Discover and read the best of Twitter Threads about #lungcancer

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1/8 IT’S #TumorBoardTuesday CASE WRAP UP TIME!

🫁@NarjustFlorezMD @ShrutiPatelMD taught us about EGFR mutated #NSCLC & adjuvant therapy–rapidly changing field. Summary below!

👉Don’t forget to grab🆓#CME (AMA/MOC) w 2 quick❓ CME eval & rationale🔗: integrityce.com/tbteval Image
2/8 #TumorBoardTuesday
Thurs Case🎀

Take🏠-pt 1
We discussed #NSCLC & EGFRm
✅EGFR mutations:
🔹Female>Male;
🔹Never smoker >> smoker
✅NEED‼️NGS data‼️BEFORE systemic tx. Order panel of common EGFR muts if limited time.

We captured much of chat:
P1: twitter.com/i/events/15369…
2.33 #TumorBoardTuesday
Thurs Case🎀
Take🏠msgs:
✅Osimertinib= EGFRi w demonstrated DFS⬆️in adj setting; waiting on OS data
✅Osi best TKI (Drake says so), diff strategies for diff mutations (i.e. ex20)
✅THINK about side FX, including fertility

P2: twitter.com/i/events/15372…
Read 15 tweets
@TumorBoardTues 1/16 #TumorBoardTuesday #LungCancer #OncTwitter

38yo 👩🏻with remote 8 pk-yr 🚬hx
CP & diarrhea
PMH: None
🩻: 2 cm focal consolidations in the LLL
PET: GGO in LLL SUV 4.5
🔪+ mediastinal staging
🔬pT2a, pN1 (Stage IIB) lung adenoCa
🤨What adjuvant systemic tx would YOU give next?
@TumorBoardTues 2/16 #TumorBoardTuesday #LCSM #LungCancer

🧪 Resected 🫁 tissue tested
🦠 Tissue NGS and IHC was sent 🧬
🔬 NGS: EGFR exon 19 deleted
🔬 PD-L1 52%

🤨 What adjuvant treatment plan do you initiate next?
@TumorBoardTues 3/16 #TumorBoardTuesday #LungCancer
👩🏽‍🏫Mini tweetorial 1 👩🏽‍🏫

🚩🚩🚩 for EGFR mutations

🚩 Asian >> Western - 47.9% vs 19.2% according to metaA
🚩 Higher in NEVER smoker 🚭
🚩 More prevalent in females
🚩 Pathologic Subtype (adeno>>SCC)
Read 18 tweets
@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation 1/13 #TumorBoardTuesday #LCSM
➡️Here’s this week's Thursday Case🎀!

🧬@Latinamd @GDutcherMD took us through METex14 skipping in older pts with 🫁#NSCLC.

👉Get 🆓#CME credit with quick❓

CME eval 🔗: integrityce.com/tbteval

@SylvesterCancer
@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 2/13 #TumorBoardTuesday
Thurs Case🎀

Take🏠points:

#LungCancer= molecular disease

✅IDEAL=wait for NGS before tx
✅Send tissue NGS & ct🧬
✅MET mut= RTK driver- rare!
🔷MET exon 14 skipping best detected w RNAseq
🔷Capmatinib/tepotinib= FDA👍🏽
✅METi side effects: 🤨EDEMA
@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 3/13 #TumorBoardTuesday
Thurs Case🎀

Take🏠points (cont’d):

✅🎯tx preferred in 1L >> IO
🗝️ IO first 👉🏽TKI (osi) 👉🏽⬆️irAE
✅Older pts may need dose adjustment of TKI d/t tox
✅MET bispecifics (amivantamab) & ADCs coming!
Read 20 tweets
1/15 #TumorBoardTuesday #LungCancer #OncTwitter

83 yo👩🏽 remote 🚬 with good PS presents with SOB
PMhx: Afib, mild cognitive dysfunction
🩻: RML 6x3cm mass & pleural effusion
🫁: Stage IV lung adenocarcinoma
PDL1 90%

