Thread by @TumorBoardTues

1/9 #TumorBoardTuesday
🔬A discussion on EBV+ #GastricCancer-important differences in tx led by @SunnieSKim

➡️Here's the Thursday Case🎀

👉👉Don’t forget to pick up🆓 #CME by answering 2 quick❓

Here's post-test🔗: bit.ly/3yRO1cb

ALL CME🔗: integrityce.com/tbt

2/9 #TumorBoardTuesday Thursday Case🎀
Take🏠:

#GastricCancer are NOT all the same; ≈10% EBV+

✅EBV+ likely⬆️PD-L1; exclusive w HER2 mut
✅EBV+ responsive to immunotx
✅Should EBV🧪be standard?

📚We captured as much of @SunnieSKim’s chat as we could:

twitter.com/i/events/14332…

3/9 #TumorBoardTuesday Thurs Case🎀
@SunnieSKim tweetorial

✅8-10% of GC =EBV+
✅Methyl of viral/host DNA➡️GC
✅⬆️in👨‍🦰/young pts
✅Diffuse type, lymphoid infiltrate & prox loc
✅🔦: hypoechoic submuc nodule
✅⬆️CD8+ TILs & immune 🧬 (IFN-g)
✅TP53, HER2 changes✖️common in EBV+

4/9 #TumorBoardTuesday Thursday Case🎀 (09/07/2021)

@SunnieSKim presented 💼 of a pt with EBV+ gastric CA (EBER+ ISH);⬆️PD-L1 CPS= 50%

Crowd 💬 FOLFOX+ nivo would be a good 1L strategy.

Recent approval of nivo+chemo upfront based on CheckMate 649✅

pubmed.ncbi.nlm.nih.gov/34102137/

5/9 #TumorBoardTuesday Thursday Case🎀 (09/07/2021)

EBER+ gastric CA tend to have excellent response to IO. Usually PD-L1, but not always...but @FogacciJoao points out a💼 of hyperprog on IO.

ascopubs.org/doi/abs/10.120…

pubmed.ncbi.nlm.nih.gov/30013197/

6/9 #TumorBoardTuesday Thursday Case🎀

❓Looks like EBV+ dz tends to be MSS, & while some dz is assoc w/ increased PD-L1, isn’t always the 💼. EBV driven dz also tends to be HER2-.

➡️🔬@ShimaghavimiMD points out: need more research on interaction w H. pylori, endo, microbiome

7/9 #TumorBoardTuesday Thursday Case🎀

Another wrinkle: EBV+ dz more common in males, but prognosis👎in females. Is there a🔗btwn the microbiome🦠, & endocrine signaling? Is there a relationship btwn immune differences in M vs F?

@NPR 🔗comparing wnycstudios.org/podcasts/radio…

8/9 #TumorBoardTuesday Thursday Case🎀

✅EBV+ gastric ca have diff biology; may be⬆️to IO
✅⬆️common than we think...should we test for EBV? ISH/IHC? Will better🧬supplant?
Time will tell.

@loconte says yes!
Pathologists were🤷‍♀️: @PancPathologist @jansen_marnix @JDekervel

9/9 #TumorBoardTuesday Thursday Case🎀(09/07/21)

Prog dz after 1 year with FOLFOX+ nivolumab
🙏Can dual IO (ipi/nivo) re-sensitize tumor?
🤔More research on EBV driven disease & unique biology needed

➡️Please be sure to join us on 09/28/21 for the next #TumorBoardTuesday case😀

#PostTest Q1️⃣ #CME #TumorBoardTuesday

🤔What percent of gastric cancer is associated with Epstein Barr Virus (EBV)?❓

👉🏽posttest🔗 bit.ly/3yRO1cb

👉🏽ALL CME🔗 integrityce.com/tbt

@SunnieSKim #GastricCancer #StomachCancer #EBV #GITwitter #OncTwitter @MPishvaian

#PostTest Q2️⃣ #CME #TumorBoardTuesday

🤔What is the gold 🥇standard test 🧪to detect EBV associated gastric cancer❓

👉🏽posttest🔗 bit.ly/3yRO1cb

👉🏽ALL CME🔗 integrityce.com/tbt

@SunnieSKim #GastricCancer #StomachCancer #EBV #GITwitter #OncTwitter @MPishvaian