Discover and read the best of Twitter Threads about #BCSM

Most recents (24)

@TumorBoardTues 1/15 #TumorBoardTuesday #BCSM #BreastCancer #OncTwitter @drteplinsky

🎯45 yo premenopausal 👩‍🦰
❌relevant medical history.
FHx: Mom 👩‍🦳 with breast cancer at 48y
Screening mammogram normal for the last few years.
Now with microcalcifications 📏3mm in the UOQ of the R breast.
@TumorBoardTues @drteplinsky 2/15 #TumorBoardTuesday #BreastCancer #OncTwitter @MPishvaian @JohnEbbenMDPhD

👩‍🦰Underwent a biopsy
🔬Surgical pathology: Atypical ductal hyperplasia
✂️Underwent a lumpectomy confirming diagnosis and no additional findings

🤔Which of the following would you recommend for her?
Read 19 tweets
🌻This Tuesday 05.16.23 at 8pm ET @drteplinsky @prarthnavb join #TumorBoardTuesday to take us through using baby Tam for high risk lesions & in #BreastCancer

💬Join us!

🧠While we finalize the case, collect FREE #CME

👉🏽 2023👈🏼#OncTwitter #BCSM Join us for a #TumorBoardTu...
@drteplinsky @prarthnavb @MPishvaian @JohnEbbenMDPhD @Dr_RShatsky @hmcarthur @DrSGraff @DrTimothyErick @MdVarvaras @sardesai_sagar @ZainabFatima100 @AnupamaN20 #TumorBoardTuesday

What to recommend for your patients who are high risk #BreastCancer?

👉🏽Join @drteplinsky @prarthnavb Tues 05/16/23 at 8PM ET

📊Respond to polls
Weigh in & bring citations🧾
Retweet & tag your colleagues
🏆Earn FREE CME: Join us for a #TumorBoardTu...

B4⃣ the #BreastCancer case, help us guide the discussion and tell us your connection to🩺 cases like these.

🧐Where you are in your 🩺 journey?

Read 5 tweets
In May 2019, Dr. @rschilsky & I co-chaired the #AAADV19 Workshop Plenary Session "Decentralized #ClinicalTrials: The Future is Now." An incredible group of panelists from academia, industry, govt, & patient #advocacy 👇discussed the rationale, challenges, & opportunities of DCTs. Image
No one knew yet that the #COVID19 #pandemic was just around the corner. In Mar 2020, FDA released a guidance on conduct of #clinicaltrials during the pandemic:…, & colleagues wrote about the impact on #OncTwitter trials:…. /2
FDA has now released a draft guidance on decentralized #clinicaltrials for drugs, biological products, & devices covering #telehealth, remote assessments, consent, shipping of IP, & more:…. #MedTwitter #regulatory #drugdevelopment Image
Read 5 tweets
@TumorBoardTues @JenniferLitton 1/18 #TumorBoardTuesday #BreastCancer #OncTwitter

32 yo 👩🏽
4 months post-partum
FHx paternal uncle with #PanCan
🔬Bx: L breast mass - IDC, G3, ER 50%, PR 30%, HER2 0, Ki67 30%
Clinically node+; FNA confirms LN involvement
🚫 e/o metastatic dz

🤔Do all EXCEPT?
@TumorBoardTues @JenniferLitton 2/18 #TumorBoardTuesday #BCSM @JenniferLitton

🧬 testing returns with BRCA2 path variant
✂️ L mastectomy and ALND
Right risk ⬇️ mastectomy
Found to have 8+/15 LNs
Undergoes adjuvant AC/T

🤔After referring to ☢️ XRT, you discuss which of these treatments?

