Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
How do you monitor for cardiac toxicity in patients taking osimertinib?
There are multiple studies that have explored the issue of cardiotoxicity from osimertinib. A large single-center retrospective observational cohort series from Taiwan, (n=401) compared a matched cohort of patients treated with osimertinib (n=253) to those treated with other EGFR TKIs (n=195) and fo...
When would you consider Amivantamab + Lazertinib combo for first line in EGFR mutated metastatic NSCLC?
I would certainly consider amivantamab + lazertinib combination treatment in the first-line setting for metastatic EGFR-mutated NSCLC. This is based on the data from the MARIPOSA phase III trial. This trial noted improved survival outcomes in the frontline setting for patients with EGFR exon 19 dele...
What systemic therapy would you use in T3N1M1 MMR proficient rectal cancer with solitary liver lesion when going for curative intent (chemo>short course RT> resection of primary and liver met)?
Hi,I think this is an important question. For resectable disease, most data we have is from the EORTC 40983 trial in which FOLFOX was used. For borderline resectable, you could consider FOLFOXIRI based on the OLIVIA trial. That being said, obtaining molecular profiling for this patient is key which ...
Would you consider using ensartinib in patients with ALK-positive NSCLC who have progressed on alectinib and lorlatinib?
I've written about this previously (https://www.themednet.org/question/23471). The question invokes a conceptual model of cancer therapy sequencing from the chemotherapy era, where it was the norm to go through lines of therapy with diminishing returns (e.g., platinum doublet, then docetaxel, then g...
How do you treat Stage IIIC T4N3 NSCLC?
Probably need a bit more information since T4 is fairly heterogeneous, but it is absolutely treatable. If it involves both ipsilateral lobes, then SBRT to one isolated lesion and CRT for the rest is one approach. If T4 is involved in critical mediastinal organs, probably some induction therapy with ...
For an elderly woman with a platinum-resistant recurrence of a high-grade serous ovarian cancer who has been rendered NED surgically, is observation a reasonable approach?
Based on her age, performance status, and goals of care, it is certainly reasonable to discuss all options with patients. With her being platinum resistant, I would counsel on prognosis and the need to consider quality of life. With the need for balance between QoL and OS, waiting until there is a m...
How do you sequence targeted therapy and immunotherapy in patients with metastatic lung adenocarcinoma with EGFR exon 20 insertion mutations?
EGFR insertion 20 mutations are a rare subset of adenocarcinoma (1-2%). Patients with disease characterized by these mutations do not respond to EGFR TKIs such as osimertinib. Until recently, the standard first-line therapy for such patients was chemotherapy alone, typically carboplatin/pemetrexed. ...
What adjuvant systemic therapy would you recommend for a premenopausal woman with a germline BRCA mutation who initially presented with locally advanced, HR+, HER2-negative (FISH) IDC, but was later found on surgical pathology to have HR+, HER2+ disease (IHC 3+) after neoadjuvant chemotherapy?
In a situation like this, I would consider 1 year of adjuvant trastuzumab and pertuzumab. The HERA study showed the benefit of adding trastuzumab after a full course of adjuvant chemotherapy for HER2+ breast cancer, which would provide some (although imperfect) evidence to support such an approach. ...