Yinno Custodio Hernández

Medical Oncologist at Hospital Nacional Arzobispo Loayza - Peru 🇵🇪 Influenced by Brazilian Oncology. Member SPOM, ESO, ESMO.

[Benlazar S M A @smbenlazar]

Concurrent pembrolizumab with AVD for untreated classic Hodgkin lymphoma https://t.co/X4vxYyGh6z #lymsm

[Yinno Custodio Hernández @YinnoH]

https://t.co/xlMMhmwAZD

[UroToday.com @urotoday]

Advanced #ProstateCancer - First-line #mCRPC/APMR: How do I select the best treatment for my patient? Presentation by @KristineLacuna @MSKCancerCenter. #AUA26 written coverage by @zklaassen_md @GACancerCenter > https://t.co/HXeVYlME8o @AmerUrological

[Dr Victor Noriega @noriega_dr]

Ahora siiiii
Actualización de las indicaciones #CART en España a 1 de abril de 2026. Nuevos productos, más indicaciones, más oportunidades para nuestros pacientes #Cordoba @GETH_info

[Fabio Torres @FabioTorressav]

Oncogenic Pathways for Three Subtypes of Diffuse Large-B-Cell Lymphoma

https://t.co/28W9Edkym6

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

Defining T-cell lymphoma doesn’t have to be complicated.

Start simple:

🔴 CD30+ → ALCL
 ALK+ vs ALK− (DUSP22 / TP63 / triple negative)

🔵 If not → check TFH markers
 PD1 / ICOS / CXCL13 / BCL6
 → often behaves like autoimmune disease

⚪ Only then → PTCL-NOS

🧬 Biology matters:
ALCL ≠ one disease
TFH = TET2 / DNMT3A / RHOA

👉 “CD30 first. TFH second. NOS last.”

#lymphoma #Hemetwitter #Medtwitter

[Laura Korin @laura_korin]

From NOS to a genomic informed category in DLBCL. Will we finally reach the point where biology can guide truly personalized treatment for our patients?

[Dr Amol Akhade @SuyogCancer]

How to the treatment algorithm is shaping up in ES-SCLC and upcoming ADC in SCLC . Nice talk by @peters_solange #elcc26

[Dr Rupam Manna MD @DrRupamOncology]

3 Hodgkin Lymphoma

[Dr. Chokri Ben Lamine @abouabdrahman0]

🧵 DLBCL 2026 – 50 High-Yield Pearls

1️⃣ 🧬 DLBCL = most common NHL in adults (~30–40%).
2️⃣ 👴 Median age at diagnosis ~67 years; elderly disease dominates.
3️⃣ ⚡ Aggressive biology → fatal within weeks–months if untreated.
4️⃣ 🧪 Diagnosis requires excisional/core biopsy (not FNA).
5️⃣ 🧾 Always do IHC + FISH at baseline (MYC/BCL2/BCL6).
6️⃣ 🧬 Cell of origin (COO): GCB vs ABC vs unclassified.
7️⃣ 🧫 GEP = gold standard; IHC (Hans) misclassifies ~20–30%.
8️⃣ 🚨 ABC subtype → inferior PFS/OS vs GCB.
9️⃣ 🧬 Double-hit (MYC + BCL2) ≠ double expressor (IHC-based).
🔟 💥 DHL/THL = high-risk biology → avoid R-CHOP alone if fit.

11️⃣ 📊 IPI still matters; NCCN-IPI best OS discrimination.
12️⃣ 🧠 Bulky disease + very high LDH = adverse, esp <60 yrs.
13️⃣ 🧲 PET/CT = staging standard; excellent NPV, weak PPV.
14️⃣ 📉 Interim PET escalation ≠ survival benefit → caution.
15️⃣ 📐 ΔSUVmax >66% outperforms Deauville for prognosis.
16️⃣ 🧬 ctDNA MRD predicts relapse earlier than imaging.
17️⃣ ⏳ ctDNA detects relapse ~3–4 months before clinical PD.
18️⃣ 🧪 EOT ctDNA+ → ~17% 3-yr PFS vs ~85% if negative.
19️⃣ 🤖 AI + PET imaging emerging for response prediction.
20️⃣ 🧠 SCNSL risk ↑ in non-GCB / high-risk genetics.

