Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a patient with a recent MI s/p DES who is being considered for neoadjuvant chemotherapy for TNBC?
This is mostly opinion as there is not data specific to this situation. First, I would coordinate closely with the cardiologist, preferably someone with knowledge of cardio-oncology. Presumably the patient is already on cardioprotective medications, such as beta blocker and ACE inhibitor, but if not...
How do the results of KEYNOTE-B15/EV-304 influence your preferred treatment for cisplatin eligible MIBC?
The management of urothelial cancer has undergone major changes in the last decade.We have seen a number of new drugs approved for relapsed BCG-refractory superficial bladder cancer. Additionally, we have seen a number of new approaches for the management of muscle-invasive bladder cancer (MIBC) or ...
How are you approaching multidisciplinary care for patients with newly diagnosed BCG-naive high-risk NMIBC in light of POTOMAC?
We have not incorporated BCG-naïve high-risk NMIBC patients into our Bladder Cancer Multidisciplinary Clinic workflows to date. That being said, we are discussing including a subset of high-risk patients in our Multidisciplinary Clinic as we incorporate the POTOMAC results into our workflows. In our...
What third line treatment do you consider for a patient with metastatic pancreatic cancer with good functional status and no targetable mutations after progression on FOLFIRINOX and gemcitabine/nab-paclitaxel?
Sadly, there is absolutely no "standard" option in this space, as no trials have demonstrated any meaningful benefit. I personally would not just "try" a therapy - and I would especially not just "try" an immune checkpoint inhibitor, as these, as single agents have shown no benefit at all (if the tu...
Would you consider using bevacizumab/atezolizumab in HCC patients who received TKI in the first line?
This is a great question. After failure of a front-line single agent TKI, I would still favor the current FDA-approved agents: regorafenib; cabozantinib; ramucirumab in AFP-high; OR immunotherapy (nivolumab, pembrolizumab, OR nivolumab plus ipilimumab). It is important to note that the second-line ...
How do you manage aromatase inhibitor- associated musculoskeletal syndrome (AIMSS) symptoms in post-menopausal breast cancer patients?
Available published data suggests that switching from one AI to another, does help to reduce AIMSS. This strategy is associated with improvement in AIMSS about 50% of the time (in published literature). From personal experience, letrozole tends to cause the most symptoms since from pharmacologic sta...
What is your approach to the management of unprovoked distal DVTs?
The management of distal deep vein thrombosis (DVT)—[involving the peroneal, posterior tibial, anterior tibial, or the muscular calf veins (gastrocnemius and soleus); proximal DVT, by contrast, refers to thrombosis in the popliteal, femoral, or iliac veins]—is evolving in step with broader changes i...
Do you attempt treatment breaks from bispecific antibody therapy in patients with relapsed myeloma who achieve a sustained MRD-negative complete response?
If the patient has had at least 12 months of therapy and has achieved MRD-negative complete response, I would give consideration to treatment breaks, especially if the patient has had significant issues with hypogammaglobulinemia, infections, or the desire to be off therapy. The patient does not nee...
Do you attempt treatment breaks from bispecific antibody therapy in patients with relapsed myeloma who achieve a sustained MRD-negative complete response?
If the patient has had at least 12 months of therapy and has achieved MRD-negative complete response, I would give consideration to treatment breaks, especially if the patient has had significant issues with hypogammaglobulinemia, infections, or the desire to be off therapy. The patient does not nee...
How do you approach treatment of eyelid sarcoma?
I have not personally treated eyelid sarcoma but have treated SCC and adenexal carcinoma both definitively and in adjuvant settings. I have used 60 and 66 Gy in 2 Gy per fraction for adjuvant and definitive patients, respectively, with electrons using appropriate eye shielding.