Discover and read the best of Twitter Threads about #PostTest
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.
🎯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?
👩🦰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?
@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd
@TumorBoardTues @PGrivasMDPhD 1/17 #TumorBoardTuesday #UrothelialCancer #OncTwitter @PGrivasMDPhD
73yo 👴🏼
PMH: HTN, CKD stage 3 (GFR 40), hearing loss
2 month hx flank pain, urinary hesitancy, & hematuria
🩻CT chest abd/pelvis: focal mass-like thickening of anterior bladder wall; no LN-pathy or other mets
73yo 👴🏼
PMH: HTN, CKD stage 3 (GFR 40), hearing loss
2 month hx flank pain, urinary hesitancy, & hematuria
🩻CT chest abd/pelvis: focal mass-like thickening of anterior bladder wall; no LN-pathy or other mets
@TumorBoardTues @PGrivasMDPhD 2/17 #TumorBoardTuesday #UrothelialCancer #BladderCancer @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter
👴🏼 underwent TURBT
🔬biopsy: high grade urothelial carcinoma, micropapillary variant (100%) with involvement of muscularis propria
🧐 What would you do for this pt?
👴🏼 underwent TURBT
🔬biopsy: high grade urothelial carcinoma, micropapillary variant (100%) with involvement of muscularis propria
🧐 What would you do for this pt?
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD @OncoAlert @BCMCancerCenter @Daniel_J_George @BlkBoiScientist @SimaPorten @dawood_findakly @mtsiatas @TomJayram @arnabguonc @KidneyCancerDoc @HHammersMD @arihakimi @AmandaNizamMD @montypal @brian_rini @shilpaonc @DrYukselUrun @TiansterZhang @fuatbcr @UROncDoc @KNJobanputra @minaseconomides @DrRosenbergMSK
@TumorBoardTues 1/15 #TumorBoardTuesday #PanCan #OncTwitter
46yo 👩🏻 asymptomatic
no comorb
🌀Screening abd US: liver nodules + pancreatic mass (body/tail)
🔬Liver bx + NET G2 Ki67 12%
🩻PET-Ga + uptake in pancreas & liver (SUVs>20)
💉1L: Lanreotide SC - DP liver after 1y (⬆️volume)
🤨What 2L tx?
46yo 👩🏻 asymptomatic
no comorb
🌀Screening abd US: liver nodules + pancreatic mass (body/tail)
🔬Liver bx + NET G2 Ki67 12%
🩻PET-Ga + uptake in pancreas & liver (SUVs>20)
💉1L: Lanreotide SC - DP liver after 1y (⬆️volume)
🤨What 2L tx?
@TumorBoardTues 2/15 #TumorBoardTuesday
👩🏻 starts 2L CAPTEM: major partial response🙏🏼
🔪Pancreatectomy + R0 liver resections
🔬Path: NET G3 Ki67 90%
🗓️2 mo later
back pain + weight loss: large retroperitoneal LN
💉3L: rechallenge CAPTEM ➡️ poor clinical control 🔀 Cisplatin + Etoposide
👩🏻 starts 2L CAPTEM: major partial response🙏🏼
🔪Pancreatectomy + R0 liver resections
🔬Path: NET G3 Ki67 90%
🗓️2 mo later
back pain + weight loss: large retroperitoneal LN
💉3L: rechallenge CAPTEM ➡️ poor clinical control 🔀 Cisplatin + Etoposide
@TumorBoardTues 3/15 #TumorBoardTuesday #NETCancer @RachelRiechelm2 @MPishvaian @JohnEbbenMDPhD
👩🏻 DP mediastinal LN after 6 mo
💉4L: FOLFIRINOX with partial response/severe toxicity
📑NGS (Foundation One): very high TMB 97 MSS
🧐What 5L tx would you pick?
👩🏻 DP mediastinal LN after 6 mo
💉4L: FOLFIRINOX with partial response/severe toxicity
📑NGS (Foundation One): very high TMB 97 MSS
🧐What 5L tx would you pick?
@TumorBoardTues @LealTiciana 1/21 #TumorBoardTuesday #LungCancer #OncTwitter
47yo 👨🏽💼🚭
No significant PMHx
Incidental 📏 2.8cm cavitary RLL nodule on coronary calcium scan in 2020
FDG 💥on PET with hilar LN 💥
🫁🎥 Mediastinoscopy shows adenocarcinoma, + subcarinal LN (stage IIIA)
🤨 How would you treat?
