Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider using bevacizumab/atezolizumab in HCC patients who received TKI in the first line?
This is a great question. After failure of a front-line single agent TKI, I would still favor the current FDA-approved agents: regorafenib; cabozantinib; ramucirumab in AFP-high; OR immunotherapy (nivolumab, pembrolizumab, OR nivolumab plus ipilimumab). It is important to note that the second-line ...
Would you offer adjuvant chemotherapy, or osimertinib if EGFR+, to patients with two synchronous stage 1A lung cancers that appear to be distinct and have both been resected?
Probably not. The cure rate for stage IA adenocarcinoma is 75-90%, depending on the details (including size). The ADAURA trial demonstrated a substantially improved DFS favoring osimertinib over placebo for patients with stage II or III NSCLC with an activating EGFR exon 19 or 21 mutation. Although ...
Should atezolimab and chemotherapy be considered for stage III dMMR colon cancer with BRAF mutation?
Yes. BRAF V600 mutations were allowed in the ATOMIC study. In fact, BRAF status was a stratification factor. Subgroup analysis showed the benefit of adding Atezolizumab was consistent across the different trial subgroups.
Is there any evidence for combining surgery and XRT +/- ADT for treatment of localized high risk prostate cancer?
Presumably, this is a question inquiring about planned post-operative RT. If so, surgery followed by adjuvant, post-operative radiation therapy (PORT) has been profiled extensively in several RCTs: EORTC 22911, SWOG 8794, ARO 96-02, FinnProstataX. The two more recent trials, ARO 96-02 and FinnProsta...
For a patient with lenalidomide-refractory R/R multiple myeloma at first or second relapse, how would MeziKd (if approved based on SUCCESSOR-2) factor into your sequencing decision relative to BCMA-directed and other available options?
There is never a good time to be a myeloma patient, but this is the best time it has ever been.Tldr; I would still prefer a BCMA-directed strategy for patients with BCMA-naive relapsed MM.The recently reported results of the phase 3 SUCCESSOR-2 trial demonstrated the efficacy of mezigdomide, a novel...
For a patient with lenalidomide-refractory R/R multiple myeloma at first or second relapse, how would MeziKd (if approved based on SUCCESSOR-2) factor into your sequencing decision relative to BCMA-directed and other available options?
There is never a good time to be a myeloma patient, but this is the best time it has ever been.Tldr; I would still prefer a BCMA-directed strategy for patients with BCMA-naive relapsed MM.The recently reported results of the phase 3 SUCCESSOR-2 trial demonstrated the efficacy of mezigdomide, a novel...
What are your recommendations for holding bevacizumab before and after SBRT to the lung?
As @Maria Werner-Wasik notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. This wo...
How would you approach iron supplementation in a beta thalassemia trait patient with restless leg syndrome?
Thalassemia does not alter my decision. I don't use PO iron for RLS as it is enormously more toxic. A ferritin of 75 is a light-year away from iron overload, and a total dose infusion of IV iron can be administered with impunity. This patient should be treated with a gram of LMW iron dextran over on...
What third line treatment do you consider for a patient with metastatic pancreatic cancer with good functional status and no targetable mutations after progression on FOLFIRINOX and gemcitabine/nab-paclitaxel?
Sadly, there is absolutely no "standard" option in this space, as no trials have demonstrated any meaningful benefit. I personally would not just "try" a therapy - and I would especially not just "try" an immune checkpoint inhibitor, as these, as single agents have shown no benefit at all (if the tu...
What is your preferred sequencing of adjuvant chemotherapy and PMRT for node + breast cancer?
I addressed this issue for patients treated with breast-conserving surgery in May 2023; please see that answer for more details. To summarize, the toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when given after RT instead of before (Recht ...