Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
Do you continue bortezomib past 8 cycles for transplant ineligible patients with multiple myeloma on VRd who are tolerating therapy well with no neuropathy?
Excellent question without a clear answer. While several RCTs have looked at post-induction maintenance among patients without planned transplantations, the British Myeloma XI trial is the biggest RCT (to my knowledge) to clearly look at lenalidomide vs observation in transplant-ineligible patients....
When using T-DXd/pertuzumab regimen in frontline treatment of HER2+ metastatic breast cancer, are you adapting the regimen with induction and then de-escalation to maintenance?
Outside of a clinical trial, I do not routinely define a fixed induction-and-maintenance strategy when starting T-DXd with pertuzumab. Instead, I individualize treatment over time based on response, tolerability, and patient priorities. While many patients achieve deep and durable responses, cumulat...
What criteria would you consider to select patients for 20 Gy consolidative RT in DLBCL/HGBL?
The primary endpoint of the study was 5-year local control. The study was powered to estimate this endpoint after the last patient had at least 2 years of potential follow-up (which will be reported at ASTRO). Local failures after 2 years are uncommon. The estimated 5-year freedom from local recurre...
How would you integrate immunotherapy into the treatment of a patient with recurrent, widely metastatic gastric adenocarcinoma after initial treatment with perioperative EOX and subtotal gastrectomy?
I agree with my friend, @Dr. First Last. Firstly, I hope that this is an entirely theoretical scenario or that the patient received EOX many years ago, prior to the FLOT4 data that established FLOT as the current standard-of-care. As Dan also mentioned, for patients who cannot tolerate FLOT, FOLFOX ...
In which scenarios would you consider adjuvant CDK4/6 inhibitor use if there is only one ipsilateral axillary lymph node positive for microscopic disease?
For patients with stage II hormone receptor-positive, HER2-negative breast cancer that is grade 3, I would offer adjuvant ribociclib irrespective of whether they are node-positive or node-negative because such patients would be included in the NATALEE trial, and both groups had statistically signifi...
When making treatment decisions, how do you deal with conflicting results on HER2 measurement via IHC, FISH, and Oncotype Dx HER2 expression levels?
IHC and FISH are the standard-of-care assays for HER2 status determination, and treatment decisions should be based on IHC/FISH results rather than Oncotype DX HER2 mRNA expression levels when discordance exists (Tozbikian and Zynger, PMID 29498449; Neely et al., PMID 30230095). The Oncotype DX HER2...
How does one approach maintenance treatment in transplant ineligible patients with newly diagnosed multiple myeloma?
IMROZ and BENEFIT trials are interesting in that they are billed as for transplant-ineligible patients, yet frail patients were excluded, so I don't think they give us the answer for how to maintain a frail patient. The best answer for a frail patient is, I believe, the MAIA trial, which gives DRD t...
How does one approach maintenance treatment in transplant ineligible patients with newly diagnosed multiple myeloma?
IMROZ and BENEFIT trials are interesting in that they are billed as for transplant-ineligible patients, yet frail patients were excluded, so I don't think they give us the answer for how to maintain a frail patient. The best answer for a frail patient is, I believe, the MAIA trial, which gives DRD t...
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...