Thread by @TumorBoardTues

Pls join us in welcoming @JohnEbbenMDPhD to #TumorBoardTuesday!! 🎊

Dr Ebben is an onc fellow from WI, interested in🧬med & immunotherapy. He’ll also debate🧀curds & the best🍦custard in WI! He’ll be assisting with case wrap up🎀

We’re excited to have him!! #TBTFellow 1/17

2/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

Bringing #ctDNA to bear to improve pts🙌🏽 @pashtoonkasi shows us how we can♻️ 🎯therapies to extend survival.

We go deep -🔬molecular biology➡️clinical trials➡️pt case.

👉🏽Don’t forget🆓#CME credit: bit.ly/3B9i6Wd

3/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

📚We captured as much of @pashtoonkasi's discussion as we could in this moment:
#ColorectalCancer #CRC #OncTwitter

twitter.com/i/events/14288…

4/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

📚 and part 2, along with the #PatientExperience

#ColorectalCancer #CRC #OncTwitter

twitter.com/i/events/14288…

5/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

Take🏠messages:
✅ Tumors are constantly evolving; serial ctDNA gives multiple📸of change
✅ Clones come & go, w predictable 1/2-lives responding to tx
✅ Specific muts confer resistance to specific🎯 tx- all EGFRi are ❌ =!

6/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

Take🏠messages (cont):

✅ Inflection☝️coming: studies underway to help us use ctDNA better!🙌🏽
✅ ctDNA= patient-centered 📞; alleviates anxiety for some, creates uncertainty for others
#OncTwitter #ColorectalCancer

7/17 #TumorBoardTuesday Thursday Case🎀 (08/24/21)

The 💼: 52 yo F with metastatic #ColorectalCancer. Heavily pre-tx with FOLFOX, FOLFIRI, Cape/bev. Tissue bx: Ras WT, MSS, TMB7, CHEK2 mut. Tried PARPi—progression☹️.

🤔What to do?

8/17 #TumorBoardTuesday Thursday Case🎀 (08/24/21)

We took a detour talking local tx options:
•@FlavioRochaMD opened discussion about liver-directed tx
•Partial hepatectomy
•Y90
•@kasi included IO + Y90
•Or renewed interest in HAIP

onlinelibrary.wiley.com/doi/epdf/10.10…

9/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

Need more data! #ctDNA reveals RAS mutant clones are gone‼️; now ≥ 2 different EGFR mutant clones!

💡✅Data show that clones predictably decay w tx and new ones take their place
🤔What to do now❓❓❓

https://twitter.com/pashtoonkasi/status/1430327422818426883?s=20

10/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

Well.....it’s @TumorBoardTues - not just any EGFR mut found: EGFR S492R

💡⁉️Means🎯EGFR tx must be chosen very CAREFULLY.

🔬EGFR S492R resistant to cetuximab…but SENSITIVE to panitumumab.

https://twitter.com/pashtoonkasi/status/1430332170812395524?s=20

11/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

The big 🖼️: pt with RAS mutated tumor, heavily pre-treated, where #ctDNA later reveals critical change: tumor is now EGFR addicted‼️ prompting a change in tx, resulting in months of disease response‼️

meme h/t: @DrBonillaOnc

12/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

✅ Tumors are always changing, especially in response to tx
✅ ctDNA is key 🧰 & allows us to tailor tx, often revealing 😮 (ex: disease now EGFR driven after earlier RAS driver noted) that can result in effective tx‼️

13/17 #TumorBoardTuesday Thursday Case🎀(08/24/21)

This case is a great example - 3 trials evaluating evolving roles for #ctDNA

#CRICKET 🦗🏏 bit.ly/3kodtkq
#CAVE 🏔 bit.ly/2WuLas5
#CHRONOS 🌚 🌙 🕧

https://twitter.com/pashtoonkasi/status/1430334904445939717?s=20

@ASCO

14/17 #TumorBoardTuesday Thursday Case🎀(08/24/21 & 08/25/21)

🔑from #PatientExperience with @manjuggm:

Our🙏🏽🙏🏽for patient’s bravely sharing their personal journey, including participants & those following along! @musickmomof3 @fireflyann @HPolymenis @letswinpc @LUFCLew

15/17 #TumorBoardTuesday Thursday Case🎀(08/24/21 & 08/25/21)
We discussed pts feelings w ctDNA
It👍🏾@manjuggm& felt more at🧘-🧰among many👀for recurrence. Role of ctDNA is📈, but will be defined; needs careful👂& ongoing convos btwn pt &🧑‍⚕️who may benefit bit.ly/3ksKRqn

16/17 #TumorBoardTuesday Thursday Case🎀(08/24/21 & 08/25/21)

Finally, "Scanxiety" = Scan + Anxiety — a real phenomenon affecting patients. Discuss their concerns & lend tips to lessen scanxiety. Important to realize the strengths and shortcomings

https://twitter.com/manjuggm/status/1430692858361692162?s=21

17/17 #TumorBoardTuesday Thursday Case🎀(08/24/21 & 08/25/21)

Pts (& their docs) often struggle w “Survivorship” idea

@Empoweringpts9 made a🤩point -survivorship starts at diagnosis
@MPishvaian highlighted - colonoscopies detect NEW #ColorectalCancers

https://twitter.com/manjuggm/status/1430683874380681218?s=21

#PostTest Q1️⃣ #CME #TumorBoardTuesday

🤔Which of the following #ColorectalCancer clinical trials report on the anti-EGFR therapy rechallenge & ctDNA use❓

👉🏽posttest🔗 bit.ly/3B9i6Wd

👉🏽ALL CME🔗 integrityce.com/tbt

@pashtoonkasi @MPishvaian #CRC

#PostTest Q2️⃣ #CME #TumorBoardTuesday

🤔Which of the following are known mechanisms of resistance post anti-EGFR therapy in patients with metastatic #ColorectalCancer❓

👉🏽posttest🔗 bit.ly/3B9i6Wd

👉🏽ALL 🆓CME🔗 integrityce.com/tbt

@pashtoonkasi @MPishvaian #CRC