47yo 👨🏽💼🚭
No significant PMHx
Incidental 📏 2.8cm cavitary RLL nodule on coronary calcium scan in 2020
FDG 💥on PET with hilar LN 💥
🫁🎥 Mediastinoscopy shows adenocarcinoma, + subcarinal LN (stage IIIA)
🤨 How would you treat?
@TumorBoardTues @LealTiciana 2/21 #TumorBoardTuesday
Due to findings👆🏽
👨🏽💼Began Neoadjuvant cisplatin/pemetrexed x 4
✂️lobectomy in 2020
ChemoIO was not SOC in 2020.
✨Checkmate 816
📍patients excluded if they had EGFR and ALK alterations:
📚@FordePatrick @DrMarkAwad @JulieBrahmer nejm.org/doi/full/10.10…
Due to findings👆🏽
👨🏽💼Began Neoadjuvant cisplatin/pemetrexed x 4
✂️lobectomy in 2020
ChemoIO was not SOC in 2020.
✨Checkmate 816
📍patients excluded if they had EGFR and ALK alterations:
📚@FordePatrick @DrMarkAwad @JulieBrahmer nejm.org/doi/full/10.10…
@TumorBoardTues @LealTiciana @FordePatrick @DrMarkAwad @JulieBrahmer @TonyMok9 @FordePatrick @RamalingamMD @RachelSanbornMD @KarenReckampMD @DrMarkAwad @JulieBrahmer @AnaVManana @DevikaDasMD @JSabari @Exon20Group @CharuAggarwalMD @tehfem @ElizSMcKenna @JineshGheeya @ShrutiPatelMD @NarjustFlorezMD @HosseinBorghaei @ThanksCancer @IASLC @IbiayiMD
@TumorBoardTues @JenniferLitton 1/18 #TumorBoardTuesday #BreastCancer #OncTwitter
32 yo 👩🏽
4 months post-partum
🚫comorbidities
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?
32 yo 👩🏽
4 months post-partum
🚫comorbidities
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
🧬 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
@TumorBoardTues @JenniferLitton @JasmineSukumar @Dr_RShatsky @awolff @jane_meisel @sardesai_sagar @andMORand @MassimoDiMaio75 @MLambouras @melindatelli @IBCradiation @TJH0828 @naborala @MuozMateu @FadwaARahman @emrekocamd @spinmaplered @LeandroJonatad1 @crisonco @adrianakahnmd @MamMa_mimumemo @LauBuisseret
@TumorBoardTues 1/15 #TumorBoardTuesday #BladderCancer #OncTwitter
75yo👴🏽
HTN: Amlodipine
T2DM: Metformin, Insulin
6 mo: haematuria & weight loss
CTCAP: thickened bladder wall with L side hydronephrosis & borderline paraaortic LNS. No distant mets
TURBT: G3 PT2N1M0 bladder TCC
CrCl: 75ml/min
75yo👴🏽
HTN: Amlodipine
T2DM: Metformin, Insulin
6 mo: haematuria & weight loss
CTCAP: thickened bladder wall with L side hydronephrosis & borderline paraaortic LNS. No distant mets
TURBT: G3 PT2N1M0 bladder TCC
CrCl: 75ml/min
@TumorBoardTues 2/15 #TumorBoardTuesday #BladderCancer @tompowles1 @MPishvaian @JohnEbbenMDPhD
👴🏽 Patient opts for cystectomy.
🤔 Should we do a PET scan prior to surgery? Why or why not?
👴🏽 Patient opts for cystectomy.
🤔 Should we do a PET scan prior to surgery? Why or why not?
@TumorBoardTues @tompowles1 @MPishvaian @JohnEbbenMDPhD 3/15 #TumorBoardTuesday #BladderCancer
❌PET scan prior to✂️
🩻PET lacks sensitivity in MIBC (70% in prior study n=43)
📚@adamkibel_uro pubmed.ncbi.nlm.nih.gov/19652070/
clinically negative CT + bone scan, PET/CT had SNS of 70% in MIBC
🧑🏻⚕️🤝👴🏽 #SharedDecision 4 cycles neoadju gem+cis
❌PET scan prior to✂️
🩻PET lacks sensitivity in MIBC (70% in prior study n=43)
📚@adamkibel_uro pubmed.ncbi.nlm.nih.gov/19652070/
clinically negative CT + bone scan, PET/CT had SNS of 70% in MIBC
🧑🏻⚕️🤝👴🏽 #SharedDecision 4 cycles neoadju gem+cis
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance 1/22 #TumorBoardTuesday #ColonCancerAwarenessMonth #OncTwitter @shafiarahman_
62 yo 👨🏼🦳 asymptomatic
🔦 Screening colonoscopy - sigmoid mass
🔬Biopsy + for pMMR/MSS adenocarcinoma
🩻Staging CT + for unresectable liver mets
🤨What first line systemic treatment would you choose?
