Thor Halfdanarson

Life-Changing Careers at Mayo Clinic Learn more about applying for Gastrointestinal Medical Oncologist at Mayo Clinic

Are you an oncologist with interest in GI cancer? If so, are you interested in joining a growing academic GI Oncology practice in Rochester, MN? We have 13 GI oncs with additional 3 joining soon and still growing 😀

We are hiring!

PM me if interested.

jobs.mayoclinic.org/job/rocheste...

Adjuvant Chemoradiation and Immunotherapy for Extrahepatic Cholangiocarcinoma and Gallbladder Cancer This randomized clinical trial evaluates the safety and efficacy of immunotherapy combining with chemoradiotherapy.

Adjuvant immunotherapy (camrelizumab) and CRT following resection of gall bladder cancer and extrahepatic cholangiocarcinoma. Small randomized trial, interesting findings in need of further validation.

jamanetwork.com/journals/jam...

Want a quick update in medical oncology on July 19 (with some heme updates in the mix)...? If so, we have the course for you! I can promise excellent content/speakers and there is a livestream (virtual) option too for those who cannot attend in person.

ce.mayo.edu/hematology-a...

The next frontier in radioligand therapy (RLT), radioligand-antibody drug conjugates...? Interesting data targeting TROP2 and HER2 in xenograft mouse models with orthotopic breast tumors. I am certainly keeping an eye on how this develops...

aacrjournals.org/mct/article/...

PRRT is a very effective for well-differentiated NETs but associated with a low risk of treatment related myeloid neoplasms ( t-MN ). If you are interested in learning more, this is the review for you...

erc.bioscientifica.com/view/journal...

Characteristics and treatment outcome in a prospective cohort of 639 advanced high-grade digestive neuroendocrine neoplasms (NET G3 and NEC). The NORDIC NEC 2 study - British Journal of Cancer British Journal of Cancer - Characteristics and treatment outcome in a prospective cohort of 639 advanced high-grade digestive neuroendocrine neoplasms (NET G3 and NEC). The NORDIC NEC 2 study

Lot to unpack from the excellent NORDIC NEC2.

- ORR: 31% for NEC (mostly plat/eto) - this is NOT SCLC
- ORR: 27% for G3 NETs (mostly TMZ-based)
- Immediate progression: 41% of NECs, 21% G3 NETs
- PFS: 3.4 m NEC; 7.4 G3 NET

NECs are really bad cancers!

www.nature.com/articles/s41...

EASL Clinical Practice Guidelines on the management of extrahepatic cholangiocarcinoma Recent years have witnessed significant advances in the imaging, molecular profiling, and systemic treatment of cholangiocarcinoma (CCA). Despite this…

Did you just wake up thinking how great it wold be to have a new review on extrahepatic cholangiocarcinoma...? If so, you are in luck. Here it is, courtesy of EASL

www.sciencedirect.com/science/arti...

Are you looking for a short update course in oncology this summer. Like a day-long course that covers recent data presented at ASCO and other recent meetings and publications. If so, we sure have the course for you. Online option also. @mayocliniccancer.bsky.social

ce.mayo.edu/hematology-a...

Relationship Between Best Tumor Shrinkage and Progression‐Free Survival and Overall Survival in Patients With Progressive Midgut Neuroendocrine Tumors Treated With [177Lu]Lu‐DOTA‐TATE: Ad Hoc Analysis of the Phase III NETTER‐1 Trial We analyzed data from the phase III NETTER-1 study of 177Lu‑DOTATATE for patients with advanced midgut neuroendocrine tumors to explore whether tumor shrinkage is associated with durable efficacy. Al...

It is not all about tumor shrinkage after PRRT. In this NETTER-1 analysis, PFS and OS were not different in patients where tumor shrinkage was seen. Not a new observation but a topic I discuss every week with patients. Benefits can be seen w/o high ORR...

onlinelibrary.wiley.com/doi/10.1002/...

Adrenocortical carcinoma: a practical guide for clinicians Adrenocortical carcinoma is a rare endocrine malignancy. The management of patients with adrenocortical carcinoma is challenging for several reasons, …

www.sciencedirect.com/science/arti...

American Association of Clinical Endocrinology Consensus Statement on Management of Multiple Endocrine Neoplasia Type 1 This document presents the findings of the American Association of Clinical Endocrinology (AACE) on the diagnosis, management, and surveillance of pat…

Wishing you had access to new and updated guidelines on MEN1...? Worry not, this team has you covered.

www.sciencedirect.com/science/arti...

Optimal Approaches to Grading Entero-Pancreatic Neuroendocrine Tumors Using Ki-67 Proliferation Index (Hotspot and Whole Slide Digital Quantitative Analysis) Grading neuroendocrine tumors using Ki-67 PI is essential for prognostic assessment and therapeutic decision-making. However, the absence of standardized guidelines has led to methodological inconsist...

Time to rethink our approach to NET grading and use whole slide analysis (WSA) in addition to hotspot analysis (HSA) when assigning tumor grade using Ki-67? It certainly seems so.... @IHC_guy

www.modernpathology.org/article/S089...

Trying to summarize nuanced treatment decisions in one slide... What to do with small NF-pNETs? Who to observe? When to intervene...? What am I missing/getting wrong...?

Genomics in Cancer of Unknown Primary: Utility in Modern Clinical Practice Cancer of unknown primary (CUP) is defined as metastatic cancer where the primary tumour responsible for metastatic spread cannot be identified despit…

Looking for a review on genomics in cancers of unknown primary...? Here you have it!

As I have said before, every CUP patient seen in the Mayo CUP Clinic will have genomic testing. It is a somewhat surprisingly target-rich malignancy.

www.sciencedirect.com/science/arti...

