Parth

You are about to give parenteral B12. Which electrolyte must be checked first and what complication are you trying to prevent?

Not all MYC lymphomas are Burkitt. A simple way to approach high-grade B-cell lymphoma: 1. High Ki-67 → suspect aggressive lymphoma 2. Check MYC (FISH) If MYC rearranged: → Check BCL2 • BCL2 negative → Burkitt lymphoma • BCL2 positive → Double Hit lymphoma If MYC not rearranged: → DLBCL / other HGBCL Key rule: BCL2 positivity excludes classic Burkitt lymphoma Morphology helps: Burkitt = homogeneous, intermediate-sized cells Double Hit = heterogeneous, pleomorphic Genetics defines biology. #Lymphoma #Hemetwitter

If “The Pitt” was an honest show it would spend 80% of the show with scenes of residents sitting in front of screens staring at Epic.

This is the treatment algorithm we’ve used during our discussion with @SKamath_MD on #BiliaryTractCancer ✅ Early disease ✅ 1L Rx in metastatic disease ✅ NGS/Biomarker testing ✅ HER2, IDH, & FGFR Rx #OncTwitter #MedX @OncUpdates @OncoAlert #gism

TNBC is no longer a chemo disease. This 1 algorithm shows the shift: 👉 ADCs + biomarkers are now driving frontline decisions. 🧬 Metastatic TNBC - how to think today PD-L1 ≥10 • Pembro + chemo • OR Pembro + SG PD-L1 <10 • SG or Dato-DXd now competing with chemo BRCA-mut • PARP inhibitors HER2-low • T-DXd option Later lines • ADC sequencing • Biomarker-directed therapy 🧠 Paradigm shift ❌ Before: one-size chemo ✅ Now: IO + ADCs + PARPi + precision oncology ⚠️ What matters next Not just “which drug” 👉 but “what sequence” Topo-1 ADCs → real cross-resistance concern 🎯 Takeaway Advanced TNBC has entered the ADC era. Smart sequencing will define outcomes. 🔖 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #TNBC #BreastCancer @OncoAlert @myesmo @esmo_open @JCOPO_ASCO

the least accurate part of the Pitt is how the med students/residents/attendings interact

@mhjrad Scrubs is the only show that ever understood the hierarchy of medicine

25 years of TKIs in CML — how I treat CML-CP today @BloodPortfolio doi.org/10.1182/blood.… #weekend_review @MayoCancerCare 1️⃣ BCR-ABL1 drives disease; all frontline TKIs deliver excellent survival. 2️⃣ Choice ≠ OS → it’s about risk (ELTS>Sokal), comorbidities, toxicity, and DMR/TFR goals. 3️⃣ Imatinib = safest CV, slowest. 2G TKIs/asciminib = faster, deeper responses (watch toxicity). Nilotinib → vascular risk. Dasatinib → lung toxicity. 4️⃣ Asciminib → allosteric, avoid b2a3/b3a3. The art is matching the right TKI to the right patient. #How_I_treat_CML #BloodPortfolio

Interesting move in the new NCCN guidelines: ADCs are now listed as a first-line option in mTNBC, even before FDA approval. Highlights how rapidly the treatment landscape is evolving. #sabcs25 @ASCO @SABCSSanAntonio #MedTwitter @OncBrothers @TotalHealthConf @PTarantinoMD @drsarahsam

• Gupta et al. (Carboplatin in TNBC, JCO 2025) • EFS missed, OS delivered • Not biology — statistics (events + power + time) • Negative primary ≠ negative drug #TNBC #BreastCancer #ClinicalTrials #Oncology #Stats #MVOnco

• Platinum in TNBC? • Survival benefit seen only in premenopausal / ≤50 yrs • No benefit in postmenopausal pts • Biology matters — not all TNBC is the same #TNBC #BreastCancer #Oncology #JCO #MVOnco

Observation: Saw it in Amdavad, then in Vadodara and now in Rajkot. Nobody wears helmets while driving two-wheelers. Is there a reason?

