Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Outside of a clinical trial, what is your preferred third-line systemic therapy option for a patient with relapsed/refractory ES-SCLC?
That will depend on what the patient has received in the second-line setting. If the patient has good PS, the NCCN recommends one of the various options. You could try either topotecan or lurbinectedin, whichever was not used in the second-line setting.
What are your top takeaways in Gynecologic Cancers from ASCO 2022?
1. ATHENA (LBA5500)- Consistent efficacy signal with PARPi maintenance therapy in the front line- Another potential option for our patients with greater dosing flexibility- The BICR PFS difference in the HRP population really caught my attention. Nearly a 6 month improvement with median PFS in the r...
What is your institutional approach to a restrictive “neutropenic diet”?
Simple answer: never. The "neutropenic diet" has no efficacy and may actually be nutritionally AND microbially inferior to normal diet. This has been shown by multiple studies. I like the title of the review, "Things We Do For No Reason: Neutropenic Diet." Ma et al., PMID 35356218. Radhakrishnan et ...
Are there differences in efficacy of ramucirumab + pembrolizumab based on extent and duration of response to first line chemo/pembro?
S1800A required that patients have at least 84 days (~4 cycles) of time on treatment before progression on anti-PD-L1 therapy. This will exclude patients who had rapid progression. Other than this entry criterion for all patients, the trial stratified by PD-L1 status, but did not select for prior IC...
What are your top takeaways in Melanoma from ASCO 2022?
1. Melanoma oral abstract session #3: Abstract 9502 Neoadjuvant PD-1 blockade in patients with resectable desmoplastic melanoma (SWOG 1512)Desmoplastic melanoma is a rare subtype of melanoma that frequently occurs in the head/neck area and is very difficult to completely resect due to its invasivene...
How would you approach therapy for a patient with a history of classical HL who achieved a CR to 6 cycles of Brentuximab plus AVD who now presents with widespread non-GC DLBCL?
Depending on the time from initial treatment, age, and the patient's fitness, could consider several options. If it has been within a short interval, then would be concerned that the DLBCL was present during or shortly after exposure to anthracycline. In that case, would treat with R-CEOP with cons...
What could explain the discordant results between PARP/abiraterone combinations in MAGNITUDE and PROpel in non-HRRm prostate cancer?
This is an important question. I would summarize this below: 1. Differences in study design and patient populations MAGNITUDE allowed prior ARSI (5%), prior exposure to abiraterone for up to 4 mo which could have been selected for patients less sensitive to abiraterone where PARPi combination syner...
In the setting of platinum resistant ovarian cancer, do you consider repeat use of bevacizumab with subsequent lines of chemotherapy following prior treatment with chemotherapy + bevacizumab with bevacizumab maintenance?
I typically do reuse bevacizumab. Now that bevacizumab is approved for front-line, maintenance, and recurrent settings, many patients with recurrence may not be bev-naive, to begin with, and I still use bev+chemo.In breast cancer (von Minckwitz et al., PMID 25273342) and colon cancer (Bennouna et al...
Are there any situations where you would consider neoadjuvant chemoradiation as opposed to chemoimmunotherapy for patients with resectable NSCLC prior to surgical resection?
For most of the last 2 decades, there has been a raging debate about the best perioperative approach for the management of patients with high-risk resectable NSCLC, such as patients for example, with preop documented nodal disease. Clinical studies have not been able to settle the key questions whet...
What is your preferred first line regimen for myeloma with severe renal impairment, either on or off dialysis?
In general, for patients with renal insufficiency related to their myeloma, time is nephrons. So the earlier you can correct the hypercalcemia, lower circulating uric acid, stop ongoing bad behaviors (NSAID overuse, etc), and treat the myeloma, the better. If the patient is admitted, I will give pa...