Discover and read the best of Twitter Threads about #PancreaticCancer

Most recents (24)

@TumorBoardTues @JohnEbbenMDPhD #TumorBoardTuesday
📣Welcome as we summarize some of the incredible data from #ASCO23
👉There was SO much to take in, that even focusing on GI Cancers was a challenge
🙏As always, these were the🧑‍🏫that caught OUR interest, but this is not a judgement on those we do not highlight‼️
@TumorBoardTues @JohnEbbenMDPhD 1/21
#TumorBoardTuesday
🤔Speaking for myself, @knutjla ‘s data has shaken my practice the most (including twice last week)
👉He presented the NORPACT-1 trial of peri-operative FOLFIRINOX vs. upfront🔪for resectable #PancreaticCancer Image
@TumorBoardTues @JohnEbbenMDPhD @knutjla @MDAkhilChawla @FlavioRochaMD @NbmerchantMD @MadameSurgeon @NirajGusani @TsengJennifer 2/21
#TumorBoardTuesday
@knutjla🗣️a well designed, well run trial
✅The authors even hypothesized a 20%⬆️in mOS
➡️However, pre-operative chemotherapy led to a significant⬇️in 18 month mOS😲
👉Despite a much better R0 resection rate

🤔What are your thoughts💭❓ Image
Read 22 tweets
1. ENTER #mRNAvaccines for #pancreaticcancer! Long-term #PDAC survivor story PART3.

"Do #PDACs REALLY have vaccine neoantigens (NAs)"? (aren’t they lowly mutated?)

If each patient = own NAs, how do you vaccinate?

Maybe mRNA? But how?

@Nature nature.com/articles/s4158…

👇🏽 [1/32]
2. In 2017, we reported in @Nature here -> nature.com/articles/natur… -> that primary tumors of long-term survivors of #PDAC had ~12x more activated CD8 T cells vs. short-term survivors

AND

despite #PDAC’s few mutations, mutation-derived NAs may still be T cell antigens in #PDAC.
3. Now, prevailing belief ->#PDAC = few mutations = fewer mutation-derived NAs = NAs unlikely #PDAC T cell antigens.

BUT...our #NeoantigenQualityModel(estimates the ~1-2% of immunogenic NAs)

found that long term #PDACsurvivors ∝ more “high quality” NAs ∝longer survival. Image
Read 33 tweets
@TumorBoardTues 1/15 #TumorBoardTuesday #PanCan #OncTwitter
46yo 👩🏻 asymptomatic
no comorb
🌀Screening abd US: liver nodules + pancreatic mass (body/tail)
🔬Liver bx + NET G2 Ki67 12%
🩻PET-Ga + uptake in pancreas & liver (SUVs>20)
💉1L: Lanreotide SC - DP liver after 1y (⬆️volume)
🤨What 2L tx?
@TumorBoardTues 2/15 #TumorBoardTuesday

👩🏻 starts 2L CAPTEM: major partial response🙏🏼
🔪Pancreatectomy + R0 liver resections
🔬Path: NET G3 Ki67 90%

🗓️2 mo later
back pain + weight loss: large retroperitoneal LN
💉3L: rechallenge CAPTEM ➡️ poor clinical control 🔀 Cisplatin + Etoposide
@TumorBoardTues 3/15 #TumorBoardTuesday #NETCancer @RachelRiechelm2 @MPishvaian @JohnEbbenMDPhD

👩🏻 DP mediastinal LN after 6 mo
💉4L: FOLFIRINOX with partial response/severe toxicity
📑NGS (Foundation One): very high TMB 97 MSS

🧐What 5L tx would you pick?
Read 19 tweets
😀I am so excited to be at my 1⃣st IN PERSON ASCO GI in 3y

✅To prepare, I have gone through the abstract titles, and here are my Top GI ASCO 2023 abstracts

📣Disclaimer: There is no bias or exclusion intended.
These are just the ones I personally want to see👀
#GI23
➡️Starting with #Cholangiocarcinoma because it is a big year - especially because of:
✅SWOG 1815: A phase III trial of gem-cis-nab-pac vs. gem-cis as 1⃣st line💊for advanced BTC
👁️Rachna Shroff, Abs LBA490
@rachnatshroff
#GI23
➡️Two impt ImmunoTx trials:
✅IMbrave151: Phase 2 trial of gem-cis-atezo + /- bev as 1⃣st line💊for advanced BTC
👁️A El-Khoueiry, Abs 491

✅Also a TOPAZ-1 report on the long-term survivors Txed with gem-cis-durva 1⃣st line for advanced BTC
👁️M Bouattour, Abs 531, Pos C1
Read 21 tweets
📢🥁By popular demand presenting the TOP Oncology publications of 2022.

