Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What adjuvant therapy do you recommend for early stage poorly differentiated small cell neuroendocrine carcinoma of the cervix after surgical resection?
As Dr. @Dr. First Last has so eloquently explained, this is a rare and aggressive tumor. Often, what we think is early stage is not early stage at all. I would recommend CT or MRI brain imaging as well as a PET/CT. if there are no distant metastases, then I would offer at least 4, and up to 6 cycles...
Based on NIAGARA data, do you now feel more comfortable offering cisplatin based chemotherapy to patients with impaired renal function?
I agree, apart from the topline positive results in the intent-to-treat population, the preplanned subgroup analysis of lower GFR patients also appears to indicate a benefit, albeit somewhat less strong than traditional criteria. This adds to evidence from the phase 3 randomized VESPER trial of ddMV...
How would you approach unresectable cutaneous angiosarcoma of the scalp?
These patients can have good outcomes with definitive chemoRT. PET and MRI brain for staging. Shave hair and have derm examine for any satellite lesions. Induction taxane-based chemo. Then chemoRT with concurrent taxol. CTV volume is controversial but needs to be generous. At a minimum, 3-5 cm in sk...
Is the currently available data from INAVO sufficient to adopt this as a new standard of care for all patients or are you awaiting overall survival and/or PROs?
The results of the INAVO120 trial are sufficient to be practice changing for patients who meet the study eligibility criteria. The improvement in progression-free survival was nearly an 8-month improvement. Although the control arm included palbociclib, which has not shown overall survival benefits ...
How do you manage copper deficiency?
Copper supplements are available. Would need to exclude zinc excess as a cause and to discontinue zinc supplements.
What treatment options would you consider for a patient with stage IV NSCLC harboring a KRAS-G12A mutation who has progressed after chemoimmunotherapy and prefers to avoid additional chemotherapy?
Unfortunately, I think the only way to avoid additional chemotherapy would be in the context of a clinical trial, where non-KRAS G12C inhibitors are being studied. From the perspective of a standard of care, I would still recommend chemotherapy. We don't have granular data to suggest dual checkpoint...
What do you view as the role for docetaxel+ramucirumab for patients with metastatic NSCLC in light of LUNG-MAP S1800A data?
I still think, at this moment, docetaxel/ramucirumab should be considered standard of care (more below). I would not yet transition to pembro/ram for everyone. A broader issue raised by this trial is whether anti-VEGF drugs, or immunotherapy regimens, alter the efficacy of concurrent or subsequent c...
What factors do you consider when choosing between asciminib vs TKI in a newly diagnosed CML patient?
I think any patient is a good candidate for asciminib, with the exception of those with atypical transcripts (e.g., b2a3, b3a3). The decision would mostly depend on the goals of the patient and the availability and access. Asciminib is particularly well suited for patients who would be interested in...
What factors do you consider when choosing between asciminib vs TKI in a newly diagnosed CML patient?
I think any patient is a good candidate for asciminib, with the exception of those with atypical transcripts (e.g., b2a3, b3a3). The decision would mostly depend on the goals of the patient and the availability and access. Asciminib is particularly well suited for patients who would be interested in...
What adjuvant therapy (regimen and duration) would you use for T2N1 ampullary adenocarcinoma (intestinal type)?
Unfortunately, we don't have randomized data to guide adjuvant chemotherapy for ampullary adenocarcinoma. For the intestinal type, I favor CAPOX or FOLFOX for 6 months. For the pancreatobiliary type, I favor modified FOLFIRINOX for 6 months (PS 0-1) or gemcitabine/capecitabine for 6 months (PS 2).