Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Following the ECHO trial, are you routinely incorporating acalabrutinib plus bendamustine-rituximab into your frontline treatment approach for patients with MCL?
I routinely discuss the combination of BR+ acalabrutinib for my patients with TP53 WT disease, but am upfront that it is not a "once size fits all" approach. I discuss that we are clearly seeing a progression free benefit of adding acala to BR, but we don't actually know at this time if giving them ...
In which clinical situations, if any, would you still consider carboplatin-paclitaxel alone rather than chemoimmunotherapy for first-line treatment of metastatic squamous anal cancer after POD1UM-303/InterAACT-2?
I think there are still rare patients who have significant autoimmune conditions requiring DMARDs or steroids where I would forgo IO. Otherwise, would routinely offer.
Would you favor starting with pembrolizumab or chemotherapy for a metastatic MSI-high pancreatic ductal adenocarcinoma?
This is a great question. MSI-H status in PDAC is rare, about 1-2% of all PDAC (Luchini et al., PMID 32350089). Marabelle and colleagues published one of the initial studies using pembrolizumab in MSI-H solid tumors showing a response rate of 18.2% among PDAC (22 patients) with a median duration of ...
Would you offer empiric lung SBRT for two growing FDG-avid lung lesions in a patient with severe COPD on oxygen?
This is a good question! The short answer is yes, most likely. Many patients are too high-risk to receive biopsies; this is decided by surgery/pulm/IR. Unless the patient has contraindications to RT or something like severe IPF (where treatment may be worse than the disease), I would likely offer th...
How do you counsel patients and caregivers regarding management of cancer-associated cachexia?
ASCO guidelines re: anorexia/cachexia were just published in May 2020. Basically, they note the magnitude of the clinical problem and the limited therapeutic options proven to be helpful. They state that dietician consultation is reasonable to employ. They also note that it is reasonable for a clini...
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
The high volume patients who were getting chemo will be offered abiraterone provided the cost of the drug will be covered. I will hold off on the low volume patients for now- the median rPFS for the low volume patients on ADT alone on the GETUG 15 was 21 months. I would also not treat M0 patients . ...
How do the results of LIBRETTO-432 shape the potential role of adjuvant selpercatinib in patients with early-stage RET fusion-positive NSCLC?
The results of LIBRETTO-432 provide strong evidence to consider selpercatinib for patients with stage II-IIIA RET fusion-positive NSCLC, with a highly significant HR of 0.172 (0.058-0.59) for this cohort. When thinking about stage IB (tumors 3- 4 cm, T2b), most of these patients were not included in...
When do you suggest ovarian suppression for fertility preservation in premenopausal women receiving neo/adjuvant chemotherapy?
The benefit of ovarian suppression in young breast cancer patients should be looked into from two different aspects. First, the suppression of the ovary resulting in the hormone receptor-dependent cancer stem cell (minimal residual disease) suppression, and second, the preservation of the fertility ...
How do you choose which LHRH agonist or antagonist to prescribe for ADT in patients with prostate cancer?
The choice of LHRH agonist or antagonist depends on patient factors. Most patients receive some form of leuprolide or goserelin since these allow longer intervals between injections (as compared to degarelix). Goserelin is used more for those on anticoagulation or with bleeding disorders since it is...
How do you counsel a patient with NCCN favorable intermediate prostate cancer but a high risk Decipher score?
Active surveillance has become the preferred management strategy for most men with low-risk prostate cancer and is increasingly used in carefully selected patients with favorable intermediate-risk disease. However, men with IR PC have approximately a three-fold greater risk of tumor upgrading or pro...