21️⃣ 💊 Frontline standard (fit): R-CHOP or Pola-R-CHP.
22️⃣ 🆕 Pola-R-CHP ↑ PFS vs R-CHOP (no OS gain yet).
23️⃣ 🎯 Pola-R-CHP benefit strongest in IPI 3–5, ABC, DEL.
24️⃣ 👵 Frail/unfit: R-mini-CHOP or trials.
25️⃣ ✂️ Limited-stage, low-risk: R-CHOP ×4 may suffice.
26️⃣ 🧭 FLYER: young, non-bulky, normal LDH → abbreviated Rx OK.
27️⃣ 🚨 MYC-R in stage II ≠ stage I → worse outcomes.
28️⃣ ⚠️ DHL/THL: DA-R-EPOCH preferred (retrospective data).
29️⃣ 🧬 MYC-BCL6 ≠ MYC-BCL2 (better prognosis).
30️⃣ 🔍 CD5+ DLBCL (~5–10%) = poorer prognosis.

31️⃣ 🔁 Early relapse (<12 mo): CAR-T preferred over ASCT.
32️⃣ 🚀 ZUMA-7 / TRANSFORM → CAR-T beats salvage + ASCT.
33️⃣ 🧠 ICANS & CRS common but manageable in CAR-T era.
34️⃣ 🧩 Post-CAR-T relapse → bispecific antibodies rising.
35️⃣ 🔗 Bispecifics (glofitamab, epcoritamab) = game-changers.
36️⃣ 💉 SC epcoritamab → outpatient-friendly BsAb option.
37️⃣ 🔥 BsAb + GemOx improves OS vs GemOx alone.
38️⃣ 🧲 ADCs matter: polatuzumab, loncastuximab active in R/R.
39️⃣ 💊 Tafasitamab-lenalidomide effective after ≥1 line.
40️⃣ ❌ Tisa-cel failed 2L vs SOC (BELINDA).

41️⃣ 🧓 Elderly trials now omit or minimize chemotherapy.
42️⃣ 🌅 Fixed-duration mosunetuzumab feasible in ≥80 yrs.
43️⃣ 🧪 Frontline trials add BsAb/IMiD to R-CHOP (ongoing).
44️⃣ 🧠 ctDNA-guided escalation/de-escalation under study.
45️⃣ 🎯 Personalized therapy = future (genomics + MRD).
46️⃣ 📚 NCCN v1.2026 integrates CAR-T & BsAbs early.
47️⃣ 🔬 Re-biopsy at relapse whenever feasible.
48️⃣ 🩸 Avoid treatment decisions based on PET positivity alone.
49️⃣ 🧠 Cure = long-term remission ≥2 years post-frontline.
50️⃣ 🚀 DLBCL care rapidly shifting away from chemo-only paradigms.

⸻

Credits: Shared with appreciation to Dr. Mohammed AlShehri

Source (Primary): 2026 Update on the Management of Diffuse Large B-Cell Lymphoma, American Journal of Hematology, 2026

[Eric Topol @EricTopol]

New @CellCellPress
The hallmarks of cancer, refined from the original concepts 25 years ago, as an outgrowth of our expanding knowledge base
https://t.co/kjAYDRxvKD

[Dr Rishabh Jain @DrRishabhOnco]

NECTIN4 is not one story. It is three different diseases hiding under one biomarker 📌
#GlobalForum25 #BLADDR25

🧬 1. Amplification = the super responder biology
Tumors with NECTIN4 amplification show ORR ~96 percent with EV vs ~32 percent without.
OS and PFS curves split early and stay apart.
FISH + IHC on metastases unlocks this group.

🧩 2. Loss = the broken door handle
Metastases lose membranous NECTIN4 in ~40 percent cases.
Low H score (0 to 99) links to EV resistance and shorter PFS.
RNA alone is unreliable. Protein matters.

🌍 3. Metastasis biology = the real tumor
Primary and metastatic tissue differ for FGFR3, HER2, NECTIN4, PD-L1.
Metastatic samples better predict response and resistance.
Trials must shift to validated biomarkers in MET tissue, ideally pre treatment.

🎯 Dual target opportunity
NECTIN4 low tumors often keep TROP2.
Sequential or combined ADC strategies make biological sense.

🔬 Takeaway
NECTIN4 is not ubiquitous.
Amplified, lost, or heterogeneous NECTIN4 determines whether EV works, fails, or needs a partner.

#OncoTwitter #MedTwitter #BladderCancer @OncoAlert @myesmo @esmo_open @asco @mirrorsmed

[Anirban Maitra @Aiims1742]

Exercise as anti-cancer medicine
(“Exercizumab”)
@Cancer_Cell
https://t.co/51bb4qGQfY
@JCO_ASCO
https://t.co/tBcD44WuML

[Papa Heme @Papa_Heme]

DLBCL treatment has gotten more complicated

Back in my day it was
RCHOP
if relapse
salvage and ASCT

[Ahmed Kotb @AhmedKo45911157]

Myeloma Dx = SLiM-CRAB 🦀
✔️ ≥10% clonal plasma cells + ≥1 MDE

MDE:
S — ≥60% plasma cells
Li — Light chain ratio &gt;100
M — MRI focal lesion
C — ↑Calcium
R — Renal failure
A — Anemia
B — Bone lesions

#Myeloma #SLiMCRAB

[Erman Akkus @Erman_Akkus]

🟠HCC guideline updates from @BCLC_group and @BritSocGastro

👉https://t.co/gYQ8EdBGcZ
👉https://t.co/xyI864VRWR

#cancer #oncology #MedX #liver #HCC @OncoAlert @OncBrothers @SuyogCancer

[Yakup Ergün @dr_yakupergun]

#ESMO25
Pegfilgrastim timing matters!

