M. Bolton @5_utr Twitter profile

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@ceokhalife

M. Bolton

@5_utr

7 months

Oh god another “data science influencer” claiming p-values are a measure of strength of the evidence against a null hypothesis, shoot me now 🙄

🔥 Matt Dancho (Business Science) 🔥

@mdancho84

7 months

Understanding P-Values is essential for improving regression models. In 2 minutes, learn what took me 2 years to figure out. 1. The p-value: A p-value, in statistics, is a measure used to assess the strength of the evidence against a null hypothesis. 2. Null Hypothesis (H0):

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M. Bolton

@5_utr

9 months

@JessicaTarlov @MeidasTouch Insane. George Carlin was right, they’re not pro-life, they’re ANTI-WOMAN

George Carlin-Pro-Life is Anti-Woman!

This video is downloaded for educational purposes to inform the public of Pro-Life and is pursuant to the Federal Fair Use Act for Educational Purposes Ony.

www.youtube.com

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M. Bolton

@5_utr

11 months

Prophylactic RT Versus SOC for High-Risk Asymptomatic Bone Metastases Multicenter, Randomized Phase II Clinical Trial N=78, 122 high risk asymptomatic bone mets 1:1 SOC vs SOC + RT ⬇️ SRE ⬇️ admissions ⬆️ OS HR 0.49 (0.27 to 0.89) P = .018 🤩

Prophylactic Radiation Therapy Versus Standard of Care for Patients With High-Risk Asymptomatic...

In a multicenter RCT (n = 78), radiation to high-risk asymptomatic bone metastases ⬇ skeletal-related events and prolonged OS.

ascopubs.org

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M. Bolton

@5_utr

3 months

Rarely have I seen an article miss the mark this badly 🤯 Misguided calls for more “real world” observational evidence should be replaced by calls for more efficient RCTs; patients and society deserve inference based on RCTs, nothing less

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M. Bolton

@5_utr

2 years

TRENDY: RCT of TACE vs. SBRT for HCC 👉 HCC, Child-Pugh grade A, one to three tumors, cumulative diameter ≤ 6cm, and ≥ 18 years old. 2 year LC 2x better with SBRT 🤩 😮 #radonc h/t @loladelamata

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M. Bolton

@5_utr

1 year

‼️ Whole Breast Irradiation in Comparison to Endocrine Therapy in Early Stage Breast Cancer-A Direct and Network Meta-Analysis of Published Randomized Trials Local recurrence in BCS + WBI vs. BCS + ET group (HR = 0.62; CI-95%: 0.42-0.92; p = 0.019) 1/n

Whole Breast Irradiation in Comparison to Endocrine Therapy in Early Stage Breast Cancer-A Direct...

Evidence from direct and indirect comparison suggests that BCS + WBI might be an equivalent de-escalation strategy to BCS + ET in low-risk breast cancer. Adverse events and quality of life measures...

pubmed.ncbi.nlm.nih.gov

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M. Bolton

@5_utr

1 year

❗️ SBRT vs conventional palliative RT for bone Mets, meta-analysis of RCTs SBRT associated with >3 odds of being pain free at 3 months and 6 months 🤩 NCCN guidelines need to be revised to reflect this #radonc

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M. Bolton

@5_utr

3 years

@palmd @AmesCG And now the CDC allowing us to be forced to work SICK

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M. Bolton

@5_utr

1 year

Fascinating work - some of the most interesting I’ve read in months Natural variation and evolution reign supreme. Why ‘targeted’ therapies fail and always will be doomed to fail, local tx like surgery and #radonc is 🔑

Diverse clonal fates emerge upon drug treatment of homogeneous cancer cells

Nature - Anti-cancer treatment often results in a subset of the clonal cell population developing resistance to therapy, with resistant cells displaying a diversity of fate types resulting from the...

www.nature.com

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M. Bolton

@5_utr

6 months

@CBSNews Will be fun to see affirmation of Trump’s status as a rapist upheld all over the news

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M. Bolton

@5_utr

25 days

@ArtCandee I think pee tape coming soon

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M. Bolton

@5_utr

3 months

🚨 TACE + TKIs +/- SBRT OS (17.93 vs. 9.61 months, HR=1.869 [95%CI, 1.059-3.266], P=0.017) Survival benefit with SBRT #asco2024

