Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In stage 4 hilar cholangiocarcinoma, after stenting the biliary tree is there value in radiating the hilar area in addition to systemic therapy so as to maintain patency of the biliary system for a longer period of time or do you depend on the systemic therapy and the stenting alone?
In the setting of metastatic hilar cholangiocarcinoma, biliary patency is one issue but the greater issue is colonization of the biliary tree with gut flora that leads to repeated bouts of cholangitis, and progressive biliary sclerosis that happens regardless of the use of radiation. These patients ...
Do you consider ADT intensification with enzalutamide or abiraterone in patients receiving adjuvant radiation with ADT?
I agree with Dr. @Dr. First Last.One thing to note is ~3% of RADICALS, for example, included pT3b and high grade disease, and almost no patients in the ART vs SRT trials had N+ disease. Was largely GS7 and pT3a population and not the very high risk patients that select surgeons choose to operate on....
How does your surveillance for DLBCL change given the new role of CAR-T in 2nd line treatment?
There were at least 2 large studies from Europe showing that surveillance imaging for lymphoma patients in remission after completion of upfront treatments don’t improve survival (regardless of histology). I don’t usually get any imaging for DLBCL in remission after the end of treatment imaging. Pos...
How does your surveillance for DLBCL change given the new role of CAR-T in 2nd line treatment?
There were at least 2 large studies from Europe showing that surveillance imaging for lymphoma patients in remission after completion of upfront treatments don’t improve survival (regardless of histology). I don’t usually get any imaging for DLBCL in remission after the end of treatment imaging. Pos...
In the era of MEK inhibitors and BRAF V600E-targeted therapy, what is the role of traditional vinorelbine/prednisone in the management of Langerhans cell histiocytosis?
A similar question came up during rounds this week, and I recalled seeing this question here.I assume the asker meant vinblastine, and not vinorelbine; the combination of vinblastine and prednisone is considered standard therapy, whereas vinorelbine has not generally been used in LCH.Let's first bet...
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
What factors do you use when selecting which NGS platform to use for sequencing solid tumors?
QNS rates are roughly comparable between vendors such as Caris, Tempus, FoundationOne. The presence of normal blood controls can help, but is not a criterion for complete exclusion of a platform for me. Many institutions have established workflow to send tests to a certain company for certain diseas...
Would you use T-DXd as a first-line agent for a patient who developed early metastatic relapse of HER2+ urothelial cancer shortly after standard perioperative chemo/immunotherapy, over other standard non-targeted treatments?
Currently, for first-line therapy in the metastatic setting, I would recommend enfortumab vedotin in combination with pembrolizumab, with T-DXd as a potential next-line option for patients with HER2 3+ IHC. However, there is still a need to see if HER2-targeted ADCs have a role in first-line.
Would you offer adjuvant AC + pembrolizumab for a triple negative breast cancer patient whose tumor progressed on carboplatin + paclitaxel + pembrolizumab on KEYNOTE-522 and required urgent surgery (ypT3 ypN0)?
In these situations, adjuvant AC should be considered. Anthracyclines have been shown to improve outcomes in high-risk TNBC in the adjuvant setting across multiple trials. CREATE-X used adjuvant capecitabine in patients who had residual disease after neoadjuvant anthracyclines and taxanes. It wasn't...