Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Classical Hematology from ASH 2024?
In the category of continuing what I already do, ASH 2024 provided an important confirmatory study of how to approach the treatment of patients with high-risk venous thromboembolism (VTE).In the EINSTEIN CHOICE (Rivaroxaban) and the AMPLIFY-EXT (Apixaban) studies, extended reduced-dose anti-coagulat...
Are you comfortable using durvalumab + tremelimumab in advanced HCC with portal vein thrombus, when these patients were not included in the HIMALAYA trial?
Main portal vein thrombus (Vp4) has consistently been associated with poor prognosis, and prevalence can range from 20-44% in HCC within 1-3 years of diagnosis (Abdelhamed et al., PMID 39957750). Prior to 2020 and the advent of immunotherapy in the first line, median OS is around 2-5 months. In many...
Do you have concerns about the generalizability of MammaPrint/Oncotype testing in making chemotherapy decisions for non-Caucasian women?
This question can be expanded to include differences in risk classification between MammaPrint and Oncotype DX. For Oncotype DX, large real-world studies and clinical trials (such as TAILORx and RxPONDER) show that recurrence score distribution and predictive value for chemotherapy benefit are simil...
Is there data supporting the omission of carboplatin from neoadjuvant TCHP therapy for HER2-positive breast cancer to reduce toxicity, particularly in light of findings from the KATHERINE study?
While there is no doubt that the inclusion of carboplatin increases the risk of hematologic and gastrointestinal (mainly diarrhea, but also more nausea) toxicities with TCHP, clinical trial results demonstrate that it also increases pathologic complete response (pCR) rates. No version of THP (using ...
What adjuvant therapy would you recommend for a woman in her 90s with ER-positive, HER2-positive breast cancer who received neoadjuvant trastuzumab, pertuzumab, and anastrozole, but did not achieve a pathologic complete response?
I agree with Dr. @Dr. First Last that the available information is extremely limited. Was the decision to avoid neoadjuvant chemotherapy based solely on age, or were other comorbidities or functional status considerations involved? If she were not a candidate for standard chemotherapy, it is likely ...
What scenario would flipped dosing versus standard dosing of ipilimumab + nivolumab be beneficial in metastatic melanoma?
Based on the CheckMate 511 study, the flipped dosing (ipi1/nivo3) demonstrated reduced high-grade (grade 3+) toxicities compared to the standard dose (ipi3/nivo1) [33.9% vs 48.3%, respectively]. In advanced melanoma patients who would benefit from combination ipi/nivo, I preferentially use the flipp...
In a patient undergoing neoadjuvant 177Lu-PNT2002 + MDT for oligorecurrent prostate cancer as per the LUNAR trial, what are the implications for other escalated systemic therapies with ARPIs/chemotherapy, which may otherwise be used concurrent with ADT in this population?
The LUNAR approach was designed for men who did not want to have hormone therapy. It is true that hormone therapy, either via ADT, ARPI, or both, could be added to MDT as well. The RADIOSA trial did show that PFS was improved with 6 months of ADT added to MDT. However, in RADIOSA, the eugonadal PFS ...
How do you decide on treatment modality for ocular surface squamous neoplasia?
For primary OSSN, my initial treatment modality will either be wide surgical excision with cryotherapy and amniotic membrane graft or medical treatment with 5-Fluorouracil drops QID x7 days, followed by a 3-week drop holiday. I find that there is little to no downside to trying 5-FU first, given tha...
What should be the first line treatment for metastatic uveal melanoma?
There is no consensus for frontline treatment of metastatic uveal melanoma. A clinical trial would be recommended for all patients if possible. If the disease is only within the liver, consideration of liver directed therapy would be reasonable. For metastatic disease beyond the liver checkpoint imm...
How do you address and mitigate neutropenia in patients with TNBC receiving sacituzumab govitecan in 3rd line or beyond?
For those who develop neutropenia, I generally use neulasta after day 8, but I don't use it with cycle 1 in all comers, unless they are heavily pre-treated and already have a relatively low ANC prior to starting treatment.