Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does the recent publication of EPCORE FL-1 (Epcoritamab + R2) change your preferred 2L SOC for R/R FL?
Partially! Epcoritamab certainly has a role in patients with FL who have more aggressive behaving disease but there is a plethora of choices in that setting. It may not be suitable for patients treated in the community away from my center because of the unique toxicities. It does have a role in that...
Does the recent publication of EPCORE FL-1 (Epcoritamab + R2) change your preferred 2L SOC for R/R FL?
Partially! Epcoritamab certainly has a role in patients with FL who have more aggressive behaving disease but there is a plethora of choices in that setting. It may not be suitable for patients treated in the community away from my center because of the unique toxicities. It does have a role in that...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...
What are your top takeaways in Radiation Oncology from SABCS 2025?
Several significant studies were presented at San Antonio this year. I will focus on the three most important abstracts reporting new data from studies of local-regional therapy. (The 10-year update of the BIG 3-07-TROG 07.01 trial comparing hypofractionated and conventional fractionation and the us...
Is there evidence supporting the adjuvant use of neratinib in patients with high-risk, hormone receptor–positive, HER2-negative breast cancer that harbors an activating HER2 mutation?
The data supporting use of neratinib for patients whose breast cancers have activating HER2 mutations is in the metastatic setting (https://www.ncbi.nlm.nih.gov/pubmed/37597578). Neratinib use in the adjuvant setting for breast cancer requires that there be HER2 amplification by IHC or FISH.
With multiple PARPi + ARSI combinations now approved, how are you selecting which combination to use for a patient with BRCA mutated mCRPC?
Updated answer: I do not feel that the data is so much different that I always prioritize saving abiraterone for mCRPC in being able to specifically choose the abi/olaparib combination. I still focus on making the best choice in the mHSPC setting whether that is using ADT/abiraterone or direct AR an...
How do you approach adjuvant therapy for resected Stage I Ewing sarcoma of the kidney?
Agree with VDC/IE to start with and monitor electrolytes/renal function. Pediatric protocols use 14 cycles, but there is a high risk of Fanconi syndrome with a single kidney (assuming the patient had a nephrectomy for resection). The COG AEWS1031 protocol allowed the use of C/E - cyclophosphamide/et...
How do you interpret nodes with minimal increased uptake on PSMA PET in prostate cancer?
This question is relatively similar to another recent question on indeterminate PSMA PET (#26360), where I provided a longer answer in a bit more detail. The summary is that this essentially relies upon your clinical judgement, and there is no definitive algorithmic way to determine the true nature ...
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...