Prof Dr Ibrahim Yildiz

🩺🔬🧬 Oncology Professor | Daily cancer updates & breakthroughs

[MV Chandrakanth @ChandrakanthMv]

ESMO 2026 mCRC — what do I test? 🧬

A simple way to remember the molecular work-up:

🔹 At diagnosis: MMR/MSI + RAS + BRAF + HER2
🔹 NGS: when available & applicable → look deeper for actionable alterations
🔹 ctDNA: when tissue isn’t feasible or a rapid answer matters
🔹 Anti-EGFR rechallenge: check ctDNA for RAS + BRAF + preferably EGFR first

Test early → NGS when applicable → ctDNA when it changes the decision.

📖 Cremolini C, et al. Ann Oncol. 2026;37:759–776.
doi:10.1016/j.annonc.2026.03.005

[Dr Rupam Manna MD @DrRupamOncology]

Cancer of Unknown Primary (CUP) made SIMPLE 🔬
Master the IHC-based stepwise approach:
➡️ Lineage → CK7/CK20 → Site-specific markers → Clinical correlation
High-yield for DM/DrNB exams + real-world oncology practice
#MedicalOncology #Oncology #CUP #Pathology #IHC #CancerDiagnosis #MedEd #NEETSS #DrNB #DMOncology #OncologyLearning #ClinicalOncology

[Dr Rishabh Jain @DrRishabhOnco]

🚨 ASCO updates the living guideline for Stage IV NSCLC with driver alterations

The major new change: EGFR exon 20 insertion NSCLC now has 2 strong first-line options:

• Sunvozertinib monotherapy
• Platinum-doublet chemotherapy + amivantamab

📌 WU-KONG28
Sunvozertinib vs carboplatin-pemetrexed:

• mPFS: 10.3 vs 7.5 months
• HR 0.65
• ORR: 58.9% vs 31.1%
• DoR: 11.2 vs 7.1 months

⚠️ No head-to-head comparison exists versus chemo + amivantamab, so the optimal frontline strategy remains uncertain. OS is also immature.

🩺 Clinical verdict:
Sunvozertinib is now a guideline-backed, chemotherapy-free frontline option for EGFR exon 20 insertion advanced NSCLC.

@ASCO @oncoalert

#LungCancer #NSCLC #EGFR

[Dr. Nikhil Agrawal @drnkhl]

Gallbladder polyp management isn’t just size-based. European vs SRU guidelines differ on size, morphology, risk & follow-up. Some polyps may be malignant, surgical planning matters.
Do you use European, SRU, or individualized approach?
When consider extended cholecystectomy?

[Dr Rishabh Jain @DrRishabhOnco]

🩸 Can ctDNA actually change what we do before the scan changes?

Liquid biopsy is moving from prognostic biomarker → treatment decision tool.

📌 4 trials that matter

SERENA-6 | ER+/HER2− metastatic breast cancer
ctDNA-detected ESR1 mutation before radiographic progression
Camizestrant + CDK4/6i vs continue AI + CDK4/6i
📈 PFS 16.0 vs 9.2 mo
HR 0.44

DYNAMIC | Stage II colon cancer
ctDNA-guided adjuvant strategy vs standard clinicopathologic management
📊 2-y RFS 93.5% vs 92.4%
💊 Chemo use 15% vs 28%
Less chemotherapy, without compromising recurrence-free survival.

IMvigor011 | Muscle-invasive bladder cancer
ctDNA-positive after cystectomy
Atezolizumab vs placebo
📈 DFS 9.9 vs 4.8 mo | HR 0.64
📈 OS 32.8 vs 21.1 mo | HR 0.59

CodeBreaK 100 | Pretreated KRAS G12C NSCLC
Plasma ctDNA identified actionable KRAS G12C alterations
🎯 ORR 37.1%
🎯 DCR 80.6%

💡 Why it matters

ctDNA now has 3 increasingly actionable roles:

Target selection → resistance detection → MRD-guided treatment

⚠️ But one rule still matters:

ctDNA positive ≠ automatically treat.

Optimal testing intervals and the benefit of intervening on molecular relapse alone remain disease-specific and incompletely defined.

🎯 Clinical verdict: PRACTICE EVOLVING

The future may be treatment based on molecular progression before radiographic progression, but prospective disease-specific validation remains essential.

@ASCO @oncoalert

#ctDNA #LiquidBiopsy #PrecisionOncology #CancerResearch

[MV Chandrakanth @ChandrakanthMv]

Advanced Well-Differentiated G1–G2 GI-NET — A Simple Treatment Roadmap

Treatment is driven largely by SSTR expression, grade, tumour burden, pace of disease and need for response.

