Elí con acento en la í

Internal Medicine 🩺
Oncologist 🦀
GI Cancer Fellowship @INCanMX
Interest in clinical research & immunotherapy 🧬
México 🇲🇽

[Elí con acento en la í @emy_244]

#OncoTwitter #Immunotherapy #chemotherapy

@OncoAlert
@myESMO
@ESMO_Open
@ASCO

[Elí con acento en la í @emy_244]

✳️ Imaging the hallmarks of cancer

☢️Imaging techniques reveal the hallmarks of cancer in the precision oncology era
⚠️But decision-making will not change, yet...

📖Grimm J, et. al. Nat Rev Cancer. 2026
🌐DOI: 10.1038/s41568-026-00950-y

[Elí con acento en la í @emy_244]

New 2L SoC in metastatic pancreatic cáncer. 👏🏼

[Erman Akkus @Erman_Akkus]

🚀Daraxonrasib curves @NEJM 👇
2L of metastatic pancreatic cancer
#ASCO26

https://t.co/JuVXy9q39c

#cancer #oncology #pancreatic #MedX @OncoAlert @realbowtiedoc @DrVilmaPBarcia

[MV Chandrakanth @ChandrakanthMv]

When Kaplan–Meier Curves Fool You 📉

A flat survival tail can look exciting…
but sometimes it reflects very few patients remaining under follow-up.

The curve alone is never enough.

Always check: • Number at risk
• Censoring patterns
• Follow-up maturity
• Late-tail denominator

A “long-term survivor plateau” is meaningful only when enough patients are still being observed.

One of the most important lessons in interpreting immunotherapy trials.

#Oncology #MedEd #Biostatistics #Immunotherapy #ClinicalTrials #KaplanMeier #MVOnco

[Wungki Park, MD MS @CentralParkWMD]

1/n

Daraxonrasib (RMC-6236), the first-in-human oral 💊RAS(ON) multi-selective tri-complex inhibitor, in previously treated RAS-mutated pancreatic cancer phase I/II study is now published in the New England Journal of Medicine @NEJM

A novel💡 way to shut down ⚔️RAS, one of the most important oncogenic drivers in cancer that had long been considered “undruggable.”

🔗https://t.co/ptfNVcxrb4

Shout out to Brian Wolpin, @CentralParkWMD @GarridoLagunaMD @AlexSpiraMDPhD @salmanpunekar @MeredithPelster @bherzbergmd Nilo Azad Aparna Hegde @DavidHongMD and the whole team who dedicated to this study. @EileenMOReilly

#HBP #HumansBeyondPatients

[Elí con acento en la í @emy_244]

#GICancer Trials in April 2026 (first 4 months) 🔥

[LARVOL @Larvol]

Top #GICancer Trials of April 2026, curated by @Larvol CLIN based on most viewed 𝕏 posts.

Explore more about oncology conferences, top trials, and reactions from oncologists: https://t.co/ct6tMIQHii

#LARVOL #Oncology #CancerResearch #CancerData #OncologyInsights #ClinicalTrials #GastrointestinalCancer #GICSM | @Aiims1742 | @arnavmehta3 | @GIMedOnc | @ilyassahinMD | @Erman_Akkus | @DaisukeKotani | @DraMartinezLago | @pashtoonkasi | @SyedAAhmad5 | @DrAngelaLamarca

[Elí con acento en la í @emy_244]

📖 N Engl J Med 2026;394:1313-24.
🌐 DOI: 10.1056/NEJMra2500106

#MedTwitter #ENARM #medicina #medicinainterna #MedInterna #metabolismo #endocrinology #USMLE

[Elí con acento en la í @emy_244]

✳️ Agonistas GLP-1: el medicamento del siglo?
Tx: Diabetes y Obesidad

✴️Promueven liberación de insulina mediada x glucosa
✴️Reducen vaciamiento gástrico
✴️Inhiben la secreción de glucagón
✴️Cambios benéficos en microbioma intestinal
✴️Regulan las vías del hambre y la saciedad

[Elí con acento en la í @emy_244]

De qué nos vamos a preocupar? 🤷‍♂️
- Adherencia a largo plazo (💰)
- Efecto “rebote” ⚽️
- Masa magra disfuncional 💪
- Alteraciones psicológicas 🙁

[Oscar Tahuahua @OscarTahuahua]

KRAS is not a mutation problem, It’s a context problem
KRAS behaves as a dynamic node within a network

KRAS ≈25% of cancers
-NSCLC: ORR ~40%, mPFS >6 mo
-CRC: rapid EGFR-driven rebound
-PDAC: stromal, metabolic, immune resistance

⚠️⚠️Tumors escape through:
EGFR/SHP2 , MAPK/PI3K, YAP/STAT3, plasticity

What this means in practice:
-combinations matter (e.g., KRAS+EGFR in CRC)
-targeting networks works better than targeting a mutation alone 👀
-trials should be built around biological context
https://t.co/WHIk3WuDk1 @OncoAlert @KRASKickers

[Elí con acento en la í @emy_244]

