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#CME Case Challenges provided by @BonumCE.bsky.social
Opinions ≠ med advice
Easy as 🔢
1️⃣Read case
2️⃣Answer polls
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4️⃣Claim CME
www.bonumce.com
Opinions ≠ med advice
Easy as 🔢
1️⃣Read case
2️⃣Answer polls
3️⃣Make clin decisions - Learn pros & cons of each
4️⃣Claim CME
www.bonumce.com
➡️ HOLD pembro + prescribe oral prednisone
February 28, 2025 at 6:08 PM
➡️HOLD pembro + prescribe loperamide
February 28, 2025 at 6:08 PM
➡️ CONTINUE pembro + prescribe loperamide
February 28, 2025 at 6:08 PM
7/⚠️ Ms Reed has immune-related Grade 3️⃣ diarrhea (>7 BM day)
🧐 How would you manage this irAE❓
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👇Choose an option & learn the pros & cons of each👇
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🧐 How would you manage this irAE❓
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👇Choose an option & learn the pros & cons of each👇
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February 28, 2025 at 6:08 PM
7/⚠️ Ms Reed has immune-related Grade 3️⃣ diarrhea (>7 BM day)
🧐 How would you manage this irAE❓
.
.
👇Choose an option & learn the pros & cons of each👇
.
.
🧐 How would you manage this irAE❓
.
.
👇Choose an option & learn the pros & cons of each👇
.
.
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?
4/❗Compared w/ White pts, Black pts w/ #TNBC have:
⬇️ Lower frequency of germline BRCA1 mutations
⬆️ Increased risk for delayed ⏰ and/or incomplete Tx
⬆️ Increased risk of late-stage (III/IV) Dx
⬆️ Increased risk of mortality
⬇️ Lower frequency of germline BRCA1 mutations
⬆️ Increased risk for delayed ⏰ and/or incomplete Tx
⬆️ Increased risk of late-stage (III/IV) Dx
⬆️ Increased risk of mortality
February 28, 2025 at 6:08 PM
4/❗Compared w/ White pts, Black pts w/ #TNBC have:
⬇️ Lower frequency of germline BRCA1 mutations
⬆️ Increased risk for delayed ⏰ and/or incomplete Tx
⬆️ Increased risk of late-stage (III/IV) Dx
⬆️ Increased risk of mortality
⬇️ Lower frequency of germline BRCA1 mutations
⬆️ Increased risk for delayed ⏰ and/or incomplete Tx
⬆️ Increased risk of late-stage (III/IV) Dx
⬆️ Increased risk of mortality
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
➡️ HOLD pembro + prescribe oral prednisone
February 28, 2025 at 5:53 PM
➡️HOLD pembro + prescribe loperamide
February 28, 2025 at 5:53 PM
2/⛔Continuing pembro+ Rx loperamide is not a safe choice
✏️For Grade1️⃣diarrhea (<4 stools/day over BL, no other symptoms of colitis) it may be a possible option
IF pts are closely watched for dehydration, chronicity, & progression
👇Pick again manage this irAE👇
✏️For Grade1️⃣diarrhea (<4 stools/day over BL, no other symptoms of colitis) it may be a possible option
IF pts are closely watched for dehydration, chronicity, & progression
👇Pick again manage this irAE👇
February 28, 2025 at 5:53 PM
2/⛔Continuing pembro+ Rx loperamide is not a safe choice
✏️For Grade1️⃣diarrhea (<4 stools/day over BL, no other symptoms of colitis) it may be a possible option
IF pts are closely watched for dehydration, chronicity, & progression
👇Pick again manage this irAE👇
✏️For Grade1️⃣diarrhea (<4 stools/day over BL, no other symptoms of colitis) it may be a possible option
IF pts are closely watched for dehydration, chronicity, & progression
👇Pick again manage this irAE👇
➡️ HOLD pembro + prescribe oral prednisone
February 28, 2025 at 5:52 PM
2/Holding pembro + Rx loperamide is not recommended for G3 diarrhea
Per ASCO irAEs toxicity mgmt guidelines
✅Holding ICI & giving CS (not loperamide) for Grade <3 diarrhea
🛑but do not resume ICI until colitis Grade <1 & CS tapered to ≤10 mg/day
👇Click to continue 👇
.
.
Per ASCO irAEs toxicity mgmt guidelines
✅Holding ICI & giving CS (not loperamide) for Grade <3 diarrhea
🛑but do not resume ICI until colitis Grade <1 & CS tapered to ≤10 mg/day
👇Click to continue 👇
.
.
February 28, 2025 at 5:52 PM
2/Holding pembro + Rx loperamide is not recommended for G3 diarrhea
Per ASCO irAEs toxicity mgmt guidelines
✅Holding ICI & giving CS (not loperamide) for Grade <3 diarrhea
🛑but do not resume ICI until colitis Grade <1 & CS tapered to ≤10 mg/day
👇Click to continue 👇
.
.
Per ASCO irAEs toxicity mgmt guidelines
✅Holding ICI & giving CS (not loperamide) for Grade <3 diarrhea
🛑but do not resume ICI until colitis Grade <1 & CS tapered to ≤10 mg/day
👇Click to continue 👇
.
