Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are you comfortable combining palliative radiotherapy with capivasertib/fulvestrant?
Yes. Follow CBC
How will you select patients with brain metastases for TTFields?
The METIS trial restricted eligibility only to patients with brain metastases from non-small cell lung cancer. Therefore, we would not be able to extrapolate these results and data to other tumor types and histologies. Indeed, a post hoc analysis of the data did demonstrate a greater impact in patie...
When do you consider using protons for breast cancer?
I think there is a limited role for protons in breast cancer outside of prospective studies at this time.With respect to partial breast irradiation, while initial trials showed some higher skin toxicities, modern institutional series have shown much better outcomes. That being said, the total number...
For patients with high-volume hormone-sensitive prostate cancer, would you consider shortening the docetaxel course to 4 cycles to facilitate better tolerance?
My default here is always evidence-based medicine, in which 6 cycles of docetaxel were given as part of either concurrent triplet therapy (ARASENS or PEACE-1) or sequential triplet therapy (ARCHES, TITAN), without prednisone. For those who develop intolerance, a dose reduction or growth factor suppo...
Would you offer adjuvant chemotherapy/immunotherapy for resected pure squamous cell carcinoma (T2-T4 or N+/-) of the renal pelvis?
Primary or pure squamous cell carcinoma of renal pelvis is very rare and the role of adjuvant therapy after surgery is unknown. Squamous cell carcinomas in head-neck, anal and other sites, tend to recur locally. Based on that behavior, I would offer radiation with a sensitizer, preferably weekly cis...
What do you recommend for patients with stage 3 MSI-H colorectal cancer who are ineligible for oxaliplatin-based adjuvant therapy?
I typically don’t offer adjuvant therapy to those patients. 5-Fu/Xeloda does not benefit as a single agent in this patient population. If Oxaliplatin-based treatments cannot be given, then there are practically no other options that are associated with a survival benefit.
How do you determine your next line of therapy In ALK+ metastatic NSCLC patients who have widespread progression on first-line lorlatinib?
In general, with TKIs, it is critical to consider mechanisms of resistance. Broadly speaking, these can be categorized as on-target (e.g., ALK G1202R), off-target (e.g., MET gene amplification), or histologic/EMT changes (e.g., small cell transformation). Lorlatinib has excellent coverage of many on...
Do you consider co-prescribing hormone therapy and anticoagulation in a patient with prior DVT and uncontrollable VSM uncontrolled by non-hormonal therapies?
While I agree that you need to be thoughtful about adding additional VTE risk to patients with a history of VTE, I am much less concerned when patients are already on full-dose anticoagulation. Especially when the medication is transdermal estrogen, which has the lowest effect on thrombotic risk. I ...
What is your approach to AYA patients with B-cell ALL who relapse after CD19 CAR-T?
This is a somewhat nuanced question based on when the patient relapsed after CAR-T, what CAR-T product they received, whether the patient prior received hematopoietic stem cell transplantation (HSCT), other salvage therapies that were prior received as well as number of prior relapses. Multiple stra...
Do you perform genetic testing when patients have persistent hypogammaglobulinemia after rituximab therapy?
I would not routinely perform genetic testing. Multicenter studies (Labrosse et al., PMID 33862010; and Otttaviano et al., PMID 35892275) show that genetic testing returns a low yield, <5%. Several authors suggest that the risk of persistent hypogammaglobulinemia due to PID is increased if there is ...