Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What factors should be considered when deciding between datopotamab deruxtecan and sacituzumab govitecan for a patient with metastatic breast cancer?
When choosing between Dato-DXd and SG, I consider payload differences, toxicity profiles, and prior therapies. Dato-DXd delivers DXd (an exatecan derivative), while SG delivers SN-38 (active irinotecan metabolite). SG demonstrated an OS benefit in TROPiCS-02 (JCO 2023), whereas Dato-DXd showed a PFS...
What scenarios, if any, are you delaying adjuvant chemotherapy in light of the COVID-19 outbreak?
This is a complex issue that our group here at MSKCC is dealing with right now, with formalized guidance pending. This is in mind of the fact that the mortality rate in Chinese patients with cancer approached 6%. While I wouldn't delay starting adjuvant therapy—which is being given with curative int...
Has your practice changed to PLEX-free initial therapy for iTTP?
I am not. The reason is that caplacizumab is not on formulary at my institution, and so implementing PLEX rapidly while obtaining caplacizumab (which typically arrives in 24-48 hours) is my current practice. If I had caplacizumab on formulary, I would utilize it as it was utilized in the MAYARI tria...
Among the metastatic/unresectable melanoma patients you would historically treat with anti-PD-1 monotherapy, are you now recommending nivolumab/relatlimab instead?
Based on the published RELATIVITY-047 study, the nivo/rela combination leads to a superior median PFS of 10.2 mo (vs 4.6 mo for nivo alone) - both updated at ASCO 2022. At the most recent update at the ASCO 2022, the median survival has not been reached yet for the patients treated with nivo/rela (v...
Is it safe to use medroxyprogesterone for vasomotor flushing?
There are many options for management of hot flashes including venflaxine and gabapentin being most frequently used as well as some data on cognitive behavioral therapy, oxybutynin, and acupuncture. For the most refractory cases, I do discuss medoroxyprogesterone 400 mg IM as a one time option based...
What measures should we take regarding routine follow-up visits for well patients in surveillance during the coronavirus pandemic?
3-6 months.
How, if at all, does the spectrum of HER2 positivity impact efficacy of T-DXd in the frontline setting?
Multiple studies have shown that HER2 3+ disease is a predictor for exceptional (long-term) response to first-line THP, and conversely, patients with HER2 2+/FISH positive disease are less likely to experience an exceptional response to THP. While I have not seen a subset analysis by HER2 2+ vs 3+ p...
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
Given results of the IDEA study presented at ASCO, would you consider truncating adjuvant therapy with stage II colon cancer?
The question asked is how one would consider incorporating the recent findings from the IDEA study into the utilization of adjuvant chemotherapy for patients with stage II colon cancer. The findings from this landmark study indicated that under certain circumstances, specifically those of patients w...
Should we consider deferring adjuvant chemotherapy for resected early-stage NSCLC in light of COVID-19?
This is a great and timely question! The absolute benefit observed with adjuvant chemotherapy in surgically resected NSCLC is greatest in those patients with stage II and III disease. The question is how long can one wait to give adjuvant chemotherapy and maintain its benefits. Salazar and colleague...