Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage locally advanced, resectable gastric cancer that is MSI-H?
I would not recommend FLOT + durvalumab for MSI-H gastric/GEJ patients. I say this because there is mounting evidence that chemotherapy may not provide a significant benefit for these MSI-H patients at all (1). All efforts should be made to spare this patient population from getting cytotoxic chemot...
What would you choose as second-line therapy in patients with ER/PR-positive, HER2-negative metastatic breast cancer progressing on first-line CDK 4/6 inhibitor/AI combination?
While we don't have direct comparative data, my own preference is fulvestrant both because in treatment-naive patients it appears better than NSAI (20% improvement in PFS in FALCON), and because the toxicity profile favors fulvestrant over everolimus/exemestane.
If a pregnant patient with a mechanical heart valve takes warfarin throughout her pregnancy, what are the chances that the fetus will be harmed?
Warfarin is effective for thromboembolic prevention in pregnant patients with mechanical valves. There is however an overwhelming evidence that warfarin taken during pregnancy is deleterious to the fetus. Its use during the first 6–12 weeks of gestation can be associated with important fetal complic...
Would you recommend ISRT for an initially bulky nodular lymphocyte predominant Hodgkin lymphoma with complete metabolic response after 4 cycles of R-CHOP?
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma. Approximately 95% of Hodgkin lymphoma cases are classified as classic Hodgkin lymphoma, including the nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted subtypes, all of which a...
When treating rectal cancer with TNT and induction chemotherapy first, do you repeat pelvic MRI prior to planning for chemoradiation?
TNT approach options for pMMR T3, N any; T1–2, N1–2; T4, N any or locally unresectable or medically inoperable rectal cancer patients include:First chemotherapy for 12-16 weeks (FOLFOX or CAPEOX may also consider FOLFIRINOX) followed by long-course chemoradiation or short-course radiation, followed ...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
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...
In patients with advanced HR+, HER2- breast cancer who have progressed on first-line CDK 4/6i and ET and found to have ESR1 mutation, are you offering combination of abemaciclib and elacestrant in the 2nd line or SERD monotherapy?
In my practice, when treating patients with advanced hormone receptor-positive (HR+), HER2-negative breast cancer who have progressed on first-line CDK4/6 inhibitors and endocrine therapy, and who harbor ESR1 mutations, I typically consider elacestrant monotherapy as the preferred second-line treatm...