62 yo 👨🏼🦳 asymptomatic
🔦 Screening colonoscopy - sigmoid mass
🔬Biopsy + for pMMR/MSS adenocarcinoma
🩻Staging CT + for unresectable liver mets
🤨What first line systemic treatment would you choose?
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ 2/22 #TumorBoardTuesday @MPishvaian @JohnEbbenMDPhD #CRCAwarenessMonth
👨🏼🦳started on first line FOLFOX
🧪NGS testing
KRAS/BRAF WT
TMB low
ERBB2 negative
ATM mutation
👨🏼🦳started on first line FOLFOX
🧪NGS testing
KRAS/BRAF WT
TMB low
ERBB2 negative
ATM mutation
@TumorBoardTues @MPishvaian @JohnEbbenMDPhD @CCAlliance @shafiarahman_ 3/22 #TumorBoardTuesday #GI23 #CRCAwareness
👩🏻🏫Mini tweetorial 1👨🏻🏫
↩️Left side tumors more common:
BRAF WT
KRAS WT
HER2 amp
↪️Right side tumors enriched for
BRAF V600E mutation
KRAS Mut
MSI-H
📚@ASCO
👩🏻🏫Mini tweetorial 1👨🏻🏫
↩️Left side tumors more common:
BRAF WT
KRAS WT
HER2 amp
↪️Right side tumors enriched for
BRAF V600E mutation
KRAS Mut
MSI-H
📚@ASCO
@TumorBoardTues 1/17 #TumorBoardTuesday #RenalCancer #OncTwitter
68yo👨🏾
HTN
T2DM
Arthritis
✂️2022: L Radical Nephrectomy
🔬Clear cell #RenalCellCarcinoma
📏8.2 cm, Grade 2, extends into renal vein (T3a)
❓No lymph nodes sampled (NX)
❌No other dz sites
What would you pick for adj therapy?
68yo👨🏾
HTN
T2DM
Arthritis
✂️2022: L Radical Nephrectomy
🔬Clear cell #RenalCellCarcinoma
📏8.2 cm, Grade 2, extends into renal vein (T3a)
❓No lymph nodes sampled (NX)
❌No other dz sites
What would you pick for adj therapy?
@TumorBoardTues 2/17 #TumorBoardTuesday #RCC
🚨There’s significant relapse risk in ≥ Stage II RCC even after local tx✂️
🔢We use tools like Fox Chase’s ASSURE Prognostic nomogram to estimate disease free survival (DFS)
📈Example for our pt below
📚Correa, Andres F cancernomograms.com/nomograms/492
🚨There’s significant relapse risk in ≥ Stage II RCC even after local tx✂️
🔢We use tools like Fox Chase’s ASSURE Prognostic nomogram to estimate disease free survival (DFS)
📈Example for our pt below
📚Correa, Andres F cancernomograms.com/nomograms/492
@TumorBoardTues 3/17 #TumorBoardTuesday @brian_rini
⭐RCC Adjuvant Therapy⭐
⚖️Weighing recurrence risk with a long list 📜 of adj trial results?
💉Focusing on adju IO & review:
✨KEYNOTE-564: Pembro
✨CheckMate 914: Nivo/Ipi
✨IMmotion010: Atezo
✨PROSPER: Periop Nivo
⭐RCC Adjuvant Therapy⭐
⚖️Weighing recurrence risk with a long list 📜 of adj trial results?
💉Focusing on adju IO & review:
✨KEYNOTE-564: Pembro
✨CheckMate 914: Nivo/Ipi
✨IMmotion010: Atezo
✨PROSPER: Periop Nivo
1/26 #TumorBoardTuesday #LungCancer #OncTwitter @DrSteveMartin
⛹🏻♀️Case 1⛹️♂️
80 yo 👵🏼 never 🚬
🩻 Imaging shows R lung mass
🦴 New hip pain found to have R femoral lytic lesion
⚒️Undergoes ORIF R femur
🔬R femur path: metastatic squamous cell carcinoma, TPS 1%
🤔What next?
