Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
With talquetamab-based combinations Tal-DP and Tal-D now showing efficacy at first relapse, if approved, how will you position GPRC5D-targeted bispecifics relative to BCMA-directed therapy in your treatment algorithm for relapsed/refractory MM after 1 prior line of therapy?
TL;DR: The choice between BCMA and GPRC5D will likely depend less on the efficacy data and more on prior BCMA exposure and toxicity profiles.The phase 3 MonumenTAL-3 trial randomized patients with first or early relapsed multiple myeloma to talquetamab/daratumumab/pomalidomide (Tal-DP), talquetamab/...
With talquetamab-based combinations Tal-DP and Tal-D now showing efficacy at first relapse, if approved, how will you position GPRC5D-targeted bispecifics relative to BCMA-directed therapy in your treatment algorithm for relapsed/refractory MM after 1 prior line of therapy?
TL;DR: The choice between BCMA and GPRC5D will likely depend less on the efficacy data and more on prior BCMA exposure and toxicity profiles.The phase 3 MonumenTAL-3 trial randomized patients with first or early relapsed multiple myeloma to talquetamab/daratumumab/pomalidomide (Tal-DP), talquetamab/...
Would you hold off using fam-trastuzumab deruxtecan-nxki in malignant pleural effusion?
No. While there may be a higher risk of higher-grade pulmonary adverse events in patients with pleural effusions, some of this is related to the impaired pulmonary function (e.g., loss of volume, lower flexibility of the lung tissue) and also the possible/probable involvement of intrapulmonary lymph...
Are maintenance therapies for ovarian cancer being held at your institution due to COVID-19?
Patient safety and health care worker safety are of the upmost importance for us. We are doing telehealth visits and able to deliver oral drugs to patient's homes. For infusion visits, those are being decided on a case by case basis, depending on the patient and their disease status.
What would be your radiotherapy plan for an overall stage IIA, low-lying, MMRd rectal adenocarcinoma to try to avoid APR?
For an MMRd rectal cancer, I would use immunotherapy! Very promising data from MSKCC suggesting upwards of 100% clinical complete response with dostarlimab alone, without the need for RT!
How do you approach the discussion about the potential risks of radiation therapy exposure and the development of secondary malignancies for patients with germline BRCA1/2 mutations?
It appears that the risk of secondary malignancies due to radiation exposure does not seem significantly enhanced in gBRCA-m carriers, unlike patients with Li-Fraumeni syndrome (for whom we would attempt to avoid radiation). The data on mBRCA-associated breast cancers would suggest that radiation is...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...
How do you approach treatment selection between adjuvant pembrolizumab alone and pembrolizumab plus belzutifan in patients with clear cell renal cell carcinoma?
This is a very clinically relevant question given the recent approval of the combination. When facing a resected high-risk ccRCC patient, the first question is: what is the estimated risk of recurrence? Keep in mind that our current models are outdated, using features such as tumor size and grade, a...
Would you recommend adjuvant androgen receptor–targeted therapy with enzalutamide or bicalutamide in a patient with pT2N0 TNBC with 100% AR expression and low Ki-67?
The combination of 100% AR positivity and low Ki-67 is highly suggestive of the luminal androgen receptor (LAR) subtype, which represents 11 to 23 % of TNBC. Important features of this subtype include androgen receptor expression, luminal-like gene signatures, and a biology that fundamentally differ...
Would you offer chemotherapy in stage IB (T2aN0) lung adenocarcinoma after segmentectomy, if visually pleura appeared to be involved per the surgeon but negative on pathology?
If final pathology is negative for visceral pleural involvement, this tumor is between 3 and 4 cm, which is rather large for segmentectomy only and is at higher risk for locoregional recurrence. Additional information regarding adenocarcinoma subtype, such as solid or micropapillary type, can also c...