@Jdcramer
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Assistant Professor at Wayne State University. Head & Neck Oncologic Surgeon. Health services, quality improvement & outcomes researcher. All opinions my own.
Detroit, MI
Joined June 2009
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1/ Tomorrow (9/23) the FDA panel reviews GRAIL's Galleri MCED test, and for the first time the packet gives head and neck performance. Prior conference talks gave essentially none. In PATHFINDER 2, HNC was the single largest contributor to the stage I-II cancers Galleri caught
4/ Once you get to the actual screening data, HNC gets shaky. The FDA doc has it at 81.2% (13/16) in PATHFINDER 2 but only 42.9% (9/21) in NHS-Galleri. Those are tiny numbers and its retrospective analysis, and NHS-Galleri missed its primary endpoint. Hard to know what to trust.
5/ So where does that leave us? On biology and stage, HNC is one of the more compelling stories in the packet: often caught early, for a cancer we otherwise pick up symptomatically and late. Whether any of that saves lives is the question for the panel and future RCTs. #HNSCC
1/ The NIVOPOSTOP fight broke out: three critical letters plus the authors reply. Biggest issue for me. Investigator-assessed DFS positive (HR 0.76, 0.60–0.98), blinded central review negative (HR 0.89, 0.69–1.14). Are central reviewers the gold standard? thelancet.com/journals/lance…
2/ The authors rebuttal is the strongest part of the exchange in my opinion. Central reviewers masked to clinical and path data logged 32 misclassifications, often reading biopsy-proven relapse as flap or radiation fibrosis.
Neck FNA shows p16+ SCC. Exam and PET show an obvious oropharyngeal primary. Do you still biopsy the primary before treatment, or is EUA in every HNSCC just habit? #HNSCC
14%Always biopsy primary
86%No, node dx suffices
0%Only if atypical
0%Depends on site/SPT risk
7 votes • Final results John Cramer, MD retweeted
The bolus versus weekly cisplatin debate rages on, but fortunately more data dropped this past week with the publication of the ConCERT trial (Concurrent Chemotherapy and External Radiation Therapy) comparing bolus with weekly schedules.
Some thoughts on this trial and the cisplatin schedules below.
academic.oup.com/jnci/articl…
1/ ConCERT (phase 3, JNCI): weekly cisplatin 40 mg/m² non-inferior to 3-weekly 100 mg/m² in definitive CRT for LA-HNSCC. 2-yr LRC 61.3% vs 51.1%, less tox, fewer admissions. #HNSCC
academic.oup.com/jnci/advanc…
4/ People forget NRG-HN009 has already reported something. Its p16+ toxicity result didn't show weekly is gentler. T-scores basically identical, so that cohort didn't advance to phase 3.
Program directors were surveyed on which OHNS procedures a resident must be competent in at graduation, then those procedures were traced through the case logs of 1,480 graduates. Nearly half of the procedures PDs called essential were logged fewer than 10 times.
And two ACGME key indicators, rhinoplasty and ossiculoplasty, did not clear the PD consensus threshold for essential. Both remain stand-alone key indicators, logged more often than many procedures PDs actually call essential. Something is misaligned.
onlinelibrary.wiley.com/doi/…
John Cramer, MD retweeted
POD alert!!!! Latest effort with @DrNeilGross talking to us about his work in the NMSC space - it's a belter.
open.spotify.com/episode/3pA…
@VinPaleri @HNSurgeon @DrUppaluri @AriRosenbergMD @PBlanchardMD @drdavidpalma @DavidSherMD @oncodaily
1/ Three trials in the last month mark how fast head and neck oncology is becoming biomarker-directed, one in thyroid and two in salivary gland cancer. Notably, all three targets were validated first elsewhere: BRAF in melanoma, AR in prostate, HER2 in breast. #HNCSM
3/ SDC is both "prostate-like" (AR) and "breast-like" (HER2), and precision agents proven elsewhere are being imported into rare H&N histologies. Worth noting the shift is concentrated in thyroid and salivary; HNSCC still lacks actionable drivers.
doi.org/10.1016/S1470-2045(2…
