Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage HHT with ongoing epistaxis despite IV bevacizumab, with a history of superficial thrombosis?
This is a complex situation with a complex answer, and the patient would likely benefit from establishing care at one of the 30 HHT centers of excellence for a more thorough evaluation. If the patient mentioned has only had cautery, we would consider them seeing an ENT at an HHT center of excellence...
Can you use immunotherapy in patients with liver transplants?
Treating metastatic melanoma in the setting of organ transplantation is indeed difficult. I work with the transplant physicians to reduce immune suppression as much as possible and see if the mTOR inhibitors can be used. I would be sure to explore all targetable mutations (BRAFV600E or K, c-KIT) an...
How do you counsel glioblastoma multiforme patients on which types of clinical trials to pursue?
This is a great question! In general, I think that a clinical trial gives someone access to promising therapies (and of course glioblastoma is an aggressive tumor for which we have no cure), but enrolling in one may not feel like the right decision for all patients (for a variety of reasons). I thin...
How would you treat a patient with ER/PR positive breast cancer with a single site of bone metastasis?
I would still treat with hormone therapy and a CDK 4/6 inhibitor. Not clear if the question refers to denovo disease or not. I generally do not treat asymptomatic bone mets with radiation, as there are late effects in patients who have a relatively long life expectancy and no data to suggest that ra...
Are you routinely recommending adjuvant ribociclib now for node-negative HR+/HER2- breast cancer given data from the NATALEE trial?
Yes, I offer eligible node-negative patients, as defined by the NATALEE trial criteria, with anatomic stage II or III hormone receptor-positive breast cancer node-negative patients who are at high risk of recurrence, as defined by and would have met criteria for the NATALEE trial.The NATALEE trial d...
How do you modify your adjuvant therapy course in a patient experiencing liver dysfunction within the first few months of starting CDK4/6i?
We will adhere to the CTCAE grading system. Most of these patients do well with dose reduction and interruption. If persistent grade 2/3, will likely change to an alternate CDK agent and evaluate whether it solves LFT issues.
When would you consider gemcitabine/cisplatin with Y90 for patients with unresectable intrahepatic cholangiocarcinoma ?
There is very limited data supporting the gemcitabine/cisplatin chemotherapy together with Y90 for treatment of unresectable intrahepatic cholangiocarcinoma (ICC). Existing studies of this combined approach (such as PMID: 31670746) report small single-group studies, and there are essentially no comp...
What are your top takeaways from ISTH 2025?
MAYARI trial - this trial was a single-arm trial for "non-severe" iTTP (excluding patients with significant cardiac or neurologic involvement) where PLEX was only used as a rescue therapy. Patients were started on caplacizumab and immunosuppression with steroids and rituximab. A large number of pa...
What are your top takeaways from ISTH 2025?
MAYARI trial - this trial was a single-arm trial for "non-severe" iTTP (excluding patients with significant cardiac or neurologic involvement) where PLEX was only used as a rescue therapy. Patients were started on caplacizumab and immunosuppression with steroids and rituximab. A large number of pa...
In what circumstances would you consider use of IDH inhibitors in high-grade astrocytomas?
Please forgive me for the length and directness of my response, but I believe it is important to first go over the INDIGO trial and explain why, in my opinion, it was a highly questionable study, with multiple significant methodological flaws and dubious evidence of Vorasidenib's efficacy.INDIGO tri...