Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
Do you offer adjuvant treatment for resected colloid pancreatic carcinoma?
I rarely offer adjuvant radiation for typical pancreatic ductal adenocarcinoma except in cases of positive margins, and then only after an adequate duration of chemotherapy has been given. Therefore, I do not think adjuvant radiation therapy should be routine in colloid pancreatic carcinoma, which i...
How would you approach incorporating immunotherapy in neoadjuvant treatment for GE junction and gastric cancer?
Neoadjuvant immunotherapy is a reasonable option for patients with locally advanced dMMR/MSI-H esophagogastric cancer. The recently published GERCOR NEONIPIGA study provides some preliminary data. Among the patients who underwent surgery following neoadjuvant immunotherapy, 59% of patients achieved ...
Are you offering chemotherapy for premenopausal patients with HR+ node-positive breast CA with OncoType dx scores in the intermediate range of 11-25?
This is a great question. Yes, I typically recommend adjuvant chemotherapy in premenopausal women with early stage HR+ breast cancer with nodal involvement regardless of Oncotype DX RS. I do not send an Oncotype DX score in this setting due to the modest benefit of chemotherapy seen in premenopausal...
How do the results of INSEMA and SOUND impact the decision of omitting SLND in young women with breast cancer and offering adjuvant RT to patients who would otherwise be candidates for omission?
Both trials required radiation so I would recommend it for a young woman not getting sentinel lymph node evaluation, and would lean toward whole breast irradiation. INSEMA required whole breast irradiation and SOUND allowed partial breast irradiation (10% of patients) but the majority of patients re...
How do you choose between Atezolizumab/Bevacizumab (IMbrave 150) versus Durvalumab/Tremelimumab (HIMALAYA) in first-line metastatic hepatocellular cancer?
I use a range of factors, discussed here and here, when deciding between atezo/bev and STRIDE regimens in my patients with advanced HCC.Summarily, both regimens demonstrated clinical benefit in patients with advanced HCC with side-effect profiles expected for the individual agents. The choice of reg...
What chemotherapy regimen would you use for a testicular cancer patient in need of BEPx3 but unable to use platinum based chemotherapy regimen due to cochlear implants?
To be succinct, the correct answer is BEP x 3 if he wants the therapy that would achieve optimal cure rate. If disease is limited to retroperitoneal nodes, especially if < 3 cm is the largest node and normal postorchiectomy, serum hCG and AFP, RPLND would then be the preferred option.
What factors do you consider when choosing between vimseltinib and pexidartinib for tenosynovial giant cell tumor (TGCT) patients?
Pexidartinib has much longer Phase 4 follow-up data than vimseltinib. Both drugs have comparable efficacy. The tolerance, especially LFT abnormalities, is not an issue with the new lower dose pexidartinib. The distinguishing factor remains the REMS program. So it is a matter of personal practice/pre...
What do you recommend for women on AI therapy who experience excessive hair loss?
In addition to the suggestions from @Dr. First Last, there was also a study reported in 2018 by Freites-Martinez et al. in JAMA Dermatology that reported a moderate to significant improvement in endocrine therapy-induced alopecia with topical minoxidil 5%. This is a relatively straightforward, over ...
Are there different strategies you would utilize to monitor and manage potential resistance in patients with CML receiving asciminib?
Overall, I use similar monitoring strategies for all CML therapies, including what responses or loss of response prompt me to consider assessment for mutations that confer therapy resistance. Sometimes it is difficult to differentiate non-adherence vs emerging resistance, and thus it is important to...