Thor Halfdanarson
@oncothor.bsky.social
🇮🇸 🇺🇸 Medical Oncologist/Educator, NET/GI/CUP enthusiast. Husband/dad x4 (bad dad jokes). Cyclist. Avant gardener. Professor of Oncology, Mayo Clinic. Tweets mine, not endorsement/advice.
https://tinyurl.com/22w4kxjj
#NETsSky #MedSky #OncSky
https://tinyurl.com/22w4kxjj
#NETsSky #MedSky #OncSky
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...
ce.mayo.edu/hematology-a...
June 9, 2025 at 4:47 PM
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...
ce.mayo.edu/hematology-a...
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...?
April 9, 2025 at 1:29 PM
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...?
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-...
academic.oup.com/bjr/advance-...
March 26, 2025 at 3:01 AM
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-...
academic.oup.com/bjr/advance-...
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...
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...
March 25, 2025 at 6:10 PM
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...
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...
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.
March 21, 2025 at 1:13 AM
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.
He convinced me…. Temps in the mid 70s yesterday and now low 30s and flurries. Gotta love the early spring in Minnesota 😂
March 15, 2025 at 4:34 PM
He convinced me…. Temps in the mid 70s yesterday and now low 30s and flurries. Gotta love the early spring in Minnesota 😂
Why are you answering emails and working on a book chapter on a Saturday…? We could be out playing.
March 15, 2025 at 3:16 PM
Why are you answering emails and working on a book chapter on a Saturday…? We could be out playing.
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…
March 12, 2025 at 11:36 PM
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…
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...
Need better predictors of efficacy and tox
I have never been good at predicting...
February 23, 2025 at 6:06 PM
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...
Need better predictors of efficacy and tox
I have never been good at predicting...
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.
February 21, 2025 at 1:33 PM
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.
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
February 21, 2025 at 1:13 PM
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
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...
www.sciencedirect.com/science/arti...
February 18, 2025 at 11:25 PM
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...
www.sciencedirect.com/science/arti...
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/...
onlinelibrary.wiley.com/doi/10.1111/...
February 13, 2025 at 1:07 PM
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/...
onlinelibrary.wiley.com/doi/10.1111/...
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.
Lots of low-ish quality data and I left out the NABNEC data on nab-pacli + carbo.
February 10, 2025 at 4:43 AM
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.
Lots of low-ish quality data and I left out the NABNEC data on nab-pacli + carbo.
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.
January 31, 2025 at 5:47 PM
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.
It’s a beautiful day in the Mayo neighborhood…
January 30, 2025 at 7:00 PM
It’s a beautiful day in the Mayo neighborhood…
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
January 29, 2025 at 11:42 PM
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
Take good history and do a physical exam before ordering tests…
January 29, 2025 at 3:37 PM
Take good history and do a physical exam before ordering tests…
Another stressful morning commute…
Soundtrack provided by Sturgill Simpson… 🤠
Soundtrack provided by Sturgill Simpson… 🤠
January 29, 2025 at 3:36 PM
Another stressful morning commute…
Soundtrack provided by Sturgill Simpson… 🤠
Soundtrack provided by Sturgill Simpson… 🤠
I am not but are you...?
January 17, 2025 at 12:17 AM
I am not but are you...?
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...
oce.ovid.com/article/0000...
January 10, 2025 at 1:47 PM
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...
oce.ovid.com/article/0000...
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.
January 8, 2025 at 7:03 PM
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.
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
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
January 8, 2025 at 6:47 PM
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
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
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?
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?
January 7, 2025 at 7:36 PM
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?
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?