Mike Pishvaian

A HUGE thank you to @YAbdouMD and @prarthnavb for the interaction and engagement tonight. You presented a challenging case and enthusiastically answered our questions along the way. During TBT I wasn't sad about not being in Dallas tonight. But next week... next week it's…

Great work, on using ctDNA as a biomarker in pancreatic cancer! What’s the biggest challenge you see in bringing this approach into routine clinical use?

Camizestrant's PFS benefit in SERENA-6 could redefine 2nd-line ET sequencing. How are you implementing liquid biopsy for ESR1m monitoring?

#TumorBoardTuesday Thank you so much @YAbdouMD & @prarthnavb for this enlightening conversation on novel estrogen modifiers - we really learned a ton🧑‍🎓

Looks like they used a VAF cutoff of 0.5%! They used standard NGS assays that were highly sensitive. These have a limit of detection down to 0.1–0.5% VAF, with specificity >99%.

#PostTest Q2️⃣ #TumorBoardTuesday 👉🏽 Free CME 🔗 integrityce.com/TBT2025 True or false? Imlunestrant is associated with significant risks for photopsia and bradycardia

#PostTest Q1️⃣ #TumorBoardTuesday 👉🏽#CME Eval 🔗 integrityce.com/TBTeval25 👉🏽ALL CME🔗 integrityce.com/TBT2025 What is the next Tx for a 65 YO♀️w/ ER+/HER2- mBC progressing after 4 years of letrozole + palbo?

In addition, prior studies with elacestrant (EMERALD) showed that any detectable ESR1m (as low as VAF<1.2%) had the same therapeutic benefit. But yes, this is the issue of possible overRx if false signal by any chance.

That’s a great question! I would imagine that given these are acquired mutations, less likely to be artifact esp if there is exposure to AI.

10-15% in the phase 1/2 studies. HyperTG less common compared to hypercholesterolemia. Appears to be mostly Gr 1 and 2 . Seems lower so far. Not currently in clinical use fully so TBD.

Is imulunestrant not associated with elevated lipids unlike elasestrant? #tumorboardtuesday

18/18 #TumorBoardTuesday 👩‍⚕️Back to our case: 🩻 w/ new liver mets Triglyceride level of 300. Elacestrant not offered. Started imlunestrant + abema All-oral, grade 1 diarrhea but otherwise well-tolerated 6-month scan: stable liver mets, energy improved No chemo yet 🙌

Wouldn’t you wait and see with another LBx in a few weeks to see if the clone is persistent? What if it’s a testing artifact? Especially at very low VAF

I bit my tongue earlier because it does feel like everyone is getting ctDNA these days, off trial and on trial. But mostly off #TumorBoardTuesday

17/18 #TumorBoardTuesday 🌟Potential new std in early ESR1m–guided therapy? 🌟From progression–based decision-making ▶️ molecular alteration based intervention

This is phenomenal. Congratulations!

While very cool and forward thinking, raises cost, access, and overtreatment concerns.

16/18 #TumorBoardTuesday Time to QoL deterioration: Extended from 6.4 to 23m, ~1.5 years w/o symptom burden ‼️ 💊 discontinuation ⬇️ 💣Side effects: Bradycardia and Photopsia (mild & reversible)

Based on the hypothesis that molecular progression often precedes clinical progression. The rationale is that by identifying resistance mutations early (like ESR1), clinicians can switch from an aromatase inhibitor (AI) to a more effective therapy (like SERD) before overt…

15/18 #TumorBoardTuesday Camizestrant+CDK4/6i vs AI+CDK4/6i 🌟mPFS 16.0 vs 9.2m (HR 0.44) 🌟56% ⬇️ in risk of progression or death