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 should Dato-DXd be managed in the absence of necessary resources for ocular exams and referrals?
We typically send patients for baseline slit-lamp exams prior to the start of Dato-DXd. If these resources are not available, telemedicine with slit-lamp biomicroscopic photography, as well as community screening resources, can be considered. Patients should still be educated on symptoms that would ...
When, if ever, do you incorporate a dental evaluation before initiating Dato-DXd to offer guidance on oral care and help limit oral toxicity?
A formal dental evaluation can be considered, but it is unclear whether it is necessary before starting Dato-DXd. Proactive dental evaluation, when feasible, should be used, but evaluation should not delay the start of treatment. The use of good daily oral hygiene, including salt/bicarbonate and Bio...
How does your management of stomatitis from Dato-DXd compare to your approach for stomatitis from other cancer-directed treatments?
By and large, the treatment is similar, though dexamethasone rinses are essential (10 mL oral solution, 4 times a day). Patients should swish/gargle the steroid solution for 1-2 minutes, then spit it out. Food and drink should be avoided for 30 minutes afterward. Similarly, patients should avoid cau...
What clinical and pathological features are you using when selecting patients for adjuvant cemiplimab in high-risk CSCC, given the differences between trial inclusion criteria and NCCN guidelines?
Identifying the select patient population who benefits from adjuvant cemiplimab for cSCC is critical. Current staging systems for cSCC are inadequate to specifically identify the tumors at highest risk for relapse and disease-specific death. The majority of high tumor category and 'high risk' cSCC a...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...
What neoadjuvant strategies do you utilize for initially unresectable biliary tract cancer?
Great question. While there is not prospective data, I tend to use the triplet chemo regimen of gem/cis/nab-paclitaxel based on the 20% conversion rate seen in this phase 2 study. There is an ongoing neoadjuvant study in IHCC that is investigating the triplet, but this is only open at select centers...
Can an AYA patient with newly diagnosed AML safely sperm bank after starting cytoreduction with hydroxyurea or cytarabine?
Thanks for the question. Unfortunately, there is not a lot of data available to answer this question with certainty. Because of that, I err on the side of saying that this should not be done. The concern lies with the possible impact on the sperm DNA, and the subsequent effect that might have on a p...
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...
What is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...