Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you determine the choice of therapy for platinum resistant ovarian cancer in healthy, good performance status patients?
Platinum-resistant epithelial ovarian cancer is generally defined as relapse less than 6 months following completion of primary or the last platinum-based chemotherapy regimen. Options for therapy include conventional, commercially available drugs or potential clinical trials. If prior genetic testi...
Would you consider adding immune checkpoint blockade to platinum + etoposide for metastatic high-grade large cell neuroendocrine tumor of the GI tract?
The addition of IO to first-line platinum/etoposide would primarily be an extrapolation of data from small cell lung cancer trials while awaiting the results of the ongoing SWOG 2012 trial being led by Dr. David Zhen (NCT05058651). We have hints of limited activity of single-agent checkpoint inhibit...
What is your second line therapy for PDL1 negative metastatic squamous esophageal cancer who did not receive a checkpoint inhibitor in first line setting?
I would not personally consider immunotherapy in any context for such a patient. For the purpose of answering this question, I assume that a "PD-L1 negative" tumor refers to a PD-L1 TPS 0% and CPS 0 tumor.As a quick reminder, the 2 relevant studies in the US for 1st-line immunotherapy in ESCC patien...
In patient with upper esophageal SCC who had partial response to neoadjuvant chemoradiation but deemed not to be a surgical candidate, would you recommend chemotherapy or nivolumab?
Once again, there's no clear answer to these head scratchers. For the purpose of answering this question, I will assume that the patient has a locally persistent tumor s/p definitive chemoradiation and is medically inoperable.In that case, the first issue to consider is whether there is a role for m...
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Assuming that the patient is truly transfusion-dependent, the usual target range is a Hb of 9.5-10.5.
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Assuming that the patient is truly transfusion-dependent, the usual target range is a Hb of 9.5-10.5.
Would you offer first line atezolizumab plus bevacizumab in unresectable/metastatic hepatocellular carcinoma based on the IMbrave 150 data?
I would definitely discuss (and offer) atezolizumab/bevacizumab as first-line therapy for advanced HCC and in fact, I have already started the treatment in 3 patients. There is no denying that this is the greatest advance in first-line therapy since the presentation/publication of the SHARP trial an...
Do the results of IMvigor011 influence you to utilize ctDNA to guide all adjuvant IO in MIBC?
Based on ESMO '25 data, I am using ctDNA in ICI-naive patients s/p radical cystectomy (with or without neoadjuvant chemotherapy) to inform the decision & timing of potential adjuvant nivolumab (FDA-approved) (following IMvigor011 design). I acknowledge the logistical burden of every-6-week ctDNA tes...
Would you use triplet chemotherapy FLOT in lieu of chemoRT for patients with localized esophageal squamous cell carcinoma?
This is a timely question in esophageal SCC (ESCC), even as we adjust to the now markedly diminished role of pre-operative chemoradiation vs. FLOT in esophageal/GEJ adenocarcinoma, based on the recent phase III ESOPEC study [Hoeppner et al., ASCO 2024; LBA1] (as well as the NeoAEGIS study that prece...
What is your approach to initial management of patients with suspected or confirmed primary cutaneous CD8+ positive aggressive epidermotropic T- cell lymphoma (PCAECTCL)?
PCAECTCL is an exceptionally rare and clinically aggressive subtype of cutaneous T-cell lymphoma, characterized by a rapidly progressive course, ulcerated or necrotic skin lesions, and early dissemination to extracutaneous sites. Due to its rarity and lack of standardized guidelines, management is l...