Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you contextualize the stage 1 results from the PRESERVE-003 trial within the current treatment landscape for patients with squamous NSCLC who have progressed on PDL-1 therapy?
The PRESERVE-003 trial evaluated gotistobart, a novel CTLA-4 antibody, compared to docetaxel in participants with squamous cell NSCLC who had tumor progression on prior platinum-based doublet chemotherapy and immunotherapy. The trial was conducted in 2 stages, and results from the first stage are av...
What is your preferred assay for assessing dabigatran levels?
The only specific assay that would reflect drug levels is the ecarin clotting time with dabigatran as a calibrator. We used to have this assay in our lab, but due to a lack of use, it was discontinued. The standard thrombin time is too sensitive; however, dilute thrombin time has been used. The mass...
What are your top takeaways in Thoracic Cancers from ASCO 2025?
More presentations that were interesting for the future, than immediately impactful in thoracic oncology this year at the ASCO meeting. Immediately impactful: 8006 and 8008 – Both in SCLC. 8006- IMforte trial suggesting improvement in survival with the addition of maintenance lurbinectedin to atezo...
How do you approach Tarlatamab use in an elderly patient with relapsed ES SCLC?
Age is relative and there are numerous studies showing that well-performing elderly patients can tolerate systemic therapy to small cell lung cancer. That being said, I first assess whether additional cancer therapy is within the goals of care for each individual patient. While the outcomes for DLL3...
When will you choose Tarlatamab over an alternative systemic therapy (e.g. lurbinectedin, topotecan) for relapsed ES SCLC?
I generally offer tarlatamab as a second line option in small cell lung cancer patients who are fit (ECOG 0-1), can logistically accommodate the hospitalization and infusion schedule, have low-risk factors for ICANS, and have treated brain metastases. I would consider a platinum etoposide rechalleng...
Would you consider delaying tarlatamab initiation in a patient with ES SCLC who recently completed RT for CNS disease, given the concern for immune effector cell-associated neurotoxicity syndrome (ICANS)?
I would not delay beyond what we already do for other systemic treatments. We tend to wait at least a week or more after whole brain RT and systemic therapy of any nature. I do not think this is any different.
What are the main practical factors to consider when using bispecific antibody therapy (Tarlatamab) for extensive-stage small cell lung cancer?
The overall survival (OS) for patients with relapsed refractory small cell lung cancer is poor with an estimated OS of 8-9 months. Prior to DLL3 bispecifics, the 2nd line therapeutic options included topotecan and lurbinectidin. Topotecan always had an unusual positioning as a second line agent. The...
Would you continue tarlatamab in CNS-only progression of small cell cancer if there is no systemic disease?
I would absolutely continue tarlatamab in this scenario. While there is evidence of at least some activity of tarlatamab in the CNS (e.g., Zhang et al., PMID 40126456), the effect can be transient, suggesting that intra- and extracranial discrepancy is possible/probable. I would handle isolated, oli...
Are you using maintenance lurbinectedin with immunotherapy in the first-line treatment of extensive stage small cell lung cancer?
Yes. I am encouraged by the recent IMforte data demonstrating both PFS and OS benefit with the addition of maintenance lurbinectedin (Paz-Ares, Lancet 2025). Landmark PFS at 6 months approximately doubled (42% vs 19%) and OS at 1 year was 56% vs 44% with atezo+lurbi vs atezo alone. The rate of attri...
How do you utilize genomic testing in HR positive breast cancer to make recommendations regarding the duration of endocrine therapy?
Extending HRT from 5 to 10 years, whether with a SERM or an AI, reduces the risk of recurrence and new breast cancers. BUT the benefit is small and the toxicity is not inconsequential, making decisions challenging. Oncotype was developed to identify patients who would benefit from chemotherapy. As c...