✳️Colorectal cancer is now the leading cause of cancer related death among males aged 20-39 and 40-49 ‼️It was third among 20-39 age group last year.
✳️ Concerning trend is also seen in young women; CRC related death and will likely surpass breast cancer in near future
@OncoAlert
An important question I receive from my patients is that sugar fuels the cancer and whether if they need to fast or follow a low carb diet❗️This is in fact very important subject particular for patients with GI cancers
@oncoalert
@CrcChange
@manjuggm
@fireflyann
Here is why 👇
I am seeing several young CRC patients at their early 30s and 40s begging for colonoscopy for rectal bleeding/ abdominal pain over SEVERAL months !
👉We must increase awareness of Early onset CRC among our PCP and GP colleagues‼️
👉
#EoCRC
is an epidemic in the US‼️‼️
@OncoAlert
#PrayForTurkey
My mom and some siblings lives in Gaziantep where the earthquake occurred ! Thankfully they are safe but so many others are still under collapsed buildings! Never felt that helpless …
Please pray for Turkey ❗️
✳️I am thrilled to share that I am appointed to
@theNCI
Colon Task Force as Alliance Early Career Investigator starting 01/2024❗️
I would like to thank Dr Meyerhardt and Dr
@EileenMOReilly
for nominating me for this position❗️
@UPMCHillmanCC
@PittDeptofMed
My patient with MMR-D rectal cancer now into 3 months of pembrolizumab and achieved complete radiological response by MRI ‼️
✳️This was one of the most amazing news to share lately with so much joy and emotion ‼️
✳️IOs do work very well in MMR-D rectal cancer ‼️
@OncoAlert
✳️The paper that we discussed the role of neoadjuvant IO therapy for pts with MSI-H colon and rectal cancer is now accepted for publication ❗️
✳️We reviewed the recent ground breaking progress and elaborated on challenges and future opportunities ❗️
@OncoAlert
@JCOOP_ASCO
@ASCO
I would like to do my 2nd deep dive post
#ASCO22
analysis on
#ctDNA
guided adjuvant therapy for pts with stage II colon cancer‼️
✳️The DYNAMIC trial is certainly step forward (kudos) ‼️But doesn’t answer many questions❗️
@OncoAlert
@manjuggm
@CrcChange
@TheColonClub
Why ?👇
#ASCO22
✳️DYNAMIC trial results are highly exciting and glad to see field is moving forward !
✳️Very encouraging findings that we are in right pathway to use
#ctDNA
for adjuvant tx‼️
However there are important points that we need to address 👇
@asco
@OncoAlert
@MoffittNews
✳️Thrilled to contribute to this work now published by
@CancerNetwrk
Oncology Journal❗️
✳️Was amazing to work with Dr.
@adasarimd
and Dr Lieu and all co-authors ❗️
✳️Here are some key points from CIRCULATE US trial discussed here 👇
@OncoAlert
@manjuggm
An important question I hear from my patients is what vitamins to take while being on chemotherapy‼️
✳️Perhaps, the question should also be asked as “which vitamins to not to take” while being chemotherapy
@oncoalert
@CrcChange
@fireflyann
@manjuggm
Here is why👇
Thrilled to announce that I will be joining to
@UPMCnews
-
@UPMCHillmanCC
❗️Look forward to excel my research on CRC/EoCRC, contribute its changing treatment paradigm‼️
Also, so excited that our paths are crossing with Dr
@teekayowo
once again❗️
My mentors
@EileenMOReilly
, +
#ASCO22
✳️Our article for ASCO Educational Book is now accepted for publication ❗️
✳️We have discussed challenges and opportunities of immunotherapy for patient with MSS CRC❗️
✳️Stay tuned for this highly exciting paper ‼️
@ASCO
#ASCOEdBook
@OncoAlert
✳️Starting to ASCO GI with a great news ❗️
✳️ Our paper on the role of Immunotherapy for patients living with MSS CRC is now accepted for publication ‼️
Stay tuned for this exciting article overviewing the literature and unmet needs ‼️
@DenizCanGuven1
@AnwaarSaeed3
@manjuggm
1️⃣
✳️I would like to dedicate my first tweetorial for Early onset CRC, as I truly believe it is an Epidemic that we know little about it❗️
✳️CRC is now the leading cause of cancer related death among males among aged 20-49 ❗️
@CrcChange
@oncoalert
#ColorectalCancerAwarenessMonth
#GI22
@ASCO
@OncoAlert
✳️CtDNA📈 establishes itself as the single most important prognostic factor in CRC after sx ❗️
✳️Patients with negative CtDNA seems to be doing well without ACT however we need randomized trials to establish this
#CIRCULATE
-US
#COBRA
@CrcChange
@FightCRC
✳️KRAS oncogene, famed as undruggable target, is now potentially actionable particularly G12C mutant !