PS: List not exhaustive - so feel free to tag & add important papers to the list @OncoAlert @NEJM @TheLancetOncol @Annals_Oncology @NatureMedicine @Nature @CD_AACR
First 2022 saw publication of Hallmarks of Cancer: New Dimensions @CD_AACR @AACR @ElizSMcKenna
aacrjournals.org/cancerdiscover…
DESTINY-Changing Results for Advanced Breast Cancer Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer @NEJM @weoncologists @ErikaHamilton9 @teamoncology nejm.org/doi/full/10.10…
Read 28 tweets
2022 was the year mutant KRAS in #PancreaticCancer truly became actionable.

Direct KRAS targeting & #PancreaticCancer, a 🧵:
In @NEJM by @DavidHongMD & colleagues:
Sotorasib in KRAS p.G12C–Mutated Advanced #PancreaticCancer
nejm.org/doi/full/10.10…
G12C is ~1.6% of KRAS alleles in pancreatic cancer, & monotherapy responses in pre-treated patients are mostly transient stable disease, but a step forward.
In addition to Sotorasib, Adagrasib is the other KRAS G12C inhibitor with demonstrated Phase 1 activity in #PancreaticCancer (2022 data).
The expansion cohort in pancreatic cancer will start accrual at @MDAndersonNews soon.
clinicaltrials.gov/ct2/show/NCT05…
@DrShubhamPant @DanZhaoMD
Read 13 tweets
#KRAS alert! Over the past 4 years, a multi-disciplinary team from @hopkinskimmel @VUMC_Cancer @DanaFarber @MSKCancerCenter & @Amgen has been studying the distribution and co-mutations of KRAS, NRAS and HRAS mutant #cancers under the auspices of @AACR project #GENIE. Read the 🧵 Image
Our work is now published online at @CR_AACR and represents the largest study of RAS genomic architecture to date, leveraging #NGS data from >600,000 mutations and >66,000 tumors across 51 #cancer types.

Full text here
aacrjournals.org/cancerres/arti….
Our findings provide insights in the genomic architecture of RAS mutant cancers and may serve as a blueprint for mapping therapeutic vulnerabilities for mut RAS. Given the vast array of findings we have put together a shiny app for interactive #dataviz:
ras-hallmarks.jhmi.edu
Read 22 tweets
📢In preparation for #ASCO22, I wanted to present my list for the #PancreaticCancer abstracts to👀for @ASCO

Again,🙏note - I went through a LOT of abstracts, and I definitely may have missed some‼️
👉And these are not in any particular order

✅But enjoy, RT, and reply😀
#ASCO22 #PancreaticCancer
🤔Is more better❓
✅Dr. Carrato🧑‍🏫a Rand trial
👉Gem-nab-pac➡️FOLFOX (sequenced Q6 wks)
vs.
👉Standard Gem-nab-pac
➡️mOS was 3.5mos⬆️with sequenced Tx
➡️Even though more standard pts got 2nd line Tx
🤯Really❓
🤔Interesting
🔎GI Can Oral Abst 4022
#ASCO22 #PancreaticCancer
🤔Is more better❓
✅Similarly, Dr. Portalesa🧑‍🏫a Rand Ph2 "Trial in Progress" comparing:
👉Sequential gem-nab-pac➡️FFX
vs.
👉Standard FFX alone
➡️Primary objective is OS
🤔But really, what will be critical will be the OS
🔎Abst TPS4190, Poster 160a
Read 11 tweets
Today, in @Nature, we reveal PART 2 of our investigations on

“What IS going on in long-term survivors of #PancreaticCancer (#PDAC)?”

“Is it REALLY the immune system?”

Well…more evidence here - > nature.com/articles/s4158…

Thread below [1/30]
In 2017, we reported in @Nature here -> nature.com/articles/natur… -> that primary tumors of long-term survivors of #PDAC had ~12x more activated CD8 T cells vs. short-term survivors. Now, others had reported this before - but we wanted to know:

“What are the antigens?” Image
Here, the prevailing belief was:

#PDAC has few mutations -> even fewer mutation-derived neoantigens -> neoantigens are unlikely T cell antigens in #PDAC.

