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#CME Case Challenges provided by @BonumCE.bsky.social
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Opinions ≠ med advice
Easy as 🔢
1️⃣Read case
2️⃣Answer polls
3️⃣Make clin decisions - Learn pros & cons of each
4️⃣Claim CME
www.bonumce.com
6/🚨Important to differentiate irAE diarrhea & colitis
Per CTCAE, irAE colitis is:
Grade2️⃣blood & mucus in stool +abdo pain
Grade3️⃣severe abdo pain w/ peritoneal signs
🗓️Onset is usually 6+ wks after Tx start
Per CTCAE, irAE colitis is:
Grade2️⃣blood & mucus in stool +abdo pain
Grade3️⃣severe abdo pain w/ peritoneal signs
🗓️Onset is usually 6+ wks after Tx start
February 28, 2025 at 6:08 PM
6/🚨Important to differentiate irAE diarrhea & colitis
Per CTCAE, irAE colitis is:
Grade2️⃣blood & mucus in stool +abdo pain
Grade3️⃣severe abdo pain w/ peritoneal signs
🗓️Onset is usually 6+ wks after Tx start
Per CTCAE, irAE colitis is:
Grade2️⃣blood & mucus in stool +abdo pain
Grade3️⃣severe abdo pain w/ peritoneal signs
🗓️Onset is usually 6+ wks after Tx start
5/🔙 to Ms Reed 👩🏾🦱
🏥14 wks after starting on pembro+ carbo/gem she is hospitalized w/ profuse diarrhea (~9 BM/day)
No⛔Hx IBD or recent travel ✈️
Stool test:⛔for C. difficile
⚠️Ms Reed & her hospitalist ask you ~
❓Is this an irAE?
🏥14 wks after starting on pembro+ carbo/gem she is hospitalized w/ profuse diarrhea (~9 BM/day)
No⛔Hx IBD or recent travel ✈️
Stool test:⛔for C. difficile
⚠️Ms Reed & her hospitalist ask you ~
❓Is this an irAE?
February 28, 2025 at 6:08 PM
5/🔙 to Ms Reed 👩🏾🦱
🏥14 wks after starting on pembro+ carbo/gem she is hospitalized w/ profuse diarrhea (~9 BM/day)
No⛔Hx IBD or recent travel ✈️
Stool test:⛔for C. difficile
⚠️Ms Reed & her hospitalist ask you ~
❓Is this an irAE?
🏥14 wks after starting on pembro+ carbo/gem she is hospitalized w/ profuse diarrhea (~9 BM/day)
No⛔Hx IBD or recent travel ✈️
Stool test:⛔for C. difficile
⚠️Ms Reed & her hospitalist ask you ~
❓Is this an irAE?
3/👩🏾🦱 Meet Ms Reed
35yo Black woman w #mTNBC
Tumor is PD-L1+ (CPS 10), HER2 low (IHC = 1+)
🚫No known germline BRCA mutation
🖌️Works as graphic designer
On frontline pembro+carbo/gem for 14 wks
35yo Black woman w #mTNBC
Tumor is PD-L1+ (CPS 10), HER2 low (IHC = 1+)
🚫No known germline BRCA mutation
🖌️Works as graphic designer
On frontline pembro+carbo/gem for 14 wks
February 28, 2025 at 6:08 PM
3/👩🏾🦱 Meet Ms Reed
35yo Black woman w #mTNBC
Tumor is PD-L1+ (CPS 10), HER2 low (IHC = 1+)
🚫No known germline BRCA mutation
🖌️Works as graphic designer
On frontline pembro+carbo/gem for 14 wks
35yo Black woman w #mTNBC
Tumor is PD-L1+ (CPS 10), HER2 low (IHC = 1+)
🚫No known germline BRCA mutation
🖌️Works as graphic designer
On frontline pembro+carbo/gem for 14 wks
2/👇Activity Instructions👇
1️⃣Read ptℹ️
2️⃣Take knowledge polls🟢
3️⃣Decide how to manage Ms Reed & learn the pros & cons of each option
Activity is for HCPs/clinicians
No side effect (AEs) reporting here.📞your 🥼or go to the product manufacturer’s site forℹ️
1️⃣Read ptℹ️
2️⃣Take knowledge polls🟢
3️⃣Decide how to manage Ms Reed & learn the pros & cons of each option
Activity is for HCPs/clinicians
No side effect (AEs) reporting here.📞your 🥼or go to the product manufacturer’s site forℹ️
February 28, 2025 at 6:08 PM
2/👇Activity Instructions👇
1️⃣Read ptℹ️
2️⃣Take knowledge polls🟢
3️⃣Decide how to manage Ms Reed & learn the pros & cons of each option
Activity is for HCPs/clinicians
No side effect (AEs) reporting here.📞your 🥼or go to the product manufacturer’s site forℹ️
1️⃣Read ptℹ️
2️⃣Take knowledge polls🟢
3️⃣Decide how to manage Ms Reed & learn the pros & cons of each option
Activity is for HCPs/clinicians
No side effect (AEs) reporting here.📞your 🥼or go to the product manufacturer’s site forℹ️
5/Ms Reed 👩🏾🦱 returns 9 wks after starting SG
She has now received 3 cycles & should have a CT scan & repeat labs
She has now received 3 cycles & should have a CT scan & repeat labs
February 28, 2025 at 5:44 PM
5/Ms Reed 👩🏾🦱 returns 9 wks after starting SG
She has now received 3 cycles & should have a CT scan & repeat labs
She has now received 3 cycles & should have a CT scan & repeat labs
4/🤔How does SG work?
