iiinova — where your digital self keeps evolving

Thor Halfdanarson @oncothor.bsky.social · 09/04/2026

Rage, rage against the dying of the light… False spring #6 this year in Rochester. How was your commute home from work…?

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Thor Halfdanarson @oncothor.bsky.social · 09/06/2025

Want a quick update in medical oncology on July 19 (with some heme updates in the mix)...? If so, we have the course for you! I can promise excellent content/speakers and there is a livestream (virtual) option too for those who cannot attend in person. ce.mayo.edu/hematology-a...

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Thor Halfdanarson @oncothor.bsky.social · 09/04/2025

Trying to summarize nuanced treatment decisions in one slide... What to do with small NF-pNETs? Who to observe? When to intervene...? What am I missing/getting wrong...?

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Thor Halfdanarson @oncothor.bsky.social · 26/03/2025

What's happened in imaging for CUPs in the last decades, where are we now and where might we be going...? Very good overview with detailed tables of detection rates for different modalities. The stuff you need for your next talk or paper on CUP... academic.oup.com/bjr/advance-...

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Thor Halfdanarson @oncothor.bsky.social · 25/03/2025

In case you needed a reminder of the not-so-predictable somatostatin receptor expression of lung NETs, here you have it... Keep in mind that only 44% had uniformly positive SSTR expression and some have none at all like this patient. jnm.snmjournals.org/content/64/1...

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Thor Halfdanarson @oncothor.bsky.social · 21/03/2025

CUP oncology is increasingly precision oncology. Patient in 60s, extensive BRG-1 deficient undifferentiated poorly diff carcinoma of unknown primary. Near complete but not durable response to docetaxel/cisplatin/pembro followed by durable response to adagrasib for KRAS G12C mut.

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Thor Halfdanarson @oncothor.bsky.social · 15/03/2025

He convinced me…. Temps in the mid 70s yesterday and now low 30s and flurries. Gotta love the early spring in Minnesota 😂

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Thor Halfdanarson @oncothor.bsky.social · 15/03/2025

Why are you answering emails and working on a book chapter on a Saturday…? We could be out playing.

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Thor Halfdanarson @oncothor.bsky.social · 12/03/2025

It may still be dull, gray and brown but spring is in the air in Minnesota. Unseasonably warm day, the fields are freshly tilled and I am off today. What better than a good dose of gravel riding. Just what the doctor ordered…

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Thor Halfdanarson @oncothor.bsky.social · 23/02/2025

Preparing for the ENETS annual conference next month. Here is a simplified vision of what might be the future in the world of radioligand therapy for NETs (RLT which I now prefer over PRRT as a term...). Need better predictors of efficacy and tox I have never been good at predicting...

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Thor Halfdanarson @oncothor.bsky.social · 21/02/2025

If you needed a reminder of the poor outcomes of patients with NECs, here you go. The current approach of platinum/etoposide yields the same disappointing results as in prior studies and outcomes of 2nd line therapy are poor. Better therapy sorely needed.

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Thor Halfdanarson @oncothor.bsky.social · 21/02/2025

This is a valuable study on the changing epidemiology of colorectal NENs. Not surprisingly, there is increase in the incidence of well diff NETs but the incidence of NECs remains the same. Also not surprisingly, outcomes of colorectal NECs are poor. #oncsky

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Thor Halfdanarson @oncothor.bsky.social · 18/02/2025

Liver resection in patients with high-grade neuroendocrine neoplasms, should that be considered...? Pts with G3 NET & NEC certainly have inferior outcomes but some may benefit from surgical debulking. Who are these patients? How can we better select? #oncsky www.sciencedirect.com/science/arti...

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Thor Halfdanarson @oncothor.bsky.social · 13/02/2025

Is the other ALT, alternative lengthening of telomeres, ready for routine use in pts w/ resected panc NETs...? I think so. In this study of large pNETs (≥3cm), ALT+ provided added prognostic info on recurrence but was not associated with OS. #oncsky onlinelibrary.wiley.com/doi/10.1111/...

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Thor Halfdanarson @oncothor.bsky.social · 10/02/2025

Can the therapy of grade 3 neuroendocrine neoplasms be distilled down to a single slide? Not sure, but here is my attempt for the upcoming NANETS Regional Conference in Mexico City next weekend... Lots of low-ish quality data and I left out the NABNEC data on nab-pacli + carbo.

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Thor Halfdanarson @oncothor.bsky.social · 31/01/2025

Unusual NET imaging this week: Tiny small bowel NET with metastasis to the right masticator space... Also a reminder that tiny sbNET primaries can have substantial mesenteric nodal mets. Stable without therapy but lanreotide was discontinued to to recurrent hypoglycemic episodes.