⛹🏻♀️Case 1⛹️♂️
80 yo 👵🏼 never 🚬
🩻 Imaging shows R lung mass
🦴 New hip pain found to have R femoral lytic lesion
⚒️Undergoes ORIF R femur
🔬R femur path: metastatic squamous cell carcinoma, TPS 1%
🤔What next?
2/26 #TumorBoardTuesday #LCSM
🩸🧬Surprise, surprise - you send ctDNA!
➡️Results show MET Exon 14 skipping mutation (VAF 0.5%)
👵🏼started on MET TKI capmatinib 400mg BID
👍CTCAP 2 months later shows impressive response 🙌🏽
🩸🧬Surprise, surprise - you send ctDNA!
➡️Results show MET Exon 14 skipping mutation (VAF 0.5%)
👵🏼started on MET TKI capmatinib 400mg BID
👍CTCAP 2 months later shows impressive response 🙌🏽
3/26 #TumorBoardTuesday #LCSM
👨🏻🏫Mini tweetorial 1👩🏻🏫
⭐️~10.5% of pts w SCC have actionable alterations
🕵🏻♀️Consider NGS in nonadeno #NSCLC pts who
1⃣🚭or light 🚬hx (1-10 pack yrs)
2⃣young age (dx age <50)
bc potentially ⬆️ prevalence driver muts
📚@IASLC jto.org/article/S1556-…
👨🏻🏫Mini tweetorial 1👩🏻🏫
⭐️~10.5% of pts w SCC have actionable alterations
🕵🏻♀️Consider NGS in nonadeno #NSCLC pts who
1⃣🚭or light 🚬hx (1-10 pack yrs)
2⃣young age (dx age <50)
bc potentially ⬆️ prevalence driver muts
📚@IASLC jto.org/article/S1556-…
@TumorBoardTues @drsarahsam 1/24 #TumorBoardTuesday #BreastCancer #OncTwitter
54yo 👩🏻 post-menopausal
HTN
hypothyroidism
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
54yo 👩🏻 post-menopausal
HTN
hypothyroidism
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
☢️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%
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%
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell 4/23 #TumorBoardTuesday
👩🏽🏫Mini tweetorial 1👩🏽🏫
📚@NCCN based #NSCLC guide for biomarker neg, PDL1 <1% ⤵️
CATEGORY 1 RECOMMENDATIONS
📍Pembro + carboplatin + paclitaxel
📍Pembro + carboplatin + nab-paclitaxel
📍Ipi/Nivo + carbo + paclitaxel
📍Cemiplimab + carbo + paclitaxel
👩🏽🏫Mini tweetorial 1👩🏽🏫
📚@NCCN based #NSCLC guide for biomarker neg, PDL1 <1% ⤵️
CATEGORY 1 RECOMMENDATIONS
📍Pembro + carboplatin + paclitaxel
📍Pembro + carboplatin + nab-paclitaxel
📍Ipi/Nivo + carbo + paclitaxel
📍Cemiplimab + carbo + paclitaxel
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell @NCCN 5/23 #TumorBoardTuesday
👩🏽🏫Mini tweetorial 2👩🏽🏫
✨KEYNOTE-407✨
♦️Phase III
♦️Untreated metastatic, squamous NSCLC
♦️Pts randomized 1:1 pembro+platinum-doublet vs plat doublet alone
♦️Median OS 15.9 mos vs 11.3 mos
♦️69.8% of grade 3+ AEs in pembro-combo vs 68.2% in placebo-combo
👩🏽🏫Mini tweetorial 2👩🏽🏫
✨KEYNOTE-407✨
♦️Phase III
♦️Untreated metastatic, squamous NSCLC
♦️Pts randomized 1:1 pembro+platinum-doublet vs plat doublet alone
♦️Median OS 15.9 mos vs 11.3 mos
♦️69.8% of grade 3+ AEs in pembro-combo vs 68.2% in placebo-combo
@NarjustFlorezMD @TumorBoardTues @drRTee @ADesaiMD @esinghimd @FawziAbuRous @ALKpositiveINT @Rothangpuia5 @SamuelKareffMD @AlyaShamsan @LVaezi @n8pennell @NCCN 6/23 #TumorBoardTuesday
👩🏽🏫Mini tweetorial 3👩🏽🏫
✨CHECKMATE 9LA ✨
♦️ Phase III in untreated metastatic NSCLC
♦️ patients randomized 1:1 nivolumab+ipilimumab + 2 cycles chemo vs 4 cycles chemo
PFS KM Curves in Squamous Pts ⬇️
👩🏽🏫Mini tweetorial 3👩🏽🏫
✨CHECKMATE 9LA ✨
♦️ Phase III in untreated metastatic NSCLC
♦️ patients randomized 1:1 nivolumab+ipilimumab + 2 cycles chemo vs 4 cycles chemo
PFS KM Curves in Squamous Pts ⬇️
@TumorBoardTues @TomJayram @arnabguonc @UroCancerMD @vinay_onc @simon_p_kim @AlexAlvaro_PSC @AlyaShamsan @MichaelStaehler @DrOmarMian @kaydaustin @josiegarcia1 @LeeJonesMBA @mcricardoa @UroDocAsh @Uromigos @AJangMD @BenMironMD @ChrisSweens1 @Tanjin097 @NikiTripathi27 1/15 #TumorBoardTuesday #BladderCancer #OncTwitter
71 y/o 👨🏽🦳
Former 🚬
👨🏭Worked in various factories in 80s-00s
Recently diagnosed metastatic #UrothelialCancer (lymph nodes/lung)
🤨 What would you pick for your first line of therapy?
