Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
If using durvalumab/tremelimumab for advanced HCC, must the tremelimumab be given with the first cycle of durvalumab?
Understandably, one may be nervous about the use of tremelimumab because of prior experience with other CTLA4 checkpoint inhibitors like ipilimumab. With tremelimumab being given only once, such concerns would be less or dissipate all together. Sure, durvalumab plus tremelimumab should be given toge...
Given several PARP inhibitors approved or with emerging positive data in castrate resistant prostate cancer, how do you decide which one and when to use?
At this point, it's easy. In the prechemo mCRPC state, the answer is olaparib, but it is expected that rucaparib will be an alternative. In the mCRPC state post chemo, could be either olaparib or rucaparib. The others are not yet approved. We are participating in the trial AMPLITUDE, which is lookin...
Do you continue endocrine therapy for women with HER2+/HR+ metastatic breast cancer when starting a HER2-directed antibody-drug-conjugate?
In general, no, I would not. I do think there is room for case-by-case evaluation in determining the right course of action for a particular patient, e.g., based on how strongly the patient's tumor seems driven by ER vs HER2, how they have historically responded to ER-directed vs HER2-directed thera...
Are there any unique toxicity concerns with combination of ramucirumab/pembrolizumab as compared with other available treatments for metastatic NSCLC?
Unique toxicities issues were not seen with ramucirumab and pembrolizumab. The adverse events aligned with known side effects of the individual agents as previously reported. Toxicities were less than those seen in the standard of care arm. Many patients are interested to learn about a potential reg...
How would positive ctDNA results after 12 cycles of adjuvant FOLFOX affect your management for patients with colon cancer?
I think the question should be, should you be testing ctDNA post adjuvant therapy? I do not want to order a test and then not know what to do with a positive result. I can imagine that this would cause fear and panic in certain patients.
In patients with breast cancer and concern for bone-only metastases on imaging but with non-diagnostic IR biopsies, do you pursue surgical bone resection for diagnosis or treat empirically for metastatic disease based on pathology from breast lesion?
The preferred approach would be to have confirmed tissue diagnosis and receptors repeated on the metastatic lesion, so if feasible/accessible, I would pursue that prior to treatment. If risks of biopsy outweigh benefits then treating empirically based on pathology from primary lesion sounds reasonab...
How would you approach a patient with high-grade gastric lymphoma who achieved a CR following chemotherapy?
About half of all lymphomas arising in the stomach are high-grade non-Hodgkin lymphomas, primarily DLBCL. Initial treatment would consist of chemoimmunotherapy (R-CHOP). The number of cycles of systemic therapy, and whether consolidation RT is appropriate, would depend upon stage, extent of disease ...
How do you prepare patients with DLBCL on the potential need for cellular therapies after progression on first line regimens?
Once a patient is identified by the lymphoma team, they are referred to our cellular therapy service for full evaluation and discussion of CAR T cell risks, benefits, and logistics. The discussion of protocol versus commercial product, chemotherapy side effects versus CRS/ICANS, and severity includi...
Would you consider adjuvant capecitabine in a patient with resected stage IA cholangiocarcinoma with MSI high status?
In general terms, I most likely would not recommend adjuvant capecitabine in a patient with completely resected, stage IA, mismatch-repair deficient cholangiocarcinoma. My justifications for this are as follows. First, the BILCAP study showed at best a marginal effectiveness of adjuvant capecitabine...
Would you add Daratumumab to upfront treatment of multiple myeloma in a patient with tetraploidy on FISH?
I think the shortest answer is, "Do what you do for your patients with high-risk cytogenetics." If you ask 4 different myeloma specialists, you'll get 4 different answers: VRd for everyone, Dara-VRd for everyone, KRd just for high-risk, Dara-KRd just for high-risk... and then some (not me) will reco...