7/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 4🏫 💊Several FDA👍PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib 🤔 When and how do you PIK one of the PIK3CA of the 3 available? ☝️Inavolisib+Fulvestrant+Palbo is approved for 1st line mER+ BC after recurrence on/after adjuvant ET therapy

7/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 4🏫 💊Several FDA👍PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib 🤔 When and how do you PIK one of the PIK3CA of the 3 available? ✌️Alpelisib & Capivasertib are approved in 2nd line mER+ BC combined with fulvestrant 🔎 NGS results, Baseline A1C

7/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 4🏫 💊Several FDA approved PIK3CA-inhibitors: Capivasertib or Alpelisib or Inalvosalib 🤔 When and how do you PIK one of the PIK3CA of the 3 available? 📎 pubmed.ncbi.nlm.nih.gov/33246021/

Alpelisib plus fulvestrant for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: final overall survival results from SOLAR-1 - PubMed

NCT02437318.

pubmed.ncbi.nlm.nih.gov

8/18 #TumorBoardTuesday Back to our case🔎 👩‍🦳 Patient received Capivasertib + Fulvestrant due to PIK3CA mutation. 👉 Not yet considered endocrine resistant so would not move onto capecitabine, sacituzumab 👉 Tumor is HER2 negative so no role for trastuzumab deruxtecan

8/18 #TumorBoardTuesday Back to our case🔎 👉 Everolimus + fulvestrant is not favored given the more targeted approach with Capivasterib for the PIK3CA mutation ✅ Tolerated therapy well with mild rash at start of treatment that resolved with antihistamines

9/18 #TumorBoardTuesday ⏭️ Case 2 #TumorBoardTuesday #OncTwitter Case 2 👩‍🦳 62 y.o. postmenopausal female 💉 mBC to the🫁, ER 70%, PR 85%, HER2⛔[IHC 1] 🩻 confirmed⬆️Dz on 1L ribo/letrozole at C7 🏃‍♀️ ECOG PS 1. No co-morbidities. ⛔ Normal vital signs, labs 🩸Liquid Biopsy shows ESR1 mutation, TMB-High

10/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 5🏫 🤔When is a patient considered to be “endocrine resistant”? Per Advanced Breast Cancer International Consensus Guidelines, Link to Guidelines: www.thebreastonline.com/article/S096...

6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)

This manuscript describes the Advanced Breast Cancer (ABC) international consensus guidelines updated at the last two ABC international consensus conferences (ABC 6 in 2021, virtual, and ABC 7 in 2023...

thebreastonline.com

10/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 5🏫 👉 Recurred on adjuvant endocrine tx 👉 Recurred <2y after adjuvant endocrine tx 👉 ⬆️Dz<6mos of starting 1L mBC tx 👉 ⬆️Dz after any duration of >=2nd line of ET-based therapy 👉 Known ESR1 mutation [now have 2 Rx for ESR1m → elacestrant or imlunestrant]

11/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 6🏫 EMERALD 👩‍🦳 2L metastatic HR+/HER2- received 💊 Elacestrant, an oral selective ER Degrader (SERD) ✅ 1-2 prior ET including CDK4/6i and < 1 chemo 💊 Elacestrant 400mg daily vs 💉fulvestrant or 💊AI ⬆️⬆️ PFS for prior💊 CDK4/6i > 12 mon with ESR1 mutated tumors

11/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 6🏫 ⬆️ Elacestrant benefited all subgroups including: 🦴only, 🫁 visceral mets, > 3 mets ⬆️ Elacestrant benefited all🧬subgroups: ✔️ESR1+PIK3CA, ✔️ESR1+TP53, ✔️ESR1+HER2-low 🤢 Most common AE: N/V

3/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 2🏫 CAPItello-291 👩‍🦳 mER+/HER2- breast cancer with PD on AI +/- CDK4/6i 💉2L Fulvestrant +/- capivasertib [oral, 🚫AKT plus.. 🚫PTEN, 🚫PIK3CA] ...continued

3/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 2🏫 CAPItello-291 ✅ Capivasertib + fulvestrant ⬆️mPFS in AKT Pathway alterations [7.3m vs 3.1m] ✅ Capi+Fulvestrant benefited all subgroups including: 🦴only, 🫁 visceral mets, prior💊 CDK4/6i, prior ☣️chemo 📎https://www.nejm.org/doi/full/10.1056/NEJMoa2214131

Capivasertib in Hormone Receptor–Positive Advanced Breast Cancer | NEJM

AKT pathway activation is implicated in endocrine-therapy resistance. Data on the efficacy and safety of the AKT inhibitor capivasertib, as an addition to fulvestrant therapy, in patients with horm...

nejm.org

4/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 3🏫 CAPItello-291: Capivasertib Side effects 💊 Capivasertib taken 4 days on, 3 days off per week 🩺 Need baseline A1C < 8% 🚽 Most common AE: Diarrhea onset ~ day 8 [All grades 72%, G3/4 9.3%] ...continued

4/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 3🏫 CAPItello-291: Capivasertib Side effects ☝️ Rash (12%) onset ~ day 12→ Pretreat with oral antihistamine, topical steroids 💉 Hyperglycemia (18%) onset ~ day 15; ⬇️ G3/G4 than other PIK3CA 📎https://www.esmoopen.com/article/S2059-7029(24)01466-2/fulltext

Capivasertib and fulvestrant for patients with hormone receptor-positive advanced breast cancer: characterization, time course, and management of frequent adverse events from the phase III CAPItello-2...

