Chris Estes

The INSEMA authors write that omission of SLNB was must be weighed against potential benefit of RNI. If RNI was a requirement in those with 1-3 nodes, and the trial was properly powered, EBCTCG 2023 suggests the results may have been different.

From one perspective, INSEMA and SOUND are poorly designed and underpowered clinical trials for RNI. SOUND authors themselves write in the discussion that the trial was not powered to detect differences from adjuvant treatments.

@AppleHelix @JackWestMD Is the pad thai standard of care for treating cancer? Then yes the chef is supposed to change it Your tweet suggests that those who failed observation should be withheld osi so that the trial is powered

@JackWestMD @EstesRadonc The trial was not designed as a salvage trial to measure timing. And not powered as such either. No amount of amendments is going to change it to your ideal trial design. It's like ordering lasagna at a restaurant, then midway, ask if the chef can change it into pad thai

Osi first line approval came 4/18/2023. By that time, it was the unequivocal preferred first line treatment in the US for patients with advanced/relapsed EGFRm+ NSCLC per NCCN guidelines.

@JackWestMD @AppleHelix I'm rad onc so not totally familiar with the practice patterns at the time, but: The trial started 10/21/2015 Osi was approved by FDA 4/18/2018 Trial closed to enrollment 1/17/2020 39% in control arm with progression had osi Seems not too bad given the timeline?

@AppleHelix Thanks, that was a total error. But you will find that I was completely supportive of osi for relapsed/metastatic EGFRm+ NSCLC from the first presentation of ADAURA at ESMO 2017. You will see that I have expected OS only for curative setting.

@SyedMAhmedMDPhD @jryckman3 @SprakerMDPhD @RadoncTables @d_golden @emmacfields @radoncreview Not the first time I've been accused of being a machine Thanks for your comments. Edits have been made

ADAURA ⭐️ It’s one of the more simultaneously controversial and landmark studies to hit the tables in a while At rad onc tables we don’t like to be boring, so we’ve spilled the tea 🫖 in the commentary 👇🏻 Thanks to all on Twitter who have provided comments - many are cited

@BijoyTelivala There is no such thing as a “surrogate” endpoint. Not only that, PFS is a heterogeneous endpoint. “Surrogates” do not take into account toxicity or QOL either Correlation doesn’t equal causation, as much as pharmaceutical companies trying to save money would like it to.

Worthwide read for everyone taking care of pts. PFS many times doesnt equate to OS Time to stop using weak surrogate endpoints in trials Also time to stop using weak & not SOC comparitor arms #medtwitter #clinicaltrials #FDA

@gammaemitter @RadoncTables Where is this in the paper? I see that it says TBI was not related, and this post is meant for people to consider ISRT, not TBI

BMT and it’s chemo can increase the risk of secondary cancer More reason for ISRT for localized incomplete response or recurrent disease in lymphoma?

@Sushilberiwal @ParikhSimul

@Sushilberiwal @ParikhSimul Teamlabs in Tokyo is an absolute must

@gillies_mckenna The dopest hammers, ones that don’t cause gastric ulcers or kidney failure

@NRGonc wishlist 1) hyperfx RT with concurrent chemo vs conventional chemoRT for newly dx H&N 2) IMRT vs conventional for breast w or w/out RNI 3) low dose RT for osteoarthritis and other benign things 4) bolus vs no bolus subanalysis on post mastectomy protocols

@safaviaa @RadoncTables It's difficult to believe that these could be the final DFS outcomes with the length of f/u and that OS hasn't even been reported yet. Data cutoff too early There are differences between the settings of the trial and SINDAS for sure

@RadoncTables Hi @RadoncTables, the OS outcomes have not been reported yet, but we do have the DFS and CNS-DFS results

ADAURA Big increases in OS and DFS with osmertinib Stage II-IIIA 4-yr DFS 70% vs. 29% overall 2-yr DFS 73% vs. 38% Stage II-IIIA 4-yr CNS recurrence 8% vs. 14% overall 4-yr CNS recurrence 6% vs. 11% But... what happens long term? 1/3

@ParikhSimul I like the scope. You can see things that don’t show up on imaging. If ENT gives you their video that’s fine but photos only are often not adequate The prostate exam though can go away for rad onc

STRIDE (tremelimumab + durvalumab) Median OS 16.4 vs. 13.8 mos 3-yr OS 31% vs. 20% Median PFS not different Grade 3-4 events similar Checkmate 459 (nivolumab) Median OS 16.4 vs. 14.7 mos 2-yr OS 37% vs. 33% Median PFS 3.7 vs. 3.8 mos 3/3

RTOG 1112 Median OS 15.8 vs. 12.3 mos Median PFS 9.2 vs. 5.5 mos TTP also improved Grade 3+ toxicity not different KEYNOTE-240 (pembro) Median OS 13.9 vs. 10.6 mos Median PFS 3.0 vs. 2.8 mos Grade 3 events 53% vs. 46% 2/3

@tjroycemd I believe that there is a rule that when the title of an article is a question, the answer is always No

Opportunity for a radiation oncologist perspective

Are We Too Reliant on Radiation Therapy for Children with Hodgkin’s Lymphoma? | NEJM This weeks NEJM nejm.org/doi/full/10.10…

@VidalRadOnc @subatomicdoc @bvbal79 @ParikhSimul @Ozradonc @KoneruMd Yes next time! I’m gonna try to make it to the next ACRO

Over 85% of radiation oncologists in Europe offer radiation therapy for #osteoarthritis compared to 10% of providers in the United States. #radonc

@subatomicdoc @bvbal79 @ParikhSimul @Ozradonc @KoneruMd Also there are lots of cancer patients we already see that just happen to also have arthritis pain. Might try this out!

@bvbal79 @ParikhSimul @Ozradonc @KoneruMd Yes. More things to discuss coming, I suspect.

@subatomicdoc @ParikhSimul @SprakerMDPhD @drbeckta Susan G Komen? I found it very interesting that they sponsored TAILORX

@ParikhSimul @SprakerMDPhD @EstesRadonc @drbeckta Do tell! I have some ideas but if something exists that is great!