Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Under which circumstances would you prefer ropeginterferon over hydroxyurea for patients with Polycythemia Vera?
The approval of ropeginterferon (Besremi) for the treatment of polycythemia vera (PV) without any restrictions was a welcome event for PV patients and their physicians. First, because this drug selectively targets the JAK2-mutated hematopoietic stem cell (HSC) responsible for PV and can produce comp...
Under which circumstances would you prefer ropeginterferon over hydroxyurea for patients with Polycythemia Vera?
The approval of ropeginterferon (Besremi) for the treatment of polycythemia vera (PV) without any restrictions was a welcome event for PV patients and their physicians. First, because this drug selectively targets the JAK2-mutated hematopoietic stem cell (HSC) responsible for PV and can produce comp...
How should immunotherapy be incorporated into the treatment strategy for patients with resectable stage III microsatellite instability–high (MSI-H) or mismatch-repair-deficient (dMMR) extrahepatic cholangiocarcinoma?
Great question, and one that we do not have clear data to support, but could certainly extrapolate. KEYNOTE 158 trial included 22 patients with advanced cholangiocarcinoma, and response was 40.9% with a median duration of response not reached (mOS 24.3 months; 6.5-NR) (Marabelle et al., PMID 3168255...
How would you treat a patient with POEMS syndrome with severe debilitating neuropathy?
This is an important question. Peripheral neuropathy is one of the mandatory criteria for a diagnosis of POEMS syndrome, and can range from mild paresthesias to devastating, wheelchair-bound neuropathy (Dispenzieri, PMID 37732822). What makes POEMS uniquely gratifying is that effective therapy can l...
What is your management approach for CAR-T induced motor neurologic deficits (cyclophosphamide/IVIG/steroids, etc.) and any prophylactic approach to an early, rapid rise in absolute lymphocyte count post CAR-T infusion?
Specifically, this seems to be a question around cilta-cel. There has been some recent guidance to consider pre-emptively starting dexamethasone if the absolute lymphocyte count rises above 3,000 in the period following CAR T administration. This partially stems from the observation that many of the...
Would you consider reserving CDK4/6 Inhibitors as second line treatment in patients with advanced HR+ HER2 negative breast cancer given SONIA and PALMIRA trial results?
Yes - in fact, based on the SONIA trial results, I believe that 1st-line administration of a CDK 4/6 inhibitor in combination with an AI should be reserved for patients in whom a rapid response to treatment is necessary due to symptoms or extent of disease, particularly those with extensive visceral...
In which breast cancer presentation would you consider earlier treatment with T-DXd, given the similar absolute PFS benefits seen with T-DXd in the DESTINY-Breast06 trial and DESTINY-Breast04 trials?
DESTINY-Breast06 was a head-to-head comparison, in the first-line chemotherapy setting for HR+ metastatic breast cancer, of T-DXd vs standard chemo (with 60% of patients receiving capecitabine and 40% of patients receiving taxane in the standard chemo arm). T-DXd had a significant PFS and ORR benefi...
In patients with metastatic hormone receptor-positive, HER2-low breast cancer, how many and which lines of therapy would you recommend prior to using trastuzumab deruxtecan?
In spite of the exciting results observed with trastuzumab deruxtecan in DESTINY-Breast04, endocrine based therapy continues to be the most appropriate first line choice for the majority of patients with hormone receptor-positive, HER2-negative disease, particularly as we are now seeing median overa...
In patients with Philadelphia-negative ALL who are transplant ineligible, is there any data to guide the duration of maintenance POMP therapy?
To my knowledge, there have not been any prospective trials in the modern era that specifically address the issue of the duration of maintenance therapy in adults with ALL.Most regimens that have been studied provide a timeframe over which maintenance therapy should be administered, and nearly all h...
In patients with Philadelphia-negative ALL who are transplant ineligible, is there any data to guide the duration of maintenance POMP therapy?
To my knowledge, there have not been any prospective trials in the modern era that specifically address the issue of the duration of maintenance therapy in adults with ALL.Most regimens that have been studied provide a timeframe over which maintenance therapy should be administered, and nearly all h...