Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there strategies to mitigate the risk of developing ILD/pneumonitis while using trastuzumab deruxtecan?
The most important strategy is global awareness of ILD as a potentially serious complication that may initially present with subtle signs. Patients and all care team members must not only be aware but remind others in the patient/family care circle. This needs to be reinforced regularly. The recogni...
For patients who have completed up-front docetaxel for metastatic castration-sensitive prostate cancer, should they proceed to abiraterone before the development of castration resistance?
There is data for upfront triplet therapy currently in high-volume HSPC. The triplet therapy consists of ADT + docetaxel x 6 cycles + either darolutamide or abiraterone. Given that this patient has already completed a course of docetaxel, holding off on adding ARSI therapy until the first signs of P...
What induction regimen would you consider for KMT2A-rearranged AML in a young patient with multiple medical co-morbidities who is ineligible for clinical trials?
Given the mention of medical comorbidities and ineligibility for trials, I am going to assume that the patient cannot be treated with an intensive induction regimen. With this in mind, a lower-intensity approach such as azacitidine + venetoclax would be my recommendation. Survival outcomes in adult ...
What induction regimen would you consider for KMT2A-rearranged AML in a young patient with multiple medical co-morbidities who is ineligible for clinical trials?
Given the mention of medical comorbidities and ineligibility for trials, I am going to assume that the patient cannot be treated with an intensive induction regimen. With this in mind, a lower-intensity approach such as azacitidine + venetoclax would be my recommendation. Survival outcomes in adult ...
Would you consider adjuvant capecitabine for a patient with triple-negative metaplastic carcinoma who has microinvasive residual disease (ypT1miN0) following neoadjuvant therapy?
For a patient with triple-negative metaplastic breast cancer and microinvasive residual disease (ypT1miN0)following neoadjuvant therapy, the decision to use adjuvant capecitabine is nuanced and not definitively addressed in current guidelines or trials. General TNBC with Residual Disease: Multiple...
What is the preferred approach for an AYA patient with VHR B-ALL with iAMP21 mutation with an isolated early CNS relapse?
For relapsed high-risk disease such as iAMP21, the recommended approach is to achieve remission followed by consolidation with allogeneic stem cell transplantation. However, in cases of isolated CNS relapse, I favor CAR T-cell therapy first to achieve and deepen CNS remission, as it has demonstrated...
What is the preferred approach for an AYA patient with VHR B-ALL with iAMP21 mutation with an isolated early CNS relapse?
For relapsed high-risk disease such as iAMP21, the recommended approach is to achieve remission followed by consolidation with allogeneic stem cell transplantation. However, in cases of isolated CNS relapse, I favor CAR T-cell therapy first to achieve and deepen CNS remission, as it has demonstrated...
What is your standard for monitoring triglyceride level during therapy for ALL, particularly in regards to receiving pegaspargase?
Routine monitoring of triglyceride levels is not considered standard practice during pegaspargase therapy. Although hypertriglyceridemia is a common side effect of asparaginase treatment, it typically has no significant clinical impact on management decisions or future use of asparaginase. The condi...
What is your standard for monitoring triglyceride level during therapy for ALL, particularly in regards to receiving pegaspargase?
Routine monitoring of triglyceride levels is not considered standard practice during pegaspargase therapy. Although hypertriglyceridemia is a common side effect of asparaginase treatment, it typically has no significant clinical impact on management decisions or future use of asparaginase. The condi...
Which regimen would you recommend for a young patient with node-positive, triple-negative breast cancer with significant anthracycline-induced cardiomyopathy?
I would consider the NeoPact regimen, consisting of 6 cycles of docetaxel, carboplatin, and pembrolizumab, which is currently being directly compared to the Keynote-522 regimen in the SCARLET trial. Given some immune-related cardiac risks of pembrolizumab, I would strongly recommend that the patient...