Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend allogeneic stem cell transplantation for consolidation in a patient with follicular lymphoma who relapsed within 13 months of initial chemo-immunotherapy?
It depends so much on the patient, especially age. I think with CART being approved in FL, I’d probably hold allo until after CART in most cases.
What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?
For newly diagnosed patients with CML, there is no benefit to using hydroxyurea before TKI. Using HU oftentimes ends up causing cytopenias and it then makes it challenging to keep patients on their TKI when it is started. There are some scenarios where it is reasonable to use- if you don’t yet know ...
What are your top takeaways in Breast Cancer from ASCO 2022?
DESTINY-Breast04: it is phase III study of Trastuzumab deruxtecan (T-DXd) vs treatment of physician’s choice in HER2-low metastatic breast cancer (MBC). This study showed improved progression-free survival (PFS) and overall survival (OS) with T-DXd vs standard therapy in this patient population. T-...
What are your top takeaways in GI Cancers from ASCO 2022?
1. DYNAMIC study: I believe circulating tumor DNA (ctDNA) will dramatically improve personalized medicine for cancer patients. This study confirmed that ctDNA-based adjuvant chemo treatment significantly decreases the patients who need/are recommended for adjuvant treatment (50% reduction) without c...
What are your top takeaways in GU Cancers from ASCO 2022?
1. Bladder cancer. Potential new non-muscle invasive bladder cancer immunotherapy with N-803, an IL-15 superagonist plus BCG. Abstract 4508. Demonstrated striking complete and durable remissions (70%), bladder preservations over 1-2 years of follow up (>90% cystectomy free survival), favorable toxic...
What are your top takeaways in Hematologic Malignancies from ASCO 2022?
Each year the American Society of Oncology Annual Meeting offers new or updated information that has the potential to change how we care for our patients. Here I highlight three hematology studies that are highly impactful, and which were rightfully highlighted at ASCO 2022. They serve to reinforce ...
Do you recommend maintenance immunotherapy after CR on chemotherapy for patients with metastatic TNBC?
The phase 2, KEYNOTE-158 study done in patients with metastatic solid tumors who progressed on at least 1 line of treatment, showed that 29% of 102 patients with TMB high status had an objective response compared to only 6% of 688 patients who had TMB low status, leading to FDA approval for tumor ag...
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
There's not a lot of data regarding the best course of action in these rare situations. Anecdotally, I've had one CML patient who had been on dasatinib and was diagnosed with breast cancer a year or two after her CML diagnosis. Her local oncologist did hold her TKI while she was receiving radiation ...
Are there patients you currently utilize neoadjuvant TKIs for stage II-III NSCLC?
Absolutely not outside the context of a clinical trial. There are no data whatsoever on improved outcomes with this approach, and in fact, some older data with 1st gen EGFR TKIs show worse outcomes. In addition, I have tried it in a few patients and everyone relapsed rapidly with widely metastatic d...
In what scenario would you consider dual IO and TKI therapy in advanced stage melanoma?
Triplet therapy with the combination of vemurafenib, cobimetinib, and atezolizumab provides a new treatment option for patients with advanced BRAF-mutated melanoma. However, given the lack of survival benefit thus far and increased toxicity, I currently do not routinely employ this as frontline ther...