Internal Medicine 🩺 Oncologist 🦀 GI Cancer Fellowship @INCanMX Interest in clinical research & immunotherapy 🧬 México 🇲🇽
México
Joined July 2011
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🧬 NICHE-2 | Phase II | dMMR colon cancer 🇳🇱
👥 111 pts | Nivo + ipi → surgery
🎯 3-y DFS 100%
📈 5-y OS 100%
🩸 ctDNA clearance 82% pre-op
✅ All ctDNA− post-op
⚠️ Single-arm trial
💡 Remarkable long-term outcomes!
🔗 doi.org/10.1016/S0140-6736(2…
@OncoAlert
Elí con acento en la í retweeted
Gastric and oesophageal cancer: @myESMO Clinical Practice Guideline for diagnosis, treatment and follow-up†
annalsofoncology.org/article…
🌐 Jennifer A. Ligibel et al. ASCO Guideline. J Clin Oncol 40, 2491-2507(2022).
🌐 Mustian KM, et. al. JAMA Oncol. 2017;3(7):961–968.
🌐 Steen C, et. al. J Psychosom Res . 2025 Apr:191:112084.
🌐 Kelly M, et. al. American Family Physician. 2023;108(1):58-69.
8) 😩 En fatiga crónica, individualizar por síntoma predominante (dolor, sueño, niebla mental, intolerancia ortostática)
7) ⚠️ Priorizar: un fármaco a la vez con objetivo claro y tiempo de prueba definido
Si ⛔️ = suspender
Evitar polifarmacia
6) 💊 Fármacos: Aprobados SÓLO si el ejercicio/TCC no funcionan:
- Psicoestimulantes (metilfenidato)
- Corticoides (corto plazo)
- ISRS (depresión asociada)
- Eritropoyetina (anemia)
5) 📊 Metaanálisis JAMA Oncology:
Intervenciones conductuales (ejercicio, psicológicas) superan a los fármacos en el manejo de la fatiga relacionada con cáncer y no oncológica
3) 🧠 TCC: reduce la fatiga a mediano y largo plazo, ayuda a romper conductas que la perpetúan
4) 🧘 Mindfulness y yoga: ASCO/SIO, ESMO, NCCN para fatiga oncológica
- Beneficio sostenido a 3-6 meses
2) 🏃 Ejercicio físico en cáncer ➡️ reduce la fatiga moderada durante el tratamiento (mama, colon, pulmón, próstata, hematológicos)
1) No siempre requiere un fármaco ✋💊
- Ejercicio físico y la terapia cognitivo-conductual (TCC) = mejores intervenciones con mayor respaldo científico
⚕️Tratamiento de la Astenia / Fatiga: lo que dice la evidencia 📚
✴️ Astenia: sensación subjetiva de cansancio o falta de fuerza que ocurre incluso sin esfuerzo físico o mental previo
✴️ Fatiga: cansancio que aparece como consecuencia de un esfuerzo físico o mental
🧵...
⛰️ MATTHERHORN Final results❗️
🧬 MATTERHORN | Phase III | Resectable GC/GEJ
👥 948 pts
💊 Periop durvalumab + FLOT vs FLOT
🎯 pCR 19% vs 7%
⏳ 2-y EFS 67.4% vs 58.5% | HR .71
📈 3-y OS 69% vs 62% | OS HR .78, P=.021
💡 New perioperative SoC.
🔗 doi.org/10.1016/S0140-6736(2…
@OncoAlert
🎊 Daraxonrasib Is now FDA-approved in 2L mPDAC 🎊
🤔 But.....what exactly means "who are not candidates for multiagent therapy"?
Is it a 1L half-open door? 🚪
❓☝️
Something caught my attention in the FDA approval of daraxonrasib.
The label includes patients who received ≥1 prior systemic therapy, consistent with RASolute 302, but also patients who are “not candidates for multi-agent systemic therapy.”
Does this effectively extend the approval into the first-line setting for patients considered unfit for multi-agent chemotherapy?
If so, how is “not a candidate for multi-agent systemic therapy” defined in practice?
It seems the FDA label may go beyond the RASolute 302 population—which may be clinically reasonable, but I’m not sure I’m interpreting it correctly.
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ESMO Clinical Practice Guideline Express Update on daraxonrasib in the treatment of metastatic pancreatic cancer
@Annals_Oncology
doi.org/10.1016/j.annonc.202…
👉pan-RAS(ON) inhibitor daraxonrasib included in second-line therapy
@myESMO
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Advanced Well-Differentiated G1–G2 GI-NET — A Simple Treatment Roadmap
Treatment is driven largely by SSTR expression, grade, tumour burden, pace of disease and need for response.
🟢 Low-burden, indolent disease → observation may be reasonable in selected patients.
🟢 SSTR+ indolent G1/lower G2 → SSA remains the backbone — PROMID, CLARINET.
🟢 SSTR+ higher G2 / bulky disease needing response → consider ¹⁷⁷Lu-DOTATATE + SSA — NETTER-2.
🔴 Progression on SSA → PRRT for appropriate SSTR+ disease — NETTER-1.
🟢 After PRRT / when PRRT is unsuitable → cabozantinib or everolimus — CABINET, RADIANT-4.
🟣 Axitinib + SSA has phase III evidence in extrapancreatic NET — AXINET — but importantly, the primary investigator-assessed PFS endpoint was not met.
🟢 SSTR-negative disease → targeted therapy rather than PRRT.
🟢 Liver-dominant bulky/symptomatic disease → consider liver-directed approaches in selected patients.
The simple principle:
SSTR+ quiet → SSA | SSTR+ aggressive → PRRT | Progression → PRRT/targeted therapy | SSTR− → targeted therapy
Applies to advanced well-differentiated GI-NET; not pancreatic NET or poorly differentiated NEC.
#NeuroendocrineTumors #GINET #PRRT #GIOncology #MedicalOncology #MVOnco
