@TumorBoardTues 1/20 #TumorBoardTuesday #GITwitter #OncTwitter @marklewismd
35yo 👱🏽♀️ develops abdominal pain
😖 Pain worse after meals
✂️ PCP referred for cholecystectomy
😖 Persists after ✂️
🩻 CT: mass adjacent to second portion of duodenum and tail of the pancreas
🤔 What would you do?
35yo 👱🏽♀️ develops abdominal pain
😖 Pain worse after meals
✂️ PCP referred for cholecystectomy
😖 Persists after ✂️
🩻 CT: mass adjacent to second portion of duodenum and tail of the pancreas
🤔 What would you do?
@TumorBoardTues @marklewismd 2/20 #TumorBoardTuesday #Pancreas @MPishvaian @JohnEbbenMDPhD @EileenMOReilly
💡DOTATATE PET scan 2 images: mild fullness in panc body, ❌significant somatostatin receptor activity
Remember
😎Spleen: physiologically ☀️ brightest organ
BUT
⛅️corona may obscure adjacent uptake
💡DOTATATE PET scan 2 images: mild fullness in panc body, ❌significant somatostatin receptor activity
Remember
😎Spleen: physiologically ☀️ brightest organ
BUT
⛅️corona may obscure adjacent uptake
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar 3/20 #TumorBoardTuesday
👨🏼🏫Mini tweetorial 1👩🏼🏫
🧪Labs
🔸Gastrin (fasting & ❌PPI) <100pg/mL
🔸Glucagon (concurrent nml glucose) <80pg/mL
🔸VIP <75pg/mL
🔸Insulin 20mcIU/mL (ULN=25)
🔸C-peptide 3ng/mL (ULN=4.4)
⬆️ CgA (❌PPI) 2296ng/mL (ULN=103)
🔸24h urine 5HIAA 7mg/day (ULN=15)
👨🏼🏫Mini tweetorial 1👩🏼🏫
🧪Labs
🔸Gastrin (fasting & ❌PPI) <100pg/mL
🔸Glucagon (concurrent nml glucose) <80pg/mL
🔸VIP <75pg/mL
🔸Insulin 20mcIU/mL (ULN=25)
🔸C-peptide 3ng/mL (ULN=4.4)
⬆️ CgA (❌PPI) 2296ng/mL (ULN=103)
🔸24h urine 5HIAA 7mg/day (ULN=15)
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @cathyengMD @SunnieSKim @fogaccijoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @AmanChauhanMD @rachaelguenter @DrShubhamPant @SWOG
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @AmanChauhanMD @rachaelguenter @DrShubhamPant @SWOG 4/20 #TumorBoardTuesday
👨🏼🏫Mini tweetorial 2👩🏼🏫
🏥Operative findings:
➡️Explor lap: no evidence of carcinomatosis
➡️Doppler US: 9 bilobar hepatic lesions
🔑Dopp US: Suspect pancreas tail mass➡️same characteristics as NML parenchyma
🔑Stomach/SB palpated x2➡️❌ evidence of tumor
👨🏼🏫Mini tweetorial 2👩🏼🏫
🏥Operative findings:
➡️Explor lap: no evidence of carcinomatosis
➡️Doppler US: 9 bilobar hepatic lesions
🔑Dopp US: Suspect pancreas tail mass➡️same characteristics as NML parenchyma
🔑Stomach/SB palpated x2➡️❌ evidence of tumor
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @AmanChauhanMD @rachaelguenter @DrShubhamPant @SWOG @JoaquinCastrotx @AE30mda @MREathome @wsliauw @DebraVaello @acarblas @ChefLindaMe @LauraDS1435 @megimenez @TheNotoriousHPB 5/20 #TumorBoardTuesday
👨🏼🏫Mini tweetorial 3👩🏼🏫
Path
🔬8 diff. liver specimens positive for NET
🤔Indeterminate midgut 🆚pancreas origin of metastases
👨⚕️Clinician requests Ki-67 proliferation index
➡️2% of tumor cells positive➡️Ki-67, consistent w/ G1 well-differentiated NET
👨🏼🏫Mini tweetorial 3👩🏼🏫
Path
🔬8 diff. liver specimens positive for NET
🤔Indeterminate midgut 🆚pancreas origin of metastases
👨⚕️Clinician requests Ki-67 proliferation index
➡️2% of tumor cells positive➡️Ki-67, consistent w/ G1 well-differentiated NET
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @drjashdatta @jordanberlin5
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta 6/20 #TumorBoardTuesday
👨🏼🏫Mini tweetorial 4👩🏼🏫
📌Carcinoid tumors have distinct🧬landscapes
📍Midgut: chrom 18 deletions + somatic CDKNs & SDHD muts
📍Foregut: MEN1 (germ & somatic), DAXX, ATRX, & TP53 somatic muts