✳️How did this perception change? I will go over some recent progress in this tweetorial for KRAS mutant CRC ❗️
@OncoAlert
@manjuggm
@UPMCHillmanCC
👇
Our paper on HER2 targeting for patients with CRC is out‼️
@ASCO
@JCOOP_ASCO
✳️In this article we have discussed recent updates and future opportunities
@oncoalert
Here are some important points discussed👇
👉BRAF mutations are now actionable in CRC.
👉However, it is critical to define distinct molecular subgroups of BRAF mutants.
👉In this work, we developed an algorithmic precision approach for the management of mCRC with a BRAF alterations
@ASCO
@ASCO_pubs
@OncoAlert
✳️Made it to the airport for
#GI24
@ASCO
‼️
✳️ Got over 20 meetings in next two days but truly excited for it ❗️ (hoping to survive ☺️)
✳️Looking forward to catching up and connecting with friends and colleagues ‼️
ASCO
#GI23
CRC highlights -2
✳️Sunlight trial phase III RCT is positive, confirming superiority of Lonsurf Avastin compared to Lonsurf monotherapy with improved OS and PFS❗️Bevacizumab should be added to lonsurf if used (when no actionable gene) period ❗️
@OncoAlert
ASCO
#GI23
CRC highlights
✳️Really excited to see new generation of immune checkpoint inhibitors showing good activity in CRC ❗️
#Botensilimab
#balstilimab
✳️While we need to more data, I am hopeful we will break immune cold nature of MSS CRC in near future ❗️
@OncoAlert
Some interesting findings of Galaxy trials from my view :
✳️Cumulative clearance rate was high but then even 19% of those who cleared
#ctDNA
, had disease recurrence in 18 months ‼️
✳️This means ctDNA clearance does not always mean a cure, rather just undetectable ❗️
@OncoAlert
✳️NAPOLI-3 trial is positive and improves both OS and PFS compared to gemcitabine abraxane ❗️
✳️However OS is similar to FOLFIRINOX (11.1 vs 11.1). ❗️
✳️High rates of diarrhea is not surprising in investigational arm❗️
@OncoAlert
✳️While concluding the
#ColorectalCancerAwarenessMonth
just received this amazing news !!
