Alex DeMare, MD | FACS

Liver, Pancreas, and GI Onc Surgeon @Corewellhealth. Formerly HPB @ClevelandClinic | Gen Surg @BeaumontSurgery | Medicine @OUWB

[Thor Halfdanarson @OncoThor]

As a CUP-ologist, I am always happy to show CUPs some love at cancer conferences. Here, @hfuentesbayne showed why he has become a recognized go-to person for all things CUP and why he is the Chair of the CUP Group at Mayo Clinic in Rochester. An excellent review on the management of patients with CUPs. Need a CUP speaker for a conference or a grand round...? I have his email and I am willing to share it... 😉

[NEJM @NEJM]

Presented at #ASCO26:

Among patients with previously treated metastatic pancreatic ductal adenocarcinoma, the RAS(ON) inhibitor daraxonrasib led to significantly longer overall survival and progression-free survival than chemotherapy. Full phase 3 RASolute 302 trial results: https://t.co/xwLWBZYRzq

@ASCO

[Society of Surgical Oncology @SocSurgOnc]

Join us for our upcoming CGSO Videoconference: Gastric. Featuring live case presentations by CGSO Fellows from Roger Williams Medical Center and Roswell Park, with guest expert Dan Blazer III (Trey), MD, FACS.

Register now:
https://t.co/i9QcFTYT3y

[Dr Rupam Manna MD @DrRupamOncology]

🚨 GIST TREATMENT MASTERCLASS – ULTIMATE EDITION 🔥
The most complete high-yield infographic you’ll ever need:
✅ Risk Stratification (Miettinen/AFIP table) – size, mitotic rate, site & rupture
✅ Choi Criteria (VERY HIGH YIELD) – why density drop beats RECIST in GIST
✅ Mutation-Based Algorithm (SUPER HIGH YIELD) – KIT exon 11/9, PDGFRA D842V → Avapritinib
✅ Complete Management Flow – Localized, Borderline, Metastatic & Special Cases
✅ Exam-critical pearls + Mutation & Treatment at a Glance table
Precision oncology prototype • NCCN-aligned • One-shot revision gold
Save this for rotations, boards & wards 📌
Tag a fellow/resident/fellow who lives on #MedTwitter 👇
RT if this just became your new GIST bible!
#GIST #Oncology #MedEd #HemeOnc #PrecisionOncology #TargetedTherapy #Cancer #MedTwitter

[Adriana Zucchiatti @zucchiatti_]

Neuroendocrine neoplasms of the stomach. Update on diagnostic
criteria, classification, and prognostic markers
https://t.co/0TNGkh2ZMQ
#GIpath

[Adriana Zucchiatti @zucchiatti_]

Gastric Cancer, A Review
https://t.co/TzcM4JNZHm
#GIpath

[Dr Rishabh Jain @DrRishabhOnco]

The new ESMO guideline just made sequencing CRYSTAL clear.

Let’s simplify the FULL pathway 👇

🧬 Step 1: Check biology FIRST
→ dMMR / MSI-H → Immunotherapy (nivolumab-ipilimumab preferred)
→ Everything else → Go chemo + targeted

🧬 Step 2: If pMMR/MSS → split by mutations

👉 RAS-mutant
→ FOLFOXIRI + bevacizumab (fit patients)

👉 BRAF V600E
→ FOLFOX + encorafenib + cetuximab (practice-changing 🔥)

👉 RAS wt / BRAF wt
→ LEFT sided → anti-EGFR combos win
→ RIGHT sided → bevacizumab-based therapy preferred

🧬 Step 3: Maintenance = not optional anymore
→ Ox-based → Fluoropyrimidine + bevacizumab
→ Anti-EGFR → Fluoropyrimidine + anti-EGFR

🧬 Step 4: Second line = switch backbone
→ Ox → Irinotecan
→ Irinotecan → Ox
+ Continue anti-VEGF pressure

🧬 Step 5: Third line (BIG update 🚨)
→ FTD-TPI + bevacizumab = NEW standard
→ Then regorafenib / fruquintinib

🧬 Precision layer (don’t miss this)
→ HER2 → tucatinib-trastuzumab / T-DXd
→ KRAS G12C → adagrasib + EGFR
→ ctDNA → EGFR rechallenge

💡 Bottom line:
mCRC is no longer “lines of chemo”
It’s a sequencing game driven by biology.