📚@seangrimmond nature.com
📚pubmed.ncbi.nlm.nih.gov
👨🏼🏫Mini tweetorial 4👩🏼🏫
📌Carcinoid tumors have distinct🧬landscapes
📍Midgut: chrom 18 deletions + somatic CDKNs & SDHD muts
📍Foregut: MEN1 (germ & somatic), DAXX, ATRX, & TP53 somatic muts
📚@seangrimmond nature.com
📚pubmed.ncbi.nlm.nih.gov
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond 7/20 #TumorBoardTuesday
👨🏼🏫Mini tweetorial 5👩🏼🏫
📌Oberndorfer & karzinoide
Mini-History:
🗓️1907
👨🏼🔬Oberndorfer, German, “Carcinoid Tumors of the Small Intestine”
👨🏼🔬described 6 pts w/ ileal tumors
🤔small size, sharp borders, & indolent nature➡️benign
📚doi.org
👨🏼🏫Mini tweetorial 5👩🏼🏫
📌Oberndorfer & karzinoide
Mini-History:
🗓️1907
👨🏼🔬Oberndorfer, German, “Carcinoid Tumors of the Small Intestine”
👨🏼🔬described 6 pts w/ ileal tumors
🤔small size, sharp borders, & indolent nature➡️benign
📚doi.org
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond 8/20 #TumorBoardTuesday
👨🏼🏫Mini tweetorial 6👩🏼🏫
📌History Cont
💭He thus called tumors “karzinoide,” which means “carcinoma-like”
BUT
⚠️Oberndorfer acknowledged in 1929, these tumors can indeed metastasize, and “karzinoide” is ⚠️ dangerous misnomer⚠️
📚pubmed.ncbi.nlm.nih.gov
👨🏼🏫Mini tweetorial 6👩🏼🏫
📌History Cont
💭He thus called tumors “karzinoide,” which means “carcinoma-like”
BUT
⚠️Oberndorfer acknowledged in 1929, these tumors can indeed metastasize, and “karzinoide” is ⚠️ dangerous misnomer⚠️
📚pubmed.ncbi.nlm.nih.gov
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond 9/20 #TumorBoardTuesday
🔀New patient
🤦🏼Tumor biology unchecked for decades
77 yo👵🏾
😖abdomen pain & leg swelling
🛍️Classic collection of misdiagnoses
💨adult-onset asthma
🥵hot flashes
🚽IBS
👵🏾I have the worst diarrhea of my life & am short of breath
🔀New patient
🤦🏼Tumor biology unchecked for decades
77 yo👵🏾
😖abdomen pain & leg swelling
🛍️Classic collection of misdiagnoses
💨adult-onset asthma
🥵hot flashes
🚽IBS
👵🏾I have the worst diarrhea of my life & am short of breath
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond 10/20 #TumorBoardTuesday #NET #NeuroendocrineTumor
🌀Scan:
massive hepatomegaly & right-sided 🫀heart failure
➡️ Small bowel dilatation
➡️ Two necrotic hepatic masses
➡️ Congestive hepatopathy + metastatic replacement
🟰HUGE liver
🌀Scan:
massive hepatomegaly & right-sided 🫀heart failure
➡️ Small bowel dilatation
➡️ Two necrotic hepatic masses
➡️ Congestive hepatopathy + metastatic replacement
🟰HUGE liver
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond 11/20 #TumorBoardTuesday #NET #NeuroendocrineTumor
💊Treatment options to discuss with this patient (assuming a follow-up DOTATATE PET with 💡)
🤨 Which would you prescribe/recommend next?
💊Treatment options to discuss with this patient (assuming a follow-up DOTATATE PET with 💡)
🤨 Which would you prescribe/recommend next?
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond 12/20 #TumorBoardTuesday
📌 Somatostatin analogues
🔐 per the lock-and-key hypothesis (SSA 🗝️ receptor)
✅ Useful in treating any SSTR-avid disease on DOTATATE PET.
BUT
‼️Between PROMID and CLARINET we need to navigate the pitfalls of cross-trial comparison‼️
📌 Somatostatin analogues
🔐 per the lock-and-key hypothesis (SSA 🗝️ receptor)
✅ Useful in treating any SSTR-avid disease on DOTATATE PET.
BUT
‼️Between PROMID and CLARINET we need to navigate the pitfalls of cross-trial comparison‼️
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond #TumorBoardTuesday
🔐Model: A protein + ligand bind in a single, instantaneous interaction due to a rigid, precise fit.
