Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you use lenalidomide for patients with MDS with 5q- without other cytogenetic abnormalities but with one or more mutations on NGS?
For patients who meet the definition of del(5q) syndrome, I typically utilize lenalidomide regardless of the molecular features of the disease. The original publication (List et al., PMID 15703420), the phase III MDS-004 study (Fenaux et al., PMID 21753188), and the phase III SintraREV study (Díez-C...
Where does the OPTIMA trial, presented at ASCO 2026, fit into decision-making for chemotherapy for premenopausal women with high clinical and low genomic risk ER+ breast cancer?
Since the median follow-up on this trial was only 4 years (which is considered short for patients with operable, hormone receptor-positive, HER2-negative breast cancer) and since the study has not yet been published in a peer-reviewed journal, I would exercise extreme caution in skipping potentially...
How do you sequence treatment for patients with HER2-mutant metastatic NSCLC?
It is a challenge that we should face with great excitement, as HER2 in lung cancer, up until recently, was EGFR’s poor sibling, as so astutely highlighted by Dr. Carbone in his recent NEJM editorial. Indeed, while we have seen dramatic changes with generations of EGFR TKIs and now combinations, suc...
Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Dr. First Last brought up other scenarios we should consider and he brings some more good points: Many patients could get active surveillance for a period of time before ADT is co...
How do you decide between anticoagulation and observation for an incidentally detected subsegmental pulmonary embolism in elderly patients with a history of gastrointestinal bleeding?
We face this conundrum not infrequently because subsegmental emboli are subject to high inter-reader variability, and the accuracy of the finding in isolation is suspect (Batayneh et al., Blood 2023). I once mentioned this to a radiologist who reads CTAs and was told, tactfully, that I was full of i...
Would you continue or stop anticoagulation for a DVT/PE in a patient with active cancer who has completed 6 months of therapy?
This is an important question that we didn’t really have a clear answer for… until this year when an NEJM RCT was published! Mahé et al., PMID 40162636 In this RCT, patients with cancer-associated VTE who completed 6 months of full-dose apixaban were randomized to half-dose apixaban vs. full-dos...
How do you decide between systemic vs. arterially directed therapies in the first line setting for unresectable HCC?
In IMbrave150, 63% of patients treated with atezolizumab/bevacizumab had extrahepatic spread of disease, and my recommendation for patients with extrahepatic involvement is for first line systemic therapy. For patients with unresectable disease without extrahepatic spread, we take a multi-disciplina...
How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?
This is difficult to answer specifically without further details. There certainly is accumulating evidence that patients with cancer, especially those receiving immunosuppressive chemotherapy, are at greater risk of COVID-19 infection if exposed, and a greater risk of serious and life-threatening co...
For patients with early stage resected giant cell lung cancer and other less common histologies, are there any specific considerations for adjuvant therapy?
Giant cell carcinomas/pleomorphic carcinomas/sarcomatoid carcinomas are difficult, and typically aggressive entities. In reviewing the literature, there is precious little data to guide the selection of cytotoxic chemotherapy (most reports are pathology studies, some case reports, and unfortunately,...
How do you advise a patient with a history of HR+ breast cancer who would like to go on HRT for postmenopausal symptoms?
I would say systemic hormone replacement therapy is generally not recommended because of concerns about recurrence. I would assess the severity of symptoms and explore non-hormonal options. If her main concern is vaginal symptoms, low-dose vaginal estrogen may be an option depending on the severity ...