Medical Oncologist- Lung cancer, thymic & NUT carcinomas. Head of Clinical Research @GustaveRoussy, Head of Scientific Chairs Council @EORTC. Tweets are my own.
France
Joined January 2015
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KRAS inhibitors in NSCLC:
-G12Di: coming soon to meet a major unmet need — same activity in smokers vs never-smokers?
-G12Ci: expanding field, active in both naïve and post-sotorasib/adagrasib pts.
Excellent summary @GarridoLagunaMD #ESMO25
ALEX final OS:
- crizo arm dragged down by <50% getting next-gen ALK. Lack of crossover really hurts.
- 5-yr OS with alectinib ≈ 5-yr PFS with lorlatinib (CROWN), but only 18% got lorla post alect — we still don’t know the optimal sequence. #ESMO25
Is MET IHC predictive of amivantamab efficacy?
Chrysalis-2 in EGFRmut NSCLC post-osimertinib (biopsy at resistance).
Cohorts D&E: ami+lazertinib | Cohort F: ami monotherapy.
ORR higher with MET+, but also seen in MET–.
#WCLC25
Be ready to screen MTAP loss in all pts with advanced NSCLC, regardless of driver.
@mihaela_aldea shows incidence, highest in ALK/RET/EGFR/ROS1.
AMG193 paved the way at #ESMO24.
BMS-986504 confirms druggability: 29% ORR + many durable SD (slide @CharuAggarwalMD). #WCLC25
EGFR update
7 potential options:
•3rd gen TKI: osimertinib, lazertinib, aumolertinib
•Amivantamab
•Pemetrexed
•Carboplatin
•Ivonescimab
•Dato-DXd
OS data favor combos upfront—but real-world ≠ trial. In RWD, ~40% of newly diagnosed pts wouldn’t qualify for FLAURA2 #WCLC25
Up to 50% of patients with metastatic cancer develop lung metastases, linked to poor prognosis and impaired quality of life.
Our Nature Reviews Disease Primers article unpacks biology, diagnosis & treatment strategies. @LodovicaZullo @GustaveRoussy nature.com/articles/s41572-0…
Morning > Afternoon for IO?
Evidence is mounting—retrospective and now prospective (210 pts, randomized, PFS HR 0.42 but no PD-L1 strat).
Given IO’s long half-life, maybe only the timing of the first dose matters.
#ASCO2025
Debate on L1 for EGFR mut NSCLC : ‘easy osi’ then escalate to CT-ami, or use doublet upfront?
Lazertinib+amivantmab likely to extend OS by ~ 1 yr vs osimertinib, but without cross over to CT-ami.
Intensify only if ctEGFR not cleared after 4w of osi? #ELCC25
ICB or chemo-ICB in PD-L1≥50% advanced NSCLC? Metabolic tumor volume (tMTV) assessed by 18F FDG petscan can guide you.
High tMTV lesions might have a different biology and be better candidate to chemo-ICB. @FilippoDallOlio
aacrjournals.org/clincancerr…
NUT Carcinoma is an ultra-rare entity with a NUTM1 fusion, diagnosed by a simple IHC NUT+ (can look like a squamous lung cancer in a never smoker pt). Previously known as midline carcinoma, its prognosis is extremely poor. Lurbinectedin appears promising! annalsofoncology.org/article…
YES! De-escalation trials matter and should be much more supported by payers! Very preliminary results from the Dutch non inferiority trial DEDICATION-1 are reassuring. In France, the PULSE trial has the same hypothesis, opens soon in Belgium, Spain, Estonia and Greece! #ESMO24
Impressive benefit for Lenvatinib-Pembrolizumab in pts with thymic carcinoma and B3 thymoma. ORR 23.3% and mPFS 14.9m are unexpected in 2nd line or more.
Lenvatinib dose matters in a subgroup analysis. Congratulations @JordiRemon #ESMO24
Adjuvant Durvalumab after resection of stage IB~IIIA NSCLC does not improve DFS. No predictive effect of PD-L1 expression as in KN-091/PEARLS (adj pembro): Biology of micrometastatic disease differs from matched primary tumor? Confirms that neoadjuvant is the way to go. #ESMO24
1st phase III trial of an ADC vs docetaxel in a biomarker selected population
Tusamitamab Ravtansine targets CEACAM5, overexpressed in 25% of non sq NSCLC
CARMEN LC03 did not meet the primary endpoints PFS and OS.
#WCLC24
Stop pembro after 2 years?
In 43,359 pts that received up-front pembrolizumab for an advanced NSCLC, continuation beyond 2 years was not associated with better OS than a fixed 2-year treatment, HR = 0.97 [0.75–1.26] p = 0.95.
@arousseaumd
sciencedirect.com/science/ar…
Another promising B7H3 ADC in pts with Small Cell Lung Cancer. « SuperTopoi » payload. DAR=4.
Very early data.
No ILD.
Unconfirmed ORR 61.3%.
#ASCO24
LIFETIME osimertinib after a treatment with curative intent?
In pts with EGFRmut stage III NSCLC, chemo-radiotherapy can CURE pts.
Were pts in LAURA properly staged by petscan/brain RMI?
Why not using MRD to select patient?
Strong concerns when OS is not positive. #ASCO24
1st generation KRAS inhibitors: a piece of the puzzle is still missing. #ASCO24
Hope it will be enough to convince refractory HTAs to refund the drug! @KRASKickers
Lorlatinib PFS is impressive with an HR 0.19 over crizotinib.
But why after 5 yrs FU can’t we see the OS curves and the cross over rate? Even if the number of events is not reached, that would help us to select our first line treatment.
@ALKPositiveinc #ASCO24
Important and completely counter intuitive study !
The NGR-LU002 stydy shows that the irradiation of all sites (primary+mets) after induction chemo or chemo-IO does not increase survival compared to the standard maintenance treatment.
« Le mieux est l’ennemi du bien » #ASCO24
