OlgaDunaeva

Medical affairs

[Erman Akkus @Erman_Akkus]

🫀Cardiac disease in cancer patients
ESMO guideline summary

#cancer #oncology #MedX #cardiac

[Nieves Martinez Lago MD PhD @DraMartinezLago]

🧬 Very early (30-39y) vs early (40-49y) onset mCRC

⚠️ Worse OS: 30 vs 38 months
🧬 More KRAS mut.
📉 Fewer APC alt.
🫃 More peritoneal metastases (32% vs 20%)
🎯 Patients aged 30–39 may represent a distinct, more aggressive subtype of EOCRC.
@OncoAlert
🔗 https://t.co/R8H7T48L3B

[OlgaDunaeva @DunyaOlga]

Trifluridine/tipiracil and survival in mismatch repair-deficient metastatic colorectal cancer - Pei-Hung Chang, Wen-Kuan Huang, Yu-Li Su, Feng-Che Kuan, Jason Chia-Hsun Hsieh, Hung-Chih Hsu, 2026 https://t.co/1PRVfbCRGo

[Eric Topol @EricTopol]

That's a lot of spatial human proteomics!
>13,000 proteins
~3,0000 samples
58 major tissues types
25 cancer types
https://t.co/GxtrlhTjMb

[Supreeth @Supreeth_medonc]

In this 4th pearl in #Clinicalpearlsinoncology series, let's learn how 5FU can rarely cause leukoencephalopathy which can cause serious consequences and why being aware of it is important to act in time. This was the third case I had encountered in my practice.

#CPOseries
#5FU

[Dr Rishabh Jain @DrRishabhOnco]

Think of a tumor as a block of wood.

RECIST uses a tape measure. It asks only one question: did the tumor get smaller?

But targeted therapy often works like termites. The tumor may look the same size from the outside while dying from the inside.

RECIST says: Stable Disease.

Biology says: Major Response.

That’s why Choi Criteria matter.

Instead of looking only at size, Choi also measures tumor density (Hounsfield Units) on CT. A ≥15% drop in density can indicate treatment response even before meaningful shrinkage occurs.

💡 Clinical pearl:

For GIST, RCC, and HCC, a tumor that isn’t shrinking may still be responding.

Sometimes the most important change isn’t the size of the tumor.

It’s what’s happening inside it.

#Oncology #MedTwitter #GIST #Radiology
@OncoAlert @ASCO @myESMO

[MV Chandrakanth @ChandrakanthMv]

Not all patients receiving moderately emetogenic chemotherapy (MEC) carry the same risk of chemotherapy-induced nausea and vomiting (CINV).

The MyRisk trial tested a simple but important concept: combine patient-specific risk factors with chemotherapy risk to guide antiemetic prophylaxis.

Among high-risk MEC patients, risk-adapted escalation with NEPA + dexamethasone improved:

• Complete response: 81.0% vs 71.8%
• No emesis: 95.4% vs 86.7%
• Complete protection: 71.8% vs 62.4%

Perhaps the most important message:

Treat the patient's emetic risk, not just the chemotherapy's emetic risk.

#Oncology #MedicalOncology #SupportiveCare #CINV #Antiemetics #MASCC #ESMO #ASCO #MVOnco

[Erman Akkus @Erman_Akkus]

🔴CTCAE v6 vs v5

🩸What changed in hematological toxicities?

#cancer #oncology #MedX @OncoAlert @realbowtiedoc @crisbergerot

[MV Chandrakanth @ChandrakanthMv]

📊 Understanding Median Survival

A common question from patients:

“Doctor, if the median overall survival improves by 1.9 months, does that mean every patient lives only 1.9 months longer?”

Not quite.

Median survival is a statistical summary of a clinical trial. It tells us when 50% of patients have experienced the event. It helps researchers, regulators, and oncologists compare treatments.

But patients do not live at the median.

Some derive little benefit.
Some derive substantial benefit.
Some do better than the median.
Some do worse.

That is why Kaplan–Meier curves matter. They show the entire survival experience of the trial population—not just a single point where the curves cross 50%.

Using NAPOLI-3 as an example:
• Median OS: 11.1 vs 9.2 months
• HR: 0.83
• 12-month survival: 45.6% vs 39.5%
• 18-month survival: 26.2% vs 19.3%

The key takeaway:

The median is a property of the trial.
The patient has their own survival curve.

Median ≠ Individual Prognosis.

