Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with high risk triple negative breast cancer with metastatic disease after recent adjuvant AC-T?
If she relapsed within 12 months of her adjuvant paclitaxel, then I would consider her TNBC taxane resistant. These patients weren't enrolled in Impassion130 and many first line trials exclude patients with short DFI. If a trial is available, consider it whenever possible. I would do BRCA germline t...
What strategies do you use for large breasted women receiving whole breast radiation?
If we can't do prone, we use a styroform wedge in the inframammary region to decrease the breast fold and thus, decrease the inferior margin and amount of inframammary fold we have to treat. I would initially try hypofractionation with mixed beam with a field-in-field technique and if the dose homog...
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...
When do you consider using protons for breast cancer?
I think there is a limited role for protons in breast cancer outside of prospective studies at this time.With respect to partial breast irradiation, while initial trials showed some higher skin toxicities, modern institutional series have shown much better outcomes. That being said, the total number...
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.
What is your preferred first-line treatment for metastatic melanoma in a patient with a class 2/non-V600 BRAF mutation?
Class II BRAF mutations have intermediate kinase activity and are much less likely than V600E or V600K mutations to respond to traditional BRAF+MEK inhibitor therapy. Targeted therapy should not be used as a front-line therapy in these patients. Immunotherapy (and immunotherapy-based front-line clin...
What are your top takeaways in Gyn Cancers from ASCO 2026?
For ASCO 2026 in the GYN world, from a radiation oncologist's point of view, there was confirmation of immunotherapy benefit in longer-term follow-up of previously reported landmark studies: NRG-GY018 study — adding pembro for advanced measurable endometrial cancer, reported by Eskander et al showe...
For early-stage, HR+ Her2- breast cancers, when do you use OncotypeDx v. Mammaprint?
The reason to use any multiparameter assay is to determine which patients need chemo and which don't. To say that another way - it is about the predictive ability, not the prognostic ability. Until very recently, Mammaprint only had prognostic data so I always used Oncotype. The MINDACT trial recent...
When would you use AVD + brentuximab instead of ABVD for newly diagnosed stage 3 or 4 Hodgkin lymphoma?
By reducing the risk of primary treatment failure from 23% to 18%, the ECHELON-1 study demonstrated that compared to ABVD, AVD + brentuximab vedotin reduces the risk of primary treatment failure by about 25% for patients with advanced-stage classic Hodgkin lymphoma. If given with prophylactic G-CSF,...
When would you use AVD + brentuximab instead of ABVD for newly diagnosed stage 3 or 4 Hodgkin lymphoma?
By reducing the risk of primary treatment failure from 23% to 18%, the ECHELON-1 study demonstrated that compared to ABVD, AVD + brentuximab vedotin reduces the risk of primary treatment failure by about 25% for patients with advanced-stage classic Hodgkin lymphoma. If given with prophylactic G-CSF,...