Daniel Ermann, MD, discusses how real-world studies, such as his recent Medicare database analysis, are providing data on frontline BTK inhibitor (BTKi) therapy in populations of patients with chronic lymphocytic leukemia that are more representative of those oncologists would see in everyday practice.
Daniel Ermann, MD, discusses what real-world retrospective analyses have elucidated about BTK inhibitor (BTKi) therapy treatment selection in the frontline setting.
Daniel Ermann, MD, discusses a retrospective study he presented at the 2026 ASCO Annual Meeting that compared real-world Medicare database data for over 10,000 patients with chronic lymphocytic leukemia treated with frontline BTK inhibitor (BTKi) therapy: zanubrutinib (Brukinsa), acalabrutinib (Calquence), or ibrutinib (Imbruvica).
Daniel Ermann, MD, shares his expert insight on proactive management of patients with chronic lymphocytic leukemia receiving BTK inhibitor (BTKi) therapy to ensure optimal treatment, particularly in older patients.
Daniel Ermann, MD, discusses how clinical and real-world data drive his discussions with older CLL patients regarding frontline BTK inhibitor (BTKi) therapy.
Daniel Ermann, MD, discusses the significance of having both clinical trial and real-word data for frontline zanubrutinib in chronic lymphocytic leukemia.
Daniel Ermann, MD, highlights 6.5-year follow-up data for zanubrutinib from the phase 3 SEQUOIA trial, which compared the BTK inhibitor to chemoimmunotherapy in patients with chronic lymphocytic leukemia.
Daniel Ermann, MD, discusses treatment considerations with newly diagnosed older/elderly patients with chronic lymphocytic leukemia.
Daniel Ermann, MD, discusses what long-term clinical trial and real-world data have shown about the benefits and durability of continuous BTK inhibitor therapy in the frontline treatment of chronic lymphocytic leukemia.
Misako Nagasaka, MD, PhD, highlights progression-free survival data from the PALOMA-2 study among patients with EGFR-mutated advanced non–small cell lung cancer (NSCLC) receiving subcutaneous amivantamab plus lazertinib in the first-line setting. She compares these data with PFS data from the MARIPOSA trial, which evaluated intravenous amivantamab plus lazertinib in similar NSCLC populations.
Misako Nagasaka, MD, PhD, discusses results from the treatment-naïve populations in the PALOMA-2 study, which evaluated subcutaneous amivantamab plus lazertinib in patients with EGFR-mutated advanced or metastatic non–small cell lung cancer. She highlights study cohorts that explored the frontline combination using amivantamab every 2 weeks and every 4 weeks.
The panel discusses first-line treatment selection once a ROS1 fusion is confirmed in a treatment-naive patient.
The panel discusses how patients with ROS1-positive advanced NSCLC arrive in clinic through in-system diagnosis, second opinions, or new patient referrals and the detective work required to ensure complete molecular testing is available before treatment decisions.
ROS1 gene fusions occur in approximately 1% to 2% of advanced NSCLC cases, a small but clinically meaningful subset predominantly found in younger patients, women, light or never smokers, and those with non-squamous histology, most commonly adenocarcinoma.
With 4 ROS1-directed TKIs now in the mix, community oncologists need a clear framework for sequencing and CNS considerations in this rare NSCLC subset.
In closing, Dr. Rodriguez emphasizes that for patients who present with brain metastases, first-line treatment selection in EGFR-positive metastatic NSCLC requires weighing CNS efficacy, overall survival, tolerability, and the patient’s priorities, all framed as a shared decision-making conversation.
Dr. Rodriguez describes the current period in EGFR-positive lung cancer as one of active change in the first-line landscape: median overall survival in recent trials has lengthened compared with historical monotherapy data, and durations of CNS disease control are now reported in the range of years. She walks through how sequencing decisions are evolving.
Dr. Rodriguez turns to treatment burden, a central concern for Mr. Smith, who cannot drive because of seizure precautions, lives 45 minutes from clinic, and has a wife who works part-time. She describes the subcutaneous (SC) formulation of amivantamab and how it changes the administration schedule: dosing is approximately 5 minutes versus up to 4 to 5 hours for intravenous (IV) chemotherapy, and the maintenance interval moves from every 2 weeks to every 4 weeks (Q4W). Patients still come weekly during cycle 1, with maintenance visits less frequent thereafter.
Dr. Rodriguez addresses the wife’s concern about managing side effects at home. She frames the main toxicities of amivantamab in two categories. The first is infusion-related reactions (IRRs), which are reduced with the subcutaneous formulation. The second is the combination of cutaneous toxicity (rash, paronychia) and venous thromboembolism (VTE), which requires structured prophylaxis and a proactive plan for at-home management.
Dr. Rodriguez discusses CNS surveillance for Mr. Smith, who has selected subcutaneous (SC) amivantamab plus lazertinib for his 4 brain metastases. His wife asks how often he will need brain MRIs and what to watch for. Dr. Rodriguez contrasts current practice with the pre-targeted-therapy era, when she would have imaged at 6 to 8 weeks primarily to document response and offer radiation if a patient had not responded.
Dr. Rodriguez turns to overall survival (OS), the second question Mr. Smith and his wife raised. For MARIPOSA, median OS has not yet been reached for amivantamab plus lazertinib, with more than half of patients projected to be alive beyond 4 years based on the current data.
Dr. Rodriguez walks through the central nervous system (CNS) efficacy data for the three first-line options. She notes that MARIPOSA was specifically designed for close intracranial monitoring: patients with baseline brain metastases were imaged every 8 weeks, and patients without baseline brain metastases were also followed closely, which she cites as a reason for its National Comprehensive Cancer Network (NCCN) Category 1 recommendation.
Dr. Estelamari Rodriguez introduces the case of Mr. Smith, a 53-year-old man who presents with new-onset headaches and a witnessed seizure. He is a former light smoker (5 pack-year, quit 15 years ago) with type 2 diabetes and no hepatic, renal, or cardiac impairment, no history of venous thromboembolism (VTE), and an Eastern Cooperative Oncology Group (ECOG) performance status of 1.
Why frontline CLL care shifts to zanubrutinib: simple daily BTK inhibitor therapy cuts infusions, eases pill burden, adds flexibility.
Six-year data show zanubrutinib remains well tolerated, with rare atrial fibrillation, low bleeding, and no new safety concerns.
Six-year Sequoia data show zanubrutinib in frontline CLL extends PFS far beyond bendamustine‑rituximab, delaying next treatment.
Six-year Sequoia data show zanubrutinib in frontline CLL extends PFS far beyond bendamustine‑rituximab, delaying next treatment.
For high-risk CLL, experts favor continuous BTK inhibitors and weigh venetoclax visit demands to match frontline therapy to lifestyle.
Experts explain racial gaps in molecular testing and how limited trial diversity affects treating HER2-mutant lung cancer in Black patients.
Compare oral vs IV HER2-targeted lung cancer therapies, including zangertinib and antibody–drug conjugates, with response rates and access considerations.