ET= AI+OS vs Tamoxifen
Read 23 tweets
@TumorBoardTues @drsarahsam 1/24 #TumorBoardTuesday #BreastCancer #OncTwitter
54yo 👩🏻 post-menopausal
FH: aunt with late-onset BC
Germline genetic testing: negative

🔪Dec ‘10 Left lumpectomy + SLNB:
left IDC G2
ER 95%
PgR 10%
HER2-neg (IHC 1+)
Ki67 35%
stage pT2 (25 mm) pN0
Oncotype 32
@TumorBoardTues @drsarahsam 2/24 #TumorBoardTuesday #BCSM

☢️Jan ‘11: TC x 4 ➡️ XRT
Treatment well tolerated, apart from alopecia, G2 fatigue

Summer ‘11 – started letrozole
🔀 Fall ‘11 – switch to exemestane due to G3 arthralgias ➡️ improvement of symptoms

2016 completed 5 years of Aromatase Inhibitor
@TumorBoardTues @drsarahsam 3/24 #TumorBoardTuesday #BCSM

Apr ‘21 – Mild abdo discomfort
🩻CT CAP scan:
liver: 5 lesions, max 15 mm
bone: spine & ribs
enlarged mediastinal lymph nodes
🩸: G1 anemia, normal LFTs, no other abnormality

🔬US-guided liver biopsy:
IDC, grade 2, ER 90%, PR 0%, HER2-0, Ki67 25%
Read 26 tweets
(1/n) One month into my new tenure as a breast oncologist, I realized I needed some sort of structured way to talk with patients about breast cancer, their diagnosis, and treatment options. As a result, I created this worksheet. I’ve used it with every new patient I’ve… Image
(2/n) Seen since. Today, one of those pts thanked me for sitting down with her with this worksheet and “being the first person who helped me and my family understand my diagnosis & options.” Yes, it takes extra time, but I tell myself that I’m saving time on the back end by…
(3/n) Answering questions they might not realize they had. I also like having something to send home for them to reference. I would love to hear from other faculty (or trainees!) about what tools they use to counsel patients! #bcsm #MedTwitter #hemonc @HemOncFellows
Read 4 tweets
1/22 #TumorBoardTuesday #OncTwitter

60yo 👩🏻‍
ER+/PR-/HER2 low met #BreastCancer
Since 2016: 3 lines of endocrine therapy including AI+CDK 4/6 inhibitor ➡️ Fulvestrant ➡️ Everolimus+exemestane
No actionable mutation

🤨 What would be your first chemotherapy choice:
2/22 #TumorBoardTuesday @MPishvaian @JohnEbbenMDPhD #BreastCancer #BCSM

2021*: Started on capecitabine for 8 months until POD
2022: Switched to paclitaxel for 5 months ➡️ POD in the liver and pleura

🤨 What would be your next step?
3/22 #TumorBoardTuesday
👩🏻‍🏫Mini tweetorial 1

📌What is HER2-low?

🔸Traditionally HER2-positive and HER2-negative were separate entities
🔸NOW, HER2-low is a separate entity 👉🏽 1+ or 2+ on IHC and ISH negative‼️

📚@PTarantinoMD @curijoey @stolaney1…
Read 24 tweets
🧬🎯Lurbinectedin, a selective inhibitor of oncogenic transcription, in patients with pretreated germline BRCA1/2 metastatic breast cancer: results from a phase II basket study 1/4 @myESMO @ESMO_Open @OncoAlert #bcsm… Image
Lurbinectedin has antitumor activity against homologous recombination repair-deficient (HRD) cell lines. The mechanism involves irreversible stalling of elongating RNA polymerase II (Pol II) on DNA template and its specific degradation by the ubiquitin/proteasome machinery 2/4
Subsequently, recruitment of DNA repair factors including xeroderma pigmentosum complementation group F nuclease induces the accumulation of double-strand breaks and apoptosis as downstream events. These effects are increased in HRD cells 3/4
Read 4 tweets
@TumorBoardTues @jane_meisel @MPishvaian @JohnEbbenMDPhD 1/17 #TumorBoardTuesday #BreastCancer #OncTwitter @JasmineSukumar @DrGattiMays
👩🏽 65 yo post-menopausal
🔺Triple-neg MBC, germline BRCA1 mut+, PD-L1 neg
👉On carbo/gem for 6 cycles

🩻NOW: Scans show progression in liver

🤨What 2L treatment do you recommend?
@TumorBoardTues @jane_meisel @MPishvaian @JohnEbbenMDPhD @JasmineSukumar @DrGattiMays 2/17 #TumorBoardTuesday #bcsm

🤨 Poll: What percent of all people diagnosed with #BreastCancer carry a germline BRCA 1 and/or 2 mutation?