🟢 Low-burden, indolent disease → observation may be reasonable in selected patients.
🟢 SSTR+ indolent G1/lower G2 → SSA remains the backbone — PROMID, CLARINET.
🟢 SSTR+ higher G2 / bulky disease needing response → consider ¹⁷⁷Lu-DOTATATE + SSA — NETTER-2.
🔴 Progression on SSA → PRRT for appropriate SSTR+ disease — NETTER-1.
🟢 After PRRT / when PRRT is unsuitable → cabozantinib or everolimus — CABINET, RADIANT-4.
🟣 Axitinib + SSA has phase III evidence in extrapancreatic NET — AXINET — but importantly, the primary investigator-assessed PFS endpoint was not met.
🟢 SSTR-negative disease → targeted therapy rather than PRRT.
🟢 Liver-dominant bulky/symptomatic disease → consider liver-directed approaches in selected patients.

The simple principle:
SSTR+ quiet → SSA | SSTR+ aggressive → PRRT | Progression → PRRT/targeted therapy | SSTR− → targeted therapy

Applies to advanced well-differentiated GI-NET; not pancreatic NET or poorly differentiated NEC.

#NeuroendocrineTumors #GINET #PRRT #GIOncology #MedicalOncology #MVOnco

[Erman Akkus @Erman_Akkus]

🏥TNT strategies in rectal cancer

#cancer #oncology #MedX @OncoAlert

[MV Chandrakanth @ChandrakanthMv]

How Epstein–Barr Virus Drives Nasopharyngeal Carcinoma

EBV is more than an associated virus—it is a key driver of nasopharyngeal carcinoma (NPC).

Through latent viral proteins and miRNAs, EBV hijacks host signaling to promote cell survival, proliferation, immune evasion, and invasion.

Key viral players:
• EBNA1 – maintains the viral genome
• LMP1 – activates oncogenic signaling
• LMP2 – promotes cell survival
• BART miRNAs – suppress immune recognition

Plasma EBV DNA is a unique biomarker in NPC, with established roles in diagnosis, prognostication, treatment monitoring, and recurrence surveillance.

#MVOnco #NasopharyngealCarcinoma #NPC #EBV #HeadAndNeckCancer #Oncology #MedicalEducation

[Dr Rishabh Jain @DrRishabhOnco]

🚨 A new biomarker-driven standard in thyroid cancer?

Phase III trial in previously treated BRAF V600E-positive, RAI-refractory differentiated thyroid cancer:

Dabrafenib + trametinib vs placebo

✅ PFS: 12.8 vs 3.7 months
HR 0.38, p<0.0001

✅ ORR: 57% vs 4%

⚠️ Interim OS: HR 0.66, not significant

Pyrexia: 48%
Serious AEs: 43% vs 25%

Take-home: A major PFS and response benefit after VEGFR-targeted therapy.

Verdict: Practice Changing

Would you choose this over cabozantinib?

@TheLancetOncol @oncoalert

#ThyroidCancer #PrecisionOncology

[MJosé Juan @mjuanfi81]

Beyond AR and BRCA. An outstanding review on the genomic landscape of prostate cancer. From targetable alterations to lineage plasticity and therapeutic strategies.
Are we finally ready to identify and treat aggressive-variant PC?

📖 https://t.co/Mea3Gr3zFk…
@OncoAlert

[Dr Rupam Manna MD @DrRupamOncology]

The future of oncology is increasingly tumor-agnostic.

Rather than selecting treatment solely based on where a cancer originated, we can now target specific genomic alterations that drive tumor growth—regardless of the tissue of origin.

Some of the most important tumor-agnostic biomarkers every oncologist should know:
🧬 MSI-H/dMMR
🧬 NTRK fusion
🧬 TMB-High
🧬 RET fusion
🧬 BRAF V600E (approved settings)
🧬 HER2 alterations (selected indications)

Comprehensive Next-Generation Sequencing (NGS) has become an essential tool to identify these actionable alterations and guide personalized treatment decisions, especially in advanced, rare, or treatment-refractory cancers.

Think molecular. Treat smarter.
The right biomarker can transform outcomes—sometimes irrespective of where the cancer began.

#Oncology #MedicalOncology #PrecisionOncology #PrecisionMedicine #TumorAgnostic #NGS #CancerGenomics #TargetedTherapy #Immunotherapy #NTRK #MSI #dMMR #TMB #RET #HER2 #BRAF #CancerEducation #FOAMed #MedEd #DrNB

[Karamvir Yadav @K_Yadavir]

🧬 Can ovarian reserve help personalize chemotherapy?

Emerging evidence suggests Anti-Müllerian Hormone (AMH) may predict which premenopausal women with HR+/HER2− early breast cancer derive the greatest benefit from chemotherapy.

Key points:
✅ High AMH → greater chemotherapy benefit
✅ Low AMH → limited additional benefit
⚠️ Not yet ready for routine clinical use—prospective validation is needed.

