Thread by @TumorBoardTues

1/10 #TumorBoardTuesday

🔬A discussion focused on precision med in cervical cancer led by @GauravGangwan15
➡️Here's the Thursday Case🎀

👉 Don’t forget to pick up your 🆓 #CME credit- answer 2 quick❓here: bit.ly/3A6ipjH

ALL CME 🔗: integrityce.com/tbt

2/10 #TumorBoardTuesday
Case🎀
Take🏠msgs re: stage IV #CervicalCancer & 🎯med.
✅Cervical ca =4th leading cause of ca☠️ in♀️around the🌍
✅Screen &💉key; some spirited debate re: 💉roll out
✅AJCC revised- consider HPV, incorp addtl imaging in staging

https://twitter.com/GauravGangwan15/status/1445541000982630402?s=20

3/10 #TumorBoardTuesday
Case🎀
Take🏠messages cont’d:
✅NGS can yield 🗝️tx, even when🎯🧬are rare in a dz
✅CRAF🎯 💊 paired with MEK 💊. Why?
✅RAF inhib➡️ ⬆️MEK activation

📚We captured as much of @GauravGangwan15’s discussion as we could: twitter.com/i/events/14455…

4/10 #TumorBoardTuesday
Case🎀
@GauravGangwan15 🗣 a case of pt w/ stage IV cervical ca w/ hydroneph & AKI; 🩸, debilitating pain. Strong 👩‍👩‍👦 of ca.
➡️Palliative chemo +/- XRT only SOC option (p ureteral stent)

Cervical ca requires multi-D care (Med Onc, Rad Onc, IR, Gyn Onc)!

5/10 #TumorBoardTuesday
Thursday Case🎀
(Case from 10/05/2021)

😱Progressive dz on nab-paclitaxel/carbo; morbidity from chemoXRT-> liver and peritoneal mets w/ severe pain

🤔What to do now❓❓
💡✅DEFINITELY NGS!

6/10 #TumorBoardTuesday
Thurs Case🎀

🩸 bx identifies CRAF S257L activating mut!
➡️Now what❓Variant allele frequency= 56% (v high)!
Well....it's @TumorBoardTues-so we have to think through the implications.
💡⁉️Potentially targetable mut, but does it make sense for the pt?

7/10 #TumorBoardTuesday
Thursday Case🎀
(Case from 10/05/2021)

Which led to @GauravGangwan15’s mini-tweetorial about targeting CRAF mutations and 🗝️ management tips for combo small molecule RAF+ MEKi

https://twitter.com/gauravgangwan15/status/1445552180723806217?s=10

8/10 #TumorBoardTuesday
Thurs Case🎀

✅CRAF part of RAS/RAF/MEK/ERK (MAPK) pathway
✅No CRAF 💊, but turns out sorafenib more specific for CRAF vs BRAF
✅If 🎯CRAF, pair with MEKi to prevent ⬆️in p-ERK
✅Combo tx= more side fx- watch for 💩, rash, HTN, ✋👣syndrome, 😴,❌🍽️

9/10 #TumorBoardTuesday
Thursday Case🎀
(10/5/2021)

✅Combo tx= more side fx! Careful for stacking AEs.
✅ @CrozrX points out CRAF specific tx coming; strats including intermittent dosing to⬇️ tox

https://twitter.com/crozrx/status/1445570918697164800?s=21

10/10 #TumorBoardTuesday
Thurs Case🎀

🙏 Pt tolerating tx; significant tumor regression! Pain 0/10 w/ partial response (>7 mo)
🤔Should we do NGS in all advanced cases?

➡️Please join on 10/12/21 when @cancercommons @ShaalanBeg @ConanKinsey presents case of #PancreaticCancer😀

#PostTest Q 1️⃣ #CME #TumorBoardTuesday

👉🏽posttest🔗 bit.ly/3A6ipjH

👉🏽ALL CME🔗integrityce.com/tbt

🤔CRAF mutations 🧬are found commonly in the following cancers except❓

#CervicalCancer #PrecisionMedicine #OncTwitter @GauravGangwan15 @MPishvaian

#PostTest Q2️⃣ #CME #TumorBoardTuesday

👉🏽posttest🔗: bit.ly/3A6ipjH

ALL🥇CME🔗: integrityce.com/tbt

🤔Commonly expected somatic alterations in cervical cancer are all of the following except❓

#CervicalCancer #PrecisionMedicine #OncTwitter @GauravGangwan15