#Oncology #PancreaticCancer #ClinicalTrials #EvidenceBasedMedicine #MedicalEducation #MVOnco

[Pashtoon Kasi MD, MS @pashtoonkasi]

🆕🗞️Pancreas cancer & #KRAS revolution updates continue. We treated last patient Nov 2024.

📚🧬KRAS Vaccine💉

While ITT DFS wasn’t significant, 2 signals emerge👇🏽:
✔️R0 resection☢️
✔️mKRAS-T-cell responders🔴

➡️👟Gearing up for phase-3.

💭@OncoAlert

🔗https://t.co/KEBHbtn5Do

[MV Chandrakanth @ChandrakanthMv]

Why Performance Status Is Not Enough in Elderly Patients

A 75-year-old with ECOG 1 may appear fit, yet have hidden vulnerabilities such as cognitive impairment, malnutrition, falls, polypharmacy, or poor social support.

Performance Status measures activity.
Geriatric Assessment measures reserve.

To treat older adults safely, we must look beyond ECOG and identify the factors that truly influence toxicity, treatment tolerance, and outcomes.

#MVOnco #GeriatricOncology #Frailty #CancerCare

[Erman Akkus @Erman_Akkus]

🟩GCSF use in oncology
NCCN guideline summary

#cancer #oncology #MedX #blood @OncoAlert @weoncologists @realbowtiedoc @crisbergerot

[Erman Akkus @Erman_Akkus]

🟦Nausea-Vomiting Prevention
ESMO-MASCC 2023 guideline summary

#cancer #oncology #MedX @OncoAlert @CancerCareMASCC

[MV Chandrakanth @ChandrakanthMv]

THE BIG 5 in Geriatric Oncology
ECOG measures activity.
The Big 5 measure vulnerability.
• G8 → Screening
• CGA → Comprehensive assessment
• CARG → Toxicity risk
• ADL/IADL → Functional status
• Clinical Frailty Scale → Frailty
Frailty drives treatment decisions in older adults with cancer.
#GeriatricOncology #Oncology #MVOnco

[Dr Rupam Manna MD @DrRupamOncology]

🚨 #ASCO2026 Landmark Updates in Medical Oncology – Visual Summary (Plenary Day Highlights)
🔥 Pancreatic Cancer Breakthrough: Daraxonrasib (RAS(ON) multi-selective inhibitor) DOUBLES median OS (13.2 vs 6.7 mo, HR 0.40) in 2L mPDAC → new standard of care! (Plenary LBA5)
Key Practice-Changing Readouts:
🫁 NSCLC: HARMONi-6 (ivonescimab OS win), LIBRETTO-432 (adjuvant selpercatinib EFS 91.5%), CROWN 7-yr (lorlatinib 55% PFS at 7 years)
🦾 Prostate: PROTEUS – perioperative apalutamide + ADT sets new standard
🩸 Lymphoma: frontMIND – tafasitamab + R-CHOP improves PFS in high-risk DLBCL
👩‍⚕️ Breast: SENOMAC – safe to omit ALND (major lymphedema reduction)
🧬 CRC: CIRCULATE validates ctDNA-guided adjuvant therapy
Paradigm shifts in targeted therapy, bispecifics, perioperative care & de-escalation!
Full infographic 👇
What’s YOUR top takeaway from #ASCO2026?
#MedicalOncology #PrecisionMedicine #Oncology
Dr Rupam Manna
Medical Oncologist | @DrRupamOncology

[Nicholas Hornstein @GIMedOnc]

#ASCO26

This one is special.

This is the hottest paper of 2026 and potentially in the history of pancreatic cancer.

Let’s dive in.

RASolute 302: Daraxonrasib vs investigator’s choice chemotherapy in previously treated metastatic pancreatic cancer
Abstract LBA5 (soon!)
Presentation: May 31, 2026, 3:21-3:33 PM CDT

For decades, pancreatic cancer has been where good ideas go to die.

We have optimized chemotherapy. We have sequenced chemotherapy. We have celebrated modest gains.

But the central driver of PDAC has always been sitting there in plain sight:

RAS.

More than 90% of pancreatic cancers have oncogenic RAS mutations, and until recently, we had essentially nothing direct to do about it.

Daraxonrasib is an oral RAS(ON) multiselective inhibitor targeting the active GTP-bound state of mutant and wild-type RAS.

And in RASolute 302, it delivered.

