Thread by @TumorBoardTues

1/10 #TumorBoardTuesday

🔬We reviewed RET mutations as an actionable🎯 in practice!
➡️Here’s this week's Thursday Case🎀

👉👉 Don’t forget to pick up your 🆓 #CME credit by answering 2 quick❓
Here’s the post-test🔗: bit.ly/2W7Acck
ALL CME 🔗: integrityce.com/tbt

2/10 #TumorBoardTuesday
Take🏠messages:
RET muts are ⬆️in medullary thyroid cancer
✅Sensitive to multikinase 💊
✅Gatekeeper resistance muts overcome by specific💊
✅RET is also seen in other cancers, including 🫁

2.5/10 #TumorBoardTuesday
9/28/2021 Case 🎀

✅Repeat NGS w progression is🗝️strategy to tx resistance

@VivekSubbiah is truly the “RET Master”!

3/10 #TumorBoardTuesday
Case 🎀(09/28/2021)

📚We captured as much of @VivekSubbiah’s discussion as we could in this moment-
Part 1:

twitter.com/i/events/14397…

3.5/10 #TumorBoardTuesday (09/28/2021)
Thursday Case🎀

And also in this moment...
Part 2: twitter.com/i/events/14397…

4/10 #TumorBoardTuesday
Thursday Case🎀 (09/28/2021)

@Viveksubbiah presented a case of a patient with medullary thyroid cancer (MTC)

➡️More likely to have an aggressive, metastatic phenotype at presentation
➡️💪evidence that all MTC pts should have germline & somatic NGS

5/10 #TumorBoardTuesday
Thursday Case🎀 (09/28/2021)
Somatic RET mutation (M918T) detected!
Interestingly- no germline mutation
🤔What to do now❓❓❓
💡✅ Targeted therapy started--at the time, multikinase inhibitors only available

https://twitter.com/RenoHemonc/status/1443016050979729421?s=20

6/10 #TumorBoardTuesday
Thursday Case🎀 (09/28/2021)

We discussed prevalence of RET alterations
✅2% of NSCLC; 10-20% of PTC. MTC almost all germline RET mut; 60-90% somatic
✅Can be🗝️for pts to connect with mutation advocacy group @RETpositive @NTRKers

https://twitter.com/VivekSubbiah/status/1443015816472145922?s=20

7/10 #TumorBoardTuesday (09/28/2021)
Response, then prog dz through 6 multikinase 💊😱

It's @TumorBoardTues - so we always repeat NGS!
💡⁉️New RET gatekeeper mut detected (V804M)
➡️🔬Great discussion re: detecting RET changes. 🗝️= sens platform (RNAseq)
annalsofoncology.org/article/S0923-…

8/10 #TumorBoardTuesday
Pt responded to selpercatinib!🎉

➡️@VivekSubbiah’s mini-🐦orial re: expanding role of RET 🎯tx. Moral of the story: RET events are important, agnostic of tumor. Selpercatinib/pralsetinib (specific💊) approved in 🫁 & thyroid ca.
threadreaderapp.com/thread/1443003…

9/10 #TumorBoardTuesday
Thursday Case🎀 (09/28/2021)

🙏Specific RET inhibitors (selpercatinib/pralsetinib) may be better tolerated (less diarrhea) vs multi-kinase 💊

But--
@RenoHemOnc points out- resistance is a problem--esp w solvent front mutations

https://twitter.com/RenoHemonc/status/1443016502517501955?s=20

10/10 #TumorBoardTuesday (09/28/2021)
🤔 Next gen small TKIs may be strat to overcome solvent front muts
❓Role for serial ctDNA eval to assess emerging resistance muts

https://twitter.com/VivekSubbiah/status/1443016038526947329?s=20

➡️Pls join on 10/05: @GauravGangwan15 presents a case of cervical ca w a C-RAF mut 🙂

#PostTest Q1️⃣ #CME #TumorBoardTuesday

@VivekSubbiah presented RET-altered thyroid ca

🤔What is the most common actionable alteration in sporadic medullary #ThyroidCancer❓

👉🏽posttest🔗bit.ly/2W7Acck

👉🏽ALL CME🔗 integrityce.com/tbt

#PrecisionMedicine #OncTwitter

#PostTest Q2️⃣ #CME #TumorBoardTuesday

🤔What would be the most appropriate Tx option for RET V804M gatekeeper mutant thyroid cancer❓

👉🏼post-test🔗: bit.ly/2W7Acck

👉🏼ALL CME🔗: bit.ly/TBTxCME

@VivekSubbiah #ThyroidCancer #PrecisionMedicine #OncTwitter