SG MOA =ADC that delivers SN-38, a topoisomerase I inhibitor that is a highly potent active metabolite of parent drug (irinotecan)
SN-38 interacts w/ Top1
Prevents❌re-ligation of single strand breaks
→tumor cell DNA🧬damage, apoptosis, & cell death💥
SG MOA =ADC that delivers SN-38, a topoisomerase I inhibitor that is a highly potent active metabolite of parent drug (irinotecan)
SN-38 interacts w/ Top1
Prevents❌re-ligation of single strand breaks
→tumor cell DNA🧬damage, apoptosis, & cell death💥
February 28, 2025 at 5:44 PM
4/🤔How does SG work?
SG MOA =ADC that delivers SN-38, a topoisomerase I inhibitor that is a highly potent active metabolite of parent drug (irinotecan)
SN-38 interacts w/ Top1
Prevents❌re-ligation of single strand breaks
→tumor cell DNA🧬damage, apoptosis, & cell death💥
SG MOA =ADC that delivers SN-38, a topoisomerase I inhibitor that is a highly potent active metabolite of parent drug (irinotecan)
SN-38 interacts w/ Top1
Prevents❌re-ligation of single strand breaks
→tumor cell DNA🧬damage, apoptosis, & cell death💥
2/ 👍 Yes! Sacitizumab govitecan is a good option for Ms Reed’s #mTNBC👩🏾🦱
🥇 SG is a first-in-class Trop-2 directed ADC
✅ Approved in 2020 based on phase 3 ASCENT study that met its PFS endpt
⭐ Trop-2, an oncogenic protein detected in >85% of TNBCs, is a new Tx target
🥇 SG is a first-in-class Trop-2 directed ADC
✅ Approved in 2020 based on phase 3 ASCENT study that met its PFS endpt
⭐ Trop-2, an oncogenic protein detected in >85% of TNBCs, is a new Tx target
February 28, 2025 at 5:44 PM
2/ 👍 Yes! Sacitizumab govitecan is a good option for Ms Reed’s #mTNBC👩🏾🦱
🥇 SG is a first-in-class Trop-2 directed ADC
✅ Approved in 2020 based on phase 3 ASCENT study that met its PFS endpt
⭐ Trop-2, an oncogenic protein detected in >85% of TNBCs, is a new Tx target
🥇 SG is a first-in-class Trop-2 directed ADC
✅ Approved in 2020 based on phase 3 ASCENT study that met its PFS endpt
⭐ Trop-2, an oncogenic protein detected in >85% of TNBCs, is a new Tx target
6/🗓️Ms Reed 👩🏾🦱 returns 9 wks after starting trastuzumab deruxtecan
She's now received 3️⃣cycles of T-DXd
⏭️She should now have a CT scan & repeat labs
#mTNBC
She's now received 3️⃣cycles of T-DXd
⏭️She should now have a CT scan & repeat labs
#mTNBC
February 28, 2025 at 5:36 PM
6/🗓️Ms Reed 👩🏾🦱 returns 9 wks after starting trastuzumab deruxtecan
She's now received 3️⃣cycles of T-DXd
⏭️She should now have a CT scan & repeat labs
#mTNBC
She's now received 3️⃣cycles of T-DXd
⏭️She should now have a CT scan & repeat labs
#mTNBC
5/T-DXd binds HER2 on tumor cells
➡️internalized & cleaved by lysosomal enzymes
➡️DxD payload enters cell nucleus
➡️DNA damage & apoptosis
🚧T-DXd also crosses cell membranes
🟰cytotoxic effects on nearby tumor cells, even if they lack HER2 (bystander effect)
#mTNBC
➡️internalized & cleaved by lysosomal enzymes
➡️DxD payload enters cell nucleus
➡️DNA damage & apoptosis
🚧T-DXd also crosses cell membranes
🟰cytotoxic effects on nearby tumor cells, even if they lack HER2 (bystander effect)
#mTNBC
February 28, 2025 at 5:36 PM
5/T-DXd binds HER2 on tumor cells
➡️internalized & cleaved by lysosomal enzymes
➡️DxD payload enters cell nucleus
➡️DNA damage & apoptosis
🚧T-DXd also crosses cell membranes
🟰cytotoxic effects on nearby tumor cells, even if they lack HER2 (bystander effect)
#mTNBC
➡️internalized & cleaved by lysosomal enzymes
➡️DxD payload enters cell nucleus
➡️DNA damage & apoptosis
🚧T-DXd also crosses cell membranes
🟰cytotoxic effects on nearby tumor cells, even if they lack HER2 (bystander effect)
#mTNBC
2/👏 Yes! T-DXd is a good option for Ms Reed, whose TNBC is HER2-low👩🏾🦱
💡T-DXd is 1st HER2-directed ADC for #TNBC
✅Approval based on DESTINY-Breast04
✅NCCN → T-DXd preferred >2L Tx for HER2-low mBC w/o BRCA mutation
💡T-DXd is 1st HER2-directed ADC for #TNBC
✅Approval based on DESTINY-Breast04
✅NCCN → T-DXd preferred >2L Tx for HER2-low mBC w/o BRCA mutation
February 28, 2025 at 5:36 PM
2/👏 Yes! T-DXd is a good option for Ms Reed, whose TNBC is HER2-low👩🏾🦱
💡T-DXd is 1st HER2-directed ADC for #TNBC
✅Approval based on DESTINY-Breast04
✅NCCN → T-DXd preferred >2L Tx for HER2-low mBC w/o BRCA mutation
💡T-DXd is 1st HER2-directed ADC for #TNBC
✅Approval based on DESTINY-Breast04
✅NCCN → T-DXd preferred >2L Tx for HER2-low mBC w/o BRCA mutation