71 y/o 👨🏽🦳
Former 🚬
👨🏭Worked in various factories in 80s-00s
Recently diagnosed metastatic #UrothelialCancer (lymph nodes/lung)
🤨 What would you pick for your first line of therapy?
@TumorBoardTues @TomJayram @arnabguonc @UroCancerMD @vinay_onc @simon_p_kim @AlexAlvaro_PSC @AlyaShamsan @MichaelStaehler @DrOmarMian @kaydaustin @josiegarcia1 @LeeJonesMBA @mcricardoa @UroDocAsh @Uromigos @AJangMD @BenMironMD @ChrisSweens1 @Tanjin097 @NikiTripathi27 2/15 #TumorBoardTuesday
1L treatment for UC
📍cis eligible: SOC is gem/cis
📚pubmed.ncbi.nlm.nih.gov/11001674/
📍Frontline EV+P promising early phase results in cis-ineligible
📚ascopubs.org/doi/abs/10.120…
📍Ongoing ph3 trial: EV+pembro vs gem/cis (or carbo) clinicaltrials.gov/ct2/show/NCT04…
1L treatment for UC
📍cis eligible: SOC is gem/cis
📚pubmed.ncbi.nlm.nih.gov/11001674/
📍Frontline EV+P promising early phase results in cis-ineligible
📚ascopubs.org/doi/abs/10.120…
📍Ongoing ph3 trial: EV+pembro vs gem/cis (or carbo) clinicaltrials.gov/ct2/show/NCT04…
@TumorBoardTues @TomJayram @arnabguonc @UroCancerMD @vinay_onc @simon_p_kim @AlexAlvaro_PSC @AlyaShamsan @MichaelStaehler @DrOmarMian @kaydaustin @josiegarcia1 @LeeJonesMBA @mcricardoa @UroDocAsh @Uromigos @AJangMD @BenMironMD @ChrisSweens1 @Tanjin097 @NikiTripathi27 @PGrivasMDPhD @PauloBergerot @spsutkaMD @shilpaonc @montypal @tompowles1 @NazliDizman 3/15 #TumorBoardTuesday
Checkpoint☑️
✅Pembrolizumab: approved as single agent for those NOT eligible for platinum chemotherapy
📚thelancet.com/journals/lanon…
BUT
✨KEYNOTE-361: adding pembro to platinum based chemo did NOT result in PFS/OS improvement
📚thelancet.com/journals/lanon…
Checkpoint☑️
✅Pembrolizumab: approved as single agent for those NOT eligible for platinum chemotherapy
📚thelancet.com/journals/lanon…
BUT
✨KEYNOTE-361: adding pembro to platinum based chemo did NOT result in PFS/OS improvement
📚thelancet.com/journals/lanon…
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:
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?
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 aacrjournals.org/cancerdiscover…
👩🏻🏫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 aacrjournals.org/cancerdiscover…
💥#EndometrialCancer TKI/IO safety data & AE mgmt webinar 💥┈┈┈ w @DrMMurphy & @drteplinsky ┈┈┈🔹#CME info 👉 bit.ly/3Vqtabi 👈 @BonumCE ┈┈┈🔸Supported by edu grants from Eisai & @Merck 🔹#TumorBoardTuesday #gyncsm #OncTwitter twitter.com/i/broadcasts/1…
1/#TumorBoardTuesday #OncTwitter
#1:Answer #PreTest❓bit.ly/PreTest-AEs-EC
#2:Tell us who u are👇
#3:🔁Retweet & tag colleagues
🧧#CME ℹ️bit.ly/3Vqtabi
Supported by edu grants from Eisai & @Merck
🟢Where r u in your career?
