Discover and read the best of Twitter Threads about #shareddecision
Most recents (7)
@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 @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 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
@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 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?
