Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely obtain CPS assay to assess candidacy for chemoimmunotherapy in newly diagnosed metastatic esophageal/GEJ/gastric adenocarcinoma?
I am still apt to assess tumor PD-L1 CPS to help inform long-term benefit from first-line chemoimmunotherapy in a patient with metastatic disease. Intrapatient, interlesional heterogeneity for PD-L1 CPS has also been recognized in the literature corresponding to discordance in levels of PD-L1 CPS po...
In the modern era, what is the role of beta-emitting bone-targeted radiopharmaceutical therapy?
Since the approval of Radium-223 dichloride (Xofigo), I have been using it as the preferred radiopharmaceutical for patients with mCRPC. While use of Samarium-153 and Strontium-89 improves pain control, Radium-223 is an alpha-emitter and is the only FDA approved radiopharmaceutical that has been sho...
Would you recommend nivo/ipi instead of chemotherapy/nivo or chemotherapy alone in advanced squamous esophageal cancer based on Checkmate 648?
How would you approach a patient whose stage II TNBC tumor is visibly progressing on the KN-522 neoadjuvant regimen?
Yes, in a patient whose TNBC is visibly progressing on neoadjuvant chemotherapy, I would change course by either changing regimen or proceeding with local management. The CR rate to the KEYNOTE 522 regimen is impressive (64.8% with pembo vs 51.2% without pembro; Schmid et al., PMID 32101663), but th...
What adjuvant therapy would you offer a TNBC patient with residual disease after receiving the neoadjuvant KEYNOTE-522 regimen?
Safety is pembro and cape was provided in phase I trials. Risk and benefit weighing is important when discussing with patients.
Would you change treatment in a patient with metastatic CRPC on PARP inhibitor with rising PSA but negative Axumin PET scan?
Short Answer: No Medium Answer: The surrogacy of PSA as an intermediate endpoint in both localized prostate cancer and metastatic prostate cancer has been problematic. Multiple variations have been explored and tested including PSA doubling time (PSADT), PSA nadir, absolute PSA level, etc. None have...
What are your considerations for choice of immunotherapy agent with patients with metastatic pMMR HER2- esophageal/GEJ/gastric adenocarcinoma with CPS >=10?
I alluded to this earlier. Although both CheckMate 649 and KEYNOTE 590 included esophageal cancer, there were caveats. Specifically, in CheckMate 649, there were relatively few patients with esophageal adenocarcinoma. The positive results of CM-649 were clearly driven by gastric adenocarcinoma, part...
What are your top takeaways from ASCO GI 2022?
1. "NEONIPIGA” GERCOR: While small numbers of patients, they evaluated an immunotherapy combination in MSI-H locally advanced gastric or GE junction cancer. They demonstrated high rates of responses and 59% path CR which is unprecedented in patients undergoing surgery. It raises the question of whet...
How do you adjust Tamoxifen use in HR+ patients with a history of gastric bypass?
No. I do not track levels of tamoxifen in patients who have had gastric bypass. Though I acknowledge that there are reports of tamoxifen being less absorbed in patients after gastric bypass (Willis et al., PMID 20099995), the therapeutic window for tamoxifen is very wide and recurrence after weight ...
What adjuvant systemic therapy would you recommend for a woman s/p ALND for a nodal recurrence of ER-/HER2+ breast cancer 1 year after completing adjuvant therapy with paclitaxel/trastuzumab for her initial disease?
If the axillary nodes were already dissected, I would try TCHP followed by HP since she is pertuzumab naive and she had a DFI of >12 months from paclitaxel. If she had her nodes clipped for neoadjuvant TCHP, I would have switched to adjuvant TDM1 if she had residual disease in the axillary nodes.