Thread by @TumorBoardTues

1/12 #TumorBoardTuesday
Thurs 10/12/21 Case🎀
@ShaalanBeg @CancerCommons present a case of #PancreaticCancer that challenges us to🤔about cell signaling & mol bio➡️better outcomes.

📚We captured as much of the chat as we could:
twitter.com/i/events/14479…
#PanCan #KRAS #OncTwitter

2/12 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:
We discussed #PancreaticCancer & specific #KRAS mut
✅All KRAS muts aren’t ≠
✅KRAS G12R➡️⬆️autophagy
✅Autophagy= tumor can♻️cell components ➡️resistance
✅MEKi + autophagy inhib= strat for G12R
✅Repeat NGS on prog is🗝️!

3/12
#TumorBoardTuesday
Thursday Case🎀

👉👉 Don’t forget to pick up 🆓 #CME credit by answering 3 quick ❓
Here is the post-test 🔗: bit.ly/3Bzgply

ALL CME 🔗: integrityce.com/tbt

4/12 #TumorBoardTuesday
Thurs Case🎀
@ShaalanBeg present a case of pt w 3cm mass in head of pancreas who presented w jaundice; +SMV abutment, borderline resectable.
‼️ Single 8mm liver lesion
➡️💪evidence for neoadj chemo; TBT📊 agrees- mFOLFIRINOX

pubmed.ncbi.nlm.nih.gov/27275632/

5/12 #TumorBoardTuesday
Thurs Case🎀

CA19-9 downtrending (<200); seems to be responding! ➡️Whipple 22+ lymph nodes!😱

🤔What to do now❓
💡✅ TBT thinks more chemo...but what regimen? Debate between mFOLFIRINOX or gem/cape?
pubmed.ncbi.nlm.nih.gov/30575490/

6/12 #TumorBoardTuesday
Thurs Case🎀

Unfortunately, dz recurrence on gem/cape. Tried gem/cis/nab-pac ➡️progressive dz.
Now what❓

Well...it's @TumorBoardTues- so we do NGS 🧬 in advanced ca (when possible)

➡️🔬KRAS G12R, TP53, STK11, SETD2 muts found
h/t @DrSteveMartin

7/12 #TumorBoardTuesday
Thurs Case (10/12/21)🎀

Which led to @ShaalanBeg's mini-tweetorial on 🎯KRAS G12R.
Small molecule 💊 exist for:
🔹KRAS G12C (& soon for KRAS G12D)
🔸KRAS G12R has no 💊, but may create unique cancer vulnerability.
cancerdiscovery.aacrjournals.org/content/10/1/1…

8/12 #TumorBoardTuesday
Thursday Case🎀

✅KRAS G12R associated with ⬆️ autophagic flux

Led to combo therapy with trametinib (MEKi) + hydroxychloroquine (HCQ) (inhibits autophagy). Pt response for 4 months, but then--disease progression😥

ncbi.nlm.nih.gov/pmc/articles/P…

9/12 #TumorBoardTuesday
Thursday Case🎀

Repeat NGS reveals new c-Myc amplification. @Oncologician was worried about 🧬genomic plasticity & acquisition of new muts given TP53 mutation background… & he was right! What to do now??

pubmed.ncbi.nlm.nih.gov/32238397/
@OHSUKnight

10/12 #TumorBoardTuesday
Thurs Case🎀

Emerging preclin 🧫 data suggests CDK4/6 inhibs could be useful to tx MYC amplified cancers. MYC amp➡️ increased cell cycle @ConanKinsey

Palbociclib +HCQ led to⏬CA19-9; unfortunately, pt experienced worsening & transitioned to hospice

11/12 #TumorBoardTuesday
Thurs Case🎀

🙏 Pt life + QoL significantly improved through rational combo approach
🙏 @LetsWinPC for sharing Rachel’s Story💪example of clinical trials making a diff:
letswinpc.org/my-treatment/2…
SETD2 clinical trial recruiting: clinicaltrials.gov/ct2/show/NCT03…

12/12 #TumorBoardTuesday
Thurs Case🎀

frontiersin.org/article/10.338…
🤔 How might oncology be further transformed by emerging agents/new combos...esp as RAS is increasingly targeted?

➡️Please join us on 10/26/2021 when @KlempnerSam presents a case of
#GEA #UpperGI #GEAwesome 😀

#PostTest Q1️⃣ #CME #TumorBoardTuesday

🤔The presence of #KRAS G12R mutation🧬is associated with unique metabolic features and higher dependency on autophagy.

👉🏼post-test🔗 bit.ly/3Bzgply

👉🏼ALL CME🔗 bit.ly/TBTxCME

@ShaalanBeg @MPishvaian #PancSM #OncTwitter

#PostTest Q2️⃣ #CME #TumorBoardTuesday

🤔Inhibition of the MAPK pathway leads to autophagic flux in #PancreaticCancer cells.

👉🏼post-test 🔗: bit.ly/3Bzgply

👉🏼ALL CME 🔗: bit.ly/TBTxCME

@ShaalanBeg @MPishvaian @cancercommons #PancChat #PancCan

#PostTest Q3️⃣ #CME #TumorBoardTuesday

🤔Combined🗺MAP kinase + autophagy inhibition can be a potential treatment option for #PancreaticCancer.

👉🏼post-test 🔗 bit.ly/3Bzgply

👉🏼ALL CME 🔗 bit.ly/TBTxCME

@ShaalanBeg @MPishvaian @cancercommons #PancChat #PancCan