Next, Mark Zhang from Memorial Sloan Kettering Cancer Center describes findings from a study examining circulating tumor cells in the cerebrospinal fluid as a prognostic and predictive biomarker in leptomagenial disease.

So, leptomeningeal disease, it's a devastating complication of patients with stage 4 lung cancer.

It's really hard to treat and really hard to track.

Our existing tools right now are, they lack sensitivity, they're non-quantitative.

And so that really drove our initial question is, can we use a different biomarker, which in this case is circulating tumor cells, CTCs, and the CSF, as a way to complement our existing tools? And so to do that, we have an in-house assay.

It's an Epcam-mediated antibody assay.

So in essence, it kind of captures the circulating tumor cells in the CSF and then gives us a quantifiable output, 0 to 200.

It also shares insights into a study evaluating the role of the zygocity of KEEP1 STK11 in response to checkpoint inhibition in patients with non-small-small cancer.

To begin, Dr. Chang presents a 96-year-old woman with a history of light smoking and a resection five years ago of a stage 2A HER2 exon 20 insertion mutant adenocarcinoma, followed shortly by disease recurrence in the bone, treated with TDM1, and then TDXD for five years, now with disease progression.

We switched her very recently to Zongirinib, and she's been on this for about three or so months now, and she's doing really, really well.

We are managing her effusion with the Plurex, but hoping that once the more response with the Zongirinib kicks in, we may be able to remove the Plurex catheter.

She had mild diarrhea just for a couple of days, but that was the only side effect that she's had so far.

This lovely 96-year-old has been doing great on it.

And one question you may bring up with the faculty is, you know, we do have these really two great TKIs that were approved back-to-back, Zangarinib and Cevabirinib.

So when they're trying to decide which of these agents to use, how would they use it? And what are the side effect profiles that may lean one way or the other? The most exciting change in the last couple of months is Zongirinib received an expanded approval to be now used in the first-line setting.

Here's the case from Dr. Zhang.

To begin, Dr. Chang presents a ninety-six-year-old woman with a history of light smoking and a resection five years ago of a stage IIA HER2 exon twenty insertion mutant adenocarcinoma, followed shortly by disease recurrence in the bone, treated with TDM1 and then TDXD for five years, now with disease progression.

We switched her very recently to zongertinib, and she's been on this for about three or so months now, and she's doing really, really well.

We are managing her effusion with the PleurX, but hoping that once the more response to the zongertinib kicks in, we may be able to remove the PleurX catheter.

She had mild diarrhea just for a couple of days, but that was the only side effect that she's had so far.

This lovely ninety-six-year-old has been doing great on it.

And one question you may bring up with the faculty is, you know, we do have these really two great TKIs that were approved back to back, zongertinib, sevibertinib.

So when they're trying to decide which of these agents to use, how would they use it, and, and what are the side effect profiles that may lean one way or the other? The most exciting change in this in the last couple months is zongertinib received an expanded approval to be now used in the first-line setting.

Here's the case from Dr. Jang.