Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach treatment selection for patients with non-small cell lung cancer who have uncommon EGFR mutations compared to those with common mutations?
In patients with NSCLC, treatment decisions for uncommon EGFR mutations differ significantly from common mutations like exon 19 deletion and L858R. Treatment is personalized based on the specific type of uncommon mutation, which varies in its sensitivity to EGFR tyrosine kinase inhibitors (TKIs). Fo...
What chemotherapy regimen do you use for de novo metastatic squamous cell carcinoma of penile urethra?
Challenging cancer and prognosis; therapy with palliative intent (Nutrition and Palliative Care consults can help regardless of which therapy to use); in pure SCC of penile urethra, would likely consider platinum/gemcitabine or platinum/taxane as 1L therapy as a conventional chemo regimen with perio...
Would you consider the use of pembrolizumab + lenvatinib after progression on first-line carboplatin + paclitaxel + immunotherapy for metastatic endometrial cancer?
Yes, I think this is borderline standard of care now. Adding Lenvima to IO when the cancer recurs seems to usually at least obtain stable disease for a few more months, or even regression.
Have you utilized a dose-reduced approach for elderly patients receiving frontline Pola-R-CHP, similar to R-miniCHOP?
I have utilized a dose-reduced approach for Pola-R-CHP for patients who are elderly, whom I would normally treat with R-miniCHOP, based on the early safety data from the POLAR BEAR trial. This randomized trial compared pola-r-miniCHP to R-miniCHOP in patients >80 years of age or >/=75 with comorbid ...
Have you utilized a dose-reduced approach for elderly patients receiving frontline Pola-R-CHP, similar to R-miniCHOP?
I have utilized a dose-reduced approach for Pola-R-CHP for patients who are elderly, whom I would normally treat with R-miniCHOP, based on the early safety data from the POLAR BEAR trial. This randomized trial compared pola-r-miniCHP to R-miniCHOP in patients >80 years of age or >/=75 with comorbid ...
How do you approach patients with biochemical relapse of high-risk prostate cancer, with PSA doubling time less than 6 months?
This is a very thoughtful question. The assumption is that the patient has no evidence on conventional imaging by (CT/Bone scan) and BCR with rapidly doubling PSA after both prostatectomy and adjuvant XRT. The biology of these patients remains concerning and although STAMPEDE would include these typ...
If there is HER2-low discordance between primary and subsequent breast cancer biopsies, in which scenarios would you choose to use trastuzumab deruxtecan?
Because of the potential heterogeneity of HER2 expression, I would still offer T-DXd for these patients. In addition, HER2 IHC 0 may not exclude T-DXd activity based on the DAISY trial.
What adjuvant treatment would you recommend for a patient with FIGO 2023 IIIB2 endometrioid endometrial adenocarcinoma (Grade 3, p53mut, MMR proficient), metastatic to the uterine serosa, bilateral ovaries, and anterior peritoneal reflection?
Chemotherapy followed by pelvic RT
What are your top takeaways in Radiation Oncology from SABCS 2024?
Wine regions have good years and bad years. This year's vintage from San Antonio was exceptionally fine, with oral presentations of several important, highly anticipated trials. The second and third of the studies I will discuss were also published on the day of the oral presentation.1. GS2-03: Kunk...
Would you recommend enfortumab vedotin plus pembrolizumab for localized advanced non-invasive urothelial carcinoma of the renal pelvis?
Urothelial carcinoma of the renal pelvis is always challenging to stage and is often understaged. However, it would be difficult to justify systemic therapy with EV + P for non-invasive disease on the path. This patient will likely need upfront RNU followed by adjuvant therapy based on pathological ...