🎂Does age impact tx decision?
📊How would you Tx this pt?
2/15 #TumorBoardTuesday

✅ Tissue NGS and💧liquid biopsy ordered
🔬Liquid biopsy comes with MET Ex 14 skip mutation
✅Confirmed with tissue NGS based assay (🧬RNA and 🧬DNA sequencing)

👉🏽Do you start 1L immunotherapy or 🎯therapy?
Read 21 tweets
1/

🚨Delighted to do a quick #tweetorial on our short report in the💚#GreenJournal @RadiotherapyOn1

☢️Heterogeneous immunogenicity of SARS-CoV-2 vaccines in #cancer patients receiving
#radiotherapy💉

➡️thegreenjournal.com/article/S0167-…

#radonc #COVID19 #CovidVaccine #lcsm
#OncoAlert
2/

Inspired by:

[Our patients]
Doctor, is the #radiotherapy I am getting affecting how well my #CovidVaccine works?

[Us]
🤷
3/

There is large heterogeneity when looking at immunogenicity of #COVID19 vaccines in #cancer patients & esp #lungcancer patients shown by @vivek_naranbhai & team in @JCO_ASCO

Chemo may suppress antibody levels somewhat.
What about #radiotherapy?

➡️ascopubs.org/doi/pdf/10.120…
Read 8 tweets
Oggi vi parlo di cosa studiamo in laboratorio. Da oltre cinque anni in @operapadrepio con il team della dott.ssa Muscarella lavoriamo alle lesioni molecolari nel tumore polmonare di un gene chiamato #NRG1. Mi scuso in anticipo per alcuni tecnicismi che troverete. 1/18
#lungcancer
Intro. In particolar modo il focus è sulle fusioni geniche che interessano riarrangiamenti a carico delle Neureguline (NRG1-4) recentemente descritti nel carcinoma polmonare non a piccole cellule (NSCLC). Ma andiamo per ordine, partendo dalle basi. 2/18
Le basi/1. Per fusione genica si intende un’alterazione in cui due geni si fondono andando a formare un gene “anomalo”, il più delle volte originatosi dalla prima metà di un gene e dalla seconda metà del secondo. 3/18
Read 18 tweets
Very happy to present our #proteomics analysis of #lungcancer published today @NatureCancer!🙂
Here’s a walk-through: #MassSpec analysis covering almost 14k proteins in 141 NSCLC tumors revealed 6 proteome subtypes with distinct biology. 1/6
rdcu.be/cBOtU
#NSCLC proteome subtypes are driven by histology, growth pattern, immune cell infiltration, driver mutations, oncogenic pathways, and cell types, suggesting potential clinical value for treatment stratification and #PrecisionMedicine. 2/6
Unexpectedly, #proteogenomics analysis revealed that high neoantigen burden was linked to global hypomethylation, and that complex neoantigens mapping to genomic regions normally not active in lung were produced in immune-cold subtypes. 3/6
Read 6 tweets
1/ 🙏 patients, investigators and funders for
@TROGfightcancer 13.01 SAFRON II trial at #ESTRO21. n=90 pts with 133 pulmonary oligometastases, across 13 centers in 🇳🇿+🇦🇺. Median F/U = 3 years, randomization for single (SF) 28Gy vs 48Gy in 4fx (MF). #radonc #LCSM @PeterMacCC
2/ No difference in SF vs MF. Both were safe (G3+ AEs were 5% MF v 3% SF), and effective - 2yr OS 85% MF v 88% SF (p=0.44), LC 83% MF v 73% SF (p=0.13). No diff. in DFS (median 13.2 MF v 14.3 SF, p=0.99). Mean time to systemic treatment ~29mo. SABR did not impact QoL measures
3/ Both SF and MF arms drove systemic immune activation
- ⬆️%CD4+FoxP3+ Tregs, ⬆️ %CTLA-4 and %PD-1 expressing CD4+, CD8+ and/or CD4-CD8- T cell subsets
- modestly ⬆️ % change of CD4+ T cell and CD8+ T cell subsets expressing PD-1 or TIGIT in the SF arm as compared to MF arm
Read 6 tweets
@ShimaghavimiMD @TumorBoardTues #TumorBoardTuesday
Case 08/03/21