But we thought: despite #PDAC’s few mutations, mutation-derived neoantigens may still be T cell antigens in #PDAC survivors
Read 31 tweets
1/9 #TumorBoardTuesday Thursday Case Wrap Up🎀

⏰ for #TBT Case Wrap Up!

We looked at dx and tx of Carcinoma of Unknown Primary (#CUP), including how 🧬 can change tx.
There was a lot to learn–we captured what we could of the discussion here:

twitter.com/i/events/15089…
2/9 #TumorBoardTuesday Thurs Case🎀
Take🏠:
#CUP is complicated!
✅Comprehensive approach needed, including:
H&P,🔬, 🩻, 🧬
✅Overall inc of CUP is ⬇️–many liver CUP being recognized as cholangio
✅NGS can help augment the w/u
✅STK11= frequently mut in lung; ⬇️response to IO Image
3/9 #TumorBoardTuesday Thursday Case🎀

@LaurenBzak’s case: Pt p/w solitary 🧠 lesion ➡️ poorly diff adenocarcinoma. But–not a primary CNS malignancy. NOTHING outside 🧠on CT or PET.

🧐What should we do next?

👍Detailed H&P (smoking hx)
👍PATH CONSULT!
Read 12 tweets
Really chuffed to share our latest work from Sanjana Lab out in @nature today (nature.com/articles/s4158…).

We tested >12,000 genes to find positive regulators of T cell proliferation to be used for next-gen #immunotherapies.

A thread...
(2/28) T cell therapies have shown the potential to cure patients from #cancer – but even in B cell cancers, relapses outnumber cures… One of the problems is limited T cell persistence. #celltherapy #CARTcell
(3/28) We wanted to find new genes (including genes never expressed in T cells) that could improve T cell persistence. Now, the question was: should we use #crispr activation or directly deliver target genes on a #lentivirus?
Read 30 tweets
#TBTWebinar is back ‼️
🥼 @MPishvaian @BreastCancerMD1 @Latinamd @BenWestphalen

#CME🔗 bit.ly/3vdXBb4
Pretest 👉 bit.ly/3rYNZir
Claim credit 👉 bit.ly/3ljVVXM

Supported by AstraZeneca Pharmaceuticals & Daiichi Sankyo, Inc

twitter.com/i/broadcasts/1…
#TumorBoardTuesday HER2 #TBTWebinar 🔑

➡️HER2 activity requires receptor dimerization
✅HER1 = EGFR
✅HER3, HER4

➡️HER2 is frequently overexpressed in multiple cancers
✅Protein⬆️due to gene🧬 amplification
✅Constitutive activation due to activating🧬mutation Slide 3 of #TBTWebinar
#TumorBoardTuesday HER2 #TBTWebinar 🔑

➡️HER2 (ERBB2) alterations occur in multiple cancer types
✅Breast Ca 25%
✅Gastric Ca 22%
✅GE jxn Ca 32%
✅CRC 5%
✅Lung Ca 6 to 30%
✅Biliary Ca 5 to 20%

🤔There is some disease specificity re: overexpression vs activating🧬mutation Slide 4 of #TBTwebinar
Read 14 tweets
Portal Vein Resection (PVR) during Pancreatico-duodeneactomy (PD) for #PancreaticCancer

