Thread by @TumorBoardTues

#TumorBoardTuesday
💥Wow - this week was TOO much‼️

A🗣️on TMB-high #PancreaticCancer & #Immunotherapy by @DrBonillaOnc

AND our 1st pt-directed🗣️led by @HPolymenis and @StephenVLiu

👉Don’t forget your🆓#CME credit-answer 3 quick❓
Here's the postest🔗
surveymonkey.com/r/6JVHCSG

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

We discussed #PancreaticCancer and:
✅Cynicism/Nihilism
✅The importance of multi-D care
✅1st line Tx
✅🧬Testing
✅#Immunotherapy

We captured as much as we could in this moment:
twitter.com/i/events/13999…

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

And also this moment:
twitter.com/i/events/14005…

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

@DrBonillaOnc presented a case of a patient diagnosed with metastatic #PancreaticCancer

❓He polled the group on their first line therapy 💊of choice - most chose FOLFIRINOX

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

There have been many🗣️about FOLFIRINOX vs. Gem/Nab-Pac

But this case➡️a lot of🤔about how to Txt a pt with⬆️bili❓

@Thalcin @ShimaghavimiMD @FogacciJoao & others 🗣️at least STARTING w/FOLFOX then➡️FOLFIRINOX

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

BUT.....this🗣️leap frogged the really critical❓raised by @HPolymenis
👇👇👇
"With about 60K new cases of #pancreaticcancer diagnosed each year- why do less than half of patients not receive treatment??"

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

There is TOO MUCH cynicism & fatalism regarding #PancreaticCancer

This can only be solved by education and awareness by OUTSPOKEN advocates
@letswinpc @PanCAN @lustgartenfdn @RueschCenter @PancreaticCanUK

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

@HPolymenis also⬆️the🗣️of multi-disciplinary care for #PancreaticCancer

Community & academic centers have Multi-D boards & as @heatherahannon put it:
"All cases are worthy of review by a multiD team/tumor board"

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

Both @DrBonillaOnc and @HPolymenis stressed the importance of 🧬testing for ALL #PancreaticCancer patients

"My docs didn't offer it to me- I had to INSIST"

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

Which brings us back to the case

The patient of @DrBonillaOnc had tumor testing and
🧬NGS results showed TMB 66 Muts/Mb (‼️)

We all🤔why there would be such a high TMB❓
✅No MMR def
✅No POLE mut

🧐A mystery

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

@SyedAAhmad5 @ShimaghavimiMD @anu_iris @pashtoonkasi and @oncologician (Thx for the image👇) all discussed that mutational "signatures" not just single mutations will give us a much deeper understanding of cancer

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

And then we had an excellent, succinct tweetorial from @DrBonillaOnc which I will repost over the next 6 tweets!

https://twitter.com/DrBonillaOnc/status/1399888898965360645?s=20

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

https://twitter.com/DrBonillaOnc/status/1399889039831019523?s=20

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

https://twitter.com/DrBonillaOnc/status/1399889125692653574?s=20

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

https://twitter.com/DrBonillaOnc/status/1399889184530239488?s=20

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

https://twitter.com/DrBonillaOnc/status/1399889239203102721?s=20

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

https://twitter.com/DrBonillaOnc/status/1399889304432807941?s=20

#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

In the end, the patient had outstanding, long term benefit from #Immunotherapy (pembrolizumab)

While this case was exceptional - it shows that this CAN happen, even in #PancreaticCancer

So continue to #wagehope

#PostTest Q1️⃣ #CME #TumorBoardTuesday

❓What are the recommended genetic 🧬 tests in mPDAC?

👉🏼post-test 🔗: bit.ly/3ibenRF

👉🏼ALL CME 🔗: bit.ly/TBTxCME

#PDAC #PancreaticCancer #PanCan @DrBonillaOnc @MPishvaian

#PostTest Q2️⃣ #CME #TumorBoardTuesday

❓What biomarker and immune checkpoint inhibitors combinations are appropriate for relapsed mPDAC?

👉🏼post-test 🔗: bit.ly/3ibenRF

👉🏼ALL CME 🔗: bit.ly/TBTxCME

#PDAC #PancreaticCancer #PanCan @DrBonillaOnc @MPishvaian