Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Following long-term efficacy and safety data from the beti-cel trials, how do you approach gene therapy for eligible patients with transfusion-dependent β-thalassemia?
The results with beti-cel are excellent. So are the results with exa-cel. These two gene therapies use different approaches to modifying hemoglobin production in erythroid stem cells. Beti-cel adds a modified hemoglobin that resembles fetal hemoglobin using viral-mediated transduction, whereas exa-c...
Following long-term efficacy and safety data from the beti-cel trials, how do you approach gene therapy for eligible patients with transfusion-dependent β-thalassemia?
The results with beti-cel are excellent. So are the results with exa-cel. These two gene therapies use different approaches to modifying hemoglobin production in erythroid stem cells. Beti-cel adds a modified hemoglobin that resembles fetal hemoglobin using viral-mediated transduction, whereas exa-c...
When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?
RAD51C, RAD51D, and BRIP1 are all associated with significant risks of ovarian cancer and are appropriate for consideration of prophylactic oophorectomy, albeit perhaps at a slightly later age than BRCA1 and BRCA2. ATM and PALB2 may be associated with ovarian cancer risks that are similar to that of...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
For muscle invasive bladder cancer, after neoadjuvant chemotherapy with cis/gem and surgery with residual tumor and lymph node involvement, would you consider adjuvant avelumab as an extrapolation base on the JAVELIN 100 results?
I would not use adjuvant avelumab following radical cystectomy finding residual high risk disease after neoadjuvant chemotherapy. Biologically, this group has disease resistant to neoadjuvant chemotherapy, and is not akin to those with stable or responding disease following platinum therapy included...
Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?
In the past, some considered fistulas to be a contraindication for radiation therapy due to concerns about potential worsening. However, our understanding has evolved, particularly in cases where the tumor itself is often the primary cause or a significant contributor to the fistula. Consequently, i...
Does the presence of a KEAP1 mutation influence your decision to use adjuvant immunotherapy in stage II–III melanoma?
It is an interesting thought when you look at the mutations that may predict resistance to checkpoint inhibitors. However, I do not think we are at a stage where we can make a firm decision in the adjuvant setting (or any other setting) based on mutation profile. If there is a concomitant BRAF mutat...
How do you prioritize treatment in a lung cancer patient who has HER2 IHC3+ along with other actionable mutations that have tumor-specific drugs available?
Non-small cell lung cancer (NSCLC) can harbor different HER2 alterations: HER2 protein overexpression (2-35%), HER2 gene amplification (2-20%), and HER2 gene mutations (1-4%). Unlike breast or gastric cancer, HER2 protein overexpression in NSCLC is not a validated biomarker for first-line HER2-targe...
In a patient with de novo stage IV breast carcinoma harboring an RB1 Q395* (nonsense) mutation, would treatment with a CDK4/6 inhibitor be appropriate, or should it be avoided due to likely resistance?
HR+/HER2- with baseline RB1Q395* nonsense mutation. This is one of those incredibly tough, "data-free zone" scenarios where standard guidelines fail us, and we have to rely heavily on clinical judgment and the underlying biology. In a de novo metastatic setting, our reflex is always to reach for a C...