Miguel Gonzalez Velez, MD

@LauraAlderMD @ASCO I know treatment attrition is a limitation, but now we see more ES-SCLC patients going into 3rd-4th line (Chemo IO, Tarlatamab, Lurbinectidin, chemo/trial) with better performance status

Important findings‼️ The longer survival with chemoIO likely contributes to the higher brain met incidence (29% vs 23%): more time at risk. Highlights the necessity of MRI brain surveillance! 🧠 Excited for the upcoming @ASCO presentation of the DeLLphi-304 post hoc analysis on intracranial efficacy! With 45% of randomized pts having baseline brain mets, this will be the largest prospective dataset yet on tarlatamab's CNS activity in ES-SCLC Stay tuned 👀 Thanks to @Latinamd for highlighting!! @drshieldsmd #SCLC @DukeMets @JCOOP_ASCO

@NEJM nejm.org/doi/full/10.10…

Grand rounds this week: Howlader et al. @NEJM 2020. Conclusion 1: Lung cancer mortality is dropping faster than incidence. The 2013 inflection in mortality lines up with first-line EGFR approvals. Those were Phase 1 trials in 2005-2008. The patient enrolling on a Phase 1 trial today is bending the 2035 curve. #LCSM

@isabelzam95 @MateoAlzateAgu1 @NehemiasGuevar5

Its a great time to work on Thoracic oncology research. Lung Cancer constitutes ~30% of solid tumor research. @Larvol CLIN @brunolarvol #LungOncology #LungCancer #NSCLC #ThoracicOncology #Oncology

🚨 A new vulnerability in oncogene-driven #NSCLC? 🔗 doi.org/10.1016/j.anno… MTAP loss is more common than we thought — and may unlock a new therapeutic strategy. 🧬 Annals of Oncology (2026): 🔹 MTAP loss frequency: • ALK+: up to 45% • RET+: up to 35% • EGFR+: up to 29% 🔹 Present early (not just at resistance) 🔹 No impact on TKI efficacy alone 💥 But here’s the key: 🟣 PRMT5 inhibition shows activity across models 🟣 Combination (PRMT5 + TKI) > either alone 💡 Clinical implication: MTAP loss → potential actionable metabolic vulnerability, even beyond resistance #LungCancer #NSCLC #PrecisionOncology #TargetedTherapy #OncoTwitter @CharuAggarwalMD @HHorinouchi @ADesaiMD @diegoadiazg @LungCancerEu @lcrf_org @EuropeanLung

@StephenVLiu @JTOonline It reinforces the idea that IO might not be then answer for EGFR in any line. Different stories developing with other AGAs + IO +/-chemotherapy

More immunotherapy disappointment in EGFR mutant NSCLC. Results from ORCHARD cohort of durvalumab + chemo after 1L osimertinib @JTOonline showed RR only 16%, PFS only 4.8m. Better options would be amivantamab + chemo, osi + chemo, dato-DXd / ADCs. jtocrr.org/article/S2666-…

Anyone in the US regularly uses CEA as indirect response marker or ctDNA beat nonspecific markers. Study from Latin America. @BrunaPellini @lungoncdoc @Latinamd @mlema @ClinicalLung @diegoadiazg @oncodaily @NarjustFlorezMD @ogarrieta #PracticalOncology #LCSM

So timely. Great to have @FDAOncology approval for #zongertinib (Hernexeos) as first 1st line oral therapy for HER2+ #lungcancer. 🫁 ▶️Beamion LUNG-1 trial (Cohort 2), showing a 76% objective response rate (ORR) and a 64% duration of response (DOR) lasting 6+mos. 👉🏽how to use these her2 directed therapies in sequence is the next question❓#lcsm

@UOzkerim @OncoAlert @OncoReporte @MedwatchKate @LungCancerEu @IFCTlung @ManuelDomine I consider that the immunotherapy in ES-SCLC are almost equivalent. Now expecting that patients will get to 3-4 lines of treatment without major complications.

Atezolizumab vs Durvalumab in 1L ES-SCLC — real-world head-to-head data 234 pts | Multicenter cohort ▪ Median OS: 12.0 vs 12.1 mo ▪ Median PFS: 5.0 vs 5.1 mo ▪ Safety: Comparable ▪ QALYs: Identical @OncoAlert @OncoReporte @MedwatchKate @LungCancerEu @IFCTlung @ManuelDomine 👉lungcancerjournal.info/article/S0169-…

ORCHARD study. Now I assume EGFR patients will make it to 4+lines. Very manageable toxicity with DatoDXD. @myESMO

@YLeyfman @jstclair1 I am worried some tools might get deployed by administration to stamp AI with little or no input by clinicians seeing patients

👩‍⚕️👨‍⚕️ Clinicians deserve a seat at the AI table. AI is entering exam rooms, notes, inboxes, and decisions — often faster than guidance follows. We’re collecting real clinician experiences with AI in medicine: ✔ What actually works ✔ What doesn’t ✔ Where the risks are ⏱️ 5 minutes 🔒 Anonymous 🌍 All training levels & practice settings 📣 If you care about patient care, physician autonomy, and responsible AI — this is your moment to speak up. 👉 Take the survey: docs.google.com/forms/d/e/1FAI… 🤝 Share with colleagues — collective insight beats isolated opinion. #MedNewsWeek #PhysicianLeadership #AIethics #FutureOfCare #MedicineAndAI

@LauraJBook @EGFRResisters Is likely multifactorial. But yes longer survival and more treatment lines gets to resistant clones that transform at some point

SCLC transformation seems to be too prevalent in our @egfrresisters community! Is it because pts are living longer and having more lines of treatment?

@allisonoconn Keep going. It gets harder but more fun once you are an attending. Training~Like adding bricks to your wall. Attending~Like rearranging and changing the bricks. Students, residents, fellows, nurses, APPs and patients all help with unexpected questions.

Today I learned you can use bevacizumab (avastin, an anti-VEGF mab) to treat steroid-refractory radiation necrosis.

I tell all my mentees that they should learn at least 1 thing per day. Sometimes is one esoteric fact, one dose, one regimen, one adverse event, one ORR etc. The more "experience" you get the harder it gets. @ASCOTECAG @NehemiasGuevar5 @isabelzam95 @RManochakian @DocOncMD @Medical

@ramsedhom I always think this way for pharma. If patients have good systems, palliative care, excersise, symptom control, they will live longer and better. Meaning they will be on pharmacological treatments longer.

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…