Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?
For extremities (e.g., the femur), if the pain is largely from structural instability, which resolves after surgical stabilization, then proceeding with systemic therapy without post-op RT would be very reasonable. On the other hand, if the patient is having persistent pain after surgery from the os...
Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?
For extremities (e.g., the femur), if the pain is largely from structural instability, which resolves after surgical stabilization, then proceeding with systemic therapy without post-op RT would be very reasonable. On the other hand, if the patient is having persistent pain after surgery from the os...
What risk factors would favor the addition of ovarian function suppression to endocrine therapy in triple-positive breast cancer?
Young age less than 40, node positive, high-grade, bulky tumor, or any patient at high risk of recurrence (requiring chemo) or residual tumor, I would favor giving ovarian suppression as per the SOFT and TEXT trial.
What is your approach to pregnant patients with type 2B von Willebrand disease, particularly when thrombocytopenia is already present?
The gist of this challenging clinical problem is that the high estrogen levels in the third trimester of pregnancy raise the VWF level normally. In type 2B VWD, this effect raises the level of the abnormal VWF, which clears more platelets from the circulation, and can lead to severe thrombocytopenia...
Would you use perioperative durvalumab in patients with diffuse-type gastric adenocarcinoma given no event-free survival benefit was seen for these patients in MATTERHORN?
Although MATTERHORN demonstrated a significant event-free survival benefit for perioperative durvalumab plus FLOT in the overall population, the forest plot does not show a clearly favorable signal in the diffuse-type subgroup. Because subgroup analyses are underpowered and not intended to confirm l...
How do you explain progression free survival to patients?
This is a really, really important question. I'd argue we often greatly undervalue the importance of communication with our patients and the impact the quality of our communication has on what they understand about their illness. I remember once having a long conversation with a patient where I outl...
How do you manage anemia associated with belzutifan therapy?
Anemia is a common toxicity with belzutifan. In a recent pooled safety analysis (Choueiri et al., The Oncologist KCRS Meeting 2024), anemia was seen in 84% of patients (any grade; 29% grade 3) with a median time to onset of 29 days. It is an on-target effect resulting from HIF regulation of erythrop...
How do you manage anemia associated with belzutifan therapy?
Anemia is a common toxicity with belzutifan. In a recent pooled safety analysis (Choueiri et al., The Oncologist KCRS Meeting 2024), anemia was seen in 84% of patients (any grade; 29% grade 3) with a median time to onset of 29 days. It is an on-target effect resulting from HIF regulation of erythrop...
Would you use adagrasib in combination with cetuximab for metastatic colon cancer with KRAS G12C mutation?
The NCCN guidelines were recently updated to include KRAS G12C inhibitors (adagrasib/sotorasib) in combination with anti-EGFR antibodies (cetuximab/panitumumab) for KRAS G12C mutant metastatic colorectal cancer. The majority of patients with this alteration obtain clinical benefit from this combinat...
Which imaging modality do you prefer when monitoring disease status for patients with prostate cancer undergoing 177-Lu PSMA treatment?
At the present time, I generally use contrast-enhanced CT of the chest/abdomen/pelvis and whole-body Tc-bone scan (every 12 weeks) for monitoring. While it is attractive to consider serial PSMA-PET imaging for monitoring disease response to 177Lu-PSMA-617, there is currently no FDA indication to use...