Thread by @MPishvaian

@TumorBoardTues #TumorBoardTuesday
Thursday Case 🎀

🧑‍🎓Great discussion on the Tx of LAPC

✳️Most preferred FFX for this pt

➡️But the only PROSPECTIVE 📋 is w/gem-nab
pubmed.ncbi.nlm.nih.gov/30220407

➡️There are ✅ retrospective 📋 for FFX
thelancet.com/journals/lanon…

➡️For both, resection rate is 10-15%

@TumorBoardTues #TumorBoardTuesday
Thursday Case 🎀

Other options for LAPC:

➡️Clinical trials should be our 1st option, if available
✳️TIGER-PAC
✳️KRAS G12D/V siRNA + chemo
✳️Gem-Nab +/- FG-3019

➡️Radiation (despite negative data from LAP-07)

➡️IRE
✳️2 abstracts @ASCO #GI21

@TumorBoardTues @ASCO #TumorBoardTuesday
Thursday Case 🎀

We had a poll on what is essentially 2nd line chemo for LAPC
✳️Not surprisingly most recommended gem-nab

➡️There are 2 abstracts @ASCO #GI21 on using nal-iri after progression on FOLFIRINOX

Any thoughts on this?🤔

@TumorBoardTues @ASCO #TumorBoardTuesday
Thursday Case 🎀

Then we discussed ATM💥
➡️Pathogenic muts in ~6% of PDACs
✳️2% are germline

➡️Genomic scars of ATM mut PDAC - NOT the same as for BRCA
✳️@ASCO #GI21 Abs 396, Sheron Perera

➡️So PARPinh may or may not work❓❓

pubmed.ncbi.nlm.nih.gov/31676541/

@TumorBoardTues @ASCO #TumorBoardTuesday
Thursday Case 🎀

🧑‍🎓Mini-Tweetorial 1

💡Tumor somatic NGS 🧬 ➡️ “Actionable Mutations” in 25% of PDACs
pubmed.ncbi.nlm.nih.gov/32135080/

💡ATM ➡️ most common actionable mutation-6.2%

💡2% of PDAC pts harbor a germline ATM mutation
pubmed.ncbi.nlm.nih.gov/29922827/

@TumorBoardTues @ASCO #TumorBoardTuesday
Thursday Case 🎀

👨‍🎓Mini-Tweetorial 2

💡ATM plays a critical role in sensing DNA 🧬 damage

💡ATM ➡️ cell cycle arrest

💡ATM ➡️ DNA repair 🛠️ by homologous recombination

💡Pathogenic ATM muts ➡️ tumors sensitive to radiation ⚡️

💡And platinum-based chemo

@TumorBoardTues @ASCO @letswinpc @PanCAN @lustgartenfdn @pashtoonkasi @rachnatshroff @W_Park_MD @FogacciJoao @OncoAlert @EileenMOReilly @ShaalanBeg #TumorBoardTuesday
Thursday Case 🎀

🧑‍🎓Mini-Tweetorial 3

💡Not all DDR muts are =
➡️ Need to 🔎 how to Tx each mut differently

💡❓🤔 if ATM-mut tumors respond to PARP inh

💡There is synth lethality of DNA damaging chemo + an ATR inh and an ATM mut

pubmed.ncbi.nlm.nih.gov/32568634

@TumorBoardTues @ASCO @letswinpc @PanCAN @lustgartenfdn @pashtoonkasi @rachnatshroff @W_Park_MD @FogacciJoao @OncoAlert @EileenMOReilly @ShaalanBeg #TumorBoardTuesday
Thursday Case 🎀

Finally - we had two CME questions. Please see the pre and post case polls below

➡️FYI - the right answers are
#1 - Both of the above
#2 - ATM (6.2%)
✳️Although perhaps the COMBINATION of BRCA1 and -2, germline + somatic, could be up to 10%