Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the preferred sequence of systemic therapy in a patient with endocrine resistant HR+ metastatic breast cancer?
Several factors can affect the next line of therapy in my view like disease free interval (DFI) before the patient developed metastatic disease, duration of response (if any) to prior endocrine with/without CDK4/6i, disease burden, patient's performance status and competing comorbidity. If the patie...
What are your top takeaways in Breast Cancer from ASTRO 2024?
There were a number of important presentations on breast cancer at the ASTRO 2024 meeting. The three randomized trial discussed below stood out.1. Abstract 1: Poppe MM, et al.: A randomized trial of hypofractionated post-mastectomy radiation therapy (PMRT) in women with breast reconstruction (RT CHA...
Would it be reasonable to offer a patient with CLL a treatment break from acalabrutinib or any BTK inihibitor after a period of time, assuming good response?
It is certainly reasonable to take breaks and I have done this for certain patients in my practice. For example, in older or frail patients whose disease is already under great control, I think it is reasonable to have a “drug holiday”. With continuous long-term use, it is almost inevitable to run i...
Would it be reasonable to offer a patient with CLL a treatment break from acalabrutinib or any BTK inihibitor after a period of time, assuming good response?
It is certainly reasonable to take breaks and I have done this for certain patients in my practice. For example, in older or frail patients whose disease is already under great control, I think it is reasonable to have a “drug holiday”. With continuous long-term use, it is almost inevitable to run i...
When would you consider testicular RT prior to TBI for BMT?
In children with ALL treated with systemic chemotherapy alone (no transplant), the risk of testicular recurrence is ~15-20% (Br J Haematol 2003;123:396, Br J Haematol 1998;102:656). In adults with AML treated with standard chemotherapy, with or without transplant using a chemotherapy alone condition...
When would you consider testicular RT prior to TBI for BMT?
In children with ALL treated with systemic chemotherapy alone (no transplant), the risk of testicular recurrence is ~15-20% (Br J Haematol 2003;123:396, Br J Haematol 1998;102:656). In adults with AML treated with standard chemotherapy, with or without transplant using a chemotherapy alone condition...
How do you use Boswellia for radiation necrosis?
I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:This study by Upadhyay et al. is a well-designed study which builds upon earlier studies...
Will you recommend pirtobrutinib following a prior covalent BTKi in patients with cardiac comorbidities?
In the MCL patients treated on the BRUIN trial, treatment was well tolerated in general with a low rate of treatment discontinuation or dose reduction. As far as cardiac toxicities, no grade ≥3 treatment emergent AEs of hypertension were observed. Atrial fibrillation/flutter (AF) was reported in 6 (...
Will you recommend pirtobrutinib following a prior covalent BTKi in patients with cardiac comorbidities?
In the MCL patients treated on the BRUIN trial, treatment was well tolerated in general with a low rate of treatment discontinuation or dose reduction. As far as cardiac toxicities, no grade ≥3 treatment emergent AEs of hypertension were observed. Atrial fibrillation/flutter (AF) was reported in 6 (...
What is your experience with the modified ramp-up of tarlatamab, where an extra 5 mg is given in the ramp-up phase before increasing to the full dose?
We have not attempted this approach and have had relatively little cytokine release syndrome (CRS) associated with the C1D8 10 mg dosing to suggest that a gentler step-up regimen is required. There are some reports that for patients with medullary thyroid cancer, a modified step-up dosing has been b...