a person stands on the top of a rocky mountain
ALT: a person stands on the top of a rocky mountain
#TumorBoardTuesday
This was a mountain of data to cover in a very fast moving treatment area - thank you so much @drgattimays.bsky.social and @KennaKoehler for this massive effort🙏
22.10.2025 01:26 — 👍 1 🔁 0 💬 0 📌 0
Integrity CE
Learn more about the
#PostTest Q2️⃣ #TumorBoardTuesday
🧐A 75yo♀️w/ ER+/HER2- PIK3CA+ mBC starts 2L Tx w/alpelisib + fulvestrant. Baseline A1C = 6.1 & BMI = 33. What steps can limit risk for severe hyperglycemia❓
1) Labs QW x 2, then Qmonth
2) Baseline A1C, then Q3 months
3) Consider metformin premed
4) All of the above
22.10.2025 01:25 — 👍 0 🔁 0 💬 1 📌 0
#PostTest Q1️⃣ #TumorBoardTuesday
🤔What 2L Tx would you offer a 45yo♀️w/ ER+/HER2- mBC and an AKT mutation on 🧪liquid biopsy after progression at cycle 47 of ribociclib ➕ AI/OFS❓
1) Capecitabine monotherapy
2) Capivasertib + fulvestrant
3) Elacestrant monotherapy
4) Everolimus + fulvestrant
22.10.2025 01:25 — 👍 0 🔁 0 💬 1 📌 0
18/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 12🏫
🔊Take home points 🔊:
✅ 🩸Bx recommended at⬆️ on 1L to screen for🧬mutations
✅ 2L options: mPFS 5-11 mos, some with⬆️OS
✅ Optimal sequence unknown, likely depends in part on patient factors
22.10.2025 01:09 — 👍 0 🔁 0 💬 1 📌 0
ClinicalTrials.gov
17/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 11🏫
Ongoing HR+/HER2- trials:
2️⃣ TroFuse-011 (NCT06841354)
💊 Sacituzumab tirumotecan vs physician’s choice chemo
💉 Trop-2 directed ADC
👆 Primary endpoints: PFS and OS
www.clinicaltrials.gov/study/NCT068...
22.10.2025 01:08 — 👍 0 🔁 0 💬 0 📌 0
ClinicalTrials.gov
17/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 11🏫
Ongoing HR+/HER2- trials:
1️⃣ HERTHENA-Breast04 (NCT07060807)
💊 Patritumab deruxtecan (HER3-DXd) vs physician’s choice chemo
💉 ADC of HER3 mAb linked to topoisomerase I payload
👆Primary endpoints: PFS and OS
www.clinicaltrials.gov/study/NCT068...
22.10.2025 01:08 — 👍 0 🔁 0 💬 1 📌 0
16/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 10🏫
DESTINY-Breast04
👩🦳 2L mBC HER2- low
✅ Both ER+ and ER-; HER2-low
➡️IHC1+ = 58% & IHC2+ = 42%
💊 Trastuzumab deruxtecan (T-DXd) v physician’s choice (Cape, eribulin, Gem, paclitaxel or nab-paclitaxel)
💊 T-DXd: ADC of humanized anti-HER2 mAb🔗to topo I⛔
22.10.2025 01:06 — 👍 0 🔁 0 💬 3 📌 0
15/18 #TumorBoardTuesday
⏭️ Moving on to Case 3…
#TumorBoardTuesday #OncTwitter Case 3
👩🦳 67 y.o. postmenopausal female
💉 Metastatic HR+, “HER2 low” BC to bone, liver
💊 Progressed on 1L CDK4/6i + ET within 4 months of starting therapy
🧪 No BRCA mutations
22.10.2025 01:03 — 👍 0 🔁 0 💬 1 📌 0
14/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 9🏫
📰 Breaking news! 🔊 evERA study
🔎 Phase III, randomized trial (NCT05306340)
👩🦳 mBC HR+/HER2-
✅ Previous tx w/CDK4/6i+ET
💊 Giredestrant (30 mg QD) + Evero vs Exemestane/Evero
💊 Giredestrant: A novel, nonsteroidal oral SERD 🚫 NOT FDA approved as of today
22.10.2025 01:00 — 👍 0 🔁 0 💬 1 📌 0
ASCO Publications
11/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 6🏫
EMERALD
👩🦳2L metastatic HR+/HER2- received 💊 Elacestrant 400mg daily vs 💉fulvestrant or 💊AI
🤢 Most common AE: nausea and vomiting
📎https://ascopubs.org/doi/10.1200/JCO.22.00338?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
22.10.2025 00:54 — 👍 0 🔁 0 💬 1 📌 0
Imlunestrant with or without Abemaciclib in Advanced Breast Cancer | NEJM
Imlunestrant is a next-generation, brain-penetrant, oral selective estrogen-receptor (ER) degrader that delivers continuous ER inhibition, even in cancers with mutations in the gene encoding ERα (E...
