Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use consolidation immunotherapy after chemoradiation for patients with stage III NSCLC and EGFR amplification?
The short answer is yes, as long as there is no concurrent oncogenic EGFR mutation. During the early days of EGFR-TKI development over 20 years ago, there were different predictive biomarkers proposed and studied. Pitted against each other were biomarkers using more established pathology methods (EG...
In what situations would you treat a rectal mass as cancer despite negative biopsies?
It is not uncommon to see a patient with rectal mass highly suspicious for malignancy by endoscopic evaluation but has a negative biopsy. Usually, this is due to superficial biopsy specimens. In our clinic, we usually get repeated endoscopic evaluation with biopsy as our first step. However, a small...
What are your top takeaways in Breast Cancer from ESMO 2025?
ASCENT-03: At ASCO, the results of ASCENT-04 already showed an improvement of PFS (11.2 months vs. 7.8 months) in first-line setting for PD-L1 positive advanced triple negative breast cancer patients treated with sacituzumab plus pembrolizumab compared to chemotherapy plus pembrolizumab. The ASCEN...
What factors should be considered when deciding between datopotamab deruxtecan and sacituzumab govitecan for a patient with metastatic breast cancer?
When choosing between Dato-DXd and SG, I consider payload differences, toxicity profiles, and prior therapies. Dato-DXd delivers DXd (an exatecan derivative), while SG delivers SN-38 (active irinotecan metabolite). SG demonstrated an OS benefit in TROPiCS-02 (JCO 2023), whereas Dato-DXd showed a PFS...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...
How do you determine which systemic therapy to recommend in the 2nd line setting for metastatic, PD-L1 NEGATIVE cervical cancer?
This is a very difficult situation because none of the available options are effective. Clinical trial or possibly pembrolizumab on compassion-care usage.
Would you recommend 1st line pembrolizumab for PD-L1 positive recurrent/metastatic cervical cancer patient who is not a candidate for or refuses chemotherapy?
No. First-line pembrolizumab has not yet been approved for that indication in cervical cancer. It is being studied in Keynote-826.
How do you reconcile the differing outcomes of the MATTERHORN and KEYNOTE-585 trials when determining systemic treatment approach for gastric/GEJ adenocarcinoma?
As it turns out, the outcomes are much more similar than dissimilar. While we all know MATTERHORN was a clearly positive study, KEYNOTE-585 was essentially also a positive study, obscured by a negative overall interpretation and undermined by its complicated statistical design.Specifically, 804 pati...
How would you treat a young patient with an EGFR 19 deletion and a locally advanced lung mass who had a brain metastasis that was resected?
The technically correct, textbook answer would be 1st line EGFR therapy for metastatic NSCLC, which would be osimertinib + carboplatin/pemetrexed (FLAURA2) or amivantamab/lazertinib (MARIPOSA). However, given the unique circumstances here, I would treat this patient slightly differently. I've writte...