Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For patients on commercial teclistamab who achieve a response, are there patient-specific or response-specific parameters that would prompt you to de-escalate therapy from once per week?
I think it’s safe to say we really lack good evidence to guide us. However, we must balance the risk of persistent immunosuppression with teclistamab and its efficacy. The only piece of data I am aware of in this regard comes from ASCO 2023 in an abstract by @Dr. First Last. In the MajesTEC-1 study,...
What are your top takeaways in Neuro Oncology from ASCO 2026?
The study on TMZ use duration. And the CAR T talk.
How do you treat an isolated in-transit recurrence of melanoma without evidence of clinical nodal involvement in a patient with a history of previously resected primary melanoma?
TVEC is an option.I could also agree on NADINA or pembrolizumab, depending on the patient's other comorbidities.Resection is also a possibility, but then would need a discussion of adjuvant therapy.Indeed, there are many options, and none has been studied in detail.I like neoadjuvant, as it gives an...
What are your top takeaways in Sarcoma from ASCO 2026?
I really enjoyed the panel presentation “Unique Challenges in Sarcoma Care for Adolescents and Young Adults", (Jessop et al., ASCO 2026). I also enjoyed “A Multidisciplinary Case-Based Approach to Non-Rhabdomyosarcoma Soft Tissue Sarcoma in Adolescents and Young Adults: Challenges and Emerging St...
How do you counsel patients on the risks and benefits of chemotherapy or radiation offered with palliative intent?
Before I start counseling a patient on these decisions, I want to know a few things first. I would want to know from the oncologists what they think the benefits are (i.e., how much more time might they get? Symptom control?) and what the risks are. The chances that the patient will see a benefit. ...
Has your practice changed to PLEX-free initial therapy for iTTP?
I am not. The reason is that caplacizumab is not on formulary at my institution, and so implementing PLEX rapidly while obtaining caplacizumab (which typically arrives in 24-48 hours) is my current practice. If I had caplacizumab on formulary, I would utilize it as it was utilized in the MAYARI tria...
For colorectal cancer, would you consider using capecitabine 5 days on, 2 days off instead of the usual 2 weeks on, 1 week off or 1 week on, 1 week off schedules?
The 14-day (q21d) schedule for cape was always difficult yet Roche did not wish to address it. The 7-day q14 day was an attempt to give a higher dose density, which is possible but not necessary. Personally, I use 7-day dosing frequently. Just as we do not need to give prolonged infusions of 5FU, pr...
Would you use MammaPrint in patients with triple-negative or HER2-positive breast cancer based on the results from the MINDACT trial?
The MINDACT data from the 2016 NEJM article has a lot of detail, in particular Table 1, which gives the number of subjects in each risk group sorted by clinicopathologic features. There were 638 Her2 positive subjects out of 6693 total, or 9.5%. Of these, 501 (7.5% of total) were ER positive and Her...
Mindful of the coming approval of abemaciclib, how would you decide between a CDK 4/6 inhibitor in either the first or second-line setting in HR-positive, HER2-negative postmenopausal metastatic breast CA?
Side effect profile is generally a good starting point since there is no head to head comparison (not will there likely be). Abemaciclib does have a higher incidence of diarrhea but also a lower incidence of neutropenia. It also has the advantage of daily dosing which can be less confusing for pati...
For T1b or T2a NSCLC cancer, approached with SABR, should chemotherapy be considered in the adjuvant setting?
It is not standard of care to give adjuvant chemotherapy in IA NSCLC.It can be considered in certain situations of stage IB, although there is no strong prospective data. The group with > 4 cm size tumars had some benefit in an unplanned subgroup analysis of the CALGB study. If other risk factors be...