Thomas Eliot Lew (@thomaseliotlew) 's Twitter Profile
Thomas Eliot Lew

@thomaseliotlew

Doc from Melbourne, Australia. Treats patients with blood cancers and researches new therapies. Loves family, immersive theatre and running.

ID: 1269538150075953153

calendar_today07-06-2020 07:54:24

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Kittai et al #ASH23 RWE for CD19 CART for RT (USA & Aus) N=69, genetically adverse, 84% VENorBTKi use for RT Mostly axi-cel 65%, 45% with concur BTKi mFU 24m, ?plateau around 25-30% PR - no durability TRM 27% - toxic!! Likely lots of unmeasured selection for pts to get here

Kittai et al #ASH23
RWE for CD19 CART for RT (USA & Aus)
N=69, genetically adverse, 84% VENorBTKi use for RT
Mostly axi-cel 65%, 45% with concur BTKi
mFU 24m, ?plateau around 25-30%
PR - no durability
TRM 27% - toxic!!
Likely lots of unmeasured selection for pts to get here
Thomas Eliot Lew (@thomaseliotlew) 's Twitter Profile Photo

Rutherford #ASH23 Pts ≥60 in S1826 (AVD + BV v Nivo in adv HL) Nivo: More neutropenia, hypoT & rash, less sepsis & neuropathy Lower NRM 4% v 14% Big EFS improvement (1y 93% v 64%) 1y OS 95% vs 83%, p =0.091 Slam dunk – more effective, better tolerated, new SoC for elderly cHL!

Rutherford #ASH23
Pts ≥60 in S1826 (AVD + BV v Nivo in adv HL)
Nivo:
More neutropenia, hypoT & rash, less sepsis & neuropathy
Lower NRM 4% v 14%
Big EFS improvement (1y 93% v 64%)
1y OS 95% vs 83%, p =0.091

Slam dunk – more effective, better tolerated, new SoC for elderly cHL!
Thomas Eliot Lew (@thomaseliotlew) 's Twitter Profile Photo

Nice (and huge) dataset Matches a few other series in this space Incorporation of CPI prior to auto for RR cHL seems to improve outcomes #ASH23 #lymsm

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Moskowitz #ASH23 Ruxo for RR T-LGL Seems highly effective in pts with STAT3 mut Correlative data suggest STAT3mut T cells drive ^ JAK/STAT in the myeloid compartment, and ruxo is acting here to improve disease. V interesting! Could be a nice option for some tricky cases…

Moskowitz #ASH23
Ruxo for RR T-LGL
Seems highly effective in pts with STAT3 mut
Correlative data suggest STAT3mut T cells drive ^ JAK/STAT in the myeloid compartment, and ruxo is acting here to improve disease. V interesting!

Could be a nice option for some tricky cases…
Thomas Eliot Lew (@thomaseliotlew) 's Twitter Profile Photo

Pretty impressive, particularly for BTKi/VEN exposed pts, for whom outcomes with 2nd target agent usually achieve mPFS ~24m and true time limited Rx uncommon Is the best place for doublets/triplets as next Rx after 1st targeted agent? May be better than doing this for everyone..

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Al-Sawaf #ASH23 P2 trial Tislelizumab + ZANU for ≤2L RT N=48 ORR/CRR 58.3% / 18.8% mPFS 10m/1yOS 75% Well tolerated Could bridge to allo Planned protocol amendment to add sonrotoclax coming Overall modest, but durable responses for some Now out in Nat Med! Baby steps for RT...

Al-Sawaf #ASH23
P2 trial Tislelizumab + ZANU for ≤2L RT
N=48
ORR/CRR 58.3% / 18.8%
mPFS 10m/1yOS 75%
Well tolerated
Could bridge to allo
Planned protocol amendment to add sonrotoclax coming
Overall modest, but durable responses for some
Now out in Nat Med!

Baby steps for RT...
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Feels like there is a subset of patients that benefit from the CPI+BTKi approach, but how do we identify them or, ideally, build on the regimen to do better? OS surprisingly good in this cohort despite modest efficacy... makes me wonder if this is a special/selected group

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Woyach #ASH23 P1 trial: LP-168, dual cov & non-cov BTKi Binds C481S & gatekeeper mut BTK N=37 CLL (21 C481S, 9 T474) Bleeding/bruising in 15-30%, all <G3 Infections in 62%, no AF ORR ~70% at ≥200mg/d (no CR), sim if T474mut RP2D 200-300mg/daily No data for L528W… one to watch!

