Paolo Tarantino Profile picture
Jun 5, 2021 5 tweets 3 min read Read on X
☕️ Since I’ve been seeing a lot of debate in the field lately, I’ve decided to provide a set of Guidelines for the management of a good 🇮🇹 coffee

1️⃣st - get a Moka. Better if an old one: just as wine, it gets better with the passing of time. Wash the Moka. Open the Moka.

[1/5]
2️⃣nd - Pour some water in the Moka. The right amount.

If you put too much, you get colored water 💧 . If you put to little, you’ve got no coffee to offer to other people. 🤷🏻‍♂️

Best is to reach just under the tiny valve. No rocket science.

[2/5]
3️⃣rd - I call this step “The Everest”.

In short, put on the filter as much coffee as it fits. Then you add some more. And then some more.

❌DO NOT PRESS.
Coffee doesn’t like to get pressed. Nobody does.

Just make it gently fall from above, & make the mountain appear ⛰

[3/5]
4️⃣th - We’re almost done - but let’s keep attention high, we’re playing with fire now 🔥

Coffee needs time. If you rush it, you burn it.

Coffee needs a small, gentle, respectful fire - and some patience. So - keep the flame low, and relax for a few minutes.

[4/5]
5️⃣th - And the magic is done!

A hot, dark, fragrant, tasty coffee is ready to give you the energy to write your next @NEJM - or to follow an intense afternoon of #ASCO21 presentations!

References for this Guideline will be available in the full publication.

No COI.

[5/5]

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More from @PTarantinoMD

Jul 7
What is HER2 « ultralow » breast cancer, and why should you care?

A thread:
First, a little history.

The ASCO/CAP guidelines from 2007 defined HER2 IHC 0 as “absence of HER2 staining”.

In truth, it did not make much difference if the tumor was 0 or 1+, since both were considered “negative” for HER2 protein expression.

1/11
ascopubs.org/doi/10.1200/JC…
Image
The 2013 update changed the definition of HER2 IHC 0 to:

-no staining
OR
-incomplete, faint/barely perceptible staining in ≤10% of cells

This change still had no clinical impact, since only 3+ and 2+/ampl cases were candidate for anti-HER2 therapy

2/11
ascopubs.org/doi/10.1200/JC…
Image
Read 13 tweets
Mar 26, 2023
Reading good review articles can shape ideas, help connecting the dots and understanding what’s coming ahead in science.

Here’s 10 review articles that helped me shape my views on breast oncology and drug development:
1. The basics, first. What is breast cancer? How do we classify it, how do we treat it? In this article, Ada Waks et al. provide a comprehensive view of the clinical management of breast cancer, recapitulating decades of advancements in the field.
jamanetwork.com/journals/jama/… Image
2. Now, a deeper dive into the subtypes. Despite being intensively studied, ER+ breast cancer remains elusive in many aspects. In this article, @DrHBurstein reviews the biology and paradigms behind the treatment of the most common subtype of breast cancer.
nejm.org/doi/full/10.10… Image
Read 12 tweets
Mar 1, 2023
@TumorBoardTues @drsarahsam 1/24 #TumorBoardTuesday #BreastCancer #OncTwitter
54yo 👩🏻 post-menopausal
HTN
hypothyroidism
FH: aunt with late-onset BC
Germline genetic testing: negative

🔪Dec ‘10 Left lumpectomy + SLNB:
left IDC G2
ER 95%
PgR 10%
HER2-neg (IHC 1+)
Ki67 35%
stage pT2 (25 mm) pN0
Oncotype 32
@TumorBoardTues @drsarahsam 2/24 #TumorBoardTuesday #BCSM

☢️Jan ‘11: TC x 4 ➡️ XRT
Treatment well tolerated, apart from alopecia, G2 fatigue

Summer ‘11 – started letrozole
🔀 Fall ‘11 – switch to exemestane due to G3 arthralgias ➡️ improvement of symptoms

2016 completed 5 years of Aromatase Inhibitor
@TumorBoardTues @drsarahsam 3/24 #TumorBoardTuesday #BCSM

Apr ‘21 – Mild abdo discomfort
🩻CT CAP scan:
liver: 5 lesions, max 15 mm
bone: spine & ribs
enlarged mediastinal lymph nodes
🩸: G1 anemia, normal LFTs, no other abnormality

🔬US-guided liver biopsy:
IDC, grade 2, ER 90%, PR 0%, HER2-0, Ki67 25%
Read 26 tweets
Feb 28, 2023
Proud to contribute to the remarkable scientific journey of #APT, whose 10-year analysis is now published on @TheLancetOncol. Adjuvant TH confirmed outstanding long-term outcomes for patients with small HER2+ breast cancer. Aim for the next decade: biomarker-informed treatments!
Here a thread on the clinical and biomarker findings from this 10-year update: 👇 🧵
Icing on the cake: a great accompanying commentary by Elena Geuna, @curijoey & @FilippoMontemu1

sciencedirect.com/science/articl…
Read 4 tweets
Feb 21, 2023
Great idea: time for Elacestrant thread Tuesday! 🧵

But first a reminder: access to paywalled papers from @Annals_Oncology, @ESMO_Open & multiple other affiliated journals is free for @myESMO members, and I could not recommend more to become a member! esmo.org/membership
1/
Endocrine treatment is among the most effective treatment strategies we have for breast cancer. 50 years ago, the approval of the SERD tamoxifen really revolutionized the field, & we still use the drug today.

Yet, no novel ET had been approved for the last 20 years. Until now
2/
Multiple oral SERDs (selective estrogen receptor degraders) are being developed for patients with HR+ MBC. The first to achieve positive phase 3 results was elacestrant, tested in the #EMERALD trial vs. SoC ET (fulvestrant or AI). Primary endpoint -> PFS overall & in ESR1-mut

3/
Read 9 tweets
Nov 14, 2022
T-DXd has shown remarkable activity for treating HER2-positive and HER2-low breast cancers.

However, it may soon expand its reach, and become a treatment option even for HER2-0 tumors.

Here’s the 10 reasons why:
1. Because it works!

The only study that tested T-DXd for treating HER2-0 metastatic breast cancer (the phase 2 DAISY trial) demonstrated a response rate of 30% and a duration of response of 6.8 months. Not bad for being “zero”.

oncologypro.esmo.org/meeting-resour…
2. Because activity of T-DXd in HER2-0 has been also observed in other tumor types.

In DESTINY-Lung01 (T-DXd for HER2-mutant NSCLC), several responses were observed in patients w/ HER2-0 tumors, including the only complete response observed in the trial.

nejm.org/doi/full/10.10…
Read 12 tweets

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