Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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,...
Would you recommend adding a mineralocorticoid receptor antagonist or endothelin receptor antagonist for a patient with bevacizumab-induced proteinuria who is already on an ACEi or ARB?
Unfortunately, we have no data to guide the choice of anti-proteinuric agents in this particular setting. We do have biological plausibility for antagonizing the endothelin pathway, as we know that vascular endothelial growth factor inhibition results in upregulation of endothelin-1, and the resulta...
What are your top takeaways in Radiation Oncology from SABCS 2025?
Several significant studies were presented at San Antonio this year. I will focus on the three most important abstracts reporting new data from studies of local-regional therapy. (The 10-year update of the BIG 3-07-TROG 07.01 trial comparing hypofractionated and conventional fractionation and the us...
How would you treat a patient with end-stage renal disease, a germline BRCA1 mutation, and pT1c pN0 TNBC s/p mastectomy?
To better address this question, I have consulted our phenomenal specialty pharmacist at our breast cancer program, Dr. Michael Berger. Based on the information he provided, doxorubicin and paclitaxel can be given at full doses in patients with end-stage renal disease (ESRD) as these agents are meta...
Would you consider immunotherapy in high-risk resectable MSI-H colorectal cancer?
Immunotherapy demonstrated great activity in treating metastatic MSI-H colorectal cancer (CheckMate 142 study, KEYNOTE-177 study, etc). There are now several small studies showing the activity of immunotherapy in early stage or locally advanced colorectal cancer. The NICHE study enrolled 40 patients...
What non-variceal EGD findings, if any, deter you from using atezo/bev in patients with advanced HCC?
I would discuss the severity and risk of bleeding with the endoscopy team and start beta blockers as indicated before starting anti-angiogenesis therapy.
What are your top takeaways from ASCO GI 2026?
GLP1 agonist use is associated with improved outcomes for colorectal cancer in a retrospective United States study. Now we need to incorporate this into randomized trials. I think this also provides more evidence that metabolic syndrome type issues may help explain early-onset colorectal cancers. W...
Should all patients diagnosed with B12 deficiency get a baseline EGD?
It is important to determine the cause of B12 deficiency. The majority of cases are due to pernicious anemia (atrophic gastritis and lack of intrinsic factor), I presume this question relates to that group. If there is another cause such as intestinal malabsorption or bacterial overgrowth, this does...
How have you incorporated ctDNA into the clinical management of patients with gynecologic cancers?
ctDNA certainly is increasing rapidly in oncology and has been led by several other disease sites. I think right now, GYN oncology is figuring out how to incorporate this in our care to meaningfully impact our patients. I have not incorporated ctDNA in my practice routinely, but do see the role of i...
How do you prioritize treatment in a lung cancer patient who has HER2 IHC3+ along with other actionable mutations that have tumor-specific drugs available?
Non-small cell lung cancer (NSCLC) can harbor different HER2 alterations: HER2 protein overexpression (2-35%), HER2 gene amplification (2-20%), and HER2 gene mutations (1-4%). Unlike breast or gastric cancer, HER2 protein overexpression in NSCLC is not a validated biomarker for first-line HER2-targe...