Balazs Halmos

Most ADAURAble long-term OS results of adj OSimertinib showing dramatic benefits! While we continue to be uncertain as to need for adjuvant chemo/ duration of adjuvant osi (3 yrs enough? Still with sustained and in fact widening OS benefits of a 15% or so additional patients alive at 8 years- Dr. Herbst/ADAURA and the AZ team do deserve a standing ovation to highlight the power of precision medicine which we all must bring to each of our patients! Roy-al results and presentation!

I will never forget Dr. Roy Herbst’s poignant comment on the (in)famous ADAURA DFS/OS debate: “If we keep waiting for OS, my patient might just die in the meantime”. The struggle between benefit for the individual vs risk/cost to society at large - where both sides of a debate can be so right but at the same time incorrect. Yes- obviously we only want treatments that in the end show OS benefit or if not then QOL benefit. But looking back over the last 25 yrs of onc- specifically thor onc, it seems early bets by our field founded on strong science and convincing early data aided by a highly competent FDA helped overall improve OS of an otherwise deadly disease tremendously. So somehow those early calls - like the 1st ALK TKI approval based on a phase 1(!!!) seem to have generally paid off. Coming back to Dr. Herbst- OS in the end WAS prolonged and in the meantime many individual lives WERE helped! So maybe the sweet truth to keep both the baby and the bathwater can sometimes be found in the middle.

I will keep it brief on this one With median PFS for lorla arm not reached at 7 years- the CROWN study deserves the Tony award! https://t.co/6daKiOWEtV

Looks like pCR was named after CROWN- the CROWN jewel of ALK TKIs and path responses alike! But as a real CROWN princess- while lorla is amazing it also requires some extra pampering! https://t.co/MHp0rURjte https://t.co/2hHXXURzX9

Dr. Heist provides a great breakdown of the MET biomarker/treatment landscape for pts w advanced EGFR mutated NSCLC In other words can EGFR/MET TKI combos complete a successful heist and break into our treatment guidelines? Looks like the answer is a resounding yes in 2nd line w multiple positive trials and a promising potential in 1st line based on the surprisingly positive results of the SANOVO trial Testing/rebiopsies/figuring out the right test/threshold will be key! #lcsm #ESMO26

Can we be Opti-mists about improving the outcome of the poorest prognosis subset of our patients w PD-L1 negative advanced NSCLC? Based on OptiTROP-Lung06 we should be! Sac-TMT/pembro sacked chemo/IO easily with much improved PFS, clear OS trends, better/different tox- only 5% discontinuation rate! (But note mucositis as common AE)

Starlatamab takes a huge BiTE today out of small cell lung cancer! Amazing PFS (0.34) and OS (0.42) HR and truly manageable added tox- 50% CRS but almost uniformly gr 1/2 and near non-existent ICANS, no new safety signal w durva combo just makes this one of the most impressive SCLC trials/ cancer trials ever.. Given extreme need for better treatments for our pts w ES-SCLC, unprecedented benefit seen in DeLLphi-305 plus availability/experience with use already it is a no-brainer to incorporate into our practice as SOC maintenance therapy on Monday… well, not Mon- whenever your flight takes you back post-#ESMO26 Amazing job by @sands_jacob and Amgen/DeLLphi team- glad we had a chance to offer such a transformational trial to our pts as well at Monte/Einstein! With these extraordinary results starlatamab is likely to continue to expand into 1st line/LS-SCLC settings and lets just dream on- if we as a field have taken such a tasty first BiTE, can hardly wait for the next one! Standing ovation- well deserved! #lcsm

REZILIENT-3: chemo/zipalertinib vs chemo for pts w EGFR Ex20ins+ advanced NSCLC Impressive PFS data presented elegantly by Dr Dan Tan w some early OS trends and very notable activity for pts w baseline CNS mets certainly highlights a welcome combo for our patients. AE data of some concern w sign heme/derm tox to note w close to 20% w zipalertinib dose discontinuations. Does zipalertinib zip up the first line space w such data? Not yet but offers a robust new choice for shared decision making/ individualization and sequencing We oncs should stay very rezilient for many more discussions on how to optimize treatment decisions!

Trust-uzumab deruxtecan delivers for pts w ErbB2 mutated NSCLC with a RR of 70% and median PFS of 14 months beating chemo/IO easily in DESTINY Lung04 BUT- no real trends for OS benefit and concerning rate of AEs- esp 20% risk of ILD are worrisome. With that and availability of very well tolerated and similarly active TKIs - for now the DESTINY of Tdxd appears to be in the 2nd line.. @JuliaRotow

A true Maverick trial asking can we avoid PCI in management of (both LS/ES) SCLC pts? While there are some shortcomings given redesigned trial/complex primary endpoint (cognitive failure free survival) Still- w improved CFFS and clearly no OS detriment w MRI surveillance- Conclusion must be: RIP- rest in PCI!