Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the preferred palliative treatment regimen for elderly patients with advanced cholangiocarcinoma?
There is very limited data to provide a data driven approach to the management of elderly patients with advanced cholangiocarcinoma. In my clinical experience, gem/cis combinational chemotherapy as given in the ABC-02 trial is well tolerated for most older adults with preserved performance status an...
What high-risk features for stage I NSCLC would lead you to consider adjuvant osimertinib?
In patients with resected stage IB non-small cell lung cancer (NSCLC) harboring EGFR mutations, adjuvant osimertinib may be considered for care. There is some evolving data that there may be some benefit in the presence of other risk factors in stage I, including solid or micropapillary histologic c...
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 ...
Would you offer adjuvant therapy for patients with resected NSCLC <3 cm with visceral pleural involvement and no lymph node involvement?
The short answer is "no", I do not typically recommend adjuvant systemic therapy or radiotherapy for people with completely resected, small (<3 cm) T2aN0M0, stage IIA NSCLC.The NCCN guidelines state that "adjuvant chemotherapy is recommended for high-risk features" in people with resected stage IB o...
Would you still offer adjuvant osimertinib to patients who elect not to receive chemotherapy in resected EGFR mutated lung cancer?
Yes- while it is important to keep in mind that platinum-based adjuvant chemotherapy confers OS benefit in the appropriate setting, adjuvant chemotherapy prior to osimertinib/placebo randomization was not mandatory in the ADAURA study design. In the updated analysis presented at ESMO 2022 by Tsuboi ...
What adjuvant therapy would you offer following adjuvant chemotherapy for a patient with Stage III lung adenocarcinoma with an atypical EGFR mutation such as EGFR L861R?
Mutations at position 861 (most commonly L861Q) have been described, occurring in approximately 2% of all EGFR-mutant patients [Mitsudomi and Yatabe, PMID 19922469]. These mutations are considered partially sensitizing to afatinib based on a post-hoc analysis of LUX-Lung 2, LUX-Lung 3, and LUX-Lung ...
Would you offer adjuvant osimertinib in a patient with complete pathologic response to neoadjuvant platinum doublet for a stage IIIA resected EGFR mutant lung adenocarcinoma?
With the caveat that we do not have level I evidence specifically for this clinical scenario yet (ongoing NeoADAURA study may potentially provide some answers in the future), based on very favorable outcomes of patients with NSCLC in general who derived pathologic complete response after neoadjuvant...
How would you treat a potentially resectable stage III lung adenocarcinoma with an EGFR mutation?
How would you treat a potentially resectable stage III adenocarcinoma with an EGFR mutation? Do you consider any neoadjuvant therapy or proceed to surgery followed by adjuvant chemotherapy and osimertinib? This is a very challenging patient scenario that we face with some frequency and it truly is l...
For patients who received neoadjuvant chemotherapy and found to have an EGFR sensitizing mutation at time of R0 surgical resection, would you offer still offer adjuvant osimertinib?
This question has several nuances to address with the rapidly evolving therapeutic landscape for early-stage lung cancer, specifically patients with EGFR mutation. First is the question of neoadjuvant therapy and whether genomic testing should be done prior to offering neoadjuvant treatment. With th...
In a patient with HER2+ breast cancer who develops metastatic recurrence after receiving neoadjuvant or adjuvant T-DXd, what will then be your approach to first-line metastatic therapy?
This is a newly created clinical scenario. T-DXd was only approved in the (neo)adjuvant setting in May 2026 (neoadjuvant with THP per DESTINY-Breast11, and post-neoadjuvant for residual disease per DESTINY-Breast05). The approach should be individualized.I would first confirm biology at recurrence b...