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Thor Halfdanarson @oncothor.bsky.social · 30/01/2025

It’s a beautiful day in the Mayo neighborhood…

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Thor Halfdanarson @oncothor.bsky.social · 29/01/2025

Just a reminder that NETs are radiosensitive tumors. Locally advanced, nonmetastatic, unresectable (extensive vascular involvement, cavernous portal vein transformation) G2 pancreatic NET (Ki67 9%). CAPTEM x12 with good partial response, followed by CRT with capecitabine. 23 mos post CRT #OncSky

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Thor Halfdanarson @oncothor.bsky.social · 29/01/2025

Take good history and do a physical exam before ordering tests…

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Thor Halfdanarson @oncothor.bsky.social · 29/01/2025

Another stressful morning commute… Soundtrack provided by Sturgill Simpson… 🤠

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Thor Halfdanarson @oncothor.bsky.social · 10/01/2025

Cystic panc NETs seem to have better prognosis than solid pNETs. Certainly not new info but by far the largest study I have seen and very clinically relevant. Can we observe localized cystic pNETs 3 cm and smaller...? oce.ovid.com/article/0000...

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Thor Halfdanarson @oncothor.bsky.social · 08/01/2025

The majority were pure PACC but 17% PACC/NEC. ORR 73% w/ chemo + RT in localized disease. PFS and OS 108 and 27.3 mos in metatstatic disease on FOLFIRINOX. Molecular alterations common, most commonly HRD, both somatic and germline.

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Thor Halfdanarson @oncothor.bsky.social · 08/01/2025

Need info on the rare acinar cell carcinoma of the pancreas (PACC)? 48% with resectable tumors and 5-yr OS following resection was 72% Outcomes of pts w/ metastatic and unresectable PACC are poor, 5-yr OS of 21%, seemingly better than PDAC. ascopubs.org/doi/pdf/10.1... #OncSky #HPBSky

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Thor Halfdanarson @oncothor.bsky.social · 07/01/2025

VIPoma... or not...? 60ish yo patient, worsening loose stools up to 5x/d, sometimes watery, most days of the month ≤ 3 BMs. Imaging below. VIP level 204 (ref:<89). EUS biopsy: Grade 1 NET. No mets but no SSTR PET yet. A few questions: 1) VIPoma or not? 2) Need for SSTR PET?

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Thor Halfdanarson @oncothor.bsky.social · 03/01/2025

If anyone needs a good fig on nodal mets in panc NETs and how size affects the risk, here you go. Nothing new, no surprises there. Bigger tumors/higher grade -> more nodal mets. Some other goodies in there too... www.sciencedirect.com/science/arti...

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Thor Halfdanarson @oncothor.bsky.social · 24/12/2024

Should I be staying in my lane of medical oncology…? Should a middle aged medical oncologist who still reads medicine outside of his specialty see a professional for help…? 😜 I still think clinical medicine is the best job in the world, regardless of your specialty…

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Thor Halfdanarson @oncothor.bsky.social · 24/12/2024

Happy shortest commuting day of the year, for me at least as I was not working this weekend. The days are getting longer, or so I am told…

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Thor Halfdanarson @oncothor.bsky.social · 09/12/2024

Just finished a wonderful trip to my old stomping grounds at the University of Iowa to lecture on CUPs. Did you know, they are looking for a NET oncologist…? If you or someone you know is interested, please check them out. That’s the institution that started my NET career 😍

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Thor Halfdanarson @oncothor.bsky.social · 07/12/2024

Delicious December day! Not many of those. Also, an opportunity to increase my fiber consumption…

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Thor Halfdanarson @oncothor.bsky.social · 06/12/2024

Life expectancy in the 10 Americas. Striking differences with a decrease in life expectancy in recent years, with a notable drop during COVID. In 2001, the gap in life expectancy between Americas was 12·8 years for females and 15·4 years for males. www.sciencedirect.com/science/arti...

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Thor Halfdanarson @oncothor.bsky.social · 05/12/2024

Today in clinic: Patient with h/o resected typical bronchial carcinoid (please, don't get me started on the terrible lung NET terminology and classification) 20 years ago. Presented with tachycardia and was found to have tricuspid and pulmonary valve regurgitation. New imaging:

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Thor Halfdanarson @oncothor.bsky.social · 02/12/2024

I guess I am armed and dangerous now, having access to digital pathology (without the knowledge to interpret what I see...). Below are pics, selected by an oncologist (married to a non-practicing pathologist who is not on BlueSky). Gotta love digital pathology, especially at tumor boards.

