Dr Arun Chandran

@PTarantinoMD What are your thoughts on the usage of nab paclitaxel in Neocarhp? Does it add any value?

The approval of T-DXd for the (neo)adjuvant treatment of HER2+ breast cancer will add an invaluable tool to our arsenal. Yet, in this era of right-sizing, not all patients require T-DXd treatment to be cured. Some thoughts in my recent JCO editorial. ascopubs.org/doi/full/10.12…

💥NEOSUMMIT-01 trial in LA gastric/GEJ cancer: perioperative toripalimab + ChT vs ChT alone (3-year follow-up, n=108) ascopubs.org/doi/full/10.12… ▪️ 3-year EFS: 74.7% vs 56.2% (HR 0.51) ▪️ 3-year OS: 81.3% vs 72.2% (HR 0.45) ▪️ Benefit maintained across most predefined subgroups Perioperative IO TORI-pal the survival curves in GC 🍜 @OncoAlert @OncoReporte @myESMO @_SEOM @GrupoTTD

🚨 RESET-C trial: single-cycle neoadjuvant pembrolizumab in stage I–III dMMR colon cancer (n=85) ascopubs.org/doi/full/10.12… 🎯 pCR 44% || MPR 57% 💥 DFS and OS rates: 96% and 98% at 18.4 months ▪️ Grade ≥3 AEs in 11%; only 1 recurrence reported One shot and the tumor may already be hitting the RESET button 🔄 @OncoAlert @OncoReporte @myESMO @_SEOM @GrupoTTD

Medicine is all about a lot of learning & then a lot of de-learning also! The very popular corrected serum calcium correction should no longer be used in the setting of abnormal albumin levels Corrected serum calcium = measured serum calcium + 0.8 (4-Albumin) formula should no longer be used In the setting of low albumin levels, serum ionised calcium should be measured instead @iofbonehealth @isbmrindia @ISBMRTweets @iofbonehealth @Osteoporosis_NL @osteoporosisNI @TeamSESH @RheumPearls @RheumJnl @RheumResearch @IndianRheum @nihardesai7 @j_metb @EndoSocAus @EndoSocJournals @TheEndoSociety @TheAACE @IndiaESI

@ChandrakanthMv So in practice , what would be the best test after biopsy ? Send straight for a molecular panel? CGP or targeted panel? any recommendations on indian labs ?

WHO changed glioma classification forever • Molecular first, not histology • IDH defines biology • Grade ≠ disease • Grade 1 = only circumscribed Simple way to remember 👇 #MVOnco #Glioma #NeuroOncology #MedEd #Oncology

@ChandrakanthMv Longest OS, but the control arm also performed spectacularly well (20 months) compared to 13 months in Imbrave 150. I think the two are comparable

• Why does immunotherapy look worse in the first few months? • Why do patients who cross that phase live longer? • CheckMate 9DW shows: early risk, late durable benefit — with the right patient. #HCC #CheckMate9DW #Immunotherapy #Oncology #MedTwitter #MVOnco

@ChandrakanthMv Dexa dose you mentioned is 3 mg. Think that's an error..

• IRRs with Amivantamab can be drastic • SKIPPIrr uses prophylactic dex (days −2/−1/0) • IRRs ↓ from ~67% → ~22% • 0% Grade ≥3 events • 0% IRR-related SAEs → Proactive toxicity prevention works #Oncology #EGFR #NSCLC #TargetedTherapy #ToxicityManagement #IRR #MVOnco

Premenopausal HR+/HER2+ eBC – Adjuvant ET • RD after NAT → OFS + AI • pCR after NAT → risk-adapted  – Stage III → OFS + AI  – Stage I–II → AI or TAM ± OFS • Upfront surgery → baseline stage-driven ET Principle: RD = ER-dependent, chemo-resistant → needs ET intensification Great editorial👇 thebreastonline.com/article/S0960-…

@ChandrakanthMv Would adding chemo to osi annul the advantage of lazertinib in exon 21?

