Susrutha Puthanmadhom Narayanan

#WashUOnc, #PittGIM, Precision-Oncology, Colorectal Cancer, Carnatic music vocalist/enthusiast | 🇮🇳🇺🇸 | tweets are mine

[NEJM @NEJM]

Original Article: Daraxonrasib in Previously Treated Advanced RAS-Mutated Pancreatic Cancer https://t.co/9y7xLrCuYV

Science behind the Study: Advances in RAS Therapeutics for Pancreatic Cancer https://t.co/mz3fgnCNUi

#Oncology #Gastroenterology

[JAMA @JAMA_current]

"Medicine was not something I did between 9 AM and 5 PM. It was not something that sat on one side of a scale opposite of 'life.' Medicine was woven through every aspect of my life."

In #APieceofMyMind, a retired family physician reflects on the boxes of paper left behind by a medical career—and the enduring relationships, lessons, and identity they represent.

https://t.co/xlTCHkMzbQ

[Nicholas Hornstein @GIMedOnc]

Amivantamab in mCRC, hot off the presses

3rd line + chemo-refractory mCRC
Terrible disease, great signal

OrigAMI-1 (phase 1/2):
• RAS/BRAF WT, HER2–
• 2–3 prior lines
• n=94

Efficacy:
• ORR:
– 29% (EGFR-naive, left)
– 19% (post–EGFR, left)
– 22% (right-sided)

• PFS: ~3.7–5.7 mo
• DoR: ~6–10 mo

Signal holds across:
• prior EGFR exposure
• sidedness

Rechallenge signal:
• longer interval from prior EGFR → higher ORR (~32%)

Toxicity:
• Rash / dermatitis (expected)
• Infusion reactions common
• Low discontinuation

Phase 1 always overestimates.

But…
These response rates are not typical for this setting.

If PFS holds in phase 3, this changes practice quickly.

And yes, I’m already filling out compassionate use forms on my patient’s behalf.

Full Article:
https://t.co/QjEhBneTZI

@OncoAlert @TheGutOncLab @Onco_Nexus

[NEJM @NEJM]

A recent study provides proof of principle that a single genetic edit can overcome the effect of nonsense variants in different genes, akin to a one-size-fits-many model.

Learn more in the Clinical Implications of Basic Research article “Editing tRNA Genes to Broaden Nonsense Therapeutics” by John D. Lueck, PhD (@littlelueck), from the University of Rochester School of Medicine and Dentistry (@URochester_SMD): https://t.co/FiBIN9jn57

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

A MUST-READ!

This is probably one of my most important papers where I try to teach how to fish rather than offer fish.

How I Read a Clinical Trial Report?

BG’s primer for Busy Clinicians.

Thank you @JCOOP_ASCO @EthicsdoctorP for the kind invitation. I hope the readers will find this useful.

https://t.co/HJhZlsBpU2

[Science Magazine @ScienceMagazine]

For decades, biology textbooks have enshrined a simple rule: DNA is made by copying a template. After one enzyme unzips a DNA double helix into separate strands, another called a polymerase builds a complementary sequence, base by base, for each strand. Presto: two copies of the original DNA.

But new research into how bacteria defend themselves from viruses now shows this synthesis rule isn’t absolute.

Now, a team describes a bacterial enzyme that synthesizes DNA without a nucleic acid template, using its own structure as a guide.

Learn more: https://t.co/TeUWvyO0OD @NewsfromScience

[nature @Nature]

Nature research paper: Emergence of oncofetal plasticity is ubiquitous in early colorectal cancers
https://t.co/g2E1wLC5Sy

[Oscar Tahuahua @drtahuahua]

🚨 Up to 40% of rectal cancer patients may not need surgery.

In dMMR disease (with proper testing)
Immunotherapy → ~90-100% CR

In MSS
TNT: ~1 in 3 achieve cCR

With watch-and-wait:
~85% keep their rectum
>95% remain metastasis-free
Local regrowth ~15%, mostly detected early and successfully salvaged

It’s smarter upfront intensification then personalized decisions.

But this isn’t a simple algorithm.
It requires clinical judgment, proper testing, careful selection and intensive surveillance.

What once seemed unthinkable is now part of evolving clinical practice; the state of the art care
https://t.co/qM4gjtik8v

[nature @Nature]

Nature research paper: Atlas-guided discovery of transcription factors for T cell programming

https://t.co/9EOHx324TX

[Adrian Lee @Adrianvlee]

Just out, our study examining gene expression differences between ILC and IDC/NST breast cancers showing consistent increases in cAMP/PKA/CREB signaling, potential for targeting?
https://t.co/UL8C57bW2z
@UPMCHillmanCC @MageeWomens @BCRFcure @SusanGKomen #lobular

[NEJM @NEJM]

Presented at #ASCO24:

Among patients with EGFR-mutated lung cancer after chemoradiotherapy, 65% of patients who received osimertinib were alive without progression at 2 years, as compared with 13% of those who received placebo. Full LAURA trial results: https://t.co/NvZXToy84j

[WashU Medicine Hematology-Oncology Fellowship @WashUHemOncFell]

Fellows across all three years had the opportunity to attend #ASCO24 (and enjoy the beautiful Chicago weather!)

[WashU Medicine Division of Physician-Scientists @WashUDPS]

You won't want to miss the next #TIPS Seminar on February 7 when we hear about #WUPhysicianScientist Dr. Susrutha Narayanan's interesting patient! Zoom link here: https://t.co/WiWOE9cMYm

[Cancer Cell @Cancer_Cell]

Online Now: Clinical and molecular features of acquired resistance to immunotherapy in non-small cell lung cancer https://t.co/rkc4Qbnvc6

[Journal of Clinical Oncology @JCO_ASCO]

🙌 Osimertinib + chemotherapy enhances CNS efficacy vs osimertinib alone in EGFRm advanced non small-cell #LungCancer ➡️ https://t.co/AI3JoBgMxu #LCSM @dplanchard

[JAMA Oncology @JAMAOnc]

Early stage NSCLC has been evolving in real time over the past few years, w/ multiple key trials of neoadjuvant &/or adjuvant therapy trials incorporating targeted therapy or immunotherapy; this review summarizes data & recs for current clinical practice. https://t.co/LEUshnfQpL

[Journal of Clinical Oncology @JCO_ASCO]

🙌 Prospective study of chemo-free treatment with pembro + RT for biomarker-selected locally advanced non-small cell #LungCancer ➡️ https://t.co/3nOgNv79xn #LCSM #ImmunoOnc @nitinohri @DrSteveMartin

[JAMA Internal Medicine @JAMAInternalMed]

JAMA Internal Medicine introduces a new series, the Guide to Statistics and Methods, to be accessible to clinicians and researchers contextualizing and interpreting statistical methods applied in studies published in JAMA Internal Medicine. https://t.co/7e8TKCbKOQ

[Susrutha Puthanmadhom Narayanan @Susruthapn]

@MargaretRosenzw @Adrianvlee @oesterreichs @breastoncdoc

[Margaret Rosenzweig @MargaretRosenzw]

From our recently published paper
- low neighborhood SES is associated with worse outcomes in patients with metastatic breast cancer