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M. Bolton

@5_utr

4 months

‼️ ORATOR T1-2N0-2 p16+ SCC OPX Randomized to: 60 Gy (+cis if N+) vs TORS + neck dissection 2-year OS 100% RT vs 90% TORS, p=0.041 Primary RT #radonc approach to de-escalation 💪

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M. Bolton

@5_utr

1 year

Friday night 🍺 after a very busy week of clinic, and wondering - why don’t we use Cox-Kalbfleisch-Prentice plots much more often and K-M rarely? These are more relevant and useful! 🤔 HT @f2harrell #rms

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M. Bolton

@5_utr

8 months

Precision Medicine: Too Big to Fail? Excellent read; the money spent on this would be much better spent on prevention, screening, surgery, radiation

Precision Medicine: Too Big to Fail?

sites.tufts.edu

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M. Bolton

@5_utr

7 months

@jonatanpallesen P-values are purely probabilities about data, they not probabilities about a hypothesis or about the effect of a variable

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M. Bolton

@5_utr

8 months

The most ridiculous figure in recent memory, and a damning statement about the state of science

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M. Bolton

@5_utr

5 months

Reading this, I am more convinced than ever that “personalized medicine” is based largely on false assumptions, and Biomarkers ™ are really Personalized Capitalism more than anything else

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M. Bolton

@5_utr

4 months

This reminds me of the @NEJM work randomizing early palliative care vs continued systemic therapy, palliative care conferred survival benefit

Yüksel Ürün

@DrYukselUrun

4 months

Does oncologic treatment for very advanced disease improve survival? 1⃣The study analyzed 78,446 adult patients with six common metastatic solid tumors. It found no significant survival benefit for patients receiving more systemic therapy for very advanced cancer. 2⃣There was no

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M. Bolton

@5_utr

1 year

‼️ ARTO Oligomet CRPC (up to 3 non-visceral metastatic lesions) -> 1:1 AAP alone vs AAP + SBRT to all the sites of disease HR for progression of 0.35 (95% CI, 0.21 to 0.57; P < .001) 🤩

Stereotactic Body Radiation Therapy and Abiraterone Acetate for Patients Affected by Oligometasta...

PURPOSE ARTO (ClinicalTrials.gov identifier: NCT03449719) is a multicenter, phase II randomized clinical trial testing the benefit of adding stereotactic body radiation therapy (SBRT) to abiraterone...

ascopubs.org

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M. Bolton

@5_utr

9 months

Re-analysis of the recent @JAMANetworkOpen article with satisfaction by specialty, cutpoints removed, and just mean score and SD. Christmas 🎄 themed #ggplot #Rstats

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M. Bolton

@5_utr

7 months

Precision/personalized medicine is largely a failure to understand variation H/T @stephensenn for his slides here

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M. Bolton

@5_utr

11 months

Felony level misinterpretation at #ESMO23 RADICALS-RT adjuvant #radonc vs salvage HR 0.68 (0.43-1.07), p=0.095 for FFDM Conclusion: “no difference” BS! Their own data is consistent with 32% reduction in FFDM, and up to a massive 57% reduction

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M. Bolton

@5_utr

2 years

@ewarren -Inflation will go higher -Kids will borrow more under assumption of future forgiveness and tuition will go higher -It’s divisive if any income thresholds: creating winners and losers for no reason -JUST SET INTEREST RATE ON ALL STUDENT LOANS TO 0%!!

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M. Bolton

@5_utr

1 year

Incredible misinterpretation here, with the addition of radiation consistent with a 10% reduction in mortality, and anywhere from 26% reduction to 9% worse. Classic absence of evidence is not evidence of absence error. Why do people respect this journal with stuff like this?

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M. Bolton

@5_utr

9 months

🚨 INCREASE trial Local advanced (76% IIIA) NSCLC 50-60 Gy + ipi/nivo + chemo -> surgery (planned 6 wks out) 2x greater pCR 0 patients didn’t make it to surgery

M. Bolton

@5_utr

9 months

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M. Bolton

@5_utr

11 months

Combined Stereotactic Body Radiotherapy and Immunotherapy Versus Transarterial Chemoembolization in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis 1-yr PFS 93.3% SBRT-IO vs 16.7% TACE, p<0.001 2-yr PFS: 77.8% vs 2.1% ❗️

Combined Stereotactic Body Radiotherapy and Immunotherapy Versus Transarterial Chemoembolization in...

