Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you reconcile the differing outcomes of the MATTERHORN and KEYNOTE-585 trials when determining systemic treatment approach for gastric/GEJ adenocarcinoma?
As it turns out, the outcomes are much more similar than dissimilar. While we all know MATTERHORN was a clearly positive study, KEYNOTE-585 was essentially also a positive study, obscured by a negative overall interpretation and undermined by its complicated statistical design.Specifically, 804 pati...
Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?
I had developed a policy during my last eight or ten years of practice evaluating how long patients should be treated after a thrombosis and I'd like to share some impressions over these years as well as conclusions that I reached. These conclusions formed the basis of my approach to this problem. I...
Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?
I had developed a policy during my last eight or ten years of practice evaluating how long patients should be treated after a thrombosis and I'd like to share some impressions over these years as well as conclusions that I reached. These conclusions formed the basis of my approach to this problem. I...
How do you manage sexual dysfunction in women receiving ovarian suppression for breast cancer?
Asking questions about sexual dysfunction during routine follow ups is important. Many women may feel uncomfortable bringing up the issue. Next important to evaluate contributors such as physical complaints of dryness, dyspareunia, or libido issues, body image concerns, or relationship concerns. Phy...
What duration androgen deprivation do you recommend with salvage pelvic radiotherapy for pelvic node relapse after prostatectomy?
6 months ADT, 2 years ADT, 2 years ADT + abiraterone/prednisone seems reasonable depending on the circumstances. For example, early pelvic node recurrence for pT3b Gleason 4+5 would be a higher risk than a very late recurrence of pT2 Gleason 3+3.
What is your approach for perioperative chemotherapy in MSI-H/dMMR localized gastric cancer?
This question gets at aspects of MSI-H biology, biomarker testing and post-hoc data from the MAGIC and CLASSIC trials suggesting a lack of benefit, and potential negative impact of treatment in MSI-H patients. The following is restricted to gastric cancer, and the rates of MSI-H in true esophageal a...
How do you manage the side effects of ropeginterferon alfa 2b for polycythemia vera patients?
Great question. Although ropeginterferon is better tolerated than other interferons, it is still associated with adverse events. If counts are controlled, I would recommend lowering the dose or spacing out the dosing interval, as that usually helps. For flu-like symptoms, I recommend pre-emptive man...
How do you manage the side effects of ropeginterferon alfa 2b for polycythemia vera patients?
Great question. Although ropeginterferon is better tolerated than other interferons, it is still associated with adverse events. If counts are controlled, I would recommend lowering the dose or spacing out the dosing interval, as that usually helps. For flu-like symptoms, I recommend pre-emptive man...
What would your initial treatment be for an elderly patient with metastatic HER2+ GEJ cancer with PD-L1 <5 who cannot tolerate any platinum agents?
The current standard-of-care is based on the KEYNOTE-811 study, which established the combination of pembrolizumab with trastuzumab and a fluoropyrimidine/platinum doublet for tumors with a PD-L1 CPS of 1 or more. Very recently, trastuzumab has been replaced in the first-line setting by the results ...
For metastatic cholangiocarcinoma that has progressed on first line chemotherapy and immunotherapy, that is HER2 3+, which HER2 regimen is preferred, TDxD, Zanidatamab or tucatinib/trastuzumab?
With the studies specific to cholangiocarcinoma with these agents and risk profile, I’d favor the bispecific Zanidatamab over the antibody drug conjugate T-DXd.Smolenschi et al., PMID 40319675The pneumonitis/ILD is still a black box warning for the ADC and varies between 5-15% depending on which stu...