Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How are you requesting testing for HER2-ultralow status, in light of DB-06 trial demonstrating benefit of T-DXd for these patients?
I have asked our breast pathologists to routinely report it on all new samples and if I have a metastatic patient that might be a candidate, I have had pathology go back and stain all their prior samples for it. I’ve now used T’ Dxd in many ultralow patients and it works beautifully.
What volume and dose would you use for a Stage I MALT lymphoma of the lung?
MALT lymphomas are highly radiosensitive. Curative standard doses are 24 Gy in 12 fractions and 30 Gy in 20 fractions. The latter and slower dose fractionation (30 Gy in 20) is best used specifically in the setting of stage IAE Gastric MALT - a unique site with significant risk of radiation induced ...
Would you consider adding abiraterone to ADT and salvage RT in a prostate cancer patient with pN1 disease at radical prostatectomy?
This is a question that is being addressed in the salvage setting by NRG GU008. Currently, we have high level evidence that adding abiraterone to ADT is superior to ADT alone for subsets of patients with metastatic disease and the combination with RT is superior to ADT alone plus RT for both clinica...
What are your top takeaways in GI Cancers from ASCO 2025?
ATOMIC - adding atezolizumab checkpoint inhibitor for 1 year to 6 months of adjuvant FOLFOX is the new standard of care for MSI-High stage III colon cancer. MATTERHORN trial - adding durvalumab to perioperative FLOT in resectable gastric adenocarcinoma significantly improved event-free survival...
Would you offer gemcitabine/cisplatin (or other platinum-based regimens) for metastatic pancreatic cancer harboring somatic ATM mutations?
Yes, potential sensitivity to DNA-damaging agents.
What is the best supportive care for lacrimation/rhinorrhea with pemetrexed for lung cancer?
Antineoplastics drugs, such as pemetrexed, can damage the epithelial cells of the conjunctival mucosa. Inflammation and fibrosis of epithelial cells of the lacrimal duct following systemic chemotherapy may lead to lacrimal outflow obstruction and epiphora. The mechanism of lacrimation caused by trea...
Would you offer adjuvant chemotherapy to a premenopausal woman with HR+ HER2 negative IDC, T1cN0, with isolated tumor cells, oncotype RS 20, grade 2, with multifocal LVI?
First - isolated tumor cells have no clear impact on prognosis and should NOT be used to alter local or systemic treatment decisions. The TAILORx trial unplanned subgroup suggested a small but real benefit from chemo. However, very few (11%) of premenopausal patients got optimal HRT that included OF...
How do you manage newly diagnosed multiple myeloma patients who have a contraindication to steroids?
This is a rather rare situation, but it can happen. Each patient will be different here. In my experience, this has been to psychosis/mania with previous steroid exposure.There is clear data that you can omit steroids following cycle 1 with daratumumab-based induction, cited here, but there are othe...
Is there any emerging data demonstrating the utility of performing gene expression assays in TNBC to understand potential chemotherapy sensitivity?
Chemotherapy drug-specific predictive markers have been impossible to find so far. General chemotherapy sensitivity features have been found, but are not part of any currently clinically used assay. High expression of DNA damage repair genes and high expression of immune-related genes have both been...
When recommending salvage RT post-prostatectomy for an ultra-sensitive PSA level <0.1, do you still recommend concurrent hormonal therapy?
There is potentially an interaction between ADT's benefit and the PSA at the time of treatment. This was most well delineated in RTOG 9601 (Dess et al., PMID 32215583), but since then, using modern LHRH agonists, that interaction has been less well established (GETUG-AFU16, SPPORT, and RADICALS-HD)....