Immunotherapy has achieved modest clinical activity in HCC patients. Propensity score matching analysis was conducted to compare the efficacy and safety of combined stereotactic SBRT-IO versus TACE...

pubmed.ncbi.nlm.nih.gov

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M. Bolton

@5_utr

3 years

@johncardillo No, clinical trials showed it’s inefficacy. 😂

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M. Bolton

@5_utr

5 months

SENOMAC: cT1-T3 breast cancer w/ 1-2 SLN macrometastases -> SLN only vs completion ALND RT in 90% HR for recurrence or death of 0.89 (95% CI, 0.66 to 1.19) - favoring SLN only! More data for AxRT #radonc and omission of ALND!

Omitting Axillary Dissection in Breast Cancer with Sentinel-Node Metastases | NEJM

Trials evaluating the omission of completion axillary-lymph-node dissection in patients with clinically node-negative breast cancer and sentinel-lymph-node metastases have been compromised by limit...

www.nejm.org

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M. Bolton

@5_utr

1 year

@RpsAgainstTrump He’s also getting BORING 🥱

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M. Bolton

@5_utr

11 months

❣️ShortHER Phase III 9 wks vs 1 year Herceptin adjuvant 10 year DFS is 77% in 1 year arm and 78% in the 9 wks arm Posterior probability of noninferiority for 9 wks vs 1 y: 93.2% Less severe cardiac toxicity with 9 wks Noninformative prior

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M. Bolton

@5_utr

3 years

@SpiroAgnewGhost How about Mazars 10 years of financial statements for evidence?

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M. Bolton

@5_utr

4 months

This drives me crazy 🤯 Misplaced concern about “generalizability” of RCTs and that somehow observational studies are more “real world” - as if RCTs are conducted on a different planet! @JAMANetwork seems to push this nonsense

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M. Bolton

@5_utr

8 months

🚨 EXTEND Ph 2 pancreatic ca ≤ 5 metastases 1:1 R to MDT plus systemic therapy versus systemic therapy alone mPFS 10.3 versus 2.5 months p=0.006 HR 0.43 (95% CI 0.20, 0.94; p=0.03) Nice work! H/T @ebludmir

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M. Bolton

@5_utr

3 months

🚨 Notable-HCC Early stage resectable HCC Neoadjuvant PD-1 blockade plus SBRT -> surgery -> adjuvant ORR 63.2%, 100% DCR!🤩 95% R0 curative resection

Neoadjuvant tislelizumab plus stereotactic body radiotherapy and adjuvant tislelizumab in early-s...

Nature Communications - The feasibility and efficacy of neoadjuvant immunotherapy for resectable hepatocellular carcinoma (HCC) have been previously suggested. Here the authors report the results...

www.nature.com

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M. Bolton

@5_utr

1 year

@stephensenn : Is Precision Medicine Terminally ill?

Stephen Senn: Is Precision Medicine Terminally Ill?

Stephen Senn (Head of Competence Center forMethodology and Statistics (CCMS), Luxembourg Institute of Health)

www.youtube.com

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M. Bolton

@5_utr

7 months

🚨 GETUG-AFU 18 Phase III RCT high risk prostate cancer: 70 Gy vs 80 Gy Overall survival HR = 0.61 [95% CI, 0.44-0.85], p = 0.0039) ❗️

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M. Bolton

@5_utr

23 days

Disappointed to see v5Gy in new @astro_org constraint recommendation for lung - this strikes me as a good example of a negative value constraint that can lead to worse plans than if v5 isn’t even looked at; also brachial plexus differs from current NCCN standard

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M. Bolton

@5_utr

11 months

UNFOLDER Trial 2 × 2 factorial 6 c R-CHOP-14 or R-CHOP-21 and to consolidation radiotherapy to extralymphatic/bulky disease or observation Interim p=0.004, meeting α spending p=0.008, no RT arm closed 3-year EFS rates: 94% ([95% CI, 89-99] vs. 78% [95% CI, 66-89]; P = 0.0069

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M. Bolton

@5_utr

5 months

Reminder: A 1 cm^3 tumor is often estimated to have around 10^9 cells. Even 90% reduction or 99% reduction = 10^-1 or 10^-2 cell kill from a treatment (such as a fancy drug), and *complete response by imaging* is still 10^7-10^8 cells Too many oncologists don’t realize this

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M. Bolton

@5_utr

1 year

This is some really good stuff @SolomonKurz

Causal inference with ordinal regression | A. Solomon Kurz

Part 7 of the GLM and causal inference series.

solomonkurz.netlify.app

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M. Bolton

@5_utr

10 months

TME-free survival was 39% (95% CI, 32 to 48) in the chemo->CRT group and 54% (95% CI, 46 to 62) in the CRT->chemo group (P = .012) CRT->chemo best sequencing 🤔 Long-term organ preservation in half of rectal cancers treated with TNT 🧨 🤩 #radonc

Long-Term Results of Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total...

