Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
How do you approach a metastatic mixed non-seminoma germ cell tumor s/p orchiectomy and chemotherapy with normalization of tumor markers and persistent multiple lung metastasis (>1 cm) that cannot be fully resected?
The first question I would ask is, does he have residual radiographic abnormalities in the retroperitoneum? If he does and it hasn't been done yet, I would go to a proper post-chemotherapy RPLND as the first step. The second question is whether we should perform any biopsy of the lung nodules to pat...
What are your top takeaways in GU Cancers from ESMO 2025?
KEYNOTE-905: These impressive results change the management paradigm of patients with MIBC who are surgical candidates but are not cisplatin-eligible. Over time, it may be that EVP perioperative therapy becomes the standard of care for all patients with MIBC with plans to proceed with cystectomy. I...
What is the appropriate monitoring for an incidental low-grade rectal neuroendocrine tumor resected endoscopically with positive margins?
Do we have information on the size of the lesion? Typically, if it was a positive biopsy and the size of the polyp was <1 cm, we typically rescope and biopsy the scar. It can harbor residual disease (40% incidence), which a deeper resection can cure. And then these patients don't need surveillance. ...
Are there any contraindications to Pluvicto therapy you personally use, given that there are none directly provided by the manufacturer?
In this situation, it is helpful to review the eligibility and exclusion criteria from the VISION protocol directly. These can be found at NCT03511664 (Sartor et al., PMID 34161051). Many of these patients have been heavily pretreated, including prior taxane therapy, so my main concern is that they ...
How do you differentiate between ERBB2 mutation vs HER2 overexpression testing when selecting patients for tumor-agnostic therapy?
This distinction is critical. HER2 protein overexpression (IHC ± ISH) underpins T-DXd’s tumor-agnostic approval. ERBB2 mutations define a different subset that perhaps may have better responses to HER2 TKIs that are in development rather than ADCs. In other words, a genomic alteration in ERBB2 does ...
Is your approach to managing immune related adverse events altered at all in light of COVID-19?
First of all, I wish to thank @Dr. First Last from Johns Hopkins/Sibley for his advice addressing this critical topic.We are all witnessing a rapidly evolving crisis that none of us have been prepared for and it is the right thing to quickly consider as best as we can how the COVID-19 pandemic shoul...
Do you use a TKI for resected EGFR+ non-small cell lung cancer?
We currently await completion of the ongoing ALCHEMIST trial investigating this question. A number of studies in the past treated NSCLC patients with adjuvant EGFR TKI regardless of mutational status. More recently, ADJUVANT (NCT01405079) is the first randomized trial to compare the EGFR TKI gefitin...
How do you decide between anticoagulation and observation for an incidentally detected subsegmental pulmonary embolism in elderly patients with a history of gastrointestinal bleeding?
We face this conundrum not infrequently because subsegmental emboli are subject to high inter-reader variability, and the accuracy of the finding in isolation is suspect (Batayneh et al., Blood 2023). I once mentioned this to a radiologist who reads CTAs and was told, tactfully, that I was full of i...
Mindful of the coming approval of abemaciclib, how would you decide between a CDK 4/6 inhibitor in either the first or second-line setting in HR-positive, HER2-negative postmenopausal metastatic breast CA?
Side effect profile is generally a good starting point since there is no head to head comparison (not will there likely be). Abemaciclib does have a higher incidence of diarrhea but also a lower incidence of neutropenia. It also has the advantage of daily dosing which can be less confusing for pati...