Houda Bahig, MD PhD

March JTO Editor’s Choice: Zhu et al. Explore a new IASLC review tackling complex, locally advanced #NSCLC scenarios commonly discussed in multidisciplinary tumor boards, offering practical insights for real-world decision-making. Read now: bit.ly/4rPk5sT

🧵 Just published in @TheLancet: TORPEdO – the first phase 3 RCT designed specifically to test whether IMPT (proton beam) improves late function & QoL vs modern IMRT in oropharyngeal SCC. Short answer: It doesn’t. Long answer (with the numbers that matter) 👇

Adaptive radiotherapy involves modifying treatment plans to account for changes in anatomical geometry that are not adequately mitigated with changes in alignment. Online adaptive radiotherapy capitalizes on advances in image guidance, real-time tumor tracking, and the enhanced speed of multiple steps in radiotherapy planning and delivery workflows (seen in image). Learn more in the Review Article “Effects of Radiotherapy in Normal Tissue” by @DeborahCitrin, MD, and Robert D. Timmerman, MD (@BobTimmermanMD), from the National Cancer Institute and @UTSWMedCenter: nejm.org/doi/full/10.10…

@RuehleAlex @DineshMakuny @PMResearch_UHN @UofTDRO @DavidSherMD The VOCAL trial has completed accrual and we expect results by next year.

@DineshMakuny @PMResearch_UHN @UofTDRO Thank you for your thoughts. I kindly disagree. The advantage is the ability to reduce the dose to the contralateral carotid, inferior constrictor, and arytenoid cartilage. Randomized trials with whole larynx are ongoing, e.g.: pubmed.ncbi.nlm.nih.gov/41520731/ @DavidSherMD @HoudaBahig

🔥 Hot off the press: "Prognostic Value of Impaired Vocal Cord Mobility in T2N0 Glottic Cancer Treated With IMRT" ➡️In T2N0 glottic cancer, impaired vocal cord mobility is associated with worse LRF (aHR 3.7) and DFS (aHR 2.7) doi.org/10.1002/lary.7… @PMResearch_UHN @UofTDRO

This is a study about “linchpin surgeons” When present, patients with stage I NSCLC are more likely to receive MDT care, leading to less siloed decisions and higher SBRT use. When scarce, care defaults to “first stop wins,” and SBRT use declines—even when appropriate. @LorraineC_MD @BTongMD @hari_keshava @STS_CTsurgery @TomVargheseJr #radonc @QuadShotNews redjournal.org/article/S0360-…

Outstanding Canadian Lung Cancer Conference #CLCCO2026. Congratulations to Barbara Melosky and the whole society. An outstanding opening talk tackling key controversies by @BenjaminBesseMD and excellent overview of evolving radiation treatment in the era of IO by @SalmaJabbour1

What if we’ve been overdosing immunotherapy all along? In our Ph III DELII study, 20 mg nivolumab q2w beat chemo in OS, with less toxicity, better QoL. It's time to rethink ICI dosing-for science and equity! ascopubs.org/doi/10.1200/JC… @JCO_ASCO @OncoAlert @TataMemorial @SuyogCancer

Imagine 4 new anticancer drugs Pallituzumab, Geriatriximab, Symptomab, & Exercizumab hit the market. They should dominate the plenary sessions at ASCO & command billion-dollar revenue. But they don't because they're nonpharmacologic & shame on us. Read our opinion piece in @JCO_ASCO ascopubs.org/doi/full/10.12…

Seminars in Radiation Oncology @ElsevierConnect is pleased to share "Radiation Therapy for Benign Diseases and Premalignant Conditions" by Dr. Eng @WinshipAtEmory, Dr. Bahig @HoudaBahig..., & Dr. Roberge @mcgillu sciencedirect.com/science/articl…

@Jdcramer has made a critical point below about KEYNOTE-689. The EFS rules in KN-689 require careful review to interpret these results.  A protocol-specific event was determined by blind independent central review (BICR), but if growth in the pre-surgical CT was perceived to be a “flare” (i.e. potential progression), surgery was supposed to proceed unless unresectable (protocol quote below). In order to be considered an event, repeat imaging was required 4-8 weeks later, and obviously if the tumor was still resectable the patient would go to surgery before then. This definition means it was extremely difficult to have an event before surgery, even if the tumor grew and the surgery was more extensive than initially anticipated. Thus some patients may have been harmed by neoadjuvant treatment, but we would not see that in the event data. Thus there is this important disconnect: 82 patients in the pembro arm stopped the drug due to progression (by the investigator, as shown in the CONSORT diagram), even though there were only 69 progression events (by BICR, used for endpoint analyses). Is perioperative immunotherapy doing something favorable and important in a subset of these patients? Yes, and hopefully we can refine its use to the right population and with the right regimen (adding neoadjuvant chemo or RT?). Is it distinctly possible/probable that some patients are progressing on neoadjuvant pembro, leading to a worse outcome in some domain, but we cannot see that in these data? Yes, unfortunately, also true.

