Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat progressive Rosai Dorfman Destombes disease after initial limited radiation therapy?
To provide the best answer, we need a little more detail on this case. Also, is the patient symptomatic from the abdominal disease? If not, I would observe in the short term. If symptomatic, I would do PET/CT and consider a repeat biopsy, given the risk of the development of another process. Do you ...
How do you approach continuing vs discontinuing ovarian suppression for high risk HR+ breast cancer when a patient becomes post-menopausal?
I'm assuming this is a woman in her late 40's or preferably over 50 (I wouldn't trust that a younger woman was permanently postmenopausal no matter what the clinical and lab picture is). It can be challenging to determine that a patient on ovarian function suppression (OFS) is actually post-menopaus...
What clinical or logistical factors influence your choice of anti-CD38 antibody in first line treatment of Multiple Myeloma?
I generally use daratumumab, because subcutaneous is more convenient for patients, and we go to once-a-month dosing much quicker with daratumumab compared to isatuximab. Once isatuximab subcutaneous is available, this advantage of daratumumab may be lost, but given comfort and familiarity with darat...
What clinical or logistical factors influence your choice of anti-CD38 antibody in first line treatment of Multiple Myeloma?
I generally use daratumumab, because subcutaneous is more convenient for patients, and we go to once-a-month dosing much quicker with daratumumab compared to isatuximab. Once isatuximab subcutaneous is available, this advantage of daratumumab may be lost, but given comfort and familiarity with darat...
Is there any benefit of anastrozole in addition to fulvestrant and palbociclib in a patient with HR+ metastatic breast cancer?
We don't have comparative data that I am aware of. SWOG S0226 showed an improvement in PFS/OS for 1st line fulvestrant + anastrozole vs anastrozole, particularly for treatment-naive or > 10-year recurrent metastatic disease. Dr. @Dr. First Last (who led S0226) has opened a phase 2 trial using abemac...
Are there scenarios where you would consider use of capivasertib for non-AKT pathway altered patients given the efficacy seen in the overall treatment population of the CAPItello-291 trial?
While PFS curves are similar in AKT-altered and the overall population, PFS curves are much closer (HR 0.79, 0.61-1.02) in patients with AKT pathway non-altered tumors excluding unknown NGS results (Fig S2), suggesting that the majority of the efficacy is from the AKT-altered population (CAPItello-2...
How would you approach mantle cell lymphoma in very elderly patients?
For patients who are very elderly, my approach depends on the patient's performance status, other comorbidities, disease features/disease behavior, and indications for treatment. There are patients with MCL who can be observed at diagnosis (those with leukemic non-nodal disease but also those with l...
How would you approach mantle cell lymphoma in very elderly patients?
For patients who are very elderly, my approach depends on the patient's performance status, other comorbidities, disease features/disease behavior, and indications for treatment. There are patients with MCL who can be observed at diagnosis (those with leukemic non-nodal disease but also those with l...
Would you extrapolate results from ELEVATE-RR study to favor use of acalabrutinib as first-line therapy in treatment-naive CLL?
The ELEVATE-RR study enrolled patients with a median of 2 prior regimens, with either deletion 11q or deletion 17p. I think one could debate whether selecting this patient population as compared to a less selected treatment naïve population would be more likely to find a difference between the two d...
How would you approach treatment for a R/R mantle cell lymphoma patient with a history of autoimmune hepatitis who has progressed on both a covalent and non-covalent BTKi?
Without the whole story, hard to know if this patient is a candidate for CAR T therapy. Presuming the answer is no, I would give venetoclax. Admittedly this is off label, but venetoclax can be very effective in this disease, both in my personal experience and in the limited available data (Davids et...