Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
How do you approach the outpatient management of bispecific antibody therapy for hematologic malignancies?
Multiple bispecific antibodies (BsAbs) targeting CD20 on lymphoma cells and CD3 on T-cells are now available in follicular and large B-cell lymphoma. A multi-disciplinary team with knowledge of the different BsAb indications and possible toxicities is an important aspect of safely administering thes...
How do you approach the outpatient management of bispecific antibody therapy for hematologic malignancies?
Multiple bispecific antibodies (BsAbs) targeting CD20 on lymphoma cells and CD3 on T-cells are now available in follicular and large B-cell lymphoma. A multi-disciplinary team with knowledge of the different BsAb indications and possible toxicities is an important aspect of safely administering thes...
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
How would you treat node positive (pN+) prostate cancer with undetectable post-op PSA after radical prostatectomy and pelvic LND?
The short answer is, YES I would, in general, recommend treatment. I also respectfully disagree that ADT monotherapy is the standard of care. It is an option of course, but rarely performed given it is non-curative and the data to support its use is of minimal relevance today.Some key points of reas...
What initial workup do you perform when there is a concern for porphyria?
This is a terrific question. But a broad question. Porphyria refers to a defect in heme biosynthesis leading to the accumulation of porphyrins and porphyrin precursors. We should remember that there are three general categories of porphyria based on clinical manifestations: acute hepatic porphyria (...
Assuming regulatory approval, what role do you foresee for varegacestat (RINGSIDE) in the management of progressive desmoid tumors, particularly in relation to existing systemic treatment options?
Once-daily dosing is certainly more attractive from the patient's perspective. Apart from that, I do not foresee many differences in the impact on how we manage desmoid tumors. Since this was also a placebo-controlled trial, there is no way to judge it against nirogacestat.
How do you think about sequencing therapy for a patient with ALK+ metastatic NSCLC given the available options?
The types and incidence of resistance mutations vary based on the 2nd generation ALK inhibitor given, and is most commonly the G1202R mutation, which unfortunately denotes resistance to alectinib where it accounts for about 29% of acquired resistance and brigatinib where it accounts for about 43% of...
What is your approach for adjuvant chemotherapy for a patient with colon adenocarcinoma, pMMR, T2 with 3 positive lymph nodes and 2 pericolic adipose tumor deposits?
This is a very timely question.The question is, should this patient be considered high-risk stage III even if this patient has a resected stage III colon cancer with pathology stage of pT2pN1b under the AJCC 8th edition? What is the prognostic value of tumor deposits (TD)?Tumor deposits (TD) in the ...
Do you offer immunotherapy for partial loss of MSH6 but MSS stable by PCR in rectal adenocarcinoma?
This is not an uncommon scenario. Often, a formal tumor board discussion with a pathologist explaining the findings can explain if it’s a true mismatch repair deficiency and/or a staining/test issue.Remember the immunotherapy approval was for mismatch repair deficiency by IHC; it doesn’t need confir...