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@MelanomaAus

@ASCO

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Alex Shoushtari, MD

@alexshoushtari

Mar 6, 2021

@CCR_AACR

I am excited to share our manuscript "Therapeutic Implications of Detecting MAPK-Activating Alterations in Cutaneous and Unknown Primary #Melanomas" published at @CCR_AACR. I think it offers important clinical and translational insights into melanoma. 1/x

clincancerres.aacrjournals.org/content/early/…

@cbioportal

All of the genomic and clinical data are available on @cbioportal at cbioportal.org/study/summary?… – thank you to @nikolausschultz Lab, esp @chatila_w + @fjsanchezrivera (bioinformatics/data viz), Arshi Arora (stats), and @sloan_kettering molecular path (all the sequencing) 2/x

This will be a loooong thread for my fellow #melanoma geeks! All other melanoma-curious oncologists and #medtwitter can skip towards the end where I try to highlight some themes for investigating other tumors. 3/x

Read 33 tweets

Alex Shoushtari, MD

@alexshoushtari

Aug 19, 2020

@CCR_AACR

Hey everyone, the first-in-human clinical trial of tebentafusp, the HLA-specific fusion protein targeting gp100, is now online @CCR_AACR! Cool mechanistic proof of concept that you can get CD3+ cells into a poorly infiltrated tumor like #uveal #melanoma.

clincancerres.aacrjournals.org/cgi/content/ab…

@Immunocore

A prelim efficacy signal for uveal melanoma in this trial with a dose (50mcg weekly) that is lower than the 68mcg weekly dose later expanded upon and presented at ASCO last year. Fingers crossed for our patients with this rare disease!

(note: I have fCOI with @Immunocore)

Cytokine Release Syndrome: uncommon but potentially serious side effect. Manageable with everyone's growing experience with adoptive T cell therapy. This trial predated the approval of tocilizumab for severe CRS. Hospitalization mandatory for first 3 doses on study.

Read 6 tweets

Alex Shoushtari, MD

@alexshoushtari

Jun 29, 2020

Hi #medtwitter + new onc fellows! I treat patients with advanced #melanoma, especially rare ones like #uvealmelanoma (UM). This #tweetorial will discuss:

1) Why UM is unique
2) When does(n’t) immunotherapy work for UM
3) Why we prefer clinical trials for advanced UM

1/x

UM affects about 5/million, and about 3-5% of advanced melanomas in the US arise from the uveal tract (iris, ciliary body, choroid). Of these, iris is rarest + least aggressive, so we often call it “choroidal” melanoma.

Get your dilated eye exams, folks!

2/x

Choroid and cilio-choroid melanomas can be aggressive. ~50% of the largest tumors metastasize; about 20% of medium ones do.

Look at that lack of plateau! Plenty of mets happen late, >5 years out. It's sad but fascinating when immune system controls disease for years, then (🤬)

Read 26 tweets

Alex Shoushtari, MD

@alexshoushtari

Jun 2, 2020

Throughout our medical training, many of us were taught it was "unprofessional" to voice our beliefs or broadcast political opinions. But we must acknowledge most of the (well-meaning) people counseling us to stay silent stood to gain by maintaining the status quo. #medtwitter

Those who maintain political activism harms the soul of medicine suggest it cripples the patient-doctor relationship. But I find this simplistic, even disingenuous. Surely most people can divorce political stance from compassionate care? Can't we trust them to make that decision?

When I am in a patient room, their well-being is paramount. When I leave that room, I need to apply that same level of dedication to bettering my community. We should be welcoming, not punishing, people who enter into political discourse.

Read 5 tweets

Alex Shoushtari, MD

@alexshoushtari

Mar 24, 2020

@sloan_kettering

A few thoughts on outpatient oncology care here in #NYC.

10 days ago, we melanoma med onc @sloan_kettering agreed to cut back in person clinic from 1-2x / week to once / 1-2 weeks. My clinic frequency was quartered. I was excited to leave the apt (I'm allergic to combs).

My commute to work is entirely by foot, and I'm privileged to be able to do so. Ordinarily I walk by hundreds of people in 15 min.

Today, I counted about 30 people. We are successfully distancing! Yay!

The in person visits that remain are the most complicated ones, where infusion and scan review are done on same day. Our (very smart) new visitor policy doesn't allow family members to attend, with rare exceptions.

Skeletal, 50% staff on site in clinic.

So today was...eerie.

Read 9 tweets

Alex Shoushtari, MD

@alexshoushtari

Feb 13, 2020

https://twitter.com/DrBetofMDPhD/status/1228072232641060865

Beautiful retrospective work suggesting the clone of melanoma that recurs after an initial complete response to checkpoint inhibitors is often different than the one that presented initially.

https://twitter.com/DrBetofMDPhD/status/1228072232641060865

Our group has taken these data to heart. I've changed a few things about my approach in clinic as a result:

1) When patients ask if we can just retry the same medicine if the disease comes back, I try to take time to say "yes, but it may not work the same way as before."

2) This recurrence rate was a little higher than the clinical trial recurrence risks of 10-15%. While length of tx wasn't statistically associated with recurrence, I now am much more reticent to stop therapy if no toxicity and length of therapy is only 6 months.

Read 4 tweets

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