• All 3 are 3rd-gen EGFR TKIs, but differ more than we think • Lazertinib strongest in L858R • Aumolertinib = clean cardiac + strong CNS • Osimertinib = only mature OS • Subtype + toxicity + combos → choice #LungCancer #EGFR #Oncology #NSCLC

• Censoring = patient exits before event is observed • Non-informative = exit unrelated to event risk • Informative = exit linked to high event risk • Informative censoring → inflates estimated OS/PFS #Oncology #Biostats #KMcurve #SurvivalAnalysis #Trials #MVOnco

@ChandrakanthMv CD 34 is a marker of immaturity (present on stem cells). As promyelocytes are more mature, they lack CD34 expression. That's how I remember.

𝐎𝐧𝐞 𝐬𝐥𝐢𝐝𝐞 𝐞𝐯𝐞𝐫𝐲 𝐫𝐞𝐬𝐢𝐝𝐞𝐧𝐭 𝐬𝐡𝐨𝐮𝐥𝐝 𝐦𝐞𝐦𝐨𝐫𝐢𝐳𝐞. APL vs usual AML—
promyelocytes ≠ myeloblasts,
faggot cells ≠ single Auer rods,
and 𝐂𝐃𝟑𝟑 𝐛𝐫𝐢𝐠𝐡𝐭+, CD34−, HLA-DR−
changes everything. #ExamPearls #Hematopathology #MVOnco

ESMO Clinical Practice Guideline: Local and locoregional prostate cancer! @myESMO @APCCC_Lugano @AttardLab @Ecastromarcos @stefanofanti4 @Silke_Gillessen @Prof_Nick_James @piet_ost @MarkARubin1 @ChrisSweens1 @Tilki_De @ZilliThomas @alison_tree @OncoAlert doi.org/10.1016/j.anno…

Why Induction Should Be Performed With T-DXd + Pertuzumab (IMO) The key distinction of DESTINY-Breast09 compared with HER2CLIMB-05 and PATINA is randomization at true treatment initiation. In both HER2CLIMB-05 and PATINA, only patients who did not progress during THP induction were randomized; early progressors were excluded by design. DESTINY-Breast09 therefore captures the full early-risk population. At 6 months—approximately the end of induction—12.2% of patients in the THP control arm had already experienced a PFS event, compared with 7.0% in the T-DXd + pertuzumab arm, corresponding to an absolute 5.2% reduction in early progression within the first 6 months. Importantly, this separation is not transient. By 12 months, the absolute PFS difference widens to 13.5%, indicating that T-DXd + pertuzumab not only prevents early progression but continues to deepen benefit over time. By contrast, PATINA and HER2CLIMB-05 never randomized the initial ~12% of patients who progressed during THP induction. Had induction been performed with T-DXd + pertuzumab instead of THP, a substantial proportion of these early progressions—approximately 5% in absolute terms—might have been prevented. These patients would not have been lost upfront and could have proceeded to effective maintenance strategies rather than being excluded at the outset. At present, because maintenance trials have uniformly used THP as induction, there are no prospective data evaluating palbociclib- or tucatinib-based maintenance following T-DXd + pertuzumab induction. Nevertheless, indirect inferences from DESTINY-Breast09 suggest a pragmatic clinical strategy: in patients who develop tolerability issues, treatment may reasonably be initiated with T-DXd + pertuzumab, followed by maintenance tailored to hormone receptor subtype once maximal disease control is achieved. This approach leverages early disease suppression while preserving the opportunity for durable, subtype-specific maintenance therapy. Critically, in HR–positive disease, ET must remain an integral component of maintenance and should not be omitted.

@Niva_Bupa @Niva_Bupa @NivaBupaSupport your people need to learn sales skills, not antagonize your customers with hate and threats. I was planning on renewal and have learnt my lesson. No way as a doctor will I ever recommend Niva Bupa to anyone. Hope the upper management knows this

This person called Tanya was just shouting over the phone saying, all other agents are cheats and then just abused me and threatened termination of the policy. All this, beciased I dared to consider another policy. @Niva_Bupa

@NivaBupaSupport @Niva_Bupa @irdaindia Had a terrible experience with the agents from Niva Bupa. I was explaining that I was planning to change the policy rather than renew it, and they were issuing threats of terminating the policy. Such crass, deplorable behavior.