In my bio classes, we now learn about the:
🔄Induced Fit Model: A protein undergoes conformational changes to optimize binding
📚doi.org
🔐Model: A protein + ligand bind in a single, instantaneous interaction due to a rigid, precise fit.
In my bio classes, we now learn about the:
🔄Induced Fit Model: A protein undergoes conformational changes to optimize binding
📚doi.org
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta @seangrimmond 13/20 #TumorBoardTuesday
✨PROMID and CLARINET✨
✨PROMID: Octreotide has superior PFS vs placebo
📚ascopubs.org
✨CLARINET: Lanreotide has superior PFS vs placebo
📚nejm.org
✨PROMID and CLARINET✨
✨PROMID: Octreotide has superior PFS vs placebo
📚ascopubs.org
✨CLARINET: Lanreotide has superior PFS vs placebo
📚nejm.org
ascopubs.org/doi/10.1200/JC…
Placebo-Controlled, Double-Blind, Prospective, Randomized Study on the Effect of Octreotide LAR in the Control of Tumor Growth in Patients With Metastatic Neuroendocrine Midgut Tumors: A Report From the PROMID Study Group
Purpose Somatostatin analogs are indicated for symptom control in patients with gastroenteropancreat...
nejm.org/doi/full/10.10…
Lanreotide in Metastatic Enteropancreatic Neuroendocrine Tumors | NEJM
Original Article from The New England Journal of Medicine — Lanreotide in Metastatic Enteropancreati...
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @DrJashDatta 14/20 #TumorBoardTuesday
✨PROMID and CLARINET✨
📌Cross-trial comparison
🍎🍏 apples and apples?
🧑🔬@Prof_M_C
🧐Lanreotide final PFS data
📚ascopubs.org
📚ncbi.nlm.nih.gov
✨PROMID and CLARINET✨
📌Cross-trial comparison
🍎🍏 apples and apples?
🧑🔬@Prof_M_C
🧐Lanreotide final PFS data
📚ascopubs.org
📚ncbi.nlm.nih.gov
ncbi.nlm.nih.gov/pmc/articles/P…
Treatment of neuroendocrine tumors: new recommendations based on the CLARINET study
Somatostatin analogs (SSAs), including lanreotide, play a fundamental role in treatment of neuroendo...
ascopubs.org/doi/10.1200/JC…
Final progression-free survival (PFS) analyses for lanreotide autogel/depot 120 mg in metastatic enteropancreatic neuroendocrine tumors (NETs): The CLARINET extension study.
4089 Background: In the CLARINET core study, lanreotide Autogel (LAN) 120 mg deep sc monthly signifi...
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd 15/20 #TumorBoardTuesday
📌Telotristat ethyl
💊‘17 @US_FDA approved as tryptophan hydroxylase inhibitor
✅1st-in-class enzyme drug🚫serotonin product w/in #NET cells
👍🏽Approval predicated on pts with carcinoid synd diarrhea with ⬇️stools/day
📚@OncoThor pubmed.ncbi.nlm.nih.gov
📌Telotristat ethyl
💊‘17 @US_FDA approved as tryptophan hydroxylase inhibitor
✅1st-in-class enzyme drug🚫serotonin product w/in #NET cells
👍🏽Approval predicated on pts with carcinoid synd diarrhea with ⬇️stools/day
📚@OncoThor pubmed.ncbi.nlm.nih.gov
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @US_FDA 16/20 #TumorBoardTuesday
📌 Telotristat ethyl
🫀May have protective effects on the right heart
🕵🏼 We await the results of
✨TELEHEART
➡️ Phase III trial: somatostatin analog therapy +/- telotristat ethyl
📚@PamelaKunzMD pubmed.ncbi.nlm.nih.gov
📌 Telotristat ethyl
🫀May have protective effects on the right heart
🕵🏼 We await the results of
✨TELEHEART
➡️ Phase III trial: somatostatin analog therapy +/- telotristat ethyl
📚@PamelaKunzMD pubmed.ncbi.nlm.nih.gov
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @US_FDA @PamelaKunzMD 17/20 #TumorBoardTuesday
✨NETTER-1✨
💊 Phase III trial: Lutathera + 30 mg Octreotide vs 60 mg Octreotide
📍Evaluated in patients with advanced midgut NET and progression on LAR therapy
➡️ Patients treated with Lutathera had longer PFS and a higher response rate
✨NETTER-1✨
💊 Phase III trial: Lutathera + 30 mg Octreotide vs 60 mg Octreotide
📍Evaluated in patients with advanced midgut NET and progression on LAR therapy
➡️ Patients treated with Lutathera had longer PFS and a higher response rate
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd 18/20 #TumorBoardTuesday
✨177-lutetium: Lutathera
🗓️‘18
📍peptide receptor radionuclide tx (PRRT)
👍🏽@US_FDA somatostatin receptor-positive gastroenteropancreatic NETs
✅Approval➡️ PFS benefit in seminal NETTER-1
📚@PamelaKunzMD pubmed.ncbi.nlm.nih.gov
📚ascopubs.org
✨177-lutetium: Lutathera
🗓️‘18
📍peptide receptor radionuclide tx (PRRT)
👍🏽@US_FDA somatostatin receptor-positive gastroenteropancreatic NETs
✅Approval➡️ PFS benefit in seminal NETTER-1
📚@PamelaKunzMD pubmed.ncbi.nlm.nih.gov
📚ascopubs.org
ascopubs.org/doi/10.1200/JC…
Final overall survival in the phase 3 NETTER-1 study of lutetium-177-DOTATATE in patients with midgut neuroendocrine tumors.