Are you still using one fixed pathway… or fully personalizing now? 🤔

📖 Full paper in comment ⬇️

#OncoTwitter #MedTwitter #colorectalcancer #crc @OncoAlert @myesmo @esmo_open @asco @larvol

[Julie Hallet @HalletJulie]

In @BJSurgery Commission on SI-NETs: safe resection of mesenteric mass

🔎Characterize it - SMA-based classification
✅Proximal masses resectable with tailored technique
🔪Mesentery-sparing to preserve intestinal length/function

All here https://t.co/4eWzoIIMEG

@spartelli

[Ahmed Dehal MD MPH FSSO @AhmedDehalMD]

Proud to collaborate with an outstanding group of experts on this important review of lymphadenectomy beyond traditional gastrectomy in gastric cancer.
@AnnSurgOncol #SurgicalOncology #GastricCancer #MedTwitter

https://t.co/OlVjy3qROR

[JAMA Surgery @JAMASurgery]

Small-bites fascial closure after elective midline laparotomy reduced long-term risk and size of incisional hernia vs traditional large-bites technique, supporting small bites as standard practice for abdominal closure.

https://t.co/wEifzN6cNH

[Alvaro Arjona @alarjosan]

Principles of cytoreductive surgery for primary and metastatic periton. Important collaborative consensus involving different specialities Proud to be involved. @ESGO_society @PSOGI_EC @ISSPP1 @HUReinaSofia @IMIBIC @TheLancetOncol @aecirujanos https://t.co/wFnOaD93MY

[Giovanni Marchegiani @Gio_Marchegiani]

Postpancreatectomy diarrhoea 🔴🔴 an emerging issue in the era of pancreas cancer surgery

🚨Incidence 33% at 90 days
😖 Severity correlates with QoL
💊 PERT always required + 40% loperamide

✂️ Arterial divestment / vascular resection risk factors

https://t.co/i03eJ7lcQS

[Surgical Oncology Insight @SurgOncInsight]

March Issue: Society of surgical oncology medical student & trainee primer for non-HPB GI oncology @_BrainyMD_ @cchildersmd

https://t.co/QqAKVetPxY

@FlavioRochaMD
@DrMikeCavnar
@SKMaithel
@HalletJulie
@JulietOkoroh
@TheNotoriousHPB
@AradhyaNigamMD
@SocSurgOnc

[Thor Halfdanarson @OncoThor]

@UGrewalMD Glad you found this helpful. If you want to get further into the weeds, I recommend this review from our European colleagues... Really excellent stuff!

https://t.co/O9hkj1z5Y6

[Flavio G Rocha, MD, FACS, FSSO @FlavioRochaMD]

Another great 🧵featuring #earlydetection by
PAC-MANN 🙂Dr. Jared Fischer @OHSUKnight

[robert verdonk @rcverdonk]

Acute pancreatitis?? Seems ‘normal’ food 🥘 as good as fat-restricted! 👉🏻Normal-fat versus fat-restricted diets in patients with acute pancreatitis: A randomized controlled study (NouRish-AP study) - ScienceDirect https://t.co/el0T6fcJoG

[Dr Amol Akhade @SuyogCancer]

🔬 Who Should Get Screened for Pancreatic Cancer?
Insights from #ESMOGI25 🔎
📌 High-Risk Germline Mutations
🧬 STK11 (Peutz-Jeghers): RR ~132 | Lifetime risk: 11–36%
🧬 PRSS1 (Hereditary Pancreatitis): RR 53–87 | Risk up to 55% by age 70
🧬 CDKN2A (FAMMM): RR 20–40 | Risk 17–25%
🧬 TP53 (Li-Fraumeni): RR 7–10 | Risk 5–15%
🧬 BRCA2 / PALB2 / ATM: RR 2–6 | Risk ~5–10%
🧬 FPC (Familial Pancreatic Ca): RR 4–32 (family burden dependent)
📊 Even rare syndromes (like STK11, CDKN2A, TP53) carry >10× risk vs general population!
💡 Emerging targeted trials:
• TNG260 + pembro for STK11 (NCT05887492)
• TCR-T cell therapy in dev for TP53
👉 Pancreas screening may be justified in select germline carriers (RR >5 + FHx)
#PancreaticCancer #Genomics #GIcancer #PrecisionOncology @myESMO
@MyriamChalabi @CathyEngMD @OncoAlert @OncBrothers

[Mecker G Möller MD FACS MAMSE @MeckerMollerMD]

Fresh out of the oven! Great read: HIPEC for Colorectal peritoneal Mets @AnnSurgOncol

https://t.co/uMh1Y4BlTR
@uchicagosurgery @UChicagoMed @UChiPritzker
Jason M Foster Garrett Nash

[EndoCollab™ | GI Endoscopy Community @EndoCollabcom]

Management of incidentally found gallbladder polyps

- Recommendations of the Society of Radiologissts in Ultrasound (SRU)

[Thor Halfdanarson @OncoThor]

Wondering about what to do for NEN patients with peritoneal metastases...? Worry not, check this paper...

The Peritoneal Surface Malignancies Consortium Group just dropped a bunch of papers on various cancers

@AGangiMD @PamelaKunzMD @SethConcorsMD

https://t.co/P9Ik5lysZH