Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
How would you approach an asymptomatic older female patient with eosinophilia to 17,000, present for years, and normal eosinophilia workup including marrow and negative FLIP1?
Interesting case. Eos have been in the 17K range for years? Was it incidentally noted? Could just be idiopathic HES. I would worry about cardiac infiltration in an older patient, but if there have never been cardiac issues and no evidence of a myeloid variant, I would probably defer to the patient a...
After induction therapy for acute promyelocytic leukemia with arsenic trioxide and ATRA, at what point do you start consolidation?
During induction, I wait for count recovery (ANC above 1000, transfusion independent- typically around Day 30, but +/- 5 days) and perform a bone marrow biopsy at that point. Patients routinely are still (but not always) + for PML-RAR at this biopsy, but that doesn't matter. As long as the marrow is...
After induction therapy for acute promyelocytic leukemia with arsenic trioxide and ATRA, at what point do you start consolidation?
During induction, I wait for count recovery (ANC above 1000, transfusion independent- typically around Day 30, but +/- 5 days) and perform a bone marrow biopsy at that point. Patients routinely are still (but not always) + for PML-RAR at this biopsy, but that doesn't matter. As long as the marrow is...
What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?
Hope for the miracle yourself! Broaden: “Are there any other things you are hoping for?” Hope for the best, prepare for the worst: “I see how much you want a miracle. I wonder if we can talk about what we should do if this doesn’t happen.” Consider involving a religious leader if relevant.
Do you recommend testing for UGT1A1 prior to initiating sacituzimab govitecan for patients with metastatic TNBC to mitigate neutropenia risk?
The phase I/II study of sacituzumab govitecan (SG) treated patients with various solid tumors and 146 patients had UGT1A1 testing. Let's first look at diarrhea. The overall incidence of grade 3 diarrhea was low (6.8%) and could not be predicted by any of the three haplotypes at the 10 mg/kg dose lev...
Would you implement CAR-T therapy earlier in practice if approved in earlier lines for multiple myeloma based on the KarMMa-3 and CARTITUTUDE-4 studies?
I agree with @Dr. First Last's excellent take on CARTITUDE-4 and KarMMA-3. For patients who have had 2 prior lines of therapy, I am absolutely going to reach for CAR-T (or bispecific antibodies as their earlier-line studies get published) with an emphasis on cilta-cel based on the data at hand.But w...
What is your approach to determining fitness for patients to undergo CAR-T therapy for relapsed/refractory multiple myeloma, and any absolute perceived contraindications for CAR-T?
This is a great question to which the only truly correct answer is, "It depends." Not just on the patient & disease biology, of course, but also the year in which the question is answered. For example, right now there are patients for whom commercial cilta-cel or ide-cel are not appropriate because ...
How would you approach choosing a regimen for a patient with multiple myeloma refractory to Daratumumab and Lenalidomide, with severe neuropathy from Bortezomib?
That's an excellent question with many answers. Ideally, CAR-T therapy is a strong option, particularly based on the findings from the CARTITUDE-4 trial. If the patient is uncertain about CAR-T, then carfilzomib-based therapy is a viable alternative. This option can be effectively combined with eith...
How would you approach choosing a regimen for a patient with multiple myeloma refractory to Daratumumab and Lenalidomide, with severe neuropathy from Bortezomib?
That's an excellent question with many answers. Ideally, CAR-T therapy is a strong option, particularly based on the findings from the CARTITUDE-4 trial. If the patient is uncertain about CAR-T, then carfilzomib-based therapy is a viable alternative. This option can be effectively combined with eith...