Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat an unresectable epithelioid angiosarcoma invading the cavernous sinus, wrapping around the carotid artery?
Stage with PET and MRI. If any concern for intradural spread, complete spine imaging and consider LP to r/o LMD. Start with neoadjuvant taxane-based chemotherapy, potentially in a doublet (e.g., gem/tax). Then definitive CRT with concurrent taxol and conventional fractionation to 70 Gy, while respec...
For patients who require aggressive debulking in multiple myeloma, what is your preferred chemotherapy regimen and why?
I prefer VDPACE or KDPACE +/- lenalidomide, for EMD and aggressive myeloma! Our team has good data retrospectively even in patients heavily treated and who are triple RRMM. There are no prospective data, but happy to collaborate to seek retrospective data to compare efficacy and safety in this popul...
Do you recommend utilizing daratumumab in the maintenance phase after a quadruplet induction for transplant eligible multiple myeloma?
Great question as always - both the Phase 2 GRIFFIN study (Dara-VRd vs VRd using IV Dara and 21-day induction cycles) and the Phase 3 PERSEUS study (Dara-VRd vs VRd using subQ dara and 28-day induction cycles) went on to use dara + lenalidomide for all patients in the post-transplant maintenance set...
What factors do you use when considering the addition of celecoxib to adjuvant chemotherapy for patients with stage III colon cancer, given CALGB/SWOG 80702 trial results?
Based on the 80702 results, I have started checking for PI3K mutations. In patients with tumors that have a PI3K mutation, I especially recommend celecoxib or aspirin for secondary prevention. However, there are separate data that aspirin may be helpful for primary prevention of polyp formation. Thu...
Are you comfortable combining palliative radiotherapy with capivasertib/fulvestrant?
Yes. Follow CBC
For patients with high-volume hormone-sensitive prostate cancer, would you consider shortening the docetaxel course to 4 cycles to facilitate better tolerance?
My default here is always evidence-based medicine, in which 6 cycles of docetaxel were given as part of either concurrent triplet therapy (ARASENS or PEACE-1) or sequential triplet therapy (ARCHES, TITAN), without prednisone. For those who develop intolerance, a dose reduction or growth factor suppo...
Would you offer adjuvant chemotherapy/immunotherapy for resected pure squamous cell carcinoma (T2-T4 or N+/-) of the renal pelvis?
Primary or pure squamous cell carcinoma of renal pelvis is very rare and the role of adjuvant therapy after surgery is unknown. Squamous cell carcinomas in head-neck, anal and other sites, tend to recur locally. Based on that behavior, I would offer radiation with a sensitizer, preferably weekly cis...
How do you determine your next line of therapy In ALK+ metastatic NSCLC patients who have widespread progression on first-line lorlatinib?
In general, with TKIs, it is critical to consider mechanisms of resistance. Broadly speaking, these can be categorized as on-target (e.g., ALK G1202R), off-target (e.g., MET gene amplification), or histologic/EMT changes (e.g., small cell transformation). Lorlatinib has excellent coverage of many on...
What is your approach to AYA patients with B-cell ALL who relapse after CD19 CAR-T?
This is a somewhat nuanced question based on when the patient relapsed after CAR-T, what CAR-T product they received, whether the patient prior received hematopoietic stem cell transplantation (HSCT), other salvage therapies that were prior received as well as number of prior relapses. Multiple stra...
Do you perform genetic testing when patients have persistent hypogammaglobulinemia after rituximab therapy?
I would not routinely perform genetic testing. Multicenter studies (Labrosse et al., PMID 33862010; and Otttaviano et al., PMID 35892275) show that genetic testing returns a low yield, <5%. Several authors suggest that the risk of persistent hypogammaglobulinemia due to PID is increased if there is ...