Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In what clinical scenarios, if any, would you consider using sacituzumab govitecan prior to trastuzumab deruxtecan for HR+/HER2- metastatic breast cancer treatment?
The ASCENT-07 trial did not meet the primary endpoint of superior PFS for 1st-line SG vs standard chemotherapy (taxane or capecitabine) in ER+ HER2- mBC. OS readout was immature with an early trend in favor of SG that needs follow-up. However, SG was still active with longer durations of responses. ...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
What treatment would you recommend for a patient with early-stage TNBC treated per KEYNOTE-522, PD-L1 CPS >10, with metastatic recurrence within 12 months of treatment completion?
In the absence of a clinical trial option for this patient with triple-negative breast cancer (TNBC) who had completed the KEYNOTE-522 regimen <12 months ago for non-metastatic TNBC and who now has metastatic TNBC which tested PD-L1 positive (PD-L1 CPS >10), I would offer immunotherapy with pembroli...
How do you approach the treatment of LS-SCLC after SBRT for a prior NSCLC in the ipsilateral lung?
You know, it was so rare to see this in the first half of my career, and now I see it a few times a year. It's a testament to the improvements we are seeing in the care of lung cancer patients... they are getting 2nd cancers. Where I am (Mayo), we generally treat it exactly like an SCLC from the per...
Is there a role for quad-shot or similar regimen in a patient with a technically resectable, but medically inoperable colon cancer that is both bleeding and causing a partial obstruction?
I do not use quad shot for the palliation of gastrointestinal tumors. I do not believe in giving doses larger than 3 Gy per fraction because it uses up tolerance, and it's difficult to retreat. My strategy is to be able to treat the patient again after recovery of tolerance in a year. This usually r...
What are your top takeaways in Myeloma from ASH 2025?
As is probably true for most multiple myeloma-focused investigators, my interest was most piqued by the results of the MajesTEC-3 trial, which demonstrated an 83% 3-year progression-free survival in a population of patients with relapsed or refractory disease resulting from teclistamab and daratumum...
How do you chose the starting dose of capecitabine?
I never start or get to this dose. At best, US patients will tolerate 1,000 mg/m2 BID x14 days on/7 days off; younger patients typically have better tolerance. There are clear ethinic differences, with Asian patients tolerating this drug better than non-Asians. Western Europeans appear to have bette...
For pediatric patients with iron overload (high ferritin and transferrin saturation), do you perform HFE screening first, or proceed to non-HFE gene sequencing upfront to evaluate for HJV mutation as well?
Because there is no recommended "screening" scenario for iron overload in pediatrics (especially with no family history), the question for me revolves around "why did the patient get tested in the first place?" If it were a routine screen for iron deficiency, which affects millions of children at an...
Are there patient populations in whom you would consider using both induction chemotherapy and maintenance pembrolizumab for a patient with locally advanced cervical cancer?
Would consider for patients with multiple pelvic and high pa bulky nodes where risk of distant mets is extremely high, with the goal to treat with systemic intent, and if good response and no mets, proceed to definitive chemo-RT.
What strategies can we use to help patients receiving Dato-DXd report symptoms earlier, with the goal of early intervention to prevent progression to higher grade side effects?
Educating and encouraging patients to report toxicities as early as possible is key to recognizing and preventing higher-grade toxicity. When feasible, having oncology nurse navigators/ancillary staff check in with patients during the first few cycles of treatment (C1D14 to C3D1) can be helpful, giv...