✳️Our paper on KRAS targeting for patients with CRC is now accepted for a publication in
@JCOOP_ASCO
‼️
✳️We discussed the recent progress and elaborated future therapeutic opportunities
✳️I was thrilled to join
@WhiteHouse
Cancer Moonshot Colorectal Cancer Listening Session ❗️
✳️I am more hopeful than ever that clinical trials and trial opening process can be revolutionized to improve inclusivity and accessibility particularly for patients with young onset
Some goodbyes are really hard in oncology…
Some last talks that I wish I never had to do, are really challenging …
Joining to the journey of my patients has been a true privilege ‼️ Yet, the last hug, the last words, and the last goodbye can be overwhelming…
✳️Although my research is purely focused colorectal cancer, I was delighted to work on this pancreatic cancer project with Dr
@SalemGIOncDoc
@elrefai_sara
‼️
✳️Also being mentee of an international PDAC expert
@EileenMOReilly
was helpful to put this together ☺️
✳️Some important
HER2 targeting for patients with CRC continues to evolve ‼️
✳️With recent data on the Mountaineer trial it is time to overview
#HER2
targeting for pts with CRC
@oncoalert
@manjuggm
@fireflyann
@CrcChange
Some important points to consider👇
Was great to be back to my medical school
#Hacettepe
University to meet with young and brilliant minds in person and chat about cancer science and academia❗️
✳️Exciting to see the future of science is bright with many young and dedicated physicians/scientists ‼️
✳️Ready for ASCO
#GI24
‼️
@ASCO
✳️Can’t wait to catch up with my mentors and colleagues from academia and pharma and brainstorm for concept development to move the field forward for patients with CRC, while learning about updates‼️
✳️Also excited that my mentees and I will be
✳️Alarming numbers for Early Onset Colorectal Cancer seen last year statistics (representing 2020) continues to be noted in this year statistics (representing 2021 data) while incidence in overall population continues to go down (effective screening for those >45)‼️
✳️CRC, once
The last day at work ✅
As a son of farmer family from small town Turkey, it was not a straight path and it won’t be❗️
I have chased my dreams/goals;will continue to do so and MLK’s inspiring words will continue to ring in my ears during this journey❗️
Our paper is out ‼️
✳️The study that we investigated prognostic markers of MSI-H CRC in a cohort of over 1100 patients is now published in the
@OncJournal
.
@CrcChange
@OncoAlert
@ElaineTanMD
✳️We identified age and BRAF mutations as prognostic markers ❗️
Pancreatic cancer stroma remains a dilemma for physicians scientist! In our study with
@EileenMOReilly
and Gokce Askan we identified that patients with dense stroma had lower cumulative local recurrence compared to pts with loose stroma! 👉
@OncoAlert
Made it home with this amazing news❗️
✳️Humbled to be the first author of the very first paper of CIRCULATE-US❗️
We discussed the rationale, study design and key tips of pts enrollment ❗️
@oncoalert
@EileenMOReilly
Was amazing to work Dr Dasari and Dr Lie ❗️True Honor❗️
A 6-2
📌TNT is not recommended for pts with MSI-H
#RectalCancer
!!
📌 Pts with MSI-H LARC may have dz progression with induction or consolidation chemo, not common in pts with MSS LARC.
📌NCCN now endorses ICI tx for MSI-H pts with intention for organ preservation
#CRCTrialsChat
A
@nature
paper suggests B-Hyroxybutyrate suppresses CRC and hereby ketogenic diet can be also considered for CRC treatment❗️
✳️The study is intriguing, yet many important points need discussion before concluding sugar fuels cancer👇
@OncoAlert
@CrcChange
✳️Completed my last clinic, and I have say it has been very emotional last few weeks and it was not easy to say good bye to my patients‼️
✳️Being oncologist is a true privilege and it was true honor being part of journey of my patients❗️They will remain in my prayers…
✳️ Colorectal is increasingly being a disease of younger population and we need more creative clinical trials ❗️
✳️ Here is the major discrepancy : Only ~6% patients living with CRC are enrolled in a therapeutic clinical trials and yet most of the precision medicine trials in
#ASCO22
✳️The standard of care for MMR-D rectal cancer is changing/changed❗️
✳️We should do all we can to avoid surgery for patients with MMR-D rectal cancer ❗️
✳️Although data is early and it is highly promising enough to move forward ‼️
@asco
@OncoAlert
@MoffittNews
👇
Immune checkpoint inhibitor therapy doesn’t only prolong survival outcomes but also improves quality of life of MMR-D/MSI-H colorectal cancer patients!
