Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider stopping nivo/ipi combination after a CR in a patient with metastatic melanoma?
Indirect data indeed suggest we can extrapolate the data on durable complete response after discontinuation of pemrolizumab. Indeed, most patients in complete response who stopped ipi/nivo combination for toxicity or any other reason in Checkmate 067 and 069 had durable ongoing complete response. Af...
Would you ever consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response?
Yes, I would consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response.Data of 655 melanoma patients treated in pembrolizumab phase 1 KEYNOTE-001 study has shown 95 patients (14.5%) achieved CR after a median follow-up of 32 months. Treatment was discontin...
How are you interpreting the early RASolute 302 trial findings (daraxonrasib) in metastatic PDAC?
This is an extremely exciting time in pancreatic cancer treatment! I note that PDAC/KRAS has a plenary this year at ASCO's Annual Meeting. The company has also put out a press release stating this is a positive study against chemotherapy with a doubling of overall survival. Of course, we all want to...
Does receipt of chemoimmunotherapy for LS-SCLC impact your recommendation for PCI?
Historic data showed that the addition of PCI for patients with limited-stage small cell lung cancer showing response after chemoradiotherapy improves overall survival and decreases brain failure rates by about 50%. Recently, the addition of consolidation immunotherapy after concurrent chemoradiothe...
How do the results of KEYNOTE-B15/EV-304 influence your preferred treatment for cisplatin eligible MIBC?
The management of urothelial cancer has undergone major changes in the last decade.We have seen a number of new drugs approved for relapsed BCG-refractory superficial bladder cancer. Additionally, we have seen a number of new approaches for the management of muscle-invasive bladder cancer (MIBC) or ...
What are the recommended prophylactic measures for managing or mitigating diarrhea when pertuzumab is combined with trastuzumab deruxtecan, given toxicity risk with each individually?
My understanding is that prophylactic anti-diarrheals were not required in the trial but left to institutional discretion. While the rate of diarrhea in DB-09 was 56%, most of these were Grade 1-2 (only 7% were Grade 3 or higher). As such, I am not starting antidiarrheals prophylactically, but I do ...
Would you consider adding adjuvant ribociclib for a patient who has already received 2 years of endocrine therapy and is eligible for ribociclib according to the NATALEE trial?
Since the NATALEE trial excluded patients who received more than 12 months of neoadjuvant or adjuvant endocrine therapy, I would probably not consider ribociclib for your patient, as she is too far out from initiation of endocrine therapy.
Are there any data regarding safety or efficacy of osimertinib and concurrent chemotherapy in patients with metastatic NSCLC harboring sensitizing EGFR mutation?
The OPAL study evaluated 1st-line osimertinib combined with platinum-pemetrexed in 67 patients with EGFR-mutated NSCLC in Japan (Saito et al., PMID 36966696). The combination yielded an objective response rate of 90.9% (95% confidence interval, 84.0-97.8), with a median PFS of 31.0 months (95% CI, 2...
For a patient with metastatic melanoma with small, asymptomatic brain mets what is your preferred systemic therapy?
In this scenario, I default to using a combination of ipilimumab plus nivolumab. We know from prior clinical trials that have looked at this combination of patients with asymptomatic brain metastases that immunotherapy seems to work similarly well intracranially as it does extracranially. This was e...
How would you sequence treatment (chemo and chemoRT) for a patient with a very symptomatic locally advanced rectal adenocarcinoma, MSS, with involved pelvic nodes and a mass abutting the sphincter, with no distant disease on CT but marked elevation in CEA above 300?
A pretreatment CEA level above 300 ng/mL is far beyond the typical range seen in stage II–III disease and warrants aggressive investigation. PET/CT should be strongly considered in this case to exclude occult distant disease, as it can change management in 8–11% of patients and is specifically recom...