Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you choose a non-anthracycline containing regimen, such as docetaxel/cyclophosphamide, for patients with hormone receptor positive, HER2 negative breast cancer who warrant adjuvant chemotherapy?
As in many of the decisions we face, we need to balance benefit and risk. Based on the ABC suite of trials, anthracycline regimens are slightly more effective than non-anthracycline (taxane only) regimens. To be clear, the ABC data is far from perfect - the trial design changed at least 3 times duri...
In light of the pending overall survival data and reported declines in quality of life associated with the PSMAddition trial, how do you envision incorporating Pluvicto into the management of mHSPC?
The PSMAddition trial was a phase III trial of [177Lu]Lu-PSMA-617 (i.e., Pluvicto) combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This trial randomized men with u...
What are your recommendations for holding bevacizumab before and after SBRT to the lung?
As @Maria Werner-Wasik notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. This wo...
Which patients, if any, do you revert back to ultrasound screening for HCC after prior diagnosis/definitive treatment of HCC?
I don't revert back to U/S for these patients ever. It's not dissimilar from colorectal cancer screening - once you have colon cancer, it's not appropriate to use iFOBT or stool DNA screening anymore - it's lifelong colonoscopy screening. Likewise, for HCC, I continue to use AFP plus cross-sectional...
Should cisplatin, gemcitabine, and veliparib be the standard of care in treating metastatic/unresectable pancreatic cancer with BRCA or PALB2 mutation?
In a recent publication (O’Reilly et al. JCO 2020), the authors reported high response rates (74.1% vs. 65.2%, respectively) of both study arm (gemcitabine + cisplatin + veliparib) and control arm (gemcitabine + cisplatin) from a phase II open-label, randomized multicenter trial. Despite the unprece...
What is your escalation strategy for chronic GvHD?
There are now several available options for steroid resistant cGVHD. The old standbys - ECP and rituxan are useful in about 30% of patients. Ibrutinib was the first new drug to get FDA approval. Unfortunately, I don't think the real-world experience is anywhere near as good as the trial (Chin et al....
What is your approach to adjuvant endocrine therapy in hormone receptor positive male breast cancers?
Tamoxifen should be the standard adjuvant endocrine therapy for ER+ breast cancer in men. There has been talk intermittently about aromatase inhibitor (AI) use as alternative endocrine therapy, and I would not recommend the use of AIs in this setting. Data is limited, with the one study comparing ou...
How do you manage hot flashes in men with prostate cancer on androgen deprivation therapy?
I prescribe Effexor extended release (XR) 37.5 mg increasing to 75 mg if needed. Serves double duty since many men would benefit from an antidepressant anyway. Works for women as well.
Will you use vadadustat in place of an ESA in treating anemia of chronic kidney disease?
Vadadustat is approved by the FDA only for patients who have been on dialysis for at least 3 months. It is not approved for patients with CKD not on dialysis. Its efficacy and safety are comparable to that of ESAs. I would consider using vadadustat in two patient populations: those on home dialysis ...
Is there data supporting the extension of adjuvant olaparib beyond one year in patients with early-stage HER2-negative breast cancer and germline BRCA1/2 mutations?
The current practice of the addition of 1 year of adjuvant olaparib in high-risk HER2-negative early breast cancer in those patients with germline pathogenic or likely pathogenic variants in BRCA1 or BRCA2 is based on the superior DFS and OS benefit reported in the Phase III OlympiA trial. Fortunate...