Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
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...
What factors impact your choice of first line therapy for PDL1-negative metastatic TNBC?
The first-line treatment landscape for PD-L1-negative metastatic TNBC has been transformed by ASCENT-03 and TROPION-Breast02. ASCENT-03 showed improved median PFS with sacituzumab govitecan compared with chemotherapy, while TROPION-Breast02 showed improved PFS with datopotamab deruxtecan and also de...
What is your current practice for obtaining mutation status for a patient with newly diagnosed ovarian cancer?
My current practice is to test all newly diagnosed epithelial ovarian cancer patients (includes fallopian tube and peritoneal) with both germline multigene and somatic multigene/NGS panels. Only recently have I adopted the practice of concurrent testing at diagnosis rather than basing the decision t...
How do you decide if a patient should get follow-up perfusion imaging after acute PE when they are minimally symptomatic?
I practice essentially as reflected in the most recent AHA/ACC/ACCP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Diagnosis and Management of Acute Pulmonary Embolism in Adults.Figure 8. Evaluating Ongoing Symptoms Following Acute PE - concisely outlines the workup of patients with ongoing symptoms f...
In which oropharynx patients would you recommend TORS vs upfront RT or chemo-RT?
With MC1675 and ORATOR2 coming out at ASTRO21, and ECOG3311 published shortly afterwards, this topic is now particularly germane. Due to the recent reports on these trials, I'll be writing in the context of possible post-op de-escalation.I think the first and most important question to ask is, "What...
Will you offer capecitabine for 1 year to all localized TNBC patients?
The SYSUCC trial enrolled stage Ib-III TNBC patients who had either neoadjuvant or adjuvant systemic treatment followed by standard local therapy, and randomized the patients to either get 1 year of metronomic dosed capecitabine (650mg/m2 BID no break) x 12 months or observation. They observed an im...
For patients starting Pluvicto, do you have patients stop their ARPI?
While the VISION trial allowed for concomitant use, it was only about half (53%) in the Lu-177-PSMA arm, and 2/3 (68%) of those on the standard of care arm - Garje et al., PMID 36693228. And the PSMAfore trial did not, as noted above by @Dr. First LastThe bigger question is, will you continue the AR...
What are your top takeaways in Head & Neck Cancers from ASCO 2026?
The study by Nair et al., ASCO 2026 (AREST), will be quite intriguing when published. First and foremost, there will hopefully be a better definition of the irradiated “at-risk neck nodal region” in these patients who only underwent ipsilateral NDs. Probably the buccal patients had ipsilateral radia...