Quick hits:

📌 Phase 3 international randomized trial 500 patients with previously treated mPDAC Daraxonrasib vs investigator’s choice chemotherapy

🧬 RAS G12 population
91.8% of patients had RAS G12 mutations

📈 OS in RAS G12 population
13.2 vs 6.6 months
HR 0.40
P<0.001

📈 OS in overall population
13.2 vs 6.7 months
HR 0.40
P<0.001

📊 PFS in RAS G12 population
7.3 vs 3.5 months
HR 0.45
P<0.001

📊 PFS in overall population
7.2 vs 3.6 months
HR 0.49
P<0.001

🔥 12-month OS
Overall population: 53.2% vs 17.3%

⚠️ Toxicity matters, but this was not just more efficacy for more toxicity
Grade ≥3 AEs: 61.8% vs 69.6%
TRAEs leading to discontinuation: 1.2% vs 11.2%

This is the kind of survival curve we almost never get to see in pancreatic cancer.

This validates RAS(ON) inhibition in the most RAS-addicted major cancer. It takes a target we have talked about for decades and turns it into a clinically meaningful survival benefit in a randomized phase 3 trial.

The next questions come fast: 1L combinations, maintenance, perioperative disease, sequencing, resistance, toxicity management, and whether this becomes a new backbone.

RAS is here, and it couldn’t have come sooner.

https://t.co/Y4WJRlRRTk

@TheGutonclab @UGrewalMD @TimothyJBrownMD @OncoAlert @Onco_Nexus @ASCO
@NazliDizman @LauraAlderMD @DVAraujoMD @DrBarbiOnc @LauraEsfeller @FunchainMD @YGaritaonaindia @DrSAHaddad @jgong15 @iandresmeraz @SakditadMD @RamilaShilpakar @RohitBanwar @lungoncdoc

[Dr. Chokri Ben Lamine @abouabdrahman0]

🧬 Pegaspargase in ALL pearls

💉 What it is
•🧪 Pegylated L-asparaginase → depletes asparagine → leukemic lymphoblast apoptosis
•⏳ Longer half-life vs native asparaginase → less frequent dosing

📌 Indications
•🩸 ALL (adult & AYA) — frontline & consolidation (protocol-based)
•🔁 Often replaces native E. coli asparaginase

💊 Dosing (protocol-dependent)
•⚖️ 2,000 IU/m² IV or IM
•⏱️ q14 days (some adult protocols adjust interval/dose)
•🧠 Give with steroids (reduces hypersensitivity)

🧫 Key Monitoring
•🧬 Asparaginase activity level (if available) → detect silent inactivation
•🧠 Amylase/Lipase → pancreatitis
•🧪 LFTs (AST/ALT, bilirubin)
•🩸 Coagulation: AT-III, fibrinogen (± PT/aPTT)
•🍬 Glucose (esp. with steroids)

⚠️ Major Toxicities
•🚨 Hypersensitivity / anaphylaxis (↓ vs native, still possible)
•🧠 Pancreatitis → stop permanently if ≥ grade 3
•🫀 Thrombosis (CNS, DVT/PE) — AT-III depletion
•🧪 Hepatotoxicity (steatosis, cholestasis)
•🍬 Hyperglycemia (steroids synergy)
•🧠 Silent inactivation (no allergy, low activity)

🛑 When to Stop
•❌ Grade ≥3 pancreatitis
•❌ Severe hypersensitivity/anaphylaxis
•❌ Recurrent thrombosis despite mitigation

🔁 If allergy or inactivation
•🔄 Switch to Erwinia asparaginase (shorter half-life; more frequent dosing)

🛠️ Supportive Pearls
•🩸 Consider AT-III replacement if low + thrombosis risk
•🧪 Cryoprecipitate if fibrinogen <100 mg/dL with bleeding/procedure
•💉 Avoid IM if coagulopathy

📊 Why it matters
•📈 Adequate asparaginase exposure improves EFS/OS, even in adults (dose-optimized protocols)

🔗 Reliable sources
•NCCN ALL Guidelines (latest): https://t.co/mg7rVQcMHp
•FDA Prescribing Information (Pegaspargase): https://t.co/4oVxLI8sVK
•ASH ALL reviews & toxicity management: https://t.co/pXRmaJLbVX

#ALL #Pegaspargase #Asparaginase #Hematology #Oncology

[Dr. Chokri Ben Lamine @abouabdrahman0]