74 yo♂️presents with RUQ pain and fatigue, 30# weight loss, PS=2

CT scan demonstrates a large panc mass and diffuse liver metastases

Liver core biopsy confirms an acinar cell #PancreaticCancer

➡️What would be your treatment recommendation❓
@ShimaghavimiMD @TumorBoardTues #TumorBoardTuesday
08/03/21

He was treated with every other week Gem-nab-pac
🙏@GIcancerDoc
➡️Had rapid symptomatic improvement
➡️Now essentially normal PS
➡️Nice response to treatment for 9 months🙂

But then disease progression❗️

What would be your 2nd line therapy choice❓
@ShimaghavimiMD @TumorBoardTues @GIcancerDoc #TumorBoardTuesday
08/03/21

Germline NGS🧬testing did not reveal any inherited alterations

☝️Somatic (tumor) NGS🧬testing revealed a
💥BRAFV600E mutation💥

✅And no KRAS mutation

➡️Done while on 1st line therapy

Would the results alter your treatment choice now?
Read 9 tweets
#WorldLungCancerDay 🎗
#lungcancerawareness
ఊపిరితిత్తుల క్యాన్సర్ (ఆంగ్లం: #lungcancer #cancer, లేదా lung carcinoma) ఊపిరితిత్తుల్లోని కణాలు విపరీతంగా పెరిగిపోవడం వల్ల వచ్చే క్యాన్సర్.ఈ పెరుగుదల మెటాస్టాసిస్ అనే ప్రక్రియ ద్వారా కేవలం ఊపిరితిత్తులతోనే ఆగిపోకుండా చుట్టూ ఉన్న
అవయువాలకు కూడా వ్యాపించే అవకాశం ఉంది. సాధారణంగా ఊపిరితిత్తుల్లో ప్రారంభమయ్యే ప్రాథమిక ఊపిరితిత్తుల క్యాన్సర్ (primary lung #cancers) లు కార్సినోమాలు (#carcinomas) ఈ క్యాన్సర్లలో అధిక భాగం (సుమారు 85 శాతం) దీర్ఘకాలం పాటు పొగాకు సేవించే వారిలో కనిపిస్తాయి.
10–15% కేసుల్లో బాధితులు ఎప్పుడూ ధూమపానం చేయలేదు.

2012 గణాంకాల ప్రకారం ప్రపంచవ్యాప్తంగా 18 లక్షల మంది ఈ వ్యాధి బారిన పడగా అందులో సుమారు 16 లక్షలమంది మరణించారు. మగవారిలో కాన్సర్ మరణాలలో ఈ వ్యాధి మొదటి స్థానంలో ఉండగా, ఆడవారిలో రొమ్ము కాన్సర్ తర్వాత ఎక్కువ మంది ఈ వ్యాధి వలననే
Read 19 tweets
Delighted to share our new study nature.com/articles/s4158… 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
#TumorBoardTuesday
CASE PRESENTATION

65 year old man presents with pain in the right upper quadrant of his abdomen and weight loss. (1/n)
Core needle biopsy of the liver mass shows adenocarcinoma. Immunohistochemical (IHC) testing was positive for CK7 and CK20. IHC was negative for TTF1 and HepPar1.

Photo taken from a very nice review from @VijgenSandrine ncbi.nlm.nih.gov/pmc/articles/P… #TumorBoardTuesday (2/n)
Imaging studies reveal a dominant liver mass & satellite liver lesions. The patient also has peritoneal and lung metastases.

Labs showed no abnormalities other than CA 19-9 of 15,000 and CEA of 100.