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or...

ascopubs.org

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M. Bolton

@5_utr

10 months

Reaction to reading an author’s conclusion that p > 0.05, there is no benefit to the intervention, and the standard of care now should be not doing the intervention

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M. Bolton

@5_utr

8 months

Some much space between SBRT and TACE here, you can park a linac in between 😊

Arndt Vogel

@ArndtVogel

8 months

🔥TACE + durvalumab +/- bevacizumab in HCC #GI24 ✅ EMERALD-1, 616 pts 👉 ORR: 41 vs 43 vs 29% 👉 mPFS: 15 vs 10 vs 8.2 mo 👉 mOS: too early... 🧐Interesting data, no Durva mono benefit? Bev adds efficacy (again) … Practice changing? @myESMO @ILCAnews @EASLnews #livertwitter

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M. Bolton

@5_utr

8 months

10.4% grade 5 toxicity🪦is not acceptable with TACE + D + B 1/85 patients died (from a lung infection) with SBRT on RTOG 1112 ~1.2%, hazards of cross trial comparison but if anything sicker patients got SBRT

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M. Bolton

@5_utr

8 months

Secondary malignancies NHL survivors: 40 yrs of f/u assessed by treatment modality This is the largest study to examine SM risk in NHL pts with the longest f/u ❗️ RT did not increase overall SM risk, while chemo was associated with a higher overall risk

Secondary malignancies in non‐Hodgkin lymphoma survivors: 40 years of follow‐up assessed by...

Survivors of non‐Hodgkin lymphoma (NHL) have increased secondary malignancy (SM) risk. We quantified this risk by patient and treatment factors.Standardized incidence ratios (SIR, observed‐to‐expec...

www.ncbi.nlm.nih.gov

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M. Bolton

@5_utr

9 months

Changes coming to the FDA for Bayesian statistical approaches and I am excited 🤩

Using Bayesian statistical approaches to advance our ability to evalua

CDER Small Business and Industry Assistance Chronicles

www.fda.gov

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M. Bolton

@5_utr

12 days

❗️ Key slide: You cannot overcome biases in observational data with large enough n An RCT with as little n=64 can be as accurate as observational data at infinite n Let’s find more efficient RCTs and less OS/CI/TTE! HT

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M. Bolton

@5_utr

3 months

@RonFilipkowski That this guy’s handle is “BGatesIsAPyscho” is all you need to know Truly “Pyscho” indeed 🙄

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M. Bolton

@5_utr

3 months

‼️ ESOPEC: CROSS vs FLOT mOS 37 months (28-43) vs 66 months (36-NE) Unexpectedly poor mOS here with CROSS! What happened? Contrast to mOS 49.4 months on CROSS, not even in the 0.95 compatibility interval (28-43) here

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M. Bolton

@5_utr

1 year

iSABR trial: SABR alone or with IO 🤩 @JoeChangMD Especially in light of STARS-ROSEL, non-surgical management is the way to go! #WCLC2023

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M. Bolton

@5_utr

2 years

@TheLancetOncol “5-year event-free survival was 86·5% (95% CI 83·3–89·8), which was less than the 90% target rate” So it missed target for omission of RT, but authors declare “on basis of all information, radiotherapy could be omitted” Why run the RCT if you just ignore the outcome 🤷‍♂️

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M. Bolton

@5_utr

9 months

@londyloo “The length of a list of publications is a dubious indicator of ability to do good research; its relevance to the ability to be a good doctor is even more obscure.”