In this randomized phase III trial (n=159, early-stage BC):
Giving pegfilgrastim 72h after chemo — instead of 24–48h — cut bone pain by &gt;50% without increasing neutropenia or FN risk.

[Dr Rishabh Jain @DrRishabhOnco]

🔥 ARASAFE: Can we make docetaxel safer in mHSPC?

Phase 3 trial testing Q2W vs Q3W docetaxel with darolutamide + ADT 💊

📊 n = 250 | Randomized 1:1
🔹 STD: 75 mg/m² Q3W (450 mg/m² total)
🔸 EXP: 50 mg/m² Q2W (600 mg/m² total)

⚕️ Primary endpoints
• Grade 3-5 AEs: 78.9 % vs 61.2 % (p = 0.0024)
• Grade 3-4 neutropenia/death: 64.1 % vs 24 % (p < 0.00001)

✅ Takeaway:
Q2W docetaxel + darolutamide cut severe toxicity by ~50 % without early drop-offs—promising safety boost for mHSPC combo therapy.

#ESMO25
#OncoTwitter #ProstateCancer #ESMO25 @OncoAlert @myesmo @esmo_open

[Dr Amol Akhade @SuyogCancer]

🚨 LBA2 | KEYNOTE-905 (ESMO 2025)
Peri-operative Enfortumab Vedotin + Pembrolizumab sets a new standard for cisplatin-ineligible MIBC 💥
🧪 EV + Pembro before & after RC vs RC alone
👥 170 vs 174 pts | FU 25.6 mo
📈 Results:
• EFS HR 0.40 (NR vs 15.7 mo)
• OS HR 0.50 (NR vs 41.7 mo)
• pCR 57% vs 9% 💪
🩹 Grade ≥3 AEs 71% vs 46% (mainly skin tox)
💬 Conclusion: EV + Pembro significantly improves EFS, OS & pCR with manageable toxicity — first effective peri-op regimen for cisplatin-ineligible MIBC.
#ESMO25 @myESMO @tompowles1 @DrChoueiri

[Dr Rishabh Jain @DrRishabhOnco]

⚠️ Tumor Lysis Syndrome (TLS) – NEJM 2025 Review

🧬 What is it?
Rapid cancer cell breakdown → release of K⁺, phosphate, uric acid
⚡ Can trigger arrhythmias, seizures, AKI → even death

📊 Epidemiology
• Classically: leukemias, Burkitt, DLBCL
• Now: venetoclax, CAR-T, bispecifics, ICIs, even solid tumors
• Less predictable, higher vigilance needed

🔬 Pathophysiology
• Hyperuricemia → kidney injury
• Hyperphosphatemia + hypocalcemia → arrhythmias, seizures
• Cardiac + renal toxicity are main killers

🧾 Diagnosis
• Cairo–Bishop criteria (≥2 labs + ≥1 clinical)
• Monitor uric acid, phosphate, calcium, creatinine

🛡️ Prophylaxis
• Risk stratify (tumor bulk, LDH, renal fn)
• 💧 IV fluids: 1–3 L/m²/day before therapy
• 💊 Allopurinol/febuxostat – low–intermediate risk
• 💉 Rasburicase – high risk (avoid in G6PD def)

🩺 Management
• Monitor labs q6–12h (first 72h)
• Treat K⁺ (IV calcium, insulin+glucose, dialysis if refractory)
• Phosphate binders + fluids for hyperphosphatemia
• Dialysis for refractory metabolic derangements

🌟 Special Scenarios
• Venetoclax: 🔑 Step-up dosing prevents TLS deaths
• CAR-T / ICIs: rare but can be fatal
• Trend shift: hyperphosphatemia > hyperuricemia as main nephrotoxic driver

✅ Takeaway
Early recognition + prevention = lifesaving 🚑
TLS risk has expanded with modern therapies → keep high vigilance!

📓Bociek RG, Lunning M. N Engl J Med. 2025;393:1104-16.
🔗https://t.co/q8vJSbfimM

#OncoTwitter #MedTwitter #Leukemia #Lymphoma
@OncoAlert @myESMO @ASCO @NEJM