.
➡️ Eribulin
February 28, 2025 at 5:51 PM
➡️Olaparib
February 28, 2025 at 5:51 PM
➡️Trastuzumab deruxtecan (T-DXd)
February 28, 2025 at 5:51 PM
➡️ Sacituzumab govitecan-hziy (SG)
February 28, 2025 at 5:51 PM
5/🔬Ms Reed’s molecular test results show:
🧬Germline BRCA mutations: negative
🧪Tumor IHC for HER2: 1+
🚫No actionable mutations on ctDNA testing
🧐 Based on these results & SDM, which Tx would you recommend❓
.
.
👇Choose an option & learn the pros & cons of each👇
🧬Germline BRCA mutations: negative
🧪Tumor IHC for HER2: 1+
🚫No actionable mutations on ctDNA testing
🧐 Based on these results & SDM, which Tx would you recommend❓
.
.
👇Choose an option & learn the pros & cons of each👇
February 28, 2025 at 5:51 PM
5/🔬Ms Reed’s molecular test results show:
🧬Germline BRCA mutations: negative
🧪Tumor IHC for HER2: 1+
🚫No actionable mutations on ctDNA testing
🧐 Based on these results & SDM, which Tx would you recommend❓
.
.
👇Choose an option & learn the pros & cons of each👇
🧬Germline BRCA mutations: negative
🧪Tumor IHC for HER2: 1+
🚫No actionable mutations on ctDNA testing
🧐 Based on these results & SDM, which Tx would you recommend❓
.
.
👇Choose an option & learn the pros & cons of each👇
4/🤝SDM w/ pts is essential for tx selection
❓Pt goals
❓Risk tolerance
❓Expected AEs
🎙Counsel on:
✅Common AEs like nausea & fatigue w T-DXd & SG
✅Serious AEs like ILD w T-DXd, hematologic AEs w SG
➡️ Discuss w/ pts that dose adjustments may be needed if AEs occur
❓Pt goals
❓Risk tolerance
❓Expected AEs
🎙Counsel on:
✅Common AEs like nausea & fatigue w T-DXd & SG
✅Serious AEs like ILD w T-DXd, hematologic AEs w SG
➡️ Discuss w/ pts that dose adjustments may be needed if AEs occur
February 28, 2025 at 5:51 PM
4/🤝SDM w/ pts is essential for tx selection
❓Pt goals
❓Risk tolerance
❓Expected AEs
🎙Counsel on:
✅Common AEs like nausea & fatigue w T-DXd & SG
✅Serious AEs like ILD w T-DXd, hematologic AEs w SG
➡️ Discuss w/ pts that dose adjustments may be needed if AEs occur
❓Pt goals
❓Risk tolerance
❓Expected AEs
🎙Counsel on:
✅Common AEs like nausea & fatigue w T-DXd & SG
✅Serious AEs like ILD w T-DXd, hematologic AEs w SG
➡️ Discuss w/ pts that dose adjustments may be needed if AEs occur
3/🏥Ms Reed stabilizes w inpatient care & CS
Unfortunately, the CT to evaluate her colon shows new 🫁mets
Next steps:
⚕️Palliative care referral = improves outcomes when incorporated early in adv cancer care
🔬Review molecular test results
🤝 Shared decision-making discussion/s
Unfortunately, the CT to evaluate her colon shows new 🫁mets
Next steps:
⚕️Palliative care referral = improves outcomes when incorporated early in adv cancer care
🔬Review molecular test results
🤝 Shared decision-making discussion/s
February 28, 2025 at 5:51 PM
3/🏥Ms Reed stabilizes w inpatient care & CS
Unfortunately, the CT to evaluate her colon shows new 🫁mets
Next steps:
⚕️Palliative care referral = improves outcomes when incorporated early in adv cancer care
🔬Review molecular test results
🤝 Shared decision-making discussion/s
Unfortunately, the CT to evaluate her colon shows new 🫁mets
Next steps:
⚕️Palliative care referral = improves outcomes when incorporated early in adv cancer care
🔬Review molecular test results
🤝 Shared decision-making discussion/s
2/👏Yes!
✅ The severity of Ms. Reed’s diarrhea means that holding pembro is the best choice while using methlyprednisone
✅ Continue CS until diarrhea <grade 1
✅ Consider early 🕐 biologics if no CS response
✅ The severity of Ms. Reed’s diarrhea means that holding pembro is the best choice while using methlyprednisone
✅ Continue CS until diarrhea <grade 1
✅ Consider early 🕐 biologics if no CS response
February 28, 2025 at 5:51 PM
2/👏Yes!
✅ The severity of Ms. Reed’s diarrhea means that holding pembro is the best choice while using methlyprednisone
✅ Continue CS until diarrhea <grade 1
✅ Consider early 🕐 biologics if no CS response
✅ The severity of Ms. Reed’s diarrhea means that holding pembro is the best choice while using methlyprednisone
✅ Continue CS until diarrhea <grade 1
✅ Consider early 🕐 biologics if no CS response