Mike Pishvaian
@mpishvaian.bsky.social
GI Oncologist at Johns Hopkins, focusing on #PancreaticCancer and #PrecisionMedicine. Striving to improve patient outcomes.
Originator of #TumorBoardTuesday
@tumorboardtuesday.bsky.social @TumorBoardTues
Originator of #TumorBoardTuesday
@tumorboardtuesday.bsky.social @TumorBoardTues
#tumorboardtuesday
🤔Hmmm....much more rapid disease progression on the CDK4/6🚫+AI - does this portend for a worse prognosis in subsequent lines of therapy❓
🤔Hmmm....much more rapid disease progression on the CDK4/6🚫+AI - does this portend for a worse prognosis in subsequent lines of therapy❓
October 22, 2025 at 12:48 AM
#tumorboardtuesday
🤔Hmmm....much more rapid disease progression on the CDK4/6🚫+AI - does this portend for a worse prognosis in subsequent lines of therapy❓
🤔Hmmm....much more rapid disease progression on the CDK4/6🚫+AI - does this portend for a worse prognosis in subsequent lines of therapy❓
Reposted by Mike Pishvaian
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
👩🏻🏫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
October 22, 2025 at 12:38 AM
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
👩🏻🏫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
Reposted by Mike Pishvaian
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
👩🏻🏫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
October 22, 2025 at 12:38 AM
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
👩🏻🏫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
Reposted by Mike Pishvaian
7/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 4🏫
💊Several FDA approved PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib
🤔 When and how do you PIK one of the PIK3CA of the 3 available?
📎 pubmed.ncbi.nlm.nih.gov/33246021/
👩🏻🏫Mini Tweetorial 4🏫
💊Several FDA approved PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib
🤔 When and how do you PIK one of the PIK3CA of the 3 available?
📎 pubmed.ncbi.nlm.nih.gov/33246021/
Alpelisib plus fulvestrant for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: final overall survival results from SOLAR-1 - PubMed
NCT02437318.
pubmed.ncbi.nlm.nih.gov
October 22, 2025 at 12:38 AM
7/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 4🏫
💊Several FDA approved PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib
🤔 When and how do you PIK one of the PIK3CA of the 3 available?
📎 pubmed.ncbi.nlm.nih.gov/33246021/
👩🏻🏫Mini Tweetorial 4🏫
💊Several FDA approved PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib
🤔 When and how do you PIK one of the PIK3CA of the 3 available?
📎 pubmed.ncbi.nlm.nih.gov/33246021/
Reposted by Mike Pishvaian
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
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
October 22, 2025 at 12:38 AM
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
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
Reposted by Mike Pishvaian
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
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
October 22, 2025 at 12:38 AM
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
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
Reposted by Mike Pishvaian
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
⏭️ 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
October 22, 2025 at 12:40 AM
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
⏭️ 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
Reposted by Mike Pishvaian
10/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 5🏫
🤔When is a patient considered to be “endocrine resistant”?
Per Advanced Breast Cancer International Consensus Guidelines,
Link to Guidelines: www.thebreastonline.com/article/S096...
👩🏻🏫Mini Tweetorial 5🏫
🤔When is a patient considered to be “endocrine resistant”?
Per Advanced Breast Cancer International Consensus Guidelines,
Link to Guidelines: www.thebreastonline.com/article/S096...
6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)
This manuscript describes the Advanced Breast Cancer (ABC) international consensus
guidelines updated at the last two ABC international consensus conferences (ABC 6
in 2021, virtual, and ABC 7 in 2023...
www.thebreastonline.com
October 22, 2025 at 12:42 AM
10/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 5🏫
🤔When is a patient considered to be “endocrine resistant”?
Per Advanced Breast Cancer International Consensus Guidelines,
Link to Guidelines: www.thebreastonline.com/article/S096...
👩🏻🏫Mini Tweetorial 5🏫
🤔When is a patient considered to be “endocrine resistant”?