The scandal of poor medical research

We need less research, better research, and research done for the right reasons What should we think about a doctor who uses the wrong treatment, either wilfully or through ignorance, or who uses the...

www.bmj.com

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M. Bolton

@5_utr

11 months

Ok who did this 😂

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M. Bolton

@5_utr

2 years

Statistical referees at @TheLancet must have been asleep for this one 🤦‍♂️

Real-world use of nirmatrelvir–ritonavir in outpatients with COVID-19 during the era of omicron...

Real-world evidence reported during a BA.2, BA2.12.1, BA.4, and BA.5 omicron surge showed an association between nirmatrelvir–ritonavir treatment and reduced 28-day all-cause hospitalisation,...

www.thelancet.com

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M. Bolton

@5_utr

18 days

@zacjanderson The act is boring; the schtick is stale. The long red tie, clownish makeup, washed up shock jock insults are boring

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M. Bolton

@5_utr

7 months

@dylanarmbruste3 I like this Greenland et al work

Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations

European Journal of Epidemiology - Misinterpretation and abuse of statistical tests, confidence intervals, and statistical power have been decried for decades, yet remain rampant. A key problem is...

link.springer.com

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M. Bolton

@5_utr

2 years

@MeidasTouch A disgrace to the great state of WI

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M. Bolton

@5_utr

3 years

@CDCgov This is so bad. So if I get sick I deserve different treatment than every other non-HCW? Will I be ordered back to work the minute my fever goes down slightly or what?

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M. Bolton

@5_utr

5 months

Misinterpretation of large p-values as evidence of no effect and similarity has done incalculable harm to science and medicine

Jordan Nafa

@ajordannafa

5 months

Periodic reminder that: ▪︎ p<0.05 isn't "evidence an effect exists" ▪︎ p>0.05 isn't "evidence that there is no effect" Statistical evidence against a vaguely defined point null is generally not evidence for or against your specific pet theory

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M. Bolton

@5_utr

9 months

OPTIMIST trial cT1-2N0-2M0; triple-negative, HER2+, or low estrogen receptor (<10%) s/p neoadj chemo -> biopsies -> if pCR is confirmed, breast surgery is omitted; whole breast RT + boost required 👏

Omission of breast surgery for predicted pCR patients with MRI and vacuum-assisted biopsy in breast...

TPS627 Background: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). The role of surgery is essential...

ascopubs.org

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M. Bolton

@5_utr

4 months

❗️ Very high-yield flow chart right here; In the Bayesian paradigm evidence for an effect comes from the data and from pre-study information, no penalty for answering multiple questions ht @f2harrell

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M. Bolton

@5_utr

6 months

NATALEE: A good example of clinically insignificant ~3% benefit in a contrived endpoint at 3-years that jacks up toxicity, plus what happens at ~40 months? Hard to tell without CIs

Yakup Ergün

@dr_yakupergun

6 months

Ribociclib plus Endocrine Therapy in Early Breast Cancer : NATALEE 3y-iDFS: 90.4% vs 87.1% (HR:0.75)

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M. Bolton

@5_utr

3 months

Hearing talk of this trial being “Level 1 evidence” for protons. How can that be? How can a non-inferiority trial with primary endpoint of PFS with 1.535x margin provide level 1 evidence for a treatment that is much more expensive and much less available?

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M. Bolton

@5_utr

11 months

❗️ The ProtecT randomised trial cost-effectiveness analysis comparing active monitoring, surgery, or radiotherapy for prostate cancer ”Radiotherapy was the most likely (58% probability) cost-effective option at the UK NICE willingness-to-pay threshold (£20,000 per QALY)” 🤩

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M. Bolton

@5_utr

7 months

@dmrind That since 2016 @AmstatNews statement on p-values has still many people to reach

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M. Bolton

@5_utr

9 months

🚨 Randomized trial of concomitant hypofractionated IMRT boost versus conventional fractionated IMRT boost for localized high-risk prostate cancer (pHART2-RCT) ⚠️ Late grade ≥3 GI toxicity was 2.4% in conventional vs 13.5% mod hypofrac group (p=0.01)

Randomized Trial of Concomitant Hypofractionated Intensity Modulated Radiation Therapy Boost Versus...

