Medical Oncologist. Interest in thoracic & GI malignancies. @ASCOTECAG and @themednet GI med onc editor. Currently @IHACares Alum @mcgillu @karmanoscancer AOA
Michigan, USA
Joined July 2022
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Ibrahim Azar, MD retweeted
Yesterday I posted about working with an AI scientist to find new ways to fight my cancer.
A chemistry professor at the University of Michigan saw it and emailed me. Matt Soellner @mbsoellner works on the exact kind of lung cancer I have. He offered to synthesize compounds and test them in cells and animals.
A lightbulb 💡 goes off above my head. Obviously...I MUST introduce Matt to Jan.
Andddd by this morning, they're talking about how to take an AI-designed molecule off a computer screen, make it in a lab, and find out whether it can fight my cancer.
EXCUSE ME!? Less than 24 hours after my post.
We haven't made a drug. We don't know whether any of this will work. Making and testing compounds will take months.
But Matt saw a patient trying to find a way forward and chose to help. He brought the ability to make and test things that might otherwise never leave a computer screen.
I'm sharing this as it happens because this is what gets me excited about AI. I can put my story out there, connect people with different skills, and help move an idea toward an actual experiment against cancer.
I deal with the every day bullshit from cancer as a patient but have realized there's an army of incredible people out there working hard behind the scenes on treatments and cures for people like me and millions of others.
It's an honor and a privilege to bring their efforts out for the world to see. AI is accelerating what these scientists can do. I'm just the human meat proxy making introductions and sharing the story.
But if that helps get a promising idea off a screen and into a lab faster, I'll take it! 🥩
So get this...a stranger DM'd me on X and offered to help design my backup cancer drug. For free!
His name is Jan Domanski @jandom_random. He runs science at @open_fold, an open-source AI model that predicts how proteins and drugs physically fit together.
My cancer is driven by one broken protein called ALK. Lorlatinib (the daily pill I take) jams itself into it and shuts it down. It's working. But resistance isn't an if, it's a when. The tumor mutates the pocket and the drug stops fitting.
So Jan started modeling it on his own time, burning his own tokens. He ran AI models against ALK and lorlatinib, mapping where the known escape mutations land.
And what did he find? Most of them hit right in the drug's pocket, swapping small pieces for bigger ones that physically block the drug. That's the good kind of bad news. A pocket problem is something you can design around.
But the normal route to a new drug is ~2 years and ~$4-5M just to be ready for human testing. Jan's dream is getting a medicine to one patient in ~1 month.
I'm not taking a homemade molecule while lorlatinib works. But if it ever fails....shit...I've got a guy!
I started posting actively on X just a few weeks ago and it has brought me together with the most amazing, generous people!
Ibrahim Azar, MD retweeted
Small-cell lung cancer has been one of the hardest cancers to treat. A practice-changing phase 3 trial reported in @NEJM found that adding the T-cell engager tarlatamab to maintenance durvalumab extended median survival from about a year to nearly two.
Ibrahim Azar, MD retweeted
Happy to report our experience treating patients with metastatic atypical carcinoid and large cell neuroendocrine carcinoma with tarlatamab; high response rates, unusual toxicity profile especially in atypical carcinoid cohort with pain flare, myalgia and generalized fatigue / weakness ( see narrative description for more detail in the paper) however the toxicities may also be linked to response - including a patient received only one 1mg priming dose and achieved partial response for over 9 months without additional therapy. DLL3 level matters ( median level higher in atypical carcinoid 80% of cells, more than sclc even) but definitely not the whole story, the immune compartment / implications remain to be explored. DLL3
T cell engagers should be considered for these patients and optimal dose and biomarkers are open questions jtocrr.org/article/S2666-364…
Ibrahim Azar, MD retweeted
Over 2 years of stage 4 lung cancer and I'm proud to present the top 10 shittiest cures genuinely sugggested to me:
10. Drinking bleach (they call it "MMS")
9. Drinking my own urine
8. Alkaline diet
7. Vicks VapoRub, massive amounts
6. Apricot pits
5. Coffee enemas
4. Ivermectin
3. Super-oxygenate, because "cancer can't survive oxygen." It's lung cancer.
2. A 444Hz sound frequency
1. Crystals in my underwear, right next to my nutsack
And yet the thing keeping me alive is a pill a scientist made. Weird 🤷♂️
Ibrahim Azar, MD retweeted
Switching ADC payload works. Even while keeping the same target.
We previously saw it in DB02. Then in TULIP. And now in ph1 trials of novel agents.