Per Advanced Breast Cancer International Consensus Guidelines,
Link to Guidelines: www.thebreastonline.com/article/S096...
Reposted by Mike Pishvaian
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]
👩🏻🏫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]
October 22, 2025 at 12:42 AM
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]
👩🏻🏫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]
Reposted by Mike Pishvaian
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
👩🏻🏫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
October 22, 2025 at 12:45 AM
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
👩🏻🏫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
Reposted by Mike Pishvaian
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
👩🏻🏫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
ASCO Publications
ascopubs.org
October 22, 2025 at 12:45 AM
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
👩🏻🏫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
#tumorboardtuesday
Any subtle differences in outcomes based on the specific mutation identified
AKT vs. PTEN vs. PIK3CA❓
Any subtle differences in outcomes based on the specific mutation identified
AKT vs. PTEN vs. PIK3CA❓
October 22, 2025 at 12:29 AM
#tumorboardtuesday
Any subtle differences in outcomes based on the specific mutation identified
AKT vs. PTEN vs. PIK3CA❓
Any subtle differences in outcomes based on the specific mutation identified
AKT vs. PTEN vs. PIK3CA❓
Reposted by Mike Pishvaian
3/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
👩🦳 mER+/HER2- breast cancer with PD on AI +/- CDK4/6i
💉2L Fulvestrant +/- capivasertib [oral, 🚫AKT plus.. 🚫PTEN, 🚫PIK3CA]
...continued
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
👩🦳 mER+/HER2- breast cancer with PD on AI +/- CDK4/6i
💉2L Fulvestrant +/- capivasertib [oral, 🚫AKT plus.. 🚫PTEN, 🚫PIK3CA]
...continued
October 22, 2025 at 12:21 AM
3/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
👩🦳 mER+/HER2- breast cancer with PD on AI +/- CDK4/6i
💉2L Fulvestrant +/- capivasertib [oral, 🚫AKT plus.. 🚫PTEN, 🚫PIK3CA]
...continued
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
👩🦳 mER+/HER2- breast cancer with PD on AI +/- CDK4/6i
💉2L Fulvestrant +/- capivasertib [oral, 🚫AKT plus.. 🚫PTEN, 🚫PIK3CA]
...continued
Reposted by Mike Pishvaian
3/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
✅ Capivasertib + fulvestrant ⬆️mPFS in AKT Pathway alterations [7.3m vs 3.1m]
✅ Capi+Fulvestrant benefited all subgroups including: 🦴only, 🫁 visceral mets, prior💊 CDK4/6i, prior ☣️chemo
📎https://www.nejm.org/doi/full/10.1056/NEJMoa2214131
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
✅ Capivasertib + fulvestrant ⬆️mPFS in AKT Pathway alterations [7.3m vs 3.1m]
✅ Capi+Fulvestrant benefited all subgroups including: 🦴only, 🫁 visceral mets, prior💊 CDK4/6i, prior ☣️chemo
📎https://www.nejm.org/doi/full/10.1056/NEJMoa2214131
Capivasertib in Hormone Receptor–Positive Advanced Breast Cancer | NEJM
AKT pathway activation is implicated in endocrine-therapy resistance. Data on the efficacy and safety of the AKT inhibitor capivasertib, as an addition to fulvestrant therapy, in patients with horm...
