Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Gyn Cancers from ESMO 2024?
Ovarian CA (Immunotherapy) There has been limited success with single agent immunotherapy in ovarian cancer. Three ovarian cancer immunotherapy studies presented at ESMO 2024 are worth noting.ATHENA-COMBO: Rucaparib +/- Nivo as Maintenance in Newly Diagnosed Ovarian Cancer - ATHENA-COMBO Ph3 TrialA...
Is the phase 2 data regarding neoadjuvant cemiplimab in cutaneous squamous cell carcinoma sufficient to adopt for all patients or will you await phase 3 data?
The current data are quite compelling, but not sufficient to adopt for all patients. We need to see the long-term recurrence and survival rates from the phase II study and also perform a confirmatory phase III trial with a survival endpoint. Unless this treatment approach results in equivalent to im...
Would you offer zolbetuximab + chemotherapy in a presumed metastatic duodenal bulb adenocarcinoma with 80% Claudin18.2 expression?
I would not. Cancers of the duodenum are different and such patients were not represented in GLOW or SPOTLIGHT. In addition, zolbe is not very easy in terms of nausea and vomiting, especially in the first cycle. Would not expect more "debulking" effect from it given the absence of significant ORR be...
For which patients, if any, do you typically order additional imaging workup for staging in early-stage breast cancer?
Many studies have shown the true-positive rate of distant metastases on pretreatment imaging to be a few percent (at most) for patients with Clinical Anatomic Stage I-II cancers. The false-positive rate is much higher. Hence, such imaging should only be used when patients have suspicious symptoms or...
Would you consider chemoimmunotherapy (CP-Pembro-AC) in triple negative breast cancer if tumor is not palpable on physical exam?
KN522 regimen is approved for cT2 or greater (tumor >2cm) regardless of nodal involvement or cT1c with nodal involvement. The tumor size can be determined by a physical exam or radiologic assessment or both. Therefore, it is perfectly fine to use KN522 regimen if the tumor is not palpable as long as...
How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?
I will try to provide some data for discussion, but also welcome comments from other experts and opinions. I'm assuming this is a younger patient without known risk factors and that an assessment for things like A. Fib, PFO, and DVT have been performed.Chemotherapy has long been associated with thro...
How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?
I will try to provide some data for discussion, but also welcome comments from other experts and opinions. I'm assuming this is a younger patient without known risk factors and that an assessment for things like A. Fib, PFO, and DVT have been performed.Chemotherapy has long been associated with thro...
Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?
In the event there are no adverse contraindications for the use of thromboprophylaxis, yes, I recommend the use of a minimum of 81 mg of aspirin daily with a low dose of lenalidomide. In this meta-analysis (Chakraborty et al., PMID 31913498), the risk of venous thromboembolism was low with a low dos...
Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?
In the event there are no adverse contraindications for the use of thromboprophylaxis, yes, I recommend the use of a minimum of 81 mg of aspirin daily with a low dose of lenalidomide. In this meta-analysis (Chakraborty et al., PMID 31913498), the risk of venous thromboembolism was low with a low dos...
How would you approach a young person with JAK2 V617F positive essential thrombocytosis with otherwise low risk features?
The first question in this situation is what is the JAK2 V617F neutrophil quantitative allele burden (NAB)? It must be less than 50% for a diagnosis of essential thrombocytosis (ET). Second, are we dealing with a man or woman? Men with so-called "ET" are much more likely than women to develop myelof...