Lightnews — Scholar-powered news

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

Don't forget to complete the post-survey &
🏆 Claim #CME 👉bit.ly/muc_tw2_post

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

23/🔑SUMMARY🔑

2L & later line tx in mUC
👉Erdafitinib FDA-approved w/ FGFR3 alt after prior tx
🎉NCCN guidelines updated Jan 2025
🔬Ongoing trials for SG in diff clin scenarios
✔️T-DXd for HER2 IHC3+ (based on gastric cancer scoring algorithm)

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

21/Why TROPiCS4 neg for OS?
Hard to est, consider:
🔸Late-line,hvly pretx pop
🔸Ltd primary G-CSF prophy in SG arm(~20%)
🔸~5% pts randomized to control never rec’d tx(~2% in SG arm)
🚫biomarker selection(UGT1A1 gene polym→⬆️tox?)
🔸~20% in each arm rec'd salvage EV(confounding)

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

20/ @Uromigos thoroughly addressed of sacitizumab govitecan TROPiCS-04 findings presented at #ESMOAsia
🎧Worth a listen 👉 bit.ly/UromigosEp371
#OncSky

Episode 371: TROPICS-04 Results from ESMO Asia by The Uromigos

Jonathan Rosenberg joins Brian and Tom to discuss this important phase 3 trial and efficacy and toxicity signals.

bit.ly

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

19/TROPiCS-04
Ph3 RCT SG vs chemo in pretx mUC
🚫sig. improvmt in OS w/ SG compared to taxane or VIN

mOS: SG 10.3 vs chemo 9.0mo
(HR:0.86; 95% CI:0.73–1.02; p=0.087)
Grade ≥3️ TRAEs (SG): Neutropenia(35%; FN 12%), diarrhea (15%)
G5 AEs: SG 7% (16 inf w neutropenia), chemo 2%

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

18/🔬TROPHY-U-01 Cohort 3 trial safety of sacituzumab govitecan👇

TRAEs led to➡️
✋SG interruptions in 46%
⬇️SG dose reduction in 39%
🛑SG d/c in 15%
@markuseckstein3.bsky.social @amandanizammd.bsky.social #OncSky

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

17/#TROPHYU01 Cohorts 1,2,3👇
1️⃣=113 pts who progrs'd after plat chemo+ICI
✅Notable efficacy compared to hist cntls
Led to accel approval 2021

2️⃣=38 cisplatin-inelig pts s/p ICI tx
✅ORR=32%

3️⃣= 41 pts who progrs'd after plat chemo w 2L SG+pembro
✅ORR=41%
mPFS=5.3m
mOS=12.7m

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

16/Sacituzumab govitecan(SG) an ADC 🎯Trop-2
An active agent in mUC but failed to show stat. significant longer OS over taxane or vinflunine (VIN) in TROPiCS-04

✅FDA approval w/drawn~Oct 2024
👉Let’s look @ original approval & possible reasons for a negative P3 trial

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

15/🏁What about T-DXd in mUC?
1st tumor agnostic ADC w FDA approval for Tx-refractory HER2+ IHC3+ Cas

From DESTINY-PanTumor02
16 pts w/ HER2 IHC3+ mUC
56.3% ORR, mPFS 7.4mo, mOS 13.4mo
No significant neuropathy
🔑AEs: pneumonitis, neutropenia, N/V, left ventricular dysfunction

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

14/💡For phosphate of 8.0 mg/dL, withhold erdafitinib & restart once phosphate <5.5 mg/dL

🙌Erdafitinib=good option for pts w susceptible FGFR3 alt

⚖️What about pts who progress after 1L tx & no FGFR3 alt?
⚖️How does the changing 1L tx landscape w EV+P affect choice of 2L tx?

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

11/Erda. Safety
Grade ≥3 TRAEs occurred in 45.9% w erdafitinib & 46.4% w chemo

⚖️Most AEs w erdafitinib manageable w dose modification & best supportive care
🛑Tx d/c rates 8.1% w erdafitinib & 13.4% w chemo
#OncSky #BladderCancer

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

10/➡️Erdafitinib cont.
👍mOS and mPFS significantly ⬆️in erdafitinib group vs taxane or vinflunine

THOR1 trial efficacy results 👇
#OncSky @achoud72.bsky.social @pbarata95.bsky.social @crisbergerot.bsky.social @paulobergerot.bsky.social @alisonbirtle.bsky.social @laurabukavinamd.bsky.social

1 2 2

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

8/Even w pembro➡️24 mo PFS rate in KEYNOTE-045 was 12.4%👉Pts likely to need subsequent line tx

🧐NCCN guidelines RE: next tx?
Options (if not given prior):
🔶EV
🔶Erda for FGFR3 alt
🔶T-DXd for HER2 IHC 3+ (gastric Ca scoring)
🔶Saci(indication withdrawn, still in NCCN gdlns)

