Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you attempt treatment breaks from bispecific antibody therapy in patients with relapsed myeloma who achieve a sustained MRD-negative complete response?
I don't attempt to stop therapy in people who achieve deep responses and are tolerating the drug, but this is mostly because there is currently a paucity of prospective trials, so the specific time at which stopping therapy is optimal has not been established. I do have a low threshold to space out ...
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.
How do you approach a patient with high titer ANA and a new diagnosis of ITP, but no other signs or symptoms suggestive of active rheumatologic disease?
I would certainly treat the ITP with hematology involvement if necessary but would continue to monitor for lupus or similar CTDs. I have seen patients present with an ITP-like picture for years before lupus declared itself eventually. It may take years. I would also check a UA for proteinuria. This ...
In a patient with very high risk prostate cancer opting for prostatectomy, when, if ever, do you recommend neoadjuvant ADT?
I generally do not offer ADT with or without a potent ARSI prior to RP even in high risk disease. While small single arm studies have shown that a few such men can achieve a pathologic CR and that path CR/MRD is associated with better outcomes after RP, for most patients, this approach has no clear ...
Would you consider utilizing pembrolizumab/enfortumab as a bladder preservation approach in patients with MIBC?
Yes, I think that this is a viable approach. Data from perioperative trials, including KN-905 and EV-304, suggest very high rates of pathologic complete responses in almost two-thirds of all patients at the time of radical cystectomy. Many of these patients may not need radical cystectomy for an opt...
How do you approach choice of second-line therapy in metastatic TNBC after progression on 1L TROP2 ADC?
The emerging consensus on the mechanism of resistance to ADC drugs suggests that payload-mediated resistance predominates over target antigen loss, though both mechanisms operate and their relative contributions differ by disease context. T-DXd-resistant (TDXd-R) and SG-resistant (SG-R) breast cance...
What is the optimal management of hot flashes for women receiving hormonal therapy?
There are many treatments that have been shown to be effective in randomized trials. I usually suggest patients first try vitamin e or acupuncture and if that is not effective to consider Effexor. Gabapentin can be effective and help with sleep, without as many sexual side effects as the antidepress...
In a patient with high-risk cutaneous squamous cell carcinoma of the face with extracapsular extension after ipsilateral neck dissection and rapid contralateral cervical nodal recurrence, what is the optimal management?
In various published series, around half of patients fail to achieve a complete response to cemiplimab. From the clinical details, the current active area of disease appears to be the contralateral neck with no distant disease. Curative treatment is preferred. C-POST trial established surgery + adju...
What would be your preferred treatment strategy for patients with NMIBC whose disease progresses after BCG plus durvalumab?
Pembrolizumab is little used in real-world practice in 2026. The response rates were lower than those of other more recently available therapies for BCG-unresponsive high-risk CIS, and the risk/benefit tradeoff is less favorable than other newly available treatments. Most urologists would treat pati...
How do you differentiate between drug-induced ILD vs radiation pneumonitis in a patient receiving adjuvant T-DXd and adjuvant radiation therapy who develops new pulmonary abnormalities on surveillance imaging?
There are different ways to differentiate between T-DXd-induced ILD and radiation pneumonitis. Radiation pneumonitis is typically confined to the radiation field and has sharp geometric borders, but T-DXd-induced ILD presents with a cryptogenic organizing pneumonia pattern and patchy consolidations ...