Sergio Casillas

[Yakup Ergün @dr_yakupergun]

Current Management of Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer in a Changing Landscape

Great review👇

https://t.co/lDy6tlwwDQ

[Dr Rupam Manna MD @DrRupamOncology]

Why can Hepatocellular Carcinoma (HCC) often be diagnosed without a biopsy, while most other cancers cannot?

The answer lies in its unique vascular transformation.

As HCC develops, it switches from portal venous to arterial blood supply, producing the classic imaging pattern:
🩸 Arterial Phase Hyperenhancement (APHE) → 🌑 Portal/Delayed Washout ± Capsule.

In a patient with cirrhosis or chronic HBV, this pattern is so specific that LI-RADS LR-5 allows a confident diagnosis without tissue confirmation in many cases.

Most other solid tumors lack such a unique imaging signature, making histopathology and molecular profiling essential before treatment.

A fundamental concept every oncology trainee should master.

#HCC #HepatocellularCarcinoma #LiverCancer #Oncology #MedicalOncology #Radiology #LIRADS #CancerEducation #FOAMed #MedEd #DrNB #DMOncology #CancerConceptsExplained #OncoTwitter #MedTwitter

[Erman Akkus @Erman_Akkus]

Systemic therapy, gastrectomy, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy versus systemic therapy alone for gastric cancer with limited peritoneal metastases (PERISCOPE II): final results of a multicentre RCT phase III https://t.co/V8f6madiNj

[Dr Rupam Manna MD @DrRupamOncology]

If they’re all called Tyrosine Kinase Inhibitors (TKIs)… why can’t we use the same drug for every cancer? 🤔

Because TKI is a mechanism—not a target.

🔑 Every cancer is driven by a different molecular “lock,” and every TKI is designed as a specific “key.”

• Imatinib → BCR::ABL1 in CML
• Osimertinib → EGFR in NSCLC
• Sunitinib → VEGFR/PDGFR in RCC

Precision oncology isn’t about where the cancer started—it’s about what’s driving it.

Treat the mutation, not just the organ. 🎯

Which TKI do you think has transformed cancer care the most? 👇

#MedicalOncology #PrecisionOncology #TargetedTherapy #TKI #TyrosineKinaseInhibitors #CancerBiology #PrecisionMedicine #CML #LungCancer #NSCLC #RenalCellCarcinoma #Oncology #FOAMed #MedTwitter #CancerEducation

[The Lancet Oncology @TheLancetOncol]

Online now: Systemic therapy, gastrectomy, cytoreductive surgery, and HIPEC versus systemic therapy alone for #gastriccancer with limited peritoneal metastases (PERISCOPE II): results of a phase 3 trial after an unplanned commissioned interim analysis

https://t.co/QGMzC2Rp8x

[Dr Rupam Manna MD @DrRupamOncology]

HIPEC vs PIPAC in Ovarian Cancer: High-Yield Comparison Every Resident Needs ✅
Strongest evidence for HIPEC is in interval debulking surgery after NACT (OVHIPEC-1 trial) — improved RFS & OS without increasing major complications.
Not routine in primary upfront CRS or most recurrent cases.
PIPAC remains investigational — useful in selected platinum-resistant/unresectable peritoneal disease (laparoscopic, repeatable, lower systemic toxicity).
Key practical points: • Achieve CC-0/CC-1 cytoreduction
• Cisplatin 100 mg/m² @ 40–43°C for 90 min (HIPEC)
• PIPAC: Low-dose cisplatin ± doxorubicin, every 6–8 weeks
Full infographic with indications, patient selection, contraindications, complications, flowcharts & guideline position 👇
Save for your notes & exam prep!
What’s your institutional practice with HIPEC in interval debulking? Drop your thoughts below 👇
#OvarianCancer #HIPEC #PIPAC #GynecologicOncology #MedicalOncology #OncologyEducation #DrNB #ExamPrep

[Dr Rupam Manna MD @DrRupamOncology]

MMR or MSI? One of the most common areas of confusion in oncology and pathology.