🧬 PARP Maintenance After First-Line Chemo Huge PFS benefit… but still no OS signal? A 7-trial meta-analysis across 4013 pts. 🔍 Study Snapshot 🧪 7 RCTs 👩‍⚕️ Advanced-stage EOC (after response to platinum) 🧬 Subgroups: BRCA, HRD, BRCA-wt, HRP 🔪Surgery types: PCS vs NACT 💊 Agents: olaparib, niraparib, veliparib, senaparib, others 📈 Overall Results 🟢 PFS improved: HR 0.57 🔵 OS unchanged: HR 0.94 🔴 Grade 3+ AEs ↑: RR 2.40 🧬 Molecular Breakdown 🔹 BRCA-mut ⭐ Strong PFS benefit (HR 0.40) ❌ No OS benefit 🔹 HRD ⭐ PFS HR 0.44 ❌ No OS advantage 🔹 BRCA-wt 👍 Moderate PFS benefit (HR 0.62) ❌ No OS benefit 🔹 HRP ⚪ Minimal PFS activity (HR 0.74) ❌ OS neutral 🧵 Treatment Context 🏥 After NACT: HR 0.51 🏥 After PCS: HR 0.54 ✔️ Works in both CR (HR 0.50) and PR (HR 0.57) 🔪 Across complete & incomplete cytoreduction ⚠️ Toxicity Landscape 🔥 Most toxicity: niraparib (RR 4.73) 🙂 Least toxicity: veliparib (RR 1.15) 🧩 Final Take PARP maintenance = robust PFS benefit, strongest in BRCA/HRD. But no OS benefit in any subgroup, and toxicity varies widely. ➡️ Use selectively, genotype-driven, toxicity-aware. 📖 Full paper in comment #OncoTwitter #MedTwitter #GYNOnc #parp @OncoAlert @myesmo @esmo_open @asco

💗 HER2CLIMB-05: TUKYSA takes the lead in HER2+ MBC maintenance! 🚀 (PRESS RELEASE) 🧪 Phase 3 | n = 654 | 1st-line maintenance after chemo Arms: 🔹 Tucatinib + trastuzumab + pertuzumab 🔹 Placebo + trastuzumab + pertuzumab 🎯 Primary endpoint met: ✨ Statistically & clinically meaningful PFS improvement by investigator assessment 💪 Safety: Tolerable & consistent with known profiles of individual drugs 📊 Why it matters: • HER2 + ≈ 15–20 % of breast cancers • 5-yr OS ~ 41–47 % • SOC unchanged since 2012 → most progress < 2 yrs ➡️ HER2CLIMB-05 offers a potential chemo-free maintenance path 🌈 💡 Takeaway: TUKYSA (tucatinib) may soon move from 3rd-line → 1st-line maintenance, shaping a new standard of care in HER2 + MBC 💥 📖 Full release: businesswire.com/news/home/2025… #OncoTwitter #MedTwitter #BreastCancer #HER2 #Tucatinib #ESMO #ASCO @OncoAlert @myesmo @esmo_open @Pfizer @JournalofOncology @ASCO @DFCI_BreastOnc

NEJM 2025 (ALASCCA): Low-dose aspirin (160 mg) in PI3K-altered stage I–III CRC ↓ 3-yr recurrence (7.7% vs 14.1%, HR 0.49). 🔎 6,397 pts screened → 2,980 sequenced → 1,103 (37%) had PI3K-pathway mutations Hotspot exon 9/20: 17% Other PI3K/PTEN: 20% 📊 NNT: Colon II → weak (42) Colon III → strong (9) Rectum III → best (6) ⚠️ Borderline stats, no OS yet, ↑ severe AEs.( 16.8 vs 11.6 % ) 👉 Signal clearest in stage III; stage II benefit marginal. Promising, not yet blanket SOC. Wait for longer follow-up @dr_yakupergun @GIMedOnc @NiuSanford @OncBrothers