The patient is diagnosed with metastatic intrahepatic cholangiocarcinoma. (3/n
Read 28 tweets
Há poucos anos a compreensão da medicina sobre o câncer de pulmão 🫁 evoluiu drasticamente: progredimos de uma simples classificação histológica para uma compressão genética e molecular. Inicialmente, dividíamos a moléstia em tumores de pequenas células, e não pequenas células...
... sendo este último subdividido em mais 03 grupos: adenocarcinoma, carcinoma escamoso e carcinoma de grandes células.
O que sabemos atualmente é que os adenocarcinomas de pulmão se originam dos pneumócitos (células importantes dos alvéolos pulmonares); os escamosos das células basais e os neuroendócrinos (pequenas células) das células com o mesmo nome.
Read 25 tweets
Today is #InternationalDayOfWomenInScience womeninscienceday.org Here are a small number of the many very awesome #WomenInScience, relevant to #RespEd 1/n
Marie Krogh, a Danish physician & scientist published a series of papers with her husand & collaborator, August, proving the mechanism of diffusion of oxygen across the alveolar-capillary membrane en.wikipedia.org/wiki/Marie_Kro… #RespEd #WomeninScience 2/n
Rosalind Franklin, chemist & xray crystallographer, whose work was fundamental to understanding the structure of DNA. Without this we would know almost nothing of CF, viral replication, alpha1antitryspin, lung cancer, LAM.... en.wikipedia.org/wiki/Rosalind_… #RespEd #WomeninScience
Read 12 tweets
1/ i was afraid you were hanging your argument on this calculation from @DrAlexLouie (of whom I’m a fan) but this is irrelevant to our current discussions...for so many reasons. Most importantly, these numbers are for clinical stage 1 #lungcancer not our 6cm cN0 mass #tssmn
2/all cancers meeting guideline criteria for invasive mediastinal staging are usually not clinical stage 1 & thus your numbers (even if we accept them as being valid) do not apply. #tssmn
3/most importantly however, these patients with N2 disease are not allowed to get best therapy for their stage upfront (ie systemic therapy). Mediastinal staging is all about how to get #lungcancer patients to the best first therapy (ie neoadjuvant vs upfront local Rx) #tssmn
Read 5 tweets
1/Sorry, my friend. I’m not seeing the logical connection between your question/premise & the evidence you quoted. Can you please clarify?
Your premise is that cN0 patients should not get invasive mediastinal staging. Your evidence focuses on benefits of adjuvant therapy. #tssmn
2/the whole point of invasive med staging is to ensure that patients with ⬆️likelihood of having N2 disease are directed towards upfront/definitive systemic therapy rather than non-SOC upfront/definitive local therapy. Thus, evidence should focus on Neoadjuvant therapy #tssmn
3/consider this :
do you think it’s ok to go directly to surgery or #SBRT for 6cm highly PET-avid #lungcancer which is cN0 on PET/CT, without EBUS?
@MaldonadoFabien @DanSteinfort @OtisBRickman @PulmCCM @IASLC @thoracic @ThoracicsCanada #tssmn
Read 4 tweets
Folks! We return for #HOTrainees with the exciting #Day2 @myESMO #ESMO20 and some more #practice relevant studies in #breastcancer #ProstateCancer #lungcancer #GI, so sit back, relax and lets go through some data (#HO #trainee-style!) Shout out to @peters_solange @OncoAlert
1. #BreastCancer: We have #monarchE and #IMPassion031 hoping to hear from experts @ErikaHamilton9 @NicoleKuderer @DrSGraff @matteolambe @tmprowell @GeorgeSledge51 @VukovicPetra for more insights- please link to your discussions here for #trainees:
1. A) #monarchE: use of #abemiciclib in HR+, HER2-,high risk #EBC in addition to endocrine therapy.
Current #SOC: adjuvant ET (5-10 years)
#monarchE: #Abemaciclib + ET iDFS HR 0.747, here's a great summary by @ErikaHamilton9 for @OncoAlert :
Read 11 tweets
Thread: What if cures already exist?

