Parth

PGY 5 | Internal Medicine (AIIMS, New Delhi) | Alma mater (GMC, Rajkot)

[Vincent Rajkumar @VincentRK]

Here is the inside story on how @UpToDate does what it does.

From my experience as an author/section editor for UpToDate for 20 years, here is how it works. It’s amazing!

Every day a team of people @UpToDate scour the top medical journals (and major meeting abstracts) for articles of importance. In my case they pertain to myeloma and related disorders. Any article that is felt to be important is sent to a expert MD medical editor at UpToDate who reviews the paper. If the information is felt to be important, the relevant chapter is updated with this content, summarized in a few sentences in Word track and then sent to the author of the chapter who is a top expert in the field.

As an author I have to review the update in detail and then make a decision whether to include the new information, and whether the way it has been incorporated is correct or needs to be edited.

Once I make a decision, it is then reviewed by an expert section editor. For 15 years for me, the section editor was Dr. Robert Kyle! (Currently I’m the section editor and we have about 6 experts serve as authors on over 40 chapters pertaining to myeloma and related disorders). The section editor independently decides whether the author made the right call and either approves or we have a back and forth till we agree.

The updated chapter is then reviewed again by the expert MD editor at UpToDate and then posted.

For important phase III trials or FDA approvals we usually make the update within a week. Sometimes by the next day! With so many important papers, every week there are 2-3 updates pertaining to my chapters that go through the above process! It’s hard work but it keeps me ridiculously current. And more importantly it keeps the content accurate and current. This is not random addition of new information. It’s vetted information that’s added.

Every UpToDate chapter is also peer reviewed annually. Each chapter also undergoes an annual author and editor review to make sure that the overall content and flow is good and to delete content that may be no longer important or accurate. The extraordinary process and rigor involved is why it’s such an invaluable irreplaceable resource. It is AMAZING and hard to replicate.

UpToDate is easy to navigate. But the newly launched UpToDate Expert AI takes it to the next level! It makes the entire content available to query just like you query a top ranked LLM. But it’s not searching the random internet or a stack of published articles. It’s primarily trained and derives vetted and adjudicated UpToDate content. It will not randomly hallucinate. It will not list 10 options for treatment newly diagnosed myeloma but will give you what experts currently feel is the best option based on the latest evidence. All answers are referenced and pointing to specific content sections in UpToDate (which also has links to source material). So you can immediately get all the background information if you need more detail.

Working with UpToDate has helped my career immensely. For the last 20 years it has been impossible for me to not know about every important study related to myeloma and related disorders as they get published! For 20 years, I have received a precise summary of every important article published in my field. More importantly I am forced to read them, review the source material, and make a judgment call. As a result I remember this stuff. A gift indeed!

[Dr. Nikhil Agrawal @DrNikhilMD]

You are about to give parenteral B12. Which electrolyte must be checked first and what complication are you trying to prevent?

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

Not all MYC lymphomas are Burkitt.

A simple way to approach high-grade B-cell lymphoma:

1. High Ki-67 → suspect aggressive lymphoma
2. Check MYC (FISH)

If MYC rearranged:
→ Check BCL2

• BCL2 negative → Burkitt lymphoma
• BCL2 positive → Double Hit lymphoma

If MYC not rearranged:
→ DLBCL / other HGBCL

Key rule:
BCL2 positivity excludes classic Burkitt lymphoma

Morphology helps:
Burkitt = homogeneous, intermediate-sized cells
Double Hit = heterogeneous, pleomorphic

Genetics defines biology.

#Lymphoma #Hemetwitter

[Brent A. Williams, MD @BrentAWilliams2]

If “The Pitt” was an honest show it would spend 80% of the show with scenes of residents sitting in front of screens staring at Epic.

[Oncology Brothers @OncBrothers]

This is the treatment algorithm we’ve used during our discussion with @SKamath_MD on #BiliaryTractCancer

✅ Early disease
✅ 1L Rx in metastatic disease
✅ NGS/Biomarker testing
✅ HER2, IDH, & FGFR Rx

#OncTwitter #MedX @OncUpdates @OncoAlert #gism

[Dr Rishabh Jain @DrRishabhOnco]

TNBC is no longer a chemo disease.

