Discover and read the best of Twitter Threads about #MBC

Most recents (16)

@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 2/5 #TumorBoardTuesday

✅CDK4/6i +endocrine tx= 1L HR+ mBC
✅Ribo =⬆️OS; select based on shared decision
✅After prog on CDK4/6i, eval muts (ESR1, PIK3CA)➡️SERD vs PIK3CAi
✅Benefit in adj- monarchE

📚Here’s @drsarahsam @PTarantinoMD’s thread…
@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 3/5 #TumorBoardTuesday

🎥 TBT in a video: HR+ #mBC tx has changed significantly, esp in 2L setting.

Check out this SHORT video w algorithm to approach tx after progression on CDK4/6i:

A bigger and bigger role for 🎯 medicine to select next best therapy!
@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 4/5 #TumorBoardTuesday

📷 TBT in an image: Selecting CDK4/6i involves shared decision making! Things to keep in mind:

🔹OS benefit seen with ribociclib, but not palbo.
🔹Different toxicity profiles
🔹Medication interactions (QTc prolongation w ribo+ tamoxifen!) Image
Read 10 tweets
@TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 2/5 #TumorBoardTuesday
✅HER2 low= 1+ to 2+ IHC, -FISH
✅T-Dxd approved in 1L HER2 low
✅Watch tox, esp ILD (need reg CT thorax)!
✅TROP-2 ADCs an option (Sacituzumab govitecan); choose based on pt profile, agent tox

📚@drteplinsky’s thread:…
@TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 3/5 #TumorBoardTuesday
🎥 TBT in a video
New 1L T-DXd option for patients w #mBC (HER2 low, ER/PR-).

T-DXd is an antibody drug conjugate (ADC), tethering deruxtecan payload to HER2 ab. Improvements over chemo in mOS and PFS, but watch carefully for ILD and all toxicities!
@TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 4/5 #TumorBoardTuesday
📷 TBT in an image

Check out quick proposed tx algorithm for HR+ & HR- HER2 low disease. Since HER2 low is defined as 1+ through 2+ on IHC with - FISH, up to ‼️60%‼️ of cases previously called HER2 NEGATIVE are actually HER2 LOW! Image
Read 16 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
@TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 2/ #TumorBoardTuesday
Thurs Case🎀

Take🏠messages :
PIK3CA mutations in ER+ #mBC
✅PIK3CA mut are common- 20-30% of all #BreastCancer & 40%+ of ER+ #mBC
✅PIK3CAm are present in founder clones!

📚We captured as much of the discussion as we could:
Pt 1…
@TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 3/5 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages (Part 2):
✅Alpelisib is a PIK3CA inhib= 5.3 mo ⬆️in PFS
✅Side effect mgmt is key- esp. 💩diarrhea,
✅Personalized medicine needs personalized side effect mgmt

Part 2 of our convo…
@TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 4/5 #TumorBoardTuesday
📷 TBT in an image: Take a look at how PIK3CA inhibitors can be clinically deployed, key side effects to watch out for, and the data that supports their use.

👀Look for more developments in this space and even more, highly specific inhibitors to come. Image
Read 13 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 @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation 2/3 #TumorBoardTuesday
Thurs Case🎀


✅3 agents (pembro, atezo, cempilimab) 👍🏽PD-L1 TPS >50% in 1L
– No head to head ICI comparisons
✅OS BETTER w IO alone vs chemo
✅💰tox huge problem!
📚We captured the convo in this moment:…
@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation 2.5/3 #TumorBoardTuesday
Thurs Case🎀

Key factors to choose ICI (in absence of head to head trials):
- Pt experiences/preferences
- Dosing schedule
- $$$ toxicity

The good news: across 3 separate agents (pembrolizumab, atezolizumab, cemiplimab) OS is BETTER w IO alone vs chemo Image
@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation @esinghimd @jacobadashek @KinhHoangMD @RenoHemonc @tanyawildes @OncBrothers 3/3
Thurs Case🎀

Thanks for joining us for #TumorBoardTuesday!

Some scheduling notes:
@jane_meisel’s #BRCA case is rescheduled for 12.20.22

➡️Please be sure to join us on 09/20/22 when @maryam_lustberg @JasmineSukumar present a case focused on PIK3CA inhibition in #mBC 😀
Read 8 tweets
@TumorBoardTues @hoperugo @laura_huppert @ErikaHamilton9 @MPishvaian @PTarantinoMD @stolaney1 @drteplinsky @JaniceTNBCmets @UCSFCancer 2/3 #TumorBoardTuesday
Thurs Case🎀

✅HER2 LOW= IHC1+ OR IHC2+ w - ISH (67% HR+!)
✅T-DXd= after 1L chemo in HER2 low
✅Careful monitoring for ILD!

