Thread by @TumorBoardTues

1/10 #TumorBoardTuesday
Thursday Case🎀
This week’s case: pt w #GEA not responding to FLOT w dMMR/MSI. Receives 3 doses of pembrolizumab->pCR!

💡Biomarker-based IO can be v successful, but better biomarkers needed‼️
➡️Explore wrap up below re: deploying IO in #UGI

2/10 #TumorBoardTuesday

👉👉 Don’t forget to pick up your 🆓 #CME credit by answering 2 quick ❓
Here is the post-test 🔗: bit.ly/3EgtZeE

ALL CME 🔗: integrityce.com/tbt

3/10 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages:
We discussed #GastricCancer & immunotherapy (IO)
✅dMMR/MSI quite common- 8-22% of non-metastatic cases
✅Chemo less effective in dMMR disease, particularly 5-FU
✅High pCR with upfront IO
✅ctDNA may be a key biomarker

3.5/10 #TumorBoardTuesday
Thursday Case🎀

📚We captured as much of @KlempnerSam’s discussion as we could in this moment: twitter.com/i/events/14531…

Our discussion ranges from upfront molecular testing, to ctDNA biomarkers of IO efficacy & more!

4/10 #TumorBoardTuesday
Thursday Case🎀

@KlempnerSam presented a case of a pt with localized, node+, HER2- gastric adenoca; high risk of R1 resection. dMMR/MSI noted.

➡️Convention says neoadjuvant FLOT-> surgery✂️->adjuvant FLOT

The SOC paradigm: pubmed.ncbi.nlm.nih.gov/30982686/

5/10 #TumorBoardTuesday
Thurs Case🎀

We discussed upfront 🧪 in resectable upper GI cancer; majority feel that upfront HER2, PD-L1, dMMR should be done!

NCCN guidelines haven’t quite caught up- NCCN Guidelines Version 5.2021 Gastric Cancer= MSI test only in resectable dz).

6/10 #TumorBoardTuesday
Thursday Case🎀
(Case from 10/26/21)

😱Pt develops worsening symptoms on FLOT, ⬆️LFTs; early CT shows progression

🤔What to do now❓
💡✅Try immunotherapy based on dMMR/MSI; TMB 385 ‼️

pubmed.ncbi.nlm.nih.gov/31513484/

7/10 #TumorBoardTuesday
Thursday Case🎀

👉Pembrolizumab x3. ctDNA ⬇️from 2% to 0.4% -> pCR on resection!! Feeling much better, NED.

💡⁉️In the right pts w #GEA, IO can be very effective‼️

➡️🔬Evolving role for periop IO? Studies underway- much more data are needed.

8/10 #TumorBoardTuesday
Thursday Case🎀
(Case from 10/26/21)

Which led to @KlempnerSam’s mini-tweetorial about dMMR and IO in #GEA:

threadreaderapp.com/thread/1453154…

9/10 #TumorBoardTuesday
Thursday Case🎀

✅ctDNA emerging tool to eval responses to IO
✅Ongoing❓: timing/kinetics of ctDNA monitoring
✅Biomarkers: some pts with dMMR respond well to IO, others not. Role of dMMR +TMB? TCR repertoire?

📢 Check dMMR status in all GEA📢

10/10 #TumorBoardTuesday
Thurs Case🎀

🙏Pt continues to do well after 3 doses of neoadj pembro- powerful demo of IO in the right pt
🤔Expansion of neoadjuvant checkpoint inhibs as biomarkers evolve?

➡️Please join us on 11/09/21 when @SirohiBhawna presents an intriguing case! 😀

#PostTest Q1️⃣ #CME #TumorBoardTuesday

@KlempnerSam presented a case of #GastricCancer

🤔According to NCCN guidelines which of these procedures or tests should be considered for a clinical T3 non-metastatic #GastricCancer fit for surgery❓

👉🏽posttest🔗bit.ly/3EgtZeE

#PostTest Q2️⃣ #CME #TumorBoardTuesday

🤔Among larger perioperative and/or adjuvant gastroesophageal cancer trials how frequently is dMMR/MSI-H observed❓

👉🏼post-test 🔗: bit.ly/3EgtZeE

👉🏼ALL CME 🔗: bit.ly/TBTxCME

#UGI #OncTwitter @KlempnerSam @MPishvaian