MUTHUVEERAPPAN S

A personal story published today in the @TataMemorial Newsletter Radiation after Cystectomy in Bladder Cancer (the BART trial): A Timeless Problem, A Timely Solution Read Here: open.substack.com/pub/jwtmc/p/ra…

Low-dose CSI (18 Gy) and boost will soon be considered as the new standard protocol in low-risk WNT subgroup medulloblastoma

We are facing shortage of two essential chemotherapy drugs - Carboplatin and Cisplatin used day to day in oncology set-up. We are facing difficulty in continuing treatment schedules for many of the common cancers. In a government setup, one of the common regimen used is Paclitaxel + carboplatin / Cisplatin How can we adapt during this difficult situation ? Here’s the adaptation plan - tried my best to adapt - can be right or wrong. Welcome suggestions from experts. Happy to learn from experts all over. Few have phase II evidence / direct / indirect evidence. Note: Immuno-chemotherapy / systemic therapy as per guideline to be offered for all patients if affordable. In a government setup from LMIC, only 5% cases can afford this. In view of the same - current chemotherapy regimen is listed as below. Share & save if you like #OncoTwitter #MedTwitter #platinumchemotherapy #platinumshortage #cisplatin #carboplatin #MedicalOncology #RadiationOncology @ConquerCancerFd @JCO_ASCO @myESMO @ISMPOofficial @IndianYoungOnco @OncologyTimes @OncoAlert @OncoDailyGI @oncodaily

BART trial from TMH Mumbai, India Vedang Murthy et al, JCO, 2026 MIBC tends to recur locally after cystectomy. Adjuvant pelvic RT till date always was WEAK evidence [EAU guideline] This trial from India - demonstrated LRFS benefit at 2 years with less than 5% of G3 toxicity with IMRT 👏 Highlight - No pelvic local recurrence 90% received chemotherapy - GC / MVAC & modified MVAC and no immunotherapy With the advent of adjuvant IO, the optimal sequencing or combination of RT with immune CPIs is not yet defined. Question - Baseline cT3-T4 - post NACT & surgery with ypT0N0 - does the LRFS benefit remain same ? #OncoTwitter #MedTwitter #MedicalOncology #UroOncology #Bladder #RadiationOncology @Uroweb @GUOncologyNow @BladderCancerUK @RadOncTMC @GTumors

This is an absolutely outstanding review on the management of patients with metastatic gastric cancer. I may have posted about this review before but it is so good that it deserves another round of applause... Thanks @KlempnerSam @YJanjigianMD @amalsargsyan and all the other co-authors I could not find on X... Sorry AI, I love you but you are just not there yet. True content experts writing a practical review still beat you easily. This should be a required read for all who take care of patients with gastric cancer. nature.com/articles/s4157…

🔬 Can we detect relapse before it becomes clinically visible? TRAK-ER trial demonstrates the feasibility of personalised #ctDNA surveillance in high-risk ER+/HER2− breast cancer. ✨ Key insights:
• ctDNA monitoring every 3 months detected molecular relapse early
• Detection rate: 1.9% per test | 11.6% per patient
• 42.9% already had recurrence at ctDNA detection
• ctDNA positivity correlated with higher stage, nodal burden & tumour grade 📌 Serial ctDNA surveillance pave the way for personalised intervention in breast cancer. #BreastCancer #LiquidBiopsy #Oncology #ESMOBreast26 #ESMOBC26 #PrecisionOncology #TRAKER #CancerResearch @myESMO @ESMO_Open

Are we entering the #ChemoFree era in #Her2positive #breastcancer? 👀 PHERGain-2 shows a pCR-guided strategy with trastuzumab–pertuzumab ± endocrine therapy and T-DM1 can achieve impressive pCR rates while preserving HRQoL. 🎯 pCR: 59.6% 🛡️ Low grade ≥3 TRAEs: 5.6% 💡 Smarter de-escalation. Personalized therapy in low risk early BC #Medtwitter #Oncology #HER2Positive #ASCO #BreastCancerResearch #BCSM #EsmoBreast26 #ESMOBC26 @myESMO @ESMO_Open

மக்களின் அன்பும் ஆதரவும் கிடைப்பது வரம். நண்பர் விஜய் மீது தமிழ்நாடு பெரிய நம்பிக்கை வைத்திருக்கிறது. தமிழக அரசியலில் புதிய அத்தியாயத்தை தொடங்கவிருக்கும் அவருக்கு என் மனப்பூர்வமான வாழ்த்துகள்.