#1:Answer #PreTest❓bit.ly/PreTest-AEs-EC
#2:Tell us who u are👇
#3:🔁Retweet & tag colleagues
🧧#CME ℹ️bit.ly/3Vqtabi
Supported by edu grants from Eisai & @Merck
🟢Where r u in your career?
2/#TumorBoardTuesday #BonumCE #OncTwitter #GynCSM #gynonc #EndometrialCancer
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3YRDkog
📸 Faculty disclosures & important CME info 👇
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3YRDkog
📸 Faculty disclosures & important CME info 👇
💥#EndometrialCancer TKI/IO safety data & AE mgmt webinar 💥┈┈┈ w @DrMMurphy & @drteplinsky ┈┈┈🔹#CME info 👉 bit.ly/3Vqtabi 👈 @BonumCE ┈┈┈🔸Supported by edu grants from Eisai & @Merck 🔹#TumorBoardTuesday #gyncsm #OncTwitter twitter.com/i/broadcasts/1…
1/#TumorBoardTuesday #OncTwitter
#1:Answer #PreTest❓🔗bit.ly/EC_AEs_TBTpre
#2:Tell us who u are👇
#3:🔁Retweet & tag colleagues
🧧#CME ℹ️bit.ly/3Vqtabi
Supported by edu grants from Eisai & @Merck
🟢Where r u in your career?
#1:Answer #PreTest❓🔗bit.ly/EC_AEs_TBTpre
#2:Tell us who u are👇
#3:🔁Retweet & tag colleagues
🧧#CME ℹ️bit.ly/3Vqtabi
Supported by edu grants from Eisai & @Merck
🟢Where r u in your career?
3/#TumorBoardTuesday #BonumCE #OncTwitter #GynCSM #gynonc #EndometrialCancer
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3YRDkog
📸 Faculty disclosures & important CME info 👇
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3YRDkog
📸 Faculty disclosures & important CME info 👇
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD 1/19 #TumorBoardTuesday #BladderCancer #OncTwitter
74 yo🧓🏼
HTN
DM2
2020: localized Rt upper tract urothelial carcinoma
2020: ✂️ radical nephroureterectomy
🧪Germline testing negative
Complicated by CKD stage 4 after ✂️ (creatinine clearance 25 ml/min)
🩻Restaging CT CAP 1 year
74 yo🧓🏼
HTN
DM2
2020: localized Rt upper tract urothelial carcinoma
2020: ✂️ radical nephroureterectomy
🧪Germline testing negative
Complicated by CKD stage 4 after ✂️ (creatinine clearance 25 ml/min)
🩻Restaging CT CAP 1 year
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD 🩻 NEW metastatic disease to spine, 🫁 and retroperitoneal lymph nodes
ECOG PS 2
🔬Biopsy of RP lymph node: Metastatic #UrothelialCarcinoma
🧪Molecular: FGFR3-TACC3 fusion, MTAP loss, CDKN2A loss
🤨 What 1L treatment would you pick for this patient?
ECOG PS 2
🔬Biopsy of RP lymph node: Metastatic #UrothelialCarcinoma
🧪Molecular: FGFR3-TACC3 fusion, MTAP loss, CDKN2A loss
🤨 What 1L treatment would you pick for this patient?
@TumorBoardTues @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD 3/19 #TumorBoardTuesday @PGrivasMDPhD @MPishvaian @JohnEbbenMDPhD #UrothelialCancer
🤔 Is the above 74yo 🧓🏼 patient a good candidate for platinum-based chemotherapy?
🤨 Poll: Which of these criteria would make this patient platinum-ineligible?
🤔 Is the above 74yo 🧓🏼 patient a good candidate for platinum-based chemotherapy?
🤨 Poll: Which of these criteria would make this patient platinum-ineligible?
@TumorBoardTues @jane_meisel @MPishvaian @JohnEbbenMDPhD 1/17 #TumorBoardTuesday #BreastCancer #OncTwitter @JasmineSukumar @DrGattiMays
👩🏽 65 yo post-menopausal
🚫comorbidities
🔺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?
