Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you treat endometrioid adenocarcinoma arising from an endometriosis lesion in a patient with prior hyst/BSO like an ovarian or endometrial primary?
For a patient with prior hyst/BSO and now an endometriosis-associated endometrioid adenocarcinoma, I would start by getting next-generation sequencing and MSI/MMR testing of the tissue specimen that was used to make the diagnosis. This would allow for additional information and the potential use of ...
How does genomic profiling/next-generation sequencing assays influence your treatment recommendations in metastatic breast cancer?
At the current time, there are no evidence-based, FDA-approved or NCCN-recommended uses of genomic or protein-based assays other than ER, PR, or HER as well as gene expression profiling results like the 21-gene/Oncotype or 70-gene MammaPrint assay for routine management of breast cancer. There is no...
Which patient characteristics or clinical factors guide the decision to use Doxorubicin and Trabectedin as first-line treatment for metastatic or unresectable leiomyosarcoma?
The trial included any patient with Grade 2/3 LMS who presented with metastatic disease or unresectable LMS and was a candidate for this regimen. Having said that, I always make the patient aware of the high risk of having a grade 3 or higher adverse event. The OS benefit demonstrated in the trial i...
In light of Aizer et al. data presented at ASCO 2025, what is your threshold for offering SRS/SRT in patients with multiple brain metastases?
Over the past 4 decades, the treatment of brain metastases has been evolving along with advances in technology, from simple whole brain radiation (WBRT) with opposed lateral fields to IMRT-driven treatment (HA-WBRT); similarly, in the field of SRS/SRT, we have pushed the envelope of what we can achi...
What front line therapy would you recommend for a patient with CLL on chronic dual antiplatelet therapy?
Given the bleeding risks associated with BTKi, I personally may prefer venetoclax-based therapy if feasible, in treating patients who require dual antiplatelet therapy (DAPT). This is based on safety considerations. I consider both BTKi-based therapy and venetoclax-based therapy great options for fr...
What front line therapy would you recommend for a patient with CLL on chronic dual antiplatelet therapy?
Given the bleeding risks associated with BTKi, I personally may prefer venetoclax-based therapy if feasible, in treating patients who require dual antiplatelet therapy (DAPT). This is based on safety considerations. I consider both BTKi-based therapy and venetoclax-based therapy great options for fr...
What factors do you take into account for recommending venetoclax/obtinutuzumab vs BTK inhibitors vs chemotherapy in front line therapy for CLL?
For most patients, either BTK inhibitor or venetoclax/obinutuzumab would be appropriate therapies. I would only consider chemotherapy (fludarabine/cyclophosphamide/rituximab) for those <65 years old with IGHV mutated disease and no high risk genetic markers. And even in these patients, I almost alwa...
What factors do you take into account for recommending venetoclax/obtinutuzumab vs BTK inhibitors vs chemotherapy in front line therapy for CLL?
For most patients, either BTK inhibitor or venetoclax/obinutuzumab would be appropriate therapies. I would only consider chemotherapy (fludarabine/cyclophosphamide/rituximab) for those <65 years old with IGHV mutated disease and no high risk genetic markers. And even in these patients, I almost alwa...
For CLL patients with high-risk cytogenetics on ibrutinib who develop a cardiac event such as an MI, would you continue ibrutinib?
It depends on the cardiac event (and the CLL status). After any serious event, if the CLL is under good control (clinical CR), I think it is very acceptable to stop the ibrutinib and wait until clinical progression occurs - which can be a while for some patients (median 2 years from the E1912 study)...
For CLL patients with high-risk cytogenetics on ibrutinib who develop a cardiac event such as an MI, would you continue ibrutinib?
It depends on the cardiac event (and the CLL status). After any serious event, if the CLL is under good control (clinical CR), I think it is very acceptable to stop the ibrutinib and wait until clinical progression occurs - which can be a while for some patients (median 2 years from the E1912 study)...