The aim of this work is to report on the results of a phase 2 randomized trial of moderately hypofractionated (MH) versus conventionally fractionated (CF) radiation therapy to the prostate with...

www.redjournal.org

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M. Bolton

@5_utr

3 months

This piece made my weekend! 💯 💯 💯 read! Key excerpt “This is misleading. Tukey showed that even highly suboptimal covariate adjustment is much better than unadjusted treatment effect estimation” 🔥 ht @f2harrell

Commentary on van Lancker et al - Frank E Harrell, 2024

journals.sagepub.com

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M. Bolton

@5_utr

3 months

❗️ RTOG 0848 mOS 3.0 -> 3.9y with CRT 5-year OS 28.6% vs 48.1% CRT Stable tail effects > 5 years — more long term cured with CRT rather than chemo alone?! #asco24

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M. Bolton

@5_utr

15 days

Phase 2 STOP 🛑 trial 1-5 metastases progressing on systemic therapy -> randomized to continued SOC treatment vs. SABR to all progressing lesions plus SOC Many patients are not willing to not get SABR is only real conclusion here

Stereotactic Ablative Radiotherapy for Oligoprogressive Cancers: Results of the Randomized Phase II...

This trial examined if patients with ≤5 sites of oligoprogression benefit from the addition of stereotactic ablative radiotherapy (SABR) to standard of care (SOC) systemic therapy.

www.redjournal.org

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M. Bolton

@5_utr

5 months

🚨 KN-412 H&N SCC chemoRT +/- pembro mEFS NR in the pembro v. 46.6 months placebo HR 0.83 [95% CI 0.68–1.03] “Pembrolizumab plus chemoradiotherapy did not significantly improve event-free survival” OMG 😱

Pembrolizumab plus concurrent chemoradiotherapy versus placebo plus concurrent chemoradiotherapy in...

Pembrolizumab plus chemoradiotherapy did not significantly improve event-free survival compared with chemoradiotherapy alone in a molecularly unselected, locally advanced HNSCC population. No new...

www.thelancet.com

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M. Bolton

@5_utr

2 years

LUMINA: Prospective cohort study to examine recurrence risk with T1N0 breast, no RT 👎 No control 👎 Dichotomania: Ki-67<13.25?! 👎 Negative margins differ from ASTRO/SSO consensus 👎 Doing same thing over: CALGB 9343 soon to be 30 🎂 T1N0 ER+ 70+ HR 0.18 👍 APBI #RadOnc 1/n

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M. Bolton

@5_utr

10 months

🚨 The most important plot in all of #radonc ? ProtecT RCT 10-year RT vs RP #pcsm Even with a *skeptical* prior, posterior prob true HR < 1 for RT vs RP is 56%! RT is likely better than RP 🤩 🤩

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M. Bolton

@5_utr

10 months

‼️ CRT has a better benefit-risk score profile than FOLFOX, as a secondary analysis of PROSPECT trial 1/n

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M. Bolton

@5_utr

8 months

As a reminder to those eager to lower dose in HPV-driven oropharynx cancers based off of single institution or nonrandomized data: HN005 was *closed* for safety because it couldn’t even clear a whopping 1.75x NI margin for PFS!

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M. Bolton

@5_utr

7 months

Very important data - don’t wait on a “negative” PSMA PET to turn “positive”

Nat Lester-Coll, MD

@DrLesterColl

7 months

#GU24 @a_dalpra unpacks all data and controversies on salvage radiotherapy: timing, dose, fractionation, ADT, volumes, genomics, reirradiation, current trials - tour de force! @OncoAlert #radonc #pcsm

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M. Bolton

@5_utr

1 year

15-year outcomes from ProtecT trial: HR 0.48 (0.30-0.77) for metastatic disease with #radonc

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M. Bolton

@5_utr

10 months

The Mack Truck 🛻 effect - when the space between survival curves is so large you can park a 🛻 in between them 🤩 What a huge win for patients #SBRT #radonc 💪

The Lancet Gastroenterology & Hepatology

@LancetGastroHep

10 months

New research - Liu et al - Systemic therapy with or without local intervention for oligometastatic oesophageal squamous cell carcinoma (ESO-Shanghai 13): an open-label, randomised, phase 2 trial #GITwitter #OncTwitter @OncoAlert

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M. Bolton

@5_utr

8 months

❗️ ❗️ 70 gene risk score does not predict locoregional recurrence in breast cancer; existing free clinical variables already in use such as tumor size and grade does The notion of adjusting dose based on polygenic risk scores just keeps failing!

Locoregional Breast Cancer Recurrence in the European Organisation for Research and Treatment of...

