Ben Fangman, MD

Oncologist @ Mid America Cancer Care by way of @MDAndersonNews @UTSWInternalMed. Opinions are my own, open to share. Tweets don’t constitute medical advice.

[Michael S. Kim @Mike_kim714]

I was getting ready to hit my tee shot on 18 with my 3 wd and noticed a decent sized crack on the face 🤦🏻‍♂️

All the trucks are gone so the rep is trying to get it shipped overnight.

My head pro from home is also shipping my back up from my locker.

For now, I stole Max Homa’s 4wd which I hit pretty good on the range.

[Ben Fangman, MD @benfangman]

@OscarTahuahua Certainly not someone who attempts to dissuade from 2nd opinions, but this was not even remotely close to my experience at MD Anderson. Numbers would be closer to 20% at most (and typically on account of pathology change). Value of 2nd opinion more about trial access.

[Ben Fangman, MD @benfangman]

@Papa_Heme How do you feel about it for suboptimal responders to induction (PR or worse)? I typically will refer to transplanters in most young or high risk, but also for this subset too.

[Ben Fangman, MD @benfangman]

@skopetz @pashtoonkasi An important breakthrough for patients in a very difficult to treat subset of metastatic colorectal cancer patients. Congratulations and thank you for your effort in moving the needle for these patients, Dr. Kopetz.

[Ben Fangman, MD @benfangman]

@RaviJainMD Depends on burden of disease I think. 50% isn’t 90%, which plays into it too. Would lean toward chemo IO in average here.

[Ben Fangman, MD @benfangman]

@Dr_Oncologista @OncoAlert @DFCI_BreastOnc @DanaFarber @DanaFarberNews Curious what, if any, evidence being cited to label this as “curative intent” therapy in de novo metastatic breast cancer?

[Ben Fangman, MD @benfangman]

@OncBrothers @PGrivasMDPhD @tompowles1 @BrendanGuercio @shilpaonc @MikeSerzanMD @dr_yakupergun @DrChoueiri @apolo_andrea Don’t think there’s any argument to be made, EV-pembro clear best SOC available, question will be other ADC/IO combos that come along are easier to give that could be better.

[Ben Fangman, MD @benfangman]

@GIMedOnc Think the better strategy here is after induction, decrease the CRS/ICANS, think will be better than Lurbi maintenance.

[Ben Fangman, MD @benfangman]

@GIMedOnc Local surgeons prefer the CRT approach here and have anecdotally had pretty good success, though is typically done after multiple cycles of induction chemo as well. Ultimately I think there certainly is a role for preop RT despite notable negative studies.

[Ben Fangman, MD @benfangman]

@MaryCushmanMD Not quite I think.

https://t.co/SJMnYgptHP

[Ben Fangman, MD @benfangman]

@CharuAggarwalMD @OncoAlert @ASCO Disagree that pCR here is “good.’ Echos issues with other targeted neoadjuvant strategies. Clearly subclones a problem with this strategy. Perhaps a combo with TKI + chemo would be more ideal.

[Ben Fangman, MD @benfangman]

@lungoncdoc @OncoAlert @OncBrothers @LungCancerRx Practice changing in a sense given how poorly chemo performed. This, coupled with LAURA data certainly challenges viability of traditional curative treatment paradigm in these patients.

[Ben Fangman, MD @benfangman]

@AnisToumeh @SuyogCancer @asco25 Calling it “maintenance” is hilarious. It’s continued induction with significant toxicity to eek out a very mild PFS benefit.

[Ben Fangman, MD @benfangman]

@GIMedOnc Always like to see full publication before obviously but definitely makes logical sense and very impressive top line result. Could definitely change my practice once see full data in very difficult disease.

[Ben Fangman, MD @benfangman]

@GIMedOnc Not sure that’s true yet actually. Adagrasib clearly better than sotorasib but comparing between two enormously expensive not-better-than-current-actual-US- SOC-drugs.

[Ben Fangman, MD @benfangman]

@GIMedOnc Not if they are anything like this result. Targeted doesn’t always mean better. KRAS inhibitors to date have not improved outcomes significantly in any sense.

[Ben Fangman, MD @benfangman]

@RossCSchumacher @TimothyJBrownMD Things could be so so much worse. Trust me.

[Ben Fangman, MD @benfangman]

@GIMedOnc Have I somehow missed where the actual full publication is? Key questions are CPS and control arm use of crossover or other IO on backend. Can’t find it anywhere.

[Ben Fangman, MD @benfangman]

@OncBrothers @DrMarkAwad @MSKCancerCenter @dr_yakupergun @BijoyTelivala @RenoHemonc @SuyogCancer @AnaVManana @ADesaiMD @LuisRaezMD @g_mountzios @DrJNaidoo Would make the argument that KEAP1 or STK11 should push for dual IO regimen based on the Anderson data showing the CTLA4 inhibition seems to help abrogate the PDL-1 resistance conveyed by these mutations.