Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How are you deciding between available third line therapies for post-transplant relapsed DLBCL?
If a patient relapses after an autologous stem cell transplant and is a candidate for CAR T-cell therapy, I would proceed with CAR T-cell therapy given longer follow up compared to bispecific antibodies, and thus a portion of the patient can achieve a durable complete response. For patients that rel...
In the era of MEK inhibitors and BRAF V600E-targeted therapy, what is the role of traditional vinorelbine/prednisone in the management of Langerhans cell histiocytosis?
A similar question came up during rounds this week, and I recalled seeing this question here.I assume the asker meant vinblastine, and not vinorelbine; the combination of vinblastine and prednisone is considered standard therapy, whereas vinorelbine has not generally been used in LCH.Let's first bet...
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
What factors do you use when selecting which NGS platform to use for sequencing solid tumors?
QNS rates are roughly comparable between vendors such as Caris, Tempus, FoundationOne. The presence of normal blood controls can help, but is not a criterion for complete exclusion of a platform for me. Many institutions have established workflow to send tests to a certain company for certain diseas...
Would you use T-DXd as a first-line agent for a patient who developed early metastatic relapse of HER2+ urothelial cancer shortly after standard perioperative chemo/immunotherapy, over other standard non-targeted treatments?
Currently, for first-line therapy in the metastatic setting, I would recommend enfortumab vedotin in combination with pembrolizumab, with T-DXd as a potential next-line option for patients with HER2 3+ IHC. However, there is still a need to see if HER2-targeted ADCs have a role in first-line.
Would you offer adjuvant AC + pembrolizumab for a triple negative breast cancer patient whose tumor progressed on carboplatin + paclitaxel + pembrolizumab on KEYNOTE-522 and required urgent surgery (ypT3 ypN0)?
In these situations, adjuvant AC should be considered. Anthracyclines have been shown to improve outcomes in high-risk TNBC in the adjuvant setting across multiple trials. CREATE-X used adjuvant capecitabine in patients who had residual disease after neoadjuvant anthracyclines and taxanes. It wasn't...
In rectal cancer patients receiving total neoadjuvant therapy, do you prefer chemotherapy followed by long-course chemoradiation, or short-course RT followed by chemotherapy?
We now have level 1 evidence showing the superiority of a few TNT regimens over standard chemoradiation->surgery->chemotherapy for these patients. There are going to be some stage II/III patients where TNT is overtreatment (ie, may be able to avoid the chemotherapy, radiation or surgery), but that c...
How does the latency from the original melanoma diagnosis affect your approach to neoadjuvant therapy in a patient with clinically detectable stage III nodal recurrence?
If the recurrence is less than 1 year from the end of prior anti-PD-1 immunotherapy treatment, that would be considered likely resistance to the therapy based on the Society for Immunotherapy of Cancer (SITC) expert consensus report on immunotherapy resistance (Kluger et al., PMID 36918224). Salvage...
How do you manage critically ill poor risk mixed germ cell tumor patients presenting de novo with extensive lung metastases and severe respiratory failure?
A few things. I would make sure the patient gets early brain imaging. I usually talk to the patient and family obviously about the severity of the condition, but also that ICU/intubation/ECMO might be needed over the course of treatment 1. I usually take the 3-day EP approach stop and watch for abou...