4112 Background: As demonstrated in the primary analysis of the phase 3 NETTER-1 trial, 177Lu-DOTATA...
pubmed.ncbi.nlm.nih.gov/28076709/
Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors - PubMed
Treatment with 177Lu-Dotatate resulted in markedly longer progression-free survival and a significan...
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @US_FDA @PamelaKunzMD 19/20 #TumorBoardTuesday
Back to our cases 🔎
Patient 1 👱🏽♀️
🧬 Loss of chromosome 18
💊Initiated Somatostatin analogue
💡Repeat scan showed: Stability
➡️Will be a candidate for PRRT if/when they progress on somatostatin analogue
Back to our cases 🔎
Patient 1 👱🏽♀️
🧬 Loss of chromosome 18
💊Initiated Somatostatin analogue
💡Repeat scan showed: Stability
➡️Will be a candidate for PRRT if/when they progress on somatostatin analogue
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd @US_FDA @PamelaKunzMD 20/20 #TumorBoardTuesday
Back to our cases continued 🔎
Patient 2 👵🏾
🧪 5HIAA > 10x ULN
💊 Initiated Somatostatin analogue + telotristat ethyl
💡Repeat scan showed: Stability (+ normalization of serotonin excess)
➡️Contemplating tricuspid + pulmonic valve repair or replacement
Back to our cases continued 🔎
Patient 2 👵🏾
🧪 5HIAA > 10x ULN
💊 Initiated Somatostatin analogue + telotristat ethyl
💡Repeat scan showed: Stability (+ normalization of serotonin excess)
➡️Contemplating tricuspid + pulmonic valve repair or replacement
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd #PostTest Q1️⃣ #TumorBoardTuesday
👉🏽#CME Eval 🔗 integrityce.com
🤔@marklewismd @CatherineaOC taught us differentiating midgut & pancreatic NETS test your🧠with quick❓
🧐What tx?
77yo👩🏼🦳
🚽diarrhea
🫁SOB
🩻SB dilation, 2 necrotic hep masses, hepatomegaly, & R🫀failure
👉🏽#CME Eval 🔗 integrityce.com
🤔@marklewismd @CatherineaOC taught us differentiating midgut & pancreatic NETS test your🧠with quick❓
🧐What tx?
77yo👩🏼🦳
🚽diarrhea
🫁SOB
🩻SB dilation, 2 necrotic hep masses, hepatomegaly, & R🫀failure
@TumorBoardTues @marklewismd @MPishvaian @JohnEbbenMDPhD @EileenMOReilly @duiliorocha_onc @CowzerDarren @VParoder @CureNETs @dcmadoff @GABOUALFA @MHLars @nihardesai7 @DrKhanUmar @KristenCiombor @rcarvalhoonco @NirajGusani @BenWestphalen @carlacav @CathyEngMD @SunnieSKim @FogacciJoao @RachelRiechelm2 @HalletJulie @shafiarahman_ @oncologician @ShaalanBeg @HardingJJMD @DrAngelaLamarca @Sarbaji85064063 @anup_kasi @jenna_k_lovely @Ja_Capdevila @cancerassassin1 @drenriquegrande @netcancerfound @curecc @CCA_Alliance @MpillaGabriel @mona_hssn @Neuroendocrine @samdoc_mamc @KGDWrites @StijnHentzen @michelle_mh2984 @kmody29 @manjuggm @benweinbergmd #PostTest Q 2️⃣ #TumorBoardTuesday #NeuroendocrineTumor #CancerResearch #NETCancer
👉🏽 Free CME 🔗 integrityce.com
🧐 Which of the following tests is useful ONLY in the management of midgut NETs (as opposed to pancreatic NETs)?
👉🏽 Free CME 🔗 integrityce.com
🧐 Which of the following tests is useful ONLY in the management of midgut NETs (as opposed to pancreatic NETs)?
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