Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach CNS prophylaxis in patients with DLBCL?
I think the NCCN-CNS-IPI based on the German data is a reasonable place to start when it comes to making decisions regarding CNS prophylaxis. We typically do IT MTX for patients on the lower end of the risk spectrum and high-dose IV MTX for patients on the higher end of the risk spectrum.
What are your top takeaways in GI Cancers from ASCO 2026?
Daraxonrasib will change the treatment paradigm for PDAC indefinitely, with implications across all stages.
How do you decide whether to use pharmacologic VTE prophylaxis in hospitalized patients with decompensated cirrhosis?
For all patients, I begin by using a standard risk prediction tool to determine if the patient is appropriate for pharmacologic VTE prophylaxis. At our institution, the Padua risk prediction tool is embedded in our electronic health record/admission set. Clinical guidelines- including those from the...
How would you approach a patient with a recent MI s/p DES who is being considered for neoadjuvant chemotherapy for TNBC?
This is mostly opinion as there is not data specific to this situation. First, I would coordinate closely with the cardiologist, preferably someone with knowledge of cardio-oncology. Presumably the patient is already on cardioprotective medications, such as beta blocker and ACE inhibitor, but if not...
How would you manage an enlarging brain metastasis that has progressed in size three months after radiosurgery?
Before making a decision, I would want to know the tumor histology, SRS dose delivered, and whether the current site of progression is truly within the prior radiation field (using new MRI fused to the SRS plan in treatment planning software). If the lesion is within the high-dose region and the pat...
In patients with muscle-invasive bladder cancer, in what clinical scenarios would you consider neoadjuvant cisplatin-based therapy in light of emerging data on enfortumab vedotin plus pembrolizumab?
Of course, we are still awaiting FDA approval of EV + Pembro in the cisplatin-eligible population, but the data from KEYNOTE-B15 presented at ASCO GU 26 are overwhelmingly positive. KEYNOTE‑B15 (EV‑304) was a randomized phase III trial in 808 cisplatin‑eligible patients with muscle‑invasive bladder ...
Would you send Oncotype for pre-menopausal women with HR+, HER2(-) breast cancer with a small tumor (pT1b) and micrometastatic LN involvement or recommend adjuvant chemotherapy without sending Oncotype?
That is a very good question, especially considering that the RxPONDER trial showed benefit from chemotherapy in pre-menopausal women with 1-3 lymph nodes involved by breast cancer. However, this trial excluded patients who had micro-metastatic disease as the only nodal involvement, so we can't appl...
Do you consider bleeding risk in elderly, frail patients with atrial fibrillation to be similar for all NOACs?
I believe that apixaban carries a lower risk of bleeding, with particular reference to GI bleed, when compared to rivaroxaban and dabigatran. This is true in the population of AF patients at large and most probably in frail patients as well.
What treatment would you consider for ES-SCLC that is refractory to first-line platinum plus immunotherapy?
Tarlatamab is my go-to in this setting. However, I think there are still good questions about who are the best patients to treat with tarlatamab. Chemorefractory patients are generally ideal for tarlatamab as was stated before, it is a different mechanism of action than chemotherapy and the response...
Would you consider definitive chemoradiation for small cell lung cancer that would otherwise be limited stage but has a solitary brain metastasis at presentation?
At the risk of sounding old-fashioned, a brain metastasis in a small cell lung cancer patient still makes them extensive, that is, stage IV. The standard of care for stage IV/extensive stage small cell lung cancer is systemic therapy and immunotherapy followed by immunotherapy consolidation, with ra...