Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you give chemotherapy and trastuzumab to a patient with multifocal high grade, microscopic (<5 mm) HR-, HER2+ IDC embedded in extensive DCIS, staged as pTis pT1a(m) N0?
The data is limited, especially in extensive high grade DCIS with microinvasion that is HER2 positive and the decision must build on the balance of benefit vs risk of treatment.In extensive DCIS with multifocal T1a as described in this question, I don't hesitate to recommend adjuvant chemotherapy wi...
Is there any role for elacestrant in patient who have received prior fulvestrant if they have ESR1 mutation?
The short answer is Yes!! The pivotal EMERALD trial that led to the approval of Elacestrant (oral Selective Estrogen Receptor Degrader) did enroll patients who previously received Fulvestrant (Faslodex). In a pre-planned subgroup analysis of EMERALD data, benefit of Elacestrant was seen even in subg...
How will you utilize the PARADIGM study results from ASH 2025, comparing azacitidine/venetoclax to intensive induction chemotherapy for fit patients with newly diagnosed AML?
It was very exciting to see PARADIGM presented as a plenary at ASH, and I look forward to the manuscript! Interpreting the findings in the context of the enrolled patients is very important. The median age of enrolled patients was approximately 65 years in both arms, and ~75% of enrolled patients ha...
How will you utilize the PARADIGM study results from ASH 2025, comparing azacitidine/venetoclax to intensive induction chemotherapy for fit patients with newly diagnosed AML?
It was very exciting to see PARADIGM presented as a plenary at ASH, and I look forward to the manuscript! Interpreting the findings in the context of the enrolled patients is very important. The median age of enrolled patients was approximately 65 years in both arms, and ~75% of enrolled patients ha...
Does the presence of paraneoplastic pemphigus influence your treatment options in CLL?
Paraneoplastic pemphigus is often difficult to treat, and if traditional measures do not control it, I often will use continuous therapy for CLL to both eliminate the disease and continue suppressing the autoimmune source of this paraneoplastic complication.
Does the presence of paraneoplastic pemphigus influence your treatment options in CLL?
Paraneoplastic pemphigus is often difficult to treat, and if traditional measures do not control it, I often will use continuous therapy for CLL to both eliminate the disease and continue suppressing the autoimmune source of this paraneoplastic complication.
Would you still offer durvalumab after chemoradiation in patients with stage III NSCLC whose treatment was delayed due to prolonged recovery from chemoradiation?
The PACIFIC study, which evaluated the use of durvalamab after completion of chemotherapy and radiation (both sequential and concurrent) is a landmark trial demonstrating improved survival for those receiving immunotherapy. The design of the study required that durvalamab commence within 42 days of ...
What factors should be considered when deciding whether to omit radiation in pediatric/AYA patients receiving N+AVD, particularly regarding long-term outcomes and second malignancy risks?
Based on the early data from S1826, it appears that radiation can be omitted if end-of-therapy scans (after 6 cycles of therapy) show metabolic remission of disease. The ability to limit RT to 1% of patients is encouraging for potential reduction in late effects such as cardiovascular disease and SM...
What factors should be considered when deciding whether to omit radiation in pediatric/AYA patients receiving N+AVD, particularly regarding long-term outcomes and second malignancy risks?
Based on the early data from S1826, it appears that radiation can be omitted if end-of-therapy scans (after 6 cycles of therapy) show metabolic remission of disease. The ability to limit RT to 1% of patients is encouraging for potential reduction in late effects such as cardiovascular disease and SM...
Would you offer immunotherapy in addition to chemotherapy and trastuzumab for patients with metastatic HER2 positive gastroesophageal cancer with low PDL1?
Very recently, trastuzumab has been replaced in the first-line setting by the results of the HERIZON-GEA-01 study, which evaluated zanidatamab, a bispecific/biparatopic antibody against 2 epitopes of HER2. This study randomized patients to the control arm of trastuzumab/chemotherapy (Arm A) versus z...