Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach adjuvant therapy in a patient with HR+ breast cancer with a high RS (>25) given the current COVID-19 pandemic?
The starting point for consideration of adjuvant chemotherapy is to quantify the risk of a distant recurrence. For estrogen receptor positive, HER2 negative breast cancer, Oncotype Dx RS data are critical for understanding the risk of a distant recurrence1 as well as endocrine and chemotherapy respo...
In patients with HER2-positive metastatic colorectal cancer who achieve a complete radiographic response on fam-trastuzumab deruxtecan, do you continue treatment until progression or toxicity?
In a patient with HER2-positive mCRC and a complete radiological response on treatment, I will give the patient a break from therapy. I would not request ctDNA in this particular patient who is getting palliative therapy. Symptoms and radiology are my treatment guides.
How do you approach immediate management of paraspinal extramedullary hematopoiesis in patients with transfusion-dependent thalassemia when lesions are enlarging or causing neurologic symptoms?
In general, the goal of transfusion therapy in transfusion-dependent thalassemia (TDT) is to suppress ineffective erythropoiesis. It is the rationale for maintaining a higher pre-transfusion hemoglobin level, at 9.5-10.5 g/dl, well above the general threshold for PRBC transfusion used in oncology pa...
For pregnant nontransfusion dependent beta thalassemia patients, when would you consider ESAs for worsening anemia?
Non-transfusion-dependent thalassemia (NTDT) patients tend to have elevated erythropoietin (EPO) levels already, proportionate to their degree of anemia. The basic pathophysiology of thalassemia is ineffective erythropoiesis (IE), in which proliferation, in response to high EPO levels, is already su...
Have you observed any tumor flare on imaging or in tumor markers after adding palbociclib in patients with HER2/ER/PR-positive metastatic breast cancer (PATINA trial)?
Bone scan flare is a recognized, guideline-acknowledged phenomenon that can be misinterpreted as progression, especially on the first follow-up scan after starting a new therapy. In a prospective bone-predominant metastatic breast cancer study using serial NaF PET/CT at baseline, 8 weeks, and 12 wee...
What could explain failure to luspatercept in patients with transfusion-dependent beta thalassemia?
Luspatercept works by trapping TGF beta ligands (GDF 11 and 15) and optimizing maturation and differentiation of erythroid precursors, thus facilitating increased output of red cells.In individuals who have beta zero-beta zero thalassemia, this must mean that the cells coming out would contain hemog...
How would you select patients for epcoritamab + R² versus R² or other regimens at second-line relapsed/refractory follicular lymphoma?
It depends on what they received as first-line therapy and the duration of response to that treatment. The disease burden at the time of relapse would also be a key factor. The rate of infections was notably higher in the epcor + R² group. In the subgroup analysis, the benefit amongst older patients...
How would you select patients for epcoritamab + R² versus R² or other regimens at second-line relapsed/refractory follicular lymphoma?
It depends on what they received as first-line therapy and the duration of response to that treatment. The disease burden at the time of relapse would also be a key factor. The rate of infections was notably higher in the epcor + R² group. In the subgroup analysis, the benefit amongst older patients...
How will the ADAURA study impact your use of adjuvant chemotherapy?
ADAURA has not and will not impact my use of adjuvant chemotherapy. Many prospective studies have demonstrated a clear significant improvement in overall survival with the use of adjuvant chemotherapy after complete surgical resection. This is standard of care for the appropriate patients. Osimertin...
When do you consider certolizumab for pregnant women with antiphospholipid syndrome with positive lupus anticoagulant?
Certolizumab is a TNF-α antagonist with minimal or no transfer across the placenta. It was evaluated in the phase 2, open-label IMPACT (Improve Pregnancy in APS with Certolizumab Therapy) trial to prevent placenta-mediated adverse outcomes in pregnant patients with antiphospholipid antibody syndrome...