2a) I am Dr. Sandip Patel @PatelOncology, Professor in Medical Oncology from @UCSDCancer. @nicogirardcurie (to follow) and I will be covering Optimal Immuno-Oncologic Management of Extensive-Stage Small Cell Lung Cancer & Strategies to Develop Individualized Treatment Plans. pic.twitter.com/cj6tzIEclS
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
3) This program is supported by an educational grant from AstraZeneca and is intended for #healthcare providers. Statement of accreditation and faculty disclosures are at https://t.co/0EkFYk5rP5
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
5) After histologic confirmation of #SCLC, comprehensive staging is 🔑. This should include CNS imaging (ideally by #MRI if available), and at very least a #CT CAP. Consideration of #PET/CT or bone scan to confirm metastatic disease may be required pic.twitter.com/ZECNYW86d6
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
7) For patients w/ #ES_SCLC w/o brain metastases, MRI surveillance q 3 months is a reasonable standard of care. Prophylactic cranial irradiation for pts responding systemically to chemotx is not unreasonable, especially if patients are unable to undergo MRI brain surveillance.
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
9a) Systemic tx for #ES_SCLC has historically involved platinum-based chemotherapy, often #carboplatin due to tolerability in the incurable setting, with #etoposide.
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
10) #Atezolizumab was combined with #carboplatin and #etoposide in frontline #ES_SCLC in the #IMP133 study ➡️ 2 months improvement in median #OS compared to #chemotherapy alone. @LeoraHorn @StephenLiu pic.twitter.com/zbH77zar6e
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
12) #Durvalumab plus chemotherapy vs chemo alone was studied in #CASPIAN which showed a similar 2mo improvement in #OS
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
See https://t.co/EpTcJrSXbp pic.twitter.com/pt294oXJCi
14) Typically, either regimen is given as concurrent #chemoimmunotherapy for 4 cycles followed by maintenance anti-PD-L1 antibody (both atezo and durva have q4week dosing schema when given as monotherapy, and q3week with chemo)
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
16) The answer is D, #MRI brain to rule out #CNS #metastasis at baseline. #Chemoimmunotherapy in ES-SCLC can be given independent of PD-L1 and NGS and TMB status
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
18) The answer is C, MRI brain every 3 months. Prophylactic cranial irradiation is reasonable especially if #MRI surveillance not feasible pic.twitter.com/9C7uySIPcr
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
20) The answer is A or B. #Chemoimmunotherapy represents the standard of care for frontline #ES_SCLC! pic.twitter.com/E61dnQzkZf
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
22) The answer is A, #Cdiff testing, though #immune_colitis (below) remains high on the differential and is a diagnosis of exclusion. pic.twitter.com/oGohYcwvT8
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
24) The answer is D. #Loperamide is an adjunctive for use after confirmation of negative #Cdiff and management of underlying immune colitis with #prednisone. For steroid-refractory cases, or for patients in extremis, infliximab and vedolizumab are reasonable options
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
25) That's it! Soon on this same 🦇-station my colleague @nicogirardcurie will delve more deeply into clinical trial data on optimal #immune_oncologic tx for #ES_SCLC. For now, go grab your 🆓0.5hr CE/#CME at https://t.co/hqEQbEr3qO .
— pulmmed_ce (@Pulmmed_CE) February 1, 2023
I am @PatelOncology and I 🙏for joining! pic.twitter.com/5ejo30jefh