Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you choose which LHRH agonist or antagonist to prescribe for ADT in patients with prostate cancer?
The choice of LHRH agonist or antagonist depends on patient factors. Most patients receive some form of leuprolide or goserelin since these allow longer intervals between injections (as compared to degarelix). Goserelin is used more for those on anticoagulation or with bleeding disorders since it is...
How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?
Fibrolamellar carcinoma is histologically unique from hepatocellular carcinoma. The disease is correctly called fibrolamellar carcinoma, and not fibrolamellar hepatocellular carcinoma, or hepatocellular carcinoma fibrolamellar variant. Even though the latter may be permissive if the lack of cirrhosi...
How would you integrate immunotherapy into the treatment of a patient with recurrent, widely metastatic gastric adenocarcinoma after initial treatment with perioperative EOX and subtotal gastrectomy?
I agree with my friend, @Dr. First Last. Firstly, I hope that this is an entirely theoretical scenario or that the patient received EOX many years ago, prior to the FLOT4 data that established FLOT as the current standard-of-care. As Dan also mentioned, for patients who cannot tolerate FLOT, FOLFOX ...
Are CHEK2 mutations a contraindication for breast conservation therapy with lumpectomy + RT?
Among women with early-stage breast cancer and moderate penetrance breast cancer susceptibility genes, such as CHEK2, decisions about breast surgery are largely based upon personal preferences. According to data from large population-based studies, women with CHEK2 pathogenic variants have about a 2...
Do the results and approval based on ADAURA trial suggest a role for adjuvant osimertinib in patients with stage IIIB-C, EGFR mutant patients treated with concurrent chemoradiation?
ADAURA trial was not designed to address this issue. But that being said, we need to remember few things before considering "maintenance durvalumab" in patients with EGFR-mutant lung cancer, following chemo-radiation: 1. EGFR-mutant NSCLC patients may not derive any clinical benefit from single-agen...
How does data from the HIMALAYA trial impact your first line treatment selection for advanced HCC?
The results from the HIMALAYA trial with the combination tremelimumab (CTLA-4 inhibitor) and durvalumab (PD-L1 inhibitor) reported an OS of 16.4 months compared to 13.8 months for sorafenib which was statistically significant (HR 0.78, p-value of 0.0035). With the limited data presented at ASCO GI 2...
How are you using liquid biopsy in the routine management of your patients with metastatic NSCLC?
The dramatic improvement in the prognosis of metastatic NSCLC patients harboring targetable oncogenic genetic alterations with highly effective therapy has underscored the need for tumor molecular profiling. There have been numerous studies in the past decade assessing the performance of ctDNA (here...
How do you present the trade off between a small chance of a sustained response for a new drug at the expense of potential worsening quality of life?
Since we now have an increasing number of treatments at our disposal, this becomes an ever more frequent conversation in oncology. This question gets at several Shared Decision Making (SDM) model steps. Usually in this scenario, there are not routine standard of care options and highlighting the pat...
What are your top takeaways from SGO 2026?
A pivotal theme of SGO 2026 was the dramatic rise in ADCs in every gynecologic cancer, from front-line to recurrent disease. Along with notable updates for several studies, data from others were treatment-defining. (1)The following studies were selected for further review.Ovarian Cancer: Low-grade s...
In patients with muscle-invasive bladder cancer, in what clinical scenarios would you consider neoadjuvant cisplatin-based therapy in light of emerging data on enfortumab vedotin plus pembrolizumab?
Of course, we are still awaiting FDA approval of EV + Pembro in the cisplatin-eligible population, but the data from KEYNOTE-B15 presented at ASCO GU 26 are overwhelmingly positive. KEYNOTE‑B15 (EV‑304) was a randomized phase III trial in 808 cisplatin‑eligible patients with muscle‑invasive bladder ...