A simple way to remember it:

🧬 MMR = Machinery (IHC)
🔬 MSI = Mistakes (PCR/NGS)

✅ IHC checks whether the DNA mismatch repair proteins (MLH1, PMS2, MSH2, MSH6) are present.
✅ PCR/NGS measures the genomic consequence—microsatellite instability.

High-yield takeaway:
• dMMR ≈ MSI-H
• pMMR ≈ MSS
• MSI-L is uncommon and is generally managed similarly to MSS for most clinical decisions, including immunotherapy selection in colorectal cancer.

Save this visual for exam revision and daily oncology practice.

#MedTwitter #Oncology #Pathology #MolecularPathology #ColorectalCancer #Immunotherapy #MMR #MSI #PrecisionOncology #CancerEducation #FOAMed #MedEd #MedicalOncology #DrNB #CancerConceptsExplained

[Arndt Vogel @ArndtVogel]

🔥off the press🔥
Durvalumab with gemcitabine-based CTx in advanced BTC: primary results from the phase IIIb TOURMALINE study
https://t.co/GGqyAGNB2s
@JHepatology
👉Consistent efficacy & safety across 7 different chemo regimes
@myESMO @EASLnews @ILCAnews @curecc

[BJS @BJSurgery]

Anal high-grade squamous intraepithelial lesions: identification, classification, and management
➡️ https://t.co/jjyoGtVXZs

Early detection and treatment of anal squamous intraepithelial lesions are key to preventing anal cancer
This review highlights the evolving role of high-resolution anoscopy in modern screening and management

Work by Emanuel Cavazzoni , Mariangela Desantis , Carlo Vivaldi , Hartmut Schäfer , Massimiliano Mistrangelo

#SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology
#Some4COLoprocto

[Dr Rupam Manna MD @DrRupamOncology]

Not every premenopausal woman with early-stage HR-positive breast cancer requires ovarian function suppression (OFS).

The greatest benefit is seen in patients at higher risk of recurrence—particularly women aged <35 years, those with node-positive disease, those who remain premenopausal after chemotherapy, and those with other high-risk clinicopathologic features.

For high-risk patients, OFS + exemestane provides the greatest reduction in recurrence based on the SOFT and TEXT trials, while tamoxifen alone remains appropriate for many low-risk patients.

Choosing the right endocrine strategy means balancing recurrence risk with treatment-related toxicity and patient preferences.

#BreastCancer #MedicalOncology #BreastOncology #EndocrineTherapy #OvarianFunctionSuppression #OFS #Tamoxifen #Exemestane #SOFTTrial #TEXTTrial #Oncology #OncologyEducation #MedEd #FOAMed #CancerEducation #DrNB #DMMedicalOncology

[Dr Rupam Manna MD @DrRupamOncology]

How to interpret an NGS report 🧬

Finding a mutation is only one part of reading an NGS report. The real skill is knowing what to check, what it means, and how it changes patient management.

In this infographic, I share a practical 18-step framework that I use to systematically review every NGS report—from sample adequacy and quality metrics to driver mutations, gene fusions, biomarkers, resistance mechanisms, actionability, and final clinical integration.

A simple mnemonic—SAMPLE–GENES—can help ensure that no clinically actionable finding is overlooked.

Whether you’re a Medical Oncologist, Pathologist, Molecular Biologist, DM/DrNB resident, or preparing for tumor boards, I hope this serves as a practical bedside checklist.

💬 Which part of an NGS report do you find most challenging to interpret?

#NGS #PrecisionOncology #MolecularOncology #CancerGenomics #MedicalOncology #TargetedTherapy #LiquidBiopsy #GenomicTesting #Biomarkers #TumorBoard #OncologyEducation #MedEd #FOAMed #DrNB #MedicalEducation #CancerConceptsExplained

[Nieves Martinez Lago MD PhD @DraMartinezLago]

🧬 PICC-2 | dMMR/MSI-H locally advanced CRC

➕ Toripalimab + celecoxib

📈 pCR: 89% vs 69% (p=0.014)
🏥 Surgery: 96% vs 93%
🛡️ Grade ≥3 TRAEs: 5% vs 7%

🚀 COX-2 inhibition may further enhance neoadjuvant immunotherapy.

