Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
How will the ADAURA study impact your use of adjuvant chemotherapy?
ADAURA has not and will not impact my use of adjuvant chemotherapy. Many prospective studies have demonstrated a clear significant improvement in overall survival with the use of adjuvant chemotherapy after complete surgical resection. This is standard of care for the appropriate patients. Osimertin...
In your practice, would you consider the all-oral option of decitabine-cedazuridine + venetoclax for an elderly, unfit AML patient, based on the ASCERTAIN-V trial results?
I see the combination of oral decitabine-cedazuridine (ASTX727) + venetoclax as largely being an appropriate option for any patient with newly diagnosed AML that would be otherwise considered for azacitidine + venetoclax. The inclusion criteria for ASCERTAIN-V (Roboz et al., PMID 42235013) and VIALE...
In your practice, would you consider the all-oral option of decitabine-cedazuridine + venetoclax for an elderly, unfit AML patient, based on the ASCERTAIN-V trial results?
I see the combination of oral decitabine-cedazuridine (ASTX727) + venetoclax as largely being an appropriate option for any patient with newly diagnosed AML that would be otherwise considered for azacitidine + venetoclax. The inclusion criteria for ASCERTAIN-V (Roboz et al., PMID 42235013) and VIALE...
Does TROP2 expression influence clinical decision-making for TNBC currently?
At this time, TROP2 IHC expression does not guide treatment selection for TROP2-directed ADCs in TNBC clinical practice. Exploratory biomarker analyses from ASCENT and TROPiCS-02 demonstrated that benefit from sacituzumab govitecan was observed across a range of TROP2 expression levels, without a cl...
Do you perform PDL1 and molecular testing for patients with stages I-III NSCLC?
Do you order PDL1 and molecular testing for patients with stages I-III NSCLC?When I answered this question about two years ago, I said no, primarily because there was no Level 1 efficacy data to support an improvement in outcomes for these patients. This has since changed... although in some ways, n...
Given the recently published results of PEACE 2, under what scenario would you offer pelvic radiotherapy for high-risk/very high-risk prostate cancer?
Although PEACE-2 was presented at GU ASCO, to my knowledge it has not yet been published other than in abstract form, and the results of the arms in PEACE-2 comparing prostate only vs whole pelvic RT were not presented, so I don't think PEACE-2 sheds any light yet on the question of whether or not t...
Are there any scenarios you would use CDK 4/6i to treat HR-positive HER2-positive breast cancer in combination with anti-HER2 agents?
There is a strong preclinical data demonstrating that CDK4/6 inhibition reduces the growth of HER2-positive breast cancer cell lines. However, we are still awaiting the results of phase 3 trials testing the addition of CDK4/6 inhibitors to systemic therapy for hormone receptor (HR) positive, HER2 po...
Are there scenarios that new visits/consults with patients can be done virtually amidst the COVID-19 outbreak?
Starting 3/16, we began offering lower-complexity / lower-risk patients the option of having a Tele-medicine consult vs re-scheduling to a later date. This offer has been extended broadly to all new consults at our facility when the provider indicates that s/he can extend comparable service virtuall...