In an abstract to be presented at #SABCS26, the HER2 ADC IKS014 (caxmotabart entudotin) showed an ORR of 50% (5/10) among patients with HER2+ MBC that had previously received T-DXd.
biospace.com/press-releases/…
Ibrahim Azar, MD retweeted
Report @ClinicalLung describes 162 consecutive pts with initially unresectable EGFR+ NSCLC (stage IIIA-N2b to IIIC) treated with TKI-based induction. 70/162 felt converted to resectable, 42 underwent resection. MPR rate 31%, 1 pCR, 60% LN downstaged.
clinical-lung-cancer.com/art…
Ibrahim Azar, MD retweeted
Report @JTOonline showing tarlatamab efficacy in pts with atypical carcinoid (n=5, RR 60%, DCR 100%, mPFS 8.8m) and large cell neuroendocrine carcinoma (LCNEC, n=7, RR 43%, DCR 88%, mPFS 5.1m). DLL3 IHC potential predictive marker here.
jtocrr.org/article/S2666-364…
Ibrahim Azar, MD retweeted
TKIs in pregnancy for lung cancer: 27 pregnancies, 96.3% live births, 80.8% of mothers responded. They can be considered in selected cases with a multidisciplinary team 🤰🏽🫁 Congrats to Dr. Noseda and Dr. Imbimbo for leading it!
doi.org/10.1007/s40265-026-0…
Ibrahim Azar, MD retweeted
I have stage 4 lung cancer and never smoked. It's driven by one gene fusion called ALK that scientists only discovered in 2007. By 2011 there was a pill that targets it. I'm on the third generation of that pill now and it's the reason I'm still here.
The wellness crowd has pushed ivermectin and fenbendazole on me more times than I can count. Not one of them could tell me what either drug does to the EML4-ALK fusion.
Ibrahim Azar, MD retweeted
I despise academic medicine.
I enjoy the research. I enjoy the teaching.
I despise the merging of academia and bureaucracy, and the aggressive misinterpretation of research that follows.
The worst example is using evidence for multidisciplinary care to justify consolidation and institutional control. Physicians working together and physicians working under one corporate owner are two different things.
Ibrahim Azar, MD retweeted
Unpopular opinion: the hardest part of cancer isn't the cancer. It's the unpaid admin job the healthcare system hands you.
Here's all the shit I did across 27 months so far:
64 "please fill out your history" questionnaires
80 calls just to get pills delivered
150+ appointments and calls
79 days in a waiting room
23 CT, MRI and PET scans
209 scheduling messages
5 radiation treatments
34 full blood panels
5,500+ cancer pills
1,360 lab results
1 thoracentesis
2 biopsies
The phone trees, the endless redundant forms, the reschedules and the "we never received that order" are what grind you down.
And I'm someone who's good at this stuff. Imagine doing it sick, alone, or without the time.
If someone you love is in treatment, "let me know if you need anything" is nice. "I'll make the pharmacy call this week" is better.
Ibrahim Azar, MD retweeted
#ESMO26 is a wrap. A few thoughts.
It is a privilege to be an oncologist. To everyone who took the time to meet with me, lend their expertise or mentor me in some way: thank you. I am grateful. Also, to the patients who contributed their time, hope and lives to allow these studies to happen, thank you. This is what allows progress.
1. ESMO absolutely brought incredible advancements. So did China. This was the first global conference where the USA has clearly been dethroned as the de facto biomedical trial leader (5 of the 7 Presidential Symposium late-breakers focused on new drugs were Chinese developed). Chinese patients will be getting access to the latest biomedical advances, first.
2. The molecular era is here for KRAS. Expect it to come to early lines, in every tumor, fast. Expect sexy combos. (I am personally very excited about Genmab + Incyte's LGR5-EGFR + G12D but also think Verastem’s and RevMed’s G12D’s look great.)
3. Some advances look meaningful but are minor. PD1-VEGF beats PD1, but it wasn't compared to PD1 + VEGF. The benefit looks similar to adding bev (duh).
4. Cellular therapy is finally here for solid tumors. Get your systems ready now, it takes years to truly prepare. The 66% response rate for TezR (SL-28) across all-comer solid tumors blew my mind.
5. ADCs will hit CRC/GI quickly, and in a few years there will be many questions about sequencing. Please please please stop using the same payloads.
6. Medical education is more important than ever with how fast the field is moving. If anyone has advice on how @TheGutOncLab can disseminate information better (like the people at @OpenMedicineHQ and @OncoAlert do), please let me know.
