Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Breast Cancer from ESMO 2025?
ASCENT-03: At ASCO, the results of ASCENT-04 already showed an improvement of PFS (11.2 months vs. 7.8 months) in first-line setting for PD-L1 positive advanced triple negative breast cancer patients treated with sacituzumab plus pembrolizumab compared to chemotherapy plus pembrolizumab. The ASCE...
Will you extrapolate EORTC 1333/PEACE-3 (enzalutamide + Rad223) to any other ARPIs for mCRPC?
PEACE-3 was a cooperative group study of radium-223 plus enzalutamide versus enzalutamide alone in men with mCRPC. There was a significant improvement in OS (38 months vs 32 months). Most patients in the trial were previously treated with ADT monotherapy instead of intensified therapy (i.e., ADT + A...
When do you recommend patients get vaccinations with respect to their RT course?
I agree with @Dr. First Last's reply, and find that some patients are under the impression they are immunocompromised during radiation therapy and thus should avoid vaccines, when in fact the opposite is true. The skepticism behind the science of vaccination also can lead to avoidance, and so I try ...
Do you recommend using a ctDNA assay for a patient with HER2+ metastatic breast cancer in a continued CR to guide decision about whether to stop HER2-directed therapy?
This is a good question and is not a rare situation in the management of HER2+ metastatic breast cancer. Radiographic complete response occurs with first-line treatment in 6-15% (CLEOPATRA, GIM-14, and other trials). Currently, the standard of care is to continue anti-Her2 therapy indefinitely. Howe...
How would you approach treatment for a HR+ HER2+ clinical T1c N0 male breast cancer?
If clinically node negative, he can receive surgery and then once confirmed to be pT1c pN0, you could provide the TH regimen (weekly paclitaxel x 12 cycles plus trastuzumab for one year). However, my favorite approach would be to give the same regimen in the neoadjuvant setting so that I can re-disc...
Do you regularly perform pharmacogenomic testing for patients prior to starting chemotherapy?
At my center, we routinely perform DPYD genotyping prior to chemotherapy with 5-FU or capecitabine. This is a practice that is supported by very strong evidence from multiple prospective studies (see especially Henricks et al., PMID 30348537). The most important benefit of screening for DPD deficien...
What is the longest acceptable interval between radical orchiectomy and adjuvant BEP for Stage IIB/III pure seminoma in the age of COVID-19?
Drs. @Dr. First Last and @Dr. First Last have worked with GCT experts to create practical recommendations during this pandemic. You can read these here. Briefly, these patients should be still be treated with timely curative intent. Treatment decisions will need to be individualized for each patient...
How would you approach missed doses of fulvestrant due to COVID-19?
There is no specific guideline for this. But, as we do for patients who occasionally miss fulvestrant doses, I would try to schedule the next dose as soon as possible. Another option would be to consider an alternative endocrine therapy option such as AI, tamoxifen, which do not require for patients...
In which patients will you consider a shorter course of adjuvant Herceptin?
At this point, I would not treat any patients with short term trastuzumab. The Short-Her study had very wide confidence intervals for non-inferiority, and there was a numerically superior 2.2% improvement in DFS in the long (standard) trastuzumab arm. Additionally, in the patients with the worst pro...
Would you recommend imatinib 400 mg BID or stay with the usual dose of 400 mg/day for adjuvant therapy for a patient with intermediate-high risk exon 9 mutated GIST?
This is an issue that has been debated for more than 10 years with no clear-cut evidence-based answer. A case can be made for both options. I personally start with 400 mg/d, watch the disease closely, and the first indication that the benefit is in question, increase the dose to 800 mg/d. Tolerance ...