Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you consider prophylactically increasing eculizumab frequency for pregnant or postpartum PNH patients?
Yes, there have been several case series and reports indicating that eculizumab may need to be prophylactically increased in dose or frequency (because the pregnancy state may further increase complement activation in PNH patients). This efficacy of eculizumab may be monitored by standard hemolysis ...
Would you consider adding atezolizumab to chemotherapy for metastatic esophageal small cell cancer?
I would consider adding atezolizumab (and indeed I have in the past). Of course, this would be based on the SCLC literature from the IMpower133 and CASPIAN trials where atezolizumab and durvalumab respectively improved outcomes when combined with platinum/etoposide chemotherapy. But there is a cavea...
How do you treat triple positive essential thrombocythemia with evidence of fibrosis on bone marrow biopsy, but does not meet diagnostic criteria for myelofibrosis?
My first thought upon encountering this question was that there must have been a typographical error and the writer actually meant “negative”, not positive, because “triple positive” essential thrombocythemia (ET) is an oxymoron. MPN driver mutations are not mutually exclusive with respect to their ...
How would you sequence PARPi vs pembrolizumab for a patient who has progressed on ARPI to mCRPC that has somatic PALB2 mutation and MSI-H?
MSI-high disease in men with mCRPC is uncommon, accounting for 3-5% of patients overall, and typically results in high TMB. MSI-high disease is usually a result of either germline MMRD (Lynch Syndrome, about 20% of MSI-high cases) or somatic MMRD (typically MSH2 or 6, MLH1, less commonly PMS2). The ...
Would you offer nodal RT for pT2N0 triple negative breast cancer s/p BCS?
I agree with above and generally haven't routinely offered RNI for such patients. However, I consider making an exception in the setting of a tumor with multiple risk factors, such as medial location, young age, large T2, poor response to neo-adjuvant chemotherapy (so cT2N0, ypT2N0) with LVI, etc.
Would you consider stopping EGFR inhibitor in EGFR mutant NSCLC on a patient who was NED for >5 years?
It's a great question! My bias would be to lean toward continuation in the absence of significant impact on QOL. Some literature is available describing the experience of long-term responders, but even then, the definition of long-term responders is up about 2-3 years, so well below the duration of ...
Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?
There is no phase III evidence I am aware of on the benefits of nintedanib in the prevention of radiation-induced pulmonary fibrosis so it is not a drug I use. There are a few case reports and some pre-clinical studies suggesting an effect. There is a small (34 patients) randomized phase II study th...
What is your approach to Myelofibrosis in Accelerated Phase (Blast percentage 10-19%) in a transplant-eligible patient?
I generally add HMA therapy to the JAK inhibitor and try to get them to transplant ASAP.
What is your approach to Myelofibrosis in Accelerated Phase (Blast percentage 10-19%) in a transplant-eligible patient?
I generally add HMA therapy to the JAK inhibitor and try to get them to transplant ASAP.
How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?
No, I do not believe that this changes anything for that population. The immunotherapy trials excluded patients with EGFR and ALK, but did not necessarily exclude patients with HER–2 mutations. Given the impressive survival outcomes seen with immunotherapy and chemoimmunotherapy, personally, I would...