12/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 7🏫
EMBER-3
⬆️ PFS in ESR1m→ 5.5 mon Imlunestrant vs 3.8 mon ET SOC vs 9.4 mon Imlunestrant + Abemaciclib
❓🙋FDA Approved Sept 2025 Imlunestrant monotherapy ONLY [combination not submitted to FDA]
22.10.2025 00:54 — 👍 0 🔁 0 💬 1 📌 0
12/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 7🏫
EMBER-3
👩🦳 2L me HR+/HER2-
💊 Imlunestrant, next gen oral SERD with 🧠CNS activity
✅ 1-2 prior ET+/-CDK4/6i [recurrence <12mo or on adj CDK4/6i/AI or PD on 1L CDK4/6i/ET]
📝 💊 Imlunestrant 400mg QD vs 💊SOC [fulvestrant or exemestane] vs💊 Imlunestrant+Abema
22.10.2025 00:54 — 👍 0 🔁 0 💬 1 📌 0
#tumorboardtuesday
🤔Hmmm....much more rapid disease progression on the CDK4/6🚫+AI - does this portend for a worse prognosis in subsequent lines of therapy❓
22.10.2025 00:48 — 👍 1 🔁 1 💬 0 📌 0
#tumorboardtuesday
Any subtle differences in outcomes based on the specific mutation identified
AKT vs. PTEN vs. PIK3CA❓
22.10.2025 00:29 — 👍 1 🔁 1 💬 0 📌 0
ASCO Publications
11/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 6🏫
⬆️ Elacestrant benefited all subgroups including: 🦴only, 🫁 visceral mets, > 3 mets
⬆️ Elacestrant benefited all🧬subgroups: ✔️ESR1+PIK3CA, ✔️ESR1+TP53, ✔️ESR1+HER2-low
🤢 Most common AE: N/V
22.10.2025 00:45 — 👍 1 🔁 1 💬 1 📌 0
11/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 6🏫
EMERALD
👩🦳 2L metastatic HR+/HER2- received 💊 Elacestrant, an oral selective ER Degrader (SERD)
✅ 1-2 prior ET including CDK4/6i and < 1 chemo
💊 Elacestrant 400mg daily vs 💉fulvestrant or 💊AI
⬆️⬆️ PFS for prior💊 CDK4/6i > 12 mon with ESR1 mutated tumors
22.10.2025 00:45 — 👍 1 🔁 1 💬 1 📌 0
10/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 5🏫
👉 Recurred on adjuvant endocrine tx
👉 Recurred <2y after adjuvant endocrine tx
👉 ⬆️Dz<6mos of starting 1L mBC tx
👉 ⬆️Dz after any duration of >=2nd line of ET-based therapy
👉 Known ESR1 mutation [now have 2 Rx for ESR1m → elacestrant or imlunestrant]
22.10.2025 00:42 — 👍 1 🔁 1 💬 1 📌 0
9/18 #TumorBoardTuesday
⏭️ Case 2
#TumorBoardTuesday #OncTwitter Case 2
👩🦳 62 y.o. postmenopausal female
💉 mBC to the🫁, ER 70%, PR 85%, HER2⛔[IHC 1] 🩻 confirmed⬆️Dz on 1L ribo/letrozole at C7
🏃♀️ ECOG PS 1. No co-morbidities.
