOmlin Again, if our patient w advanced prostate cancer has sexual health-related distress, management options include….??? - PDE5 inhibitors? - Tri-mix injections? - Vasoconstrictive penile rings? Open to suggestions for affordable options in resource-constrained settings. Thanks!

⭐ Supportive care & real-world decisions in mHSPC — what are we actually doing? @OncoAlert @APCCC_Lugano #APCCC26 @Silke_Gillessen @AOmlin 🔹 Key voting insights 👇 • Metformin ➕ ADT ➡️ Majority: ❌ NOT recommended routinely • Statins ➕ ADT ➡️ Similar pattern → ❌ no routine use without clear indication • Sexual health 🧠❤️ ➡️ 74% say we should ask patients ➡️ But only ~45% consistently do it in practice 🔹 The gap: What we know vs what we do 🔹 Take-home: • Avoid adding treatments without solid evidence • Address what truly matters to patients → including sexuality ➡️ Implementation still lags behind intention @declangmurphy @RenuEapen @DrYukselUrun @fabioturco92 @UrsulaVogl @SScagliarini @Tylersbrt @neerajaiims @amerseburger @Cdanicas @AarmstrongDuke @BertrandTOMBAL @ChrisSweens1 @EAntonarakis @KOSJ12 @VedangMurthy @DrRanaMcKay @LoebStacy @stefanofanti4 @mirrorsmed @profkhermann @dr_coops @piet_ost @_ShankarSiva @DrSpratticus @scocmem @AmandaNizamMD @tompowles1 @brian_rini @Uromigos @EUplatinum @EANM_NucMed @ESTRO_RT @Uroweb #ProstateCancer #UroOncology #Oncology

@5_utr Could we agree that imatinib is precision oncology’s greatest triumph?

ALK and EGFR aren’t precision oncology’s greatest triumph. They’re its most elegant demonstration of why it cannot work. Resistance isn’t a complication. It’s a mathematical certainty. Non-sparse redundant biology has no single points of failure. You were always going to lose 🧵

@nataliagandur @OncoAlert @APCCC_Lugano @Silke_Gillessen @AOmlin If we ask about sexual health, and this ends up being an area of distress for our patient and:or their partner, then we ….???

@katy_beckermann How tough was capivasertib? Based on these KM curves 27 patients in that arm may have been censored in the first 3 month and none in the control arm. Early censoring likely reflects toxicity @VPrasadMDMPH @Timothee_MD

ODAC voted 7-1-1 today in favor of capivasertib + abiraterone for PTEN-deficient mHSPC. The vote came despite a negative immature OS readout, which is the real story. CAPItello-281 (n=1012): 🎯 PTEN-deficient mHSPC, biomarker-selected 📈 rPFS 33.2 vs 25.7 mo, HR 0.81, P=0.034 ❓ OS HR 0.90, P=0.40 (immature, 26.4% maturity) ⚠️ Serious AEs 42.5% vs 26.0% Worth watching how the FDA responds and how they label the indication, including which companion PTEN assay is required. Adoption in clinic will hinge on testing access and proactive AE management as much as the label itself. 📄 bit.ly/4t677aw #ProstateCancer #mHSPC #GUonc #ODAC #FOAMonc

Mississippi ranks last in the US in cancer mortality rates. Black men in the Mississippi Delta have cancer mortality rates equal with the country of Mongolia (the worst cancer mortality rates in the world). @OleMiss is changing that.

@Uromigos In a study like this, when the investigators at the time of trial design declare a clinically significant primary outcome of PFS to be a HR of 0.7 and then the results come in with a HR of 0.81, are they asked if the results are not clinically significant?

Our ESMO podcast on CAPITELLO expressed doubt of the clinical benefit of capivasertib in PTEN positive prostate cancer ODAC today voted positively for the clinical data. I wonder if you agree? guoncologynow.com/podcast/episod…

@5_utr In short - I agree with your sentiment. Some of the first few entries into the “precision medicine” field - that predate the genomic sequencing era - set expectations that later entries have not met.

@5_utr The improvement in OS w adjuvant or concurrent (sorry - quite sloppy terms there) chemotx for colon, lung, breast ca, etc indicates there are patients cured w appropriately timed chemotx after/w definitive surgery or RT. But the chemotx would not work without the surgery or RT.

❗️ Hot take Friday: Precision oncology is the biggest narrative scam in cancer medicine. “Find the right gene and we’ll cure cancer.” We’ve been hearing this for 30 years. Meanwhile, surgery and radiation are still the only things that actually cure solid tumors. Let’s go 🧵

This week, CCRI researchers are in San Diego sharing their latest discoveries at the AACR Annual Meeting, one of the world’s leading cancer research conferences. Their work is shaping the future of cancer prevention, diagnosis and treatment. We’re proud of our team.

🌟 We’re grateful to the Magnolia Charitable Foundation for selecting the CCRI campaign as the beneficiary of this year’s Golf Tournament & Gala! The weekend brought guests from across the country and raised an incredible $100,000 in support of CCRI. 💙

Telehealth is a big part of continuity of care in predominantly rural states like ours I am at the hill to advocate for permanency of this much need modality in care delivery specially for patients and families with cancer ! Thank you to @ASCO #ASCOAdvocacySummit Specific ASK: Cosponsor the CONNECT for Health Act (H.R. 4206/S. 1261) • Unless Congress acts before the 2027 deadline, Medicare telehealth flexibilities granted during the public health emergency will expire, removing vital access for patients and providers. • The CONNECT for Health Act would make telehealth flexibilities permanent for Medicare,ensuring patients can access telehealth from home-regardless of whether they live in a rural or urban area!

Thank you, @ASCO for naming me an Advocacy Champion at the #ASCOAdvocacySummit. I am proud to advocate on issues like prior authorization reform,continued Telehealth and NCI/NIH funding. Looking forward to continuing my involvement next year!

@5_utr We’ll diasgree on Checkmate 214. At 9 years w up to 30% of patients w advanced RCC still alive with drugs alone, I would classify that as a cure. Bringing in toxicity now and not referring to proctitis, impotence etc w radiation or surgery in your original post seems unfair.

@ClarkHenegan "Drugs alone has not been proven as a cure." We agree. Checkmate-214 — you question the nephrectomy. Did you question the nivolumab? Grade 3-4 toxicity. Lifelong morbidity. Immune deaths. Skepticism applied selectively isn't science. It's bias.

Name a common solid tumor cured by drugs alone. I’ll wait. The oncology world is drunk on vaccines, pills, and infusions. Surgery and radiation are quietly doing the work nobody celebrates. The math is unambiguous. The narrative is embarrassing. Thread. 🧵

@5_utr So if you’re asking for decades of follow up in a common solid tumor that drugs alone cure - then the answer is no, drugs alone has not been proven as a cure. I am going to assume that you feel the nephrectomy was needed in all patients still alive & with NED in Checkmate-214.

@ClarkHenegan pCR is what a pathologist sees under a microscope at one point in time. Cure is what happens to the patient over a lifetime. Confusing the two isn't a counterargument, Clark It's the entire problem with how oncology thinks about local control.

@5_utr Is your interpretation that in NADINA, EV-903 and KEYNOTE-B15 surgery was needed in all the patients that had a path CR? If that is your take, I will not be able to name a solid tumor that drugs alone cure.

@ClarkHenegan Melanoma — the primary is surgically excised every single time. Immunotherapy gets the assist. Surgery scores the goal. Bladder — still waiting on that cure rate. Next.