David Einstein

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David Einstein

David Einstein

@davidjeinstein

Disease Group Leader, GU Medical Oncology @BIDMChealth @DanaFarber_GU, Asst Prof @harvardmed, dad, cyclist, Far Side superfan

Massachusetts, USA Katılım Ocak 2015
687 Takip Edilen857 Takipçiler
Dr. Foxpaws Fauxpas
Dr. Foxpaws Fauxpas@foxpaws_onco·
Let's review taxanes in prostate cancers. Evidence for Weekly 25-30/m² - TAX327 2-weekly 50/m² - ARASAFE, PROSTY 3-weekly 75/m²- CHAARTED, STAMPEDE What's your choice? #gu #asco #gucsm #cancer #oncology
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Daniel E Spratt
Daniel E Spratt@DrSpratticus·
Agree. Current data like RADIOSA are important but do not clearly show adding ADT improves outcomes over MDT. It shows ADT lowers PSA. Need endpoints that show that earlier ADT for all helps more than later ADT. For too long the field has been duped that lowering PSA and delaying BCR and then getting a scan = patient benefit. Needs to provide benefit beyond what later ADT can provide.
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Ravi A Madan M.D.
Ravi A Madan M.D.@Dr_RaviMadan·
These data have implications for #SBRT “oligomet” therapy in #PSMA+ #BCR #ProstateCancer Data to add ADT/ARPI is scant yet claims of “synergy w/ADT +RT” abound These data further❓synergy-Need prospective data Need to justify ADT in pts who may not even require therapy #GU26
Daniel E Spratt@DrSpratticus

#GU26 This is the highest level of data on role of HT. Included 6057 patients with a median follow-up of 9·0 years -Adding HT to RT did not significantly improve OS w/ HR 0.87.

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David Einstein
David Einstein@davidjeinstein·
@Prof_IanD @SandhuShahneen Love it! Likewise, anyone advocating “shared decision-making” for a challenging decision should say exactly what phrases they use in clinic. Otherwise you’re yadda yaddaying over the best part!
GIF
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Ian Davis (Bluesky @profiand)
Wisdom at #GU26: * Mack Roach: sometimes people have bad outcomes even though you did the “right” thing. * Shang Zhao: we should not use the fact that some people will do badly to justify using the most aggressive approach. * @SandhuShahneen always consider patient preferences
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Andrea Apolo, M.D.
Andrea Apolo, M.D.@apolo_andrea·
KEYMAKER-04 Phase2 testing EVP alone and with anti-TIGIT or anti-LAG3 in 124pt with metastatic #BladderCancer showed no clinical benefit compared to EVP alone. Disappointing results. Dr. Van Der Heijden and team. Great study! @ASCO #GU26
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David Einstein
David Einstein@davidjeinstein·
Less is often more. Novel endpoints may help us better capture these tradeoffs.
Daniel E Spratt@DrSpratticus

#GU26 and #fengsymposium was a blast to see progress. Hoping it eventually moves away from San Fran 😁. Another red eye on the books back home. My observations from PCa sessions: - the field continues to push for over tx and many fail to recognize high risk dz is not high risk anymore for most patients. Enzarad negative, Rtog 0924 neg, ascend-RT neg for MFS/OS, peace2 neg. RT+ADT plenty for most. Many need even less. Select trials paving the way. - for mHSPC not all patients need doublet let alone triplet; age matters - continuous ADT can often be more harmful than helpful now with MDT -most BCR patients post RP do not need ADT—> get biomarker testing to help -many have jumped on bandwagon that OS too hard to improve and settling for early non-surrogate endpoints; peace3 should remind us it’s possible -sequential PARPi /Abi often just as good as combination -early germline/somatic testing for all high risk disease remains without data to support it; even testing in mHSPC unclear benefit as can give PARPi in mCRPC setting (earlier not better than later). -actinium RLT promising but toxicity remains concern -neoadj before RP remains largely ineffective, adds costs and toxicity and most still need postop tx.

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Sean McBride
Sean McBride@seanmmcbride·
Hard to say though. It might delay or it might prevent it entirely. If it simply delayed it for the duration of T suppression, you would expect those curves to quickly converge at perhaps 12 mos (for the scADT). But if anything, you see even greater separation at the tails (10-12 years!). So I don't think this is imply an artifact of a suppressed T....
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Sean McBride
Sean McBride@seanmmcbride·
Great work @DrSpratticus and @AmarUKishan ! For me, a clear MFS benefit for 6 mos ADT in the salvage setting is certainly worth recommending it for most patients. And that benefit looks to hold for PSAs >= 0.20. Although, the NRG data showing DECIPHER is predictive of MFS benefit in this setting is quite helpful for further triage. #GU26
Sean McBride tweet media
Daniel E Spratt@DrSpratticus

#GU26 @TheLancet Extremely proud to co-lead with @AmarUKishan and all investigators in MARCAP for helping make these exciting results possible. Presents POSEIDON assessing use of hormone therapy use and duration with post-op RT for recurrent PCa: An individual patient data meta-analysis of 6 trials thelancet.com/journals/lance… @ASCO

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Ravi A Madan M.D.
Ravi A Madan M.D.@Dr_RaviMadan·
#BRCAaway OS data presented by Dr. Maha Hussein #GU26 @asco Launched prior to large phase 3s in #ProstateCancer Cancer Provocative data but as Dr Hussein acknowledges small numbers in cross over (8 patients) limits ability to truly understand sequencing vs combo
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David Einstein
David Einstein@davidjeinstein·
@DriesDeveltere ICI (at least conventional targets) is indeed likely dead in unselected advanced prostate cancer. The interesting question is how TIL-H localized tumors are generating immune responses, and what’s allowing immunoevasion/survival. May have implications for novel IO.
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Ravi A Madan M.D.
Ravi A Madan M.D.@Dr_RaviMadan·
🔜@asco #GU26 PFS benefit less than I would have expected… “The median (95% CI) PFS was 14.7 (11.7–21.3) mos among pts in the concomitant ARPI cohort vs 12.5 (11.5–13.6) months in the no concomitant therapy. Ongoing follow-up… on long-term clinical outcomes, including OS.”
Ravi A Madan M.D. tweet mediaRavi A Madan M.D. tweet media
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David Einstein
David Einstein@davidjeinstein·
@Dr_RaviMadan @theNCI @ASCO @JCO_ASCO So many podcasts for the flight to #ASCOGU26! Here’s the companion @Uromigos on BCR and EMBARK:
Uromigos@Uromigos

Don’t miss the latest Uromigos podcast! 🎧 Episode 473 features @davidjeinstein discussing the EMBARK study, high-risk BCR prostate cancer, PSMA PET imaging, and MFS data informing clinical decision-making. Listen now! 🔗GuOncology Now: buff.ly/qoenIu7 🎧Apple Podcasts: buff.ly/oDJkhax 🎧 Spotify: buff.ly/Uwz1GHQ #Uromigos #GUOncology

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