Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is maintenance capecitabine indicated for a patient with pT1cN0 triple-negative breast cancer who has completed adjuvant dose-dense doxorubicin/cyclophosphamide followed by paclitaxel (AC-T)?
This patient has received appropriate adjuvant therapy with ddAC- weekly paclitaxel for early-stage node-negative TNBC. The added benefit of capecitabine is unclear. Evidence supporting its use in the adjuvant setting from CREATE-X and EA1131 is largely applicable to patients with residual disease f...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...
Is there any evidence that ivermectin suppresses the PSA level in prostate cancer?
Is this even the right question, though? ADT drops PSA very reliably and yet does not cure patients. Finasteride suppresses PSA, but we do not use it as a mainstay of cancer treatment. Even if ivermectin *did* suppress PSA, unless there is a meaningful oncologic benefit (*at least* reduced recurrenc...
How, if at all, has the FDA approval of zidesamtinib changed your treatment approach for patients with locally advanced or metastatic ROS1+ NSCLC who have previously received a ROS1 kinase inhibitor?
The availability of zidesamtinib gives patients with ROS1+ NSCLC an important option after prior ROS1 TKI therapy. The overall efficacy is encouraging: RR after prior ROS1 TKI was 44%, median duration not yet reached but 62% were ongoing at 18 months. If the prior TKI was an older generation (crizot...
Is DESTINY Breast-09 data sufficient for T-DXd/P to replace THP as the first line standard of care for HER2-positive metastatic breast cancer?
With the impressive improvement in PFS to a 1L PFS to a remarkable 40.7 months, T-DXd + P is definitely an attractive option. However, I do not think this will be an approach I use for all patients. For ER+ patients, a THP induction strategy, followed by maintenance HP + AI and palbociclib, is also ...
How do you approach treatment selection for patients with non-small cell lung cancer who have uncommon EGFR mutations compared to those with common mutations?
In patients with NSCLC, treatment decisions for uncommon EGFR mutations differ significantly from common mutations like exon 19 deletion and L858R. Treatment is personalized based on the specific type of uncommon mutation, which varies in its sensitivity to EGFR tyrosine kinase inhibitors (TKIs). Fo...
How would you treat an elderly female with residual TNBC following surgery and neoadjuvant carboplatin and paclitaxel?
I think there will be some differing opinions on this. There are a number of things I would factor in, assuming the patient has enough life expectancy where the breast cancer is the main mortality risk. 1) Data from carbo/taxane neoadjuvant trials (Sharma et al., PMID 30061361) and others suggest RC...
What are your top takeaways in Breast Cancer from ASCO 2026?
OPTIMA (phase III trial presented by Robert Stein): I think this trial was interesting in that, like Oncotype DX, it supports de-escalation of chemotherapy with lower-risk patients and included pre-menopausal as well as higher nodal burden patients. Omission of axillary dissection from the update...
How would you determine the safety of anticoagulation in patients with evidence of cerebral microhemorrhages who present with acute stroke secondary to cardioembolism?
This question assumes that the patient already had an MRI showing microhemorrhages. The Boston criteria provide guidelines for the number of microbleeds, associated superficial siderosis, or major hemorrhage to make the diagnosis of cerebral amyloid angiopathy. I would also assume that at least some...