Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with metastatic HCC on atezolizumab/bevacizumab who requires holding bevacizumab due to persistent proteinuria >2g?
This is a great clinical question, one that we often see since the approval of atezolizumab/bevacizumab in first line setting for HCC. Incidence of proteinuria with bevacizumab has been reported anywhere from 0.8%-4% for grade 3 (more than 3.5 g in a 24-hour urine protein level) (Brandes et al., PMI...
For a Jehovah's Witness patient with multiple myeloma, could you safely offer a BCMA-directed bispecific antibody or CAR-T therapy?
Short answer is - yes! Long answer is - it depends. Patients can be optimized leading into CAR T-cell therapy by using ESAs and possible TPO agonists, iron, B12, folate supplementation. The main issue is around propensity for anemia and thrombocytopenia, especially if profound and prolonged. Patient...
Would you extrapolate from EMBARK to use an ARPI other than enzalutamide in high risk biochemically recurrent prostate cancer for a patient with contraindications to enzalutamide?
This is a good question and my general answer is no, as no other ARSI has a phase 3 trial in this nmHSPC setting showing similar benefits. PRESTO was a smaller phase 2 trial of ADT/apalutamide but did not measure or report MFS or OS and was underpowered to look at these endpoints. However if a patie...
Would you offer adjuvant osimertinib in a patient with complete pathologic response to neoadjuvant platinum doublet for a stage IIIA resected EGFR mutant lung adenocarcinoma?
With the caveat that we do not have level I evidence specifically for this clinical scenario yet (ongoing NeoADAURA study may potentially provide some answers in the future), based on very favorable outcomes of patients with NSCLC in general who derived pathologic complete response after neoadjuvant...
Is a bone marrow necessary in patient with splenomegaly and polycythemia vera?
Yes. Bone marrow is necessary in a patient with polycythemia vera and splenomegaly. There is a possibility of missing ET or associated primary or secondary myelofibrosis. The only way to distinguish between the three bcr-abl negative MPN namely MF, ET, and PV is by performing a bone marrow biopsy an...
Will you offer adjuvant olaparib to patients with somatic BRCA mutated breast cancer given that OlympiA only enrolled germline BRCA+?
I agree that the 3-year DFS benefit is quite compelling for considering adjuvant olaparib in patients meeting the eligibility criteria in NSABP B55 (Tutt et al., PMID 34081848). This also raises the possibility of clinical benefit in other scenarios, particularly those where PARPi have shown meaning...
How would you sequence 177LU-PSMA-617 with current therapies for men with mCRPC?
I would like to congratulate the VISION study investigators and Dr. @Dr. First Last for the outstanding presentation and good news. The study was designed to use a hybrid control (best "standard of care"-SOC) and as such, it met its endpoints (OS, rPFS, etc). Secondary endpoints also significantly f...
What neoadjuvant chemotherapy would you consider for squamous cell carcinoma arising from a ruptured tailgut cyst?
Tailgut cysts are congenital lesions that develop from tailgut embryonic remnants. Though malignant transformation has been described, literature is largely limited to case reports. I would ensure the patient has been adequately staged with PET/CT and/or MRI of the pelvis. If resectable, I would adv...
Are there any clinical scenarios in which you would treat BRCA mutated HER2 negative metastatic breast cancer with a PARP inhibitor in combination with carboplatin?
There is a large prospective phase III study that showed a significant improvement in DFS for veliparib+carbo+ paclitaxel versus carbo+paclitaxel (BROCADE3 study; Dieras V et., PMID 32861273).
How would you manage anastomotic site recurrence of colon cancer 3 years after resection of a T3N0 tumor without high-risk features?
I will do metastatic work up. If negative:- FOLFOX.