Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage a patient with multiple similar appearing ground glass opacities (~8-9) on Chest CT where one has been surgically removed and confirmed to be adenocarcinoma in situ?
This is a common scenario. Determining the stage of lung cancer can be challenging. Many patients, especially those with chronic lung disease, will have multiple non-specific abnormalities seen on CT scans. The patient with multiple GGO's on CT can be especially challenging. GGO's can represent canc...
How do you manage toxicities in patients with mPDAC receiving daraxonrasib?
In our experience, we have found several strategies effective: Rash: Doxycycline 100 mg twice daily, avoid all sun exposure and use sunscreen, apply hydrocortisone 2.5% twice daily to face and upper chest and back and neck apply emollient moisturizer to arms, legs, hands, feet at least twice daily....
Would you consider stopping nivo/ipi combination after a CR in a patient with metastatic melanoma?
Indirect data indeed suggest we can extrapolate the data on durable complete response after discontinuation of pemrolizumab. Indeed, most patients in complete response who stopped ipi/nivo combination for toxicity or any other reason in Checkmate 067 and 069 had durable ongoing complete response. Af...
How does the POSEIDON meta-analysis results influence your decision on which patients should receive hormone therapy with post-operative radiotherapy for recurrent prostate cancer?
POSEIDON is another landmark analysis from the MARCAP consortium. It adds to the seminal work performed in localized prostate cancer (Kishan et al., PMID 35051385), which serves as the reference study for the use and duration of ADT with radiotherapy, but now in the post-prostatectomy setting.The st...
Does the possibility of future Lu-177–PSMA therapy change your current threshold to offer earlier metastasis-directed RT in oligometastatic prostate cancer?
There is a lot of excellent research being done on the efficacy and tolerance of combined Lu-177-PSMA therapy and EBRT. So far, the combination is well tolerated, and there is some data that sequencing the two to allow EBRT to treat the more “Pluvicto-resistant” lesions may help with efficacy.The qu...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
With the recent FDA approval of nipocalimab and the emerging LUMINA 2 data for rilzabrutinib, what is your approach to wAIHA refractory to or relapsed after steroids and rituximab?
Probably because of its rarity (1–3 new cases per 100,000 people), we often joke that there are more treatments at our disposal for the management of wAIHA than the number of cases any hematologist sees on an annual basis—or even during their lifetime. A partial list includes typical first-line trea...
In the current era of adjuvant CDK4/6 inhibitor use for high-risk HR+/HER2-negative breast cancer, what is the preferred adjuvant chemotherapy regimen for premenopausal women — AC-T or TC?
In premenopausal women with genuinely high-risk HR+/HER2- disease (MonarchE and some NATALEE groups, especially Stage III), I believe there remains a role for dose-dense AC/T as the adjuvant chemotherapy backbone. Data from EBCTCG do portray a 2.5–2.6% 10-year recurrence and 1.6% 10-year breast canc...
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...