DLL3 Expression in Neuroendocrine Carcinomas and Neuroendocrine Tumours: Insights From a Multicentric Cohort of 1294 Pulmonary and Extrapulmonary Neuroendocrine Neoplasms - Endocrine Pathology Delta-like ligand 3 (DLL3) is frequently expressed in pulmonary small cell neuroendocrine carcinoma (SCNEC) and has emerged as a promising therapeutic target. However, limited data on DLL3 expression ...

DLL3 expression in high-grade NENs? Not rare at all! Check out this large study. 64% of NECs pos, 42% lung NETs, but only 5% GEPNETs are pos with the exception of G3 NETs which are 20% mod or strongly pos. DLL3-directed trials coming but not for G3 NETs.

link.springer.com/article/10.1...

What's happened in imaging for CUPs in the last decades, where are we now and where might we be going...? Very good overview with detailed tables of detection rates for different modalities. The stuff you need for your next talk or paper on CUP...

academic.oup.com/bjr/advance-...

Are you interested in learning more about the management of small panc NETs and how molecular analysis may predict outcomes? If so, I have just the right paper for you... 😀 Thanks to @PancPathologist, Anna Vera Verschuur, C. Heaphy, L. Brosens et al.

erc.bioscientifica.com/view/journal...

In case you needed a reminder of the not-so-predictable somatostatin receptor expression of lung NETs, here you have it...

Keep in mind that only 44% had uniformly positive SSTR expression and some have none at all like this patient.

jnm.snmjournals.org/content/64/1...

CUP oncology is increasingly precision oncology. Patient in 60s, extensive BRG-1 deficient undifferentiated poorly diff carcinoma of unknown primary. Near complete but not durable response to docetaxel/cisplatin/pembro followed by durable response to adagrasib for KRAS G12C mut.

<em>Journal of Neuroendocrinology</em> | BSN Journal | Wiley Online Library Poorly differentiated extrapulmonary neuroendocrine carcinomas are rare and aggressive cancers with a poor prognosis. In neuroendocrine carcinoma of the lung, addition of immunotherapy to chemotherap...

Similar findings here...

And did I mention you should seek out and enroll on SWOG S2012...? Just wanted to be sure you understood that epNECs are NOT SCLC and we have a trial ongoing.

onlinelibrary.wiley.com/doi/10.1111/...

Efficacy of atezolizumab combined with platinum and etoposide in the treatment of extrapulmonary neuroendocrine carcinoma AbstractBackground. Neuroendocrine carcinoma (NEC) is an aggressive, poorly differentiated Grade 3 (G3) tumor with high nuclear and cellular atypia and Ki-

Should we routinely add ICIs to chemo (platinum/etoposide) in extrapulmonary NECs? I think no. Yes, I realize the outcomes in advanced NEC are poor but we simply do not have the data yet. No benefit in this retrospective study. Enroll on SWOG S 2012!!!

academic.oup.com/oncolo/artic...

He convinced me…. Temps in the mid 70s yesterday and now low 30s and flurries. Gotta love the early spring in Minnesota 😂

Why are you answering emails and working on a book chapter on a Saturday…? We could be out playing.

Functioning neuroendocrine tumors (NET): Minimum requirements for a NET specialist Functioning neuroendocrine tumors (f-NETs) represent a minority of all NETs, however their management is challenging due to the impact on patients’ su…

If you were thinking of how nice it would be to have a recent review on functional NETs, you got one here courtesy of Francesca Spada and team. Excellent introduction to the fascinating world of functional NETs.

www.sciencedirect.com/science/arti...

Differentiation Versus Grade for Pancreatic Neuroendocrine Neoplasms Context.—. Pancreatic neuroendocrine neoplasia (panNEN) is a tumor disease with distinctive morphology and often poses diagnostic challenges.Objective.—. To present and discuss the current diagnostic ...

Still a little confused on the difference between grade and differentiation in panc NETs...? Need a quick primer on the pathology of pNETs including the genetic/molecular alterations. If so, Dr's. Rindi and Inzani have you covered.

meridian.allenpress.com/aplm/article...

It may still be dull, gray and brown but spring is in the air in Minnesota. Unseasonably warm day, the fields are freshly tilled and I am off today. What better than a good dose of gravel riding. Just what the doctor ordered…

Association Between Vacation Characteristics and Career Intentions of US Physicians—A Cross-Sectional Analysis To assess the association between physicians’ vacation characteristics and career intentions.

Not sure about you but I find this depressing..

Of 5059 respondents, 47.7% reported fewer than 15 days of vacation in the last year, with 9.8% taking 5 or fewer days.

Personally, I take 5-6 weeks off every year and rarely log into the EMR or do work.

www.mayoclinicproceedings.org/article/S002...

Accelerometer-Derived To examine the association of “weekend warrior” (WW) pattern and physical activity distributed throughout the week with mortality risk.

Look, I am posting a non-NET, non-CUP paper! Weekend warrior exercise does seem to have similar protective benefits as more regular exercise throughout the week. Very large study from the UK Biobank. What about us who do both...? 😀
www.mayoclinicproceedings.org/article/S002...

No wonder I am gently nudging my teenage daughters to study in Europe (they are dual citizens with Europe open) and even better, permanently settle there, ideally in one of the Nordic countries...

PRRT + PARP inhibitors in advanced NETs? To date, no trials have convincingly shown that PRRT + drug X (whatever that may be) is better than PRRT alone. The addition of PARPi seems to add little early toxicity but larger trials needed to show efficacy.

jnm.snmjournals.org/content/earl...