👩🏽 65 yo post-menopausal
🚫comorbidities
🔺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
🤨 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 🚹
📚science.org/doi/10.1126/sc…
👩🏽🏫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 🚹
📚science.org/doi/10.1126/sc…
@TumorBoardTues @MPishvaian 1/18 #TumorBoardTuesday #RenalCancer #OncTwitter
60yo 👴🏽#RenalCell dx in 2022 tx with right radical nephrectomy
6mo f/u
Uses WC d/t DM2 - limited mobility & homebound
🤨 What would be your next step?
60yo 👴🏽#RenalCell dx in 2022 tx with right radical nephrectomy
6mo f/u
Uses WC d/t DM2 - limited mobility & homebound
🤨 What would be your next step?
@TumorBoardTues @MPishvaian 2/18 #TumorBoardTuesday
🩻Lung nodules, mediastinal lymphadenopathy🫁
🔬: Bx returns as metastatic clear cell #RCC
➡️1st relapse at 6mo f/u
👴🏽 limited mobility and difficult time leaving the house.
🤨 What treatment would you select for this patient?
🩻Lung nodules, mediastinal lymphadenopathy🫁
🔬: Bx returns as metastatic clear cell #RCC
➡️1st relapse at 6mo f/u
👴🏽 limited mobility and difficult time leaving the house.
🤨 What treatment would you select for this patient?
@TumorBoardTues 1/15 #TumorBoardTuesday #GastricCancer #OncTwitter
Here goes
🎬Starting out with an overall poll Q
When a new advanced GC/GEJ patient presents to your clinic, your institution reflexively tests for which of the following?
Here goes
🎬Starting out with an overall poll Q
When a new advanced GC/GEJ patient presents to your clinic, your institution reflexively tests for which of the following?
@TumorBoardTues 2/15 #TumorBoardTuesday
68y/o with poorly diff gastric cardia adeno, diffuse LAD, +peritoneal mets.
🧬Biomarkers HER2-, PD-L1-, MSS
🧪Pre-screened for trials & FGFR2b-, Claudin18.2+
🔦Enrolls in frontline SPOTLIGHT trial.
❓What is Claudin18.2?
❓What is SPOTLIGHT?
68y/o with poorly diff gastric cardia adeno, diffuse LAD, +peritoneal mets.
🧬Biomarkers HER2-, PD-L1-, MSS
🧪Pre-screened for trials & FGFR2b-, Claudin18.2+
🔦Enrolls in frontline SPOTLIGHT trial.
❓What is Claudin18.2?
❓What is SPOTLIGHT?
@TumorBoardTues 3/15 #TumorBoardTuesday
✨Claudin18.2 (CLDN18.2)✨
Transmembrane protein typically present in tight junctions of gastric mucosal cells, maintains barrier function of gastric mucosa, & prevents leakage of H+ in gastric acid through paracellular pathways.
✨Claudin18.2 (CLDN18.2)✨
Transmembrane protein typically present in tight junctions of gastric mucosal cells, maintains barrier function of gastric mucosa, & prevents leakage of H+ in gastric acid through paracellular pathways.
@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+
Now?
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+
Now?
@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?
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?
📌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?
@TumorBoardTues 1/17 #TumorBoardTuesday #LungCancer #OncTwitter
42yo 👨🏽💼
PMH: never smoker
persistent cough
🩻PET/CT: 3.5 cm mass LLL & bulky, coalescing LNs in L hilum & mediastinum (AP 🪟, subcarinal, bilat paratracheal, supraclav)
Axillary LNs
🦴multi bony mets
🫀small pericardial effusion
42yo 👨🏽💼
PMH: never smoker
persistent cough
🩻PET/CT: 3.5 cm mass LLL & bulky, coalescing LNs in L hilum & mediastinum (AP 🪟, subcarinal, bilat paratracheal, supraclav)
Axillary LNs
🦴multi bony mets
🫀small pericardial effusion
@TumorBoardTues 2/17 #TumorBoardTuesday #LungCancer #NSCLC
🫁🎥Mediastinoscopy shows adenocarcinoma with signet rings.
🔬 ALK IHC positive
🐟 FISH positive
🧬 PDL1 = 0
🤨What’s your recommended initial therapy:
🫁🎥Mediastinoscopy shows adenocarcinoma with signet rings.
🔬 ALK IHC positive
🐟 FISH positive
🧬 PDL1 = 0
🤨What’s your recommended initial therapy:
@TumorBoardTues 3/17 #TumorBoardTuesday #LCSM
🧲MRI: Brain shows 4 CNS mets in frontal lobes & cerebellum
📏 = 13, 10, 8 and 4 mm
💧No edema
🧠 no neuro symptoms
🤨 Does the presence of CNS mets change your 1st line recommendation?