🤔Are there features that might make you more likely to suspect a patient is a mutation carrier?

@StoverLab @sardesai_sagar @OncoAlert
@TumorBoardTues @jane_meisel @MPishvaian @JohnEbbenMDPhD @JasmineSukumar @DrGattiMays @StoverLab @sardesai_sagar @OncoAlert 3/17 #TumorBoardTuesday
👩🏽‍🏫Mini tweetorial 1👩🏻‍🏫

📌BRCA1/2 mutation

🔸Repair double-stranded breaks thru HRR
🔸Unable to fix 🧬 when damaged ➡️ add’l muts ➡️ cancer
🔸~5% of #BreastCancer;⬆️w/ TNBC
🔸Assoc w/ 40-65% of BC dx in 🚺, ≤ 9% in 🚹
Read 22 tweets
I got into a screaming match with a jerk oncologist who sold out by working for insurance companies to deny claims today. My whole office stopped and stared. But then they clapped after they realized why I was yelling. @premera is denying my patient’s Keytruda for her #TNBC
I asked the oncologist on the line why he was doing what he was doing and he had no answer. I then asked him if this was really the hill he wanted to die on, denying potentially life saving therapy for a young women with bad breast cancer. Again no answer. #MedTwitter #bcsm
He started with some nonsense about how the data wasn’t yet clear if patients really need adjuvant Keytruda and that if I had wanted adjuvant Keytuda she shouldn’t have been treated on the I-SPY2 trial in the neoadjuvant setting😡🤬. This man is not a breast oncologist.
Read 5 tweets
@TumorBoardTues @DrSGraff @CharlesMilrod 1/18 #TumorBoardTuesday #OncTwitter

44 yo👩🏾
Stage 1 triple neg #BreastCancer #TNBC
✂️right lumpectomy
adj ACx4
radiation ☢️

8⃣🗓️months later
New R breast mass, ⬆️fatigue x3 mos
🩻CT many small 🫁 nodules & 4cm liver mass
🔬Breast & Liver ➡️ breast ca ER0% PR0% HER2 1+
@TumorBoardTues @DrSGraff @CharlesMilrod 2/18 #TumorBoardTuesday
Closer look at the biopsies:

🔬Breast: Invasive Ductal Carcinoma w/dense lymphocytic infiltrate, G3, ER 0% PR 0% HER2 1+
🔬Liver: met carcinoma c/w breast primary, ER staining absent

❓What additional testing?

🤨Would it differ with ER+ #BreastCancer?
@TumorBoardTues @DrSGraff @CharlesMilrod 3/18 #TumorBoardTuesday #BreastCancer

📌For metastatic #TNBC

📍Germline BRCA1/2 (gBRCApv) and PD-L1 are 🔑 in early decision making📍

🤔What if she were 3L or beyond?

❓What factors–clinical, genomic–impact decisions?
Read 20 tweets
@TumorBoardTues 1/15 #TumorBoardTuesday #BreastCancer #OncTwitter
59yo 👩🏽
palpable left breast mass
Dx: clinical prognostic stage IIB node positive (cT2N1) ER+/PR-/HER2+ poorly differentiated invasive ductal carcinoma.

She’s referred for neoadjuvant chemotx.
🤨What treatment do you offer her?
@TumorBoardTues 2/15 #TumorBoardTuesday #BCSM
👩🏽 receives neoadjuvant chemotherapy with TCHP.
👩🏽 undergoes left mastectomy & sentinel lymph node biopsy & is found to have 12 mm of residual disease in breast.
No residual disease in the lymph nodes.

