Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer adjuvant bisphosphonates to high-risk premenopausal women on ovarian suppression for early-stage breast cancer who would want to consider pregnancy in the future?
ASCO guidelines from 1/2022 recommend a discussion of bisphosphonate therapy in post-menopausal women or women on ovarian suppression who are candidates for adjuvant therapy, but risks and benefits should be carefully weighed.In a large meta-analysis of adjuvant bisphosphonate therapy in early breas...
What criteria would you use to decide between trastuzumab-deruxtecan and sacituzumab govitecan in HER2 low metastatic TNBC given T-DXd approval in HER2 low breast cancer?
There are currently unfortunately no biomarkers to select participants for antibody drug conjugate therapies, including sacituzumab and trastuzumab deruxtecan for HER2 low metastatic TNBC. The studies evaluating sacituzumab govitecan and trastuzumab deruxtecan had different I/E criteria, including w...
How often do you assess for frailty in your clinical practice for patients with Multiple Myeloma and what tool do you use?
Excellent question - the short answer is that I suspect the "eyeball test" is used by the vast majority of people reading this, to the point where launching a Mednet poll might not even be helpful...For those who are interested in trying out the IMWG frailty score, it's available (for free) at this ...
Would you start anticoagulation in a patient with RCC and related (tumor) thrombus with extension to renal vein and further?
Tumor thrombus is an intraluminal extension of tumor mass, rather than a true thrombus. There is no evidence that anticoagulation improves outcomes in tumor thrombus (Marcoux et al., Blood 2019). Primary management is surgical resection, typically as part of radical nephrectomy for localized RCC or ...
Would you start anticoagulation in a patient with RCC and related (tumor) thrombus with extension to renal vein and further?
Tumor thrombus is an intraluminal extension of tumor mass, rather than a true thrombus. There is no evidence that anticoagulation improves outcomes in tumor thrombus (Marcoux et al., Blood 2019). Primary management is surgical resection, typically as part of radical nephrectomy for localized RCC or ...
How would you approach a patient over the age of 40 with a sub-totally resected frontal oligodendroglioma, WHO Grade II, 1p/19q co-deleted, IDH mutant, with imaging concerning for second site in the pontomedullary junction?
The pontomedullary junction is not usually amenable to a biopsy (unless the lesion is exophytic); as such, there are 2 possibilities: a) the second lesion is related to the one that has undergone subtotal resection, or b) the lesion is of a different nature. Statistically, it is more likely to be a ...
What is your approach to a patient with muscle invasive bladder cancer getting neoadjuvant gemcitabine/cisplatin who develops significant ototoxicity due to cisplatin after two cycles?
My approach would be to proceed to surgery and based on pathological response, determine if the patient is a candidate for nivolumab.For patients who cannot tolerate cisplatin, there is no recommendation for an alternate regimen in the neoadjuvant setting.If treatment-naive and cisplatin-ineligible ...
How do you treat a patient with TNBC, BRCA WT, who received KEYNOTE-522 with residual disease post neoadjuvant therapy?
Yes, in this (unfortunately high-high-risk) situation, I would continue adjuvant pembrolizumab as per the KEYNOTE-522 trial, and add adjuvant capecitabine per the CREATE-X trial. Though these two agents were not specifically studied together in this exact setting, there is other safety data to reass...
How have the results of RTOG 1112 influenced your opinion of Y90 and other IR ablative strategies vs SBRT for HCC not amenable to surgery?
My opinion has changed to a fact with RTOG/NRG 1112 (NCT01730937). RTOG/NRG 1112 now provides definitive evidence that treatment of the entire tumor with an adequate dose of radiation has a survival benefit in patients who are TACE refractory or have macrovascular invasion. The controversy now is wh...
When do you consider using ALK targeted systemic therapy in lieu of WBRT or SRS for patients with metastatic ALK-positive NSCLC?
The development of crizotinib in ALK positive patients led to incredible control rates systemically, but as is now well known, less ability to control CNS disease. When crizotinib was the sole FDA approved ALK directed therapy, this led to the concept of "treatment beyond progression" such that pati...