“🩸 Pegaspargase Drug Reactions: Grading and Management 🧬💉

1️⃣ Hypersensitivity Reactions
•🛑 Grade 1 (Mild):
•Symptoms: Localized rash, itching, or flushing.
•Management: Continue infusion at a slower rate; administer antihistamines.
•🛑 Grade 2 (Moderate):
•Symptoms: Widespread rash, fever, mild respiratory symptoms (e.g., wheezing).
•Management: Stop infusion temporarily, treat with antihistamines ± corticosteroids. Restart at a slower rate if symptoms resolve.
•🛑 Grade 3 (Severe):
•Symptoms: Severe wheezing, hypotension, or mild anaphylaxis.
•Management: Discontinue infusion. Treat with epinephrine, IV fluids, antihistamines, and corticosteroids. Consider switching to Erwinia asparaginase.
•🛑 Grade 4 (Life-Threatening):
•Symptoms: Anaphylactic shock (severe hypotension, respiratory failure).
•Management: Immediate discontinuation. Administer epinephrine, oxygen, IV fluids, and advanced life support. Permanent discontinuation of Pegaspargase.

2️⃣ Pancreatitis
•🛑 Grade 1 (Mild):
•Symptoms: Asymptomatic elevation of lipase/amylase >ULN.
•Management: Monitor closely. Continue therapy with regular lipase/amylase testing.
•🛑 Grade 2 (Moderate):
•Symptoms: Mild abdominal pain with enzyme elevation ≤2x ULN.
•Management: Hold Pegaspargase temporarily; provide supportive care (IV fluids, pain control). Restart therapy cautiously if enzymes normalize.
•🛑 Grade 3 (Severe):
•Symptoms: Severe abdominal pain, enzyme elevation >2x ULN, or imaging-confirmed pancreatitis.
•Management: Discontinue Pegaspargase permanently. Treat with bowel rest, IV fluids, and pain management.
•🛑 Grade 4 (Life-Threatening):
•Symptoms: Pancreatic necrosis or life-threatening complications (e.g., sepsis, multi-organ failure).
•Management: Permanent discontinuation. ICU care with aggressive supportive management.

3️⃣ Thrombosis and Coagulopathy
•🛑 Grade 1 (Mild):
•Symptoms: Subclinical clot detected on imaging without clinical symptoms.
•Management: Monitor coagulation parameters (fibrinogen, antithrombin III). Continue therapy.
•🛑 Grade 2 (Moderate):
•Symptoms: Clinically evident thrombosis with mild symptoms (e.g., DVT).
•Management: Hold Pegaspargase. Consider anticoagulation if no contraindications. Restart therapy cautiously after resolution.
•🛑 Grade 3 (Severe):
•Symptoms: Symptomatic thrombosis with complications (e.g., PE, CNS thrombosis).
•Management: Discontinue Pegaspargase. Initiate therapeutic anticoagulation and manage complications.
•🛑 Grade 4 (Life-Threatening):
•Symptoms: Massive PE, life-threatening CNS thrombosis.
•Management: Permanent discontinuation. ICU care and aggressive anticoagulation.

4️⃣ Hepatotoxicity
•🛑 Grade 1 (Mild):
•Symptoms: AST/ALT <3x ULN or bilirubin <2x ULN.
•Management: Continue therapy with close monitoring of LFTs.
•🛑 Grade 2 (Moderate):
•Symptoms: AST/ALT 3–5x ULN or bilirubin 2–3x ULN.
•Management: Hold Pegaspargase temporarily. Resume at a lower dose when LFTs normalize.
•🛑 Grade 3 (Severe):
•Symptoms: AST/ALT >5x ULN or bilirubin >3x ULN.
•Management: Discontinue Pegaspargase. Provide supportive care for hepatic dysfunction.
•🛑 Grade 4 (Life-Threatening):
•Symptoms: Acute liver failure or life-threatening hyperbilirubinemia.
•Management: Permanent discontinuation. ICU care for hepatic failure.

Key Practical Points

💡 Monitor Closely:
•Baseline and frequent testing: CBC, coagulation profile (PT/INR, fibrinogen), LFTs, lipase/amylase.

💡 Premedicate for Hypersensitivity:
•Antihistamines ± corticosteroids reduce mild-to-moderate reactions.

💡 Switch to Alternatives:
•Use Erwinia asparaginase if severe hypersensitivity or pancreatitis occurs.

💡 Manage Coagulopathy:
•Replace fibrinogen or antithrombin III if levels are critically low.