Capivasertib is a potent, selective pan-AKT inhibitor. In CAPItello-291, the addition of capivasertib to fulvestrant resulted in a statistically significant (P < 0.001) improvement in progression-free...

esmoopen.com

5/18 #TumorBoardTuesday Back to our case🔎 💉 57yo ♀️ with mBC to the 🦴, liver, ER 100%, PR 95%, HER2⛔[IHC 0]-🩻confirmed⬆️Dz on 1L ribo/letrozole at C47 ✅ Normal labs (A1C=5.8) & VS 🩸Liquid Biopsy: +PIK3CA mutation, TP53 mutation, TMB-Low (4 mut/mb), High tumor fraction (> 5%) 👩🏻‍⚕️What 2L Tx is advised❓

6/18 #TumorBoardTuesday POLL What 2L therapy would you give this patient❓ 1) Capecitabine 2) Trastuzumab deruxtecan 3) Sacituzumab govetican 4) Capivasertib + Fulvestrant 5) Everolimus + Fulvestrant

2/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 1🏫 ...cont 📝Tissue-based assays or plasma-based assays (ctDNA) can be used ☝️Some alterations may be better detected by tissue-based assays like homozygous loss of PTEN or TMB-H. ☝️Liquid assays may reflect tumor heterogeneity more accurately

2/18 #TumorBoardTuesday 👩🏻‍🏫Mini Tweetorial 1🏫 Actionable Mutations in 2L mER+/HER2- BC 🧬Several actionable mutations in 2L+ mBC: ESR1, PIK3CA, AKT, PTEN, BRCA (germline, somatic) 🔍Evaluation of acquired mutations at progression will help to direct therapy options Cont.....

#TumorBoardTuesday POLL What would you do next❓ 1) Start capecitabine 2) Liquid biopsy to assess for actionable mutations 3) Start trastuzumab deruxtecan 4) Check tumor markers Ca 15-3 & Ca 27.29

1/18 #TumorBoardTuesday @KennaKoehler & @drgattimays.bsky.social Case 1 👩‍🦳57 y.o. postmenopausal female 📋Well controlled DM (A1C = 5.8) 🏃‍♀️ECOG PS 0 💉Metastatic BC to bones, liver, ER 100%, PR 95%, HER2- [IHC 0] w/scan confirmed progression on 1L ribociclib/letrozole at C47 in bones ⛔ Normal labs & VS

#TumorBoardTuesday 📢Join us Tuesday, 10-21-25 at 8PM ET as @drgattimays.bsky.social & @KennaKoehler 🗣️ Tx options after CDK4/6⛔️: What to consider in the 2nd line for HR+/HER2– mBC❓ RT and bring others into the discussion‼️

#TumorBoardTuesday 🧠And while we finalize the case details, collect FREE #CME 👉🏽https://integrityce.com/tbt2025

#TumorBoardTuesday ➡️Before @drgattimays.bsky.social & @KennaKoehler 🗣️ 2nd line Tx options for HR+/HER2– mBC, #BCSM tell us your connection to this medical🩺discussion 👇👇🏼👇🏾 1) Onc/Surg/Rad/IR/Gyn Onc 2) Other MD/APP/RN/Pharm D 3) Patient/Patient Advocate 4) Fellow/Resident/Trainee

✅This #TumorBoardTuesday🗣️with @KennaKoehler & @drgattimays.bsky.social‬ is provided by @IntegrityCE 👍Supported by ed grants from Exelixis, Ferring, Ipsen, Lilly, Janssen Scientific Affairs, Merck & Taiho Oncology 🙏 👉🏽Info about 🆓 CME: integrityce.com/tbt2025

#PreTest Q1️⃣#TumorBoardTuesday Free #CME integrityce.com/tbt2025 B4 @KennaKoehler & @drgattimays.bsky.social‬🗣️2nd-line Txs for #breastcancer, test your🧠with these 2❓

🤔What 2L Tx would you offer a 45yo♀️w/ AKT mutated, ER+/HER2- mBC after⬆️Dz on ribociclib➕AI/OFS❓ 1) Capecitabine monotherapy 2) Capivasertib+fulvestrant 3) Elacestrant monotherapy 4) Everolimus + fulvestrant

#PreTest Q2⃣#TumorBoardTuesday 🧐 A 75yo♀️w/ER+/HER2- PIK3CA+ mBC is starting 2L therapy with alpelisib+fulvestrant. Baseline A1C=6.1 & BMI is 33. What steps can limit risk for severe hyperglycemia❓ 1) Labs QW x 2, then monthly 2) Baseline A1C, then q3 mos 3) Consider metformin 4) All of the above

#ASCO25 📢Join me & my colleagues EileenMOReilly, Gabi Chiorean, & Brian Wolpin to discuss #PancreaticCancer management in a case-based format 📅Friday, May 30th, 6:30- 8:00pm CDT 📍Sheraton Grand Chicago Riverwalk 4th Floor 📋Link to Registration: (tinyurl.com/mra3pt9s

@hopkinspress.bsky.social #GIOnc 📢Launching Day 2⃣‼️ 😀I am confident that today's sessions will be as GREAT as yesterday's sessions So - join us NOW for this 3rd Annual Johns Hopkins Updates in Gastrointestinal Cancers Conference

@hopkinspress.bsky.social #GIOnc 📢We are underway‼️ 😀Join us today and tomorrow for our 3rd Annual Johns Hopkins Updates in Gastrointestinal Cancers Conference ✅As always - the conference is free to register and all sessions are available streaming🖥️on line integrityce.com/Hopkins25Str...