Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend holding a KRAS inhibitor during palliative radiotherapy?
I have no personal experience or anecdotes and know of no current data or literature that would address this very specific question and this may be due to the limited experience on the potential interaction of this class of drugs and radiotherapy, since this drug is relatively new.This class of drug...
What are your top takeaways in Thoracic Cancers from ASCO 2022?
1. Abst 8502 - Quality metrics and survival after lung cancer surgery: More efficient work-ups and consistently high quality resections will likely do more to improve lung cancer survival than any adjuvant or neo-adjuvant therapy we can come up with. This is low-hanging, low-cost fruit. 2. Abst 9007...
Is there any role for re-biopsy and NGS for patients with NSCLC and KRAS G12C at time of progression after first line therapy before starting sotorasib, or after progression on sotorasib?
This is a great question and one that will come up more frequently. There clearly is a role for biopsy at the time of progression on targeted therapies in other driver alterations in NSCLC, and in limited data; to date, we know that occasionally there are resistance mechanisms to KRAS inhibitors tha...
What is the preferred second line, systemic therapy for NSCLC patients following first line chemoimmunotherapy?
This is as usual a quite complex question, and for a sophisticated audience such as theMednet readers, I always want to provide a nuanced answer; so here is what my preferred second line systemic therapy currently is:None.None.Still none…Indeed, now that chemo/immunotherapy has become the de facto s...
How would you approach the staging and treatment of extranodal marginal zone lymphoma of left and right lacrimal gland?
This entity is described in literature as "ocular adnexal lymphoma". I usually screen those patients for Chlamydia infection and would empirically consider a 3-week course of doxycycline especially if the disease is indolent behaving clinically and there is prior serologic evidence of Chlamydia infe...
How would you approach the staging and treatment of extranodal marginal zone lymphoma of left and right lacrimal gland?
This entity is described in literature as "ocular adnexal lymphoma". I usually screen those patients for Chlamydia infection and would empirically consider a 3-week course of doxycycline especially if the disease is indolent behaving clinically and there is prior serologic evidence of Chlamydia infe...
Would you consider doing Oncotype for a locoregional recurrence of ER positive breast cancer?
To re-phrase the question, would evidence that a local recurrence is biologically more aggressive than the primary affect our recommendations about administering adjuvant chemotherapy in a patient who recurred on adjuvant endocrine therapy, especially if she had never received adjuvant chemotherapy?...
In which patients with MGUS do you recommend a kidney biopsy to evaluate for MGRS?
If a patient has unexplained renal disease, and this could be interstitial or glomerular, and an MGUS, I strongly consider it. I typically try to get heme to do a bone marrow biopsy first because their findings may obviate a renal biopsy if they find something (although sometimes they may find low-g...
What treatment options do you consider if eosinophilia with end organ dysfunction persists with q8 week dosing of benralizumab and you can't obtain approval for q4 week dosing?
Depending on the degree of eosinophilia and end-organ dysfunction, if the patient is not already on oral steroids, they probably should be pending a new plan for a steroid-sparing agent. Is the diagnosis more consistent with HES or EGPA? Has the patient failed mepolizumab 300 mg? There is good data ...
Do you prefer to use the FAST or FAST-Forward regimen when treating stage I breast cancer with an ultra-hypofractionated approach?
We favor APBI like the Florence regimen but if technically not suitable, then FAST-Forward.