Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you ever consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response?
Yes, I would consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response.Data of 655 melanoma patients treated in pembrolizumab phase 1 KEYNOTE-001 study has shown 95 patients (14.5%) achieved CR after a median follow-up of 32 months. Treatment was discontin...
How do you approach ADT in patients with high-risk prostate cancer who have risk factors for VTE, such as Factor V Leiden?
My default recommendation for patients with localized, high-risk prostate cancer is to recommend the use of long-term ADT. This intervention seems to offer a relatively large, clinically significant OS benefit for patients in the modern era receiving dose-escalated ADT. This benefit has been observe...
How do you approach ADT in patients with high-risk prostate cancer who have risk factors for VTE, such as Factor V Leiden?
My default recommendation for patients with localized, high-risk prostate cancer is to recommend the use of long-term ADT. This intervention seems to offer a relatively large, clinically significant OS benefit for patients in the modern era receiving dose-escalated ADT. This benefit has been observe...
How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?
Normal body mass index (BMI) and maintenance of weight is associated with a more favorable outcome (in many series both cancer-related and non-related) compared to higher BMI. Similarly higher level of exercise and metabolic equivalent (MET) is also associated with better outcome in many observation...
How do you manage infection risk when using BTKi-chemoimmunotherapy combinations in MCL patients?
This is a broad question, but BTKi are used in younger/fit patients (TRIANGLE-like therapy, including cytarabine) and approved in combination with BR (acalabrutinib). Regarding the latter: bendamustine is known to be T-cell depleting and associated with zoster/HSV and risk of other viral infections....
How do you manage infection risk when using BTKi-chemoimmunotherapy combinations in MCL patients?
This is a broad question, but BTKi are used in younger/fit patients (TRIANGLE-like therapy, including cytarabine) and approved in combination with BR (acalabrutinib). Regarding the latter: bendamustine is known to be T-cell depleting and associated with zoster/HSV and risk of other viral infections....
Do you offer consolidation durvalumab in a patient who had pneumonitis requiring steroids following chemoradiation for LS-SCLC?
In the ADRIATIC trial, pneumonitis or radiation pneumonitis occurred in 38.2% of durvalumab-treated patients, and 8.8% discontinued treatment due to pneumonitis (Cheng et al., PMID 39268857). While there is emerging interest in immune checkpoint inhibitor rechallenge after successful management of i...
What is your approach to adjuvant chemotherapy for a postmenopausal woman with pT1cN0 grade 2 ER+ breast cancer (IDC) and OncoType RS of 25?
Since the Oncotype Dx recurrence score of 25 was the upper cut-off for randomization in the TAILORx trial, and since post-menopausal women with Oncotype Dx of 25 or less did not experience any benefit from chemotherapy, I would lean towards avoiding chemotherapy in this situation. However, I would d...
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
Has precision medicine changed how you consent patients for treatment?
The use of precision oncology technology and genetics has changed the ability to provide informed consent. In general, the riskier or less standard of care a therapeutic intervention might be, the greater the need for informed consent. In this way, precision oncology has pushed the envelope especial...