Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you do risk stratification for patients with light-chain-only MGUS?
This is a great question, Dr. @Dr. First Last. Apologies for the delay in responding.Light-chain disease is not as clearly defined as heavy-chain disease.There is some guidance here based on current studies, such as Maeng et al., PMID 40295472, revised free light chain reference intervals enhance ri...
What is your preferred treatment option after tarlatamab for patients with ES-SCLC?
The preferred treatment is a clinical trial - and there are several promising agents in development for SCLC, including a number of antibody-drug conjugates targeting B7-H3, Trop2, SEZ6, and DLL3. Outside of a trial, our treatment algorithms focus on chemotherapy, and my preferred agent here is lurb...
What initial systemic therapy would you offer a patient with metastatic colon cancer with BRAF V600E mutation, MSS, who is not an oxaliplatin candidate?
In patients with BRAF-V600E mutant colon cancer who are not candidates for oxaliplatin, replacing the chemo backbone with FOLFIRI is what I’ve done for a few patients without any clinical or insurance issues.This is based on the BREAKWATER study, which, of note, had a FOLFIRI/EC arm - results report...
Do you recommend MSI testing to any tumor that is not already eligible for immunotherapy?
The accelerated approval of pembrolizumab in MSI-H tumors was based on data from 149 pateints with MSI-H or dMMR cancers from five different single arm studies. Ninety of those patients were colorectal, the remaining 59 were a mix of 14 different types. The ORR for the entire group was almost 40% wi...
What second line therapy do you use for metastatic thymoma that recurs following CAP?
Multiple agents can be used to treat recurrent thymoma that requires systemic therapy. Thymoma can be indolent and may not require systemic therapy for some time. Radiation therapy can also postpone the need for systemic treatment in selective cases. Therefore, in some cases, observation is appropri...
Do you take into account ALK fusion variants in your practice for deciding treatment for NSCLC?
EML4-ALK v3 subtypes and TP53 co-mutations tend to be associated with shorter overall survival in patients, and while we take note of these molecular changes, they have not yet been affected by the selection of frontline therapy. I pay attention to ALK mutations, specifically the G1202R mutation, wh...
What time frame, number of PSAs, and calculator do you use for calculating PSA doubling times?
I typically use only values of 0.10 ng/mL or greater, and at least 3 separate PSA values that are at least 3 weeks apart from each other. The greater the number of PSA values, the more accurate the PSADT calculation will be. I like to use the MSKCC calculator: Prostate Cancer Nomograms: PSA Doubling...
Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?
Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...
Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?
We looked at this question and published our analysis in 2007. We looked at the timing of administration and radiation delivery. The dosing of capecitabine was standardized, and the radiation timing was random. The 2-year local control, distant control, and disease-free survival were nearly identica...
What factors do you use to decide between trastuzumab-deruxtecan and sacituzumab govitecan in HER2-low metastatic breast cancer?
Updated answer - 11/26/2024There is currently limited data to guide the efficacy of trastuzumab deruxtecan (T-DXd) after progression on sacituzumab or vice versa. Since both drugs have a topoisomerase 1 inhibitor payload, cancers resistant to topoisomerase 1 inhibitors may be resistant to both drugs...