#BreastCancer #Oncology #MedTwitter #AMH #PrecisionMedicine #BreastOncology #RxPONDER #AnnalsOfOncology

[Dr Rupam Manna MD @DrRupamOncology]

Mastering ovarian cancer histologic diagnosis with IHC? 🧬
Here’s a high-yield, resident-focused infographic covering:
• Key IHC profiles for the 5 major epithelial subtypes (HGSC, LGSC, Endometrioid, Clear cell & Mucinous)
• Practical diagnostic algorithm (PAX8 → WT1 → Napsin A/HNF1β or ER/PR → GI markers)
• Distinguishing primary ovarian mucinous carcinoma from metastatic colorectal carcinoma (SATB2 & CK7 pattern are key!)
• High-yield exam pearls for DrNB/DM
Morphology (H&E) remains most important — IHC confirms subtype, identifies primary site, and guides molecular testing & treatment decisions.
Save this for exam prep & daily sign-out!
What’s your most useful IHC marker/panel for ovarian tumors? Drop it below 👇
#OvarianCancer #IHC #GynecologicOncology #MedicalOncology #Pathology #DrNB #DMOncology #OncologyEducation #CancerConceptsExplained

[Dr Rupam Manna MD @DrRupamOncology]

Crossover can change how we interpret clinical trial results.

When patients in the control arm switch to the experimental treatment after disease progression, the overall survival (OS) difference may appear smaller—even if the new therapy truly improves survival.

Key takeaways:
🔹 Crossover is ethically appropriate in many oncology trials.
🔹 It can dilute the observed OS benefit.
🔹 Progression-free survival (PFS) is generally less affected.
🔹 Always interpret OS alongside crossover rates, subsequent therapies, and adjusted analyses (e.g., RPSFT, IPCW).

Understanding crossover is essential for critically appraising landmark oncology trials and applying evidence to clinical practice.

#ClinicalTrials #Oncology #EvidenceBasedMedicine #MedicalOncology #ClinicalResearch #OverallSurvival #ProgressionFreeSurvival #Biostatistics #CancerResearch #FOAMed #MedEd #OncologyEducation #DrRupamOncology

[Hong Jae Chon @hongjaechon]

💡 ICI moving to earlier stage of primary liver cancer @JHepatology
👉 TACE+ICI: PFS improved across 4 RCTs, but OS immature
👉 Neoadjuvant HCC: CARES-09 positive (HR 0.59)
👉 Adjuvant HCC: IMbrave050 & KEYNOTE-937 negative
👉 Adjuvant BTC: no RCT yet  
DOI: https://t.co/XvKb3WQNbz
@myESMO @ILCAnews @EASLnews
#HCC #TACE #ICI

[Karamvir Yadav @K_Yadavir]

Should we reconsider platinum rechallenge in advanced biliary tract cancer?

A multinational real-world study suggests that reintroducing cisplatin + gemcitabine + durvalumab (CGD) after progression on durvalumab maintenance may outperform standard FOLFOX/XELOX in selected patients.

🔹 OS: HR 0.47
🔹 PFS: HR 0.44
🔹 2L PFS: 9.0 vs 4.9 months

Prospective validation is still needed, but these findings are hypothesis-generating and clinically relevant.

#BiliaryTractCancer #Cholangiocarcinoma #BTC #GIOncology #Immunotherapy #Oncology #ESMOOpen

[Dr Rupam Manna MD @DrRupamOncology]

🧬 Immunotherapy in Soft Tissue Sarcoma (STS): Who Really Benefits?

Immune checkpoint inhibitors are not standard for most STS, but they play a crucial role in selected patients.

🔹 Tumor-agnostic indications: MSI-H/dMMR and TMB-high tumors → Pembrolizumab
🔹 Strongest evidence: Alveolar Soft Part Sarcoma (ASPS) ⭐
🔹 Other responsive subtypes: Undifferentiated Pleomorphic Sarcoma (UPS) and Cutaneous Angiosarcoma
🔹 Most other STS subtypes derive limited benefit outside clinical trials.

💡 Exam Pearl: Remember “3 A’s + Biomarkers”:
✅ ASPS
✅ Angiosarcoma
✅ Atypical/Undifferentiated Pleomorphic Sarcoma (UPS)
✅ MSI-H/dMMR & TMB-high

#SoftTissueSarcoma #Sarcoma #Immunotherapy #MedicalOncology #Oncology #CancerEducation #Pembrolizumab #Atezolizumab #ASPS #UPS #ESMO #NCCN #FOAMed #MedEd #DrNB #CancerConceptsExplained

[Rohit Malde @roxboxfix]

IDH mutant Astrocytoma
A Review and Latest Update

From Diagnosis to Treatment

Risk Stratification and Therapeutic Advances

Part 1

[Frank Sinicrope, MD @FASinicropeMD]

Daraxonrasib in mPDAC data in 2L compared to chemotherapy results in 1L and 2L. @myESMO

[Rohit Malde @roxboxfix]

"Adjuvant Chemotherapy ± Chemoradiotherapy for Adenocarcinoma of the Pancreatic Head: Results of the Radiotherapy Randomization of NRG Oncology/RTOG 0848