Thread by @TumorBoardTues

#TumorBoardTuesday

THANK YOU to @KristenCiombor for leading us through a🗣️on pMMR CRC w/ dMMR liver mets

AND thank you for @fireflyann for leading our #PatientExperience 🗣️as well

👉Don’t forget your🆓#CME credit-answer 3 quick❓
Here's the postest🔗
surveymonkey.com/r/DMN786G

#TumorBoardTuesday
Thursday Case🎀(Reverse jet-lag edition✈️)
(07/06 and 07/07/21)

We🗣️ #ColorectalCancer and:
✅1st line Tx for dMMR met CRC
✅✔️ing MMR status EVEN in patients with Lynch Syndrome
✅Tumor heterogeneity

We captured the🗣️in this moment:
twitter.com/i/events/14131…

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

In the #PatientExperience 🗣️we added:
✅Defining the "lingo", e.g.
👉dMMR = MSI-high
👉pMMR = MS-stable
✅Ensuring tumor testing - and🗣️results w/ docs
✅Scanxiety

Also captured in this moment:
twitter.com/i/events/14132…

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

@KristenCiombor polled the group on 1st line treatment choice in a patient with known dMMR met #CRC

As per Keynote-177, most chose pembro:

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

@ShimaghavimiMD & @MPishvaian 🗣️options for rendering the disease surgically curable

Although @fireflyann @manjuggm & @CathyEngMD emphasized that with dMMR CRC and a cCR, non-operative management might be an option

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

@SuyogCancer and @DocMCotant raised the concern that perhaps pembro does not work better than chemo in a dMMR #CRC that also has a KRAS or NRAS mutation.

Figure from the Keynote 177 NEJM article:👇👇👇

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

From @KristenCiombor, surprisingly, the patient's PRIMARY rectal Ca was pMMR‼️

@aaleshin 👉us to an article that 👁️at this (below).

➡️a🗣️on testing primary and met for all patients❓❓❓

jnccn.org/view/journals/…

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

So @KristenCiombor asked - how would we manage this patient now❓

Most (including me) chose chemo + IO - but based on no data in #CRC (borrowing from other cancers):

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

The patient had surgery, with path showing essentially a CR in the dMMR liver mets‼️

BUT...residual disease in the pMMR rectal cancer

So @KristenCiombor asked if we should give adjuvant chemo❓

Most said yes!

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

Then we got into the mini-tweetorial, and @KristenCiombor fed us the data:

https://twitter.com/KristenCiombor/status/1412575829272432640?s=20

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

https://twitter.com/KristenCiombor/status/1412576404504514561?s=20

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

https://twitter.com/KristenCiombor/status/1412576649078530054?s=20

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

https://twitter.com/KristenCiombor/status/1412576987118440455?s=20

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

A couple🔑points from our #PatientExperience 🗣️:

It is really important for oncologists to be sure to define the lingo for patients, as emphasized by @fireflyann @manjuggm and @perilonthesea

https://twitter.com/TumorBoardTues/status/1412927141990211586?s=20

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

BUT.....patients more often than not prefer to know all the details. Even complex biology can be explained for the benefit of patients and caregivers.

#TumorBoardTuesday
Thursday Case🎀
(From 07/06 and 07/07/21)

Finally, we discussed the term "Scanxiety"
Scan + Anxiety

It is a real issue for patients‼️

https://twitter.com/TumorBoardTues/status/1412933675159801856?s=20

#PostTest Q1️⃣ #CME #TumorBoardTuesday case 07/06/21

👉🏼posttest🔗: bit.ly/3dNX9H0

ALL🏆CME🔗: bit.ly/TBTxCME

🧬True or False: In a patient with known Lynch syndrome, it is unnecessary to test tumors for microsatellite 🧬instability/mismatch repair deficiency.

#PostTest Q2️⃣ #CME #TumorBoardTuesday case 07/06/21

👉🏼posttest🔗: bit.ly/3dNX9H0

ALL🏆CME🔗: bit.ly/TBTxCME

🧐In a patient with #ColonCancer and loss of MLH1/PMS2 by IHC, which subsequent 🧬genomic finding would most likely convince you of sporadic dMMR❓#CRC