Key urologists not much impressed by Keytruda results Dr. John Sfakianos on Twitter Bernie Bochner, MD @bbmdmsk ·
Dec 18, 2019 A step in the right direction but with appropriately cautious acceptance.
A substantial subset of these high risk pts WILL progress with time.
While 19% is encouraging it’s not overwhelming and longer follow up is needed. Key: markers of response to aid in pt selection.
Dr. John Sfakianos @DrJohnSfakianos Replying to
@bbmdmsk @UroDocAsh and 3 others This is only adding to the financial toxicity of treating bladder cancer... the most expensive cancer to treat. The smart way is to identify the markers then approve the treatment for specific patients. Money being invested in the wrong direction.
11:10 PM · Dec 18, 2019 from
Manhattan, NY·
Twitter for iPhone Ashish M. Kamat, MD, MBBS @UroDocAsh ·
Dec 19, 2019 Replying to
@DrJohnSfakianos @bbmdmsk and 3 others Maybe also stop robotic cystectomies from taking place under we find a marker to predict who actually benefits from it? Or which patients are harmed by it? Or both?
Dr. John Sfakianos @DrJohnSfakianos ·
Dec 19, 2019 You know and I know that is not a similar comparison and randomized trials completed and ongoing! 100’s of thousands of dollars for a 19% RR with ? Durability. How much of that money will he used to help identify bio markers?
Arjun Balar MD @ArjunBalarMD ·
Dec 19, 2019 To be fair, it’s only 100s of thousands of dollars if it works. Non-CRs came off study at 3 months and majority will not respond or will recur. The durable responses (~20%) will cost $, but at least those patients are benefiting.
JL Boormans @joostboormans ·
Jan 8 Could it be that a CR at 6 mo would have been more appropriate? Evaluate at 3 mo; if CIS persists, continue Pembro for 3 mo and then assess CR?
Arjun Balar MD @ArjunBalarMD ·
22h all patients underwent cystoscopy/urine cytology every three months, so yes, CR was again assessed at month 6, 9, 12... "treatment beyond persistence of CIS" was not permitted by the FDA, would have been interesting to see if delayed responses occurred.
JL Boormans @joostboormans ·
9h Some patients who participated at our site and had to come of trial at 3 mo because of persistent CIS did not proceed to radical surgery. With subsequent non-surgical treatment and even surveillance some are still disease free.
Arjun Balar MD @ArjunBalarMD ·
8h That’s fantastatic! The concept of delayed immune responses to CPI is widely accepted today - not so ~6+ years ago when this study was first designed. It was ahead of its time unfortunately.
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Andrea Necchi@AndreaNecchiWe are accumulating similar patients with MIBC who have refused RC in
#PURE01 and are disease free w pembro alone. Demonstrating that high risk NMIBC and early-stage MIBC are likely a unique disease state
@UroDocAsh @ewanagibb @MRoupret @PGrivasMDPhD1
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Dr. John Sfakianos @DrJohnSfakianos ·
8h We have similar situations with
@MattGalsky neoadjuvant chemo/ICI trial for MIBC. For high risk NMIBC what will the NNT for 1 anecdotal case as described? Worth complication rate? There are so many unknowns and approval clouds our ability to further study!
Gary Steinberg @garysteinbergmd ·
Dec 19, 2019 Replying to
@DrJohnSfakianos @bbmdmsk and 3 others This is true for all cancers. Immunotherapy is still in the early stages but clearly innovative and providing long term cures for some albeit not enough. Combinations and understanding TME are key. Progress is real
and not inexpensive @UroDocAsh @ArjunBalarMD #bladdercancer