www.nejm.org
October 22, 2025 at 12:21 AM
3/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
✅ Capivasertib + fulvestrant ⬆️mPFS in AKT Pathway alterations [7.3m vs 3.1m]
✅ Capi+Fulvestrant benefited all subgroups including: 🦴only, 🫁 visceral mets, prior💊 CDK4/6i, prior ☣️chemo
📎https://www.nejm.org/doi/full/10.1056/NEJMoa2214131
👩🏻🏫Mini Tweetorial 2🏫
CAPItello-291
✅ Capivasertib + fulvestrant ⬆️mPFS in AKT Pathway alterations [7.3m vs 3.1m]
✅ Capi+Fulvestrant benefited all subgroups including: 🦴only, 🫁 visceral mets, prior💊 CDK4/6i, prior ☣️chemo
📎https://www.nejm.org/doi/full/10.1056/NEJMoa2214131
Reposted by Mike Pishvaian
4/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
💊 Capivasertib taken 4 days on, 3 days off per week
🩺 Need baseline A1C < 8%
🚽 Most common AE: Diarrhea onset ~ day 8 [All grades 72%, G3/4 9.3%]
...continued
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
💊 Capivasertib taken 4 days on, 3 days off per week
🩺 Need baseline A1C < 8%
🚽 Most common AE: Diarrhea onset ~ day 8 [All grades 72%, G3/4 9.3%]
...continued
October 22, 2025 at 12:23 AM
4/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
💊 Capivasertib taken 4 days on, 3 days off per week
🩺 Need baseline A1C < 8%
🚽 Most common AE: Diarrhea onset ~ day 8 [All grades 72%, G3/4 9.3%]
...continued
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
💊 Capivasertib taken 4 days on, 3 days off per week
🩺 Need baseline A1C < 8%
🚽 Most common AE: Diarrhea onset ~ day 8 [All grades 72%, G3/4 9.3%]
...continued
Reposted by Mike Pishvaian
4/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
☝️ Rash (12%) onset ~ day 12→ Pretreat with oral antihistamine, topical steroids
💉 Hyperglycemia (18%) onset ~ day 15; ⬇️ G3/G4 than other PIK3CA
📎https://www.esmoopen.com/article/S2059-7029(24)01466-2/fulltext
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
☝️ Rash (12%) onset ~ day 12→ Pretreat with oral antihistamine, topical steroids
💉 Hyperglycemia (18%) onset ~ day 15; ⬇️ G3/G4 than other PIK3CA
📎https://www.esmoopen.com/article/S2059-7029(24)01466-2/fulltext
Capivasertib and fulvestrant for patients with hormone receptor-positive advanced breast cancer: characterization, time course, and management of frequent adverse events from the phase III CAPItello-2...
Capivasertib is a potent, selective pan-AKT inhibitor. In CAPItello-291, the addition
of capivasertib to fulvestrant resulted in a statistically significant (P < 0.001)
improvement in progression-free...
www.esmoopen.com
October 22, 2025 at 12:23 AM
4/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
☝️ Rash (12%) onset ~ day 12→ Pretreat with oral antihistamine, topical steroids
💉 Hyperglycemia (18%) onset ~ day 15; ⬇️ G3/G4 than other PIK3CA
📎https://www.esmoopen.com/article/S2059-7029(24)01466-2/fulltext
👩🏻🏫Mini Tweetorial 3🏫
CAPItello-291: Capivasertib Side effects
☝️ Rash (12%) onset ~ day 12→ Pretreat with oral antihistamine, topical steroids
💉 Hyperglycemia (18%) onset ~ day 15; ⬇️ G3/G4 than other PIK3CA
📎https://www.esmoopen.com/article/S2059-7029(24)01466-2/fulltext
Reposted by Mike Pishvaian
5/18 #TumorBoardTuesday
Back to our case🔎
💉 57yo ♀️ with mBC to the 🦴, liver, ER 100%, PR 95%, HER2⛔[IHC 0]-🩻confirmed⬆️Dz on 1L ribo/letrozole at C47
✅ Normal labs (A1C=5.8) & VS
