Thread by @TumorBoardTues

1/9 #TumorBoardTuesday Friday Case Wrap Up

🚨Special Friday Edition of #TBT🚨
This week, mgmt of #Pancreatic neuroendo tumors (pNET), led by @nanudasmd. We discussed SOC, role of IO, & brand🆕 💊. Buckle up! We captured the discussion in this moment:

twitter.com/i/events/14995…

2/9 #TumorBoardTuesday Friday Case🎀
Take🏠messages:
We discussed #pNET:
✅Well diff= sens to cape/tem; high% of MGMT methylation -but not predictive of response
✅Tx dictated by disease extent
✅NOT all NETs are ➕ on dotatate! If they are, ☢️PRRT option- but may use late line

2.5/9 #TumorBoardTuesday Friday Case🎀

Take 🏠 messages continued:

✅Mixed track record of IO, despite TMB increase s/p TMZ. Higher prolif rate = better IO response
✅New: belzutifan (HIF-2a inhibitor) w activity in pNET!
✅Each pt is different- 💊 customized to pt situation

3/9 #TumorBoardTuesday Case🎀

@nanudasmd presented case: pt w G2 pNET (Ki67=18%) liver mets +FMHx of RCC. Tumor 🌡️–wanted to get a response fast! (already tx w lanreotide, TACE)

👍Cape/temozolomide
Why? Can be v sens. Many hypermeth MGMT, but 🚫 a clear biomarker of response👎🏽

4/9 #TumorBoardTuesday Case🎀

😱Tem ⏫TMB. Does this mean pNET responds to IO? Debate on this one!✨⏫TMB IS predictive of response✨, but initial TMB (pre-tem) is probably MORE predictive.🌟

@nanudasmd’s pt = 🎉response to cape/tem–2 years! Then prog.

🤔What to next❓
✅NGS!

5/9 #TumorBoardTuesday Friday Case🎀

Dr Das reaches for the original tissue (pre cape/tem). Finds TMB 17, with mut NF1, DAXX, ATRX, TSC2. No VHL germline🧬

➡️Now what❓❓

Well........it is @TumorBoardTues - so we bring the latest.

💡Belzutifan!

➡️🔬HIF2a 🔑 to pNET biology

6/9 #TumorBoardTuesday Friday Case🎀

Which led to our discussion of belzutifan–new HIF2a inhibitor approved in RCC (VHL) as well as pNET (regardless of VHL status)

nejm.org/doi/10.1056/NE…

fda.gov/drugs/resource…

7/9 #TumorBoardTuesday Friday Case🎀

But we talked about so much more. ☢️PRRT is a key mgmt tool in pNET.

Lots of discussion: should it be upfront, or reserved for later? Esp. given MDS/tAML risk…

Ongoing research on CHiP, other risk factors @OncoThor

8/9 #TumorBoardTuesday Friday Case🎀

Now that you’ve made it this far–you’re well equipped to get some free CME! 🎓

Answer 2 questions re: pNET treatment here: bit.ly/3piNoq9

8.5/9 #TumorBoardTuesday Fri Case🎀

🙏 Pt responding to belzutifan!
🤔 Lots of options for pNET. Choice depends on each pt.

CAPTEM is an upfront tool 👍🏽response in ⏫ Ki67. IO MAY be a good tool in *select* pts. PRRT in later line w new agents (belzutifan) entering the field.

9/9 #TumorBoardTuesday Case 🎀
📅Next TBT= special feature #OncFellows! Join @LaurenBzak & @JohnEbbenMDPhD 03/29/22 8pm EST to discuss using NGS to🎯 CUP! #PrecisionMedicine @MPishvaian

We try to make 🌍better for pts 🙏 for 🕊️& freedom. Thanks for joining.

@nanudasmd @anu_iris @HalletJulie @NTrikalinos @OncoThor @PamelaKunzMD @DrJashDatta @FogacciJoao @sonbol_bassam @DianeReidyLagun @KevinCalsina