CRITICS-II: multicenter Ph2 RCT in resectable gastric ca showing preop chemo (DOC) + CRT improved 1-yr EFS & pCR (20%) v CRT or chemo alone. But w D-FLOT now SOC, q’s are: 1. Could adding pre-op chemoRT to D-FLOT further improve pCR enabling organ pres option? #GI26 🧵1/2

📘Gastric cancer ✅A practical review jamanetwork.com/journals/jama/… #cancer #oncology #gastric #MedX @OncoAlert

4 studies that we touched on during Triple Negative #BreastCancer highlights 🗣️ from #SABCS25 w/ @Dr_RShatsky: ✅ #RJBC1501 (PhIII) ✅ #CITRINE (PhIII) ✅ #TBCRC056 (PhII) ✅ #OlympiaN (PhII) When do you consider carboplatin if not used in neoadj settings? #bcsm #OncTwitter

Because most of these patients receive neoadjuvant therapy, platinum agents are usually utilized in that setting and therefore are not carried over into the adjuvant phase. However, in high-risk TNBC patients who undergo upfront surgery for any reason—particularly those who are younger, have a high Ki-67 level, are germline BRCA mutation carriers, and are expected to tolerate treatment—I would consider adding a platinum agent. It is important not to compromise taxane delivery by having to discontinue therapy due to platinum-related toxicity. It should also be kept in mind that the BR003 trial reported negative results.

🧠📘 𝐖𝐡𝐞𝐭𝐡𝐞𝐫 𝐢𝐧 𝐞𝐱𝐚𝐦𝐬 𝐨𝐫 𝐢𝐧 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞, 𝐭𝐡𝐢𝐬 𝐪𝐮𝐞𝐬𝐭𝐢𝐨𝐧 𝐢𝐬 𝐮𝐧𝐚𝐯𝐨𝐢𝐝𝐚𝐛𝐥𝐞.
🧬 𝐅𝐎𝐋𝐅𝐎𝐗—𝐦𝐚𝐝𝐞 𝐬𝐢𝐦𝐩𝐥𝐞. #FOLFOX #MedicalOncology
#OncologyEducation #MVOnco

𝐖𝐡𝐲 𝐝𝐨𝐞𝐬 𝐋𝐞𝐧𝐂𝐚𝐛𝐨 𝐟𝐚𝐯𝐨𝐫 𝐋𝐞𝐧+𝐄𝐯𝐞 𝐚𝐟𝐭𝐞𝐫 𝐈𝐎 𝐟𝐚𝐢𝐥𝐮𝐫𝐞 𝐢𝐧 𝐦𝐜𝐜𝐑𝐂𝐂? 👇 🔹 𝐂𝐚𝐛𝐨𝐳𝐚𝐧𝐭𝐢𝐧𝐢𝐛 → horizontal inhibition
Blocks multiple 𝐞𝐬𝐜𝐚𝐩𝐞 𝐫𝐞𝐜𝐞𝐩𝐭𝐨𝐫𝐬 (VEGFR, MET, AXL) 🔹 𝐋𝐞𝐧𝐯𝐚𝐭𝐢𝐧𝐢𝐛 + 𝐄𝐯𝐞𝐫𝐨𝐥𝐢𝐦𝐮𝐬 → vertical, end-to-end inhibition
Blocks 𝐚𝐧𝐠𝐢𝐨𝐠𝐞𝐧𝐞𝐬𝐢𝐬 + 𝐬𝐮𝐫𝐯𝐢𝐯𝐚𝐥 𝐬𝐢𝐠𝐧𝐚𝐥𝐢𝐧𝐠
from 𝐕𝐄𝐆𝐅𝐑/𝐅𝐆𝐅𝐑 → 𝐦𝐓𝐎𝐑 ⬆️ 𝐄𝐧𝐝-𝐭𝐨-𝐞𝐧𝐝 𝐩𝐚𝐭𝐡𝐰𝐚𝐲 𝐬𝐡𝐮𝐭𝐝𝐨𝐰𝐧 = 𝐥𝐨𝐧𝐠𝐞𝐫 𝐏𝐅𝐒 ⏳ #RCC #mccRCC #UroOncology
#CancerBiology

In older and/or frail patients with CLL, treatment with acalabrutinib is highly efficacious and can improve underlying frailty. Read full article in Blood: ow.ly/z1vv50XO8HP

IT IS THIS TIME OF THE YEAR AGAIN! TOP 10 GU clinical trials in 2025! 1/ Practice-changing IMvigor011: In ctDNA+ MIBC post-cystectomy, adjuvant atezo improved DFS (HR 0.64) & OS (HR 0.59) vs placebo. ctDNA- pts spared therapy w/ 2-yr DFS ~88%. @tompowles1 @DrYukselUrun @OncoBellmunt @NEJM #ESMO2025 Plenary @myESMO nejm.org/doi/full/10.10…