🔗 https://t.co/j2yUUwsJ8H
@OncoAlert

[BJS Open @BjsOpen]

Pattern of lymph node spread in gastric cancer: Western multicenter retrospective study
➡️https://t.co/jIa9EAPMos

Tumour location determines the anatomical routes of lymph node spread in gastric cancer, whereas histological phenotype and microsatellite status modulate metastatic risk and extent. Diffuse and mixed tumours exhibit a higher nodal burden, whereas MSI cancers show restrained lymphatic dissemination despite advanced local invasion. Integrating biological profiling with anatomically tailored lymphadenectomy may optimize oncological adequacy while avoiding unnecessary nodal dissection.

👏👏👏Francesca Blasa , Giuseppe Verlato , Hidde Overtoom , Martina Hermez Chole , Fabrizio Tedone , Federica Filippini , Markos Despotidis , Evgenia Mela , Tania Triantafyllou , Dimitrios Schizas , Dimitrios Theodorou , Magnus Nilsson , Suzanne S Gisbertz , Maria Bencivenga , Ioannis Rouvelas
#SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #some4UGI #uppergi #esophagealcancer #gastriccancer @ISDE_net @Augishealth @roux_group @T4UGIS #ESDE @young_esde

[Sergio Casillas @scasillasmd]

RT @ArndtVogel: ATOMIC (A021502/AIO-KRK-0317): Does duration of adjuvant CTx or immunotherapy matter?
@ESMO-GI
😯surprising,benefit of atezo…

[Arndt Vogel @ArndtVogel]

OS in EMERALD-1: A phase III study of durvalumab ± beva and TACE in unresectable embolisation-eligible HCC
👉OR &amp; PFS improved
👉no OS benefit
🧐No safety concerns, but also not strongly supporting the combination
@myESMO @EASLedu @ILCAnews

[Arndt Vogel @ArndtVogel]

Zolbetuximab plus gemcitabine and nab-paclitaxel in CLDN18.2+ metastatic PDAC: phase II GLEAM study
@ESMO-GI
👉Primary endpoint not met, no OS &amp; PFS benefit
👉Toxicity manageable
🧐Not the right drug, but maybe the right target

[Giovanni Marchegiani @Gio_Marchegiani]

Chyle leak 🍼 after pancreas surgery is never fatal but increases in vascular dissections …

🔴 1k cases &gt; 11% chyle leak (most grade B as per @ISGPS_news)

❌🥛 Minimally invasive approach + drain volume risk factors / Not milky appearance!

https://t.co/5t0kaAnM3z

[Enrique Grande @drenriquegrande]

⚡️ Histological subtypes of urothelial carcinoma — micropapillary, plasmacytoid, sarcomatoid, squamous — don't fit the one-size-fits-all treatment paradigm.

Each carries distinct biology, is often understaged on TURBT, and shows variable response to standard systemic therapy.

https://t.co/NnF32TmzJn

#BladderCancer

[Giovanni Marchegiani @Gio_Marchegiani]

🆕 Drain management risk-stratified dynamic algorithm after Whipple 🆕

💦 Drain fluid amylase still key but pathways different based on intraop risk assessment

🚨 800 PD included / 32% high risk

Check out the thread 👉 practice changing algorithm

https://t.co/aqskbzXT8Y

[Paolo Tarantino @PTarantinoMD]

Developing more effective therapies is critical. But just as important is to identify which pts may be cured with less chemo, an effort often only made possible thanks to philanthropy. Thanks to BCRF for supporting DAPHNe and for highlighting its results. https://t.co/nZ9GZb9Hq9