A thread..
ISGPS types, technical points, images, videos 1/9

#HPBtwitter, please add what i have missed

@ISGPS_news @IHPBA @EAHPBA @TeamSurgery247 @hpb_so @me4_so @Cirbosque @surgery_hps
Type 1 PVR - sleeve resection of vein wall, less common. Most often site is at the PSPDV insertion in lateral PV border (during early phase of tumor extention in vein)
The other common situation is during distal resections,when SV is involved flush to its insertion.
2/9
Type II PVR - Part of the wall is excised but primary closure (type I) is not feasible. The patch recon is more tedious than end to end recon. Hence most suitable cases are lateral/posterior wall involvements at the level of S-P confluence as splenic vein can be preserved.
3/9
Read 9 tweets
1) Welcome to a new #accredited #tweetorial on a🗝️ topic in #cancer care & #vascular medicine: #VTE (#DVT and #PE). Cancer patients are at⬆️risk from their disease, their comorbidities, & often from their treatment. It's a sticky wicket & @cardiomet_CE is proud to welcome ...
2) ... one of the world's leading authorities on cancer-associated VTE as new faculty both here and on @onc_ce: Dr. Alok Khorana @aakonc of @ClevelandClinic, to talk about advances and best treatment in this space!
3) This educational program is intended for health care providers & is supported by a grant from Bristol Myers Squibb & its Alliance partner Pfizer, Inc. Faculty disclosures are listed at cardiometabolic-ce.com/disclosures/. Earn CE/#CME credit from prior programs at cardiometabolic-ce.com.
Read 39 tweets
Good Morning #GImedTwitter

🌅🌄🌇Whether you are waking up in San Francisco…..or not (Curse you COVID-19😡)

🧑‍🏫Get ready for 3 packed days of presentations at #GI22

And to get the🧠started, we are going to share our
Top 10 Targeted Therapy Abstracts🎯

#TumorBoardTuesday
#TumorBoardTuesday

1⃣/
Once again HER2🎯💊is everywhere #GI22

👉The DESTINY trials have been👍4⃣T-DXd

✅DESTINY-CRC01
➡️T Yoshino, et al "RAPID" Abs 119
⏩53 "Group A" HER2+ RASWT CRC pts
⏩ORR 45%, mOS 15.5 mos
👍Even with prior HER2 Tx
😨But GR>=3 AEs in 65% of pts, 9% ILD
#TumorBoardTuesday #GI22

2⃣/
✅DESTINY-Gastric 01
➡️K Yamaguchi, et al "RAPID" Abs 242
⏩Randomized Ph II trial of >=2nd line💊
👉T-DXd vs. Physician’s choice (PC) which was Iri or Paclitaxel
⏩mOS 12.5 v 8.9 mos
⏩ORR 51% vs 14%
😨But Grade >= 3 AEs were 86% vs 57%
Read 11 tweets
1/8 #TumorBoardTuesday
➡️This week's Thurs Case🎀 is here!

🔬We discussed locally advanced #PancreaticCancer--& sig of germline muts (ATM). @SirohiBhawna takes us on her pt’s treatment journey.

🗝️insights 🤔on locally advanced #PANCAN below!
#PancreaticCancerAwarenessMonth Image
1.5/8 #TumorBoardTuesday

👉👉 Don’t forget to pick up your 🆓 #CME credit by answering 2 quick❓
Here’s the post-test 🔗: bit.ly/3ws480C

ALL CME 🔗: integrityce.com/tbt Now...on to the case!
2/8 #TumorBoardTuesday
Thurs Case🎀
11/09/2021
Take🏠:

✅Upfront tx depends on pt- mFFX vs gem/nab-pac
✅Test all #PDAC for germline mut regardless of FH!‼️
✅Screen w annual MRI/EUS in gATM
✅Emerging 💊combos tx ATM-mut
#PANCAN req multi-D- role for palliative SBRT, ?IRE
Read 12 tweets
1/12 #TumorBoardTuesday
Thurs 10/12/21 Case🎀
@ShaalanBeg @CancerCommons present a case of #PancreaticCancer that challenges us to🤔about cell signaling & mol bio➡️better outcomes.

📚We captured as much of the chat as we could:
twitter.com/i/events/14479…
#PanCan #KRAS #OncTwitter
2/12 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:
We discussed #PancreaticCancer & specific #KRAS mut
✅All KRAS muts aren’t ≠
✅KRAS G12R➡️⬆️autophagy
✅Autophagy= tumor can♻️cell components ➡️resistance
✅MEKi + autophagy inhib= strat for G12R
✅Repeat NGS on prog is🗝️!
3/12
#TumorBoardTuesday
Thursday Case🎀

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

ALL CME 🔗: integrityce.com/tbt
Read 15 tweets
1/10 #TumorBoardTuesday

🔬A discussion focused on precision med in cervical cancer led by @GauravGangwan15
➡️Here's the Thursday Case🎀

👉 Don’t forget to pick up your 🆓 #CME credit- answer 2 quick❓here: bit.ly/3A6ipjH

