ADCs are among the most rapidly expanding treatment modalities in oncology, with 11 ADCs approved and >200 in active development.

Here’s 10 facts to know to prepare for the rise of ADCs🧵 1. The first name utilized for antibodies linked to chemotherapy was “immuno-conjugates”.

Es: or

The name progressively evolved towards “antibody-drug conjugates”, which is widely preferred today.pubmed.ncbi.nlm.nih.gov/2162255/
ascopubs.org/doi/abs/10.120…

What is HER2 « ultralow » breast cancer, and why should you care?

A thread: First, a little history.

The ASCO/CAP guidelines from 2007 defined HER2 IHC 0 as “absence of HER2 staining”.

In truth, it did not make much difference if the tumor was 0 or 1+, since both were considered “negative” for HER2 protein expression.

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ascopubs.org/doi/10.1200/JC…

Reading good review articles can shape ideas, help connecting the dots and understanding what’s coming ahead in science.

Here’s 10 review articles that helped me shape my views on breast oncology and drug development: 1. The basics, first. What is breast cancer? How do we classify it, how do we treat it? In this article, Ada Waks et al. provide a comprehensive view of the clinical management of breast cancer, recapitulating decades of advancements in the field.
jamanetwork.com/journals/jama/…

@TumorBoardTues @drsarahsam 1/24 #TumorBoardTuesday #BreastCancer #OncTwitter
54yo 👩🏻 post-menopausal
HTN
hypothyroidism
FH: aunt with late-onset BC
Germline genetic testing: negative

🔪Dec ‘10 Left lumpectomy + SLNB:
left IDC G2
ER 95%
PgR 10%
HER2-neg (IHC 1+)
Ki67 35%
stage pT2 (25 mm) pN0
Oncotype 32 @TumorBoardTues @drsarahsam 2/24 #TumorBoardTuesday #BCSM

☢️Jan ‘11: TC x 4 ➡️ XRT
Treatment well tolerated, apart from alopecia, G2 fatigue

Summer ‘11 – started letrozole
🔀 Fall ‘11 – switch to exemestane due to G3 arthralgias ➡️ improvement of symptoms

2016 completed 5 years of Aromatase Inhibitor

Proud to contribute to the remarkable scientific journey of #APT, whose 10-year analysis is now published on @TheLancetOncol. Adjuvant TH confirmed outstanding long-term outcomes for patients with small HER2+ breast cancer. Aim for the next decade: biomarker-informed treatments!

https://twitter.com/stolaney1/status/1630557281787219968

Here a thread on the clinical and biomarker findings from this 10-year update: 👇 🧵

https://twitter.com/prat_aleix/status/1630455898253451265

Great idea: time for Elacestrant thread Tuesday! 🧵

But first a reminder: access to paywalled papers from @Annals_Oncology, @ESMO_Open & multiple other affiliated journals is free for @myESMO members, and I could not recommend more to become a member! esmo.org/membership
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https://twitter.com/BenWestphalen/status/1627938037903523841

Endocrine treatment is among the most effective treatment strategies we have for breast cancer. 50 years ago, the approval of the SERD tamoxifen really revolutionized the field, & we still use the drug today.

Yet, no novel ET had been approved for the last 20 years. Until now
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T-DXd has shown remarkable activity for treating HER2-positive and HER2-low breast cancers.

However, it may soon expand its reach, and become a treatment option even for HER2-0 tumors.

Here’s the 10 reasons why: 1. Because it works!

