🧐 A 75yo ♀️w/ ER+/HER2- PIK3CA+ mBC is starting 2L therapy with alpelisib + fulvestrant. Baseline A1C is 6.1 and BMI is 33. What steps can limit risk for severe hyperglycemia❓
Margaret Gatti-Mays, MD MPH
@drgattimays.bsky.social
Deputy Director Ohio State #MedicalOncology and #BreastCancer Section Chief @OSUCCCjames |#immunotherapy | #Medsky #OncSky #BoyMom | #NIH alumnus | #HoyaSaxa | Posts -My Own
18/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 12🏫 🔊Take home points 🔊: ✅ Liquid biopsy recommended at progression on 1L to screen for mutations ✅ 2L options have mPFS 5-11 months, some with OS benefit ✅ Optimal sequence unknown at this time, likely depends in part on patient factors
17/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 11🏫 Ongoing trials in the HR+/HER2- space… 1️⃣ HERTHENA-Breast04 (NCT07060807) 💊 Patritumab deruxtecan (HER3-DXd) vs physician’s choice chemo 💉 ADC of HER3 mAb linked to topoisomerase I payload 👆Primary endpoints: PFS and OS
16/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 10🏫 DESTINY-Breast04 👩🦳 2L metastatic HER2- low BC ✅ Included both ER+ and ER-; HER2-low breakdown: IHC1+ = 58% and IHC2+ = 42% 💊 Trastuzumab deruxtecan (T-DXd) vs physician’s choice chemo (capecitabine, eribulin, gemcitabine, paclitaxel or nab-paclitaxel)
15/18 #TumorBoardTuesday ⏭️ Moving on to Case 3… #TumorBoardTuesday #OncTwitter Case 3 👩🦳 67 y.o. postmenopausal female 💉 Metastatic HR+, “HER2 low” BC to bone, liver 💊 Progressed on 1L CDK4/6i + ET within 4 months of starting therapy 🧪 No BRCA mutations
14/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 9🏫 📰 Breaking news! 🔊 evERA study (#ESMO2025) 🔎 Phase III, randomized trial (NCT05306340) 👩🦳 Metastatic HR+/HER2- ✅ Previous tx w/ CDK4/6i + ET 💊 Giredestrant is a novel, nonsteroidal oral SERD 🚫 NOT FDA approved as of today
13/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 8🏫 PrE0102: An oldie but goodie 👩🦳 2L mBC AI-resistant, HR+/HER2- ✅ Prior ET, < 1 chemo 💉 Fulvestrant + Everolimus (mTOR inh) vs Fulvestrant ⬆️ mPFS 10.3 months fulvestrant + everolimus vs 5.1 fulvestrant 👄 Mucositis → steroid mouth rinse (SWISH study ppx)
12/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 7🏫 EMBER-3 👩🦳 2L mHR+/HER2- 💊 Imlunestrant, next gen oral SERD with 🧠CNS activity ✅ 1-2 prior ET +/- CDK4/6i [recurrence < 12 mon or adj CDK4/6i/AI or PD on 1L CDK4/6i/ET] 📝 💊 Imlunestrant daily vs SOC [fulvestrant or exemestane] vs Imlunestrant + Abema
11/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 6🏫 EMERALD 👩🦳 2L mHR+/HER2- Elacestrant, po SERD ✅ 1-2 prior ET incl CDK4/6i, < 1 chemo 💊 Elacestrant daily vs 💉fulvestrant or AI ⬆️PFS for prior CDK4/6i >12 mon + ESR1mut ⬆️ PFS all subgroups incl 🦴only, 🫁 visceral, >3 mets
10/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 5🏫 🤔What is “endocrine resistant”? Per ABC Intern'l Guidelines, 👉 Recurred while taking adj ET 👉 Recurred < 2 yrs of adj ET 👉 Progressed < 6 mons of starting 1L mBC tx 👉 Progression after 2L+ ET 👉 Known ESR1 mut [use elacestrant or imlunestrant]
9/18 #TumorBoardTuesday ⏭️ Moving on to Case 2… #TumorBoardTuesday #OncTwitter Case 2 👩🦳 62 y.o. postmeno female 💉 mBC to the lungs, ER 70%, PR 85%, HER2 neg [IHC 1] with progression on 1L ribociclib/letrozole at C7. 🏃♀️ ECOG PS1. No co-morbidities. ⛔ Nml VS, labs 🩸Liquid Biopsy: ESR1mut, TMB-High
8/18 #TumorBoardTuesday Back to our case🔎 👩🦳 Received Capi + Fulvestrant [PIK3CA mutation]. 👉 Not yet endocrine resistant [not move to cape, saci] 👉 Tumor is HER2 neg [no TDxD] 👉 Not Everolimus + fulvestrant b/c more targeted approach PIK3CA ✅ Mild rash at start -> resolved with antihistamines
7/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 4🏫 💊Approved PIK3CA-inh: Capivasertib or Alpelisib or Inalvosalib 🤔 How do you PIK? ☝️Inavolisib + Fulvestrant + Palbo-> 1st line mER+ BC s/p recurrence on/after adj ET ✌️Both Alpelisib, Capi approved in 2nd line mER+ BC + fulvestrant 🔎 NGS, Baseline A1C