PURPOSE A number of studies are currently investigating de-escalation of radiation therapy in patients with a low risk of in-breast relapses on the basis of clinicopathologic factors and molecular...

ascopubs.org

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M. Bolton

@5_utr

9 months

Double-blind, multicenter, phase II study (NCT02022098) in 96 patients with previously untreated locally advanced HNSCC CRT 70 Gy +/- xevinapant DoR KM-estimate, 79 % vs 36 %; adjusted HR=0.21; 95 % CI, 0.08-0.54 5-yr OS 53 % (95 % CI, 37-66) OS rate vs 28 % (15-42) 🤩

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M. Bolton

@5_utr

7 months

@JReinerMD

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M. Bolton

@5_utr

9 months

Spot on! Radical prostatectomy is a fine option, radiotherapy is a fine option, but the best option for 3+3=6 is leave them the heck alone as long as possible (active surveillance)

Ricardo Soares

@soares_uro

9 months

Whole gland HIFU or cryotherapy: - biochemical cancer recurrence in 31% at 5 years and 42% at 10 years (and this is in a cohort with 52% of Gleason 3+3) - urethral stricture in 12% of HIFU and 5% of cryotherapy - 4% incontinence - 0.7% fistulas Why do it?

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M. Bolton

@5_utr

1 year

Reminder: stage III N2 induction chemo -> surgery vs RT Median and 5-yr OS for patients randomly assigned to resection versus radiotherapy were 16.4 versus 17.5 months and 15.7% versus 14%, respectively (hazard ratio = 1.06, 95% CI = 0.84 to 1.35)

Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage...

In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free survival compared with...

pubmed.ncbi.nlm.nih.gov

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M. Bolton

@5_utr

3 months

Excellent reply re: FASTRACK II by @_ShankarSiva SBRT is excellent option for RCC

Stereotactic ablative radiotherapy for primary kidney cancer – Authors' reply

We thank Priyank Bhargava and colleagues and Nicholas Brown and colleagues for their interest in TROG 15.03 FASTRACK II trial.1 The main consideration of these correspondences regards the use of...

www.thelancet.com

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M. Bolton

@5_utr

1 year

Phase 2 HIFU for prostate cancer: 2-year failure rate after HIFU: 38% ⚠️ ⛔️ 👎

Single-center, prospective phase 2 trial of high-intensity focused ultrasound (HIFU) in patients...

World Journal of Urology - Focal therapy (FT) for localized prostate cancer (PCa) is only recommended within the context of clinical trials by international guidelines. We aimed to investigate...

link.springer.com

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M. Bolton

@5_utr

5 months

@JoJoFromJerz Many people are saying this! Big strong men with tears in their eyes are saying bigly Poorleone!

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M. Bolton

@5_utr

1 year

This is an absolutely excellent read and must serve as a rallying cry We must better fund research in prevention, surgery, #radonc , palliative medicine

Common Sense Oncology

@csoncol

1 year

Our inaugural paper, our manifesto is now out in @TheLancetOncol . This paper describes our mission, vision, and guiding principles. We also now invite you all to join our movement- our website is now live.

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M. Bolton

@5_utr

3 months

🚨 LAURA Unresectable stage III NSCLC EGFRmut -> CRT -> Osi vs placebo PFS Osi vs placebo: HR 0.16 95% CI (0.10, 0.24) p<0.001 Pneumonitis mostly grade 1-2 🤩 a new standard of care for these patients! #asco24

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M. Bolton

@5_utr

5 months

Phase 3 RCT - Painful spine met 48.5 Gy/10 fx (with epidural involvement) or 40 Gy/5 fx SBRT group vs 30 Gy/10 fx or 20 Gy/5 fx cEBRT Interesting work, but can we stop using change from baseline and responder analysis please? 🙏

Dose‐intensified stereotactic body radiotherapy for painful vertebral metastases: A randomized...

