Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
While using bridging therapy prior to CAR-T cells in myeloma, if possible, do you target a certain response prior to proceeding with cell infusion?
While CAR-T cell therapy was, of course, first studied and shown to be highly effective in heavily pretreated patients with active disease, experience and newer data show the following themes: CAR-T cell therapy in earlier lines of therapy appears to lead to more durable responses. Lower disease bu...
What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?
I think the role of adjuvant radiotherapy in stage III cutaneous melanoma is difficult to define at this time (June 2019). To be clear, the TROG trial mentioned above showed that adjuvant lymph node basin radiotherapy after therapeutic lymphadenectomy can decrease the chances of lymph node basin dis...
Is there therapeutic relevance for FLT3-ITD mutation in relapsed APML?
FLT3-ITD mutations are seen in anywhere from 12-38% of APL cases, and there are conflicting data on the prognostic impact of the mutation on outcomes (Kuchenbauer et al., PMID 16029447, Beitinjaneh et al., PMID 20096459, Kiyoi et al., PMID 9305596, Kainz et al., PMID 12522450, Schnittger et al., PMI...
Is there therapeutic relevance for FLT3-ITD mutation in relapsed APML?
FLT3-ITD mutations are seen in anywhere from 12-38% of APL cases, and there are conflicting data on the prognostic impact of the mutation on outcomes (Kuchenbauer et al., PMID 16029447, Beitinjaneh et al., PMID 20096459, Kiyoi et al., PMID 9305596, Kainz et al., PMID 12522450, Schnittger et al., PMI...
Would you consider TPO mimetics for chemotherapy induced thrombocytopenia that persists despite dose reductions?
The reported evidence on using a TPO-RA in chemotherapy-induced thrombocytopenia (CIT) is complicated but this seems like a situation where it is worth trying a TPO-RA. Repeated dose reduction and/or delay is not good for treatment of a cancer in general. It is very important to individualize the ca...
Would you consider TPO mimetics for chemotherapy induced thrombocytopenia that persists despite dose reductions?
The reported evidence on using a TPO-RA in chemotherapy-induced thrombocytopenia (CIT) is complicated but this seems like a situation where it is worth trying a TPO-RA. Repeated dose reduction and/or delay is not good for treatment of a cancer in general. It is very important to individualize the ca...
Would you consider a treatment break for a patient with metastatic urothelial carcinoma who achieved a near-complete response to enfortumab?
The answer to this question is highly dependent on the specific clinical context. However, for a patient who has a deep and durable response to enfortumab vedotin monotherapy and has been on treatment for a prolonged period of time (again context-dependent, but at least a few months), I think it is ...
What is your preferred neoadjuvant chemotherapy regimen for borderline resectable pancreatic ductal adenocarcinoma?
Agree while guidelines for the use of adjuvant therapy in resected PDAC are stronger (6 mos therapy for T1N0 tumors or greater), those for the use of neoadjuvant therapy are less clear. Some guidelines recommend not to use NAT unless there is a radiographic interface with mesenteric vessels, or in t...
What are your top takeaways in GI Cancers from ESMO 2025?
The new results from CheckMate 8HW confirmed an ORR of 73% vs 61%, with a “not reached” median duration of response. Importantly, I note that the time to response is 2.8 months. The confirmed and updated PFS at 4 years is 64% vs 49%. The OS at 4 years is 78% vs 65%. BREAKWATER at ASCO 2025 cemented ...
If Ianalumab + eltrombopag (VAYHIT2) gains regulatory approval, what would make you consider its use for second-line therapy after glucocorticoid failure/relapse, given its potential hematologic toxicity?
I would consider this in patients who have a more immunoinflammatory phenotype (perhaps with other autoantibodies or with a significant family history of autoinflammatory disease) or in patients who have significant bleeding symptoms and need rapid control of the disease.