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

7/ IMvigor130 safety results 👇

🎯 Fewer AEs ➡️ withdrawal of any agent in atezo only group
🎯 Most common TRAEs mainly related to chemo
✓ Anemia
✓ Neutropenia
✓ Thrombocytopenia
#OncSky

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

6/Atezolizumab EMA approved as monotx
✓1L in cisplatin-ineligible + PD-L1 +ve
Based on IMvigor 210 & 130 trials

🔬IMvigor 130:
✅mPFS significantly longer in atezo+plat/Gem vs plat/Gem alone
🚫mOS not sign. longer in atezo grps vs plat/Gem alone
@oncobellmunt.bsky.social @sandysrimd.bsky.social

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

5/Other 2L options(depending on prior tx):
✔️Erda for FGFR3 alterations
✔️EV monotx
Taxane if no access to☝️

✔️Nivo or avelumab if no access to pembro + ICI naïve
✔️T-DXd for HER2 3+ IHC (gastric Ca scoring)
✔️Sacituzumab govitecan (FDA indication withdrawn)
@pcvblack.bsky.social #OncSky

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

4/Preferred 2L tx for cisplatin-ineligible pts after 1L ICI monoTx
✅EV or ➡️gem + carbo or ➡️erdafitinib (if FGFR alt+)

👉Pembro alone is one of2L tx options for pts who progress after 1L platinum-based chemo and have not received ICI
#OncSky

1 1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

3/Chemo-naive cisplatin eligible pts
👇Post-1L IO monotx👇
💡2L gem+cisplatin (or ddMVAC) pref'd
💡Erda for FGFR3 mut/fusion (THOR level 1 evidence for erda post-IO)

👉Cisplatin ineligible pts can get gem+carbo or EV (or erda if FGFR3+ alt)
#OncSky

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

2/ 📸👇COI & CME info👇
Full #CME ℹ️ bit.ly/muc_tw2
1️⃣ Answer Pre-survey 👉 bit.ly/muc_tw2_pre
2️⃣ Review #MedTweetorial👇
3️⃣ claim CME🏆bit.ly/muc_tw2_post

#MedTwitter #OncTwitter #gucsm #BladderCancer #MetastaticUrothelialCarcinoma #OncX #CommunityOncology

1 1

pgrivasmdphd.bsky.social @pgrivasmdphd.bsky.social · Apr 1

1/ Best practices for 2L+ tx #MetastaticUrothelialCarcinoma 🧵
w🌟 @tiansterzhangmd.bsky.social & me

...assuming EV+P 1L
✅FGFR3 alts: THOR/erda
🎯Trop-2: sacituzumab govitecan
🏁HER2 IHC 3+: T-DXd

Support by edu grants: Astellas, Gilead Sci, Merck, Seagen
#CME from @bonumce.bsky.social ℹ️👇

1 1 1

Reposted

Tian Zhang, MD @tiansterzhangmd.bsky.social · Jan 24

This GU oncology family — wonderful first #AUC3 consensus conference!
@drchoueiri.bsky.social @pgrivasmdphd.bsky.social @davidaggen.bsky.social

3 8

Reposted

Jame Abraham, MD, FACP @jameabraham.bsky.social · Jan 31

Expanded indication for TDXd!

The ASCO Post @ascopost.bsky.social · Jan 28

The FDA has approved trastuzumab deruxtecan (T-DXd) for patients with HR-positive, HER2-low, or HER2-ultralow metastatic breast cancer based on DESTINY-Breast06 trial results. #BreastCancer #Oncology ascopost.com/news/january...

2 6

Reposted

The OncoAlert Network 🚨 @oncoalert.bsky.social · Jan 1

Happy New Year from OncoAlert

@jrgralow.bsky.social
@elisabettabonzano.bsky.social
@stolaney1.bsky.social
@stoverlab.bsky.social
@pgrivasmdphd.bsky.social
@axelmerseburger.bsky.social
@drnataliagandur.bsky.social
@biagioricciutimd.bsky.social
@fernandoonco.bsky.social

1 2 6

Reposted

Tian Zhang, MD @tiansterzhangmd.bsky.social · Jan 23

Awesome panel moderated by #MontyPal #BradMcGregor for non clear cell #Kidneycancer. Histology matters! And so do molecular markers! #AUC3

@drchoueiri.bsky.social @pgrivasmdphd.bsky.social @davidaggen.bsky.social @erplimackmd.bsky.social

1 4

Reposted

Yüksel Ürün @yukselurun.bsky.social · Dec 9

Redefining first-line options for advanced urothelial carcinoma! Insights on platinum chemotherapy, immunotherapy combos, and patient-tailored strategies. @tiansterzhangmd.bsky.social @oncoalert.bsky.social @oncbrothers.bsky.social
#Oncology #BladderCancer

3 6