Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach restarting immunotherapy in a patient with metastatic melanoma who previously developed immune-mediated hepatitis (Grade 3), with liver enzymes now back to baseline levels?
I prefer to rechallenge when the irAE is back to grade 0. It depends on how long the hepatitis took to revert to a normal level. If it goes back to normal quickly (within 4 weeks), I keep patients on 8 mg methylprednisolone when rechallenging patients. If they do well, I wean them off at the second ...
What is the preferred systemic therapy regimen for a patient in their 40s with untreated metastatic sarcomatoid carcinoma of unknown primary, presenting with hepatic lesions, abdominal lymphadenopathy, and a lytic bone lesion?
Molecular phenotyping. Two of three of my patients with this presentation this year (lots of nodes, no primary) turned out to be melanoma. The other one probably has a sarcomatoid recurrence of his remote 2014 renal cell carcinoma. A melanoma patient gets just immunotherapy for this presentation. P...
Under what circumstances is it okay to initiate treatment for suspected multiple myeloma without a bone marrow biopsy?
Excellent question! It is uncommon to start treatment for any malignancy without a pathologic proof and the age-old principle of 'Tissue is the Issue' applies to multiple myeloma as well. Having said that, certain emergent situations do merit starting treatment early without waiting for the biopsy o...
Under what circumstances is it okay to initiate treatment for suspected multiple myeloma without a bone marrow biopsy?
Excellent question! It is uncommon to start treatment for any malignancy without a pathologic proof and the age-old principle of 'Tissue is the Issue' applies to multiple myeloma as well. Having said that, certain emergent situations do merit starting treatment early without waiting for the biopsy o...
How do you use baby tam, low dose tamoxifen, in your practice?
At SABCS 2022, we heard additional follow up results from Dr. DeCensi for TAM-01 (previous publication), which randomized patients with DCIS, LCIS, or atypia to low dose tamoxifen (5 mg daily) or placebo for 3 years. Similar to the prior full dose tamoxifen prevention trials, this resulted in about ...
Do you offer hormonal therapy in combination with an anti-HER2 T-DM1 or T-DXd in metastatic ER+ HER2+ breast cancer?
The hormone receptor-positive, HER2-positive (HR+/HER2+) breast cancer subtype is a distinct clinical entity from hormone receptor-negative, HER2-positive (HR−/HER2+) breast cancer. Moreover, there is heterogeneity among HR+/HER2+ tumors. The main oncogenic driver may vary among HR+/HER2+ patients w...
In patients with CML who are receiving 1st line TKI with good molecular response, are you continuing therapy or switching to asciminib based on the ASC4FIRST data?
For a CML patient with optimal response and excellent tolerability to their current TKI, there should not be impetus to switch to asciminib. For patients with less than optimal response, diminished quality of life, and in certain settings of adverse effects from current therapy, consideration of TKI...
In patients with CML who are receiving 1st line TKI with good molecular response, are you continuing therapy or switching to asciminib based on the ASC4FIRST data?
For a CML patient with optimal response and excellent tolerability to their current TKI, there should not be impetus to switch to asciminib. For patients with less than optimal response, diminished quality of life, and in certain settings of adverse effects from current therapy, consideration of TKI...
How would you treat a post-menopausal woman with recurrent breast cancer, T1bN0 HR+ (ER/PR > 90%), HER2- s/p lumpectomy and adjuvant RT with low oncotype of 6?
The question does not provide the details of recurrence as to whether this is a locoregional breast recurrence, with or without lymph node or chest wall involvement. Ipsilateral or contralateral or second primary? Prior lumpectomy margins, prior type, and extent of radiation therapy? Time to recurre...
What factors do you take into account when deciding which gene expression assay to utilize when making adjuvant treatment decisions in patients with non-metastatic breast cancer?
Oncotype DX has been validated in multiple large prospective trials and has demonstrated predictive value, while MammaPrint has not been validated to be predictive for chemotherapy benefit but only identifies low-risk biology. Oncotype DX has been validated in node-negative and 1–3 node-positive dis...