#Pegaspargase #ALL #DrugReactions #Hematology”

[Dr. Chokri Ben Lamine @abouabdrahman0]

Pegaspargase 💊⚠️ – Complications by CTCAE Grades + Management (Exam/Practice Cheat Sheet)

🩸 1. Coagulopathy (Hypofibrinogenemia / ↓ATIII)

🔹 Grade 1–2
📊 Fibrinogen 100–150 mg/dL, no bleeding
👉 Monitor 2–3×/week
👉 No routine replacement

🔹 Grade 3
📊 Fibrinogen <100 mg/dL OR minor bleeding
👉 Cryoprecipitate
👉 Target >150 if procedure/bleeding
👉 Continue cautiously

🔹 Grade 4
🚨 Life-threatening bleeding
👉 Cryoprecipitate + platelets ± FFP
⏸️ Hold pegaspargase

🧠 2. Thrombosis (CVST / DVT / PE)

🔹 Grade 1–2
📊 Incidental / mild thrombosis
👉 Consider LMWH (case-by-case)
👉 Continue vs hold based on site

🔹 Grade 3
⚠️ Symptomatic thrombosis
👉 LMWH full dose
🧪 Check ATIII (<60% → replace)
⏸️ Hold pegaspargase

🔹 Grade 4
🚨 Life-threatening (massive PE, CNS)
👉 Anticoagulation ± ICU care
❌ Delay/omit further doses

🔥 3. Pancreatitis (KEY 🚨)

🔹 Grade 1
📊 Asymptomatic ↑ enzymes
👉 Monitor only

🔹 Grade 2
⚠️ Symptomatic, no complications
👉 Hold temporarily
👉 Supportive care

🔹 Grade 3–4
🚨 Severe / necrotizing / ICU
❌ Permanently STOP pegaspargase
👉 IV fluids, NPO, analgesia

🧪 4. Hepatotoxicity

🔹 Grade 1–2
📊 Mild ↑AST/ALT or bilirubin
👉 Continue + monitor

🔹 Grade 3
📊 Bilirubin >3× ULN or significant LFT rise
👉 Hold drug
👉 Resume when improved

🔹 Grade 4
🚨 Liver failure
❌ Discontinue permanently
👉 Supportive ± L-carnitine

🍬 5. Hyperglycemia

🔹 Grade 1–2
📊 Mild ↑ glucose
👉 Monitor

🔹 Grade 3
📊 Persistent / symptomatic
👉 Start insulin

🔹 Grade 4
🚨 DKA / HHS
👉 ICU + insulin infusion
⏸️ Hold drug

🧬 6. Hypersensitivity reactions

🔹 Grade 1–2
⚠️ Rash / mild reaction
👉 Slow infusion + antihistamines

🔹 Grade 3–4
🚨 Anaphylaxis
❌ STOP immediately
🔄 Switch to

🧪 7. Hypertriglyceridemia

🔹 Grade 1–2
📊 TG <500 mg/dL
👉 Monitor

🔹 Grade 3
📊 TG >500 mg/dL
👉 Fibrates / omega-3

🔹 Grade 4
🚨 TG >1000 (pancreatitis risk)
👉 Insulin ± plasmapheresis
⏸️ Hold drug

🧠 8. Neurotoxicity (Hyperammonemia)

🔹 Grade 1–2
📊 Mild confusion
👉 Monitor ammonia

🔹 Grade 3–4
🚨 Encephalopathy
👉 Lactulose ± rifaximin
⏸️ Hold pegaspargase

🧠 9. Silent inactivation (Antibody-mediated)

🔹 Definition
📉 Low asparaginase activity without clinical allergy

👉 Check levels if poor response
🔄 Switch formulation

🧠 Master Pearls ⚡ 📌 Pancreatitis ≥G3 = never rechallenge
📌 Thrombosis → anticoagulate but balance bleeding
📌 Always monitor fibrinogen + ATIII
📌 Hypersensitivity → switch, don’t premedicate and continue
📌 Think silent inactivation if unexpected relapse

🎯 MCQ Patient develops Grade 3 pancreatitis on pegaspargase → next step?
A) Reduce dose
B) Hold then resume
C) Permanently discontinue
D) Switch to LMWH

✅ Answer: C – Permanently discontinue

🎓 OSCE ALL patient on pegaspargase, fibrinogen 90 + new DVT
👉 Management?
✅ Cryoprecipitate + LMWH + check ATIII + hold drug

#ALL #Pegaspargase #Toxicity #CTCAE #HemOnc #KFSHRC