#OncoTwitter #Immunotherapy #chemotherapy #radiationtherapy

@OncoAlert
@myESMO
@ESMO_Open
@JCO_ASCO

📚 Mager KL, et, al. JAMA 2026 Apr 13.
🌐 10.1001/jama.2026.2248
♾ https://t.co/OOseJDwJ3m

[Elí con acento en la í @emy_244]

Endometrial cancer: JAMA Review 2026 🔥

✅ Risk factors
✅Clinical features
✅Diagnosis
✅Staging
✅Treatment (Qx > RT / QTRT / IO)

[Nieves Martinez Lago MD PhD @DraMartinezLago]

🧪 Periop PEM in dMMR/MSI localized CRC

📊 IMHOTEP: Phase II, prospective (n=81)

🔹 pCR 52.7%
🔹 ↑ pCR with 2 cycles: 68% vs 46%
🔹 Only 3 recurrences (median FU ~24 mo)
💥 Early IO shows remarkable activity in localized MSI-H CRC
👉 Toward de-escalation strategies

🔗 https://t.co/Y58NStApIN
@OncoAlert

[Elí con acento en la í @emy_244]

✳️"New" RAS inhibitors in mPDAC
Revolution has started ⏳

[Dr Rishabh Jain @DrRishabhOnco]

🚨 Practice-changing in pancreatic cancer?

Daraxonrasib shows a massive OS benefit in phase 3 RASolute 302.

👥 Study population:
Previously treated metastatic PDAC (RAS-mutant & WT)

⚔️ Trial arms:
🟣 Daraxonrasib 300 mg OD
🔵 Investigator’s choice chemotherapy

📊 Key results:
✔️ OS: 13.2 vs 6.7 months
✔️ HR 0.40 (p < 0.0001)
✔️ PFS also significantly improved

🛡️ Safety:
Well tolerated, no new safety signals

💡 Why this matters:
Post-progression options in PDAC have been weak.
A ~2x OS improvement is something we’ve almost never seen here.

⚠️ But:
Topline press release data only
Full breakdown (subgroups, ORR, QoL) awaited at ASCO

🔥 Takeaway:
If confirmed, RAS(ON) inhibition may redefine PDAC beyond KRAS G12C

#OncoTwitter #MedTwitter #GIOnc #PancreaticCancer
@OncoAlert @myesmo @esmo_open

[Elí con acento en la í @emy_244]

Metastatic colorectal cancer: ESMO Living Guidelines update 2026 🔥

🎯Molecular-driven algorithm
🥇1L: MSI-H: ICI (Nivo-Ipi, Alt. Pembro) /// RASwt left-side: anti-EGFR
🥉3L FTD/TPI + BEV preferred

@OncoAlert
@myESMO
@ESMO_Open

[Yakup Ergün @dr_yakupergun]

Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up†
https://t.co/2SQy8HNxiY

[MV Chandrakanth @ChandrakanthMv]

MMR IHC Interpretation – Super Simple Quick Algorithm 🔥

Test the 4 proteins → All present? → pMMR (good)

One or more missing? → dMMR (needs attention)

Then follow the exact pattern of loss:

MLH1 & PMS2 lost (most common) → Check BRAF & MLH1 methylation

MSH2 & MSH6 lost → Likely Lynch
Only MSH6 or only PMS2 lost → Possible Lynch

Weird single losses (MSH2 alone or MLH1 alone) → Not possible, recheck!

Key rule: Always read MMR as pairs, not single markers!

(MLH1 protects PMS2 • MSH2 protects MSH6)

Saves time in daily practice. Save & share!

#MVOnco #Oncology #Pathology #MedEd

[MV Chandrakanth @ChandrakanthMv]

MMR IHC — Don’t get the pairs wrong!

Think of MMR proteins as a team of 2:

👉 MSH2 works with MSH6
👉 MLH1 works with PMS2

There’s always a “boss” + “assistant”

🧠 Key rule:
If the boss is lost → assistant cannot survive
But assistant can be lost alone

So if you see:
❌ MSH2 absent but MSH6 present
❌ MLH1 absent but PMS2 present

👉 That pattern is biologically impossible → recheck the report

💡 Easy memory:
“No boss → no assistant”

#Oncology #Pathology #MedEd #MVOnco

[Elí con acento en la í @emy_244]

📖 Lancet Oncol. 2024 Oct;25(10):e520-e525
🌐 10.1016/S1470-2045(24)00218-3

[Elí con acento en la í @emy_244]

⚠️The tyranny of non-inferiority trials‼️
1⃣ Obsolete Doses 💊
2⃣Goal Statistics 🧮
3⃣Large amount of evidence 📚
4⃣Priority?🤔
5⃣Superimposable survival curves
6⃣Timming?⏲️
7⃣Industrial Friction 🧪
8⃣Variability
9⃣Comparative trials ✅
🔟 Utility = Survival x Quality of life😃

[Elí con acento en la í @emy_244]

To clarify:
✴️Do we need non-inferiority trials?
✴️What is the optimal cutoff point for their evaluation?
✴️Who would actually benefit from them?
✴️Compare the “current” standard ... is time-appropriate?