ALL CME 🔗: integrityce.com/tbt
2/10 #TumorBoardTuesday
Case🎀
Take🏠msgs re: stage IV #CervicalCancer & 🎯med.
✅Cervical ca =4th leading cause of ca☠️ in♀️around the🌍
✅Screen &💉key; some spirited debate re: 💉roll out
✅AJCC revised- consider HPV, incorp addtl imaging in staging

3/10 #TumorBoardTuesday
Case🎀
Take🏠messages cont’d:
✅NGS can yield 🗝️tx, even when🎯🧬are rare in a dz
✅CRAF🎯 💊 paired with MEK 💊. Why?
✅RAF inhib➡️ ⬆️MEK activation

📚We captured as much of @GauravGangwan15’s discussion as we could: twitter.com/i/events/14455…
Read 12 tweets
@ShimaghavimiMD @TumorBoardTues #TumorBoardTuesday
Case 08/03/21

74 yo♂️presents with RUQ pain and fatigue, 30# weight loss, PS=2

CT scan demonstrates a large panc mass and diffuse liver metastases

Liver core biopsy confirms an acinar cell #PancreaticCancer

➡️What would be your treatment recommendation❓
@ShimaghavimiMD @TumorBoardTues #TumorBoardTuesday
08/03/21

He was treated with every other week Gem-nab-pac
🙏@GIcancerDoc
➡️Had rapid symptomatic improvement
➡️Now essentially normal PS
➡️Nice response to treatment for 9 months🙂

But then disease progression❗️

What would be your 2nd line therapy choice❓
@ShimaghavimiMD @TumorBoardTues @GIcancerDoc #TumorBoardTuesday
08/03/21

Germline NGS🧬testing did not reveal any inherited alterations

☝️Somatic (tumor) NGS🧬testing revealed a
💥BRAFV600E mutation💥

✅And no KRAS mutation

➡️Done while on 1st line therapy

Would the results alter your treatment choice now?
Read 9 tweets
Delighted to share our new study nature.com/articles/s4158… introducing PhasED-Seq out today @NatureBiotech.
A fantastic collaboration from @StanfordMedicine led by Dave_Kurtz & Joanne Soo with @max_diehn to help transform #cancer interception & monitoring by improving #LiquidBiopsy #ctDNA detection of #MRD.
For many cancers & nearly all currently available techniques, the impressive KM plots of #ctDNA #MRD immediately after definitive Rx w/ curative-intent unfortunately still miss ~50% of all events which occur in the MRD-negative subset, thus having modest NPV.
Read 21 tweets
#TumorBoardTuesday
💥Wow - this week was TOO much‼️

A🗣️on TMB-high #PancreaticCancer & #Immunotherapy by @DrBonillaOnc

AND our 1st pt-directed🗣️led by @HPolymenis and @StephenVLiu

👉Don’t forget your🆓#CME credit-answer 3 quick❓
Here's the postest🔗
surveymonkey.com/r/6JVHCSG Image
#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

We discussed #PancreaticCancer and:
✅Cynicism/Nihilism
✅The importance of multi-D care
✅1st line Tx
✅🧬Testing
#Immunotherapy

We captured as much as we could in this moment:
twitter.com/i/events/13999…
#TumorBoardTuesday
Thursday Case🎀
(Case from 06/01 and 06/02/21)

And also this moment:
twitter.com/i/events/14005…
Read 20 tweets
#ASCO21 #PancreaticCancer

📢ASCO is a few days away, and I decided to put together my list of
✅Top Abstracts to watch for

📝I tagged who I could

Starting with my Top Pancreatic Cancer Abstracts...in no particular order.....

(A common theme: NGS and fusion testing is🗝️)
#ASCO21 #PancreaticCancer

@VivekSubbiah, et al (Abstr 3079)
➡️RET inhibitor pralsetinib in patients with RET fusion-positive solid tumors

I know - he has presented this before🙄

🥳but now 3/3 patients with pancreatic cancer responded - one with a CR ongoing at 20.8 months‼️
#ASCO21 #PancreaticCancer

Alison M. Schram, @EileenMOReilly @graokane @benweinbergmd (abstr 3003)
➡️Zenocutuzumab (MCLA-128) in pancreas cancer and other solid tumors harboring NRG1 fusions

✅INV-assessed ORR = 40% (4/10)
✅Tumor regression in 7/10 pts
✅DCR = 90%
✅DOR TBD
Read 9 tweets

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