Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
At what time points during a patient's treatment for metastatic ER+ breast cancer are you checking liquid NGS for endocrine pathway alterations?
Traditionally, liquid NGS testing for PIK3CA, PTEN/AKT/PIK3CA, and ESR1 alterations has been performed at discrete clinical decision points, primarily at progression on endocrine therapy or when considering targeted agents.Currently, I order NGS at disease onset, even for those who do not fit INAVO ...
For ALK positive NSCLC, where in treatment sequencing do you utilize lorlatinib?
The CROWN trial was one of the most important trials reported in the field of lung cancer in 2020. The results of this trial with a median follow up of 18 months were presented by Dr. Ben Solomon at ESMO 2020. The HR for Investigator assessed PFS in this trial with lorlatinib was 0.21 (0.28- Indepen...
What is your approach to a patient with metastatic lung cancer with HER2 mutant NSCLC who is not a trial candidate?
For newly diagnosed (first line regimen), I would offer either platinum doublet chemotherapy or chemo-immunotherapy (i.e. KN189 regimen) although I might be a little bit more hesitant to do immunotherapy while we figure out the risk factors associated with developing ILD from use of trastuzumab deru...
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...
Do you offer IV iron first line to women with iron deficiency anemia from heavy menstrual bleeding?
I offer first-line IV iron because oral iron cannot keep up with the losses from heavy menstrual bleeding, and the majority can't tolerate it. I routinely give a gram of LMW iron dextran in one hour, Feraheme (not ferumoxytol generic) 1,020 mg in 30 minutes, or ferric derisomaltose 1 gram in 30 minu...
Is there benefit to aggressively treating hemochromatosis in a patient who has already progressed to cirrhosis at the time of diagnosis?
The short answer is yes, there is a benefit to treating iron overload in a patient with hereditary hemochromatosis (HH) with cirrhosis. HH involves at least five mutations, most commonly in the HFE gene (common variants include C282Y and H63D), leading to hyperabsorption of iron and progressive accu...
How do you sequence Pluvicto vs docetaxel in a fit, chemotherapy-naïve patient with high-volume PSMA-avid mCRPC progressing on an ARPI?
I generally favor starting with docetaxel, though both are reasonable options. CCTG Study PR21 did not show a difference in radiographic progression-free survival between starting with docetaxel versus starting with Pluvicto in this setting. However, OS favored patients who started with docetaxel, a...