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Thor Halfdanarson @oncothor.bsky.social · 02/12/2024

ENETS has excellent guidance on the management of colorectal NETs including on use of imaging. Rectal NETs increasingly diagnosed on screening colonoscopies - mostly resected endocopically at a small size and are G1 and do not need further imaging. onlinelibrary.wiley.com/doi/10.1111/...

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Thor Halfdanarson @oncothor.bsky.social · 02/12/2024

Please approach grade 2 and/or >10 mm rectal NETs with caution. 10 mm rectal NET found on routine colonoscopy, resected endoscopically w/ pos deep margin, Ki67 9%. Pelvic MRI with rectal mass larger than appreciated and perirectal and pelvic nodal mets as per below.

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Thor Halfdanarson @oncothor.bsky.social · 28/11/2024

One of my imaging workhorses in the NET clinic, the CT enterography (CTE). Nothing better to visualize small NETs in the ileum. This patient has at least 30 small lesions that have been stable over many years and monitored with annual CTE. 50% or more of sbNETs are multifocal.

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Thor Halfdanarson @oncothor.bsky.social · 23/11/2024

Oral presentations at @nanets.bsky.social #NANETS24 ongoing. Two young/early career researchers, Lizeth Estrada (med student at UCSF School of Medicine) and Dr. Rushabh Gujarathi (post-doc scholar at U of Chicago). Both presenting for the first time at a conference. The future is bright! #NETsSky

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Thor Halfdanarson @oncothor.bsky.social · 23/11/2024

Chicago night scenes… a little night walk break from #NANETS24

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Thor Halfdanarson @oncothor.bsky.social · 23/11/2024

Outstanding session on systemic therapy for NETs at #NANETS24 @nanets.bsky.social Impressive lineup of speakers including a superb presentation by Dr. Rocio Garcia-Carbonero, the Chair of ENETS. We need better drugs, better predictive markers, and better trial designs. #NETsSky #OncSky

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Thor Halfdanarson @oncothor.bsky.social · 22/11/2024

Is PRRT safe in patients with NETs and extensive bone metastases…? Excellent presentation by Dr. Osama Mosalem at Mayo Florida @nanets.bsky.social 2024. Higher G3/G4 heme tox (29%), some persistent heme tox but no signal of increase in treatment related myeloid neoplasia. #NANETS24 #NETsSky #OncSky

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Thor Halfdanarson @oncothor.bsky.social · 22/11/2024

Where should we place cabozantinib in the treatment algorithm of patients with NETs. Excellent review by Dr. Bhavana Konda from Ohio State University. #NANETS24 #NETsSky

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Thor Halfdanarson @oncothor.bsky.social · 22/11/2024

Good morning, Chicago! Are you ready for day 2 of the @NANETS1 Annual Symposium? A day packed with exciting presentations ahead! #NANETS24 #NETsSky #OncSky

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Thor Halfdanarson @oncothor.bsky.social · 21/11/2024

The 2024 NET year in review. Fantastic presentation by Dr. Jennifer Chan at Dana Farber. Lots of things happening on many fronts, basic/translational science, trials, genomics, population science and more. If you see NET patients, consider joining @nanets.bsky.social #NetSky #OncSky #NANETS24

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Thor Halfdanarson @oncothor.bsky.social · 21/11/2024

Outstanding session on career development by an impressive lineup of speakers including @cancerassassin1.bsky.social, Claire Mulvey, Nikos Trikalinos and Emily Bergsland. More sessions of this kind, please! @nanets.bsky.social #NANETS24 #NETsSky

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Thor Halfdanarson @oncothor.bsky.social · 21/11/2024

And it is on! @nanets.bsky.social - NANETS annual symposium has started. What better way to start than have a concurrent career development session and surgical therapy session. Looking forward to 3 exciting days of all things NETs and meeting friends. #NANETS24 #NETsSky

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Thor Halfdanarson @oncothor.bsky.social · 18/11/2024

Classic NET imaging from the Monday clinic. Notice the arterial enhancement of the primary small bowel NET with the corresponding SSTR avidity on the PET. The nearby densely calcified lymph nodes have much less avidity and are likely very fibrotic. No symptoms, observed. #NETSky #OncSky

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Thor Halfdanarson @oncothor.bsky.social · 16/11/2024

New winter wheels 😀. Shakedown ride done, now bring me some snow and lots of it…

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Thor Halfdanarson @oncothor.bsky.social · 13/11/2024

OK, here is the inaugural Bluesky post. Much needed cycletherapy in sunny Scottsdale after the Mayo HPB cancer meeting in Las Vegas. Appropriate hydration afterwards.

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