The only study that tested T-DXd for treating HER2-0 metastatic breast cancer (the phase 2 DAISY trial) demonstrated a response rate of 30% and a duration of response of 6.8 months. Not bad for being “zero”.

oncologypro.esmo.org/meeting-resour…

@TumorBoardTues @CaterinaSpo 1/16 #TumorBoardTuesday #BreastCancer #OncTwitter

52yo 👩🏻 post-menopausal, no sig comorbidities.
FH: 2 sisters with young onset BC.
Genetic testing: BRCA1+

🔪‘Bilat Mastectomy + left SLNB:

left IDC G3
ER 0%
PgR 0%
HER2 1+ (TNBC)
Ki67 95%

stage pT1c (17 mm) pN0 @TumorBoardTues @CaterinaSpo 2/16 #TumorBoardTuesday

👩🏻 adjuvant TC ➡️ discontinued after 3rd cycle➡️poor tolerance & recurring FN

22 mo. later --> CT: Lt supraclavicular & multi mediastinal LN met, Rt pleural effusion

🔬LN bx: metastasis of TNBC (ER 0%, PgR 0%, HER2 1+, Ki67 81%). PD-L1 CPS: <10%.

In ten days, the presentation of DB-04 may redefine the way we classify and treat breast cancer.

Here’s ten HER2-low facts you need to know before attending the ASCO Plenary Session: 1/10 About half of all BCs have HER2-low expression, defined as HER2 IHC 1+ or 2+/ISH-.

The rate of HER2-low tumors depends however on the expression of ER:
- TNBC: 40% HER2-low
- Moderate ER-exp: 45-55% are HER2-low
- Highly ER-exp: >60% are HER2-low

oncologypro.esmo.org/meeting-resour…

@TumorBoardTues @HeekeMd @BreastCancerMD1 @BreastCaupdates @breastcancer @SirohiBhawna 1/13 #TumorBoardTuesday #BreastCancer #OncTwitter

48yo♀️, persistent cough, 4cm L breast mass

PMH: Retinal detach

🖥️Many small lung🫁& mediastinal LN mets

Breast💉Bx: G3 IDC, ER 0%, PR 0%, HER2 3+, Ki67 80%

🤔For newly Dxed HR-/HER2+ MBC which 1L systemic Tx would you use❓ @TumorBoardTues @HeekeMd @BreastCancerMD1 @BreastCaupdates @breastcancer @SirohiBhawna 2/13 #TumorBoardTuesday #BreastCancer #OncTwitter

💊Treated with THP➡️PR for 9 months

👉Then,🖥️new lung and LN mets

🤔Which 2L systemic treatment would you recommend for this patient❓

A significant fraction of patients with HER2+ MBC achieve long lasting responses to HER2-blockade, with no evidence of disease for many years after Tx start

Are these patients cured? Can we increase this fraction?

A 🧵 on our latest JAMA Onc review: jamanetwork.com/journals/jamao…

1/6 Several aspects are associated w/ a long-lasting response to HER2-blockade

Important clinical features are de-novo presentation, low burden of dz & achievement of CR. Highly HER2+, immune inflamed tumors w/ no detrimental gene muts are more likely to achieve long responses

2/6

☕️ Since I’ve been seeing a lot of debate in the field lately, I’ve decided to provide a set of Guidelines for the management of a good 🇮🇹 coffee

1️⃣st - get a Moka. Better if an old one: just as wine, it gets better with the passing of time. Wash the Moka. Open the Moka.

[1/5] 2️⃣nd - Pour some water in the Moka. The right amount.

If you put too much, you get colored water 💧 . If you put to little, you’ve got no coffee to offer to other people. 🤷🏻‍♂️

Best is to reach just under the tiny valve. No rocket science.

[2/5]

In questi giorni stiamo assistendo all’approvazione dei primi vaccini per il #COVID19.

Tuttavia, si parla meno di un’altro grande traguardo scientifico, che permetterà in futuro di ridurre sostanzialmente l’utilizzo di chemioterapia adiuvante nel carcinoma mammario.

[Thread] Circa 50 anni fa, due ricercatori italiani (Bonadonna e Veronesi) conducevano uno storico studio clinico, dimostrando al mondo che somministrare chemioterapia dopo la rimozione di un tumore mammario poteva ridurre sostanzialmente il rischio di recidiva di malattia.

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