Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
In what clinical scenarios, if any, would you consider using sacituzumab govitecan prior to trastuzumab deruxtecan for HR+/HER2- metastatic breast cancer treatment?
The ASCENT-07 trial did not meet the primary endpoint of superior PFS for 1st-line SG vs standard chemotherapy (taxane or capecitabine) in ER+ HER2- mBC. OS readout was immature with an early trend in favor of SG that needs follow-up. However, SG was still active with longer durations of responses. ...
Given results of the RADICALS trials, is LT-ADT standard of care for salvage prostate RT?
I do not think long-term ADT is established as standard of care for salvage prostate radiation, as this would require a demonstration of improved overall survival in at least specific subgroups of patients. RADICALS-HD demonstrates improvement in freedom from metastasis as well as freedom from non-p...
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
Could patients with smIPI > 1 and poor tolerability to RCHOP be offered ISRT after 3 cycles of RCHOP if interim PET showed 5-PS 1-3 response?
The FLYER and LYSA/GOELAMS studies have significantly influenced the management of DLBCL. Although the studies were quite different, they both demonstrated that patients with non-bulky, stage I-II DLBCL and a favorable IPI do very well with 4 cycles of R-CHOP alone. For patients with 0 or 1 stage-mo...
Could patients with smIPI > 1 and poor tolerability to RCHOP be offered ISRT after 3 cycles of RCHOP if interim PET showed 5-PS 1-3 response?
The FLYER and LYSA/GOELAMS studies have significantly influenced the management of DLBCL. Although the studies were quite different, they both demonstrated that patients with non-bulky, stage I-II DLBCL and a favorable IPI do very well with 4 cycles of R-CHOP alone. For patients with 0 or 1 stage-mo...
Would you give consolidation durvalumab to a patient who underwent chemoradiation for his stage III NSCLC and is being started on antifibrotic therapy by pulmonology for his ILD?
This is a difficult scenario. On the one hand, we know from the PACIFIC trial that there is a clear benefit to the addition of durvalumab in this setting. On the other hand, there is a higher risk of pneumonitis due to both the prior use of radiotherapy and the history of underlying ILD. I think ECO...