🩸Liquid Biopsy: +PIK3CA mutation, TP53 mutation, TMB-Low (4 mut/mb), High tumor fraction (> 5%)
👩🏻⚕️What 2L Tx is advised❓
Back to our case🔎
💉 57yo ♀️ with mBC to the 🦴, liver, ER 100%, PR 95%, HER2⛔[IHC 0]-🩻confirmed⬆️Dz on 1L ribo/letrozole at C47
✅ Normal labs (A1C=5.8) & VS
🩸Liquid Biopsy: +PIK3CA mutation, TP53 mutation, TMB-Low (4 mut/mb), High tumor fraction (> 5%)
👩🏻⚕️What 2L Tx is advised❓
October 22, 2025 at 12:25 AM
5/18 #TumorBoardTuesday
Back to our case🔎
💉 57yo ♀️ with mBC to the 🦴, liver, ER 100%, PR 95%, HER2⛔[IHC 0]-🩻confirmed⬆️Dz on 1L ribo/letrozole at C47
✅ Normal labs (A1C=5.8) & VS
🩸Liquid Biopsy: +PIK3CA mutation, TP53 mutation, TMB-Low (4 mut/mb), High tumor fraction (> 5%)
👩🏻⚕️What 2L Tx is advised❓
Back to our case🔎
💉 57yo ♀️ with mBC to the 🦴, liver, ER 100%, PR 95%, HER2⛔[IHC 0]-🩻confirmed⬆️Dz on 1L ribo/letrozole at C47
✅ Normal labs (A1C=5.8) & VS
🩸Liquid Biopsy: +PIK3CA mutation, TP53 mutation, TMB-Low (4 mut/mb), High tumor fraction (> 5%)
👩🏻⚕️What 2L Tx is advised❓
Reposted by Mike Pishvaian
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
POLL
What 2L therapy would you give this patient❓
1) Capecitabine
2) Trastuzumab deruxtecan
3) Sacituzumab govetican
4) Capivasertib + Fulvestrant
5) Everolimus + Fulvestrant
October 22, 2025 at 12:26 AM
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
POLL
What 2L therapy would you give this patient❓
1) Capecitabine
2) Trastuzumab deruxtecan
3) Sacituzumab govetican
4) Capivasertib + Fulvestrant
5) Everolimus + Fulvestrant
Reposted by Mike Pishvaian
2/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 1🏫
...cont
📝Tissue-based assays or plasma-based assays (ctDNA) can be used
☝️Some alterations may be better detected by tissue-based assays like homozygous loss of PTEN or TMB-H.
☝️Liquid assays may reflect tumor heterogeneity more accurately
👩🏻🏫Mini Tweetorial 1🏫
...cont
📝Tissue-based assays or plasma-based assays (ctDNA) can be used
☝️Some alterations may be better detected by tissue-based assays like homozygous loss of PTEN or TMB-H.
☝️Liquid assays may reflect tumor heterogeneity more accurately
October 22, 2025 at 12:15 AM
2/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 1🏫
...cont
📝Tissue-based assays or plasma-based assays (ctDNA) can be used
☝️Some alterations may be better detected by tissue-based assays like homozygous loss of PTEN or TMB-H.
☝️Liquid assays may reflect tumor heterogeneity more accurately
👩🏻🏫Mini Tweetorial 1🏫
...cont
📝Tissue-based assays or plasma-based assays (ctDNA) can be used
☝️Some alterations may be better detected by tissue-based assays like homozygous loss of PTEN or TMB-H.
☝️Liquid assays may reflect tumor heterogeneity more accurately
Reposted by Mike Pishvaian
2/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 1🏫
Actionable Mutations in 2L mER+/HER2- BC
🧬Several actionable mutations in 2L+ mBC: ESR1, PIK3CA, AKT, PTEN, BRCA (germline, somatic)
🔍Evaluation of acquired mutations at progression will help to direct therapy options
Cont.....
👩🏻🏫Mini Tweetorial 1🏫
Actionable Mutations in 2L mER+/HER2- BC
🧬Several actionable mutations in 2L+ mBC: ESR1, PIK3CA, AKT, PTEN, BRCA (germline, somatic)
🔍Evaluation of acquired mutations at progression will help to direct therapy options
Cont.....