🤨 What adjuvant treatment do you recommend?
@TumorBoardTues 3/15 #TumorBoardTuesday
👩🏻‍🏫Mini tweetorial 1

🔸randomized open-label
🔸1486 🚺 with residual invasive HER2-positive early #BreastCancer after neoadjuvant taxane-containing chemotx +/- anthracyclines & trastuzumab
📚von Minckwitz @NEJM
Read 17 tweets
@TumorBoardTues 1/17 #TumorBoardTuesday #bcsm

CASE: 55 yo post-menopausal 👩🏽
🦴metastases, on letrozole+palbociclib 2 yrs
🩻Scans: progression in liver
🔬Liver biopsy: ER 90% PR 90% HER2- (IHC 1+)
Tissue NGS➡️ESR1 & PIK3CA mutation

🤨What 2L tx do you recommend?
@TumorBoardTues 2/17 #TumorBoardTuesday #BCSM #OncTwitter

🤨 What is the prevalence of PIK3CA activating mutations in metastatic HR+/HER2- breast cancer?

@Dr_RShatsky @PTarantinoMD @hoperugo @NicoleKuderer @StoverLab @CarmenCalfa @sardesai_sagar @stolaney1 @OncoAlert
@TumorBoardTues @Dr_RShatsky @PTarantinoMD @hoperugo @NicoleKuderer @StoverLab @CarmenCalfa @sardesai_sagar @stolaney1 @OncoAlert 3/17 #TumorBoardTuesday
👩🏽‍🏫Mini tweetorial 1👩🏻‍🏫

🔸⬆️PI3K/Akt/mTOR pathway➡️cell proliferation, growth & survival
🔸Class I PIK3 proteins have catalytic subunit (p110)
🔸p110 contains 4 isoforms: α, β, γ, δ
🔸p110α mut (PIK3CA encoded)➡️ resistance to ET
📚 Image
Read 19 tweets
@TumorBoardTues @hoperugo 1/20 #TumorBoardTuesday #BCSM #OncTwitter

CASE: 54yo post-menopausal 👩 with HR+/HER2- (IHC 1+, 🐠FISH neg) MBC who had disease progression on 3 lines of endocrine/targeted rx, then capecitabine.

Scans show progression in liver.

🤔 What therapy would you use next?
@TumorBoardTues @hoperugo 2/20 #TumorBoardTuesday

What is HER2-low #BreastCancer?
🔹 HER2 IHC 1+ or 2+/ISH neg
🔹 Large % of HR+ BC (~67%), less in TNBC
🔹 Prognosis/biology indistinct from HER2-0
🔹 Unreliable IHC scoring; need better tests!
🔹 NOT a BC subtype; but targetable
@TumorBoardTues @hoperugo 3/20 #TumorBoardTuesday

Antibody-drug conjugates (ADCs)

Novel chemo delivery system with 3 parts:
1️⃣Targeted ab (selectivity)
3️⃣Cytotoxic payload (potent chemo)

1️⃣Anti-HER2 IgG1 mAb
2️⃣Tetrapeptide-based linker
3️⃣Topo-1 inhibitor
Read 20 tweets
Today, FDA approved Enhertu (fam-trastuzumab deruxtecan-nxki) for unresectable or metastatic HER2-low breast cancer, a newly defined subset of HER2-negative breast cancer. This is the first drug approved to treat this subtype. thread 1/3
About 80-85% of breast cancer diagnosed annually in the US were considered HER2-negative (including HR+ and triple negative breast cancer). Now, about 60% of patients previously considered HER2-negative can be considered HER2-low (IHC 1+ or IHC 2+/ISH‑) 🧵 2/3
Efficacy was based on DESTINYBreast04, a randomized clinical trial enrolling 557 patients with unresectable or metastatic HER2-low breast cancer. FDA approved this application about 4 months ahead of the PDUFA date.
🧵 3/3
Read 5 tweets
@TumorBoardTues 1/19 #TumorBoardTuesday #BreastCancer #OncTwitter

45yo 👩🏼 non smoker 🚭 with 2 kids is diagnosed with T2N0 TNBC
Fmh: mother (78) HTN, grandmother BRCA+
🧪Genetic testing shows BRCA1 mutation

🤨How would you proceed?
@TumorBoardTues 2/19 #TumorBoardTuesday #TNBC
Rxed with Neoadj AC-T (IO not approved at time), followed by B/L mastectomy.

