Yuly A. Remolina

🤰 Cancer during pregnancy: ASCO Guideline at @JCO_ASCO! ascopubs.org/doi/10.1200/JC… 🎯 Multidisciplinary, patient-centered decision-making 📸 Imaging: follow ALARA principle ☝🏼 Systemic therapy → avoid 1st trimester; consider from 2nd 🛑 Contraindicated: MTX, anti-HER2, VEGF inhibitors, ADCs, cellular therapies Treating two patients, one decision ✨ @OncoAlert @OncoReporte @ASCO @myESMO @_SEOM @SuyogCancer

Adjuvant nivolumab works in muscle-invasive bladder cancer. But not for everyone. CheckMate 274 (5-year data): → DFS benefit is real → OS trend is emerging But the real story is ctDNA: ctDNA (+) → clear benefit (HR ~0.35) ctDNA (−) → no benefit (HR ~1.0) Same drug. Completely different biology. Adjuvant therapy is no longer “one size fits all.” It’s time to treat residual disease — not just risk. @oncodaily @myESMO @ASCOPost @OncBrothers @DrChoueiri annalsofoncology.org/article/S0923-…

Original Article: Perioperative Enfortumab Vedotin and Pembrolizumab in Bladder Cancer (phase 3 KEYNOTE-905 trial) nejm.org/doi/full/10.10… Editorial: Enfortumab Vedotin plus Pembrolizumab as Perioperative Therapy nejm.org/doi/full/10.10… #Oncology

Algorithm for Systemic Therapy in Early HR+/HER2- Breast Cancer (Recommendations in gray areas reflect my own clinical judgment— eg. olaparib and CDK4/6 sequence)

Here is Version 2.0 of when to hold systemic tx during RT. Updated & w 3 additional drug categories (ADCs, CDK4/6 inhibitors, PARPi). More details on newer drugs in 🧵 below. Please use this version as reference & thanks for all input/experience crowdsourcing! (1/3)

How modern therapies dislodged chemotherapy in advanced urothelial carcinoma

How I think about 1st line HER2+ Metastatic Breast Cancer. Decision 1: THP versus T-DXd + P Decision 2: Maintenance based on receptor status @OncoAlert #bcsm

⚡️ New SITC clinical practice guideline (v3.0) on immunotherapy in RCC: practical recommendations across adjuvant + metastatic settings, special populations, response monitoring, and QoL. Key reminders: PD-L1/TMB/MSI don’t guide selection; sarcomatoid features favor IO—nivo/ipi remains a preferred option. #KidneyCancer #RCC @crisbergerot @OncoAlert jitc.bmj.com/content/14/3/e…

1/ 🚨 New @NEJM: Perioperative enfortumab vedotin + pembrolizumab (EV+pembro) in MIBC (KEYNOTE-905) Congrats to the authors on an important randomized phase 3 trial in a tough, cisplatin-ineligible population 👏 Let’s walk through it 👇

Nectin-4 is expressed in almost all urothelial cancers . Nectin-4 fluorescence imaging during cystoscopy makes sense and seems to work well (see below) #EAU26 @urotoday . This potentially improves diagnostic accuracy. It would be good to generate large randomized data. @OncoAlert

How will we sequence ADCs in bladder cancer in the future #EAU26. Changing target and payload is logical, especially payload which seems to generate most resistance. Here @MattGalsky highlights most work focuses on only 2 payloads (topo-1 MMAE), this might be tricky for multiple combinations or sequences.

🚨 VIKTORIA-1 Trial DOI doi.org/10.1200/JCO-25… In HR+/HER2–, PIK3CA WT advanced breast cancer progressing after CDK4/6i + AI, targeting the PI3K/mTOR pathway with gedatolisib showed significant benefit. 📊 Results (n=392): • Gedatolisib + palbociclib + fulvestrant: mPFS 9.3 mo (HR 0.24) • Gedatolisib + fulvestrant: mPFS 7.4 mo (HR 0.33) • Fulvestrant: mPFS 2.0 mo Toxicity consistent with CDK4/6 use (notably neutropenia in the triplet), with low discontinuation rates. 🌎 Why relevant for LATAM? Many pts progressing after CDK4/6i are PIK3CA WT, leaving few targeted options beyond chemotherapy. Gedatolisib could expand the toolbox in this setting—pending access and sequencing considerations. @OncoAlert @weoncologists @Yuly_Remo congrats 🎉🎊🍾

⚡️ IMDC real-world (n=1,551) metastatic non–clear cell RCC: 1L IO+VE, IO-IO or cabozantinib showed higher ORR and longer OS vs sunitinib/pazopanib or mTOR—but the benefit varies by histology. Papillary: ORR 31–37% & OS ~31–33 mo with contemporary regimens vs 13% & 17.2 mo (SUN/PAZ). Sarcomatoid: IO-IO had the best outcomes (ORR 39%, OS 31.9 mo). #KidneyCancer #RCC sciencedirect.com/science/articl…

Phase 3 DESTINY-Breast05 trial: Patients with HER2-positive early breast cancer who have residual disease after neoadjuvant therapy are at high risk for recurrence. Research evaluating postneoadjuvant trastuzumab deruxtecan is summarized in a new Quick Take video. nej.md/4az805J

Combination therapy is emerging as a standard in refractory RCC. Combos increase tumor shrinkage endpoints. TKI provides early disease control. CRs are possible but is cure? Toxicity consideration is critical in this setting. Biomarkers to guide choice of drug(s) are needed

Extremely honored to present our work on the genomic landscape of upper tract urothelial carcinoma with & without sarcomatoid differentiation at @ASCO #GU26 🙏 Deeply grateful to my mentors @WesleyYipMD @montypal @AbhiTrip87 @ClaytonLauMD for their unwavering support. ⭐️ @cityofhope @CityofHopeSurg @CityofHope_GU

RII KEYMAKER-U04 study tests EVP with Favezelimab (anti–LAG3) or Vibostolimab (anti-TIGIT) #GU26 in 1st line UC. Response rates and PFS are essentially the same in the 3 arm. Less CRs than expected for EVP. Even more evidence that TIGIT and LAG-3 are ineffective in urothelial cancer. It’s time to stop looking at these 2 targets and try something else more promising instead IMO. @OncoAlert

DAY3⃣ @asco #GU26 #kidneycancer The BELZUTIFAN story! 🔴LITESPARK-011 Belzu + lenva vs cabo for aRCC after PDL1 🔵LITESPARK-022 Adjuvant pembro+belzu vs pembro in localized ccRCC @DrChoueiri 🟠LITESPARK-024 dose escalation of belzu + palbo #ASCOVoices @OncoAlert @oncodaily

DAY 2: #Urothelialcancer @asco #GU26 🟢 KEYNOTE-B15 EV + pembro cisplatin-eligible MIBC 📢 TOP abstract @MattGalsky 🧑‍🔬 RC48G001 P2 disitamab HER2+ previously tx aUC @tompowles1 🌅 SunRISe-2 Gem-intravesical +cetre vs ChemoRT in MIBC @AndreaNecchi @OncoAlert @oncodaily

Original Article: Phase 1 Study of Rezatapopt, a p53 Reactivator, in TP53 Y220C–Mutated Tumors (PYNNACLE study) https://nej.md/3OIQC5P Science behind the Study: Restoring Function to a Variant of p53 in Solid Tumors https://nej.md/3N0pQW8 #Oncology #Genetics