This 1 algorithm shows the shift:
👉 ADCs + biomarkers are now driving frontline decisions.

🧬 Metastatic TNBC - how to think today

PD-L1 ≥10
• Pembro + chemo
• OR Pembro + SG

PD-L1 <10
• SG or Dato-DXd now competing with chemo

BRCA-mut
• PARP inhibitors

HER2-low
• T-DXd option

Later lines
• ADC sequencing
• Biomarker-directed therapy

🧠 Paradigm shift

❌ Before: one-size chemo
✅ Now: IO + ADCs + PARPi + precision oncology

⚠️ What matters next

Not just “which drug”
👉 but “what sequence”

Topo-1 ADCs → real cross-resistance concern

🎯 Takeaway

Advanced TNBC has entered the ADC era.

Smart sequencing will define outcomes. 🔖

📖 Full paper in comment ⬇️

#OncoTwitter #MedTwitter #TNBC #BreastCancer @OncoAlert @myesmo @esmo_open @JCOPO_ASCO

[Michael Justus @mhjrad]

the least accurate part of the Pitt is how the med students/residents/attendings interact

[Ashley Shoemaker @aehal1]

@mhjrad Scrubs is the only show that ever understood the hierarchy of medicine

[Talha Badar @TalhaBadarMD]

25 years of TKIs in CML — how I treat CML-CP today @BloodPortfolio https://t.co/LJoG2U54dw
#weekend_review @MayoCancerCare

1️⃣ BCR-ABL1 drives disease; all frontline TKIs deliver excellent survival.

2️⃣ Choice ≠ OS → it’s about risk (ELTS>Sokal), comorbidities, toxicity, and DMR/TFR goals.

3️⃣ Imatinib = safest CV, slowest.
2G TKIs/asciminib = faster, deeper responses (watch toxicity).
Nilotinib → vascular risk. Dasatinib → lung toxicity.

4️⃣ Asciminib → allosteric, avoid b2a3/b3a3.
The art is matching the right TKI to the right patient.

#How_I_treat_CML #BloodPortfolio

[Abi Siva MD @AbiSivaMD]

Interesting move in the new NCCN guidelines: ADCs are now listed as a first-line option in mTNBC, even before FDA approval. Highlights how rapidly the treatment landscape is evolving. #sabcs25 @ASCO @SABCSSanAntonio #MedTwitter @OncBrothers @TotalHealthConf @PTarantinoMD @drsarahsam

[MV Chandrakanth @ChandrakanthMv]

• Gupta et al. (Carboplatin in TNBC, JCO 2025)
• EFS missed, OS delivered
• Not biology — statistics (events + power + time)
• Negative primary ≠ negative drug
#TNBC #BreastCancer #ClinicalTrials #Oncology #Stats #MVOnco

[MV Chandrakanth @ChandrakanthMv]

• Platinum in TNBC?
• Survival benefit seen only in premenopausal / ≤50 yrs
• No benefit in postmenopausal pts
• Biology matters — not all TNBC is the same
#TNBC #BreastCancer #Oncology #JCO #MVOnco

[Harsha Bhogle @bhogleharsha]

Observation: Saw it in Amdavad, then in Vadodara and now in Rajkot. Nobody wears helmets while driving two-wheelers. Is there a reason?

[Dr. Nina Niu Sanford @NiuSanford]

CRITICS-II: multicenter Ph2 RCT in resectable gastric ca showing preop chemo (DOC) + CRT improved 1-yr EFS &amp; pCR (20%) v CRT or chemo alone. But w D-FLOT now SOC, q’s are:

1. Could adding pre-op chemoRT to D-FLOT further improve pCR enabling organ pres option? #GI26
🧵1/2

[Erman Akkus @Erman_Akkus]

📘Gastric cancer

✅A practical review

https://t.co/dhaPe1BW88

#cancer #oncology #gastric #MedX @OncoAlert

[Oncology Brothers @OncBrothers]