October 22, 2025 at 12:15 AM
2/18 #TumorBoardTuesday
👩🏻🏫Mini Tweetorial 1🏫
Actionable Mutations in 2L mER+/HER2- BC
🧬Several actionable mutations in 2L+ mBC: ESR1, PIK3CA, AKT, PTEN, BRCA (germline, somatic)
🔍Evaluation of acquired mutations at progression will help to direct therapy options
Cont.....
👩🏻🏫Mini Tweetorial 1🏫
Actionable Mutations in 2L mER+/HER2- BC
🧬Several actionable mutations in 2L+ mBC: ESR1, PIK3CA, AKT, PTEN, BRCA (germline, somatic)
🔍Evaluation of acquired mutations at progression will help to direct therapy options
Cont.....
Reposted by Mike Pishvaian
#TumorBoardTuesday POLL
What would you do next❓
1) Start capecitabine
2) Liquid biopsy to assess for actionable mutations
3) Start trastuzumab deruxtecan
4) Check tumor markers Ca 15-3 & Ca 27.29
What would you do next❓
1) Start capecitabine
2) Liquid biopsy to assess for actionable mutations
3) Start trastuzumab deruxtecan
4) Check tumor markers Ca 15-3 & Ca 27.29
October 22, 2025 at 12:07 AM
#TumorBoardTuesday POLL
What would you do next❓
1) Start capecitabine
2) Liquid biopsy to assess for actionable mutations
3) Start trastuzumab deruxtecan
4) Check tumor markers Ca 15-3 & Ca 27.29
What would you do next❓
1) Start capecitabine
2) Liquid biopsy to assess for actionable mutations
3) Start trastuzumab deruxtecan
4) Check tumor markers Ca 15-3 & Ca 27.29
Reposted by Mike Pishvaian
1/18 #TumorBoardTuesday
@KennaKoehler & @drgattimays.bsky.social
Case 1
👩🦳57 y.o. postmenopausal female
📋Well controlled DM (A1C = 5.8)
🏃♀️ECOG PS 0
💉Metastatic BC to bones, liver, ER 100%, PR 95%, HER2- [IHC 0] w/scan confirmed progression on 1L ribociclib/letrozole at C47 in bones
⛔ Normal labs & VS
@KennaKoehler & @drgattimays.bsky.social
Case 1
👩🦳57 y.o. postmenopausal female
📋Well controlled DM (A1C = 5.8)
🏃♀️ECOG PS 0
💉Metastatic BC to bones, liver, ER 100%, PR 95%, HER2- [IHC 0] w/scan confirmed progression on 1L ribociclib/letrozole at C47 in bones
⛔ Normal labs & VS
October 22, 2025 at 12:03 AM
1/18 #TumorBoardTuesday
@KennaKoehler & @drgattimays.bsky.social
Case 1
👩🦳57 y.o. postmenopausal female
📋Well controlled DM (A1C = 5.8)
🏃♀️ECOG PS 0
💉Metastatic BC to bones, liver, ER 100%, PR 95%, HER2- [IHC 0] w/scan confirmed progression on 1L ribociclib/letrozole at C47 in bones
⛔ Normal labs & VS
@KennaKoehler & @drgattimays.bsky.social
Case 1
👩🦳57 y.o. postmenopausal female
📋Well controlled DM (A1C = 5.8)
🏃♀️ECOG PS 0
💉Metastatic BC to bones, liver, ER 100%, PR 95%, HER2- [IHC 0] w/scan confirmed progression on 1L ribociclib/letrozole at C47 in bones
⛔ Normal labs & VS
Reposted by Mike Pishvaian
#TumorBoardTuesday
🧠And while we finalize the case details, collect FREE #CME
👉🏽https://integrityce.com/tbt2025
🧠And while we finalize the case details, collect FREE #CME
👉🏽https://integrityce.com/tbt2025
October 21, 2025 at 12:39 PM
#TumorBoardTuesday
🧠And while we finalize the case details, collect FREE #CME
👉🏽https://integrityce.com/tbt2025
🧠And while we finalize the case details, collect FREE #CME
👉🏽https://integrityce.com/tbt2025