Excited to share our Phase 2 trial results in the @RedJournal, investigating the combination of SBRT and pembrolizumab for patients with recurrent, or metastatic HNSCC that was refractory to prior PD-1 inhibitor treatment. HNSCC patients progressing on PD-1 inhibitors have poor prognoses. While many systemic therapies are under investigation, our data suggests that comprehensive SBRT+pembrolizumab is an effective strategy for patients with oligoprogression. Key Findings with comprehensive SBRT+pembro to all progressing lesions (Cohort B): 3-Month PFS: 67% (median PFS 5.7 months) OS: Median OS was 10.1 months. Safety: The approach was feasible and safe, even in the re-irradiation setting. Results with comprehensive SBRT in Cohort B were more favorable to Cohort A where only a single lesion was irradiated+pembro. Consistent with other studies, we did not observe abscopal responses. Huge credit to Jonathan So for leading the correlative analyses. Higher baseline CD8+ central memory T cells were correlated with treatment benefit - a starting point for deeper analyses currently ongoing. Full article here: doi.org/10.1016/j.ijro… #HNSCC #RadOnc #Immunotherapy #SBRT Figure 2: Kaplan-Meier analysis demonstrating more favorable PFS and OS for Cohort B (blue, comprehensive SBRT).

Shocking! Only 1.4% of global cancer spend is used for surgical research and only 2.8% on radiotherapy research. Please help us learn how to cure more patients by funding curative therapies research! #radonc

This is unacceptable. We must make more noise about this and DO SOMETHING to demand a change. Do it for our patients who deserve to have more options than drugs that often don’t work for them.

Valuable data from this study by UPenn team! 👇👇 They reviewed the patterns of failure following chemo-RT (with or without Durva) for LA-NSCLC in their institution. They defined primary tumor failure (PTF) as failure inside the 90% isodose line. Recurrences were called on PET-CT; histological confirmation was not required. Isolated PTF rate was only 5.1%!! Synchronous PTF and regional failure rate was 3.7%. PTF + any synchronous distant/regional failure was 16%. @JeffBradleyMD @DrewMoghanaki @drdavidpalma @_ShankarSiva @jryckman3 @adib_elio @5_utr @PercyLeeMD @HoudaBahig @DoctorJSpicer @BrendonStilesMD @ElliotServaisMD redjournal.org/article/S0360-…

Relevant points here Indeed it seems premature to me to propose the routine use of HPV ctDNA if it does not alter management (de-escalating surveillance) or improve detection of relapses. This is what we test in the randomized SURVEILLE HPV trial (clinicaltrials.gov/study/NCT05582…)

@_ShankarSiva @drdavidpalma @DrAlexLouie @DrewMoghanaki @NormandBlais @CJTsaiMDPhD @jefilion @CRCHUM Hi Shankar! Among patients who clearly stated their reason for declining participation, none refused because they did not want the SABR arm. In fact it is almost invariably the opposite..

@HoudaBahig @drdavidpalma @DrAlexLouie @DrewMoghanaki @NormandBlais @CJTsaiMDPhD @jefilion @CRCHUM Hi Houda, sorry to hear this!!! Do you have info on how many % patients declined randomisation because they did not want the SABR arm?

The phase II randomized SUPPRESS-Lung trial evaluating SBRT for oligoprogressive NSCLC was closed today due to accrual challenges, before reaching its target. (NCT04405401) @drdavidpalma @DrAlexLouie @DrewMoghanaki @NormandBlais @_ShankarSiva @CJTsaiMDPhD @jefilion @CRCHUM

I’m sorry to hear this, great tweetorial below by @HoudaBahig - it is looking harder and harder to find equipoise for oligoprogression trials in #lungcancer when the treatment (SABR/SBRT) arm is available and seems so attractive to clinicians and patients….

Proud of @neildwallaceie and @PeterMacRadOnc + ☢️ @PeterMacCC Nuc Med teams for this innovative observational clinical trial investing 4D Ga68-V/Q PET for patients with #lungcancer having #radiotherapy #radonc. A great multidisciplinary publication➡️ shorturl.at/dlJnC😀

@DrewMoghanaki Good point! Perhaps they are too conservative but they did not favour a posteriori power calculation. For what is it worth, interim analysis for futility favoured continuing.. I think at this point, we just have to hope for a large enough effect size 🤞🤞

Have you discussed with your biostatistician how much power your study has at this point, given that accrual lasted 5 years instead of the planned 4 years? With 82% enrolled (53/65), you may already have the 80% power the study was originally designed for, depending on the number of actual events. If so, the study can report the results with sufficient power, making the reason for slow accrual irrelevant, unless there was an a priori plan to measure pre-randomization reasons for refusal (very rarely done). I think we can glean a reliable signal here. Can't wait to see the results of the comparison between treatment arms.