@OncoAlert
@MoffittNews
Wanted start my day with a clarification as I am getting messages from my patients due to incomplete media reporting‼️
✳️Dostarlimab was studied only Mismatch Repair Deficient Rectal Cancer seen only 5-10% only of pts‼️
@OncoAlert
@colontown
@CrcChange
Excited and thrilled to co-chair
#Pittsburgh
First Annual Gastrointestinal Cancer Symposium ❗️
👉With outstanding list of speakers and exciting topics, we will overview recent progress and provide a projection to the future of GI Oncology
@OncoAlert
@AnwaarSaeed3
@AmerZureikatMD
✳️It was first but also very memorable first in-person experience with
#IGICC
in Turkey with several GI Oncology giants from Europe and the US including Dr Van Cutsem, Dr Marc Peeter, Dr Philip Philip and Dr Ahmed Kaseb and several experts from the field
@AnwaarSaeed3
✳️Was amazing to meet
#KRASkickers
team today ‼️
✳️We agreed on continuing to work together to deliver cutting edge science to our patients ❗️
Thank you
@TerriConneran
❗️
@JanieYZhang
✳️So proud of my mentees who made it to all the way to SF to present their work ‼️
#GI24
They will be presenting their work in CRC from young onset CRC to molecular subgroups of CRC‼️
✳️Consider stopping by their posters‼️
@ASCO
@UPMCHillmanCC
@MasoodPashaSyed
✳️Starting to
#colorectalcancerawareness
with a great news ❗️
Our Editorial with
@manjuggm
@ARosen380
, Dr Seth Felder and Dr Jessica Frakes discussing the most recent updates on management of locally advanced rectal cancer and the PROSPECT trial is accepted for a publication ‼️
Our ASCO Educational Book Chapter is out!l Happy to see that in the first day of
#ASCO22
✳️We have discussed challenges of immunotherapy for MSS CRC and existing opportunities to move the field forward❗️
@OncoAlert
@ASCO
@manjuggm
@fireflyann
Here are some take home points
✳️Was exciting to join
#Alliance
GI committee meeting in-person and discuss and stay up to date on ongoing studies in the field and also create opportunities for collaboration to move the field forward !
Always true pleasure and honor catching up with my life long mentor
✳️So excited and ready to make it home after a busy but also quite productive meeting ❗️Was a memorable one indeed ‼️
#GI24
@ASCO
✳️Safe travels back to home everyone ‼️
Tried to carve T cell and Cancer cell interaction on my pumpkin 🎃❗️Well, would not say it was so successful even with extra help of antibody cucumbers 😄
✳️The AZUR-1 trial, testing the efficacy of dostarlimab for patients with MMR-D/MSI-H rectal cancer, is now open and enrolling at
@UPMCHillmanCC
‼️
✳️This trial will serve to patients in with
#lynch
syndrome and rectal cancer or those with sporadic MMR-D Rectal Cancer‼️ Please
#GI22
@ASCO
@OncoAlert
✳️ A Highly promising KRAS 12C inhibitor is on its way‼️
#Adagrasib
✳️Even though early result, 50% of PR is quite impressive ❗️
Congrats Dr
@GIcancerDoc
❗️
👉We need more RAS inhibitors for other RAS mutations for GI cancers…
✳️Was amazing to see with my twitter friends
@ARosen380
@CancerInsider
in person ☺️, such a privilege ❗️
✳️Was so happy to hear my twitter contents contribute to awareness on colorectal cancer ❗️
✳️Look forward to working closely and help our community ❗️
It was delightful to finish the long day by listening the pearls of targeting DDR pathway from my life long mentor Dr.
@EileenMOReilly
and Dr. Bekaii-Saab
@GIcancerDoc
!
Exciting studies in CRC
#GI22
@ASCO
👉CtDNA 📈 remains single most powerful prognostic factor for recurrence .
#CIRCULATE
Japan
👉patients who clear ctDNA after chemo do well while persistent ctDNA predicts poor outcomes❗️
👉 Conversion ➖ to ➕ also associated with worse DFS.