4 studies that we touched on during Triple Negative #BreastCancer highlights 🗣️ from #SABCS25 w/ @Dr_RShatsky:

✅ #RJBC1501 (PhIII)
✅ #CITRINE (PhIII)
✅ #TBCRC056 (PhII)
✅ #OlympiaN (PhII)

When do you consider carboplatin if not used in neoadj settings? #bcsm #OncTwitter

[Yakup Ergün @dr_yakupergun]

Because most of these patients receive neoadjuvant therapy, platinum agents are usually utilized in that setting and therefore are not carried over into the adjuvant phase. However, in high-risk TNBC patients who undergo upfront surgery for any reason—particularly those who are younger, have a high Ki-67 level, are germline BRCA mutation carriers, and are expected to tolerate treatment—I would consider adding a platinum agent. It is important not to compromise taxane delivery by having to discontinue therapy due to platinum-related toxicity. It should also be kept in mind that the BR003 trial reported negative results.

[MV Chandrakanth @ChandrakanthMv]

🧠📘 𝐖𝐡𝐞𝐭𝐡𝐞𝐫 𝐢𝐧 𝐞𝐱𝐚𝐦𝐬 𝐨𝐫 𝐢𝐧 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞, 𝐭𝐡𝐢𝐬 𝐪𝐮𝐞𝐬𝐭𝐢𝐨𝐧 𝐢𝐬 𝐮𝐧𝐚𝐯𝐨𝐢𝐝𝐚𝐛𝐥𝐞.
🧬 𝐅𝐎𝐋𝐅𝐎𝐗—𝐦𝐚𝐝𝐞 𝐬𝐢𝐦𝐩𝐥𝐞.

#FOLFOX #MedicalOncology
#OncologyEducation #MVOnco

[MV Chandrakanth @ChandrakanthMv]

𝐖𝐡𝐲 𝐝𝐨𝐞𝐬 𝐋𝐞𝐧𝐂𝐚𝐛𝐨 𝐟𝐚𝐯𝐨𝐫 𝐋𝐞𝐧+𝐄𝐯𝐞 𝐚𝐟𝐭𝐞𝐫 𝐈𝐎 𝐟𝐚𝐢𝐥𝐮𝐫𝐞 𝐢𝐧 𝐦𝐜𝐜𝐑𝐂𝐂? 👇
🔹 𝐂𝐚𝐛𝐨𝐳𝐚𝐧𝐭𝐢𝐧𝐢𝐛 → horizontal inhibition
Blocks multiple 𝐞𝐬𝐜𝐚𝐩𝐞 𝐫𝐞𝐜𝐞𝐩𝐭𝐨𝐫𝐬 (VEGFR, MET, AXL)
🔹 𝐋𝐞𝐧𝐯𝐚𝐭𝐢𝐧𝐢𝐛 + 𝐄𝐯𝐞𝐫𝐨𝐥𝐢𝐦𝐮𝐬 → vertical, end-to-end inhibition
Blocks 𝐚𝐧𝐠𝐢𝐨𝐠𝐞𝐧𝐞𝐬𝐢𝐬 + 𝐬𝐮𝐫𝐯𝐢𝐯𝐚𝐥 𝐬𝐢𝐠𝐧𝐚𝐥𝐢𝐧𝐠
from 𝐕𝐄𝐆𝐅𝐑/𝐅𝐆𝐅𝐑 → 𝐦𝐓𝐎𝐑

⬆️ 𝐄𝐧𝐝-𝐭𝐨-𝐞𝐧𝐝 𝐩𝐚𝐭𝐡𝐰𝐚𝐲 𝐬𝐡𝐮𝐭𝐝𝐨𝐰𝐧 = 𝐥𝐨𝐧𝐠𝐞𝐫 𝐏𝐅𝐒 ⏳
#RCC #mccRCC #UroOncology
#CancerBiology

[Blood Journals Portfolio @BloodPortfolio]

In older and/or frail patients with CLL, treatment with acalabrutinib is highly efficacious and can improve underlying frailty. Read full article in Blood: https://t.co/W9RP0LgXlL