Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
Would you treat an early stage transformed DLBCL from indolent lymphoma in the same way as a standard, newly diagnosed de novo DLBCL?
To my knowledge, all studies in limited-stage LBCL excluded prior indolent lymphoma. Therefore, we do not have prospective data to support shorter courses of CIT. It will be an interesting subject of investigation. However, given that, in general, cell of origin or MYC double-hit status does not rea...
Would you treat an early stage transformed DLBCL from indolent lymphoma in the same way as a standard, newly diagnosed de novo DLBCL?
To my knowledge, all studies in limited-stage LBCL excluded prior indolent lymphoma. Therefore, we do not have prospective data to support shorter courses of CIT. It will be an interesting subject of investigation. However, given that, in general, cell of origin or MYC double-hit status does not rea...
Do you routinely check serum phosphorus levels after IV iron therapy?
Only before and after FCM. I hold subsequent doses if phosphorus low. There is no need to monitor with the other formulations. For people needing multiple doses of IV iron (IBD, bariatric surgery, heavy uterine bleeding, angiodysplasia), I avoid FCM.
What is your approach for persistent and romiplostim-refractory thrombocytopenia after temozolomide with radiation in a patient with recurrent GBM?
Even if bone marrow does not show leukemia, I would consider checking for CHIP or CCUS variants. I would probably not have a high index of suspicion for immune-mediated thrombocytopenia related to TMZ in this context. Beyond transfusion, time, TPO-RA, and supportive care, I am not sure there are man...
What is your approach for persistent and romiplostim-refractory thrombocytopenia after temozolomide with radiation in a patient with recurrent GBM?
Even if bone marrow does not show leukemia, I would consider checking for CHIP or CCUS variants. I would probably not have a high index of suspicion for immune-mediated thrombocytopenia related to TMZ in this context. Beyond transfusion, time, TPO-RA, and supportive care, I am not sure there are man...