5/18 #TumorBoardTuesday Back to our case🔎 💉 57yo ♀️ mBC to the bones, liver, ER100%, PR95%, HER2 neg [IHC 0] with progression on 1L ribociclib/letrozole at C47 ✅ Normal labs (A1C = 5.8), VS 🩸Liquid Biopsy: +PIK3CA mut, TP53 mut, TMB-Low, tumor fraction (> 5%) 👩🏻⚕️ Recommend 2L therapy next…
4/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 3🏫 CAPItello-291: Capi Side effects 💊 Capi: 4 days on, 3 days off per week 🩺 Baseline A1C < 8% 🚽 Common AE: Diarrhea day 8 [All grades 72%, G3/4 9.3%] ☝️ Rash (12%) ~ day 12→ oral antihistamine, topical steroids 💉 Hyperglycemia (18%)~ day 15; ⬇️ G3/G4
3/18 #TumorBoardTuesday 👩🏻🏫Mini Tweetorial 2🏫 CAPItello291 👩🦳 mER+/HER2- BC, PD on AI+/-CDK4/6i 💉2L Fulvestrant +/- capi [🚫AKT plus 🚫PTEN, 🚫PIK3CA] ✅ Capi + fulvestrant ⬆️mPFS in AKT alterations [7.3m vs 3.1m] ✅ Capi+Fulvestrant benefited all incl 🦴only, 🫁 visceral mets, prior CDK4/6i, prior ☣️chemo
POLL What would you do next? A) Start capecitabine B) Liquid biopsy C) Start trastuzumab deruxtecan D) Check tumor markers Ca 15-3, Ca 27.29 @christianrolfo.bsky.social @quirogad.bsky.social @nerealliamd.bsky.social @stoverlab.bsky.social @drsgraff.bsky.social @oncbrothers.bsky.social
1/18 #TumorBoardTuesday #OncTwitter Case 1 👩🦳 57 y.o. postmenopausal female 📋 Well controlled diabetes (A1C = 5.8) 🏃♀️ ECOG PS 0 💉 Metastatic breast cancer to the bones, liver, ER100%, PR95%, HER2 neg [IHC 0] with scan confirmed progression on 1L ribociclib/letrozole Cyc 47 in bones. ⛔ Normal labs,VS
Tune in tomorrow 10/21/25 at 8pm EST for discussion about the ever changing landscape of 2L metastatic ER+ breast cancer #TBT #BCSM @tumorboardtuesday.bsky.social @osuwexmed.bsky.social #BreastCancer
Margaret Gatti-Mays, MD MPH@drgattimays.bsky.social · 11mo ago🎙️Looking forward to a great #TBT discussion on Oct 21, 2025 on 2L ER+/HER2- #metastaticbreast cancer #BCSM @osuwexmed.bsky.social
🎙️Looking forward to a great #TBT discussion on Oct 21, 2025 on 2L ER+/HER2- #metastaticbreast cancer #BCSM @osuwexmed.bsky.social
Excited to share my #Top5 in #breastcancer from #ASCO25 #bcsm @osuwexmed.bsky.social www.vumedi.com/video/ascor-...
ASCO® 2025 Highlights: Key Trial Updates Across Breast Cancer Subtypes - ADCs, Chemo De-Escalation, CDK4/6i, IO Combinations, and Oral SERDs
A video from Margaret Gatti-Mays (as part of 2025 ASCO® Annual Meeting Insights Hub), posted on Aug 27, 2025.
vumedi.com
Last training ride before #pelotonia25. Since May, I’ve spent 30 hours and traveled more than 360 miles so that next Saturday I will ride 50 miles with more than 7,000 of my closest friends to help support #CancerResearch #onegoal #LetsDoThis #FuelMyRide ➡️ www.pelotonia.org/profile/MG0328
@oncoalert.bsky.social annual #ASCO25 5K on a beautiful morning in Chicago! Had some great running partners this am @quirogad.bsky.social @christeeny513.bsky.social
Wonderful time giving grand rounds today at #Georgetown There’s nothing quite like going “home” to your alma mater and seeing all the amazing preceptors and mentors that so positively impacted your life #HoyaSaxa
Beautiful morning on campus with Buckeye grove in bloom @osuwexmed.bsky.social @osucccjames.bsky.social
Today family picture with some of the 87 amazing faculty of our Division of Medical Oncology at The James CCC. Very honored to be part and lead this incredible team! @OhioStateMedOnc @OSUCCC_James @OhioStateMed @drgattimays.bsky.social @stoverlab.bsky.social
Honored and grateful for the opportunity to discuss 3 oral abstracts at #ASCO25 and represent #OSUCCC @osucccjames.bsky.social @osuwexmed.bsky.social #Immunotherapy @sitcancer.bsky.social #PIIO @ascocancer.bsky.social
Passed this every day in Building 10 on the way to my office at the NIH. “…look to the service from the healthcare givers at the NIH. It is where knowledge, pride and love is given from each healthcare giver; To heal and comfort the sick and afflicted helping to give a brand new start”
