Manish A Shah
126 posts
@MDmanishshah
Oncologist and Researcher. #CureCancer https://t.co/mWwmvvuQ6q CancerCast Podcast - https://t.co/QQtwvBzB6n
An incredible honor to join this group of researchers pushing cancer care forward. Grateful to @ASCO @ConquerCancerFd for investing in early-career investigators and to my mentors for the support. @MDmanishshah @ElementoLab @WeillCornell @WCMHemOncFellow @WCMGIcancer @WCM_MeyerCancer
@TumorBoardTues @MDmanishshah @IntegrityCE 24/24 #TumorBoardTuesday 📚 References: • Bekaii-Saab TS, et al. 2023;28(10):885-893. • Valtorta E, et al. Mod Pathol 2015. (HERACLES IHC) • Harding JJ, et al. Lancet Oncol 2023. (HERIZON-BTC-01) 🙏 Thank you to our patient.
21/24 #TumorBoardTuesday 🎯 Take-homes 1️⃣ Test EVERY advanced GI cancer for HER2. 2️⃣ "I sent NGS" ≠ "I tested for HER2." Confirm your panel calls CNV. 3️⃣ HER2 amp is also a mechanism of primary anti-EGFR resistance in RAS-WT mCRC. 4️⃣ In 2026 the 2L menu for HER2+ RAS-WT mCRC = tucatinib + tras; T-DXd (tumor-agnostic) is an option. 5️⃣ Long-tail responders exist. We don't know who, yet.
@John_Will_I_Am @TumorBoardTues @MDmanishshah @IntegrityCE #TumorBoardTuesday I don't take care of breast cancer and certainly not a patient on HER2🎯💊 for years: ➡️Are there some people that will just never develop anti-HER2 cardiac toxicity❓ ➡️Can you stop checking echoes at some point on some people❓ ➡️Or is there always a risk❓
@TumorBoardTues @MDmanishshah @IntegrityCE 18/24 #TumorBoardTuesday ⏱️ 9 years on tras + pertuz (and counting) 📉 ctDNA undetectable (5/2025) 🫁 Lung nodules unchanged since 2018 - treated mets 🩻 Serial CT CAP: no new disease 🚶 KPS 90 / ECOG 0 Clinically NED.
17/24 #TumorBoardTuesday ❤️ Long-term HER2 Tx = long-term cardiac surveillance. This patient: ~36 echos over 9 years. EF nadir 50% (12/2020), full recovery to 67% on continued Tx, no holds. In HER2+ breast we have stop/restart algorithms. In HER2+ mCRC, very few of us have a written one. Should we?
@John_Will_I_Am @MPishvaian @TumorBoardTues @MDmanishshah @IntegrityCE Do you have any information if the time of the biopsy and analysis of HER2 matter? Before first line? After any specific line of treatment? #tumorboardtuesday
@TumorBoardTues @MDmanishshah @IntegrityCE 15/24 #TumorBoardTuesday ✅ Answer: 3 — trastuzumab deruxtecan (T-DXd) Fits later-line HER2 IHC 3+ mCRC, especially after prior HER2 therapy. 📌 DESTINY-CRC02: T-DXd 5.4 mg/kg confirmed; cORR 37.8%, IHC 3+ subset 46.9%. ⚠️ Key toxicity: ILD/pneumonitis.
11/24 #TumorBoardTuesday 👨🏽🏫 Mini Tweetorial 2 (4/4) 🧪 DESTINY-CRC01 (Siena, Lancet Oncol 2021): T-DXd 6.4 mg/kg; cohort A (HER2+) ORR 45.3%, mPFS 6.9 mo. ILD concerning. 🧪 DESTINY-CRC02 (Raghav, Lancet Oncol 2024): 5.4 mg/kg confirmed; cORR 37.8% (IHC 3+ subset 46.9%). 🇺🇸 Tumor-agnostic T-DXd approval Apr 2024.
@John_Will_I_Am @TumorBoardTues @MDmanishshah @IntegrityCE #TumorBoardTuesday ⭐️Great point - if you have ever been surprised at how unresponsive a patient with RAS/RAF WT CRC has been to anti-EGFR Tx combination, this is at least one possible explanation
4/24 #TumorBoardTuesday 👨🏽🏫 Mini Tweetorial 1 (2/4) · HERACLES IHC criteria 🔑 HER2+ in mCRC if ANY (Valtorta, Mod Pathol 2015): • IHC 3+ in ≥50% of tumor cells • IHC 3+ in 10–50% + FISH HER2/CEP17 ≥2 • IHC 2+ in >50% + FISH ≥2 📌 Basolateral/lateral pattern accepted — NOT circumferential like breast.
2/24 #TumorBoardTuesday ⚠️ Hotspot SNV panels are NOT designed to call copy-number changes. ERBB2 amplification is INVISIBLE to them. 🚫🧬 Still relevant in 2026: small institutional panels, older liquid-biopsy assays, & broad panels w/ different ERBB2 copy-# thresholds. Know what your NGS reports.
@TumorBoardTues @MDmanishshah @John_Will_I_Am @GIcancerDoc @KristenCiombor @benweinbergmd @CathyEngMD @TGeorgeMD @KimmieNgMD @Ahn_Daniel_Onc @ILSONDavid @RonaYaeger #TumorBoardTuesday 😀This topic is making me "Jazzed" in preparation for #ASCO26, because it is my "Destiny" to climb the "Mountain" of knowledge on HER2🎯💊to be presented🤣🤣🤣 OK - enough of that! Just looking forward to a great discussion tonight‼️
