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Nat Lester-Coll, MD

@DrLesterColl

Chair, Radiation Oncology, University of Vermont Health
Burlington, VT Joined January 2014
1.4K Following 4.6K Followers 7K Posts

Latest posts 5

Nat Lester-Coll, MD @DrLesterColl
Target-trial emulation is still observational research. Treatment selection isn't random.

Same core concern as other observational comparisons: unmeasured confounding, particularly confounding by indication.

Better design helps, but doesn't replace randomization.
Nat Lester-Coll, MD @DrLesterColl
Great breakdown👇

Clean randomized signal for pembro + MDT in oligometastatic RCC:

RFS 11 → 25.4 mo (HR 0.47), 72% got SABR

Next Q: patterns of recurrence after MDT ± pembro

#radonc #ESMO26
Jeff Ryckman Verified account @jryckman3 Oct 26
PE-PE is a fantastic study, giving us randomized data on adding pembrolizumab to MDT in oligometastatic RCC!

Phase II, open-label, multicenter trial: 85 pts with prior nephrectomy and ≤3 mets within 5y of nephrectomy or previous metastasectomy, all amenable to surgery or SABR. Randomized 2:1 favoring pembro: MDT alone (n=29) vs pembro + MDT (n=56).

Pembro 400 mg q6w x9c (1y). First dose BEFORE MDT; registry specifies MDT on C1d21-42.

At MFU 17.5 mo, median RFS was 11→ 25.4 mo (HR 0.47, 95CI 0.24-0.92, p=0.024), MDT alone→ pembro + MDT. 35 RFS events, 16→ 19.

SABR 72→ 73%; surgery 28→ 23%. SABR dose/fx and per-site data weren't reported. I'd like to see those details along with local vs distant relapse.

Any AE 21→ 80%; G3 AEs 3→ 7%. The 21% control rate is with no study systemic therapy. Pembro-related AEs occurred in 59%, including G3 in 2 pts; no G4/5 pembro-related events were reported. Four pts stopped pembro for AEs.

Both groups received MDT, so the randomized question is what pembro adds. This doesn't establish the benefit of MDT itself or RT-ICI synergy. With 1 death/arm and no QoL results reported, an OS/QoL benefit remains unestablished.

I'd also like the prior systemic therapy history and the timing/burden at first metastatic presentation. The eligibility window alone doesn't tell us whether these pts were oligometastatic from the outset.

Congratulations to the investigators on this important work!

cslide.ctimeetingtech.com/esmo2026/atten…

#radonc #ESMO26 #RCC
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Nat Lester-Coll, MD @DrLesterColl
Honored to be elected to the @nnecos_oncology Board. NNECOS brings together oncology across ME, NH, and VT & gives our trainees a real regional stage. Looking forward to the work ahead with colleagues across the region.
NNECOS @NNECOS_ONCOLOGY Oct 26
2026 NNECOS BOD Election Results
Thanks to all who participated in the 2026 NNECOS Board of Directors Election, as candidates and as voters. We are pleased to announce the following individuals have been elected/reelected to a three year term on the board, which begins January 1.
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Nat Lester-Coll, MD @DrLesterColl
#ESMO26 @niazi_Dr7 DASL-HiCaP (ANZUP1801)

n=1,106 | mFU 3.8 yrs | 85% definitive RT

darolutamide + ADT + RT v placebo + ADT + RT

MFS-CI ➡️ HR 0.42 (0.27–0.66)
4-yr MFS 95% vs 88%
Shankar Siva Verified account @_ShankarSiva Oct 24
🚨📣📣 #ESMO26 presidential: @niazi_Dr7 Adding darolutamide to ADT + RT dramatically ⬇️ risk of metastasis or death in high-risk localized prostate cancer. Phase 3 DASL-HiCaP = 58% ⬇️ in MFS (HR 0.42) + early OS signal (HR 0.88). #ProstateCancer #RadOnc #pcsm @ChrisSweens1
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