🔬Pathology showed 5mm residual disease.

ER 0%
PR 0%
HER2 0
Ki-67 90%
Stage ypT1aN0

She receives adjuvant capecitabine.
@dradityabardia @MPishvaian @JohnEbbenMDPhD
@TumorBoardTues @dradityabardia @MPishvaian @JohnEbbenMDPhD 3/19 #TumorBoardTuesday #BreastCancer #BCSM
🗓 Two years after completing capecitabine, she’s found to have liver metastases.

🔬 Bx: TNBC, PD-L1+

🤨 What would you do next?
🤨 Would your decision change if she had received neo/adjuvant pembrolizumab?
Read 19 tweets
Is there a role for Local Tx of the Primary Tumor for Patients with Metastatic Cancer?

🚫Many studies demonstrate no benefit.
📌We performed a MetaAnalysis to evaluate the average effect of Local Tx across various tumors.

A thread🧵#AMSM #PRIMETX…

Critics of Local Tx to the Primary Tumor

📌 Many providers think local control of the primary tumor in the setting of M1 dz is akin to “closing the barn door after the horse has bolted”
📌 Ian Tannock wrote a fantastic article on this back in 2000.

Supporters of Local Tx

📌Some support aggressive ablation of all sites due to the enhanced ability to detect occult disease with improved imaging technologies and 📉 toxicities with complete ablation.

Read 28 tweets
@TumorBoardTues @CaterinaSpo 1/16 #TumorBoardTuesday #BreastCancer #OncTwitter

52yo 👩🏻 post-menopausal, no sig comorbidities.
FH: 2 sisters with young onset BC.
Genetic testing: BRCA1+

🔪‘Bilat Mastectomy + left SLNB:

left IDC G3
ER 0%
PgR 0%
HER2 1+ (TNBC)
Ki67 95%

stage pT1c (17 mm) pN0
@TumorBoardTues @CaterinaSpo 2/16 #TumorBoardTuesday

👩🏻 adjuvant TC ➡️ discontinued after 3rd cycle➡️poor tolerance & recurring FN

22 mo. later --> CT: Lt supraclavicular & multi mediastinal LN met, Rt pleural effusion

🔬LN bx: metastasis of TNBC (ER 0%, PgR 0%, HER2 1+, Ki67 81%). PD-L1 CPS: <10%.
@TumorBoardTues @CaterinaSpo 3/16 #TumorBoardTuesday #BCSM

🤨 Which 1L systemic treatment would you choose for a patient with a gBRCA1m and metastatic recurrence of TNBC with the above 👆🏽 characteristics?

@ErikaHamilton9 @FilipaLynce @maryam_lustberg @SusanGKomen @HeekeMd @stolaney1 @barrosolab
Read 16 tweets
@TumorBoardTues @MPishvaian @HeekeMd 1/14

#TumorBoardTuesday #bcsm

Join us to discuss a personalized approach to BC tx in pts with ER+ #bcsm

A 53 yo👩 with HR+, HER2- IDC, very large grade 3 tumor, multiple + nodes

@OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam
@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam 2/14

#TumorBoardTuesday #bcsm

She has 3👨‍👦‍👦,🚭, no comorbidities

FMHx: maternal aunt had gastric cancer & paternal cousin had CRC

Tx with neoadjuvant AC ----> T with some response but significant residual disease. 😥

What info would you need to treat this patient?
@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam 3/14 #TumorBoardTuesday #bcsm Mini-Tweetorial 1

