Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What do you prioritize when a patient has discordant clinicopathologic features and genomic risk scores to estimate melanoma recurrence risk?
At this time, the test to assess genomic risk score (i.e., Castle DecisionDx) is based on retrospective analysis, and there are no prospective data yet. So it should not be used solely for decision-making, especially when it comes to whether to do adjuvant systemic therapy or not. The traditional Am...
What approaches do you take to avoid further eGFR decline in patients undergoing unilateral nephrectomy for renal cell carcinoma?
The most important/effective intervention by far is good blood pressure control. Secondarily, if there is proteinuria, one should consider ACE/ARB, SGLT-2, etc. The optimal blood pressure target can be uncertain, but I would advocate for a systolic pressure of less than 130 mmHg.
Where does the OPTIMA trial, presented at ASCO 2026, fit into decision-making for chemotherapy for premenopausal women with high clinical and low genomic risk ER+ breast cancer?
Since the median follow-up on this trial was only 4 years (which is considered short for patients with operable, hormone receptor-positive, HER2-negative breast cancer) and since the study has not yet been published in a peer-reviewed journal, I would exercise extreme caution in skipping potentially...
How do you approach chemotherapy-induced thrombocytopenia in patients who do not respond adequately to romiplostim?
That's definitely a difficult and highly nuanced clinical scenario, especially since it can hamper future delivery of chemotherapy and compromise disease outcomes. My approach to this question also depends on whether we are talking about patients with a hematologic or solid tumor malignancy. I will ...
How do you approach chemotherapy-induced thrombocytopenia in patients who do not respond adequately to romiplostim?
That's definitely a difficult and highly nuanced clinical scenario, especially since it can hamper future delivery of chemotherapy and compromise disease outcomes. My approach to this question also depends on whether we are talking about patients with a hematologic or solid tumor malignancy. I will ...
How is the CARES kappa subgroup data changing your approach to newly diagnosed kappa AL amyloidosis?
The CARES trial was a negative phase 3 trial comparing standard-of-care therapy with or without anselamimab (an anti-amyloid monoclonal antibody) for newly diagnosed amyloidosis.While the overall results were negative, there was a subgroup analysis that was prespecified that showed a significant sur...
How is the CARES kappa subgroup data changing your approach to newly diagnosed kappa AL amyloidosis?
The CARES trial was a negative phase 3 trial comparing standard-of-care therapy with or without anselamimab (an anti-amyloid monoclonal antibody) for newly diagnosed amyloidosis.While the overall results were negative, there was a subgroup analysis that was prespecified that showed a significant sur...
What is your preferred management strategy for a patient with hairy cell leukemia requiring treatment who has stage 3 CKD?
This is an excellent question and depends on factors beyond just renal function. I do not have one preferred regimen for patients with hairy cell leukemia with impaired renal function (or without). Treatment selection depends on the disease features, prior treatments received, patient comorbidities ...
What is your preferred management strategy for a patient with hairy cell leukemia requiring treatment who has stage 3 CKD?
This is an excellent question and depends on factors beyond just renal function. I do not have one preferred regimen for patients with hairy cell leukemia with impaired renal function (or without). Treatment selection depends on the disease features, prior treatments received, patient comorbidities ...
How do you choose between the approved Bispecific Antibodies for Relapsed/Refractory Multiple Myeloma?
I would pick BCMA directed BsAbs first, treat on label (weekly or q 2 week) to best response and then space out the schedule to q 4 weeks (or even q 8 weeks). Basing this on 6+ years experience of using BsAbs in FIH/PI-III as well in the commercial setting. The way to mitigate infections/AEs will be...