📚We captured @hoperugo & @LauraHuppert’s discussion in below:……
@TumorBoardTues @hoperugo @laura_huppert @ErikaHamilton9 @MPishvaian @PTarantinoMD @stolaney1 @drteplinsky @JaniceTNBCmets @UCSFCancer @LauraHuppert 2.75/3 #TumorBoardTuesday

Check out this graphic outlining the key role for ADCs in the tx of HER2 low #MBC after prior 1L chemo and endocrine therapy.

Hoping for even more changes in the near future w
DB-06! Image
Read 7 tweets
@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 1/8 #TumorBoardTuesday

🔬🧬Discussion on 1L treatment for BRCA+ #MBC led by @PTarantinoMD @CaterinaSpo #BreastCancer

➡️Here’s the week's Thursday Case 🎀

👉Don’t forget your🆓 #CME credit by answering 1 quick❓
CME eval🔗:
@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 2/8 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages for germline #BRCAm & 2L tx in #BreastCancer
✅BRCAm fairly common - 10-20% of #TNBC
✅PARPi approved in met, BRCAm dz
✅Fast responses, with ORR > chemo

📚Much of @PTarantinoMD @CaterinaSpo’s chat👇🏽…
@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 2.33/8 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages (continued):

✅Toxicities for 🤢, myelosuppression- managed w ⬇️ reduction, tx holiday
‼️(remember 3-5% risk of MDS/AML)‼️
Read 15 tweets
@TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 1/8 #TumorBoardTuesday
🔬🧬@CharuAggrawalMD @ADesaiMD taught us about EGFR mutations in #LungCancer–specifically, new 2L strategies for EGFRexon20m.

➡️Here's this week's Thursday Case🎀
Pick up your 🆓#CME
CME eval🔗:
@TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 2/8 #TumorBoardTuesday
Thurs Case🎀

We discussed #EGFR mutations in #LungCancer
✅Not all EGFR mutations are the same!
✅Osimertinib=tx for most activating EGFR mutations
✅…but exon20insmut more resistant to TKIs
✅Amivantamab, mobocertinib= 2L strategies
@TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 2.5 / 8 #TumorBoardTuesday

📚We captured as much of @CharuAggrawalMD @ADesaiMD’s discussion as we could in this moment:…

CRITICAL point: if you don’t look, you won’t know! RNA based NGS recommended for 🫁cancer cases to identify actionable mut
Read 17 tweets
1/12 #TumorBoardTuesday
2L treatment in #HER2+ breast cancer #MBC is 🤯! @PTarantinoMD led us through latest evidence👩‍⚖️

➡️Here's the Thurs Case🎀
👉Grab🆓 #CME credit by answering quick❓
CME rationale🔗:
Here we go!
2/12 #TumorBoardTuesday
Thurs Case🎀

⬆️ options to tx HER2+ #MBC
✅T-DXd >T-DM1 in 2L setting (DESTINY BREAST-03)
✅Beware ADC tox- think 🫁pneumonitis & GI w T-Dxd
✅ADC design is 🗝:
➡️Need to consider DAR, linker, ability to cause ADCC
✅ADC + IO= open ❓
3/12 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages (cont’d):
✅T-DXd active against brain mets (TUXEDO-1)
✅Triplet (tucatinib, cape, tras) also active in brain mets
✅Next up: T-DXd in HER2 LOW- trials ongoing

📚We captured the discussion here:…
Read 15 tweets
It's Friday evening. And today is the day where I've been patient-involved one too many times. So all of you patient-at-the-heart-of-all-we-dos, this is for you 🧵
I got into patient advocacy because #Melanoma killed my husband in a horrific way. And the healthcare system overall, in particular the clinical trials that were his only option, only added to the insult.
He died barely 37. I was 35. Our daughters 4 and 6. The time between his diagnosis and his death- and the time after- were horrendous. Looking back, I'm not quite sure how I managed. But I DID manage.
Read 72 tweets
This is NOT a reason to choose Medical Aid in Dying. You haven’t run out of options. I STRONGLY suggest talking to someone and working on your #Mentalhealth

*I am NOT making light of this tweet*

I was in the same headspace not too long ago. Please read this @LibbyMbc
Following the deaths of VERY close #MBC friends, coupled with the pandemic, I felt the same way you do now. I was deeply depressed. My #palliativecare team had me speak with a therapist who specializes in people w Cancer.

