Thread by @JohnEbbenMDPhD

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 1/8 #TumorBoardTuesday

🔬🧬Discussion on 1L treatment for BRCA+ #MBC led by @PTarantinoMD @CaterinaSpo #BreastCancer

➡️Here’s the week's Thursday Case 🎀

👉Don’t forget your🆓 #CME credit by answering 1 quick❓
CME🔗: integrityce.com/tbt
CME eval🔗: integrityce.com/tbteval

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 2/8 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages for germline #BRCAm & 2L tx in #BreastCancer
✅BRCAm fairly common - 10-20% of #TNBC
✅PARPi approved in met, BRCAm dz
✅Fast responses, with ORR > chemo

📚Much of @PTarantinoMD @CaterinaSpo’s chat👇🏽
twitter.com/i/events/15487…

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 2.33/8 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages (continued):

✅Toxicities for 🤢, myelosuppression- managed w ⬇️ reduction, tx holiday
‼️(remember 3-5% risk of MDS/AML)‼️

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 2.67/8 #TumorBoardTuesday
Thurs Case🎀

✅New options after prog on PARPi:
✅ADCs-
🔸T-Dxd, even if HER2 low (1+; debate on what low means now)
🔹Sacituzumab
🫧In pipeline: Dato-DXd

✅Trials coming 🕵️ other HRDi in combo- ATMi + PARPi

clinicaltrials.gov/ct2/show/NCT04…

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 3/8 #TumorBoardTuesday
Thursday Case🎀

🥼@PTarantinoMD @CaterinaSpo presented 52yo 👩🏻 w #TNBC (HER2 1+) s/p bilat mastectomy, with met recurrence & malignant 🫁effusion
FH: 2 sisters w early #BreastCancer; germline BRCA1 mut detected.
PD-L1 CPS<10%

💪evidence for PARPi as tx!

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 4/8 #TumorBoardTuesday
Thursday Case🎀

😰PARPi can have MAJOR side effects.

👩🏻 Patient develops significant 🩸anemia, ongoing 🤢 & 🤮

🤔 What now❓
💡✅ Dose ⬇️ + anti-emetics

💊olaparib vs talazoparib SE similar

https://twitter.com/PTarantinoMD/status/1549553780030689281

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 5/8 #TumorBoardTuesday
Thursday Case🎀

Decision to use a PARPi based on OLYMPIAD and EMBARCA studies.

Caveat: we WISH these studies would’ve used platinum as comparison, but they didn’t.

BOTH trials (olaparib, talazoparib) show ⬆️⬆️ ORR & PFS–but no OS benefit.

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry 6/8 #TumorBoardTuesday
Thurs Case🎀

✨Comparatively✨
PARPi= rapid responses, ⬆️PFS, ORR vs IV chemo with generally better adverse event profile 👉🏽 better tolerability.

💰Financial toxicity 💸
‼️NEED better solutions to HELP patients‼️ @NicoleKuderer @gary_lyman @benjiwal

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry @NicoleKuderer @gary_lyman @benjiwal 7/8 #TumorBoardTuesday
Thurs Case🎀

Another 🔑
Pt w stage I #TNBC, later w recurrent dz. Scans❌NOT shown to have utility in detecting early recurrence, hoping new tools like 🩸ctDNA could be useful.

🔥Now studying: vaccines post-op in high risk dz to ⬇️ recurrence‼️@rshatsky

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry @NicoleKuderer @gary_lyman @benjiwal @rshatsky 8/8 #TumorBoardTuesday
Thursday Case🎀

🙏Pt doing well on olaparib w ongoing PR
🤔Data to suggest re-treatment of pts w gBRCAm w PARPi if treatment free interval >1y; need to 🧐 ADCs as next line tx!

➡️Be sure to join on 08/02/22 when @dradityabardia presents a case of
#TNBC😀

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry @NicoleKuderer @gary_lyman @benjiwal @rshatsky @dradityabardia Remember #TumorBoardTuesday continues to offer AMA & now MOC credit for FREE! Don’t forget to answer the polls👇🏽
Then click this link to quickly request your credit!
CME eval🔗: integrityce.com/tbteval
ALL CME 🔗: integrityce.com/tbt

https://twitter.com/tumorboardtues/status/1549566641289183233?s=21&t=iaXvDD7-Fj_eW64dzdhhFA

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry @NicoleKuderer @gary_lyman @benjiwal @rshatsky @dradityabardia @lab_kok @DrRBarroso @DrChoueiri @stolaney1 @NicoleKuderer @hoperugo @ErikaHamilton9 @FilipaLynce @maryam_lustberg @DrSGraff @SusanGKomen @HeekeMd @DrHBurstein @barrosolab @JavierCortesMD @MCristofanill @drenriquegrande @tmprowell @DrTashaG @RICKLIN4TH @ProfWishart

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry @NicoleKuderer @gary_lyman @benjiwal @rshatsky @dradityabardia @lab_kok @DrRBarroso @DrChoueiri @FilipaLynce @maryam_lustberg @DrSGraff @HeekeMd @DrHBurstein @barrosolab @JavierCortesMD @MCristofanill @drenriquegrande @ProfAMThompson @oncoplastics @Liz_ORiordan @BreastDocUK @LiangRhea @MdVarvaras @Lucarecco @BianchiniGP @aftimosp @matteolambe @OncBrothers @benjiwal @RenoHemonc @YLeyfman @antonyruggeri @Dr_RShatsky @manjuggm @KoheiShitara @realdrgabriel @itsnot_pink @LaurenBzak

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry @NicoleKuderer @gary_lyman @benjiwal @rshatsky @dradityabardia @lab_kok @DrRBarroso @DrChoueiri @FilipaLynce @maryam_lustberg @DrSGraff @HeekeMd @DrHBurstein @barrosolab @JavierCortesMD @MCristofanill @drenriquegrande @ProfAMThompson @SorenBentzen @Carmela_surgery @JaniceTNBCmets @abhenilmittal @seiichi_mori @Prof_M_Ristow @Gobnait @jansen_marnix @MeriemMakhlou11 @ImaiMitsuho @DrReshmaMahtani @rafa_p10 @TBlackburn25 @DrLauraEsserman @naborala @nancyjmac1 @dra_izabela @nwabudike_sm @Nat71553043 @AChargy

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 @Myshastry @NicoleKuderer @gary_lyman @benjiwal @rshatsky @dradityabardia @lab_kok @DrRBarroso @DrChoueiri @FilipaLynce @maryam_lustberg @DrSGraff @HeekeMd @DrHBurstein @barrosolab @JavierCortesMD @MCristofanill @drenriquegrande @ProfAMThompson @SorenBentzen @Carmela_surgery @JaniceTNBCmets @abhenilmittal @seiichi_mori @Prof_M_Ristow @MridulaGeorgeMD @Rick_Villalobos @s_santiesteban @kazuki_nozawa @OlgaMartnezSez1 @BarbaraPistill2 @NagiSaghir @Myshastry @geneman20042000 @drsarahsam @DFCI_BreastOnc @nlinmd @elmayermd
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