Razelle Kurzrock, Founding Director at Michels Rare Cancers Research Laboratories, shared a post by Ahmet Dirican, Professor of Medical Oncology at Medicana International İzmir Hospital on X, adding:
“Can’t target every mutation. But can circumvent mutations. What is TMB – if high, use immunotherapy.
What is HRD? (Pt has BRCA so maybe high); use PARPi for synthetic lethality. Is her2 IHC high? Use Enhertu (ADC) etc etc.”
Quoting Ahmet Dirican‘s post:
A metastatic gastric cancer patient with rapid progression under chemotherapy.
Tissue vs liquid NGS.
Liquid biopsy shows:
- high ctDNA (52%) with multiple low VAF alterations (MAP2K1, NF1, BRAF non-V600, FGFR2, BRCA1 rearrangement)
Not seen in tissue. Likely chemotherapy-selected resistant subclones
So the question is:
- Can we target every mutation?
- Or are these just survival strategies?
This is not a mutation list – it’s an evolution map.
Are we treating the tumor, or chasing its evolution?”
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