Mind you I was already on an antidepressant....
I gave her every reason I rationalized why giving up was the answer. My son was old enough -he didn’t “need me” I would end up a burden. My parents are older- It would be easier if I wasn’t “a problem” My husband would be happier w/o me. At the time these were VALID in my head
Read 7 tweets
தமிழக , இட ஒதுக்கீட்டின் , அவலநிலை :

தெரிந்துகொள்ள வேண்டிய , செய்தி.

#ST பட்டியலில் மொத்த சாதிகளின் எண்ணிக்கை = 36. அதில் , 20 வெளியாட்கள்

கொண்டாரெட்டி, மலையாளி, மலையக்கண்டி, ஊராளி, காட்டு நாயக்கர், கம்மாரா, கொரகா, மலை அரையர், குடியா, கண்யான், இது போல இந்த பட்டியலில் உள்ள +
36 சாதிகளில் 20 சாதிகள் பிற மொழியை சார்ந்தவர்கள் உள்ளனர்.

#SC பட்டியலில் மொத்த சாதிகளின் எண்ணிக்கை = 76. இதில் , 40 வெளியாட்கள்

ஆதிஆந்திரர், ஆதிகர்நாடகர், அஜிலா, பைரா, ராணேயர், குஞ்சமா, நாயாடி, டோம், ஜக்கலி, பகூடா , இது போல இந்த பட்டியலில் உள்ள 76 சாதிகளில் 40 சாதிகள் வேறு +
மொழியை சார்ந்தவர்கள்.

#BC பட்டியலில் மொத்த சாதிகளின்எண்ணிக்கை=138.இதில், 65 வெளியாட்கள்

பில்லவா, செளத்திரி, கெளடா, ஜெட்டி, கன்னடிய நாயுடு, கேரளமுதலி, மராட்டியர், ஒதியா, ரெட்டி, சலிவாகனாலம்பாடி, இது போல இந்த பட்டியலில் உள்ள 138 சாதிகளில் 65 சாதிகள் வேறு மொழியை சார்ந்தவர்கள்.+
Read 9 tweets
@BalkaurDhillon @ashokgehlot51 सर,मेरा सवाल भी पूछना,#MBC की छात्राओं को पूर्ववर्ती 'देवनारायण स्कूटी वितरण एवं प्रोत्साहन योजना' के तहत मिलने वाली प्रोत्साहन राशि ₹10,000 प्रति वर्ष स्नातक 2nd &3rd year एवं ₹20,000 प्रति वर्ष परास्नातक को नवीन योजना 'कालीबाई भील स्कूटी योजना' के अनुसार हटा दिया गया है 1/2
@BalkaurDhillon @ashokgehlot51 इससे छात्राओं को प्रत्यक्ष तौर पर आर्थिक रूप से परेशान होना पडेगा और इससे उनके भविष्य पर इसका प्रतिकूल प्रभाव पड़ेगा ।
Read 7 tweets
This is treatment for #MBC:
1) Patient with new metastatic disease. Evidence-based treatment recommended.
2) All documentation collected and submitted with with published evidence as part of Prior authorization.

Aggregate provider time: 35 min
3) Patient called insurance to expedite request. Told to have medical team call.
4) Team calls insurance. Insurance 'mis-coded' original treatment, thus cancelling. Need new submission.
5) New submission completed w all requested documentation

Aggregate provider time: 1hr 15 min
6) Team called insurance. Insurance required re-confirmation of the same documentation. Again.
7) Request cannot be escalated without additional documentation
8) Additional documentation faxed.

Aggregate provider time: 1hr 45 min
Read 8 tweets
Amy Treadway should be VERY ashamed of herself right now.
She used a #MetastaticBC womans' death to promote an organization that FAILED her and the thousands before her. 1/10 #bcsm
Fact: Wendy had a TREATABLE kind of TNBC.
Fact: She found it HERSELF the way many women like her do.
Fact: Wendy was NED before her recurrence to Stage 4
2/10 #bcsm
Amy ignores all of that. She instead focuses on the same crap everyone has heard for over 30yrs yet hasn't moved the needle in the right direction.
3/10 #bcsm
Read 11 tweets

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