Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use bevacizumab in a patient with advanced HCC and multiple large esophageal varices that have not been endosopically intervened upon?
Large varices should be treated endoscopically. I would avoid using Atezo/bev in a patient who has not had adequate treatment of their varices as there is a real risk of bleeding with bev in this setting.
What factors should be considered when deciding whether to omit radiation in pediatric/AYA patients receiving N+AVD, particularly regarding long-term outcomes and second malignancy risks?
Based on the early data from S1826, it appears that radiation can be omitted if end-of-therapy scans (after 6 cycles of therapy) show metabolic remission of disease. The ability to limit RT to 1% of patients is encouraging for potential reduction in late effects such as cardiovascular disease and SM...
What factors should be considered when deciding whether to omit radiation in pediatric/AYA patients receiving N+AVD, particularly regarding long-term outcomes and second malignancy risks?
Based on the early data from S1826, it appears that radiation can be omitted if end-of-therapy scans (after 6 cycles of therapy) show metabolic remission of disease. The ability to limit RT to 1% of patients is encouraging for potential reduction in late effects such as cardiovascular disease and SM...
Would you offer immunotherapy in addition to chemotherapy and trastuzumab for patients with metastatic HER2 positive gastroesophageal cancer with low PDL1?
Very recently, trastuzumab has been replaced in the first-line setting by the results of the HERIZON-GEA-01 study, which evaluated zanidatamab, a bispecific/biparatopic antibody against 2 epitopes of HER2. This study randomized patients to the control arm of trastuzumab/chemotherapy (Arm A) versus z...
How would you approach a patient with metastatic high-grade neuroendocrine carcinoma of the breast, which is HR+ HER2-negative?
Carbo/VP16.
What approach is suggested for extended adjuvant endocrine therapy in a HR+ breast cancer?
This can be a complicated decision for which you need to take into consideration the patient's estimated risk of late recurrence, her understanding of that risk, how well (or poorly) she has tolerated the first 5 years of adjuvant endocrine therapy, and her age and comorbidities, including the prese...
What adjuvant therapy would you offer a postmenopausal woman with a new pT2N0 HR+/HER2+ breast cancer primary who is concurrently being treated with anastrozole/ribociclib for well controlled oligometastatic HR+/HER2- disease?
It is always disconcerting when a primary tumor arises in the context of already ongoing therapy. Presumably, this tumor is somewhat resistant. Firstly, I would add in anti-HER2 therapy (there is a broad range of options depending on the patient's details, ranging from single-agent trastuzumab to TH...
How do you select between imlunestrant ± abemaciclib and elacestrant for those with an ESR1 mutation and progressed on AI and CDK4/6 inhibitor for patients with metastatic ER+/HER2- breast cancer?
My choice of oral SERD to use in this setting would be based on side-effect profile and ease of administration, as both are approved for use after progression on 1st-line ET. Based on information from the phase III trials, EMERALD and EMBER-3, and in the absence of a head-to-head comparison, imlunes...
Are there patients in whom you would modify the course of adjuvant durvalumab in resected gastric/GEJ adenocarcinoma following treatment with neoadjuvant FLOT + durvalumab?
I would not de-escalate or modify the adjuvant course of treatment in the D-FLOT regimen based on the pathologic results. The protocol continues adjuvant durvalumab for 10 additional cycles after FLOT, but almost 50% of patients on the trial did not undergo these full 10 additional cycles, and so if...
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
Although I anticipate that the Stampede investigators will publish (an underpowered) comparison of their ADT plus docetaxel arm vs ADT plus abiraterone which may provide some insight, for the most part we will be in a data free zone re: this issue for some time. I suspect that clinicians will contin...