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MedCaseCME @medcasecme.bsky.social · 28/02/2025

7/⚠️ Ms Reed has immune-related Grade 3️⃣ diarrhea (>7 BM day) 🧐 How would you manage this irAE❓ . . 👇Choose an option & learn the pros & cons of each👇 . .

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

6/🚨Important to differentiate irAE diarrhea & colitis Per CTCAE, irAE colitis is: Grade2️⃣blood & mucus in stool +abdo pain Grade3️⃣severe abdo pain w/ peritoneal signs 🗓️Onset is usually 6+ wks after Tx start

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

5/🔙 to Ms Reed 👩🏾‍🦱 🏥14 wks after starting on pembro+ carbo/gem she is hospitalized w/ profuse diarrhea (~9 BM/day) No⛔Hx IBD or recent travel ✈️ Stool test:⛔for C. difficile ⚠️Ms Reed & her hospitalist ask you ~ ❓Is this an irAE?

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

4/❗Compared w/ White pts, Black pts w/ #TNBC have: ⬇️ Lower frequency of germline BRCA1 mutations ⬆️ Increased risk for delayed ⏰ and/or incomplete Tx ⬆️ Increased risk of late-stage (III/IV) Dx ⬆️ Increased risk of mortality

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

3/👩🏾‍🦱 Meet Ms Reed 35yo Black woman w #mTNBC Tumor is PD-L1+ (CPS 10), HER2 low (IHC = 1+) 🚫No known germline BRCA mutation 🖌️Works as graphic designer On frontline pembro+carbo/gem for 14 wks

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/👇Activity Instructions👇 1️⃣Read ptℹ️ 2️⃣Take knowledge polls🟢 3️⃣Decide how to manage Ms Reed & learn the pros & cons of each option Activity is for HCPs/clinicians No side effect (AEs) reporting here.📞your 🥼or go to the product manufacturer’s site forℹ️

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

📢 all🩺#oncology #bcsm #MedSky #OncSky 🎯#TNBC patient case CME w/ @dr-rshatsky.bsky.social y.social & @ptarantinomd.bsky.social ✍️Supported by an edu grant from Gilead Sciences 🆓 #CME info 🔗 bit.ly/tnbc_casesim Provided by @bonumce.bsky.social 🖱️👇Scroll down to start

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/⛔Continuing pembro+ Rx loperamide is not a safe choice ✏️For Grade1️⃣diarrhea (<4 stools/day over BL, no other symptoms of colitis) it may be a possible option IF pts are closely watched for dehydration, chronicity, & progression 👇Pick again manage this irAE👇

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

➡️ CONTINUE pembro + prescribe loperamide

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/Holding pembro + Rx loperamide is not recommended for G3 diarrhea Per ASCO irAEs toxicity mgmt guidelines ✅Holding ICI & giving CS (not loperamide) for Grade <3 diarrhea 🛑but do not resume ICI until colitis Grade <1 & CS tapered to ≤10 mg/day 👇Click to continue 👇 . .

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

➡️HOLD pembro + prescribe loperamide

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

5/🔬Ms Reed’s molecular test results show: 🧬Germline BRCA mutations: negative 🧪Tumor IHC for HER2: 1+ 🚫No actionable mutations on ctDNA testing 🧐 Based on these results & SDM, which Tx would you recommend❓ . . 👇Choose an option & learn the pros & cons of each👇

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

4/🤝SDM w/ pts is essential for tx selection ❓Pt goals ❓Risk tolerance ❓Expected AEs 🎙Counsel on: ✅Common AEs like nausea & fatigue w T-DXd & SG ✅Serious AEs like ILD w T-DXd, hematologic AEs w SG ➡️ Discuss w/ pts that dose adjustments may be needed if AEs occur

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

3/🏥Ms Reed stabilizes w inpatient care & CS Unfortunately, the CT to evaluate her colon shows new 🫁mets Next steps: ⚕️Palliative care referral = improves outcomes when incorporated early in adv cancer care 🔬Review molecular test results 🤝 Shared decision-making discussion/s

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/👏Yes! ✅ The severity of Ms. Reed’s diarrhea means that holding pembro is the best choice while using methlyprednisone ✅ Continue CS until diarrhea <grade 1 ✅ Consider early 🕐 biologics if no CS response

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

➡️ HOLD pembro + prescribe oral prednisone

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/A good choice for some pts, but not🚫Ms Reed, who is BRCA-negative 🔧 Olaparib & talazoparib=PARP inhibitors ✅ Approved for Tx of germline BRCA-mutated #mTNBC (for olaparib, pts must have rec’d chemo in M0 or M1 setting) . 👇👇👇Try again & pick better tx for Ms Reed👇 . .

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/🚫 Eribulin is not the best option here 📌 Other agents outperformed eribulin and other single-agent chemo Txs in this setting based on pivotal trials . 👇👇👇Try again to select a better tx for Ms Reed👇 . .

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

5/✌️Want to explore if you had selected sacituzumab govitecan? 🖱️Click 👇 to see this treatment path ➡️ 🏁or to finish & claim #CME👇 🖱️Go to🔗bit.ly/tnbc_casesim 1️⃣View the resources🔖 2️⃣ Complete the posttest & eval to claim credit

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

6/ 🆕 CT scans show Ms Reed has stable Dz 🧪Serum lab tests show no relevant abnormalities or new safety signals 🎉Ms Reed feels well How would you proceed in managing Ms Reed? . . 👇Select an option below to continue 👇 . .

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

5/Ms Reed 👩🏾‍🦱 returns 9 wks after starting SG She has now received 3 cycles & should have a CT scan & repeat labs

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

4/🤔How does SG work? SG MOA =ADC that delivers SN-38, a topoisomerase I inhibitor that is a highly potent active metabolite of parent drug (irinotecan) SN-38 interacts w/ Top1 Prevents❌re-ligation of single strand breaks →tumor cell DNA🧬damage, apoptosis, & cell death💥

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

3/📊In ASCENT, PFS benefits w/ SG were seen across clin & demo subgroups ✅NCCN→SG pref'd 2L for #mTNBC (after >2 systemic tx, at least 1 for mets dz) 🆕data suggest G-CSF & loperamide prophylaxis⬇️AEs 👀 Monitor for neutropenia & diarrhea &⬇️dose as needed 🧑🏿‍🦲Alopecia common AE

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/ 👍 Yes! Sacitizumab govitecan is a good option for Ms Reed’s #mTNBC👩🏾‍🦱 🥇 SG is a first-in-class Trop-2 directed ADC ✅ Approved in 2020 based on phase 3 ASCENT study that met its PFS endpt ⭐ Trop-2, an oncogenic protein detected in >85% of TNBCs, is a new Tx target

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

➡️ Sacituzumab govitecan-hziy (SG)

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MedCaseCME @medcasecme.bsky.social · 28/02/2025

2/✋Stopping SG would not 🚫 be the best course of action 💎Ms Reed currently feels well 🤝As long as she has stable disease, treatment w/ sacituzumab govitecan should continue . . 👇Select “Continue SG” to move forward👇 . .

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