⛔ Normal vital signs, labs
🩸Liquid Biopsy shows ESR1 mutation, TMB-High
22.10.2025 00:40 — 👍 1 🔁 1 💬 2 📌 0
8/18 #TumorBoardTuesday
Back to our case🔎
👉 Everolimus + fulvestrant is not favored given the more targeted approach with Capivasterib for the PIK3CA mutation
✅ Tolerated therapy well with mild rash at start of treatment that resolved with antihistamines
22.10.2025 00:38 — 👍 1 🔁 1 💬 1 📌 0
8/18 #TumorBoardTuesday
Back to our case🔎
👩🦳 Patient received Capivasertib + Fulvestrant due to PIK3CA mutation.
👉 Not yet considered endocrine resistant so would not move onto capecitabine, sacituzumab
👉 Tumor is HER2 negative so no role for trastuzumab deruxtecan
22.10.2025 00:38 — 👍 1 🔁 1 💬 1 📌 0
7/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 4🏫
💊Several FDA👍PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib
🤔 When and how do you PIK one of the PIK3CA of the 3 available?
✌️Alpelisib & Capivasertib are approved in 2nd line mER+ BC combined with fulvestrant
🔎 NGS results, Baseline A1C
22.10.2025 00:38 — 👍 1 🔁 1 💬 1 📌 0
7/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 4🏫
💊Several FDA👍PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib
🤔 When and how do you PIK one of the PIK3CA of the 3 available?
☝️Inavolisib+Fulvestrant+Palbo is approved for 1st line mER+ BC after recurrence on/after adjuvant ET therapy
22.10.2025 00:38 — 👍 1 🔁 1 💬 1 📌 0
6/18 #TumorBoardTuesday
POLL
What 2L therapy would you give this patient❓
1) Capecitabine
2) Trastuzumab deruxtecan
3) Sacituzumab govetican
4) Capivasertib + Fulvestrant
5) Everolimus + Fulvestrant
22.10.2025 00:26 — 👍 1 🔁 1 💬 1 📌 0
Current MGP Fellow and previous GI/Liver Surgical Pathology Fellow @ Duke Pathology. Views are my own and do not represent my employer. Posts are not medical advice. #PathSky #Pathology #GIPath #Molpath
Associate Professor @VUMC #Hypertension, #kidney, #immunology #HostMicrobiotaInteraction. Mother of 2, wife. Associate Editor @CircRes
Associate Professor of Medical Oncology at HUNIMED, GI cancer specialist with research interest in #livercancer, #HCC, #biliarytractcancer, #cholangiocarcinoma
Breast Med Onc & Chief of Heme/Onc/Pall Care, UW Medicine & Carbone Cancer Center. Mom of 3. Enjoys travel, books, volleyball. Thoughts shared are my own and not my employer.
GI Oncologist @MayoClinic | Large/Small Bowel Cancer Eradicator | Rare GI Cancer Crusader | Bad at Bluesky | Let’s Play Tennis | Views=Own
Studying genomics, machine learning, and fruit. My code is like our genomes -- most of it is junk.
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Medical Oncologist/ Clinical Development and Global Medical Affairs Executive/ Clinical and Medical Strategist / Precision Medicine
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Physician in Chief @UCSFCancer; Chief Hem/Onc @UCSFHealth; @ASTCT Past-President. Father of four, husband, shutterbug, aspiring pizzaiolo. Views here mine only.
Medical oncologist Cleveland Clinic Akron General, Chair of Internal Medicine, mother. Posts are my own.
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