Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you decide between neoadjuvant or perioperative chemoimmunotherapy, as per Checkmate 816 or KEYNOTE-671, for early-stage NSCLC?
All of us caring for patients with a lung cancer diagnosis face a very challenging “now what” scenario following publications of many studies demonstrating benefits of a neoadjuvant and/or perioperative approach for the treatment of patients with resectable NSCLC with already 2 FDA approvals of the ...
Mindful of the coming approval of abemaciclib, how would you decide between a CDK 4/6 inhibitor in either the first or second-line setting in HR-positive, HER2-negative postmenopausal metastatic breast CA?
Side effect profile is generally a good starting point since there is no head to head comparison (not will there likely be). Abemaciclib does have a higher incidence of diarrhea but also a lower incidence of neutropenia. It also has the advantage of daily dosing which can be less confusing for pati...
How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?
Normal body mass index (BMI) and maintenance of weight is associated with a more favorable outcome (in many series both cancer-related and non-related) compared to higher BMI. Similarly higher level of exercise and metabolic equivalent (MET) is also associated with better outcome in many observation...
Do you use a TKI for resected EGFR+ non-small cell lung cancer?
We currently await completion of the ongoing ALCHEMIST trial investigating this question. A number of studies in the past treated NSCLC patients with adjuvant EGFR TKI regardless of mutational status. More recently, ADJUVANT (NCT01405079) is the first randomized trial to compare the EGFR TKI gefitin...
Would testing for ATTR cardiac amyloidosis be considered in an older patient with bilateral carpal tunnel surgeries and multiple spinal stenosis surgeries, but no obvious cardiac symptoms?
I would not look for ATTR-CM in the absence of cardiac findings such as abnormal echo (increased LV thickness) or conduction abnormalities that are suggestive. Only 10% of patients with bilateral CTS have ATTR-CM. I would do an echo if not done and review ECG. As much as we are concerned about under...
Does the lack of survival data with palbociclib in metastatic breast cancer make you lean towards using abemaciclib or ribociclib in various combinations?
While some comparative studies have shown survival differences among CDK4/6i, it is unclear how these differences will play out when CDK4/6i are combined with PI3K/AKT inhibitors. I prefer to evaluate the different combinations individually, paying attention to the efficacy, clinical context where t...
How does the presence of PSMA negative lesions in a patient with mCRPC affect your decision to treat with Lutetium (177Lu) vipivotide tetraxetan?
The tl;dr answer: If the patient met VISION criteria for exclusion based on PSMA-negative disease burden, then yes, I would most likely not recommend Pluvicto and would prefer alternative systemic options. Consider cabazitaxel if the patient has already seen docetaxel. Also, ensure the patient has b...
How would you treat a patient with cN1 MIBC, treated with neoadjuvant cisplatin-based chemotherapy with outstanding clinical response, who is no longer a cystectomy candidate?
This is certainly a not uncommon clinical scenario in practice with, unfortunately, limited prospective data. The ECOG ACRIN INSPIRE trial (EA8185) is aiming to generate key prospective data in this setting. For patients with node positive patients and great response to initial systemic neoadjuvant ...
What recommendations do you give to patients who ask about diet during breast cancer treatment?
Women with breast cancer are at risk of gaining weight during treatment. It is the perfect storm: Decreased activity and increased appetite from the steroids. Sometimes women think they are going to loose weight so they compensate - so informing patients of the risk is a first step. There are numero...
How do you anticipate rusfertide will be used in the management of polycythemia vera?
Rusfertide, an injectable hepcidin mimetic (1), is another new arrow in the quiver of 21st-century therapies for controlling erythropoiesis without phlebotomy in polycythemia vera (PV), though likely to be replaced in the near future by gene silencing technology, which does not require as frequent d...