A = alectinib
B = brigatinib
L = lorlatinib
🧲MRI: Brain shows 4 CNS mets in frontal lobes & cerebellum
📏 = 13, 10, 8 and 4 mm
💧No edema
🧠 no neuro symptoms
🤨 Does the presence of CNS mets change your 1st line recommendation?
A = alectinib
B = brigatinib
L = lorlatinib
📽️Watch NOW & Summit #HCC Mts🏔---🧗🏽AEs w AA ICIs & combos--- 🧗♂️Practical approaches & nuances---🧭w @MarkYarchoan @marinabaretti @MPishvaian---🆓#CME BonumCE🔗bit.ly/3D2O60S---Supp… by edu grants from Eisai & @Merck---#TumorBoardTuesday twitter.com/i/broadcasts/1…
🪂BEFORE diving in 🪂…
🔗👇open link below (right click🖱️> open in 🆕tab)
✅ Answer #PreTest polls
🔁Retweet & tag colleagues
🔗👇open link below (right click🖱️> open in 🆕tab)
✅ Answer #PreTest polls
🔁Retweet & tag colleagues
3/ #TumorBoardTuesday #HCC #OncTwitter #GITwitter #LiverTwitter
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3D2O60S
📸 Faculty disclosures & important CME info 👇
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3D2O60S
📸 Faculty disclosures & important CME info 👇
@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?
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?
👩🏽 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
✨KATHERINE Trial✨
🔸randomized open-label
🔸1486 🚺 with residual invasive HER2-positive early #BreastCancer after neoadjuvant taxane-containing chemotx +/- anthracyclines & trastuzumab
📚von Minckwitz @NEJM pubmed.ncbi.nlm.nih.gov/30516102
👩🏻🏫Mini tweetorial 1
✨KATHERINE Trial✨
🔸randomized open-label
🔸1486 🚺 with residual invasive HER2-positive early #BreastCancer after neoadjuvant taxane-containing chemotx +/- anthracyclines & trastuzumab
📚von Minckwitz @NEJM pubmed.ncbi.nlm.nih.gov/30516102
@TumorBoardTues 1/17 #TumorBoardTuesday #LCSM #OncTwitter
50y 👩🏻 never 🚬 presents with cough
🩻CT: 2cm RLL 🫁 mass & pleural effusion
💧Tap of pleural fluid: adenocarcinoma TTF1+ (T1bN0M1a) Stage 4A #NSCLC
🧪NGS: exon19 deletion EGFR mutation & PDL1 70%+
🤨What’s most appropriate initial tx?
50y 👩🏻 never 🚬 presents with cough
🩻CT: 2cm RLL 🫁 mass & pleural effusion
💧Tap of pleural fluid: adenocarcinoma TTF1+ (T1bN0M1a) Stage 4A #NSCLC
🧪NGS: exon19 deletion EGFR mutation & PDL1 70%+
🤨What’s most appropriate initial tx?
@TumorBoardTues 2/17 #TumorBoardTuesday #LCSM
👩🏻 starts osimertinib with resolution of effusion
She has🧴dry skin & occasional 💩diarrhea managed with loperamide
After 18 months she develops headache
🧲MRI brain shows new 2cm 🧠 metastasis with edema
🤨What’s the most appropriate next step?
👩🏻 starts osimertinib with resolution of effusion
She has🧴dry skin & occasional 💩diarrhea managed with loperamide
After 18 months she develops headache
🧲MRI brain shows new 2cm 🧠 metastasis with edema
🤨What’s the most appropriate next step?
@TumorBoardTues 3/17 #TumorBoardTuesday #LCSM
👨🏼🏫Mini tweetorial 1
EGFR mutations
📍≈15% of🫁adenocarcinomas
📍More common in light or never smokers, women, & Asian ethnicity
📍90% sensitizing & either exon19 del/ins or L858R mut in exon21
@NatureRevCancer Sharma et al
nature.com/articles/nrc20…
👨🏼🏫Mini tweetorial 1
EGFR mutations
📍≈15% of🫁adenocarcinomas
📍More common in light or never smokers, women, & Asian ethnicity
📍90% sensitizing & either exon19 del/ins or L858R mut in exon21
@NatureRevCancer Sharma et al
nature.com/articles/nrc20…