I'm gonna be quick. Please check out my sheet in the next tweet about the connections between #HCQ, #Malaria and #Covid19. I made that sheet back in April. Add #cancer to the picture.
I'm not a doctor, I was just observing as a concerned citizen, thinking logical and connecting dots. When @realDonaldTrump and #17 mentioned HCQ I started paying REAL ATTENTION and started my sheet shortly after. docs.google.com/spreadsheets/d…
My gut feeling and logical thinking where confirmed by this brave lady, @stella_immanuel

bitchute.com/video/F2MbeGcO…
Read 14 tweets
Thrilled to share our work showing ASCL1 transcriptionally activates DARPP-32 to promote small cell #lungcancer growth published in @BrJCancer. #OpenAccess A thread! 1/
nature.com/articles/s4141…
This project was admirably led by a talented postdoc, @kayumalam, and resulted from outstanding @UMNresearch, @UMNCancer, and @MayoClinic
collaborations with @cauyrd, Dr. Farhad Kosari, and Dr. Anja Roden. Thanks to all co-authors for their important contributions! 2/
DARPP-32 and its N-terminally truncated splice variant, named t-DARPP, promote oncogenesis in a variety of adenocarcinomas, but the role of DARPP-32 in neuroendocrine tumors hadn't been explored yet. 3/
Read 15 tweets
#CHEST bronchoscopy guidelines fir #COVID19 patients. The 6 statements in a thread .. #MedEd #FOAMed #MedTwitter #StaySafeForScience #EBM #CriticalCare journal.chestnet.org/article/S0012-…
1-Use full #PPE and #n95Masks with confirmed and suspected #COVID19 cases undergoing #bronch.
2-Check nasopharyngeal swab test for #COVID19 first, if more deep samples are indicated, bronch + BAL can be performed.
3-Use #n95Masks during #bronchoscopy procedures to asymptomatic patients in areas with #COVID19 community spread.
4-Test patients for #COVID19 prior to #bronchoscopy in areas with community spread.
Read 5 tweets
Missed #COVID19nCancer plenary in #AACR20 @AACR?
Here’s a thread to catch up on all the fascinating global research presented by:
@AACR @AACRPres #AntoniRibas #LiZhang @marinagarassino @barlesi #CarlosGomez #LouisVoigt #HongbingCai cc:@OncoAlert @COVID19nCCC @ASCO @ASH_hematology
#1: Chinese Experience by #LiZhang and #HongbingCai

More evidence of increased prevalence of #Cancer among #COVID19, ~2% similar to what we found in our #metanalysis @ASCO_pubs #JCOGO here: ascopubs.org/doi/10.1200/GO…
#LiZhang described 35.7% required mechanical ventilation and significant risk factors for severe outcomes on #multivariate analysis was recent #cancertreatment and #consolidation on CT
Read 12 tweets
🦠 #COVID19 & #Cancer🧬
⚠️Preliminary information from our own experience in lung cancer patients with #COVID19. #LCSM #OncoAlert
So far n=20 with SARS-CoV-2 confirmed by PCR.
🧶 Thread 👇
📊But first, quick poll: How many lung cancer patients with #COVID19 have you already attended?
🔎Expected demographic distribution reflecting our regular clinical practice.
Mean age 65 yo; pathology: 63% ADK, 21% SqCC, 11% SCLC; Stage IV 79%, III 16%, I-II 5%.
Prevalence of men (84%) in infected but without apparent differences by gender in mortality.
Read 13 tweets
The all-cause mortality result in the NELSON #lungcancer screening trial has generated major debate.

How do we interpret this? Let's start with what we expected to observe.

@NEJM #lcsm #lungcancerscreening #EpiTwitter
NELSON showed a 24% statistically significant reduction in lung cancer mortality with low-dose CT screening in men.

If the intervention (screening) does not lead to fatal harms, then we expect the rate of death from other (non-lung-cancer) causes to be the same in both arms.
Now, a large reduction in lung cancer mortality would translate to a small reduction in all-cause mortality, since lung cancer only causes a portion of deaths (see NLST).

NELSON did not have enough power to test whether the hazard ratio for all-cause mortality differed from 1.
Read 6 tweets

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