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#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD 11/20 #TumorBoardTuesday 👨🏽‍🏫Mini Tweetorial 8👨🏽‍🏫 🦋 MARIPOSA2 compared Ami/chemo, Ami/chemo/Laz vs. chemo alone following progression on Osi 👉Ami/CP: mPFS 6.3 mo (HR 0.48), ORR 64% 👉Ami/CP/Laz: mPFS 8.3 mo (HR 0.44), ORR 63% 👉Chemo alone: mPFS 4.2 mo, ORR 36%

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD 12/20 #TumorBoardTuesday 👨🏽‍🏫Mini Tweetorial 9👨🏽‍🏫 ‼️ Can’t forget about the 🧠 🧪Ami/CP: CNS PFS 12.5 mo (HR 0.55)  🧪Ami/CP/Laz: 12.8 mo (HR 0.58)  🧪Chemo mono: 8.3 mo

Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Julia Rotow MD As combination strategies move to the frontline for our patients, how do we integrate the #MARIPOSA2 regimen in our practice? Balazs Halmos Oncology Brothers Jill Feldman

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD 13/20 #TumorBoardTuesday 👨🏽‍🏫Mini Tweetorial 10👨🏽‍🏫 ➡️Led to the approval of Ami+carbo+pemetrexed after progression in EGFRm NSCLC

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD 14/20 #TumorBoardTuesday 👨🏽‍🏫Mini Tweetorial 11👨🏽‍🏫 Can resistance mechanisms help us select 2L 💊? At #ASCO25, Raffaele Califano presented the efficacy of Ami-chemo by post-Osi resistance mechanisms 🔹 Most common= MET amp, secondary EGFR (C797X, L718X, etc) 🔆 Ami-chemo ⬆️ mPFS vs. chemo

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano 15/20 #TumorBoardTuesday 👨🏽‍🏫Mini Tweetorial 12👨🏽‍🏫 Let’s review Amivantamab AEs: ⬆️rate of infusion rxn (63%) ⬆️rate of derm toxicities (rash😳, paronychia💅 ) ⬆️time toxicity  BUT  🌟Subq Amivantamab can ⬇️ IRRs 5-fold (13% vs. 66%) &  ⬇️ <5 minutes  #PALOMA3 🌟#COCOON Ph2 trial

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano 16/20 #TumorBoardTuesday 👨🏽‍🏫Mini Tweetorial 13👨🏽‍🏫 At #ASCO25, Jill Feldman @EGFRresisters demonstrated derm ppx from COCOON⬆️ improving pt-reported outcomes: ⬇️severity of derm sx ⬇️ impact on QOL - Most pts in COCOON DM arm reported mild or no derm sx

Mike Pishvaian Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Julia Rotow MD Right?! But we do have some data from #PALOMA3 of subq/IV Ami + Laz after TKI and after chemo 👇🏽👇🏽

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters 17/20 #TumorBoardTuesday 👨🏽‍🏫Mini Tweetorial 14👨🏽‍🏫 WAIT there’s more: 💊 Ppx dex can help mitigate Ami IRRs #SKIPPirr ⬇️ IRR 22% vs 67%

Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters Fantastic presentation at #ASCO25 by Jill Feldman!!

Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Julia Rotow MD Raffaele Califano Super important slide to have in clinic if you are prescribing amivantamab plus lazertinib to patients!! Thanks for sharing Kelsey Pan, MD, MPH!!

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters 18/20 #TumorBoardTuesday Back to our case🔎 For our pt 👩🏻, s/p shared-decision making,  1L tx chosen is Ami/Laz per pt’s preference given various high risk features (🧠met, TP53🧬, +baseline ctDNA🩸) and promising OS benefit

Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters Jill Feldman educate us all please about INFORMED decision making AND SHARED decision making!

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters 19/20 #TumorBoardTuesday In summary…. ⭐️ Intensification strategies for metastatic EGFRm NSCLC beyond Osi monotherapy: ✅Osi + chemo: PFS benefit, including in all high risk features, OS data pending ✅Ami + laz: PFS benefit (all high risk features) + OS benefit!!

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters 20/20 #TumorBoardTuesday 👉BUT major differences in potential toxicities, infusion schedules; both may affect QOL ‼️ Shared & Informed decision-making with pt is key: molecular factors, disease factors, & PATIENT factors

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters #PostTest Q1️⃣ #TumorBoardTuesday 👉🏽#CME Eval 🔗 integrityce.com/TBTeval25 👉🏽ALL CME🔗 integrityce.com/TBT2025 Which strategy reduces derm toxicity with 1L ami + laz?

#TumorBoardTuesday Eric K. Singhi, MD Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters #PostTest Q2️⃣ #TumorBoardTuesday 👉🏽 Free CME 🔗integrityce.com/TBT2025 Patient with an EGFR L858R+ mNSCLC, s/p 14 months on Osimertinib ➡️Now w/ liver & CNS progression. Resistance testing: MET amp + EGFR C797S 🤔What is the best 2L therapy❓

Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Julia Rotow MD Raffaele Califano Jill Feldman EGFR Resisters So proud of you Kelsey Pan, MD, MPH!!!

Aakash Desai, MD, MPH, FASCO Eric K. Singhi, MD Mike Pishvaian Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Fawzi Abu Rous, MD Bruna Pellini, MD Isabel Preeshagul Arthi Sridhar Misty Dawn Shields Dr. Estela Rodriguez Great discussion on EGFR-mutated NSCLC—collaboration like this drives real progress. #TumorBoardTuesday

Misty Dawn Shields Eric K. Singhi, MD Aakash Desai, MD, MPH, FASCO Mike Pishvaian Kelsey Pan, MD, MPH #TumorBoardTuesday Integrity CE, LLC Fawzi Abu Rous, MD Bruna Pellini, MD Isabel Preeshagul Arthi Sridhar Dr. Estela Rodriguez Taylor Swift Ami- lazer= Long-term relationship! (Although a little rocky at times😉)