Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
The high volume patients who were getting chemo will be offered abiraterone provided the cost of the drug will be covered. I will hold off on the low volume patients for now- the median rPFS for the low volume patients on ADT alone on the GETUG 15 was 21 months. I would also not treat M0 patients . ...
How do you approach and counsel women with high risk, early stage breast cancer requiring chemotherapy for whom fertility preservation is a major concern?
Fertility preservation is a major issue in survivorship for younger cancer patients. Discussion with a specialist regarding banking eggs or embryos as early as possible is important. Proven techniques such as embryo cryopreservation may not be available due to financial constraints or other issues. ...
After the MAJESTEC-3 results, what is your approach to choosing between tec-dara vs. cilta-cel versus another triplet for multiple myeloma in first relapse?
This is an excellent question, and literally a million-dollar question for various companies involved. It's worth noting that the US FDA can change the package insert at will (and has done so) compared to what the trials did, so there's no guarantee as of yet that Tec-Dara (based on MajesTEC-3) will...
After the MAJESTEC-3 results, what is your approach to choosing between tec-dara vs. cilta-cel versus another triplet for multiple myeloma in first relapse?
This is an excellent question, and literally a million-dollar question for various companies involved. It's worth noting that the US FDA can change the package insert at will (and has done so) compared to what the trials did, so there's no guarantee as of yet that Tec-Dara (based on MajesTEC-3) will...
How do you approach treatment selection among novel bispecific antibodies and ADCs for patients with EGFR+ NSCLC previously treated with 3rd generation EGFR inhibitors?
I will focus the conversation here on metastatic NSCLC with EGFR exon 19 deletion or exon 21 L858R mutation. Patients with EGFR exon 20 insertion mutations are discussed in a separate question.The frontline therapy for our involved patient population is osimertinib single agent (less and less used w...
Would you consider a cycle of EP in a patient with good risk stage IIIB seminoma on BEP but with bleomycin omitted for cycle 3?
There are many aspects to this question. Good risk stage II seminoma has a 90-99% cure rate. I presume he has had all 3 five day courses of the EP component and 6 of 9 weeks of bleomycin. An ECOG study from about 30 (!) years ago compared BEP X 3 versus 3 courses EP for all types and histologies of...
Do you offer treatment of prostate/oligomets upfront with systemic therapy for oligometastatic de novo prostate cancer?
There's no right or wrong answer here, and I've done both options (treat everything up front and treat sequentially) based on disease sites and volume, and patient symptoms and priorities. I can share how I think through the decision-making: Do they qualify for prostate RT based on STAMPEDE and life...
How do you reconcile data from the PATINA trial and DESTINY-Breast09 with respect to CDK4/6 inhibitor maintenance in metastatic ER+ HER2+ breast cancer?
We don't have data on using T-DXd with palbociclib concurrently, but the data from DB09 and PATINA does lead to questions about the optimal 1st line approach in ER+HER2+ metastatic disease. DB09 allowed for concurrent endocrine therapy with T-DXd + P, and the ADC was continued until intolerance or p...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...
When do you start ADT for a patient with a new diagnosis of node positive prostate cancer receiving radiation?
I would reverse the question order. For node-positive disease, I start ADT once staging imaging is complete. If logistically practical (as with high-risk localized), I often perform the simulation and start ADT at the same time, then start RT without a neoadjuvant period. Evidence for neoadjuvant AD...