Woyach #ASH23
P1 trial: LP-168, dual cov &amp; non-cov BTKi
Binds C481S &amp; gatekeeper mut BTK
N=37 CLL (21 C481S, 9 T474)
Bleeding/bruising in 15-30%, all &lt;G3
Infections in 62%, no AF
ORR ~70% at ≥200mg/d (no CR), sim if T474mut
RP2D 200-300mg/daily
No data for L528W… one to watch!
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Jasani #ASH23 P1 trial: ROR1-CD3 bispecific +/- IBR Short t1/2, admin via CADD 12 response eval pts Unclear how high risk they really were ORR 58% MRD-4 in 3 CLL/PET CMR 1 MCL CRS 54%, ICAN 15% (1 G3) Limited data, admin difficult, CRS & ICANS Still - deep remissions w/o BCL2i!

Jasani #ASH23
P1 trial: ROR1-CD3 bispecific +/- IBR
Short t1/2, admin via CADD
12 response eval pts
Unclear how high risk they really were
ORR 58%
MRD-4 in 3 CLL/PET CMR 1 MCL
CRS 54%, ICAN 15% (1 G3)

Limited data, admin difficult, CRS &amp; ICANS
Still - deep remissions w/o BCL2i!
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Hillmen #ASH23 FCR v MRD I+V 1L fit CLL (Rx 2x time to uMRD) I+V: Higher BM uMRD (62% v 40%) PFS & OS signif better (but driven by IGHVunmut) More tMN & TRM in FCR Lots of Qs: - Who really needs 1L doublet? IMO - not all - Fixed dur vs MRD driven? - Will re-Rx work? IMO - yes

Hillmen #ASH23
FCR v MRD I+V 1L fit CLL (Rx 2x time to uMRD)
I+V:
Higher BM uMRD (62% v 40%)
PFS &amp; OS signif better (but driven by IGHVunmut)
More tMN &amp; TRM in FCR

Lots of Qs:
- Who really needs 1L doublet? IMO - not all
- Fixed dur vs MRD driven?
- Will re-Rx work? IMO - yes
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And nice MRD data from Andy Rawstron Using I+V, BM uMRD-4 is confidently predicted by: PB uMRD -5 once PB uMRD-4 on two recordings 6 months apart #ASH23

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Kumar #ASH23 – impressive work BOVen (ZANU, Obin, VEN) for TP53mut MCL 1L N=25 Tox profile looks good - G3+ neutropenia 12%, G1 diarrhea common ORR 96% CRR 88% 2yPFS 72% 2yOS Frequent uMRD The best outcomes ever achieved in this high risk group

Kumar #ASH23 – impressive work
BOVen (ZANU, Obin, VEN) for TP53mut MCL 1L
N=25
Tox profile looks good - G3+ neutropenia 12%, G1 diarrhea common
ORR 96% CRR 88%
2yPFS 72% 2yOS
Frequent uMRD

The best outcomes ever achieved in this high risk group
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Ribrag #ASH23 MCL >60 or auto ineligible 1L Randomisation 1: RCHOP v RCHOP/RHAD – no PFS difference Randomisation 2: Len-R v R as maintenance – PFS better, no OS difference R2 definitely more toxic, infections & 2nd malignancies Seems clear to me – don’t add LEN to maintenance!

Ribrag #ASH23
MCL &gt;60 or auto ineligible 1L
Randomisation 1: RCHOP v RCHOP/RHAD – no PFS difference
Randomisation 2: Len-R v R as maintenance – PFS better, no OS difference
R2 definitely more toxic, infections &amp; 2nd malignancies

Seems clear to me – don’t add LEN to maintenance!
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Cohen BRUIN #ASH23 #lymsm PIRTO for MCL with prior BTKi N=152, high risk Median LOT=3 30/60 (50%) TP53mut ORR 49% CRR 16% mPFS <6 months, still poor in TP53 unmut group Bit of a contrast to CLL, PIRTO really quite disappointing in this setting IMO

Cohen BRUIN #ASH23 #lymsm 
PIRTO for MCL with prior BTKi
N=152, high risk
Median LOT=3
30/60 (50%) TP53mut
ORR 49% CRR 16%
mPFS &lt;6 months, still poor in TP53 unmut group

Bit of a contrast to CLL, PIRTO really quite disappointing in this setting IMO
Thomas Eliot Lew (@thomaseliotlew) 's Twitter Profile Photo

Nice data! We’ve observed similar results in our Australian cohort. VenR achieved responses in cBTKi-exp, but a mPFS of 26m. Worse if p53 abn. Rx free remission with VenR post cBTKi is uncommon, and outcomes are modest Very different from chemo only exp pts as in MURANO

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Great to see this in print! VenR is active in BTKi (and mostly chemo) exposed CLL, but most pts will develop PD during or shortly after 2y on VEN Time limited Rx a rarity in this context Appears comparable to PIRTO Lots of room for improvement here Eddie Cliff Dr Victor Lin