Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you offer nivolumab/relatlimab to a metastatic melanoma patient following progression on BRAF/MEK targeted therapy?
It depends on what previous therapies have been used. If this patient has already progressed on anti-PD1 monotherapy and BRAF/MEK inhibitor, then TIL therapy should be explored. I would use IPI-3 and NIVO-1 as a bridge in that scenario, after harvest (can start before harvest as well if a date is no...
Where do you anticipate positioning Mim8 (denecimig) alongside existing options within your hemophilia A prophylaxis approach, assuming regulatory approval (FRONTIER2)?
It is hard to say at this point, but I suspect it will be similar to emicizumab - i.e., it will be more frequently than the currently available rebalancing agents. What remains to be seen is if it will replace emicizumab by way of better perceived efficacy or only if someone is deemed to have "faile...
Where do you anticipate positioning Mim8 (denecimig) alongside existing options within your hemophilia A prophylaxis approach, assuming regulatory approval (FRONTIER2)?
It is hard to say at this point, but I suspect it will be similar to emicizumab - i.e., it will be more frequently than the currently available rebalancing agents. What remains to be seen is if it will replace emicizumab by way of better perceived efficacy or only if someone is deemed to have "faile...
What is your approach to screening a cancer survivor for iron overload, and what is your treatment of choice?
We check the ferritin level after completion of chemotherapy. If ferritin is >1,000 ng/ml, we recheck the level as it can be falsely elevated with inflammation/infection. If ferritin is >1,000, we obtain a liver MRI with iron quantification. If liver iron concentration (LIC) is > 5 mg/g dry weight, ...
What is your approach to screening a cancer survivor for iron overload, and what is your treatment of choice?
We check the ferritin level after completion of chemotherapy. If ferritin is >1,000 ng/ml, we recheck the level as it can be falsely elevated with inflammation/infection. If ferritin is >1,000, we obtain a liver MRI with iron quantification. If liver iron concentration (LIC) is > 5 mg/g dry weight, ...
Do you consider omitting adjuvant radiation therapy in an older patient with node positive TNBC who achieve pCR to neoadjuvant chemotherapy?
It depends on what surgery the patient has received. If lumpectomy plus SLNB, I would not omit unless there is absolute contraindications, intolerance to radiation therapy. PRIME II, CALGB 9343, and this meta-analysis provided evidence that post lumpectomy radiation therapy can be omitted in women >...
How do you choose among regimens for relapsed refractory myeloma?
To be brief - no one chooses elotuzumab with no single agent activity if Daratumumab is available, with its approximate 30% response rate in its pivotal study. I was just sitting down at a meeting with a number of myeloma physicians asking how do we currently choose treatment for relapsed myeloma.Fo...
How do you choose among regimens for relapsed refractory myeloma?
To be brief - no one chooses elotuzumab with no single agent activity if Daratumumab is available, with its approximate 30% response rate in its pivotal study. I was just sitting down at a meeting with a number of myeloma physicians asking how do we currently choose treatment for relapsed myeloma.Fo...
Based on the DREAMM-7 and DREAMM-8 data, how would you incorporate belantamab mafadotin in your practice?
This is definitely top of mind with the publication of the DREAMM, BENEFIT, and IMROZ trials. Given my standard sequencing of myeloma treatments in non t(11;14) patients who are not clinical trial candidates, there is no longer a good time to incorporate a toxic BCMA antibody drug conjugate into the...
Would you give consolidation durvalumab to a patient who underwent chemoradiation for his stage III NSCLC and is being started on antifibrotic therapy by pulmonology for his ILD?
This is a difficult scenario. On the one hand, we know from the PACIFIC trial that there is a clear benefit to the addition of durvalumab in this setting. On the other hand, there is a higher risk of pneumonitis due to both the prior use of radiotherapy and the history of underlying ILD. I think ECO...