Target the liver 🎯, Change the game 🚀 HAI oxaliplatin doubles hepatic control after surgery of 4 or more colorectal liver metastases 🔥 “25 vs 12 months — that’s real impact.” 📊 #OncoTwitter #MedTwitter #ColorectalCancer @JCO_ASCO @myESMO @CCAlliance @OncoDailyGI @GIMedOnc @SurgOncInsight @GiOncNow @GelliMaximilia1 @OncoAlert

Desmoplastic small round blue cell tumour (DSRCT) - overview 🎯 Young male + diffuse peritoneal masses without primary → think DSRCT ☢️ CT: bulky peritoneal disease + ascites + liver mets 🎀 Histology: small round blue cells + desmoplastic stroma ✒️ IHC: trilineage positivity + WT1 nuclear ☢️ PET-CT: staging + extra-abdominal spread 🔢 Prognosis: aggressive, early relapse Real all in one go | 10 mins #oncology #medtwitter #sarcoma @JCO_ASCO @myESMO @Sarcoma_UK @CureSarcoma @SarcomaAlliance

💊 Low-dose vs Standard-dose Abiraterone in mCRPC 📍 TMH Trial | JCO global oncology | Noronha et al., 2026 🔹 250 mg with food ≈ 1000 mg fasting 🔹 Similar PSA-PFS, OS, toxicity & QoL 🔹 Despite 8× lower drug exposure 🔹 Biology > dose escalation 💡 Game-changer for LMICs: Lower cost, better convenience, same outcomes Majority of institutes are practising this, but now we have first RCT evidence from India 🇮🇳 ⚠️ Underpowered → non-inferiority not proven #Oncology #mCRPC #Abiraterone #ASCO #MedTwitter #ProstateCancer #ProstateCancerWeek @JCO_ASCO @myESMO @Uroweb @ProstateUK @oncodaily

Remaining 5 clinical pearls from day 1 of APCCC 2026, Lugano

Day 1 Highlights & decision making pearls from APCCC 2026, Lugano 14 pearls from day 1 Here’s the summary of pearls 9 pearls are here. Look down in comments for the remaining 5 pearls #ProstateCancer #ProstateCancerWeek #APCCC26 @Uroweb @Uromigos @APCCC_Lugano @oncodaily @gu_onc

Early cancer detection from breath samples by using canine olfaction 🐕‍🦺combined with bayesian modelling High analytical accuracy and consistent sensitivity across major cancer Interesting study & methodology 🚀 @JCO_ASCO

I have been attending this from GITA chapter 1 - since my first year of Medonc through online. The sessions were much informative with pre-quiz assessing our unknowns in the subject, followed by theoretical sessions, case presentation and tumour board discussion. Case presentation and tumour board sessions were really good - makes us to understand the subject well and complete. A total academic feast for resident like me. Thank you sir for this twice a year GI academic feast. #GIonco #GITAchapter1to4

Renal cell carcinoma (RCC) in one go 3 slides | 15 mins read 🎇 1. Non-metastatic RCC Pathogenesis - VHL + angiogenesis + kinases Staging Surgery Adjuvant therapy role in RCC 5 year survival 2. Metastatic clear cell RCC - 1st line from evolution till the triplet era 3. Metastatic clear cell RCC - 2nd line Rare scenarios to follow #medtwitter #oncology @myESMO @JCO_ASCO @GUOncologyNow @Uroweb @UroOnc @UroOncologyOk

Thank you for your reply. RMS relapse is tough to handle especially from LMIC’s. Every case looks different. If i have to see, i will look at histology, site of relapse, time to relapse, prior treatment and overall burden of disease. Patient will do good - if only local relapse, late relapse, embryonal histology, completely resectable and good response to salvage chemo. They will generally do poor - if distant/ metastatic, early relapse, alveolar histology and progression on salvage chemo. Then we discuss with our MDT team. If isolated late local relapse, limited metastatic disease which is responding to chemo - salvage chemo plus local therapy with curative intent Early widespread disease - Palliation with supportive care. If available clinical trial at anytime. At present data is little and scarce, a lot to learn in this space, especially much more for adult patients

It's impressive that you're diving deep into rhabdomyosarcoma. This rare cancer type presents unique challenges across different age groups. Pondering over its manifestations, especially the differences seen in adults vs. children, can indeed be complex and worth further exploration. How are you approaching the facets of relapsed disease? For colleagues and curious minds looking for in-depth biomedical insights, consider exploring Sci-Quest at sciqst.com, a hub for generating comprehensive biomedical reviews. It's invaluable for dissecting intricate topics like rhabdomyosarcoma. #Medicine #ClinicalResearch

A concise summary on Rhabdomyosarcoma - in 3 pages at one go 🎇 1. Epidemiology to evaluation 2. Staging grouping and management 3. Residual disease at end of therapy 4. Relapsed disease and 5. How different in adults Once again a difficult disease to remember as a budding medical oncologist Save & share if you like ✅🤟 #oncology #medtwitter @oncodaily @myESMO @ASCO @OncoAlert @COGorg @SIOPEurope @PaedOncoMICC @PGSIG23 @CureSarcoma @Rhabdomyosarco @POTGUK1