Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider adding abiraterone to ADT and salvage RT in a prostate cancer patient with pN1 disease at radical prostatectomy?
This is a question that is being addressed in the salvage setting by NRG GU008. Currently, we have high level evidence that adding abiraterone to ADT is superior to ADT alone for subsets of patients with metastatic disease and the combination with RT is superior to ADT alone plus RT for both clinica...
What are your top takeaways in GI Cancers from ASCO 2025?
MATTERHORN: it’s practice-changing and establishes durvalumab/FLOT as the new standard for perioperative therapy for gastric cancer DESTINY-Gastric04: it confirms the superiority of 2L trastuzumab deruxtecan vs. ramucirumab/paclitaxel for HER2-positive gastric CA. CHALLENGE study in colorectal CA: ...
Would you offer gemcitabine/cisplatin (or other platinum-based regimens) for metastatic pancreatic cancer harboring somatic ATM mutations?
Yes, potential sensitivity to DNA-damaging agents.
What is the best supportive care for lacrimation/rhinorrhea with pemetrexed for lung cancer?
Antineoplastics drugs, such as pemetrexed, can damage the epithelial cells of the conjunctival mucosa. Inflammation and fibrosis of epithelial cells of the lacrimal duct following systemic chemotherapy may lead to lacrimal outflow obstruction and epiphora. The mechanism of lacrimation caused by trea...
How do you manage newly diagnosed multiple myeloma patients who have a contraindication to steroids?
This is a rather rare situation, but it can happen. Each patient will be different here. In my experience, this has been to psychosis/mania with previous steroid exposure.There is clear data that you can omit steroids following cycle 1 with daratumumab-based induction, cited here, but there are othe...
Is there any emerging data demonstrating the utility of performing gene expression assays in TNBC to understand potential chemotherapy sensitivity?
Chemotherapy drug-specific predictive markers have been impossible to find so far. General chemotherapy sensitivity features have been found, but are not part of any currently clinically used assay. High expression of DNA damage repair genes and high expression of immune-related genes have both been...
When recommending salvage RT post-prostatectomy for an ultra-sensitive PSA level <0.1, do you still recommend concurrent hormonal therapy?
There is potentially an interaction between ADT's benefit and the PSA at the time of treatment. This was most well delineated in RTOG 9601 (Dess et al., PMID 32215583), but since then, using modern LHRH agonists, that interaction has been less well established (GETUG-AFU16, SPPORT, and RADICALS-HD)....
Any role for adjuvant systemic therapy for resected sebaceous skin carcinoma?
There is no data about this situation.I would probably treat adjuvantly if margins are positive or if there are localized metastatic lesions that were resected with the primary surgery. I strongly recommend genomic studies to look at mismatch repair, as 25 to 30% of cases could have a deficiency and...
How do you approach adjuvant chemotherapy in an adult with localized osteosarcoma who demonstrates 50–90% tumor necrosis on surgical pathology following neoadjuvant doxorubicin and cisplatin?
There remains controversy regarding this. The largest trial to compare MAP (continuation of induction therapy into consolidation therapy) vs MAP-IE (addition of IE to conventional MAP) - EURAMOS-1 did not show any benefit to the addition of IE; however, certain centers still do so (i.e., MD Anderson...
How do you approach restarting immunotherapy in a patient with metastatic melanoma who previously developed immune-mediated hepatitis (Grade 3), with liver enzymes now back to baseline levels?
I prefer to rechallenge when the irAE is back to grade 0. It depends on how long the hepatitis took to revert to a normal level. If it goes back to normal quickly (within 4 weeks), I keep patients on 8 mg methylprednisolone when rechallenging patients. If they do well, I wean them off at the second ...