Out now in @JCOOP_ASCO: our SR/MA of neutropenic diet (ND) vs liberalized diet (LD) in patients with cancer. 15 studies, 4,320 patients. ND vs LD: • Major infections: RR 1.02 (0.88–1.18) • Bacteremia/fungemia: RR 0.97 (0.78–1.22) • Pneumonia: RR 0.98 (0.59–1.63) • Diarrhea: RR 1.12 (0.96–1.31) • Mortality: RR 0.94 (0.77–1.15) RCT-only analyses were consistent. In heme/HSCT studies overall (9 studies; n=1,769), no difference across outcomes. One signal to not over-read or ignore: in RCTs limited to heme/HSCT (6 studies; n=855), ND was associated with lower bacteremia/fungemia (RR 0.67, 0.47–0.95), with no difference in the other endpoints. Bottom line: these data do not support routine ND for short-term neutropenia or lower-risk populations. Selected high-risk patients — particularly HSCT or prolonged neutropenia from hematologic malignancy — may still warrant a more cautious approach. Led by @Faresjamall. ascopubs.org/doi/full/10.120… @OncoAlert @TalalHilalMD @MayoCancerCare

Can't agree more with the discussion below! Replacing these pancreatic enzymes is important not just for symptomatic relief, but also to decrease the chance of oxalate nephropathy! This just came out in @BMJCaseReports where we describe a pt with #NET who d/t financial constraints was unable to consistently take pancreatic enzymes and had worsening kidney function; we confirmed the diagnosis of oxalate nephropathy as below. Led by @Faresjamall casereports.bmj.com/content/… As stated below, diarrhea in #NET is multifactorial but I typically think of three main things that need to be ruled out: 1- Secretory: get plasma 5-HIAA (has its limitation); tx: treat the disease +/- short acting SSA +/- telotristat 2-Bile acid diarrhea (BAD): get 7AC4; if abnormal, then colestipol (more pt friendly than cholestyramine). Note here: BAD can happen even in the absence of prior bowel surgery in #NET pubmed.ncbi.nlm.nih.gov/3436… 3-Pancreatic insufficiency: stool pancreatic elastase. If abnormal, then tx with pancreatic enzymes as prescription if possible (BIG problem here with $$; it is ridiculous that such therapy can be hundreds of dollars even with insurance! as @OncoThor mentioned, OTC options are available but unfortunately I only had rare success w that)

Grateful for a strong showing at #GI26 @ASCO, especially the outstanding work led by our trainees- 6 mentored posters (two with Merit Awards from @ConquerCancerFd) and 2 presentations. Looking forward to sharing updates from my investigator-initiated ACCRU 1810 study, Modeling analysis from RATIONAL305, LLM performance in CRC @IrbazRiaz , IO in dMMR gastric cancer, timing of immunotherapy, and more! #ASCOGI @MayoCancerCare @Faresjamall @sesayo @WallaceKleinS @angelopirozzi3 @BeOneMedicines

Tweet 1/9: Just out! Our paper evaluating FDA approval of GI cancers in the last two decades! Led by the our superstar research fellows @Faresjamall and Oudai Sahvan Detailed analysis of these approvals in terms of: types of studies, endpoints, and applying the ESMO-MCBS to evaluate the benefit! Let’s dive in… #GIonc #Oncology #FDAapprovals academic.oup.com/oncolo/arti… @GIcancerDoc @PedroUson @OncoAlert