Medical Oncologist, Research Fellow @DanaFarber | @Harvard | PhD @LaStatale. SoMe Editor @ESMO_Open. Interested in breast oncology, HER2, ADCs & good music.
Jul 7 • 13 tweets • 6 min read
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.
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/…
☢️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
Feb 28, 2023 • 4 tweets • 3 min read
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!
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 1/
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 2/
Nov 14, 2022 • 12 tweets • 7 min read
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”.
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
🤔Which 2L systemic treatment would you recommend for this patient❓
Jan 13, 2022 • 6 tweets • 3 min read
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?
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
Jun 5, 2021 • 5 tweets • 3 min read
☕️ 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.
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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.
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Dec 12, 2020 • 10 tweets • 2 min read
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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