Here's to next year. Already getting ready for @ASCO GI
@TheGutOncLab @Onco_Nexus
Ibrahim Azar, MD retweeted
#ESMO26 LBA5
🚨 Krascendo-1 (Phase 3)
Divarasib vs sotorasib/adagrasib in KRAS G12C-mutant NSCLC after platinum chemotherapy and immunotherapy (n=338).
💊 91% of controls received sotorasib (only 9% adagrasib).
✅ mPFS: 9.8 vs 5.7 mo (HR 0.58; P<0.0001)
✅ mOS: 17.7 vs 12.0 mo (HR 0.56; P=0.0005)
✅ ORR: 58.4% vs 32.3%
🛡️ Safety
• G3–4 TRAEs: 24.6% vs 34.5%
• TRAE-related discontinuation: 4.8% vs 11.7%
• Median treatment duration: 11.3 vs 5.0 mo
Impressive head-to-head PFS and OS benefits, with fewer severe TRAEs despite longer treatment exposure.
#LCSM
1/4
🔥 #ESMO26
Lung Cancer Presidential Highlights
🇪🇸 Madrid | October 24–25, 2026
Three major Phase 3 lung cancer LBAs, each with potential to reshape treatment paradigms:
🎙️ LBA3 | DeLLphi-305
🎙️ LBA5 | KRASCENDO 1
🎙️ LBA6 | SAFFRON
Three Phase 3 readouts to watch closely at #ESMO26 👀
@myESMO @OncoAlert @Larvol
Ibrahim Azar, MD retweeted
Well, can we now put the adjuvant irinotecan question to bed…? A very important but negative trial.
IROCAS trial: mFOLFIRINOX versus mFOLFOX6 in high-risk stage III colon cancer
3-year DFS: 65.6% vs. 66.3%
3-year OS: 91.2% vs. 86.7%
#ESMO26 @OncoAlert
Ibrahim Azar, MD retweeted
Starlatamab takes a huge BiTE today out of small cell lung cancer!
Amazing PFS (0.34) and OS (0.42) HR and truly manageable added tox- 50% CRS but almost uniformly gr 1/2 and near non-existent ICANS, no new safety signal w durva combo just makes this one of the most impressive SCLC trials/ cancer trials ever..
Given extreme need for better treatments for our pts w ES-SCLC, unprecedented benefit seen in DeLLphi-305 plus availability/experience with use already it is a no-brainer to incorporate into our practice as SOC maintenance therapy on Monday… well, not Mon- whenever your flight takes you back post-#ESMO26
Amazing job by @sands_jacob and Amgen/DeLLphi team- glad we had a chance to offer such a transformational trial to our pts as well at Monte/Einstein!
With these extraordinary results starlatamab is likely to continue to expand into 1st line/LS-SCLC settings and lets just dream on- if we as a field have taken such a tasty first BiTE, can hardly wait for the next one!
Standing ovation- well deserved!
#lcsm
Ibrahim Azar, MD retweeted
NICHE-2. Keeping it short because the plot speaks for itself.
1. Rename it Chalabi's disease
2. Stop operating on patients first
For those who don't know: 111 patients with locally advanced dMMR colon cancer got one dose of ipi and two of nivo, then surgery. Zero events. A flat line.
Next up? Avoid the surgery altogether.
#ESMO2026
@Onco_Nexus
@OncoAlert @TheGutOncLab
Ibrahim Azar, MD retweeted
HERIZON-GEA-01 second OS interim at #ESMO26, and I'm a triplet believer.
In January I wondered if tislelizumab was necessary. With 35 months of follow-up, my answer is yes.
914 patients, 1L HER2+ GEA, randomized 1:1:1 to zani + chemo ± tislelizumab vs trastuzumab + chemo.
Median OS
• Zani + chemo + tisle: 27.0 mo
• Zani + chemo: 22.9 mo
• Tras + chemo: 19.6 mo
3-year OS: 39.8% vs 31.5% vs 22.9%
The doublet now has its own OS win over trastuzumab (HR 0.76, 95% CI 0.62–0.93, p=0.0088). The triplet vs trastuzumab got better with time (HR 0.72 at IA1, now 0.65).
Triplet vs doublet: HR 0.81 (95% CI 0.65–1.00), p=0.0502.
Yes, it technically misses. But 4 more months of median OS is clinically meaningful in metastatic gastric cancer.
Patients also stayed on the triplet longer (~47 vs ~30 weeks), with no new safety signal.
Takeaway: zani + chemo + tisle is my 1L default for HER2+ GEA.
Bring on the bispecifics 🔥
@OncoAlert @TheGutOncLab
@OncoAlert