Immune checkpoint inhibitors have led to paradigm shift in MMR-D CRC management. In our multinational study we investigated predictor of IO therapy response :
@MoffittNews
@OncJournal
@OncoAlert
#ASCO22
#plenary
✳️The results of the PARADIGM trial was somewhat expected and was consistent with FIRE-3 trial ‼️
✳️Lack of improvement in PFS but improvement in OS perhaps driven by clonal selection process ‼️
@OncoAlert
@ASCO
@MoffittNews
#ASCO22
✳️I would like to do deep dive post ASCO analysis for some important CRC studies with cross comparison ‼️
✳️I think some studies did not get enough attention and also there is value elaborate more on future opportunities ❗️
@OncoAlert
@manjuggm
@CrcChange
✳️Svea, a medical student from
@PittTweet
will be presenting incidences of MAPK and mTOR pathway alterations seen in HER2 amplified CRC which is unique subgroup ‼️
#GI24
@ASCO
✳️Interesting findings indeed ❗️So proud of her ‼️
✳️It was interesting to read this article but I do think the title of this manuscript and conclusion is not reflecting each other very well ‼️
@OncoAlert
@manjuggm
@CrcChange
@fireflyann
Here is why 👇
👉Hard to believe that there are health insurances rejecting molecular profiling for cancer patients❗️❗️
👉While we advocate precision medicine to capture each single opportunity to make a chance in cancer patients life, looks like facts are not facing each other‼️
@OncoAlert
✳️Nivo&Ipi combination is moving to first line for MSI-H CRC as expected and we need a randomized trial❗️
✳️Interestingly, unlike KYN 177, RAS mutant MSI-H CRC pts seems like doing better than RAS wild type with Nivo&Ipi‼️
@CrcChange
@ASCO_pubs
@OncoAlert
Was such a great pleasure to meeting
@MyriamChalabi
@aparna1024
in person ❗️
✳️The progressive and bold move of Dr
@MyriamChalabi
to bring IOs to neoadjuvant space - years ago - should be a model for our oncology community❗️
✳️Look forward to follow footsteps of Dr
@aparna1024
❗️
#ASCO22
So glad to be back to in person after a long break
@ASCO
‼️
✳️Looking forward to reconnect with colleagues and mentors in person and discuss progresses in science more interactively ‼️
An important question is how to optimize BRAF targeting for patients with mCRC❗️
In fact, prescise approach for BRAF may impact outcomes❗️
✳️Therefore, it’s important define BRAF alterations to determine right therapy
@oncoalert
@CrcChange
@fireflyann
@manjuggm
Here is why👇
✳️Targeting therapy for BRAF V600E mutant CRC moving forward‼️
✳️The findings of the ANCHOR trial are promising but also suggests BRAF doublets/triplets may need to be combined with chemotherapy in the first line tx❗️
@ASCOPost
@CrcChange
@OncoAlert
#ASCO21
Excited for
@asco
2021 !!
#Early
CRC updates
@OncoAlert
👉Pembrolizumab doubled mPFS (16.5 vs 8.2 ms)-KYN177 ! OS favored Pembro yet not significant due to crossover!
👉HER2 targeting with Trastuzumab Deruxtecan /T-Dxd resulted in 43% ORR in pts with prior HER2 tx!
✳️Happy to see a concept I presented in CRC Task Force year ago for pts with BRAF V600E MSI-H CRC in refractory setting is now being brought to first line by
@pfizer
‼️
Happy to see this concept moved forward (without my involvement) as this is highly important for our patients
#ASCO22
✳️Would like to do my 3rd post
#ASCO22
analysis on neoadjuvant therapy for patients with colon cancer ‼️
✳️Beside, the OPTICAL trial, there is also growing interest for neoadjuvant approaches for colon CA, are we there yet? opportunities and challenges ?
@OncoAlert
👇