Only 12% of ♀️ in general population develop BC, BUT 55-65% of ♀️ with inherited BRCA1 can develop BC! Image
Read 15 tweets
1/14 🆕 🚨Accelerated article on #breastcancer just out in @nature! #bcsm

We asked:
1️⃣ What drives response to #chemotherapy in #breast #cancer
2️⃣ Can we use #machinelearning to predict response to chemotherapy❓


A 🧵👇👇👇 @OncoAlert
2/14 We are unable to #predict #response to treatment in clinic…

✅Good response ➡️treatment very effective ➡️better survival
❌Poorer response ➡️treatment less effective ➡️worse survival

Being able to forecast response would be a landmark advance!
3/14 We ran a study in women with #breastcancer @CUH_NHS+@CRUK_CI:
1️⃣who had a #cancer biopsy (which we analysed)
2️⃣received 18 weeks of chemo+/-targeted therapy
3️⃣had surgery (and we measured how much cancer remained)

We associated PRE-therapy profiles↔️POST-therapy response👇
Read 14 tweets
1/ The June 2021 Edition of MDA Fellows JCWatch 📰 is now available❗️ Check out all 6️⃣ #journalclub summaries below 👇🏽 that cover GU, GI, & breast medical oncology ➕ classical hematology & SCT! #meded @MDanmolsingh @HemOncFellows @HOJournalClub @Hemoncq @MDAndersonNews
2/ First up, Dr. Ferreri presented an interesting article evaluating the potential to classify tumor microenvironments into one of four subtypes to predict response to immunotherapy ⚡️ 🔗
3/ Next, Dr. @FasaAgbedia presented the results of the phase 3️⃣ ASCENT trial that demonstrated ⬆️ OS and ⬆️ PFS w/ sacituzumab govitecan vs standard single agent chemotherapy in pretreated metastatic TNBC #bcsm 🔗
Read 8 tweets
Delighted to share our new study… introducing PhasED-Seq out today @NatureBiotech.
A fantastic collaboration from @StanfordMedicine led by Dave_Kurtz & Joanne Soo with @max_diehn to help transform #cancer interception & monitoring by improving #LiquidBiopsy #ctDNA detection of #MRD.
For many cancers & nearly all currently available techniques, the impressive KM plots of #ctDNA #MRD immediately after definitive Rx w/ curative-intent unfortunately still miss ~50% of all events which occur in the MRD-negative subset, thus having modest NPV.
Read 21 tweets
@DrAttai T2. Let’s talk now about radiation specifically for breast cancer. We’ll start w/ breast conserving therapy (BCT) – a term for breast conserving surgery w/radiation as a combined strategy with similar results to a mastectomy. #bcsm #radonc 1/
@DrAttai T2. Vera Peters, whose mother had breast cancer, was a radiation oncologist advocating for smaller surgery w/RT in the 1960s-1970s. Amazing researcher and helped push us toward BCT as an option… #bcsm #radonc 2/
@DrAttai T2. The thought initially was that with a smaller breast surgery, we should irradiate the entire breast with whole breast irradiation since we weren’t doing a mastectomy. In a 2D era without molecular medicine it worked great. #radonc #bcsm 3/
Read 15 tweets
@DrAttai T1. Radiation therapy (RT) is the use of ionizing radiation as way to focus subatomic energy to interact with a particular part of body in order to treat a disease. #bcsm #radonc 1/
@DrAttai T1. Radiation oncology is a specialty that evolved out of radiology, which emerged as a medical field with the discovery of the x-ray in 1895. I was a history major, so I’ll share this more as a story #bcsm #radonc 2/
@DrAttai T1. In the early 20th century, radiation used either an electrically generated beam of x-rays at a high energy (x-rays) or by radium, a radioactive element discovered by Marie Curie emitting gamma rays. X-rays and gamma rays are both photons, or light. #bcsm #radonc 3/
Read 19 tweets

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