In this randomized clinical trial that included 63 patients with 67 painful vertebral metastases, the proportion of those who had metastases with pain improvement at 6-month follow-up was 69% in the...

acsjournals.onlinelibrary.wiley.com

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M. Bolton

@5_utr

4 months

PACE-C: 60/20 vs 36.25/5 No surprises given PACE-B — more toxicity with SBRT and also worse urinary and GI QoL after SBRT ⚠️ Similar to PACE-B, the only question is how this team will misinterpret and spin the results in favor of SBRT anyway 🤷‍♂️ #ESTRO2024

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M. Bolton

@5_utr

10 months

AUC of 99.9%, no 🚩 there at all 🙄

Eric Topol

@EricTopol

10 months

A very impressive study for #AI picking up pancreatic cancer from non-contrast CT with 93% sensitivity, 99.9% specificity, AUC ~0.99, including from chest CT scans performed Covid. @NatureMedicine

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M. Bolton

@5_utr

7 months

‼️ Personalized Biomarker-Based Umbrella Trial for Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: KCSG HN 15-16 TRIUMPH Trial ORRs of literally 0% in NGS matched drugs! What a complete boondoggle this stuff is. Truly sad!

Personalized Biomarker-Based Umbrella Trial for Patients With Recurrent or Metastatic Head and Neck...

PURPOSE A precise oncologic approach for head and neck squamous cell carcinoma (HNSCC) is necessary. We performed a genomic profile-based umbrella trial for the patients with platinum-refractory...

ascopubs.org

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M. Bolton

@5_utr

1 year

🚨 only 8% of prediction model studies justified their sample sizes I recently asked an @arteraAI author about this and the reply was sample size calcs weren’t necessary, their prediction model doesn’t need them! Then blocked me for having the audacity to ask a question🤦‍♂️

Paula Dhiman

@pauladhiman

1 year

NEW PAPER: Sample size is not being considered when developing a prediction model Only 8% of studies justified their sample size and unsurprisingly 73% didn’t meet their minimum required sample size (using Riley et al formulae) by a median of 75 events

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M. Bolton

@5_utr

2 years

Korean Phase 3 RCT Proton vs RFA for HCC ✅ 66 GyE in 10 fractions vs RFA ✅ TLV30<40% and/or RLV30<30% ITT Local PFS with PBT vs. RFA: 92.8% vs. 83.2%, a difference of 9.6 percentage points (90% CI 0.7–18.4; p < 0.001) 🤩 #radonc

Proton beam radiotherapy vs. radiofrequency ablation for recurrent hepatocellular carcinoma: A...

Proton beam radiotherapy (PBT) has recently been applied to treat hepatocellular carcinoma (HCC); however, there is no randomized controlled trial-based evidence on its safety and efficacy. We...

www.journal-of-hepatology.eu

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M. Bolton

@5_utr

1 year

@KrishanJethwa @ALLIANCE_org Isn’t the idea of “DE-escalation” to reduce the toxicity/burden of treatment? More intense chemotherapy ESCALATES toxicity of the treatment to the tune of ~4x higher grade 4+!

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M. Bolton

@5_utr

1 year

@AntiToxicPeople Hopefully this disgrace

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M. Bolton

@5_utr

3 months

SBRT is an excellent bridge while waiting for liver transplant - I think underutilized..? @jryckman3 @NiuSanford @KrishanJethwa what do you think?

Erman Akkus

@Erman_Akkus

3 months

☢️SBRT and liver transplant in previously untreated unresectable HCC @JAMANetworkOpen ✅SBRT may be used as a bridging treatment while waiting for deceased donor liver transplant ✅PET-CT and MRI with contrast may be used for response evaluation

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M. Bolton

@5_utr

1 year

🚨 SOUND RCT N=1463 women, any age with BC up to 2 cm and negative preop axillary ultrasound: randomized to SLNB or no surgery 5-year distant DFS 97.7% SLNB group vs 98.0% no surgery LRR: 1.7% SLNB vs 1.6% no surgery The end of most SLNB?

Sentinel Lymph Node Biopsy vs No Axillary Procedure in Small Node-Negative Breast Cancer

This randomized clinical trial assesses whether the omission of sentinel node biopsy is noninferior to sentinel lymph node biopsy in female patients with small breast cancer and negative results on...

jamanetwork.com

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M. Bolton

@5_utr

8 months

Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials Local recurrence with neoadjuvant chemotherapy vs adjuvant, RR 1.37 (1.17-1.61)

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M. Bolton

@5_utr

1 year

Marketing: What was previously propensity score observational data became “RWD” “real world data”, now “Real world synthetic control arms” 🤔

Addressing challenges with real-world synthetic control arms to demonstrate the comparative...

Nature Communications - Real-world data (RWD) based control arms provide an option to compare the effectiveness of single-arm trials. By performing multiple quantitative bias analyses to alleviate...

www.nature.com

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