Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What risk factors would favor the addition of ovarian function suppression to endocrine therapy in triple-positive breast cancer?
Young age less than 40, node positive, high-grade, bulky tumor, or any patient at high risk of recurrence (requiring chemo) or residual tumor, I would favor giving ovarian suppression as per the SOFT and TEXT trial.
What is your approach to pregnant patients with type 2B von Willebrand disease, particularly when thrombocytopenia is already present?
The gist of this challenging clinical problem is that the high estrogen levels in the third trimester of pregnancy raise the VWF level normally. In type 2B VWD, this effect raises the level of the abnormal VWF, which clears more platelets from the circulation, and can lead to severe thrombocytopenia...
What radiation doses and subsequent treatment monitoring would you recommend for multiple myeloma patients with multifocal bony lesions who decline chemotherapy?
Systemic therapy is the cornerstone of treatment for multiple myeloma, and the vast majority of patients initiate an appropriate regimen upon diagnosis. Occasionally, patients will have very limited disease and will be referred to Radiation Oncology for consideration of local therapy to delay the ne...
What radiation doses and subsequent treatment monitoring would you recommend for multiple myeloma patients with multifocal bony lesions who decline chemotherapy?
Systemic therapy is the cornerstone of treatment for multiple myeloma, and the vast majority of patients initiate an appropriate regimen upon diagnosis. Occasionally, patients will have very limited disease and will be referred to Radiation Oncology for consideration of local therapy to delay the ne...
Would you use perioperative durvalumab in patients with diffuse-type gastric adenocarcinoma given no event-free survival benefit was seen for these patients in MATTERHORN?
Although MATTERHORN demonstrated a significant event-free survival benefit for perioperative durvalumab plus FLOT in the overall population, the forest plot does not show a clearly favorable signal in the diffuse-type subgroup. Because subgroup analyses are underpowered and not intended to confirm l...
How do you explain progression free survival to patients?
This is a really, really important question. I'd argue we often greatly undervalue the importance of communication with our patients and the impact the quality of our communication has on what they understand about their illness. I remember once having a long conversation with a patient where I outl...
How do you decide which immunotherapy agent to utilize for 1st line in PD-L1 high (>50%) NSCLC?
Now with the approval of atezolizumab based on the positive Impower110 study (led by @Dr. First Last and @Dr. First Last), we have 2 frontline checkpoint inhibitors to choose from. Indeed the data appears very convincing for both, therefore on scientific grounds, I would not be able to choose one ve...
How do you manage anemia associated with belzutifan therapy?
Anemia is a common toxicity with belzutifan. In a recent pooled safety analysis (Choueiri et al., The Oncologist KCRS Meeting 2024), anemia was seen in 84% of patients (any grade; 29% grade 3) with a median time to onset of 29 days. It is an on-target effect resulting from HIF regulation of erythrop...
How do you manage anemia associated with belzutifan therapy?
Anemia is a common toxicity with belzutifan. In a recent pooled safety analysis (Choueiri et al., The Oncologist KCRS Meeting 2024), anemia was seen in 84% of patients (any grade; 29% grade 3) with a median time to onset of 29 days. It is an on-target effect resulting from HIF regulation of erythrop...
Would you use adagrasib in combination with cetuximab for metastatic colon cancer with KRAS G12C mutation?
The NCCN guidelines were recently updated to include KRAS G12C inhibitors (adagrasib/sotorasib) in combination with anti-EGFR antibodies (cetuximab/panitumumab) for KRAS G12C mutant metastatic colorectal cancer. The majority of patients with this alteration obtain clinical benefit from this combinat...